Home to five UNESCO heritage sites, Ecuador is a country of rich cultural heritage and exceptionally diverse wildlife. It has long been a hub for life sciences research, such as Darwin’s work in the Galapagos Archipelago, which has built the foundations of many modern theories of geography, ecology and evolutionary biology.
But what role has Ecuador played in the World of Genomics? In this instalment, we explore how a potentially successful universal healthcare system may be held back by public perception of genomic medicine.
The Population of Ecuador
Ecuador is located in South America. It shares borders with Colombia to the north and Peru to the south, as well as the Pacific Ocean to the west.
Figure 1 | Map of Ecuador. Source: Canva.
Ecuador was conquered by the Incan Empire in the late 15th Century, and then by the Spaniards 1534, finally gaining independence in 1822 under the leadership of Simon Bolivar.
Ecuador has a turbulent political history, with various governmental shifts and border disputes. In 2000, Ecuador experienced a severe economic crisis. During this time, the country experienced exceptionally large levels of emigration and adopted the US Dollar as its national currency. Shortly afterward, Ecuador also experienced a huge increase in migration from Colombia as many people were seeking asylum from armed conflict in the country. As of 2019, Ecuador was home to 381,507 immigrants, accounting for 2.21% of its population. 63.34% of these were from Colombia. In the same year, Ecuador registered 1,183,685 emigrants, accounting for 6.85% of its population, many of whomich move abroad to seek better work opportunities.
Geographic and Demographic Information
Summary statistics
- Land area: 256,370 km2
- Gross domestic product (GDP):
- Total: $115.05B (2022)
- Per capita: $6,391 (2022)
Population statistics
- Population size: 18,190,484 (2023)
- Birth rate: 18.474 births per 1000 people (2023)
- Death rate: 5.208 deaths per 1000 people (2023)
- Infant mortality rate: 11.666 deaths per 1000 live births (2023)
- Average Life expectancy: 77.71 years (2023)
- Male estimate: 70 (2021)
- Female estimate: 77 (2021)
- Ethnicities: 71.9% Mestizo, 6.1% European, 7.0% Amerindian, 7.4% Montubio, 7.2% Afroecuadorian, 0.4% other (2010 Census)
Healthcare System
Ecuador’s healthcare system was completely overhauled in 2008 following constitutional amendments. Government spending on medical care rose, stimulating structural and systemic improvements. Additionally, a Ministry of Public Health was established to develop and maintain a public health system. Education on health, sanitation and disease prevention was also introduced.
Ecuadorians can access healthcare in one of three ways:
- The Public Health System provides publicly funded healthcare to all citizens regardless of their income.
- The Social Security System (IESS – Instituto Ecuatoriano de Seguridad Social) provides healthcare to the working population and their families, paid through tax deductions. Contributions are mandatory for all citizens in full-time employment.
- The Private Healthcare System is available to those who can afford it and usually provides a higher standard of care and wider range of services than public hospitals. Private non-profit medical providers are also available in a few locations.
Access to health care is unequal, particularly between urban and rural areas. Although traditional medicine has a significant presence in rural regions, many people struggle to access healthcare due to geographical barriers and often die from preventable issues such as malnutrition, parasitic disease and infection. In response to this, the government has introduced one year of mandatory “rural service” for healthcare professionals.
Health Priorities
The number one cause of death in Ecuador is coronary heart disease, followed by kidney disease, stroke, influenza and pneumonia, and diabetes mellitus. The prevalence of non-communicable diseases is likely to be the result of poor lifestyle choices. As of 2023, 10.6% of the population aged 15 years or older smoke tobacco. Overweight and obesity are high across the entire population (8.6% of children under five years old; 29.9% of school-age children; 26% of adolescents; and 62.8% of adults). Nevertheless, approximately 25% of children under 5 suffer from stunting or anemia due to malnutrition, with these figures rising to over 40% in indigenous populations. In rural and indigenous communities, poor living conditions result in malnutrition and infection, which are also common causes of death.
To address these issues, the Ecuadorian government has adopted a national nutrition agenda that aims to achieve several goals by 2025, including eradicating stunting in children under 2 years old and reducing the percentage of overweight and obese children (between 5-11 years old) to 26%.
In 2021, the Ministry of Public Health (MSP) in Ecuador implemented a collaborative initiative to formulate the Ten-Year Health Plan 2022–2031 (PDS 2022–2031). Its main goal is to diminish disparities in accessing the fundamental right to health by employing a holistic, intersectoral approach that addresses social and environmental factors. This aims to provide effective, universal, and cost-free healthcare access.
Political leaders have also catalysed healthcare advances. The democratic socialist party Revolucion Ciudadana (“Citizen Revolution”) founded in 2018 played an instrumental role in to improving the quality of higher education and expanding research capacity in Ecuador. A 2021 study reported a decade’s worth of health sciences-related articles to quantify the research facilitated by the Revolucion Ciudadana movement. The number of Ecuadorian health sciences-related articles significantly increased between 2009 and 2019. However only a small percentage of these were focussed on addressing urgent health priorities.
Genomic Medicine Capabilities
Despite the partial successes of Ecuador’s healthcare system, the government does not widely support genomic medicine efforts in the country. However, they have previously sponsored genetic research, which is most prevalent in the universities of Ecuador’s largest cities: Quito, Guayaquil and Cuenca.
