Transcript Slide 1

Genomics and Global
Public Health
Abdallah S Daar
University of Toronto
Genomics and Population Health
Conference, London
Jan. 26, 2006
Global Health Inequities:
A key ethical challenge
10/90
GAP
Underlying issue: Knowledge Divides
(Digital-, Genomic-, Nano-, etc.)
Medical Genetics and Biotechnology: Implications for Public Health
unedited draft report, version: 22 December 1999, by
Professor A.S. Daar and Professor J-F. Mattei
with the assistance and guidance of members of the WHO Working Group on Genetic Manipulations and incorporating
modifications suggested at the meeting of the working group of independent and external experts held at WHO
headquarters 12-14 October 1998
© World Health Organization
This report is not issued to the general public, and all rights are reserved by the World Health Organization. The report may not
be reviewed, abstracted, quoted, reproduced or translated, in part or in whole, without the prior written permission of WHO. No
part of this report may be stored in a retrieval system or transmitted in any form or by any means - electronic, mechanical or
other - without the prior written permission of WHO.
The views expressed are solely the responsibility of the authors.
Collins et al. A Vision for the future of genomics research. Nature, April 14, 2003
Canadian Program on Genomics
and Global Health (CPGGH)
• Main focus is in reducing global health inequities through
use of genomics/ biotech knowledge. Not “ethics as usual”
• The only WHO Collaborating Centre in Bioethics in the
world
• Empirical qualitative research, plus concept development.
• 40 million Canadian dollars of peer-reviewed research
grants; 22m in 2005
• Aiming for major policy impacts
• International recognition includes 5 prizes this year:
UNESCO Avicenna Prize for Ethics in Science; Dales
Prize; Anthony Miller Prize; Maud Menten Prize; Yale
Award for Excellence in Bioethics
What Do We Mean By Genomics
(where is the field going?)
The powerful new wave of
health related life sciences
(biotechnologies) energized
by the human genome
project and the knowledge
and tools it is spawning
(proteomics, transcriptomics,
metabolomics, etc)
Avoiding a Genomics Divide
Harnessing Genomics and
Biotechnology to Improve Global
Health Equity
Singer PA & AS Daar (2001).
Science 294(5540):87-89.
Some Projects in Our Program
• Promotion of Global Public Goods
• Developing New Models of Intellectual Property Regimes
• Biotechnologies from Improving Health in Developing
Countries (DCs)
• Grand Challenges for Global Health
• Biotechnologies and the Millennium Development Goals
• Health Biotech Innovation Systems of DCs
• How Biotechnology Companies Deal with Ethical Challenges
• Role of the Private Sector in S&T innovation in DCs and
what developed countries can do to help
Projects
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Diaspora Contributions to Home Country Development
Knowledge Societies
Global Health Ethics
Pharmacogenetics and Geographical Ancestry
Genome Policy Courses
Nutrigenomics
Plant Derived Vaccines
Convergent Technologies (e.g. Nanotechnology)
Bio-development vs. Bio-security (Bioterrorism)
Grand Challenges in Non-Communicable Diseases
Regenerative Medicine
International Executive Courses on Genomics/Policy
Top 10 Biotechnologies for
Improving Health in Developing
Countries
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Molecular diagnostics
Recombinant vaccines
Drug and Vaccine delivery systems
Bioremediation
Sequencing pathogen genomes
Female-controlled STI protection
Bioinformatics
Enriched GM crops
Recombinant drugs
Combinatorial chemistry
Daar AS et al (2002). Top 10 biotechnologies for improving
health in developing countries. Nature Genetics 32(2).
2. Recombinant Vaccines
EXAMPLE: A malaria subunit vaccine recently
protected 71% of Gambian adults against
natural infection for the first 9 weeks in a test
study
• A broad category of
vaccines made by the
manipulation of DNA
• Safer than traditional
vaccines, and can be
cheaply produced
• Examples include
subunit vaccines,
edible vaccines and
viral vector vaccines
HIV
• One of the most rapidly mutating viruses
known
• Great threat to human thriving in
developing countries
• No effective vaccine
• Almost all approaches will have to take into
account HIV genomics
• Novel approaches e.g. CCR5 blockers
MALARIA
• With previous technology no safe vaccine
• Subunit vaccine, 70% response rate in Gambia
• Fosmidomycin as new class of antimalarial
discovered through partial genome sequence and
bioinformatics
• Now genome of both falciparum and its insect
vector has been sequenced
• Vector control will almost certainly depend on
genomics knowledge
• Synthetic biology to make artesunate
4. Bioremediation
EXAMPLE: Bioremediation was part of the
strategy to clean up the Alaskan shoreline
after the Exxon Valdez oil spill in 1989
• The use of bacteria
and plants to clean up
water and soil
pollution
• Much cheaper and
more sustainable than
waste excavation and
disposal
Bangladesh’s Mass Arsenic
Poisoning
• 50 million people exposed
• Bacteria convert insoluble arsenic in
aquifer wall to soluble arsenic in water
• In Australia there are bacteria that do the
opposite
• We led a coalition with Australian,
Canadian, Bangladeshi and US scientists to
study genomes of both types of bacteria
• Sequencing started in Canada
6. Female-Controlled STD
Protection
EXAMPLE: Antibodies bind to and
disable pathogens. Monoclonal
antibodies applied as a vaginal gel
have been effective at preventing
STDs.
