What will health ministers and thought leaders gathering for the 72nd Annual World Health Assembly (WHA) imagine for the future of global healthcare in 2030?
I envision a future where babies survive debilitating or fatal conditions because of implemented universal newborn screening; where parents avoid aggressive cancers because genetic screening programs placed them on care pathways more likely to keep them alive; where people suffer from fewer medication side effects because tests predicted negative reactions and enabled doctors to proactively prescribe other treatments.
This is a glimpse into a globally attainable future using precision medicine approaches. Precision medicine refers to a more precise and targeted approach to screening, diagnosing, treating and potentially curing patients based on their own unique genetic and biologic make-up.
Precision medicine is often perceived as a new and expensive foray into sequencing whole genomes, diagnosing glitches in DNA and developing medications targeted to very small populations. However, such advancements are examples of how healthcare builds on and progresses decades-old achievements like newborn screening tests, hereditary risk-factor tests, cancer screenings and personalized medication dosing. These achievements are widespread in some countries, and realizable and beneficial for many more. A growing number of low- and middle- income countries have recognized this possibility, and its progression, and started pursuing policy approaches and partnerships for precision medicine.
Thailand uses genetic testing to identify epilepsy patients at risk of developing severe skin reactions to a commonly prescribed medication, so an alternative can be chosen before this skin reaction ever occurs. The success of this pharmacogenomic test in preventing debilitating side effects and its cost-effectiveness for their health system led Thailand to implement country-wide testing and adopt this genetic testing into benefit packages for universal health coverage. Thailand is now sharing implementation approaches throughout south-east Asia.
Botswana, through the Botswana-Baylor Children’s Clinical Centre of Excellence and funded in part by the Wellcome Trust, released a comic-book series to educate readers on heredity and genetics, how genetics impacts health, and the process for enrolling in biomedical or genomics research studies. Argentina, in 2017, launched a Precision Medicine Initiative Grant to establish the scientific knowledge and protocols needed to move precision medicine approaches into clinical practice. Three grants were awarded, focused on the genomics of paediatric diseases, the genomics of cancer, and the creation of a national biobank.
These examples illustrate how policymakers are integrating precision medicine approaches into national strategies to improve healthcare. These approaches will ultimately dovetail with efforts to address rising rates of NCDs (non-communicable diseases, including cancer), expand health data infrastructure, develop genomic data policy, increase diagnostic capacity, and create biobanks that hold both physical and digital resources.
Unfortunately, the first steps towards precision medicine are often muted in global public health dialogs or planning. As a result, disparities in healthcare will grow and increasingly practical and efficient solutions for prevention, diagnosis, treatment and potential cure – particularly in non-communicable diseases – may remain inaccessible to many.
The World Health Organization can play a crucial role by raising the visibility of sustainable and effective precision medicine approaches implemented by member nations, leading a dialogue on cost-effective methodologies and new technologies, and developing recommendations to prepare for a future informed by our deepening understanding of the biologic and genetic factors of disease and our increasing ability to address them. The launch in March of a Science Division to identify opportunities to harness the latest scientific developments to improve global health and the expert meeting on Genomics and Genetic Disorders held last month in Cape Town, South Africa are encouraging steps.
To be sure, there are fundamental and crucial health issues facing the world that need urgent attention. We must address those. But they should be addressed while simultaneously preparing for the future of healthcare.
If health ministers’ and thought leaders’ visions for the future of global healthcare in 2030 has any overlap with mine, then planning must start now. Member states should bring precision medicine approaches and their related policies to the agenda, so they can begin to address this topic with other future-oriented thinkers in government, industry, civil society, bioethics and academia. This is the first step in enabling healthcare systems to adopt the most scientifically and technologically appropriate approaches to a more targeted and personalized way of diagnosing and treating patients with disease, and in taking actions to advance precision medicine approaches in an equitable and societally beneficial way around the globe.