Unprecedented advances in the genomic sciences have arrived “just in time” to help alleviate a daunting spectrum of health problems in the developing world ranging from tropical infectious diseases to non-communicable diseases to the health impacts of globalization. Pharmacogenomics and personalized medicine, applied judiciously, ethically and in the context of developing world needs and realities, can help in diagnosis, prevention and treatment of infectious and chronic diseases through new interventions, better assessment of responses to drugs, evaluation of disease susceptibility, and ultimately to more efficient health care delivery. Such applications are likely to be most relevant at the public health and population level and not in the context of ‘boutique’ medicine benefiting individuals, and should address both the curative and preventive aspects of public health strategies. Complex challenges exist for effectively integrating pharmacogenomic advances in the context of improving the efficiency of weak and fragile health care delivery systems, especially during the current global financial crisis. Pharmacogenomics will also help in the development of research and development capacity which would, in turn, enable developing countries themselves to make meaningful contributions to the advancement of the field. For benefits to be equitably realized, however, close attention needs to be given to a multitude of ethical, legal, social and policy issues which includes effective communications, building public trust, adopting a multidisciplinary approach to research, developing adequate ethical and regulatory frameworks, and involving all concerned stakeholders in decision- and policy-making.