For instance, asparaginase in HICs is unlikely to be the same native product used in LMCs and LICs, with differences in products noted even within Europe.36 53 The special issue with asparaginase is compounded by the marketing and distribution in LMICs of substandard products54 which have deleterious effects on children with ALL.55 Significant additional challenges were apparent in obtaining price data. This evidence concerns the gene ASPG and acute lymphoblastic leukemia.