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GENOMICS AND HEALTH

WHEN THE WORLD Health Assembly, the top decision-making body for the World Health Organisation, meets in Geneva this month one interesting question will come up for discussion. It is how best to ensure that the developing world also reaps the benefits of the tremendous revolution happening in genomics and the related molecular approaches to understanding and treating disease. Not only has the entire human genome been sequenced; so have the genomes of many disease-causing organisms (including those causing AIDS, malaria, cholera, diarrhoeal disease, typhoid, tuberculosis, leprosy, and plague) and of some of the vectors that spread disease. Knowing the genetic sequence of host and pathogen makes it possible to study the proteins that various genes produce and how those proteins act. These approaches are providing unsurpassed insights into the way pathogens gain entry into the body and into specific cells, cunningly avoid human defences; and into how the infection affects vital body functions. This information becomes the basis for improved diagnostics, more effective vaccines, and better drugs. Mining genome data led German researchers to discover that fosmidomycin, which had originally been developed by a Japanese company in the 1970s to treat recurrent urinary infections, could be a highly effective anti-malarial drug. Likewise, Indian researchers were able to identify another potential anti-malarial drug in an antiseptic commonly used in mouthwash and other household products. "There is growing evidence that a better knowledge of the genomics of pathogens and their vectors is likely to play a major role in the prevention and treatment of infectious disease," observes an Advisory Committee on Health Research that has been asked by the WHO to examine the implications of advances in genomics and biotechnology.

Just 10 per cent of the global health research investment of tens of billions of dollars goes to research that addresses 90 per cent of the world's health problems, points out the Global Forum for Health Research. Global research effort is high for diabetes, cardiovascular disease, hepatitis B, and influenza, which are major problems in the developed world. There is substantial but insufficient research going into HIV/AIDS, tuberculosis, and malaria. But Chagas disease, schistosomiasis, kala azar, African sleeping sickness, African river blindness, and lymphatic filariasis, which are predominantly or exclusively problems of developing countries, are neglected. Of the 1,233 new drugs marketed between 1975 and 1999, only 13 were specifically for tropical diseases.

"The concept of industrial partnerships between developed and developing countries, and among developing countries themselves, might constitute a particularly promising approach for Member States to advance," recommends the WHO Advisory Committee. It points out that genomics-based approaches to identify potential vaccine or drug candidates involved a long, complex, and expensive process, and suggests that large pharmaceutical companies are not necessarily well-suited to dealing with many of the diseases that plague developing countries. It is critical that developing nations help one another in health research and drug production. Countries such as Brazil, China and India already have considerable research and industrial capability. Further, developing countries spend substantial sums on their military; according to the SIPRI Yearbook 2003, China and India ranked second and third, right behind the United States, when military expenditure was computed in terms of purchasing power parity. If developing countries could reallocate just a little of the money they now spend on armaments, it would make a world of difference to health research that directly benefits their citizens.

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