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Affordable Health Care Delivery Through Biotechnology: Lessons For Our Youth

Introduction

I have always felt deep emotional distress whenever people die of diseases that arebelieved to be preventable or treatable with the modern tools and therapies available in

the twenty-first century. The distress is exacerbated if deaths result from health

conditions in which my knowledge and expertise as a Medical Biotechnologist couldhave made some positive contribution that would ultimately have made a difference. We

all know that death is a natural end which must come when it must: that everybody is

bound to die one day when their time comes. However, our human nature also makes us

feel, especially when notable scientific advances have made available diverse tools toaddress and resolve many health issues, that many cases of death may have been avoided

if the right treatment regimens were implemented at the right time and by the right

medical personnel. It should be emphasized here that whereas some of the current

diseases with high morbidity and mortality in our society, such as malaria andtuberculosis, have been prevalent for a long time, others such as diabetes, hypertension,

anemia and hepatitis are relatively newcomer killers. Importantly also, nearly all of thesenewcomer diseases owe their prevalence to changing and evolving lifestyles and dietary

habits.

The society of my childhood had the efficient structures and systems to prevent and

manage the long standing diseases, and these consisted in the existence of Health Centres

coupled with strictly enforced practices of environmental sanitation. However, our

modern society has, not only failed to cope with the rapid progress and scientificdevelopments which have provided the systems and tools for the prevention and

management of newcomer diseases in many developed countries, but has also witnesseda progressive decay in the earlier functioning systems of health care delivery.

Among the various new tools that contribute to the successful delivery of health care

services in developed countries, the practice of modern biotechnology appears to occupya position of relevance. Therefore, in the following review, I would like to explore how

the processes of modern biotechnology could be successfully adapted and adopted to bear

beneficial fruits of health care delivery to the rural poor in our society. In particular, I

would discuss the contribution of biotechnology and generic bio-pharmaceuticals to theprevention, detection and treatment of diseases, all of which collectively contribute to

ensuring affordable health care delivery. We shall begin by trying to understand what

biotechnology is and what is a generic bio-pharmaceutical product, and subsequentlyexplore how we could employ these to bring affordable health care to the masses of the

rural poor.

Biotechnology

Biotechnology in very simple terms, means harnessing biology through technology. It isthe application of living organisms or parts thereof, to develop new products or to

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improve on the properties/qualities of existing products for the benefit of mankind. Some

authors have also defined biotechnology as the integration of biological sciences with

certain aspects of engineering, or still as the exploitation of biological research for theproduction of novel technology.

Biotechnology has been practiced for millennia by different peoples all over the world. Infact, by 300 BC, horticulturists and plant breeders developed grafting techniques in plant

breeding to create new plant species and varieties. Further back by 1800 BC, the use ofyeast in making wine, beer and unleavened bread was developed. However, these

processes, which are generally regarded today as traditional biotechnology, were very

laborious processes, energy and time-intensive and often required many generations ofcross-breeding to introduce and select a single desired trait in the receiving plant species.

Conversely, modern biotechnology employs the tools of genetic engineering to achieve

transfers of genetic material between organisms of the same or different species, hencethe term genetically modified organisms (GMOs) which is often used to describe the

new species. Thus, modern biotechnology presents the advantages of specificity, ease and

rapidity of execution with respect to traditional biotechnology. It can, therefore, bedescribed as a technique for accelerating and enhancing naturally occurring processes in

order to produce large quantities of any desired and useful products for the benefit of

mankind.

Generic Bio-pharmaceuticals

A generic bio-pharmaceutical is a pharmaceutical product, produced through biologicalprocesses, that is usually intended to be inter-changeable with an innovator product in

terms of efficacy and safety with respect to the disease for which it was developed. It is

usually manufactured and marketed by another company, without a licence from the

innovator company, after the expiry of the patent or other exclusive rights held by theinnovator company.

