World of Genomics: The United Arab Emirates

The United Arab Emirates (UAE) is famous for the opulent city of Dubai, where you’ll find the world’s tallest building, the Burj Khalifa. What you may not know is that the UAE also created the world’s first cloned camel, Injaz, who gave birth to a female calf in 2015 – proving a cloned animal can be fertile and reproduce normally! The UAE is investing heavily in its health sector, particularly in genomic medicine, so read on to learn more.

The population of the UAE

The UAE is located in West Asia at the south-eastern point of the Arabian Peninsula, bordering Saudi Arabia, Oman, Iran, and Qatar, with Abu Dhabi as the capital city.

It is composed of seven emirates, and the federation of 6 of these emirates (Abu Dhabi, Dubai, Sharjah, Ajman, Umm Al Quwain, and Fujairah) was founded on December 2, 1971. The seventh, Ras al Khaimah, joined on February 10, 1972. Previously the UAE was known as the Trucial States.

Archaeological evidence of human habitation, trade, and migration in the UAE date back 125,000 years ago, with burial sites from the Neolithic and Bronze Ages having been discovered in the region. The area was previously home to the Magan people, who traded with coastal towns and bronze miners. In the 7^th century, Islam began to spread in the region, and this era saw the emergence of the region as an important trade centre. The region was disrupted by the arrival of the Portuguese in the 15t^h century, leading to a decline in trade and an increase in regional conflicts.

In the late Islamic era, small trading ports and agriculture developed in the area, forming an important link in the Arab monopoly of trade between the East and Europe. The arrival of the British in the region led to a series of treaties with the Trucial Rulers, which eventually led to the formation of the UAE in 1971. Today, the UAE is a modern and diverse economy with Dubai being a global city and hub for tourism, retail, and finance.

Geographic and demographic information

Summary statistics

1. Land area: 71,020 sq km
2. Gross domestic product (GDP):
   • Total: $415 billion
   • Per capita: $44,315

Population statistics

• Population size: 9,365,145 people
• Birth rate: 11 per 1,000 people
• Death rate:  2 per 1,000 people
• Infant mortality rate: 6 per 1,000 live births
• Life expectancy: 79 years
  • Male 2020 estimate: 77 years
  • Female 2020 estimate: 81 years
• Ethnicities: Emirati (11.6%), South Asian (59.4% – includes Indian 38.2%, Bangladeshi 9.5%, Pakistani 9.4%, other 2.3%), Egyptian (10.2%), Filipino (6.1%), Other (12.8%)

(Source: World Bank)

Healthcare system

The UAE has a comprehensive healthcare system that provides universal coverage for all its citizens. In addition, mandatory health insurance is required for citizens of other countries. In June 2015, the UAE government launched a new health insurance program in Dubai to support nationals not covered under any other government-funded health insurance scheme, which benefited around 130,000 people. The Dubai Health Authority (DHA) announced in June 2016 that all Dubai residents should be covered by health insurance, which will be tied to the renewal and issuance of their UAE residence visas.

The country has a reputation for providing high standards of healthcare, and this has led the World Bank to rank Dubai and Abu Dhabi as the 2^nd and 3^rd most popular medical tourism destinations in the region respectively, after Jordan. The healthcare system in the UAE comprises both government-funded and private health services, which work together to deliver a high standard of care to the population. The healthcare system is regulated at both federal and emirate levels. The Ministry of Health is responsible for regulating the public health sector, while the Emirates Health Authorities take care of service delivery at the state level. With 100% of the population having access to clean water and sanitation facilities, and prenatal and postnatal care being on par with the developed world, it’s no surprise that the UAE’s health system is in high demand.

To continue to improve the healthcare system, the UAE’s public policy focuses on developing organizational and legal frameworks based on best practice, and on overhauling and upgrading the private and public sector health service capabilities. The government has also placed emphasis on increased spending for healthcare. In 2018, the UAE’s healthcare expenditure reached $13.7 billion (AED 50.3 billion), including expenditures from all seven emirates and contributions to the federal budget, and spending is forecast to rise to $18.3 billion (AED 67.2 billion) by 2023.

