With the upcoming FIFA World Cup being hosted in Qatar, our latest World of Genomics takes us to the Persian Gulf. The Middle East is a historic crossroads of human civilisations, yet the genetics of Arab people are largely understudied. Qatar hopes to become a pioneer in genomics, with high investment in healthcare and a push to sequence one in three of the Qatari population by 2026.
The population of Qatar
Qatar is a country in western Asia. It shares its sole land border with Saudi Arabia to the south, with the rest surrounded by the Persian Gulf. The capital, Doha, contains over 80% of the nation’s population and is home to Pearl-Qatar, an artificial island off the mainland.
Human habitation of Qatar dates back over 50,000 years. Settlements and tools dating back to the Stone Age have been unearthed in the peninsula and Mesopotamian artefacts have been found in coastal regions. The peninsula fell under the domain of several different empires during its early years of settlement, including the Seleucid, the Parthians and the Sasanians.
Following Ottoman rule in the 1800s, Qatar became a British protectorate in the early 20th century, until gaining independence in 1971. Qatar is ruled as a hereditary semi-constitutional monarchy by the House of Thani. Its official religion is Islam and Qatar’s legal system is a mixture of civil law and Sharia law.
It is a high-income economy, backed by the world’s third-largest natural gas reserves and oil reserves.
Geographic and demographic information
- Land area: 11,571 km2
- Gross domestic product (GDP):
- Total: USD$146.4 billion
- Per capita: USD$50,804
- Population size: In 2020, the total population of Qatar was estimated to be 2.88 million.
- Birth rate: In 2020, the crude birth rate was 9 per 1,000 people.
- Death rate: In 2020, the crude death rate was 1 death per 1,000 people.
- Infant mortality rate: In 2020, the crude infant mortality rate was 5 deaths per 1,000 live births.
- Average life expectancy: In 2020, the average life expectancy was 80 years.
- Ethnicity: Qatar (Arab) nationals make up less than 15% of the total population. The remaining distribution includes other Arab groups (13%), Indian (24%), Nepali (16%), Filipino (11%) and Bangladesh (5%) and Sri Lankan (5%).
The public healthcare system operates through the state-run Hamad Medical Corporation (HMC), established in 1979. Qatari citizens and residents can access subsidised public healthcare at HMC clinics or hospitals. Public healthcare delivers primary care services through a network of health centres. Public hospitals deliver over 80% of secondary and tertiary care services. Private sector healthcare provision is expected to increase significantly as opportunities for investment are identified.
In 2019, the Universal Health Coverage of Qatar was deemed to be 80, in comparison to the global score of 57. The World Health Organisation (WHO) has rated Qatar as 44th in the world for overall efficiency in providing healthcare to its citizens. Qatar has 5.8 nurses and 2.5 physicians per 1,000 people.
Nevertheless, some health issues are difficult to get treated. Having sex while unmarried is criminalised in Qatar. Therefore sexual health, pregnancy, or abortion requirements are not available for unmarried individuals. Abortion is legal in few specific instances, namely when the mother or foetus’s life is in danger. In addition, migrants face difficulties as they are not entitled to public healthcare and, under Qatar’s Kafala system, migrant workers are dependent on their employers. Migrants can rarely afford or receive health insurance.
According to the Ministry of Public Health, the system is heavily burdened, seeing unbalanced demand across services as they are currently designed to provide care for those with short-term acute conditions. Those with ongoing needs potentially receive episodic care and community and home-based services are minimal. In addition, Qatar’s growing, changing and aging population is creating a shift in the healthcare landscape. Qatar aims to tackle these issues by expanding existing services, increasing integrated care and easing operational pressures.
In Qatar, the most widespread causes of death in 2019 were ischemic heart disease, road injuries, diabetes, stroke, cirrhosis and chronic kidney disease.
Key metabolic, behavioural and environmental risks driving death and disease in Qatar were high BMI, high fasting plasma glucose, tobacco, air pollution and high blood pressure. Over 40% of adults are classed as obese and Qatar sees high comorbidity rates as a result.
The Qatar National Vision 2030 established that the Qatari health system should meet the needs of existing and future generations and provide for an increasingly healthy and lengthy life for all. The Public Health Strategy 2018-2022 set out core goals, including preventative healthcare, mental health and high-quality research. In 2016, the National Cancer Framework, National Diabetes Strategy and the Communicable Diseases Framework were launched.