Let me explain: when a pharmaceutical company develops and produces a new drug, the

National Licensing Authority in that country usually grants the company some yearsduring which only that company may produce and sell the new drug. This is called a

Licensing Period (protected by a Licence or Patent) and the new drug is called a

proprietary, innovator or brand-name drug. This licensing period varies from 15 to 20years depending on the nature of the drug, and is intended to grant the innovator company

sufficient time and opportunity to recover the financial resources invested in the

development and production of the new drug. At the end of this period, the licence

expires and the drug becomes a generic drug unless the innovator company hassuccessfully made significant improvements on the properties of the drug and has secured

another period of protection. At the expiry of a licence, therefore, the drug may be

produced and marketed as a generic version of the original drug by any other companythat has successfully shown that their generic drug can be inter-changeable with the

innovator drug in terms of efficacy and safety. Generic drugs are usually as effective and

as safe as, but much cheaper than brand-name drugs, and because of their lower price,generic drugs are often the only medicines that the poorest masses in any country can

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afford. This happens often because the production and sale of generic drugs, stimulates

competition between the producer companies and the producers of the innovator version

of these drugs, and therefore leads to significant reduction in the price of the drugs.

Generic Bio-pharmaceuticals in Affordable Health Care Delivery

Let us now explore how generic bio-pharmaceuticals can contribute to affordable health

care delivery. Remembering the definitions given above we see that we can employ the

tools of genetic engineering and biotechnology at various levels and in the various phasesand stages of the health care value chain, including the production of bio-generics to

achieve affordable health care. For the purposes of this essay, we shall take the diseases

mentioned above as our yardstick for measuring the impact of biotechnology and bio-pharmaceuticals in health care delivery.

In our society, malaria is essentially caused by infection by plasmodium falciparum, and

this parasite is vectored by theanopheles mosquito which thrives in dirty environmentsas well as in stagnant water which abound in areas surrounding our homes. Through theprocesses of Environmental Biotechnology (also called Bioremediation), it is easy to

achieve cleaner environment thereby denying the mosquito its usual breeding habitat. The

life cycle of the malaria parasite starts when the female anopheles sucks human blood,

which the mosquito needs in order to develop its eggs, and in the process injects theplasmodium sporozoites into the human body. These later invade red blood cells

(erythrocytes) as merozoites (another developmental stage of the parasite) and cause

malarial fever when they burst the red blood cells and invade other erythrocytes. Themeroziotes are later transformed intogametocytes which would lie dormant waiting to be

picked up in another cycle of mosquito bite. By employing the tools of Vector Control

Biotechnology, scientists are engineering sterile male anopheles mosquitoes that would

transmit sterility to female mosquitoes upon mating. This conferred sterility would thusabolish the need for the females to suck human blood in order to develop their eggs and

therefore lend a hand in preventing malaria. Bioremediation can also be employed forappropriate waste management and de-contamination of harmful environmental

pollutants, thus promoting disease prevention and health care delivery by reducing human

exposure to health hazards.

Diabetes is a newcomer killer disease in our society that owes its etiology to changinglifestyles and also to poor, unbalanced dietary habits. Agricultural Biotechnology can, not

only enhance agricultural productivity to ensure adequate food security in our society, but

could also be employed to improve the nutritional qualities of our staple foods. By

augmenting the abundance of good quality food and guaranteeing balanced diet,agricultural biotechnology would have positive impact in preventing diabetes. Typical

examples of food-crops that have been improved through agricultural biotechnology are

the Golden rice, a species of rice containing beta-carotene (precursor for Vitamin A)and iron which protect against blindness and anemia respectively; tomatoes with a higher

content of the antioxidant lycopene which is associated with reduced risks for prostate

cancers and fruits and vegetables containing higher than normal levels of vitamins C andE which are potentially protective against heart diseases. Other achievements of

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agricultural biotechnology include the engineering of recombinant vaccines, DNA

vaccines and nutraceticals (crops containing pharmaceuticals).

It has also been shown that the majority of cases of diabetes related to unbalanced diet areequally insulin-dependent. In this context, Medical Biotechnology can be employed,

through genetic engineering and recombinant DNA techniques, to produce largequantities of the generic version of human insulin for the treatment of diabetes. Finally,

medical biotechnology can be employed to produce the generic version of the variousbio-pharmaceuticals used for the treatment of such health conditions as anemia,

hypertension, hepatitis and some cancers. These drugs are recombinant Human

Erythropoietin (rh-EPO), granulocyte colony stimulating factor (G-CSF) andrecombinant Interferons.

