A powerful new wave of health-related life sciences, energized by the knowledge and tools of the Human Genome Project, is upon us. Genomics ”” the study of the entire genetic material of an organism ”” holds the promise of significantly improving health care at all levels in the foreseeable future. This revolution will undoubtedly become a force in shaping international relations.
Science and technology are now widely recognized as factors in the economic health of nations. Industrialized countries use them as competitive tools to advance their rel- ative power in the global economy. As evidence, note their centrality in international controversies involving food and drugs. They have been central in negotiating international legal regimes, informing the countries’ positions and interactions with industry and nongovernmental organizations.
Although there has long been an emphasis on managing the risks posed by science and technology, more recently sci- ence and technology have been promoted as tools for improving the human condition and addressing the needs of the poor ”” a case made persuasively in the UNDP Human Development Report (2001). However, far too often techno- logical revolutions have created divides (for example, the ”œdigital divide”) between industrialized and developing coun- tries. Much of the research in genomics takes place in devel- oped countries, where it primarily addresses the health needs of people in those countries. The 2000 Global Forum for Health Research report identified this notorious ”œ10/90” gap, whereby 90 percent of health research dollars are spent on diseases affecting 10 percent of the world’s population.
Genomic and related biotechnolo- gies have a potential global signifi- cance that will give rise to problematic access-to-knowledge issues and attempts to assert global influence over them as emerging resources. They will bring new opportunities to solve global health problems, but they will also test our skill in managing interna- tional relations, a phenomenon we call ”œgenome diplomacy.”
In this paper we argue that: a) sci- ence and technology are becoming important elements of foreign policy and international relations; b) genomics is relevant to people in developing countries, but interventions need to be targeted to avoid a ”œgenomics divide”; c) there are compelling reasons why Canadians should share the fruits of genomics with the developing world; and d) Canada has an opportunity to take the lead in ensuring that the rewards of genomics benefit both Canada and the developing world ”” that is, to become the world’s premier ”œgenome diplomat.”
In the United States, the Bush adminis- tration is highlighting the role of sci- ence in US diplomacy. In a recent address to the National Academy of Sciences, Secretary of State Colin Powell said that in issues ranging from creating condi- tions for sustainable development to stemming the global HIV/AIDS pandem- ic, ”œthe formulation of our foreign policy must proceed from a solid scientific foun- dation.” The State Department is sup- porting the US National Research Council (NRC) study into the role of sci- ence within the US Agency for International Development, similar to an NRC inquiry three years ago that helped pave the way for the reinstatement of a science office within the State Department. The recent increase of over $2 billion in the National Institutes of Health budget ”” with most of it devoted to bioterrorism ”” is also a testament to the role of science and technology in international affairs. At the World Summit for Sustainable Development, held in Johannesburg in August 2002, Powell stressed ”œthat good governance, including solid science and technology policies, are fundamental to sustainable development.”
Similarly, in the United Kingdom, the July 2000 white paper, ”œExcellence and Opportunity: A Science and Innovation Policy for the 21st century,” drew attention to the growing impor- tance of the international dimension of science and technology work for wealth creation in the UK. The Foreign and Commonwealth Office is expanding the network of science and technology spe- cialists at posts overseas, and it has estab- lished a dedicated Science and Technology Unit supported by secondees from UK research councils. In a recent speech parliamentary Under-Secretary of State for Foreign and Commonwealth Affairs Bill Rammell said ”œMore than ever the global challenges we face in the 21st century, whether the issue is internation- al terrorism, sustainable development, HIV/AIDS, or the environment, require a strong partnership between UK science and technology and UK foreign policy. Science to understand problems and technology to tackle them. Science and technology are in my view integral ele- ments in shaping our foreign policy.”