Health priorities

The UAE has made significant progress in eradicating infectious diseases like malaria, measles, and poliomyelitis. The country was certified polio-free in 2000 and declared malaria-free in 2007. However, tuberculosis remains present in the UAE at a low rate, and the incidence and prevalence of HIV is also very low. The Emirates Polio campaign supports the Global Polio Eradication Initiative (GPEI) of WHO’s General Assembly for eradicating polio. H.H. Sheikh Mohamed bin Zayed Al Nahyan (third president of the United Arab Emirates and the ruler of Abu Dhabi) made a personal donation of $30 million to support global efforts to eradicate polio. The donation supports Global Polio Eradication Initiative (GPEI) activities such as vaccination and disease monitoring.

Non-communicable diseases, on the other hand, are responsible for 67% of the estimated burden of mortality in the UAE. Over 60% of the population is overweight, 20% of the population has been diagnosed with diabetes, and cardiovascular diseases accounted for 38% of all mortality. The UAE has launched several initiatives to reduce the prevalence of diabetes in the country as part of the Ministry of Health and Prevention’s National Strategy for Fighting Diabetes. One of these initiatives is the Diabetes Screening and Professional Healthcare Education programme, which aims to provide better medical care to diabetic patients. The program’s key objectives include screening 10,000 high-risk individuals and training 90 nurses based on the Johnson and Johnson Diabetes Institute (JJDI) curriculum; 25 doctors will also attend the globally recognized JJDI program. The diabetes screening and education initiative aims to address critical areas of diabetes management, such as maintaining a healthy lifestyle for diabetes prevention, increasing the rate of diagnosis and early detection, and improved care via self-management programs.

In the UAE, approximately 4,500 new cases of cancer are reported each year. In 2012, cancer was the third leading cause of deaths in Abu Dhabi. The top five cancers in males are leukaemia, colorectal, prostate, non-Hodgkins, and brain cancer. In females, the top five cancers are breast, leukaemia, colorectal, thyroid, and uterus cancer. To combat this, the Ministry of Health and Prevention (MoHaP) encourages all women in the UAE to go for free screenings for the early detection of breast cancer. To promote this, mobile clinics equipped with mammography technology were deployed in several shopping centres in Dubai and the Northern Emirates in 2017. The campaign aimed to raise public awareness on the importance of early detection of breast cancer, diagnosis, treatment and rehabilitation.

Genomic medicine capabilities

Genetic disorders are a significant health concern in the UAE. According to a news report from 2012, 75 out of 1000 babies born in the UAE suffer from a birth defect, which is mostly of genetic origin. Scientists and researchers have attributed these high rates of genetic disorders to the high prevalence of consanguineous marriages in the UAE. Another news report from 2013 estimates that there may be more than 400 genetic disorders in the UAE. Genetic disorders are the fourth-highest cause of deaths in the UAE and the nation is ranked sixth among 193 countries in terms of prevalence of birth defects, mainly due to genetic causes.

Consequently, the UAE has been investing heavily in the field of genomics medicine in recent years. One of the key areas of focus for genomics medicine in the UAE is the identification and screening of individuals at risk for genetic disorders in order to implement preventative measures and personalised treatment. One example is a pre-marriage mutual check which is mandatory for all citizens and residents who wish to get married in the UAE.

The UAE has established a number of centres dedicated to genomic medicine, such as the Dubai Genome Center and the Abu Dhabi Genome Center, which are focused on providing genomic services and research facilities to improve healthcare in the country. These centres are also working to develop new technologies to improve the accuracy and cost-effectiveness of genomic testing. In addition, the UAE has established a registry of individuals with genetic disorders and a registry of clinical trials and research studies related to genomics medicine, which will be a useful resource for researchers and healthcare professionals alike.

The Centre for Arab Genomic Studies (CAGS) also aims to prevent genetic disorders in Arab countries by identifying disease-causing genes in the Arab population and raising public awareness about genetic diseases. They also work to address ethical, legal, and social issues that may arise from genomics medicine. Additionally, the Genetics Centre at Dubai’s Health Authority also offers services in prevention, diagnosis and management of genetic disorders.

Notable projects

• Emirati Genome Programme – A national project aimed at using genomic data to improve the health of the UAE population by profiling and determining the gene sequencing of UAE Nationals to aid in the prevention and treatment of chronic diseases.
• National Neonatal Screening Programme – The UAE national neonatal screening program screens for 16 disorders, achieving 95% coverage in 2010.

