Page 30 - Genomic Medicine in Emerging Economies

Overcoming Barriers to Implementing Genomic Medicine in Developing Countries 19

world. In our case, future plans for expanding our efforts and reaching out to
a larger population include establishing public–private partnerships, lobbying
for increased research funding, increasing access to research funding through
international collaborations, and creating new training programs on genomic
medicine aimed at health care professionals. These measures would ensure
sustainable future development of genomic medicine services and research
in Sri Lanka.

OVERCOMING BARRIERS TO IMPLEMENTING GENOMIC
MEDICINE IN DEVELOPING COUNTRIES

Measures to be taken to facilitate the implementation of genomic medicine in
developing countries are listed in Fig. 2.2. Some of these are discussed in detail
below.
j Convince national governments that genomic medicine is important
and that government support for funding genomics medicine
infrastructure is vital to provide affordable genomic medicine services.

The lack of access to genome sequencing facilities in developing countries
makes outsourcing the only available option to utilize these technologies.
Typically in developing countries, the sequencing facility of the outsourcing
company is located abroad, far removed from where the output of their ser-
vices is utilized. This results in many problems: improper handling of sam-
ples, improper transport of samples, long delays in generating data, quality
issues related to the data generated, and interpretation and clinical correlation
of results. An added danger is that the entire outsourcing process can fail at
any stage, especially when the companies decide to terminate their services
abruptly. The solution to this is the establishment of centers of excellence in
developing countries where sequencing and bioinformatics facilities are made
available. These centers can be set up at the national or regional level.
Financing the setting up of such facilities, however, may be challenging. The
estimated costs start at US$100,000 for even the lowest end NGS instrument
when ordered from a developing country. In fact, when the added cost of ship-
ping, customs duties, and margins kept by local distributors are taken into
account, setting up a facility can cost from 50% to 100% more in a develop-
ing country when compared with the cost in the West. In addition, in most
instances other laboratory infrastructure and computational facilities also
have to be established from scratch or improved. Once the facility is set up,
operational costs can be prohibitive as well. Most developing countries do not
have the volume of testing that the suppliers demand to bring down the price
of reagents, and as a result, at the point of delivery, the cost of reagents is
50%–100% higher when compared with the cost in the West. Such huge costs