These American and British gov- ernment views of science and technol- ogy are echoed by industry. In June 2002, at the biotechnology industry’s annual convention held in Toronto, Carl Feldbaum delivered his presiden- tial address on ”œBiotechnology’s Foreign Policy.” In his speech he argued that the biotechnology indus- try needed to ”œformulate its first for- eign policy, one which is cognizant of the miserable judgments and mistakes of other industries ”” and avoids them,” with the goal of ensuring ”œthe widest possible dissemination of biotechnology’s benefits while respect- ing the diversity of the world’s nations and peoples.” The first point of his 10- point plan was that the industry ”œmust work with governments and interna- tional bodies to integrate biotechnology into compelling responses to public-health crises.”
Science and technology also appeared in NEPAD ”” the New Partnership for Africa’s Development. In placing NEPAD firmly on the agenda of the G8 summit in Kananaskis in 2002, Canada also showed its understanding that Africa needs more than aid: it needs partner- ships, trade and investment.
The 2001 United Nations Development Program report, Making New Technologies Work for Human Development, clearly documents the historical role of science and technology in human development. It argues that it would be to developing countries’ benefit to adopt and leverage science and technology to improve both their economic performance and their populations’ health. In his foreword to the report, Mark Malloch Brown, admin- istrator of the UNDP, says that we have ”œmoved in a new direction this year by challenging some cherished opinions about what the third world needs.” The report looks at three areas ”” food, med- icine and information systems ”” where high technology can be made relevant and useful to poor countries, as long as the risks are well managed.
In its seminal report, Genomics and World Health, the World Health Organization (WHO) explores genomics potential to improve the health of peo- ple in developing countries. When the report was released in May 2002, Dr. Gro Harlem Brundtland, the director general of the WHO, said: ”œGenome research, if we handle it correctly, can change the world for all health care. In particular, it has the potential to allow developing countries to leap frog decades of medical development and bring their citizens greatly improved care and modern methods in the much more immediate future.” WHO Collaborating Centres, aware that genetic defects contribute a significant burden of disease in develop- ing countries, met in Toronto in 2002 to plan concrete steps to provide basic genetic services in developing countries.
Genomics, however, goes beyond basic genetic services. It is the study of whole genomes, and it is rapidly spawning major new disciplines such as proteomics, bio-informatics and metabolomics, which will not only help scientists to understand diseases at a molecular level and allow us to develop novel preventive and thera- peutic tools, but will create new eco- nomic opportunities for those able to harness its potential.
Although developing countries have so far been largely excluded from cutting-edge genomics research, they have a number of important assets to leverage in the long term. First, they are potential consumers, and 90 per- cent of the world’s population lives in developing countries. Even though current research focuses on the devel- oped world and its concerns, it is quite likely that, as with vaccines, in the long term, the largest numbers of consumers will be in the developing world. Second, much of the world’s biodiversi- ty resides in developing countries in the genomes of its vast stores of flora and fauna. Third, in the developing world there are a still number of homo- geneous, well-defined communities that we should study because of their genetic predisposition to certain dis- eases. The results of such studies would be useful for all of humanity. Fourth, once they have been developed and standardized, genome-based technolo- gies (for example, PCR, or the poly- merase chain reaction, which is a method of amplifying minute amounts of DNA for research and diagnosis) are actually quite easy to transfer and adopt. Fifth, the diaspora of scientists from developing countries working in the developed world is a grossly under- utilized resource that could, with imag- inative policies, be utilized to transfer knowledge, skills and investment to their countries of origin.
In the Canadian Program on Genomics and Global Health at the University of Toronto Joint Centre for Bioethics, we have addressed the issue of how best to harness genomics and relat- ed biotechnologies to reduce global health inequities, highlighting some important applications in developing countries. To focus on specific biotech- nology platforms, we have recently com- pleted a foresight study where we have identified the top 10 biotechnologies that are most likely to improve the health of people in developing countries. These technologies are likely to improve health not only directly but also indirect- ly through improved agriculture and increased economic activity. We are cur- rently engaged in studying the biotech- nology innovation systems of Cuba, Mexico, Brazil, India, China, South Africa, Egypt and South Korea ”” all countries that appear to be establishing active biotechnology industries ”” to see if there are any generalizable lessons that would enable other developing countries to benefit. For example, since the 1980s, Cuba has invested heavily in biotechnol- ogy research infrastructure and manufac- turing. It holds a number of international patents in the biotech field, and has developed the only meningitis B vaccine. One can assume that biotechnology is destined to become a major export industry in Cuba.