Notable organisations and companies

• UAE Genomics Council – Established to improve healthcare by regulating and implementing the Emirati Genome Programme, supporting technology companies, and partnering with global firms for cutting-edge genomics research.
• Centre for Genomic Discovery – Aims to diagnose and treat patients with genetic disorders, enhance local genomic research, and train the next generation of scientists by creating a scientific and clinical interdisciplinary ecosystem across institutions in Dubai.
• Dubai Illumina Solutions Center – Newly opened center by Illumina with the aim of making NGS technology more affordable and accessible.
• The Centre for Arab Genomic Studies (CAGS) – A not-for-profit organization that aims to prevent genetic disorders in the Arab World. One of its key projects is an online database of genetic disorders in the Arab World known as the Catalogue for Transmission Genetics in Arabs (CTGA).
• Abu Dhabi Health Services Company (SEHA) – The largest healthcare network in the UAE, owning and operating all public hospitals and clinics with the goal of providing high quality healthcare services to the citizens and residents of Abu Dhabi.
• Al Jalila Foundation – Founded by the UAE’s Vice-President and Prime Minister, dedicated to transforming lives through supporting medical treatment for individuals, providing scholarships, and supporting medical research specifically addressing health challenges prevalent in the region.

Notable individuals

• Fatima Al Kaabi, Director, UAE Genome Office
• Dr. Asma Al Mannaei, Executive Director, Research and Innovation Center, Department of Health – Abu Dhabi

Future genomics landscape

In addition to the focus on genetic disorders, the UAE is also investing in technology and infrastructure for genomics medicine more broadly. For example, the Abu Dhabi Health Services Company (SEHA) has established a genetics laboratory that provides genetic testing services for patients. Additionally, the UAE Genomics Program is working on improving the use of genomics in precision medicine, which allows for the personalized treatment of various diseases, such as cancer.

In 2018, the UAE launched the Emirati Genome Programme. Individuals who participate in the study will provide a single blood sample that will be analysed using advanced sequencing technology and artificial intelligence to generate a comprehensive genome database and produce a reference genome specific to UAE citizens.

The successful outcome of the programme will equip healthcare practitioners with quality information that will enable them to provide advanced diagnosis, treatment options, and personalized and preventive programs tailored to an individual’s unique genetic makeup. It will also help to predict and prevent present and future genetic diseases better and implement new therapies for rare and chronic diseases. The genomic data will be used to develop healthcare strategies that address the population’s specific needs now, and in the future, and support the advancement of preventive medicine in the country.

To support the implementation of the Emirati Genome Programme into the healthcare system across the country, the UAE Genomics Council was formed in 2021. The council will regulate, oversee and guide the programme, as well as support technology start-ups and companies and build partnerships with world-leading technology firms to drive cutting-edge genomics research. SEHA will apply the results of the Genome Programme to ensure the delivery of world-class healthcare services. Additionally, in April 2020, a research team at Mohammed Bin Rashid University of Medicine and Health Sciences accomplished the UAE’s first full genome sequencing of the COVID-19 virus from a patient in Dubai, demonstrating the progress and capabilities of genomics research in the UAE.

The Emirati Genome Programme is especially significant because despite the recent advances in pharmacogenomic research, the majority of the genetic samples used globally are primarily from the US and Europe. The Emirati Genome Programme is expected to pave the way for genomic testing in the Middle East. The UAE’s Department of Health in Abu Dhabi is also keen on creating an ecosystem to enable the application of clinical genomics within the UAE’s healthcare system. The goal is to move from the traditional healthcare provider setup to more of an inclusive academia, public-private, collaboration to provide the best genomic medicine services.

The country is also partnering with international organizations like the Global Alliance for Genomics and Health (GA4GH) – an international collaboration of public and private sector organizations – to promote the use of genomics medicine in the UAE. The collaboration is focused on developing and sharing best practices for genomic medicine. The UAE is also working with the World Health Organization (WHO) to provide technical assistance and support to countries that are introducing genomics into their healthcare systems.

References

• Peterson, J.E. and Crystal, Jill Ann. “United Arab Emirates”. Encyclopedia Britannica, 8 Jan. 2023, https://www.britannica.com/place/United-Arab-Emirates. Accessed 13 January 2023.
• “The United Arab Emirates Government Portal” https://u.ae/#/ Accessed 13 January 2023