Page 25 - Genomic Medicine in Emerging Economies

14 CHAPTER 2: Taking Genomics From the Bench to the Bedside in Developing Countries

evaluate its public health impact among all segments of the global population.
One can argue that the emphasis should first be on cataloguing the vast range
of genomic and phenotypic variations in the diverse global human population
prior to developing effective interventions at the level of the individual patient
(Pang, 2013). It is, however, the impact that it makes on the lives of individu-
als that would help the clinical implementation of genomic medicine gather
momentum.
Although research in genomics and other “omics” is advancing at a rapid pace
in the affluent Western world, progress has been much slower in less resourced
countries, mainly because of various constraints. This inequity has raised con-
cerns about whether the advances in genomics and the impact that it has had
on health care—through the development of novel and improved diagnostics,
personalized treatment, risk identification, and disease prevention—would
ever be shared and become available to populations living in less resourced
regions of the world (Isaacson Barash, 2016). The ability for developing nations
to effectively implement genomic medicine would advance knowledge specific
to their populations that is crucial to improving the health and wellbeing of
the people living in those countries in the future (Helmy et al., 2016).

Implementation of genomic medicine in any country is, to a large extent,
dependent on successful implementation of genome sequencing and clini-
cal bioinformatics. This prerequisite has posed tremendous challenges for
resource-constrained countries and has impeded the translation of genomic
medicine from bench to bedside, creating a significant gap between them and
the better resourced nations.
In 2015 in an effort to ascertain specific differences between the “haves and
have-nots,” the National Human Genome Research Institute and the Institute
of Medicine of the National Academies of Sciences assembled 90 leaders in
genomic medicine from the United States and 25 other countries across five
continents to identify regional capabilities and the current state of implemen-
tation and opportunities for collaboration. An informal poll from attendees
showed that most of these countries to different extents had specialized clinical
genomic capabilities (e.g., cancer detection and treatment, rare disease diag-
nosis, and microbial pathogen identification). It is noteworthy that the poll
results were similar to those in a survey done in 2012 (Isaacson Barash, 2016;
Manolio et al., 2013).

UNMET NEEDS OF THE DEVELOPING WORLD

The developing world lags behind in two areas. First, there is lack of genomic
laboratory infrastructure. Second, there is a lack of a coordinated effort to
impart the necessary knowledge, skills, and attitudes to the health care work-
force to successfully implement genomic medicine (Isaacson Barash, 2016).