Concerted action is needed, howev- er, to avoid a genomics divide in health. In a 2001 issue of Science, Singer and Daar identify the need for research, capacity strengthening, consensus building, public engage- ment and investment.
First, innovative research is required to explore the barriers to the application of genomics knowledge for developing countries. Which specific biotechnologies offer the greatest prom- ise for improving the health of people in developing countries? How can potential barriers to their application be overcome? How important is public investment in education and research? How can pro- ductive international research and devel- opment alliances be forged? Can intellectual property rights be used cre- atively to ensure meaningful returns while also benefiting the needy? We share Bloom and Trach’s hope that ”œknowledge of the genome will encour- age some medical researchers to seek new interventions that are population based and that emphasis will be put on devel- oping inexpensive drugs (comparable to aspirin and beta-blockers) and vaccines that prevent disease and disability in populations, rather than individual based designer therapies.”
Second, there must be sufficient capacity in developing countries to address both the scientific and policy aspects of genomics and biotechnology. There is already very significant genomics research in some developing countries such as Cuba, China and India. Science and technology policy units such as the African Centre for Technology Studies in Nairobi will sure- ly be an important advisory resource for developing country governments. There will be a need for people to address the ethical aspects of genomics research, such as those trained through the bioethics and genetics networks established by the Fogarty International Center of the US National Institutes of Health. There is also a need for short workshops on genomics and public health policy that will bring together stakeholders from government, NGOs, industry, universities and the media.
Third, we need mechanisms for building consensus among those stake- holders, and also from international organizations and the public. Examples of such mechanisms are the highly influ- ential international commissions such as the Evans Commission on Health Research for Development (1990) and the World Commission on Environment and Development (1987). A genomics and global health commission, or a glob- al public policy network, could serve as a platform for stakeholders to develop a modus operandi that would focus on their common interest in improving the health of people in developing countries and closing the health equity gaps.
Fourth, the views of people in developing countries must be heard as the health biotechnology revolution unfolds. Developing countries need to have a voice of their own where science and technology policy is concerned. A September 11, 2000 article in the Washington Post quoted Nigeria’s former minister of agri- cultural and rural development, Hassan Adamu as saying: ”œWe want to have the opportunity to save the lives of millions of people and change the course of his- tory in many nations.” Adamu warns, ”œThe harsh reality is that, without the help of agricultural biotechnology, many will not live.” What happened? Burundi’s sick and dying were not among those protesting in Brussels. The views of people from developing coun- tries were not at the forefront in the agricultural biotechnology debate, espe- cially early on; they must be there in the health biotechnology debate. How this opinion can best be captured poses a methodological challenge. We believe that identifying opinion leaders and tapping their views could be instructive. Information technology could provide the platform for network of global opin- ion leaders ”” a large-scale, on-line dis- cussion of genomics, biotechnology and global health.
Finally, mechanisms for financing genomics research and development as well as its ultimate application will be required. This would probably take the form of a combination of public grants (using a model such as the Global Fund for AIDS, Tuberculosis and Malaria), public-private partnerships (such as the Medicines for Malaria Venture), and private venture capital funds targeting genomics and developing countries.
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Canadians should care about glob- al inequities and the opportunity to harness genomics to improve them for both altruistic and self-interested reasons. Global health inequities are one of the biggest ethical challenges facing the world today. Life expectan- cy in some developed countries, such as Australia, Canada and Japan, is approaching 80 years, while in 7 sub- Saharan African countries it is 40 years and dropping. By some estimates, by 2010, 11 countries in Sub-Saharan Africa will see their life expectancies fall to near 30 years.
