We have entered an era of great hope and promise, of advancing human health and well-being and of social and economic progress. The shape of things to come can be visualised with a rough timetable. Will the new order of things reduce and eventually eliminate the inequities and disparities that characterised our world as we entered the Third Millennium, or as is widely feared, will it accentuate these phenomena heralded by the instrumentalities of liberalisation, globalisation and the gtt? Will the slow-moving Darwinian natural evolution, up to now the heritage of humankind, be replaced by more rapidly-moving, artificially-induced evolution (revolution?) with hitherto unknown, even unimagined, expressions of human characteristics? Will we be able to create, through intervention at the level of the genetic code, an ever more beautiful and graceful human being with an elevated level of consciousness and understanding and a heightened responsiveness which is supremely sensitive to human need and suffering? Will we be able to create a “maximal human-being” with the highest attainable level of caring and compassion? Desired individual human characteristics such as height, body mass, colour and texture of the skin and eyes may be inducible by genetic means in the near term. Genetic enhancement is much in the air.
The notion that genetic modification could confer special advantages on an individual is widely shared, but a persistent concern is how to ensure equal access. What will be the effect of genetic enhancement on human evolution? As Eric Lander and Robert Weinberg said in the 10th March, 2000 issue of Science: “The most serious impact of genomics may well be how we choose to view ourselves and each other…lest we loose sight of why we are here, who we are and what we wish to become.”
It is important to remember that genes, while maintaining their pre-eminent position in biology, are not everything. We are not prisoners of an unalterable destiny through our genes. Environmental influences, lifestyles, diet and nutrition can modify genetic destiny positively. The basis of the new genetics is that it is not only single gene mutation that affects health but also interaction between multiple genes and the environment that give rise to complex phenotypes associated with health and disease.
While all this is in the realm of distant vision, nay a dream, there are harvests of the genetic revolution which can be reaped in the near future. They touch many aspects of human development and welfare. Newer vaccines and drugs are likely to be developed to counter emerging and re-emerging diseases and to overcome the spreading problem of multi-drug resistance. Predictive and preventive medicine will become realities increasingly through genes for health as a new strategy in the health care of individuals and populations. In this process, knowledge of the genomic sequencing of pathogenic microbes will accelerate discovery of new drugs and vaccines.
These are exciting times for genetic science to discover new approaches to the control of challenging diseases such as malaria, tuberculosis and hiv/aids: no less challenging are afflictions such as cholera, kala-azar, Japanese B encephalitis and diarrhoeal diseases. Microbial genomics will play an increasingly important role in providing clues to the molecular basis of human diseases. The ultimate aim would be a vaccine that could be given at birth, preferably by mouth, that would immunise children against an array of diseases locally prevalent in different parts of the world. There should be no need for boosters, there should not be undue sensitivity of the vaccines to temperature variations and they should be affordable by all people irrespective of their socio-economic status. The dream for ‘Health for All’ may then be fulfilled in the 21st century, which the gene technologies can help to fulfil.