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  • Writer's pictureSwaha Chakraborty

Interview With Dr. Yanice Mendez-Fernandez: Health Equity

One of the fundamental concerns regarding the commercialization of gene therapy has always been its potential to further enlarge pre existing economic and social disparities. This new technology is no doubt highly expensive, making it accessible only to our society’s wealthiest. To gain a better understanding of the intersection between biology and health equity, I decided to turn to expert opinion.

A few weeks back, I was fortunate enough to have a chance to interview Dr. Yanice Mendez-Fernandez, a biology professor at the University of New Haven. Dr. Fernandez started off as a biomedical researcher with a specific interest in immunology, completing her pHD in biomedical sciences. However, her scientific career took a sharp turn towards public health when her family in Puerto Rico was personally impacted by Hurricane Maria in 2017. Puerto Rico was her home and where she had received her education, no doubt inspiring her to pursue research regarding the long impacts of the devastation caused by the natural disaster. Driven by this personal experience, she now focuses her research on health equity and access to education.

Dr. Fernandez points out that gene editing technology is generally not covered by health insurance, making its cost exceptionally higher than alternative treatment options. Furthermore, health insurance tends to be tied to a person’s employment, meaning that those who are either unemployed or self employed are automatically at a disadvantage. Essentially, only a select few, who have the wealth to afford paying the expenses tied to these therapies, can reap the benefits of “scientific progress”. This means that the lack of equity between those who are and are not denied access to this technology will have serious ethical implications. Those who bear the burden of diseases and suffer the effects of genetic disorders, are those who do not have the resources to access those therapies. Fernandez explains that families from lower socioeconomic backgrounds already suffer from delayed care, out of fear of healthcare cost, which only provides their illnesses with more time to get worse and ultimately leads to a greater cost of remedy. It can be assumed that such systemic issues will only worsen with the addition of gene editing technologies.

The other aspect of ensuring equitable use of gene therapy is fully understanding the technology or therapy’s impact on multiple types of individuals and body systems. Fernandez brings up the substantial number of women who experience changes to their menstrual cycle after receiving the COVID-19 vaccine. I myself remember the panic shared by friends, parents, and myself regarding future fertility and the permanent changes made to our bodies. Essentially, when developing these new therapies, it is crucial to examine its intended effect, but also its possible side effects. These side effects can vary depending on the types of subjects being treated. Gene editing, or anything that is used to treat disease needs to be safe and ethical for all individuals who choose to use it. For that reason, it is important that larger experimental groups are used for the development of these therapies.

If these side effects are not identified early enough, scientists must be prepared for public mistrust regarding future technologies. Suffering the consequences of unwanted side effects, without adequate warning for them, breeds fear. This ultimately affects a population’s likelihood of trusting and utilizing that technology again later on. For example, there is a big difference between taking a COVID-19 vaccine and suddenly experiencing a change in your menstrual cycle without warning, and being told that the changes are temporary and harmless beforehand. One group will most likely be more willing to continue receiving vaccines in the future.

As Dr. Fernandez puts it, “Public health is about the health of a population and doing what is the best for the majority”. In order to do what is best for the majority, policies must aim to allow the “majority” equal access to these sciences. While gene therapy promises progress in a variety of fields, including healthcare, the technology can only improve more lives if more people can utilize it. For that reason, it should be developed with the needs of diverse populations in mind (including those in the minority), while also making it equitable.

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