The sequencing technology has also made it possible for quick development of mRNA vaccines that protect us from the virus. In short, the use of genomics has advanced public health and clinical care strategies to save more lives.

The COVID-19 pandemic may be over soon, but we know that the coronavirus is unlikely to be the last pandemic in our lifetime. New, more dangerous strains could emerge in the post-COVID era.

Certainly, there will be another pandemic in the future. Genomic surveillance is, therefore, imperative to anticipate the next disease outbreaks, especially in tropical countries with a lot of risk factors for diseases, like Indonesia.

Although the use of genomics clearly has the potential to improve healthcare outcomes, the benefits obtained by Indonesia from analyzing the whole genome have not yet been optimal. There has been a lack of biosamples from Indonesia that are instrumental in drug discovery and development, scientists say. The shortage of genomic data from local patients has also hampered the country’s bid to build a more individualized treatment called “precision medicine”.

Indonesia is not alone. About 60 percent of the world’s population lives in Asia, but the continent is still marginalized in human genetic studies. Most genetic databases being used to advance diagnostic tests and medicinal therapy come from the Caucasian race. As a result, 90 percent of medicinal treatments in 50 percent of patients are ineffective.

Unlike evidence-based medicine, in which doctors often rely on their intuition in prescribing medicinal therapies to patients, precision medicine uses genomic biomarkers to develop a personalized treatment that works and reduces patients’ risk of side effects.

Deputy Health Minister Dante Saksono Harbuwono says that to facilitate precision medicine, the government is striving to boost its sequencing capacity to collect more information from genomes and their derivatives, which will be combined with clinical characteristics of patients and later analyzed with computer programs to guide medical decision-making.

“Precision medicine will reduce the rate of ineffective medicinal treatments, which now stands at 90 percent, and maximize patient care so they can achieve a more optimal recovery. This will also help cut unnecessary healthcare costs,” the newly inaugurated professor of endocrinology said in the opening of a series of three webinars held from Oct. 14 to Oct. 28.

The webinars, entitled "Emerging Topics in Health Research Ethics", were held by the Health Research Ethics Committee of Cipto Mangunkusumo Hospital-University of Indonesia's School of Medicine (RSCM-FKUI), in collaboration with the Indonesian Clinical Training and Education Center (ICTEC).

Molecular biologists shared concerns on the country’s lack of diversity in its genetic databases.  

Herawati Sudoyo says current medical interventions are mostly based on genomic data from Western countries, while researchers need genomic data from diverse populations to understand the effect of genetic variants on disease susceptibility and drug responses.

“DNA has memory. By carrying out whole-genome sequencing, we can understand our genetic background and know precisely whether there are mixed genes that could lead to or be associated with susceptibility to certain diseases,” said the principal investigator of the human genome diversity and disease division at the Mochtar Riady Institute for Nanotechnology.

“With precision medicine, which considers individual genetic, environmental adaptation and lifestyle, we can build more targeted health prevention, diagnostics and treatments.”

Genomics are a key part of health technology development, one of the six pillars of the healthcare transformation strategy laid out by the Health Ministry earlier this year. To implement the strategy, the government has established the Biomedical and Genome Science Initiative for Precision Medicine (BGSi), which will lead the implementation of precision medicine through the use of genetic technology.

The BGSi will provide genetic information needed to strengthen disease-prevention strategies, develop safe and effective medicines and improve healthcare treatment. The BGSi will start adopting precision medicine in four areas of disease — infectious diseases, diabetes, cancer and rare diseases—and two pharmacogenomics, which will study how human genes affect the way a person responds to a drug.

In this regard, the government has appointed five hospitals—RSCM, Persahabatan Hospital, Sulianti Saroso Infectious Diseases Hospital (RSPI), Dharmais Cancer Hospital and Dr. Sardjito Hospital—to act as BGSi hubs. Under the BGSi, the Health Ministry will oversee the first Indonesia National Genome Project, which will be implemented at RSCM.

Genomic technology is a potentially powerful tool for disease prevention for several reasons.

“By using the genetic information, clinicians could have an earlier screening or monitoring program based on ctDNA/RNA circulating tumor genetic materials in patients’ blood. With the genomic data, they can detect or diagnose earlier and treat earlier for cancer prevention. They can use the information to stratify the different diseases and design the individualized treatment for personalized medicine,” MGI Tech Co. Ltd. (MGI) Asia Pacific president director Roy Tan told The Jakarta Post recently.

“All diseases related to cancer, are due to genetic changes in our aging process. The more one can understand the genomic changes and status, the better one can control and improve life with precision medical intervention,” he said.

The Health Ministry has selected MGI as one of its partners to implement the first phase of the National Genome Project, which aims to establish an accountable, accurate and credible population database of 10,000 whole genomes.

Health Minister Budi Gunadi Sadikin said whole-genome sequencing had demonstrated its value in health services with the detection and treatment of COVID-19 and would continue to play an important role in ensuring the health of the Indonesian people.

However, precision medicine in Indonesia still has a long way to go. Among the challenges are the lack of genetic counsellors, who can advise patients about their genomic analysis results.

In the absence of formal education to recognize the profession of genetic counsellors, “precision therapy” is unlikely to transform into practical therapy in the country.

 -- The author is a staff writer at The Jakarta Post.