Lamech M Mwapagha
Africa faces a heavy disease burden of both communicable and non-communicable diseases.
Although the continent has generally succeeded in the last 20 years in decreasing the levels of a number of communicable diseases (including cholera and polio), there are some (like malaria and HIV/AIDS) whose prevalence remains quite high.
This disease burden has been aggravated with the emergence of drug-resistant strains of various pathogens.
Non-communicable diseases, such as cardiovascular diseases (heart attack and stroke), cancer, diabetes and chronic respiratory diseases (chronic obstructed pulmonary disease and asthma) are also on the rise in Africa, with the number of deaths projected to rise over the next decade.
The high disease burden in Africa can, therefore, be significantly reduced through a proactive strategy that combines public health tactics to help identify genetic risk factors for diseases (and hence make timely interventions), and to tackle the spread of emerging infections and drug resistance.
Achilles ‘heels’
Africa still lags behind the rest of the world in the field of genomic research. This is largely attributed to the following challenges:
The cost of genomic research remains prohibitive for African research centres due to lack of enough government funding and support.
A dearth of African scientists with genomic research and computational expertise, who can appropriately and accurately translate genomic information into clinical medicine.
Limited biomedical research infrastructure by means of which to undertake genomic research.
Limited collaborative research among African scientists.
A climate of fear about genomic information among the public and health professionals in Africa.
Lack of proper engagement with national and regional agencies in the uptake of genomic research as novel methodologies to help tackle health problems.
No proper policies and clear guidelines to inform medical and public health professionals about the level of confidence and the utility of genomic information.
Opportunity awaits
There is an increasing body of research which suggests that a better understanding of the genomics of pathogens is likely to play a crucial role in the prevention and treatment of infectious diseases.
Knowledge of particular gene expression patterns in pathogens has provided novel targets for drug therapy.
Some examples of how genomic research has been used to address public health issues include the identification of a new antimalarial, using computational analysis of the sequence data of Plasmodium falciparum; development of new vaccines against Mycobacterium tuberculosis and Neisseria meningitidis, group B, as well as in the investigation of causes of infectious disease outbreaks, including, Ebola virus, drug-resistant strains of Staphylococcus aureus, and Klebsiella pneumonia.
Genomic analysis has also provided important prognostic indicators for breast cancer patients, and helped identify the drugs to which such individuals could respond best.
This has opened the door to the new era of personalised medicine that aims to tailor therapy according to each person’s genetic makeup, and hence achieve the best outcomes for individual patients, rather than treating all persons with a ‘one size fits all’ approach.
A good example was the utilisation of genome sequencing that pointed to a new treatment regimen for Nicholas Volker with a gastrointestinal disorder that was cured with a bone marrow transplant.
To date, the US Food and Drug Administration has approved 45 human genetic tests and more than 100 nucleic acid-based tests for microbial pathogens.
Although most of this research is being carried out in the developed world, scientists on the African continent are continuously attempting large-scale genome research studies, focused on specific diseases.
Previous studies have shown that Africans have the greatest amount of genetic variation.
Thus, understanding the genetic basis of both communicable and non-communicable diseases in Africans may provide useful insights into devising effective strategies to combat these diseases that have had a large impact on African populations.
Remedies
African Union member states set a target of 1% of GDP to be invested on research and development, but this has not been realised.
So far, only South Africa, Kenya and Senegal are close to this target – being at around 0.8% in all three countries.
Given the huge potential of genomic research in addressing public health problems, it is crucial that such research is given higher priority in Africa.
Such research should be supported in the context of establishing infrastructure for genomic studies, capacity building and enhancing research collaborations with credible international partners.
African genomic scientists should also engage in collaborative research and networks that would enable the exchange of new ideas and knowledge transfer.
Such collaborations could indirectly influence policymakers in governments to support investments in genomic research.
There are already programmes that are supporting such initiatives, but there is scope for considerable expansion.
Overall, policymakers need to be involved from the beginning in all discussions and debates involving genomics research.
By engaging community stakeholders, academics and public health professionals in the development of research questions as well as setting-up of legal regulatory frameworks to address issues in public health and genomics, the gap between genomics and public health needs can be bridged.
This would go a long way towards ensuring the translation of genomic research findings into public health benefits.
*Professor Lamech M Mwapagha is an associate professor of Medical Biochemistry and the coordinator of PhD Natural and Applied Sciences programme in the Faculty of Health Natural Resources and Applied Sciences at the Namibia University of Science and Technology. The opinions expressed in this piece are his own, and not the views of his employer.