Genetic services were first established in Quito in the early 1980s. In 1989, the Ecuadorian Society of Human Genetics was formed. Almost thirty years later, in 2007, the first Ecuadorian Congress in Human Genetics was held. Currently, Ecuador has around 10 trained geneticists, which is about a third lower than the World Health Organisation recommendation. Genetic services didn’t arise in private practices until the 1990s and, even then, their services were limited.
The 2010 Census identified that 5.64% of population had a disability, 24% of which were intellectual, that was moderate or severe in almost two thirds of the group.
The Manuela Espejo Solidarity Mission was established in 2009 to identify, register and investigate the causes of intellectual disabilities in Ecuador. The report published in 2011 showed that 43% of causes are multifactorial, 42% are due to chromosomal abnormalities, 16% are monogenic and 8% are associated with a diagnosis of cerebral palsy. This mission was instrumental in creating better legislation and providing better support for those living with disabilities and their caregivers.
Currently, health policies do not allow prenatal diagnosis and therapeutic termination of pregnancies. Abortion is illegal in Ecuador, except for pregnancies that endanger the mother or are the result of rape. Consequently, parents do not have access to information regarding genetic illnesses of the embryo.
In terms of post-natal care, new-born screening is available for only four disorders: phenylketonuria, galactosemia, congenital adrenal hyperplasia and congenital hypothyroidism. In comparison, in the USA all states require new-born screening for a minimum of 29 health conditions, but some states off testing for up to 50. Ecuador does not have a specific definition for the term rare disease, which complicates both diagnosis and policy progression.
Notable projects
- Ten-Year Health Plan 2022–2031 (PDS 2022–2031): Developed in 2021 by the Ministry of Public Health to improve accessibility of public healthcare.
- Revolucion Ciudadana: A political movement that has implemented various policies and interventions to improve education and research in the healthcare sector.
- Manuela Espejo Solidarity Mission: Part of an Ecuadorian social investigation for identifying disabled people. This mission paved the way for caregivers of disabled people to receive financial support from the government.
Notable organisations and companies
- Sociedad de Lucha Contra el Cancer (SOCLA a.k.a. Society to Fight Cancer): An Ecuadorian committee formed in 1951 to share knowledge about cancer, aiming to prevent and treat the disease. In 1953, the Ecuadorian government began building the SOLCA hospital, which today remains one of the most important hospitals in the entire country.
- The Ecuadorian Red Cross: A branch of the non-profit charity Red Cross that offers basic genetic testing for organ transplants, forensics
,and more.
Notable individuals
- Dr. Juan Tanca Marengo (1895-1965) was an Ecuadorian doctor who, following concern about public health and cancer, formed a group of medicine students and doctors that went on to become SOLCA in the early 1950s.
The Future Genomics Landscape
Ecuador’s healthcare system has a decent foundation, as their public health system provides basic medical care to most of the population. However, as genomic medicine advances in the rest of Latin America, it is apparent that Ecuador is struggling to keep up. There are clear efforts to improve the accessibility of their universal healthcare system, such as the Ten-Year Health Plan 2022-2031. However, further work is needed.
Public perception on genomic testing and data protection is negative, so these services are not widely available yet. Newborn screening is limited, prenatal testing does not exist and abortion is currently illegal. However, maternal mortality and adolescent pregnancies rates have significantly decreased in the last 20 years. Further improvements in maternal healthcare will pave the way for better newborn screening and, hopefully, a more positive attitude towards genomic medicine.
References
- Giugliani, R., Castillo Taucher, S., Hafez, S., Oliveira, J.B., Rico-Restrepo, M., Rozenfeld, P., Zarante, I. and Gonzaga-Jauregui, C. (2022). Opportunities and Challenges for Newborn Screening and Early Diagnosis of Rare Diseases in Latin America. Frontiers in Genetics, 13. doi:https://doi.org/10.3389/fgene.2022.1053559.
- Health in the Americas. (2022). Ecuador – Country Profile. [online] Available at: https://hia.paho.org/en/countries-22/ecuador-country-profile [Accessed 21 Sep. 2023].
- March 23, internationalmedicalaid and 2022 (2022). Facts about Ecuador’s Healthcare System. [online] International Medical Aid. Available at: https://medicalaid.org/facts-about-ecuadors-healthcare-system/ [Accessed 21 Sep. 2023].
- Paz-y-Miño, C. (2004). Genetic Services in Ecuador. Community Genetics, 7(2/3), pp.137–141.
- Paz‐y‐Miño, C., Guillen Sacoto, M.J. and Leone, P.E. (2015). Genetics and Genomic Medicine in Ecuador. Molecular Genetics & Genomic Medicine, 4(1), pp.9–17. doi:https://doi.org/10.1002/mgg3.192.
- Sisa, I., Abad, A., Espinosa, I., Martinez-Cornejo, I. and Burbano-Santos, P. (2020). A Decade of Ecuador´s Efforts to Raise Its Health Research output: a Bibliometric Analysis. Global Health Action, 14(1). doi:https://doi.org/10.1080/16549716.2020.1855694.
- World Life Expectancy. (n.d.). HEALTH PROFILE ECUADOR. [online] Available at: https://www.worldlifeexpectancy.com/country-health-profile/ecuador [Accessed 21 Sep. 2023].
- Ochoa, A. and Verstraeten, G.R.-M. and R. (2017). Tackling Overweight and Obesity in Ecuador : Policies and Strategies for Prevention. [online] Nutrition Exchange 8. Available at: https://www.ennonline.net/nex/8/tacklingoverweightandobesityinecuador#:~:text=In%20response%20to%20these%20public [Accessed 26 Sep. 2023].