• Women lack ways of
protecting themselves
against STDs without
needing their partner’s
consent
• Biotechnology may help
by providing vaccines,
vaginal microbicides or
blockers of viral receptors
e.g. CCR5
UN MILLENNIUM
DEVELOPMENT GOALS
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Eradicate extreme poverty and hunger
Achieve universal primary education
Promote gender quality and empower women
Reduce child mortality
Improve maternal health
Combat HIV/AIDS, malaria and other diseases
Ensure environmental sustainability
Develop a global partnership for development
Bill and Melinda Gates Foundation
$437 M Grand Challenges in Global
Health
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Elias
Zerhouni,
Director of
NIH
Budget: 28
billion $
www.grandchallengesgh.org
What is a Grand Challenge?
“A specific scientific or technological
innovation that would remove a
critical barrier to solving an important
health problem in the developing
world with a high likelihood of global
impact and feasibility.”
Goals and Grand Challenges
GOAL 1: To improve childhood vaccines:
GC 1: Create effective single-dose vaccines that can be used soon after birth;
GC 2: Prepare vaccines that do not require refrigeration;
GC 3: Develop needle-free delivery systems for vaccines.
GOAL 2: To create new vaccines:
GC 4: Devise reliable tests in model systems to evaluate live attenuated vaccines;
GC 5: Solve how to design antigens for effective, protective immunity;
GC 6: Learn which immunological responses provide protective immunity.
GOAL 3: To control insects that transmit agents of disease:
GC 7: Develop a genetic strategy to deplete or incapacitate a disease-transmitting
insect population;
GC 8: Develop a chemical strategy to deplete or incapacitate a diseasetransmitting insect population.
GOAL 4: To improve nutrition to promote health:
GC 9: Create a full range of optimal bioavailable nutrients in a single staple
plant species.
GOAL 5: To improve drug treatment of infectious diseases:
GC 10: Discover drugs and delivery systems that minimize the likelihood of
drug resistant microorganisms.
GOAL 6: To cure latent and chronic infections:
GC 11: Create therapies that can cure latent infections;
GC 12: Create immunological methods that can cure chronic infections.
GOAL 7: To measure disease and health status accurately and
economically in poor countries:
GC 13: Develop technologies that permit quantitative assessment of
population health status;
GC 14: Develop technologies that allow assessment of individuals for multiple
conditions or pathogens at point-of-care.
Genetically Modify Mosquito Populations To
Make Them Incapable Of Transmitting Dengue
Virus
(O’Neill)
• Targets insect age, one of the most sensitive parameters
influencing the epidemiology of insect-transmitted
diseases.
• By introducing known life-shortening strains of inherited
• Wolbachia endosymbionts into mosquitoes we can
selectively eliminate old mosquito adults in the population.
Because of the length of the extrinsic incubation period of
dengue virus within a mosquito, the removal of old
individuals can stop disease transmission to humans.
• Moreover, the inherited Wolbachia endosymbionts that are
capable of shortening lifespan provide their own genetic
drive mechanism that allows them to spread throughout the
host population.
Learning From the Human Genome How Protective
Immunity Against Malaria Works (GC#6 Kwiatkowski)
• To identify critical mechanisms of protective immunity
against malaria by combining state-of-the art human
genome technologies with large-scale epidemiological
studies in malaria-endemic regions. To answer:
• How do people naturally clear malaria parasites from the
blood stream?
• Why some people and not others get severe malaria? Most
human genes show variation between individuals. By
investigating how this natural genetic variation affects
disease susceptibility, we can build a catalogue of host
molecules that are critical for protective immunity.
“Engineered Immunity” (David Baltimore’s
Grand Challenge in Global Health)
• New method using genetic engineering and cell
transplantation methods to deal with infectious diseases of
developing countries
• Antibody repertoire in humans is altered to direct life-long
production of specified antibodies with desired properties
• The antibodies are produced in vivo by infecting
autologous haematopoietic stem cells with lentiviral
vectors bearing specific antibody genes and injecting the
cells back into the patient.
• Initial focus on HIV, but the method is applicable to other
infectious diseases.
Health Biotechnology Innovation
in Developing Countries (Nature
Biotechnology)
Case
studies:
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Brazil
China
Cuba
Egypt
India
S Africa
S Korea
The only
Meningitis
B Vaccine
IMPACT: Some Examples
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Canadian Prime Ministers’ 5% commitment
Argentina bill on nanotechnology
Nigerian Health Minister
United Nations Task Force
High Level Africa Biotechnology Panel
etc
UNITED
NATIONS
UNITED
NATIONS
Nigerian Health Minister
Eyitayo Lambo – London 2005
“Tells me what to do”
“Tells me how to do it”
It's a miracle: mice regrow hearts
29 August 2005
SCIENTISTS (at Wistar Institute) have created
"miracle mice" that can regenerate amputated
limbs or damaged vital organs, making them
able to recover from injuries that would kill or
permanently disable normal animals.
“There can be no peace, no security, when a few
rich countries with a small minority of the
world’s people alone have access to the brave,
and frightening, new world of technology and
science, while the large majority live in
deprivation and want, shut off from
opportunities of full economic development;
but with expectations and aspirations aroused
beyond the hope of realizing them.”
Prime Minister Lester B. Pearson