Precision Medicine: Latin America Is Already Practicing It (Whether It Has Decided To or Not)

 

José Luis Cárdenas Tomažič / Dr. César Benites & Sebastián Millar

Adapted from the Spanish column originally published in El Economista on July 17th, 2026 (Medicina de precisión: América Latina ya la está practicando – aunque no lo haya decidido).

A few days ago, in this same forum, health policy expert Óscar Flores wrote about precision medicine as an opportunity for incremental improvement in our healthcare systems and invited us to take seriously what has just happened in Geneva. That invitation is worth accepting, because on May 22, the 79th World Health Assembly adopted Resolution EB158.R2, Precision Medicine: A Path Towards Targeted, Personalized and Equitable Care.

This is not just another declaratory document. The resolution mandates the World Health Organization (WHO) to map existing guidelines, develop a country readiness self-assessment framework, establish an international cooperation platform, and report progress to the World Health Assemblies in 2027 and 2029, when a global strategy is expected to be adopted. The Pan American Health Organization (PAHO), for its part, publicly assumed the regional mandate in June.

 

WHO itself has warned about the risk that precision medicine may end up serving only those who already have access to healthcare. A recent academic analysis likewise argues that personalized medicine is likely to increase inequalities between countries, regions, and social groups unless the policy framework surrounding it is fundamentally redesigned.

The key question for Latin America is not whether we are going to practice precision medicine. It is whether we will recognize that we are already doing it—and whether we are going to do it well.

It Is Already a Coverage Requirement

It is useful to dismantle the original misconception: precision medicine is not a laboratory promise nor a chapter of the future. Today, it is already an administrative condition for accessing public healthcare spending.

In Chile, Law 20,850—the Ricarte Soto Law—created a financial protection system for high-cost diagnoses and treatments covering more than two dozen conditions, including rare diseases such as Fabry disease and Gaucher disease. Its protocols do not fund therapies based on clinical suspicion alone; they require precise diagnostic confirmation, in many cases enzymatic or genetic, as a prerequisite for coverage.

In other words, the Chilean State has spent the past decade conditioning the reimbursement of biological and highly expensive therapies on a molecular laboratory result. That is precision medicine, even if the law never explicitly calls it that.

The pattern repeats across the region.

In Brazil, CONITEC evaluates the incorporation of technologies into the Unified Health System (SUS), while the Genomas Brasil Program seeks to embed genomics within the public healthcare system. At the same time, the literature documents that implementing next-generation sequencing (NGS) in Brazilian public hospitals continues to face barriers related to financing, pre-analytical processes, and infrastructure.

In Mexico, the National Institute of Genomic Medicine (INMEGEN) has, since 2004, built the scientific foundations of population genomics, while the General Health Council has publicly discussed incorporating these approaches into healthcare decision-making.

In Argentina, Colombia, and across the region, a consensus paper published last year in the International Journal of Environmental Research and Public Health was unequivocal: current policy frameworks are not designed to guarantee timely access to biomarker testing, and without policy redesign, precision medicine will widen gaps rather than close them.

This reveals the regional paradox: we require the test in order to pay for the medicine, yet we do not fund the test with the same seriousness with which we fund the medicine.

That paradox has a visible symptom: the absence of systematic evaluation. Patients resort to litigation to gain access to advanced, high-cost therapies, placing financial sustainability under pressure. This is exactly what should be expected when biomarker testing is required but not adequately financed.

Access ultimately depends on who has a lawyer rather than who has the correct molecular result.

The region has already experimented with an alternative. The financing process for Zolgensma for spinal muscular atrophy positioned Argentina as the first country in the region to acquire a medicine under a shared-risk, outcomes-based payment agreement.

The Fiscal Argument, Not Only the Clinical One

In rare and high-cost diseases, diagnostic precision is one of the most effective tools for spending efficiency.

A targeted oncology treatment or an enzyme replacement therapy administered without the appropriate biomarker is not merely poor medicine; it is public money allocated to a patient who will not benefit from it in systems where every dollar has competing priorities.

 

Molecular diagnosis does not make healthcare systems more expensive. It prevents them from paying for interventions that do not work.

