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World of Genomics: Hungary

Known for its rich heritage and incredible cultural sights, Hungary promises to captivate all of its visitors. From Matyó folk art, folk dancing and folk music to the Busó festivities and the Hungarian greeting-of-spring carnival, this country offers endless opportunities to explore its fascinating culture. Outside of its festivities, there is still much to see in Hungary. Across the entire country, there are a total of 103 castles and a multitude of other monuments built in a variety of styles across different time periods. Finally, for those looking to relax, there is a choice of 1,500 hot springs and more than 270 locations with medicinal waters to do so. In fact, Hungary is one of the world’s central locations for medical and spa tourism, thanks to its abundance of thermal waters.

Population of Hungary

Hungary is bordered by Slovakia to the north, Austria to the west, Slovenia to the southwest, Croatia and Serbia to the south, Romania to the east and Ukraine to the northeast. Over the centuries, Hungary’s strategic location has played a pivotal role in its development, fostering a unique national identity influenced by a variety of cultures from its neighbouring countries. A prime example of this relates to linguistics. Surrounded by countries with languages that were substantially different from its own, Hungary was eventually profoundly influenced by Christianity and, consequently, Latin, which became ingrained in this nation’s culture, education and politics. As part of the group of Christianized nations, Hungary then became a fundamental player in the defence against Eastern countries that subscribed to other religions.

Despite this, Hungary remained independent for several centuries until it joined the Habsburg and Ottoman empires in the 16th century. Even then, Hungary retained much of its identity and political independence, which facilitated its union with Austria in 1867 to form “Austria-Hungary”.

However, at the turn of the 20th century, a lot changed for Hungary. Previously a diverse country, Hungary became ethnically homogenous due to major political changes that led to the mass emigration of over 1.3 million people to Hungary’s neighbouring countries, western Europe and North America. Further, with the end of World War I, Hungary lost 71% of its territory due to the Treaty of Trianon. This significantly impacted Hungarians, prompting the so-called “Trianon Syndrome.”

When World War II ensued, Hungary attempted to stay neutral but eventually became an ally to Nazi Germany. In 1944, Hungary tried to switch sides and join the Allies. However, this attempt failed, and Hungary eventually allied with the Soviet Union. Even after Hungary regained independence in 1990, its population remained split politically, socially and culturally between those who still feel aggrieved by the Treaty of Trianon and those who want to move on.

Geographic and demographic information

Summary statistics

  • Land area: 91.260 sq. km (2020)
  • Gross domestic product (GDP):
    • Total: 181.85 billion USD (2021)
    • Per capita: 18,728.1 USD (2021)

Population statistics

  • Population size: 9,709,891 (2021)
  • Birth rate: 9.6 per 1000 people (2020)
  • Death rate: 14.5 per 1000 people (2020)
  • Infant mortality rate: 3.3 per 1000 live births (2021)
  • Average Life expectancy: 76 years (2020)
    • Male estimate: 72.3 years (2020)
    • Female estimate: 79.1 years (2020)
  • Ethnicities: 2011 census – 83.7% Hungarian, 3.1% Roma, 1.3% German and 11.9% other ethnicities, such as Slovaks, Croats, Romanians, Serbs, Poles, Slovenians, Rusyns, Greeks and Armenians

Healthcare system

In 1992, Hungary’s primary health care system was established. This system centres around the patient’s choice of a general practitioner (GP) who acts as their primary healthcare provider. Health care for almost all residents in Hungary (even those who are not citizens) is covered by a single health insurance fund administered by the country’s National Institute of Health Insurance Fund Management (NEAK). In fact, the constitution demands that all citizens and foreigners that reside and work in Hungary join this insurance. Those that don’t automatically have access to the scheme, like non-EU students, can also opt to purchase the insurance. This scheme covers a wide range of services across all levels of healthcare, as well as a variety of medications. Nevertheless, this coverage is limited in areas like outpatient care and pharmaceuticals, medical devices and dental care, leading to substantial out-of-pocket (OOP) spending.

While healthcare spending in Hungary has increased over the years, particularly before the pandemic, spending still remains below the EU average. Only 68.3% of healthcare spending in Hungary is publicly covered, which is significantly lower than the EU average of 79.8%; the remaining percentage has to be paid OOP. This issue is further exacerbated as people are forced to opt for private care services because of long waiting times in the public sector.

Another significant healthcare issue in Hungary is the need for more healthcare workers. Overall, these workers are ageing, and many professionals are emigrating to other countries for better conditions and pay. As such, while there is a rise in the number of graduates, there is still a shortage of doctors and nurses, especially in less populated and economically disadvantaged areas. Even so, the level of unmet medical needs in Hungary remains low.

