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Developing and Emerging Countries—A European Perspective 147

promising progress in that direction, although many are struggling to keep up
with a rising population burden (Zhang et al., 2017).
The rational use of healthcare technologies is based on a review of efficacy,
safety, and quality of similar agents as well as their comparative efficacy, safety,
and their “value-for-money.” Frequently, an important deficiency in the pro-
cess of a national formulary is the lack of national data, which is a common
issue in developing and emerging countries. Drug efficacy and/or toxicity data
are mostly generated by European/Anglo-American populations, despite the
fact that local/national data concerning efficacy, safety, and quality is “man-
datory” with regard to healthcare treatment of worldwide communities.
Standardization remains an issue, especially when developing and emerging
countries are considered, as they are struggling for resources. Thus pharma-
cogenomics is slowly becoming a part of health care systems in Western high-
income countries, as low- and middle-income countries are lacking coherent
national policies.

DEVELOPING AND EMERGING COUNTRIES—A
EUROPEAN PERSPECTIVE

Despite the advances in pharmacogenomic research and its use in the clinic in
high-income European countries (especially, the United Kingdom, the Nether-
lands, and Germany), the clinical application of pharmacogenomics is still in
its infancy for the majority of low-resourced and developing countries. Notably,
the anticipated cost-efficacy outcomes following the implementation of phar-
macogenomics in developing and emerging counties are greatly needed, as the
public health system or other public sectors (such as education and environ-
mental policies) may be empowered by this surplus.
Many note that there is some criticism inherent in the use of the term “devel-
oping country,” as the term implies the inferiority of a developing country
or an undeveloped country compared with a developed country, and that
exact inferiority relates to their economy. Hence, the term “low-income” will
replace those of “developing” and “emerging” from now on. According to
2017 data, low-income economies are defined as those with a gross national
income (GNI) per capita of US$1025 or less; lower middle-income econo-
mies are those with a GNI per capita between US$1026 and US$4035; upper
middle-income economies are those with a GNI per capita between US$4036
and US$12,475; high-income economies are those with a GNI per capita of
US$12,676 or more. Table 8.1 summarizes the low-income European coun-
tries and their corresponding GNI values.
Similar to worldwide challenges when low-income countries are considered,
if pharmacogenomics is to be implemented in the clinic and involved in