Much media space is devoted to the debate about the impact of global- ization and liberalized trade, drawing attention to increased disparities between developed and developing countries, notwithstanding evidence of positive economic benefits for some countries such as India and China. Many have argued that these disparities exacerbate international tensions, and that in order to address these increasing tensions we have to reduce poverty, increase communication and give a voice to the powerless. Now, more than ever, we need to find common ground.
We need a global health ethics that seeks to identify the key ethical prob- lems faced by the world’s six billion inhabitants and envisions and imple- ments solutions that can transcend national borders and cultures, say Benatar, Daar and Singer in a recent issue of International Affairs (2002). Similarly, Frenk and GoÌmez-Dantés, in the British Medical Journal (2002), point to the unifying role of health in the era of globalization. They quote Martin Luther King, who said: ”œIt really boils down to this: that all life is interrelated. We are all caught in an inescapable net- work of mutuality, tied into a single garment of destiny. Whatever affects one directly, affects all indirectly.”
Genomics, of course, is by no means the only issue that needs to be addressed to improve global health equity. The current focus on improv- ing governance and reducing conflict is more fundamental. However, we are at a moment in history when a major technological revolution is about to unfold, and this is the right time to try to harness genomics so it benefits all.
In addition to the ethical case for developing genomics so that it benefits the developing world, there is also an economic case to be made. Ninety per- cent of consumers are in developing countries, and it seems unwise, econom- ically, to ignore this ”œmarket.” Rather than focusing on ”œblockbuster” drugs for markets in developed countries, pharma- ceutical companies could focus on ”œglobal blockbusters” that would have far more consumers but lower profit margins. Over time, the individual pur- chasing power of people in developing countries is likely to increase.
Genome Canada, funded with $300 million from the federal govern- ment, positions Canada as a serious international player in genomics. Canada already has about 400 biotech- nology companies, with revenues of $3 billion a year. The Ontario BioCouncil has recently set out to make Ontario a major world player in biotechnology, aiming to become the third most pro- ductive cluster after Boston and the San Francisco Bay area in the United States. Quebec has a large and growing biotechnology industry. We argue that in the long run the health of the biotech sector in Canada could benefit from looking at a huge global market of six billion people rather than focusing exclusively on the six hundred million people in North America and Western Europe. Canada should make the first move to serve this market for genomics technologies.
Canada has always been at the fore- front of advocacy for the interests of developing countries. Lester Pearson said: ”œThere can be no peace, no security, nothing but ultimate disaster, when a few rich countries with a small minority of the world’s people alone have access to the brave, and frighten- ing, new world of technology, science, and of high material living standard, while the large majority live in depri- vation and want, shut off from oppor- tunities of full economic development; but with expectations and aspirations aroused beyond the hope of realizing them.” Canada’s current policy is very supportive of this sentiment. Last year, in introducing Canada’s innovation strategy, the prime minister said, ”œIn the 21st century, our economic and social goals must be pursued hand-in- hand. Let the world see in Canada a society marked by innovation and inclusion, by excellence and justice.”
At a time when Canada is being criticized for its weakened role in world affairs, we believe that Canada could and should take bold steps to become the world’s premier genome diplomat. To accomplish this, Canada could consider the following interna- tional and domestic agenda.
Foreign Policy: Canada should examine how to explicitly include genomics and biotechnology as a plank in its foreign policy. Canada is current- ly ranked 15th in the world with regard to its support for national science and technology research. In the past five years, the Canadian government has invested $8 billion in innovation initia- tives. This includes the formation of the Canadian Foundation for Innovation (CFI), the Canada Research Chairs, Genome Canada and the Canadian Institutes for Health Research (CIHR). The federal government is expected to continue to invest in Canadian innova- tion and move Canada from its present position to 5th globally.
If the innovation agenda is good domestic policy, it could also be good foreign policy. There is enormous poten- tial for these Canadian assets and resources to be leveraged into a foreign policy agenda. There are already signs of movement in this direction. These include CFI’s International Funds, CIHR’s Global Research Initiative, and DFAIT’s Going Global S&T Fund. But this move into foreign policy needs much more. It needs a ”œdiscontinuous leap” to by-pass the evolving, piecemeal approach and mobilize Canadian research talent. A national innovation strategy directed at international development is needed to invigorate Canadian science and tech- nology research and ensure that Canada earns a position of leadership among other countries presently engaged in sim- ilar initiatives.
