The critical need to implement pharmacogenomics in public health services: Mexico in the global picture

Adverse drug reactions (ADRs) are responsible for a significant proportion of hospitalizations globally, and represent a significant, yet partially preventable, burden on public health systems, particularly in resource-limited and low- and middle-income countries (LMICs), where chronic diseases and polypharmacy are highly prevalent. Pharmacogenomics (PGx), through targeted gene panels on drug-gene interactions, has shown potential to reduce ADRs, and improve prescription safety in health systems. The central hypothesis of this article is that the gradual implementation of panel-based pharmacogenomics within public health services in LMICs is possible, ethically justifiable, and potentially cost-effective, when adapted within regulatory, epidemiological, and infrastructural conditions in each region. Using Mexico as a representative case study within the global context, this manuscript synthesizes the international implementation experience and proposes a conceptual and operational framework for the gradual integration of PGx in Public Health Institutions. Estimated hypothetical projections of the clinical and economic potential impact discussed in this article-such as the potential reduction in preventable ADR-related hospitalizations and associated costs-are illustrative and inferential, based on international evidence, and not as empirically demonstrated results within the Mexican health system. The proposed model puts emphasis on scalability, regulatory framework, ethical oversight, and equity-oriented implementation as its core principles. Through the development of a hypothetical policy-relevant model, this article seeks to serve as a basis for the implementation of future pilot programs, empirical evaluations and evidence-based decisions regarding the integration of pharmacogenomics into public health services in Mexico and in similar regions of resource-limited LMICS.