Health priorities  

From 2000 to 2020, life expectancy in Hungary increased progressively from 71.9 years to 75.7 years. Even so, it remains five years below the EU average. Furthermore, due to the COVID-19 pandemic, life expectancy fell in 2020, though this decrease was similar to the average in the EU. Overall, deaths from treatable and preventable causes in Hungary are both significantly above the EU average, highlighting the issues in this country concerning the quality of healthcare services and risk factors such as smoking.

In 2018, the leading causes of death in Hungary included ischaemic heart disease, stroke, and lung cancer. These could, in large part, be mitigated by tackling behavioural and other risk factors, which account for approximately half of the deaths in this country. For one, alcohol and tobacco consumption are very high for both adolescents and adults when compared with other EU countries. For example, in Hungary, approximately 25% of adults smoke daily, which represents the third highest rate of tobacco consumption in the EU. Alcohol consumption is also 13% higher than the EU average. Overall, smoking and alcohol consumption are estimated to cause 21% and 7% of all deaths in Hungary, respectively.

Furthermore, dietary risks are also a significant concern in Hungary, accounting for approximately 25% of all deaths in 2019. Poor nutritional habits, such as low consumption of fruit and vegetables, are more common in Hungary than in most EU countries, which explains why 24% of adults and almost 25% of adolescents are obese. Deaths linked to air pollution are also significantly higher in Hungary (7%) than the EU average (4%).

To tackle these issues and improve preventative care in Hungary, the government introduced the “Three Generations for Health Program” in 2019, which provided funding to GP practices to invest in public health and preventative care activities and services. In particular, the program focused on areas such as paediatric care, mental and cardiovascular health, cancer screening, management of musculoskeletal disorders and promotion of healthy habits, including a balanced diet, physical activity, and smoking cessation.

Another vital program introduced in Hungary was the National Health Programme for Cancer which aimed to reduce cancer-related mortality by improving preventative care. As part of this program, for example, an initiative called “Health Care At Your Doorstep”was created to offer accessible cancer screening for free.

Genomic medicine capabilities

In 2008, the “Genetic Act” was introduced in Hungary. This law set forth the regulations for genetic testing, screening, and counselling and the research conducted in this field. Notably, while this law was created with the public healthcare system in mind, it is also applicable to the private sector.

The Genetic Act establishes the purposes, methods and requirements needed to conduct genetic testing on humans. Some vital aspects of this law include the requirement for genetic testing to be undertaken only for specific health-related reasons, by a healthcare provider and with the explicit consent of the person concerned.

While the Genetic Act doesn’t directly answer the main issues observed with regard to commercial genetic tests, as these only surfaced after the introduction of this law, it does include certain points that can help mitigate these problems.

Looking specifically at newborn screening, in 2007, Hungary expanded its coverage to include 16 diseases. All newborns are screened 48 to 72 hours after birth, under the national health insurance scheme, with their samples sent to and processed in one of two screening centres in the country.

In some cases, parents can also opt for prenatal testing. In the public sector, four ultrasound sessions and chromosomal investigations are available if the mother is more than 37 years old and, in some cases, when there is a family history of certain genetic conditions. In other cases, parents have to resort to the private healthcare sector, where non-invasive prenatal testing (NIPT) is available. According to a recent report, despite the cost, NIPT has become more common in Hungary since 2015, and in 2021, 13% of the babies born were tested.

Conversely, preimplantation genetic testing, carried out before embryo implantation as part of assisted reproduction techniques, has been restricted in this country. In 2015, the legislation was changed to reclassify preimplantation genetic testing for aneuploidy (PGT-A) as an experimental procedure, which essentially led to its banning in medical practice.

PGT-A is used to detect aneuploid embryos, that is, embryos with the incorrect number of chromosomes, which would be selected out for implantation. This practice ensures a better chance for a viable pregnancy and live birth. Nevertheless, PGT-A is no longer available in Hungary, which is undoubtedly one of the main factors leading Hungarian patients to procure IVF services abroad.

Genetic testing for preventative and diagnostic purposes is also available for various conditions. For example, since 2003, molecular genetic tests have been available to diagnose primary immunodeficiency diseases.

In some cases, genetic testing isn’t supported by Hungary’s National Health Insurance Fund, even when there is a family history of a disease that would warrant it. Genetic testing for mutations in the BRCA1 and BRCA2 genes, which are associated with a higher risk of breast cancer, isn’t directly covered by the fund, for example. In these cases, patients need to obtain a specialist referral and appropriate justification to be considered for funding for this test.

Further, even if diagnosed, patients cannot always access preventative treatments through this insurance fund, such as a risk-reducing mastectomy. This essentially means that, in Hungary, not only are genetic screening and diagnostic tests only selectively available to patients, but the information collected isn’t always used to provide appropriate prevention and treatment to these patients.

Even so, genetic screening and diagnostic tests have increased over the last few years, creating a higher demand for appropriate genetic counselling. Overall, while genetic counselling is required in Hungary when carrying out any genetic test, a limited number of clinical geneticists are available to provide this service.