Even the WHO resolution explicitly recognizes that precision medicine can improve healthcare system efficiency through targeted therapies, reduced adverse reactions, and shorter diagnostic journeys.

In oncology, the OECD has noted that biomarker testing forms the foundation for moving from generalized treatment approaches to individualized strategies. Yet even in Europe, access to NGS, multigene panels, and comprehensive genomic profiling remains limited by reimbursement, prescribing, and infrastructure barriers.

In the Americas, one important mechanism to avoid duplicating assessments across countries is the Health Technology Assessment Network of the Americas (RedETSA), which brings together more than 4,000 health technology assessments produced by member institutions throughout the region.

The same logic explains why newborn screening should be understood as a precision medicine policy rather than a routine maternity procedure.

Latin America has highly heterogeneous programs, with significant variation in coverage and screening panels. Regional literature consistently advocates expanding these programs and seriously evaluating genomic integration.

Detecting phenylketonuria, congenital hypothyroidism, or spinal muscular atrophy during the first week of life means intervening before damage becomes irreversible—and before costs become catastrophic.

It is arguably the most cost-effective and equitable form of precision medicine that governments can purchase.

What Is Missing: Infrastructure, Data, and People

Three major gaps explain why progress remains slower than it could be.

Genomic Biobanks and Data Sovereignty

Countries do not need mature biobanks before launching clinical precision medicine programs—both can evolve in parallel. However, Latin America cannot indefinitely rely on genomic reference data derived from other populations.

The Mexican Biobank, published in Nature in 2023, demonstrated that for several complex traits, association studies predict outcomes in Mexican populations more accurately than studies based on the UK Biobank. Likewise, analyses from the UK’s 100,000 Genomes Project found that the performance of variant prioritization algorithms depends significantly on patients’ genetic ancestry.

In simple terms: without Latin American genomic data, we will interpret Latin American patients less accurately.

Data sovereignty is not a political slogan—it is a prerequisite for clinical accuracy.

This requires addressing governance issues once and for all: consent, privacy, interoperability, and management of incidental findings.

Diagnostic Capacity and Human Capital

This is the least glamorous bottleneck—and the most decisive one.

Chile has approximately 33 practicing clinical geneticists, roughly one-third below internationally recommended ratios, and lacks a formal genetic counseling program.

Without geneticists, molecular pathologists, bioinformaticians, and accredited laboratories, even the best coverage law becomes little more than a right on paper.

Artificial intelligence—whose enabling role is explicitly recognized in the WHO resolution—can realistically expand genomic analysis capacity, but it cannot replace the professionals ultimately responsible for clinical interpretation and reporting.

International Cooperation

Latin America does not have to start from scratch.

The United Kingdom transformed a research initiative into an NHS service. The United States built a deliberately diverse cohort through the NIH’s All of Us program. Japan has operated BioBank Japan for more than two decades.

Germany may offer one of the most instructive models because it solved regulatory challenges before technological ones. Its genomic sequencing model project rests on an explicit legal foundation (§64e of the Social Code) and on the national GenomDE strategy, whose architecture connects institutions such as Charité and the Berlin Institute of Health with centers such as Freiburg University Hospital.

The lesson is straightforward: genomics is implemented when someone writes the rules that pay for it.

Sustainable Financing for the Therapies Enabled by Diagnosis

This is perhaps the most expensive gap to close—and the least discussed.

Shared-risk agreements require sophisticated contract design, monitoring systems, data availability, and institutional capabilities that most countries in the region still lack. This is essentially the same human-capital challenge discussed earlier, now applied to those responsible for negotiating and overseeing agreements with industry.

At the same time, another pathway exists to reduce dependence on unilateral pricing models. Argentina and Brazil already lead regional biosimilar production, and PAHO’s Revolving Fund increasingly incorporates locally produced high-cost medicines.

The Next Concrete Step

The WHO resolution provides a roadmap. PAHO—having already convened the first regional meeting on human genomics for health in 2024 and currently developing its PAHOHumanGen platform—has the mandate to coordinate implementation.

