Boateng R, Petricca K, Tang B, et al. - The Caribbean region exemplifies deficiencies in access to childhood cancer medicines that could be remedied through improved regional harmonisation of drug registration, pharmacovigilance, and procurement, as well as national forecasting, to strengthen global pharmaceutical planning and prioritisation. To ensure efficient, dependable, and long-term availability of cancer medicines, focused political attention is needed.

• Data for 28 childhood cancer medicines from Barbados, 32 from The Bahamas, 30 from Trinidad and Tobago, and 31 from Jamaica were collected and analyzed.

• Despite the inclusion of childhood cancer medicines in the national essential medicines lists (NEMLs) in stages, all four countries experienced frequent and recurring stockouts of many cytotoxic medicines, demonstrating that there is no consistent relationship between NEML inclusion and availability.

• A mean MPR of more than 3·0 in Trinidad and Tobago, The Bahamas, and Barbados indicates uniformly high procurement inefficiency, which has a significant impact on drug stockout days.

• The adjusted odds ratio of stockout increased by 10% for every unit increase in MPR.

• These barriers to access to paediatric cancer medicines are caused by the health system and policy dynamics at the institutional, national, and supranational levels, which result in price volatility and erratic medicine availability.

• Disparate policy commitments (for example, across sites), inefficient procurement and supply chain management practices, and the local effects of international market pressures are all major challenges.