How the genomics revolution could finally help Africa

By Linda Nordling

It took a public-health disaster for the Zimbabwean government to recognize the power of precision medicine. In 2015, the country switched from a standard three-drug cocktail for HIV to a single-pill combination therapy that was cheaper and easier for people to take every day. The new drug followed a World Health Organization recommendation to incorporate the antiretroviral drug efavirenz as a first-line therapy for public-health programmes. But as tens of thousands of Zimbabweans were put onto the drug, reports soon followed about people quitting it in droves.

Collen Masimirembwa, a geneticist and founding director of the African Institute of Biomedical Science and Technology in Harare, was not surprised. In 2007, he had shown that a gene variant carried by many Zimbabweans slows their ability to break down efavirenz1. For those with two copies of the variant — about 20% of the population — the drug accumulates in the bloodstream, leading to hallucinations, depression and suicidal tendencies. He had tried to communicate this to his government, but at the time efavirenz was not a staple of the country’s HIV programme, and so the health ministry ignored his warnings.

Masimirembwa continued to publish his research, but the authorities took no heed until there was trouble. A lot of confusion could have been avoided if the government had listened, he says, “It’s not a bad drug. We just know it can be improved in Africa.”

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