Merck & Co., Inc., Kenilworth, New Jersey, USA.
Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa.
Clin Pharmacol Ther. 2021 Oct;110(4):946-951. doi: 10.1002/cpt.2274. Epub 2021 May 19.
Low- and middle-income countries (LMICs) have the highest rates of mortality and morbidity globally, but lag behind high-income countries in the number of clinical trials and trained researchers, as well as research data pertaining to their populations. Lack of local clinical pharmacology and pharmacometrics expertise, limited training opportunities, and lack of local genomic data may contribute to health inequalities and limit the application of precision medicine. Continuing to develop health care infrastructure, including well-designed clinical pharmacology training and data collection in LMICs, can help address these challenges. International collaboration aimed at improving training and infrastructure and encouraging locally driven research and clinical trials will be of benefit. This review describes several examples where clinical pharmacology expertise could be leveraged, including opportunities for pharmacogenomic expertise that could drive improved recommendations for clinical guidelines. Also described are clinical pharmacology and pharmacometrics training programs in Africa, and the personal experience of a Tanzanian researcher currently on a training sabbatical in the United States, as illustrative examples of how training in clinical pharmacology can be effectively implemented in LMICs. These training efforts will benefit from advocacy for employment opportunities and career development pathways for clinical pharmacologists that are gradually being recognized and developed in LMICs. Clinical pharmacologists have a key role to play in global health, and development of training and research infrastructure to advance this expertise in LMICs will be of tremendous benefit.
中低收入国家（LMICs）在全球的死亡率和发病率最高，但临床试验和训练有素的研究人员数量以及与这些人群相关的研究数据却落后于高收入国家。缺乏当地的临床药理学和临床药代动力学专业知识、有限的培训机会以及缺乏当地的基因组数据，可能导致健康不平等，并限制精准医学的应用。继续发展医疗保健基础设施，包括在 LMICs 中进行精心设计的临床药理学培训和数据收集，可以帮助应对这些挑战。旨在改善培训和基础设施并鼓励当地驱动的研究和临床试验的国际合作将是有益的。本文综述了一些可以利用临床药理学专业知识的例子，包括药物基因组学专业知识的机会，这些机会可以推动改善临床指南的建议。本文还描述了非洲的临床药理学和临床药代动力学培训计划，以及目前正在美国接受培训休假的坦桑尼亚研究人员的个人经验，这些例子说明了如何在 LMICs 中有效地实施临床药理学培训。这些培训工作将受益于倡导为临床药理学家创造就业机会和职业发展途径，这些机会在 LMICs 中正在逐渐得到认可和发展。临床药理学家在全球健康中发挥着关键作用，在 LMICs 中发展培训和研究基础设施以推进这一专业知识将具有巨大的益处。
