Global public health in an age of genomics

Philippa Brice

30 September 2013

A new report examines the drivers and barriers to implementation of genomic biotechnology for health in different countries.

 

The document presents the findings of a joint project on Personalised Medicine and Global Public Health by the OECD Working Party on Biotechnology and the now defunct UK ESRC Genomics Network. The project used a 2012 survey of case studies on the application of genomics to stratified medicine and infectious diseases from Finland, Israel, Luxembourg, Mexico, the UK, China and South Africa.

 

The public health benefits of genomics in the control of infectious diseases (notably diagnosis, outbreak monitoring and accelerated vaccine design) are becoming very evident; all the countries surveyed were active in this area, and international collaboration on research and implementation issues was seen as essential.

 

Stratification of populations for the practise of personalised medicine is at a more preliminary stage of development, with more emphasis on research and fewer practical applications. It is a much greater priority for the higher income-countries as a potential means of tackling the burden of chronic diseases and improving efficiency of health care provision, whereas the low and middle income countries remain focused on using genomics to address the infectious disease burden. The lower-income countries therefore have stronger drivers towards international collaboration for their public health genomics work.

 

The report concludes that these findings, if accurate, have important implications for global; public health genomics policy, since it is unfair for the poorer countries to be bearing a disproportionate burden in addressing issues of international concern in infectious disease genomics whilst richer countries adopt an isolationist stance and focus primarily on efforts to create a supportive international regulatory and economic climate for stratified medicine.

 

The value of genomics for improving health protection and health services in infectious disease and personalised medicine is indisputably very high; the PHG Foundation has active projects in both these areas.

 

It is perhaps not surprising to learn that countries with lower healthcare budgets and higher infectious disease burdens are concerned primarily with genomic applications in infectious disease. However, the OECD’s response to this issue is less than robust; the report expresses the hope that unspecified ‘others’ will ‘address themselves to determining whether or not this is actually the case, and if so, to taking appropriate action’. Whose responsibility is this research and policy development, and how far is it realistic to expect countries to address international over national health priorities?

The important take-home message may be not to project national interests onto other countries, but rather to focus international collaboration in the most productive areas; in this case, infectious disease genomics. However, it is worth also bearing in mind that chronic diseases are increasingly a problem of lower and middle-income countries, so it may be that international collaboration on stratified medicine will become more relevant in the coming years.