Successful public health initiatives include the National Cancer Program (NCP) initiated by the Ministry of Public Health. The ‘Screen for Life’ program was launched in 2016, enabling early detection of bowel and breast cancer.
In 2019, a national diabetes screening programme was proposed and is in pilot stage. Diabetes is one of Qatar’s health priorities as approximately 17% of Qatari adults have diabetes. Work is being done to ensure awareness, prevention, research and treatment are available and accessible as part of the national strategy.
Furthermore, two Qatari cities, Doha and Al Rayyan, have been awarded the World Health Organisation’s “Healthy City” status. This recognises the cities’ public health levels, acknowledging the promotion of health and wellbeing, empowerment and equity among residents and preventing the main causes of diseases through incorporating health in all policies.
As of May 2022, Qatar had 374,591 confirmed COVID-19 cases and 678 confirmed COVID-19 deaths.
Genomic medicine capabilities
The Qatar Genome Programme has already sequenced the genomes of nearly one in ten Qataris. It aims to sequence one in three by 2026.
The success of a national population-based genome program depends on the willingness of citizens to donate samples and take up genomic testing services. In 2020, 71% of Qatari respondents surveyed reported that they were willing to participate in genomics research. Willingness to participate was significantly associated with basic literacy in genetics, a family history of genetic diseases, and previous experience with genetic testing through premarital screening.
Qatar also has large Science, Technology, Engineering and Maths (STEM) education initiatives to promote science and genomic literacy. From comic books featuring scientists, to genomics and genetic engineering being on the curriculum alongside enhanced teacher training, Qatar aims to supply the Qatari labour market with qualified scientists.
Premarital screening has been a legal requirement in Qatar since 2009. Qatar has high consanguineous marriage rates and this carries genetic risks. Couples who wish to wed must first get tested for mutations linked to a range of inherited diseases such as cystic fibrosis, spinal muscular atrophy, sickle cell anaemia and thalassaemia. Those with risky results may choose not to marry or have in vitro fertilisation with unaffected embryos, which is paid for by the government.
The Qatar Newborn Screening Program (NBS) was established in 2003 and tests all new-borns born in Qatari hospitals. The heel-prick blood-test is free of charge and screens for over 80 disorders. Under the Qatar NBS, 1,000 babies have been diagnosed with a rare disorder or genetic condition, enabling earlier treatment and care.
The COVID-19 Host Initiative was an international collaboration to map the human genetic architecture of COVID-19 in 2020. Qatar was the only Arab country to participate, and one of the few non-European or North American contributors. The results of the global initiative revealed 13 loci that were strongly associated with infection or severe COVID-19 and 2 of these had higher frequencies in Asian or Middle Eastern patients, demonstrating the value of Qatari datasets.
- Qatar Genome Program (QGP): A national population-based research project that aims to study the genetic makeup of the Qatari and other Arab populations. It intends to generate large scale genomic databases for researchers, to introduce precision medicine to the national health care system.
- Qatar Biobank: A long-term health initiative that aims to reduce the number of chronic illnesses in the population. It will collect biological samples and information on the health and lifestyle of Qatari people and provide international data sets.
- Qatar Genome Program Research Consortium: The Consortium brings together researchers from across institutions to coordinate a nationwide effort to map the Qatari genome.
- Qatar Biomedical Research Institute (QBRI): The QBRI is comprised of two research centres, the Applied Stem Cell Research Centre and the Genomic Medicine Research Centre. It also includes five research laboratories, the Cancer Research Laboratory, Applied Diabetes Research Laboratory, Biomedical Engineering Research Laboratory, Translational Systems Biology Research Laboratory and Gene Therapy Research Laboratory. The QBRI aims to contribute to the delivery of personalised medicine through the discovery of new drugs, new biomarkers, new gene therapies and new applications for stem-cell research.
Notable organisations and companies
- Qatar Foundation: A non-profit organisation established in 1995. It comprises of 3 national research institutes, and it funds and supports entrepreneurs, schools, universities and research.
- Biotech Qatar: A medical distributor providing services, technology and research across cardiology, diabetes and pathology.
