Genomics chair sounds warning bellBy Megan Brodie 3 months ago | In Cell and gene therapies, Industry, People
- 3 months ago
1 September 2021
David Bunker is at the forefront of genomics in Australia and has a warning for government policymakers and funders – they have only a few years before genomics will be a normal part of Australian healthcare and a topic of broad social conversation.
If anyone knows what’s coming and is in a position to sound the alarm bell, it is David Bunker, head of Queensland’s advanced health research translation centre, Brisbane Diamantina Health Partners, and the architect of the State’s $25 million genomics accelerator program designed to prepare its health system for the adoption of genomics.
Before his life in genomics, Bunker was a leader in the national digital health program holding executive responsibility for strategy and architecture, clinical informatics and cybersecurity.
He has also worked for and contributed to a number of Australian Health Ministers’ Advisory Council sub-committees, worked with the leadership of the Australian Alliance for Artificial Intelligence in Healthcare, co-chaired the Research Advisory Group for the National Children’s Digital Health Collaborative, and chaired Epilepsy Queensland.
If this wasn’t enough to keep him busy, earlier this year he also took on the position of inaugural chair of the newly formed Industry Genomics Network Alliance (InGeNA), a consortium of pharma and medtech companies that includes big-name players such as Sanofi, Roche, Novartis, Janssen, Takeda, BMS and Amgen.
Bunker traces his recognition of the value of InGeNA back to a Blueprint for a National Approach to Genomic Information Management developed and released by Queensland Genomics last year.
“I could get to the hospitals, I could get to the researchers, I could get to government and I could even get to consumer and community advocacy groups but I didn’t have a way of effectively engaging industry – an important stakeholder in genomics,” he said.
“Roche and Deloitte were working to develop a national industry alliance and InGeNA essentially grew from there. Beyond the founding members, we’re now talking to many other companies interested in taking part and being part of the conversation – to have a voice.”
From IT geek to genomics expert
In just eight months, InGeNA has fast established itself as the go-to industry body involved in the fast-moving conversation sparked by the emergence of genomics, largely due to Bunker’s extensive connections and influence in the field. While he may be the national go-to genomics guy, surprisingly Bunker has only been working directly in the field for five years.
His background was, quite literally, a cyberworld away. With a Masters in Innovation and Technology Management, Bunker spent the early part of his career as a management and technology consultant specialising in IT and cybersecurity and working on exciting innovations such as the first iterations of the internet and mobile services during the dot-com era of the late twentieth century.
Consulting required long hours and international travel meaning time away from his young family so, pending the birth of a third child, his wife encouraged him to take a job with a more ‘sustainable’ commitment – in other words, no more 18-hour days.
The result was Bunker moving to the National eHealth Transition Authority, initially as lead architect and later, upon joining the executive team in 2010, tasked with securing and delivering a national eHealth infrastructure that is now known as My Health Record.
When the authority transitioned into the Australian Digital Health Agency in 2016, Bunker looked for a new challenge that would draw on both his broad experience and business acumen. He found the answer in genomics – what he called “the next frontier for our health and medical research systems to grapple with”.
Given one of the many opportunities the field presents is the capacity to generate masses of data that need to be collected, stored and translated in order to inform health practice, Bunker’s background in IT proved to be especially useful, particularly when engaging with policymakers. But he says genomics has much to offer and is advancing at such a pace, translation is struggling to keep up.
“The delta between what we know and what we practice is expanding and must be addressed through strategic investment and, critically, innovative and collaborative partnerships,” he said.
“Access to knowledge and how it translates into healthcare is the biggest issue for the health system. Politicians say genomics is the future of healthcare, and it is, but how do we get there?
“Just think about the rapidly emerging direct-to-consumer market for genomics-based tests. Where will consumers go if they get something medically actionable like a pharmacogenomic test they can do at home indicating their personalised response to certain medications? Most GPs have done no more than a few hours of study in this area, if any at all.
“We are also looking at expansive tests that map the whole genome but the future of primary care is more likely linked to cheap, fast tests that assess polygenic risks determining whether you have a greater risk of asthma, diabetes or glaucoma.
“Genomics can be seen as ‘just another test’ or it can be seen as changing the way the health system works. This is a disruptive technology that is forcing us to take a longer view of healthcare; it is change at a social level, and the pace of that change is largely governed by social trust, not just technical know-how.”
The rapid pace of change
The early phases of genomics enabled faster triaging and access to treatment in areas like cancer and rare diseases. A large-scale project funded through Queensland Genomics is already providing clinicians with valuable information so people with the most aggressive blood cancers can be treated faster and more accurately through a better understanding of each patient’s unique response to treatment options.
Large-scale genomic testing has the potential to not just unlock treatments but also identify people at risk before they fall ill and prevent children from being born with undesirable inherited conditions such as genetic diseases. Yet, having worked in government for years, Bunker understands health budgets are finite and shifting funding into any new technology means removing it from other parts of the system.
“The pile of money doesn’t get any bigger so health technology assessment has to adapt quickly, as do the rules about evaluation,” he says.
“The opportunity of genomics is there and the social conversation will grow as people are able to make decisions about inherited characteristics. Whether it is carrier testing or newborn screening, our governments need to be facilitating the social conversation before people start talking about whether they want a child who can play chess or run fast along with what school they might attend.”
Playing its own role in Bunker’s personal and professional choices is the fact his second child, a daughter, was born in 1999 with multiple and severe physical and intellectual disabilities including quadriplegic cerebral palsy and intractable epilepsy due to the extremely rare genetic condition, Pachygyria.
It is a part of his life Bunker rarely discusses, citing discrimination early in his career and not wanting people to dismiss his professional intentions as driven by his personal situation. But, like everything in his life that makes him who he is, it is hard to avoid the impact it has on his thinking – and his drive for change.
“Would we have put her through what she has gone through if we had a choice? Absolutely no – you wouldn’t wish this on any person, or any family,” he says. “But there is also no doubt we are different people because we have her in our lives. What would we be like if we didn’t have a daughter born with a rare genetic disease? I don’t know but we would be different.”
It is the personal choices that genomics offers that Bunker sees as being as challenging if not more so than implementing the economic and health frameworks required to rollout diagnostic testing and to fund the gene therapies rapidly coming through.
He also recognises some disability advocates argue disabilities such as deafness are a gift rather than something to be eliminated.
“The expression of individuality and diversity and what it means to be a person in the world is at the heart of this conversation,” he says.
“Genomics to date is being used episodically but when we look at what it can unlock, it raises many questions. If we know someone is born with a genetic trait that means they will inherit motor neurone disease, for example, at what stage do you have that conversation with them or with the parents?”