9-Misc: Genetic research unlikely to help world's poor

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                                  PART I
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TITLE:  Genetic Gains Unlikely to Help World's Poor, Report Predicts
SOURCE: The Washington Post, by Susan Okie
        http://www.washingtonpost.com/wp-dyn/articles/A11291-2002Apr30.html
DATE:   May 1, 2002

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Genetic Gains Unlikely to Help World's Poor, Report Predicts

The flood of new knowledge from genetic research is likely to worsen inequalities in health between rich and poor countries unless money, training and technical assistance are provided to help developing countries benefit from new discoveries, according to a report issued yesterday by the World Health Organization. "Frankly, in a time frame of three to five years, there can be quite considerable breakthroughs," said WHO Director-General Gro Harlem Brundtland. "And at that moment, it is important who is going to be able to benefit from those breakthroughs."

New vaccines and drugs for major killers such as malaria, AIDS and tuberculosis are being developed through genetic research, but mechanisms are needed to ensure that the victims of such diseases, most of whom live in poor countries, will have access to such treatments, according to the report, "Genomics and World Health." Moreover, representatives of developing countries should be included in the global ethical and scientific debates over how personal genetic information should be used and how genetically engineered products should be developed and regulated, the report says. "The risk is there that . . . people in poor countries could be used for doing research and really not benefit from the results of that research," Brundtland said.

The report, prepared by an international team of 14 physicians, researchers and ethicists, endorses an earlier recommendation by the WHO's Commission on Macroeconomics and Health urging the creation of a Global Health Research Fund, to be initially endowed with $1.5 billion that could be made available to all countries through peer-reviewed grant applications. Although the United States and other donors are already contributing to a similar global fund to provide treatments for people infected with HIV, malaria and tuberculosis, "some funds have to go not just for existing pills, but for new products for developing countries," said Barry Bloom, dean of the Harvard School of Public Health and a coauthor of the new report.

Drug companies lack market incentives to develop treatments for many diseases that mainly affect people in poor countries. Without funding of such research by governments and nonprofit organizations, "the potential of genomics to combat these diseases will not be realized," the report predicts. Among other recommendations, the report said that developing countries should seek to improve biotechnological capacity and establish programs in clinical genetics and genetics research, and establish partnerships between academic institutions, government and industry to use new genetic technologies to control communicable diseases.


                                  PART II
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TITLE:  GENOME RESEARCH CAN SAVE MILLIONS IN DEVELOPING WORLD
SOURCE: WHO Press Release WHO/34
        http://www.who.int/inf/en/pr-2002-34.html
DATE:   April 30, 2002

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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 WHOÕs Advisory Committee on Health Research (ACHR), the organizationÕs 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 UniversityÕs 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 Ôdigital divideÕ," Prof. Dan Brock of Brown University and another of the ReportÕs 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-drugÐresistant 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 Ð 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."



For more information, contact Dr Tikki Pang, Director, Evidence and information for Policy, WHO, Geneva. Tel. (+41 22) 791 2786/2788; Fax (+41 22) 791 4169; E-mail: pangt@who.int

All WHO Press Releases, Fact Sheets and Features as well as other information on this subject can be obtained on Internet on the WHO home page http://www.who.int/

Free downloading & information: www.who.int/genomics
downlad report at: http://www3.who.int/whosis/genomics/genomics_report.cfm




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