It is one of those moments when you know history is being made — quietly, but profoundly. In Abuja, Nigeria, four patients with metastatic colorectal cancer have begun receiving nivolumab, marking first access to immunotherapy in Nigeria for this disease. Behind this milestone lies a story of persistence, collaboration, and belief that access to cutting-edge cancer treatment should not be a privilege of geography.
When I spoke with Dr. Olufunke Fasawe, the energy and conviction in her voice were unmistakable. She leads this initiative with a mix of precision and heart — representing the Clinton Health Access Initiative (CHAI), which has been instrumental in shaping what might become a turning point for oncology in Africa.
“This journey began around 2017,” she recalled. “CHAI and Sean Parker started a conversation — how do we expand access to immunotherapy beyond developed countries like the U.S.? At that time, most low- and middle-income countries were still using first- or second-generation chemotherapies. We wanted to change that.”
The idea grew into a multi-partner effort to demonstrate the feasibility of introducing immunotherapy in Africa. The Parker Institute for Cancer Immunotherapy (PICI) provided the initial funding and technical support through CHAI. Bristol Myers Squibb (BMS) — the manufacturer of nivolumab — agreed to donate all the required drug doses. Roche joined in, contributing reagents for diagnostic testing and biomarker screening. The Nigerian government was brought on board, with the National Hospital Abuja selected as the first center of excellence to implement the program.
But the road was far from easy. “We had ups and downs,” Dr. Fasawe said. “Our regulatory agency, NAFDAC, initially viewed the initiative as a clinical trial rather than a demonstration project. They were concerned about patient safety and protocol compliance.”
What unlocked the process was leadership and understanding. “The intervention of the former Minister of State for Health — a kidney specialist — was crucial. He helped the agency see that nivolumab wasn’t experimental anymore. It had been used worldwide for years. This wasn’t about testing efficacy; it was about giving Nigerian patients access to a proven and effective therapy.”
That conversation changed everything. The green light came, and by October this year, the first patients began treatment. “We now have four patients receiving nivolumab, with three more completing the screening process,” she said. “Our goal is to reach 30 patients in this first phase.”
For those 30, treatment is completely free. “There’s no cost to the patients,” Fasawe explained. “The Parker Institute has funded CHAI to provide technical assistance to the hospital, and part of that funding also supports the medical team — oncologists, pharmacists, radiation oncologists, and everyone involved. We even provide health insurance for the patients to cover any adverse events, and transportation stipends so that nothing prevents them from completing their treatment.”
BMS donates the drug entirely; Roche covers the diagnostic reagents; and CHAI coordinates the logistics. “It’s been heartwarming,” she said. “The feedback from the public has been incredible — people writing to ask how they can enroll. It has given many patients a renewed sense of hope.”
A Feasibility Study With Far-Reaching Goals
The current phase is a feasibility study, designed to prove that Nigeria’s National Hospital Abuja can safely administer nivolumab. “If it succeeds — and we’re confident it will — the next step is policy,” Fasawe explained. “We want nivolumab to be included in the national health insurance scheme and the Cancer Health Fund, which supports low-income Nigerians.”
The Cancer Health Fund, managed by the government, has been expanding in recent years. “Our hope is that immunotherapies will become part of it,” she said. “But even more crucially, our long-term work at CHAI is about market shaping — negotiating price reductions so that governments can afford these drugs sustainably.”
Today, a year of nivolumab treatment can cost over $160,000 per patient — a staggering figure in any health system, let alone in low- and middle-income countries. “Even if governments wanted to buy it at that price, it’s impossible,” Olufunke Fasawe admitted. “So, we’re working toward differential pricing for Sub-Saharan Africa — something far below Western market costs.”
That effort extends beyond Nigeria. “Uganda is also part of this initiative,” she noted. “The idea is that success in one country can help open doors for the entire region.”
Building on a Foundation of Access
This is not CHAI’s first major cancer access program. “Our Cancer Access Program actually started in 2016, initially funded by the American Cancer Society,” she said. “At that time, we negotiated with Pfizer to reduce prices on 16 essential chemotherapy drugs, including carboplatin. Those prices dropped by more than 50%, making them accessible across Sub-Saharan Africa.”
