For a long time, infectious diseases such as malaria, tuberculosis and HIV have dominated disease profiles in Africa. They have been the main contributors to the continent’s burden of disease, causing an estimated annual productivity loss of over $800 billion. However, Africa has also had to deal with emerging and re-emerging disease pathogens, most of which were unknown at the time most countries in Africa gained independence in the 1960s. These include the Chikungunya, Zika, Monkeypox and Ebola viruses in most of East and Central Africa.
While infectious diseases remain a concern for the continent, there is now an ongoing epidemiological shift caused by the burgeoning rates of non-communicable diseases (NCDs) such as diabetes, chronic respiratory, kidney, cardiovascular diseases, cancers, mental and substance use disorders. Research has shown that most adults in sub-Saharan Africa are exposed to at least one NCD risk factor, which could translate to increased mortality rates caused by NCD. Importantly, the exposure to infectious diseases is in many cases a risk factor for NCDs such as those affecting the cardiovascular system and for many cancers affecting the African population.
Like in many other fields, the practice of medicine is changing thanks to technological advancement that has brought about new and transformative medical models and tools that can be used to address the disease burden in Africa. One such innovation is Personalised Medicine (PM) which is also known as precision medicine. PM is an evidence-based healthcare medical model that uses an individual’s or population’s characteristics such as medical history, genetic information, environment, and social context, and employs data analytics to identify patterns that can be used for optimal interventions for individuals and specific populations. The goal of PM is to offer tailored health care at individual and population levels.
The question that PM answers is why some people or groups of people develop certain diseases while others do not, and why some people respond to certain treatments while others do not. Certain treatments appear to be clinically ineffective resulting in treatment failure because individual’s or certain populations’ response to drugs is influenced by their genetic makeup. PM eliminates the trial-and-error method of drug prescription and deviates from the “one dose fits all” approach. For instance, most treatments have been developed and tried on Western populations but do not work optimally on African populations due to their inherent genetic diversity. The PM model provides tailor-made prevention, diagnosis, and treatment for individuals or groups of individuals; facilitates early detection of patients at risk and enables prevention strategies; provides a more accurate disease diagnosis for individualised or population based treatment strategies; and improves outcomes through targeted treatments and reduced side effects.
PM is a relatively new concept and is currently being practiced in developed countries, mostly in the United States of America and Europe, where findings from genomic studies have been integrated into healthcare. While PM has advanced in Western countries, especially in treating cancer, progress in Africa has been slow with only a few countries prioritizing PM in terms of investment, infrastructure and mainstreaming into policy and practice. South Africa and Egypt are two African countries well on their way to integrating PM into their health care systems given their prioritization and investment on PM in research and health care programmes.
In a report of its Science Council titled ‘Accelerating access to genomics for global health: promotion, implementation, collaboration, and ethical, legal, and social issues’ published in 2022, WHO urges member states to consider adoption and implementation of PM, noting that genomics presents unique opportunities to address public health issues. While PM at the individual level may not be immediately achieved in Africa, strategies that may be employed to address public health issues need to be explored to ensure that health care disparities seen in Africa are not further driven by the lack of access to PM.
As we mark this year’s World Health Day, the timely conversation of how African countries can achieve health for all calls for a rethink of our health systems, care, investment, and financing, and to engage in meaningful discussions about employing innovative strategies such as PM. For the continent, it is opportune to progress the implementation of PM now rather than later especially if we are to meet the ambitious health goals of SDG3.
Published as part of EU-Africa PerMed (Building Links between Europe and Africa in Personalised Medicine), a four-year project funded by the European Commission H2020 Programme (Grant Agreement Number 964333.) that has the final objective of integrating more African countries in the global PM research agenda. EU-Africa Permed is implemented by a Consortium of 13 partners, seven from Africa and six from Europe. Learn more about the project: https://www.euafrica-permed.eu/