Governance: Achieving an integrated national science and technology for development agenda will require cre- ative thought about an appropriate gov- ernance model. It will not be easy to harness foreign policy and adequate financial resources to encourage and facilitate collaboration among technolo- gies as diverse as genomics, nanotech- nology and information technology. We should support the development of innovative intellectual property models that balance competing economic, man- agerial, and ethical concerns by provid- ing different levels of protection of, and access to, biomedical innovations. In a 2003 issue of the journal Global Governance, Dowdeswell, Daar and Singer propose that Canada could take a leadership role in establishing a global networked policy formulation mecha- nism of communities committed to avoiding a genomics divide.
Human Resources: The effects of wors- ening economic circumstances, the exo- dus of trained staff, poor pay, the devastating impact of diseases like HIV and low morale all have their impact on the workforce in developing countries. Before they can be in a position to meet the challenges of sustainable develop- ment, they need to devote considerable attention to human resource manage- ment in science and technology innova- tion. The Rockefeller Foundation is currently examining how it can provide support for developing countries to boost their public health human resources. The US National Academy of Science is also prioritizing education and training needs to address global health concerns.
Canada needs to focus on these issues in a way that links its foreign poli- cy to its domestic science and technology innovation agenda. Canada is perhaps the most multi-ethnic society in the world. We have talented immigrants who are contributing greatly to our inno- vation agenda. We should study models to help harness the skills, knowledge, connections, and investment capability of the people from the developing world who live and work here. As well, we could create, on a massive scale, a Canadian scholarship program for schol- ars from developing countries, particular- ly from Africa. We could help to increase the global genomics and biotechnology capacity by leveraging our strong research community to develop partner- ships with centres of excellence in devel- oping countries, by increasing access to our science library holdings, and by sup- porting genomics and health policy edu- cation in developing countries
Advocacy: Internationally, Canada should advocate including science and technology for development, and genomics in particular, on the agendas of the various international forums. We should continue to support WHO pro- grams that address the health needs of developing countries, particularly through genomics and related biotech- nologies, and support the development of simple regulatory regimes for genetics and genomics in developing countries.
Domestically, Canada should pro- mote a global approach in the develop- ment of its own biotechnology industry. For example, if the biotechnology industry had focused on golden rice (enriched with provitamin A to address vitamin A deficiency), disease resistant indigenous crops, and in general the needs of the developing-country con- sumer, instead of Flavr Savr tomatoes (genetically engineered to improve shelf life in Western supermarkets), things might have worked out differently in agricultural biotechnology.
We should encourage CIHR and Genome Canada to support genomics research in areas that are relevant to developing countries; and we should encourage CIDA and IDRC to incorpo- rate genomics and related biotech- nologies into their strategies, in order to address the emerging genomics divide.
Investment: Realizing the potential of science and technology will require financial investment. While reallocating existing public funds and private sector spending would be a positive move, bolder measures would hasten achieve- ment of this goal. Canada should con- sider creating an investment fund geared to leveraging and networking Canadian science and technology for development. Such a fund could invest in mature technologies that would address the health needs of developing countries, to help rectify market failures.
A coherent and dedicated plan of action that incorporates all these ele- ments could make a significant contri- bution to Canada and the world. If we mobilized the best of Canada’s scientif- ic and technological innovation capaci- ty in academia; public institutions such as the NRC, IDRC, Health Canada and Industry Canada; federal funding agen- cies such as Genome Canada, CIHR, NSERC and SSHRC; and industry; we could generate innovative solutions for sustainable development in industrially less advanced countries. Preventing a health genomics divide is an objective worthy of Canadians. By continuing along the path set by visionary leaders of the past, Canada could well become the world’s premier genome diplomat.
