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Genome research can save millions in developing world

WHO Report Calls for Genetic Medicine Benefits for All

Genetic research has the potential to lead to major medical advances within the coming years against such killer diseases as malaria, tuberculosis and HIV/AIDS, potentially saving millions of lives, especially in the developing world, the World Health Organization (WHO) says in a major new Report on the impact of genomics.

The WHO Report, entitled Genomics and World Health, also makes a major contribution to the debate on the ethics of genome research, covering a wide array of themes, from using DNA tests to select the sex of children to the need to ensure that poor countries are not left out of the coming medical advances.

The report strongly endorses the recommendation of the Commission on Macroeconomics and Health to create of a Global Health Research Fund, a new central organization for research and development with an initial US$ 1.5 billion, which would be available through peer-reviewed application, to every country. It argues that a second US$ 1.5 billion should be made available to institutions which are working on new vaccine and drug development for HIV/AIDS, tuberculosis and malaria.

"Genome research, if we handle it correctly, can change the world for all health care," says Dr Gro Harlem Brundtland, WHO Director-General. "In particular, it has the potential to allow developing countries to leap frog decades of medical development and bring their citizens greatly improved care and modern methods in the much more immediate future,"

A team of 14 internationally prominent doctors, medical researchers and ethicists in both developed and developing countries, coordinated by Dr Tikki Pang, WHO Director, Research Policy & Cooperation, developed the 241-page Genomics and World Health Report over a 12 month period.

The Report was issued on behalf of WHO’s Advisory Committee on Health Research (ACHR), the organization’s highest level scientific advisory body. Based on a wide-ranging consultative process, the Report details the latest advances in genome research, explains how this research could result in medical advances against many diseases, including those pandemic in poor countries, warns about potential risks of such research and makes recommendations on how the fruits of this research can be brought to the developing world.

"This is the first ever Report to put genomic research in a global perspective," says Sir David Weatherall, lead writer of the Report, professor at Oxford University’s Weatherall Institute of Molecular Medicine and a pioneering researcher in molecular genetics, hematology, pathology and clinical medicine. "The Report anticipates how the global community could use genetics to attack the unfinished agenda of infectious diseases such as malaria, TB and HIV/AIDS that are still killing so many in the developing world, and eventually the diseases that are crippling the health care systems of all countries, like heart disease, diabetes and cancer."

In recent years, scientists have succeeded in sequencing the entire human genome, which contains between 28,000 and 40,000 genes -- lengths of DNA that carry the information required for every biological function of all living creatures. Researchers are also mapping the genomes of some important pathogens, disease vectors and plants.

Such research involves large-scale creation and utilization of databases through a high level of automation, and therefore requires major capital investment. This has mostly limited research to the rich industrial nations, although Brazil, China, India and Cuba are notable exceptions. These achievements should allow other researchers to develop both preventative and treatment techniques that have pinpoint accuracy for a wide range of afflictions.

"Developing nations are in danger of being left out of the benefits of genomic research, like they were left behind in the computer revolution of the 1980s and 90s, resulting in the so-called ‘digital divide’," Prof. Dan Brock of Brown University and another of the Report’s writers.. "Genomics and related technologies should be used to narrow the existing unethical inequities in global health. The Report is an important first step towards this goal."

"The whole thrust of the Report is that we will not change medical practice overnight by this new technology," Dr. Weatherall says."However, the long-term possibilities are such that developing countries, as well as developed countries, must prepare themselves for this new technology and carefully explore its possibilities."

DNA research is underway on a number of projects that can improve health care in developing countries, with some projects already yielding results. Among the research mentioned in the report are:

Creating a new designer mosquito that cannot carry the malaria parasite, one of the biggest killers in the developing world.

Rapid identification of a class of anti-malarial drugs that have the potential to be effective against multi-drug–resistant parasites, as well as being inexpensive and stable. A combination of malaria parasite DNA sequencing, bioinformatics (use of computer technology to store, analyze and interpret biological data-), and data mining (searching for comparative genomic data) have been instrumental in the creation of these drugs.

Two new types of vaccines derived from genetic research have been developed against tuberculosis, which is spreading in both developing and developed countries. Clinical trials of one of these vaccines has already started.

The diagnosis of leishmaniasis and dengue fever, both pandemic in some Latin American countries, has already been improved by the use of polymerase chain reaction techniques – one of the basic techniques in DNA research.

Cuba has developed a meningitis B vaccine at the Carlos J. Finlay Institute, attesting to the potential of biotechnology in developing countries.

Clinical trials have begun in Nairobi, Kenya and Oxford, UK, of a DNA-based AIDS vaccine candidate designed specifically for Africa.

Scientists are using DNA technology to produce vaccines that can be incorporated into potatoes and other vegetables, and fruits, against hepatitis B, cholera, measles, and human papilloma virus (associated with cervical cancer, a common malignancy in women in sub-Saharan Africa), allowing the vaccines to be ingested as part of a meal.

A candidate vaccine for Plasmodium vivax, the main type of malaria in India, has been identified by a recent collaborative effort between Indian researchers at the International Centre for Genetic Engineering and Biotechnology in New Delhi and the Malaria Vaccine Initiative.

Pharmacogenetics may save lives and valuable health care resources in developing countries by identifying populations who will respond favorably to therapeutics; there is preliminary evidence for this in relation to certain anti-HIV drugs in West Africa.

"The importance of this WHO Report is to make clear that while most of the incentives to develop new drugs and vaccines are appealing to the markets in the industrialized world, there are enormous opportunities to apply knowledge of the genome to diseases of the poorest people as well, and that we all have a responsibility to help make those opportunities into realities," says Professor Barry R. Bloom, Dean of the Harvard University School of Public Health and a member of the Committee which prepared the WGO Report.

The Report carries the first ever global examination of the role that ethics should play in genetic research and genetic medicine.

The Report warns that the planned development of large-scale genetic databases offers a series of hazards and ethical issues which have not been previously encountered. It says that there is still considerable controversy about the desirability of establishing databases of this type and there are many ambiguities regarding access and control. Concerns are focused on the potential harm to individuals, groups and communities.

Another ethical problem deals with decisions families may make regarding children as a result of DNA research. "These concerns are based on the notion that in our attempts to help families or individuals with a genetic disease we may increase the number of deleterious genes in the human gene pool," the Report says. "Preventing parents who are carrying the same genetic defect from reproducing, and hence having affected children, will tend to interfere with the normal evolutionary mechanism for reducing the frequency of deleterious genes within a population."

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