It seems counterintuitive to think about personalized medicine in the emerging markets. Personalized medicine is a technology intensive platform, utilizes genomic testing and tailored treatments and therefore is predominantly discussed in the context of developed economies. Developing economies’ health systems, often faced with fundamental challenges of access to basic health services, won’t have or won’t allocate the resources for adopting personalized medicines protocols. Yet, the economics of personalized medicines could eventually justify a role in strengthening health systems there.
Personalized medicine introduces treatment protocols that indicate the risk of disease on a genetic level before symptoms appear. The ability to identify, track and treat conditions before diseases reach advance stages of development improve the survival rate and quality of life for patients as well as increase the efficiency and affordability of health systems . Treatment protocols for smaller populations might increase initial costs, but the targeted strategy should be more effective, quicker and with fewer side effects. The benefit in a cost-benefit calculation would substantially increase.
NOT AN EASY PATH
Generally in developing economies, half or more of the health services delivered will come from the private sector and the vast majority of the payment will be out-of-pocket. Although progress is being made in micro-insurance offerings, it is unrealistic to expect more than a fraction of the population to be able to afford the battery of tests that identify a person’s genetic disposition. Capturing long-term savings also means long-term tracking of the individual. Future savings is difficult to defend when confronted with overwhelming and immediate burdens of disease.
Therefore in the foreseeable future, any integration of personalized medicines into a developing country’s health system will have to be government mandated, enforced and heavily subsidized. The calculations of cost benefit, efficacy and cost avoidance will challenge the government officials in developing countries with their health systems because, for the time being, the government will be the only one able to consider bringing forth personalized medicine. The advancement of personalized medicines and their adoption within health systems will force the re-evaluation of policy, education, ethics, laws and the use of clinical information delivering health services.
A SAVING GRACE
The divide between rich and poor nations health care is already being played out in the fight between the supporters of intellectual property and pharmaceutical patents versus proponents of low-cost access to medicines. The point of contention is that providing low cost access to patented medicines has come at the expense of patent infringement. The controversy is not close to a resolution, with both sides firmly entrenched in their positions. The difference and perhaps a saving grace in the case of personalized medicine is that in the nascent stages of personalized medicine, much of the advancement is predicated on computing power, data processing and studies targeting smaller populations. Public sector officials and ministries in the developing world must carefully consider the public’s rights, responsibilities and access to the advancements that they have funded or supported and how that translates to an access strategy. Equitable access will be paramount.
Emerging markets could benefit and contribute to the advancement of personalized medicines by:
# Pooling resources – emerging markets have concentrations of research talent and research capabilities. Forging bilateral and multilateral agreements between ministries of health as well as research and academic institutions.
# Coordinating research efforts and harmonizing agendas and priorities of regulatory agencies.
# Using the joint research efforts to provide the backbone for interoperable systems between ministries, countries and regions.
# Educating and clearly articulating the rationale for personalized medicines programs versus directing resources toward more immediate and wide spread disease and health challenges.
# Shaping the policy agenda of personal medical data.
This article was written in 2015.
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