That effort evolved into Nigeria’s National Cancer Access Partnership program, now a model for pooled procurement and transparent supply. “Twenty-four tertiary hospitals are part of it,” Fasawe said. “We built an electronic payment system to prevent stock-outs — a common issue when hospitals couldn’t pay suppliers because patients couldn’t pay hospitals. Today, that cycle is broken.”
Through this mechanism, more than 7,000 patients have received affordable, quality-assured chemotherapy in Nigeria. Pharmaceutical partners have expanded beyond Pfizer to include AstraZeneca, Sandoz, Janssen, Hetero, and Roche — the latter providing Herceptin at reduced cost for HER2-positive breast cancer patients.
“So this immunotherapy initiative,” she reflected, “is really an extension of what we’ve been building for years — equitable access through partnership, infrastructure, and price reform.”
The Broader Landscape: A Country in Transition
Nigeria records around 6,000 deaths from colorectal cancer each year, and approximately 7,000 new cases are estimated annually. For now, the capacity to treat only 30 patients with nivolumab seems like a drop in the ocean. But as Fasawe emphasized, this is the beginning of a new era — a proof that advanced cancer care can happen safely in Nigeria.
Still, the challenges are immense. “We have a huge cancer burden and very limited funding,” she said. “Chemotherapy has improved access, but we still face serious gaps in radiotherapy and surgery, especially in timely treatment.”
Yet there are reasons for optimism. “This year, the Nigerian government approved the largest budget allocation for cancer care in our history,” she said. “The Minister of Budget and Planning has been personally supportive, and there’s new hope that the Cancer Health Fund will reach more patients.”
This year, the Nigerian government approved the largest budget allocation for cancer care in our history.
The National Sovereign Investment Authority has also launched three new cancer centers, with plans for three more before year’s end. “They’ll be equipped with modern radiotherapy machines — something we desperately need,” she said.
At present, the numbers are stark. “In the public sector, we have about 11 radiotherapy machines — and only one or two are functional,” she said. “In private centers, there are two fully functional LINACs, but for a country of 200 million people, we need at least 200.”
Even when the machines exist, access remains a problem. “On paper, radiotherapy is covered by the national insurance,” she said. “But in reality, hospitals don’t trust the system because of delayed reimbursements. So costs are transferred to patients, or waiting lists become unbearably long.”
Patients often have to travel across the country for treatment. “Imagine being diagnosed in Kaduna in the north, and being told the only functioning machine is in Lagos. You need to fly there, find accommodation, and wait your turn — sometimes for weeks. It’s emotionally and financially exhausting. For those who can afford it, the easier path is to travel abroad.”
Hope and Leadership
Despite these obstacles, there is an undeniable momentum. “Advocacy has been one of our strongest assets,” she said, referring to Dr. Zainab Shinkafi-Bagudu, the President of MedicAid Foundation and a powerful voice in cancer control.
“When Dr. Zainab was elected to be the President of UICC — the first African to do so — it was a huge moment for our country,” Dr. Fasawe said. “She’s used her proximity to government to raise awareness, mobilize people, and inspire real change.”
When Dr. Zainab was elected to be the President of UICC — the first African to do so — it was a huge moment for our country.
Just last week, Dr. Zainab led a cancer awareness walk in Abuja that drew thousands. “She literally shut down the city,” Fasawe said, smiling. “Everyone came out. It was one of the most powerful advocacy events we’ve ever seen.”
As Nigeria moves forward — expanding its cancer access programs, building infrastructure, and negotiating for equitable drug pricing — there is a palpable sense that the tide is beginning to turn.
“This initiative isn’t just about 30 patients,” Fasawe concluded. “It’s about showing that it can be done — that advanced cancer care can be delivered safely, ethically, and affordably in Africa. Once we prove that, everything changes.”
For Nigeria, and perhaps for the continent, this is more than a study — it is the beginning of a transformation.
Interview is part of the “World Health Voices” Series by Dr. Gevorg Tamamyan, the Editor-in-Chief of OncoDaily.