Notable projects

  • Beyond 1 Million Genomes (B1MG) project: The B1MG project was created to expand on the work carried out under the European Union’s 1+ Million Genomes (1+MG) Initiative. The aim is to create a framework and legal guidance that allows European countries to share genomic and clinical data and, as a result, improve scientific research and policy-making. Hungary is one of the participants in the 1+MG initiative and is represented by the National Institute of Oncology.
  • Hungarian National Genome Programme – Launched in 2021 by the University of Pécs Szentágothai Research Centre, this programme was created to study the genetic characteristics of Hungarians and develop genetic panels for a multitude of diseases and identify new pharmaceutical targets. This is a revolutionary programme, not just in Hungary but in Eastern-Central Europe.
  • Szeged Biobank – In 2020, the University of Szeged started to construct this fully automated biobank, which is expected to have the capacity to hold 19 million samples. The main goals for this project are to contribute to the development of personalised medicine and accelerate research into new therapeutics, especially in the field of oncology. Even now, the biobank is already making history as it has led to the university becoming the first institution in Hungary to join BBMRI-ERIC.

Notable organisations and companies

  • Hungarian Academy of Sciences – Founded in 1825 by Count István Széchenyi, the Hungarian Academy of Sciences (Magyar Tudományos Akadémia, MTA) is a vital scientific institution in Hungary. Its primary aims are to help implement and promote science, safeguard the freedom to express scientific opinions, support the advancement of science conducted by Hungarians both in Hungary and abroad, and facilitate public understanding of scientific matters.
  • Semmelweis University Clinical Centre – Amongst other healthcare services, the Clinical Centre at Semmelweis University provides genetic testing services. Not only does the centre conduct newborn screening and prenatal testing, but it also offers screening for a variety of genetic disorders, like Huntington’s disease and Duchenne and Becker muscular dystrophy, genetic counselling services and pharmacogenomic tests.
  • Institute of Genetics at Szeged’s Biological Research Centre –  The Biological Research Centre (BRC) was founded in 1971 and, today, is a key institution in Hungary for biological research, having been awarded the title of “Centre of Excellence“ by the EU in 2000. The BRC’s Institute of Genetics, in particular, focuses on research in the fields of genome instability and carcinogenesis, developmental genetics and immunology.
  • Department of Molecular Genetics at the National Institute of Oncology – The Department of Molecular Genetics provides genetic testing to screen for mutations associated with a higher risk of developing certain types of cancer, including breast, ovarian and colorectal cancer. This can help provide patients with preventative strategies and earlier diagnosis and treatment. This department is also involved in various research programs to discover new cancer-associated genes and strategies to diminish cancer risk.

Notable individuals

  • Prof. George Szemere –  Prof. Szemere was a renowned Hungarian medical geneticist. Amongst his various accomplishments, he founded the Institute of Medical Genetics at the University of Szeged as well as the Hungarian Society of Human Genetics and created the first genetic counselling centre in the countryside. Throughout his life, Prof. Szemere made significant contributions to the field of human genetics in Hungary and advocated for accessible genetic counselling.
  • Prof. Dr. Béla Melegh – Dr. Melegh is a professor of medical genetics and paediatrics and currently serves as head of the Department of Medical Genetics at the University of Pecs, head of the National Rare Disease Research Coordinating Centre and president of the Hungarian Society of Human Genetics. He is also one of the leaders of the national biobank consortium and runs one of the leading molecular diagnostic centres in Hungary. Dr. Melegh’s research primarily focuses on neuromuscular and neurogenetic diseases.
  • Prof. Dr. Miklós Kásler – Dr. Kásler is a renowned doctor, professor and minister in Hungary. He served as Minister of Human Resources from 2018 to 2022 and is the Director General of the National Institute of Oncology. As a researcher, he made several important contributions to the field of cancer genomics, including the discovery of new diagnostic and therapeutic strategies for patients with acute myeloid leukaemia and breast cancer, and the study of genetic markers to help predict the risk of breast cancer.

The future genomics landscape

While there are still several shortcomings in the healthcare system in Hungary, overall improvements have been gradually made over the years.

It’s clear that there is a growing effort from the Hungarian government to improve healthcare, especially preventative care, as shown by the creation of initiatives like the “Three Generations for Health Program”. With more investment into the public healthcare sector, hopefully, it will become more accessible and all-encompassing, leading to better prevention, diagnosis, and treatment for all.

Along with these changes to the healthcare system, projects like the Hungarian National Genome Programme and the Szeged biobank will hopefully lead to key discoveries and breakthroughs in human genomics with clinical applications that help address the concerns in Hungary and the rest of the world. In particular, these projects offer exciting opportunities to advance fields like personalised medicine, pharmacogenomics and biotechnology and to create new prophylactic, diagnostic and treatment strategies for various conditions.

References

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