By producing large quantities of the generic version of these bio-pharmaceuticals which

have significantly reduced prices thus making the drugs affordable to all, biotechnology

would contribute enormously to improved health care delivery accessible by the rural

poor in our society.

What Does the Above Mean to Our Youth?

As a young boy in the primary school, I recall that much emphasis was placed oneducation, and entire families prided themselves on the academic prowess of their

children. Parents made sacrifices to pay school fees for their children, especially if these

children were intelligent and performed well in school. But even if children were not veryintelligent, parents still valued the importance of education because they wanted their

children to have the opportunity that eluded them themselves when they were young. I

recall that parents rejoiced or mourned with their children, as the case may be, at the

release of the results of the year-end examinations which confirmed whether or not pupilsmoved on to a new class. In those days, it was also not uncommon to hear the youth

dream aloud of becoming a doctor, an engineer, a lawyer, a clergyman, a businessman,

etc, and good education was generally understood to be sine qua non achieving those

dreams in adulthood.

But unfortunately, in todays society, this emphasis has dramatically shifted to the desireto get-rich-quickby all means, and this new culture of riches at all costs and as soon as

possible has terribly eroded the integrity and fabric of our society. In the mad rush to

acquire wealth overnight, it appears the youth has lost sight of the sayings that nothinggood comes easy or that Rome was not built in a day or still that brick by brick a

tower is built. The youth, especially the males have promptly abandoned school and

education as a means of earning a decent living. In fact, it is now generally said thatfemales outnumber males in nearly the totality of post-secondary institutions of learning.

In their myopic ambition, the youth seem also to have lost sight of the short-lived nature

of all ill-gotten wealth, since such wealth that is not founded on hard work also vanishes

easily just as they were acquired. Lawlessness, banditry and armed robbery have becomethe order of the day, and our formerly boisterous villages gradually degenerated into

ghost towns where everybody stayed in hiding even before sunset. Neither is it also safe

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to stay in-doors since the practice of kidnapping has become the most recent and

infamous means of attempting to get rich quick.

But it is never too late to change, to re-discover the core values of honesty, integrity,

discipline and community love that molded the fabric of our ancient, famous and strong

society and gave us the joy and pride to play our brothers keepers. It must becategorically stated here that no situation that exists in the society can justify the reign of

lawlessness and banditry among the youth. The only explanation can be that todays

youth is NOT ready to work hard and lacks the patience to look around carefully for theopportunities that abound to earn an honest living even in the remote villages. I must

stress again that success in life takes a long time and requires patience, hard work and

perseverance. Becoming a successful engineer, doctor, biotechnologist, lawyer, etc, in

adult life begins with diligent hard work and studies to pass ones exams as a child in theprimary school. But if one works very hard and patiently, success inevitably comes in the

end according to the Latin proverb: labor omnia vincit.

For this reason I am particularly happy at the welcome news of the re-discovered unity inour village, Umudim, and I pray that the same is true and genuine to mark a true turning

point to start re-building from where our fathers handed over to us the baton of villageunity. However, in order to be effective, it is very important that this unity emanates from

the unity reigning in the individual families that make up Umudim according to the

saying that charity begins at home.

So as we celebrate the Unity of Umudim and the joyful recurrence of the 70 th Birthday of

our dear brother and elder, Dim Nna O. Nnakife (affectionately called Caesar), I would

call on our youth to abandon all desires to get rich overnight, but rather to embracehonesty, integrity and hard work as the only avenues to successful life. Let us re-discover

the culture of learning and the joys of education as a positive means for achieving an

honest living.

Alexander E. Ochem, PhD

Coordinator, Biotechnology Development in AfricaInternational Centre for Genetic Engineering and Biotechnology (ICGEB)

Cape Town Component

South Africa

Programme Officer

African Network for Drugs and Diagnostics Innovation (ANDI)

World Health Organization/United Nations Economic Commission for AfricaAddis Ababa, Ethiopia

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