'Accelerating access to genomics for global health: promotion, implementation, collaboration, and ethical, legal, and social issues', a report of the WHO Science Council, comments
In 2021 WHO Director-General (DG) Dr Tedros Adhanom Ghebreyesus established the Science Council to advise him on WHO’s scientific agenda.
At its first meeting, the Science Council identified genomics as the focus of this report, for a number of compelling reasons, chief among them, the substantial and extensive benefits of genomics for personal and public health. The ongoing COVID-19 pandemic has clearly demonstrated the importance of genomics for global public health. In addition, there are many examples of the successful uses of genomics in humans, animals, and agriculture in high-, low- and middle-income countries, as revealed during three international workshops convened by the Science Council. The Council recognizes that there are many impediments to the implementation of expensive genomic technologies, especially in low- and middle-income countries, including high costs of equipment and reagents and lack of trained personnel. We are, however, convinced that current uses and future applications of genomic technologies are critical for improving the health and livelihood of people in all parts of the world, regardless of economic status, and that strategies to overcome the impediments are available.
Our report to the Director-General makes 15 recommendations for WHO and for consideration by multiple sectors within its Member States.
The recommendations are grouped under four themes:
1. promotion of genomics through advocacy
2. implementation of genomic methodologies
3. collaboration among entities engaged in genomics, and
4. attention to the ethical, legal, and social issues (ELSIs) raised by genomics.
All four sets of recommendations are intended to accelerate the establishment of genomic technologies and to sustain their beneficial use. The Council has also concluded that a long lag time between the availability of genomic technologies in rich countries and their availability in less-resourced countries is neither ethically nor scientifically justifiable. We strongly support the early diffusion of genomic technologies throughout the world so that humankind can collectively derive the health and other benefits from genomics.
The report features the following Goals and recommendations
1 Promote the adoption or expanded use of genomics in all Member States through advocacy by many parties.
1.1 WHO should use its leadership role in global public health to advocate for the expanded use of genomics in its Member States. In particular, WHO should promote affordable access to genomic technology globally so that all Member States, especially low- and middle-income countries (LMICs), can adopt and expand the use of genomics for better health and other benefits. This will require persuading Member States, as well as commercial and non-commercial organizations, academic institutions, and others, of the medical, scientific, and economic benefits of genomic technologies.
1.2 Member States, especially LMICs, should develop and conduct advocacy programmes that support the adoption or expansion of genomics.
1.3 International, regional, and national professional societies in medicine, public health, and biomedical research should advocate for the uses and benefits of genomics.
1.4 WHO should establish a Genomics Committee to assess and report annually to the WHO Director-General on progress in implementing the recommendations in this report. This evaluation should encompass all four themes—promotion, implementation, collaboration, and ELSIs. The Genomics Committee should also be mandated to take up additional tasks (elaborated below in 2.1, 2.3, 2.4, and 4.1).
2 Identify and overcome the practical issues that impede the implementation of genomics through local planning, financing, training of essential personnel, and the provision of instruments, materials, and computational infrastructure.
2.1 WHO should provide guidance to Member States on best practices for implementation of national or regional genomic programmes. 2.2 Member States should establish national programmes for building or expanding genomic capabilities or join a regional programme. 2.3 Organizations in the genomics commercial sector should be convened by the Genomics Committee to develop and execute approaches to make their products and technologies affordable in LMICs.
2.4 Organizations in both the public and private sectors should develop and execute plans to enhance the training of individuals capable of making effective use of genomic technologies.
3 Foster commitments to collaborative activities to promote all aspects of national and regional programmes that advance genomics in Member States.
3.1 WHO should promote international collaborations on genomics by strengthening effective existing collaborative arrangements and by helping form new ones for specific needs.
3.2 Funding agencies should promote collaborative arrangements and encourage the participation of investigators, health care personnel, and computational experts from a diversity of disciplines to promote the optimal use of new genomic information.
3.3 Industry, academia, and civil society should collaborate on the use of genomics to help solve important health problems, especially those prevalent in LMICs.
4 Promote ethical, legal, and equitable use and responsible sharing of information obtained with genomic methods through effective oversight and national and international rules and standards in the practice of genomics.
4.1 WHO, working through its Genomics Committee, should be the custodian of guidance on how to deal with the ethical and social ramifications of genomics, including the global governance of genomic information.
4.2 WHO should take a leading role in the resolution of debates about policies that govern the attribution of credit for genomics research.
4.3 Organizations in Member States, especially funding agencies, academic institutions, and governmental units should be attentive to ELSIs and to efforts being made by WHO and other international bodies to develop solutions to outstanding issues related to genomic ELSIs.
4.4 WHO should aspire to become the global authority on ELSIs for health-related genomic applications.
