As childhood mortality from infectious diseases continues to dramatically decline in resource-limited settings, cancers account for a greater proportion of deaths in those aged 19 years and younger. Childhood cancer is a significant public health issue for several reasons: its high disease burden (¹1. GBD 2017 Childhood Cancer Collaborators. The global burden of childhood and adolescent cancer in 2017: an analysis of the Global Burden of Disease Study 2017. Lancet Oncol. 2019;20(9):1211-1225. doi:10.1016/S1470-2045(19)30339-0. Erratum in: Lancet Oncol. 2021;22(8):e347. PMID: 31371206.
https://doi.org/10.1016/S1470-2045(19)30... ), the wide disparities in survival rates (estimated at 30% in low- and middle-income countries and over 80% in high-income countries) (²2. Ward ZJ, Yeh JM, Bhakta N, Frazier AL, Girardi F, et al. Global childhood cancer survival estimates and priority-setting: a simulation-based analysis. Lancet Oncol. 2019 Jul;20(7):972-983. doi:10.1016/S1470-2045(19)30273-6. PMID: 31129029.
https://doi.org/10.1016/S1470-2045(19)30... ), and the limited political prioritization in national health programs despite the highly cost-effective nature of pediatric cancer interventions (³3. Atun R, Bhakta N, Denburg A, Frazier AL, Friedrich P, Gupta S, et al. Sustainable care for children with cancer: a Lancet Oncology Commission. Lancet Oncol. 2020;21(4):e185-e224. doi:10.1016/S1470-2045(20)30022-X. PMID: 32240612.
https://doi.org/10.1016/S1470-2045(20)30... ). Unlike other types of cancer, those that affect children are mostly not preventable. However, survival and quality of life for children with cancer can be improved by strengthening health systems for timely and quality diagnosis and treatment. In Latin America and the Caribbean (LAC), over 29 000 children and adolescents (0 to 19 years) are diagnosed with cancer each year with 10 000 of them succumbing to the disease, representing the second cause of death in this age group (⁴4. Pan American Health Organization. Childhood Cancer country profiles, 2021. Available at: https://www.paho.org/en/documents/childhood-cancer-profiles-region-latin-america-and-caribbean. Accessed on August 14, 2023.
https://www.paho.org/en/documents/childh... ). In LAC, the survival rate for children with cancer is 55%, although it varies widely across countries, reflecting disparities in healthcare availability, access, and quality (⁴4. Pan American Health Organization. Childhood Cancer country profiles, 2021. Available at: https://www.paho.org/en/documents/childhood-cancer-profiles-region-latin-america-and-caribbean. Accessed on August 14, 2023.
https://www.paho.org/en/documents/childh... ). Among the key factors contributing to poor survival from childhood cancer are misdiagnosis, late diagnosis, high rates of treatment abandonment, mortality associated with infections, and difficulty in accessing treatment (⁵5. CureAll framework: WHO Global Initiative for Childhood Cancer. Increasing access, advancing quality, saving lives. Geneva: World Health Organization; 2021. Available at: https://www.who.int/publications/i/item/9789240025271. Accessed on August 14, 2023. License: CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo/
https://www.who.int/publications/i/item/... ). To improve childhood cancer survival, a global initiative was launched by the World Health Organization (WHO) and St. Jude Children's Research Hospital (St. Jude) in 2018, known as the Global Initiative for Childhood Cancer (GICC), with the aim to achieve a global survival rate of at least 60% for all children and adolescents with cancer (⁵5. CureAll framework: WHO Global Initiative for Childhood Cancer. Increasing access, advancing quality, saving lives. Geneva: World Health Organization; 2021. Available at: https://www.who.int/publications/i/item/9789240025271. Accessed on August 14, 2023. License: CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo/
https://www.who.int/publications/i/item/... ). Since its launch the Pan American Health Organization (PAHO) is implementing GICC in the Region of the Americas which began with a comprehensive situational analysis and a series of country-specific childhood cancer profiles (⁴4. Pan American Health Organization. Childhood Cancer country profiles, 2021. Available at: https://www.paho.org/en/documents/childhood-cancer-profiles-region-latin-america-and-caribbean. Accessed on August 14, 2023.
https://www.paho.org/en/documents/childh... ). To date, 18 PAHO Member States have committed to implementing the GICC, using the CureAll framework (⁵5. CureAll framework: WHO Global Initiative for Childhood Cancer. Increasing access, advancing quality, saving lives. Geneva: World Health Organization; 2021. Available at: https://www.who.int/publications/i/item/9789240025271. Accessed on August 14, 2023. License: CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo/
https://www.who.int/publications/i/item/... ). This framework focuses on strengthening health systems through four pillars: Centers of Excellence (C), Universal Coverage (U), Treatment Regimens (R), and Evaluation and Monitoring systems (E); and through the promotion of three key facilitators: Advocacy (A), Financing (L), and Governance (L) (⁵5. CureAll framework: WHO Global Initiative for Childhood Cancer. Increasing access, advancing quality, saving lives. Geneva: World Health Organization; 2021. Available at: https://www.who.int/publications/i/item/9789240025271. Accessed on August 14, 2023. License: CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo/
https://www.who.int/publications/i/item/... ). GICC implementation in LAC involves a collaborative and multifaceted strategy, engaging governments, non-governmental organizations, healthcare professionals, and civil society. This special supplement of the Pan American Journal of Public Health highlights some of the significant advances in the Region such as reduced rates of treatment abandonment in Peru; improvements in early detection referral programs in Andean countries, the Dominican Republic, and Panama; and progress made in legislation for pediatric cancer in Argentina, Brazil, and Peru. In addition, the establishment of the WHO/St Jude Global Platform for Access to Childhood Cancer Medicines in Ecuador, the pioneering country for this initiative in LAC, has resulted from collaborative work to address an unmet need in essential medicines and diagnostics and improve care standards for children and adolescents affected by cancer.

The first five years of the GICC have led to numerous regional public goods produced by PAHO, St. Jude, GICC working groups and collaborators based on interventions to promote earlier diagnosis, psychosocial support, better nutrition, reduce treatment abandonment, optimize supportive care, nursing, and palliative care for childhood cancer (⁶6. Pan American Health Organization. Childhood and adolescence cancer. Available from: https://www.paho.org/en/topics/childhood-and-adolescence-cancer. Accessed on February 28, 2023.
https://www.paho.org/en/topics/childhood... ). These public goods include virtual courses, guidelines, publications, communication campaigns, and other materials, which have reached hundreds of thousands of health professionals to improve their knowledge and awareness and contribute to enhancing childhood cancer care.

Childhood cancer is not only a regional concern, but also a global challenge. This special supplement aims to inspire both global and regional actions to strengthen health systems to improve the management of childhood cancer by sharing the lessons learned from national and regional experiences in the Americas raising awareness and promoting evidence-based best practices.

If we are to achieve a future where no child dies from cancer, this can only be possible if we work collaboratively and in coordination across all sectors of society and government, in our efforts to strengthen the health system response.

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