Genomics offers new clues to better treatment

Dr George Ngondi Michuki, staff and Equity representatives at the launch of Genomics equipment at NextGen. [Noel Nabiswa, Standard]

Imagine taking medication as prescribed, only for your condition to persist or for the treatment to cause unexpected side effects. Another patient with the same illness takes the same medicine and responds well.

Part of the difference may lie in their genes.

As healthcare advances towards personalised treatment, scientists are exploring how genetic variations influence the way people respond to medicines. In Kenya, local genomic sequencing is opening new possibilities for precision medicine, supported by investments in specialised medical equipment.

At the centre of this emerging field is Dr George Ngondi Michuki, a genomics expert whose work through The Africa Genomics Centre and Consultancy Company (TAGCC) and NextGen Molecular Lab is helping build local capacity for genetic research.

His laboratory has sequenced 40 whole human genomes locally, marking a step towards strengthening Kenya’s ability to generate and analyse its own genetic data. The next challenge is translating this scientific progress into affordable, practical healthcare services.

Precision medicine seeks to tailor healthcare decisions to individual patients by considering their genetic makeup alongside their medical history, lifestyle and other clinical factors.

One of its applications is pharmacogenomics, which examines how genetic differences affect the body's response to medicines.

Genes influence enzymes responsible for breaking down drugs. Some people process certain medicines faster than expected, while others metabolise them more slowly. These differences can affect a drug’s effectiveness and the risk of adverse reactions.

Pharmacogenomics testing can identify selected genetic variations that help doctors determine whether particular medicines may be suitable for a patient or whether alternatives should be considered.

The approach has potential applications in selected areas, including psychiatric treatment, blood thinners and some cancer therapies. However, genetic testing does not replace clinical assessment. Doctors must also consider factors such as age, kidney and liver function, existing conditions and other medicines.

The aim is to provide additional evidence to support treatment decisions and reduce avoidable medication-related complications.

Much of the genomic research informing modern medicine has historically relied on populations of European ancestry, leaving gaps in the understanding of genetic diversity across Africa.

Michuki says Kenya needs to invest in research that reflects its own populations to improve understanding of genetic variations and their potential clinical significance.

“For decades, Africa has been a consumer of genetic data generated in Europe or the US,” he says.

Genetic variations differ in frequency across populations, making representative data important for research into inherited conditions, disease susceptibility and medicine response.

According to Michuki, analysis of the 40 genomes sequenced locally revealed millions of differences when compared with a commonly used reference genome. These differences are not necessarily harmful; they demonstrate the extent of human genetic diversity and the need for further study.

The laboratory is processing another 50 genomes as it expands its work. Michuki says a much larger dataset, potentially running into thousands or tens of thousands of genomes, will be necessary to build a more representative picture of Kenya’s genetic diversity.

Such research could strengthen local scientific knowledge, although individual genetic findings must be validated before they can reliably guide clinical decisions.

Whole-genome sequencing requires specialised laboratory equipment, reagents, computing infrastructure and trained professionals. The costs of acquiring and maintaining this technology can be a major barrier for laboratories seeking to establish local capacity.

Michuki says financing was a significant challenge as he worked to acquire the equipment needed for sequencing.

Support from Equity Bank helped bridge the gap, enabling NextGen Molecular Lab to establish local whole-genome sequencing capacity.

The investment highlights the role of medical equipment financing in healthcare innovation. Beyond conventional hospital infrastructure, specialised laboratory technology is essential to expanding diagnostic and research capabilities.

Local sequencing capacity could reduce dependence on sending samples abroad for certain specialised analyses while developing expertise within Kenya.

However, equipment acquisition is only the beginning. Laboratories must also meet recurring costs for maintenance, reagents, skilled personnel, quality assurance and secure data storage.

Sustained investment will be necessary to ensure that these services remain operational and eventually reach more patients.

Despite its promise, genomic testing remains expensive for many Kenyan households.

Michuki says whole-genome sequencing at NextGen Molecular Lab currently costs Sh240,000, placing it beyond the reach of many patients who pay for healthcare out of pocket.

The laboratory has also introduced myDNAid-PGx, a more focused pharmacogenomics service designed to provide information that can support discussions between patients and healthcare professionals about medicine compatibility.

Because inherited DNA generally remains stable throughout life, genetic information may be useful for future treatment decisions as scientific knowledge advances. However, not every genetic finding has established clinical significance, and some conditions require separate tests.

Michuki says the long-term ambition is to work with the government and insurers to lower costs and widen access.

Public investment, insurance coverage and carefully designed testing programmes could help make selected genomic services available to more patients. The challenge will be ensuring that precision medicine does not remain the preserve of those who can afford expensive tests.

The expansion of genomic testing also raises questions about privacy and consent. Genetic information can reveal details about inherited health risks and biological relationships, with implications extending to relatives who have not undergone testing.

Michuki says his organisation uses safeguards including informed consent, de-identification and secure local data storage, and has taken steps to comply with Kenya’s Data Protection Act.

As the sector grows, strong standards will be needed to govern access to genetic information, its use in research and how results are communicated to patients.

Genetic findings must also be interpreted carefully, without presenting uncertain risks as definite predictions of future illness.

Kenya needs more specialists in genomics, bioinformatics, genetic counselling and molecular diagnostics, alongside investment in laboratory infrastructure and clinical guidelines.

Without these supporting systems, precision medicine risks remaining concentrated in a few specialised facilities.

Michuki hopes that within five years, Kenya will have developed a robust genomic biobank and expanded access to evidence-based pharmacogenomics testing for selected commonly prescribed medicines.

Achieving this will require collaboration among researchers, healthcare professionals, government, insurers and financial institutions.

The sequencing of 40 human genomes locally is an important starting point. The bigger task is translating that capacity into affordable, evidence-based services that can improve treatment decisions.

Ultimately, precision medicine is about more than decoding DNA. It is about building the technology, expertise, financing and safeguards needed to help doctors make better-informed decisions and ensure that patients remain at the centre of medical innovation.