Pharmacogenomics, Precision Medicine and African Genomic Diversity: A Theoretical Framework for Equitable Translation of Genomic Knowledge into Prescribing Practice

Abstract

African populations carry the greatest genomic diversity of any human population, yet they are the least represented in the databases from which pharmacogenomic knowledge is derived. As a result, dosing guidelines, drug-response predictions and the machine-learning models increasingly built on them are least reliable for the populations in which genetic variation is greatest. This theoretical paper develops a framework for the equitable translation of pharmacogenomics into African prescribing practice. It draws on pharmacogenomics and clinical pharmacology, on the health-equity and genomic-justice literatures, and on recent research on African genomic variation, pharmacogenomic implementation and the prediction of drug response. The analysis separates three gaps between genomic knowledge and clinical benefit: a discovery gap, in which variants of African relevance remain under-studied; an evidence gap, in which associations established elsewhere are unvalidated in African populations; and an implementation gap, in which genotyping, decision support and trained prescribers are unavailable. The paper argues that closing the first two gaps without the third produces knowledge that does not reach patients, while closing the third on imported knowledge produces confident but unreliable prescribing. On this basis it advances a set of propositions concerning the sequencing of investment across the three gaps, the governance of African genomic data in international research, and the design of pharmacogenomic decision support for settings where genotyping is rare, before drawing out implications for Nigerian pharmacy practice, regulation and research. It concludes that machine-learning models for drug-response prediction must be developed or validated on African data, and that the governance of genomic data collected in Africa determines whether the resulting knowledge serves African patients or only external research.