In 2010, life expectancy in Botswana is expected to drop to about 30 years if the AIDS epidemic remains unchecked. In Canada, life expectancy is over 80 years and rising. Such shocking inequities in health are perhaps today's greatest ethical challenge. Can the unfolding revolution in genomics (the study not of individual genes but of all genes as an entity) and biotechnology be harnessed to reduce these inequities? We believe the answer is a qualified "yes," if certain conditions are met.
First, we must not mistakenly view genomics/biotechnology as "high-tech," expensive and therefore irrelevant for developing countries. Vaccines were and still are high-tech, but their cost has come down and they have made a huge impact in developing countries. In many developing nations, genetic disorders are among the top public health priorities. The ongoing sequencing of the genomes of malaria, the tubercle bacillus, leprosy, hepatitis viruses and HIV raises serious hopes of better vaccines in the future. A vaccine against HIV is already being tested in Kenya. Edible vaccines from transgenic plants are likely to be more useful for developing countries than for developed ones because they avoid the need for refrigeration.
Second, developing-country concerns must be kept at the forefront of discussions about the potential benefits of genomics and biotechnology. People who protest against globalization in places like Genoa are unlikely to die of hunger in Somalia. The voices of people in developing countries must be heard. For example, Hassan Adamu, Nigeria's former minister of agricultural and rural development has noted: "It is possible to kill someone with kindness, literally. That could be the result of the well-meaning but extremely misguided attempts by European and North American groups that advise Africans to be wary of agricultural biotechnology."
Third, we must build on the research strengths and human capital of developing countries. For example, Cuba has a significant biotechnology industry: it developed the only effective meningitis B vaccine (which, despite the embargo, is imported into the US), and in 1998 it produced 30 tonnes of transgenic tilapia fish. Income from Cuba's biotechnology exports is sufficient to sustain Cuba's biotech research and development expenditure.
India, Brazil, China and several other developing countries also have serious research-and-development efforts in biotechnology. Developing countries must also build capacity for policy analysis and ethics. The African Center for Technology Studies in Nairobi is influential internationally and already plays an important policy research and capacity-strengthening role.
It recently became clear that one key to success is to forge mutually beneficial collaborations with well established and successful institutions wherever they may be, not just between neighboring countries. One of the developing world's least leveraged resources is its human capital working overseas, often in leadership positions in academia and industry. India successfully drew from this resourceful pool in the "diaspora" to become one of the world's leading exporters of software.
Fourth, we must broaden the concept of human security, introduced into the UN Security Council by Canada in recent years, to include not only protection of civilians in military conflict but also protection of civilians from health threats. Linking genomics, global health is not only a scientific and policy issue, but also a diplomatic one.
We collectively need to make a positive policy decision to capitalize on the potential of genomics/biotechnology to help reduce inequities in global health. Ultimately, it will be necessary to crystallize the many lessons learnt in a format that is easily digestible. The effort should bring together industry, academia, the media, NGOs, and governments to alleviate suspicion, facilitate dialogue, build trust, arrive at consensuses and agree on good practice guidelines. This should harmonize the approach toward the application of genomics and biotechnology to solve major health problems worldwide.
An early indicator of success will be when the global discourse on biotechnology focuses on the benefits as well as the risks, and on the concerns of both the developing and developed world. In the long run this may translate into a reduction in the avoidable burden of disease and better health indicators. If we act, Botswana's life expectancy may one day be closer to 80 than to 30 after all.
Peter A. Singer is Sun Life Chair and director of the University of Toronto Joint Centre for Bioethics. Abdallah S. Daar is director of the Centre's Program in Applied Ethics and Biotechnology and a member of the Ethics Committee of the Human Genome Organization.
Copyright: Project Syndicate
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