- Qatar Scientific Company: Established in 2005, it provides tools and services in multi-omics and informatics.
- Sidra Medical and Research Centre: First opened in 2016, Sidra Medicine is a hospital focused on women’s and children’s health, as well as a medical education and biomedical research centre.
- Hamad Medical Corporation: Established in 1879, it is a non-profit health care provider. It delivers the Academic Health System, a cross-university initiative to ensure that research is collaborative and that healthcare innovations and developments are integrated into the clinical setting smoothly.
- Nahla Al Afifi: Al Afifi is Director of Qatar Biobank. Her expertise lies in biobanking, biomedicine and health sciences.
- Omar El-Agnaf: El-Agnaf is Executive Director of Qatar Biomedical Research Institute. He is considered a pioneer in the field of Parkinson’s and related neurodegenerative diseases.
- Khalid A. Fakhro: Fahkro is the Chief Research Officer at Sidra Medicine and Director of the healthcare facility’s Precision Medicine program.
- Nadia Abu Hijleh: Hijleh is the Chief Executive Officer of Qatar Scientific. Her background is in chemistry with experience in genetics, proteomics and metabolics, chemicals industry and applied science and artificial intelligence.
- Said Ismail: Ismail is the Director of the Qatar Genome Programme. His expertise and research lie in the fields of molecular biology and genetics, with a focus on cancer genetics, precision medicine, and the screening and characterisation of disease-related mutations in the Arab population.
The future genomics landscape
The Qatar gene chip or ‘Q-chip’ is in development. The Q-chip will contain gene variants specific to the Qatari population, identified through the sequencing and genetic screening of thousands of Qatari citizens. Unlike the genetic results that come from international laboratories abroad or gene assays developed using data from other populations, diagnosis using the Q-Chip will be based on genetic information derived from Qataris, making the results obtained more relevant and accurate. In addition, the chip will save on funds spent by healthcare providers on sending samples abroad for diagnosis of many hereditary diseases.
A pan-Arab genotyping array has been proposed and is in development. The aim is to create a cost-effective alternative to whole-genome sequencing and to provide a greater diversity in genome-wide research studies. Qatar plans to spearhead the leverage of whole-genome sequencing data from 19 Arab countries. The array will include roughly 800,000 variants, which can be broadly used for a range of medical conditions including diabetes, cardiovascular and metabolic diseases, autism, inherited genetic disorders, and cancer.
Qatar wishes to implement pre-emptive pharmacogenomics into healthcare settings. Pharmacogenomics uses an individual’s genetic information to identify the right drug at the right dose at the right time. PGx information can maximise the therapeutic efficacy of the medications and prevent adverse drug reactions by identifying how specific genetic variations might affect individual responses to medications.
The Disease Genomics Database (DGD) is in development. It aims to enhance data sharing and support researchers at healthcare and research institutes. They seek to generate comprehensive genotyping, sequencing, and other relevant genomic data for their respective cohorts by utilising their clinical samples and subsequently making it available for the wider research community.
Overall, Qatar is investing heavily in genomics and aims to be positioned as a pioneer in the implementation of advanced personalised healthcare. Through innovation and integration of genomic and other ‘omics’ technologies into medical and research practices, Qatar seeks to improve population healthcare and contribute to a knowledge-based economy.
- Al Abdulla et al. SMART population screening and management in Qatar. Diabetes and Clinical Research. 2019.
- COVID-19 Host Genetics Initiative. Mapping the human genetic architecture of COVID-19. Nature. 2021.
- El Shanti et al. Genetic testing and genomic analysis: a debate on ethical, social and legal issues in the Arab world with a focus on Qatar. Journal of Translational Medicine. 2015.
- GBD 2019 Universal Health Coverage Collaborators. Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. 2020.
- Ministry of Public Health. Qatar Public Health Strategy 2017-2022. State of Qatar. 2017.
- Ministry of Public Health. National Health Strategy 2018-2022. State of Qatar. 2018.
- Qatar Foundation. Arab participation in global genomic study could lead to new therapies for COVID patients. Cision. 2021.
- Zawati et al. Genomics, Islamic ethics and public engagement: towards bridging the knowledge and communication gaps. Dimensions. 2018.
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