For Mexico, the challenge is not starting from zero. INMEGEN already recognizes that approximately one in three diseases treated in highly specialized hospitals requires genomic testing and has developed programs in hereditary cancer, pediatric oncogenomics, and Mexican genetic diversity.

The opportunity for Mexico lies in translating scientific capacity into effective coverage: funded testing, clinical networks, molecular interpretation, and clear rules ensuring that diagnosis leads to actual access to precision therapies.

The immediate task is therefore both simple and measurable: every country in the region should conduct, with PAHO support, a rigorous situational assessment and apply the readiness self-assessment framework that WHO will make available.

How many accredited laboratories exist? How many geneticists and pathologists? Which tests are financed and which are required but unfunded? What data governance framework applies? Does the country participate in pooled procurement mechanisms such as PAHO’s Strategic Fund or Revolving Fund? Does it have a health technology assessment agency and a legal framework capable of negotiating and monitoring shared-risk agreements—or will it continue relying on case-by-case litigation?

That inventory, completed before the 2027 reporting cycle, will determine whether Latin America reaches 2029 with a global strategy that includes it—or one that merely describes it.

Latin America is already paying the price of precision medicine. The challenge now is to capture its benefits.

Sebastián Millar is Chilean attorney, specialist in precision and high-cost medicine (Chile/Germany).

References:

1. Borrajo GJC. Newborn screening in Latin America: a brief overview of the state of the art. Am J Med Genet C Semin Med Genet. 2021;187(3):322-328. doi:10.1002/ajmg.c.31899.
2. Cabello JF, Novoa F, Huff HV, Colombo M. Expanded newborn screening and genomic sequencing in Latin America and the resulting social justice and ethical considerations. Int J Neonatal Screen. 2021;7(1):6. doi:10.3390/ijns7010006.
3. Calderón-Aparicio A, Orue A. Precision oncology in Latin America: current situation, challenges and perspectives. Ecancermedicalscience. 2019;13:920. doi:10.3332/ecancer.2019.920.
4. Encina G, Castillo-Laborde C, Lecaros JA, et al. Rare diseases in Chile: challenges and recommendations in universal health coverage context. Orphanet J Rare Dis. 2019;14:289. doi:10.1186/s13023-019-1261-8.
5. Nagai A, Hirata M, Kamatani Y, et al. Overview of the BioBank Japan Project: study design and profile. J Epidemiol. 2017;27(3S):S2-S8. doi:10.1016/j.je.2016.12.005.
6. OECD/European Commission. Delivering High Value Cancer Care: European Cancer Inequalities Registry Analytical Report. OECD Publishing; 2026. doi:10.1787/060869fe-en.
7. Precision Medicine for Cancer and Health Equity in Latin America: Generating Understanding for Policy and Health System Shaping. Int J Environ Res Public Health. 2025;22(8):1220. doi:10.3390/ijerph22081220.
8. Silva-Zolezzi I, Hidalgo-Miranda A, Estrada-Gil J, et al. Analysis of genomic diversity in Mexican Mestizo populations to develop genomic medicine in Mexico. Proc Natl Acad Sci USA. 2009;106(21):8611-8616. doi:10.1073/pnas.0903045106.
9. Sohail M, Palma-Martínez MJ, Chong AY, et al. Mexican Biobank advances population and medical genomics of diverse ancestries. Nature. 2023;622(7984):775-783. doi:10.1038/s41586-023-06560-0.
10. Stenzinger A, Moltzen EK, Winkler E, et al. Implementation of precision medicine in healthcare — a European perspective. J Intern Med. 2023;294(4):437-454. doi:10.1111/joim.13698.
11. The 100,000 Genomes Project Pilot Investigators. 100,000 Genomes Pilot on Rare-Disease Diagnosis in Health Care — Preliminary Report. N Engl J Med. 2021;385(20):1868-1880. doi:10.1056/NEJMoa2035790.
12. The All of Us Research Program Investigators. The “All of Us” Research Program. N Engl J Med. 2019;381(7):668-676. doi:10.1056/NEJMsr1809937.
13. World Health Assembly. Resolution EB158.R2, Precision medicine: a path towards targeted, personalized and equitable care. Seventy-ninth World Health Assembly, Geneva, 22 May 2026.