Abstract

In this paper, we advance the extant health technology innovation frames on global personalized medicine by highlighting the need to rethink genomics medicine in real-life settings – including situations where populations are frequently faced with natural disasters or man-made conflicts. We identify the steps towards building sufficient capacity to effectively harness and integrate genomic medicine and molecular diagnostics in order to benefit global society including those in resource-limited settings and post-war capacity building contexts. Surprisingly, despite a great number of populations currently living in developing countries, including in a state of post-war or conflict resolution context, the public health pharmacogenomics community has largely neglected this crucial dimension in biomedical literature. By exploring the particular case of Sri-Lanka in this paper, we are able to investigate the obstacles commonly faced by low and middle income countries similarly afflicted by crises, natural disasters, conflict and the need for improved, more cost effective health care. Sri Lanka has a relatively strong platform for launching molecular diagnostic technology, including a well networked set of primary, secondary and tertiary care institutions, a small but burgeoning private health and research sector and a strong science base in its universities. Despite this, there has been slow uptake and exploitation of novel molecular diagnostics due to various factors such as a weak regulatory framework and high costs associated with the import of molecular reagents and import and maintenance of equipment. In summary, as a way forward for health technology assessment in resource-limited countries, this paper brings to the fore an integrated discourse on real-life experiences and putative solutions on genomics and molecular diagnostic medicine. For a comprehensive discussion in the nascent field of public health pharmacogenomics, post-war and post-conflict capacity building on biotechnologies such as genomics is essential.

Keywords: Genomics and development studies, global personalized medicine, health technology assessment in resourcelimited countries, low and middle income countries, LMICs, post-war capacity building in pharmacogenomics, Sri-Lanka.