Abstract
Advances in genomics are contributing to the development of more effective, personalized approaches to the prevention and treatment of infectious diseases. Genetic sequencing technologies are furthering our understanding of how human and pathogen genomic factors - and their interactions - contribute to individual differences in immunologic responses to vaccines, infections and drug therapies. Such understanding will influence future policies and procedures for infectious disease management. With the potential for tailored interventions for particular individuals, populations or subpopulations, ethical, legal and social implications (ELSIs) may arise for public health and clinical practice. Potential considerations include balancing health-related benefits and harms between individuals and the larger community, minimizing threats to individual privacy and autonomy, and ensuring just distribution of scarce resources. In this Opinion, we consider the potential application of pathogen and host genomic information to particular viral infections that have large-scale public health consequences but differ in ELSI-relevant characteristics such as ease of transmission, chronicity, severity, preventability and treatability. We argue for the importance of anticipating these ELSI issues in advance of new scientific discoveries, and call for the development of strategies for identifying and exploring ethical questions that should be considered as clinical, public health and policy decisions are made.
Highlights
Genomic information offers the opportunity for more personalized treatment and prevention [1] in clinical practice and public health settings
It may be premature, we must anticipate the possibility of ELSI-associated challenges in the future. This Opinion aims to anticipate what some of these issues might be and under what conditions they could arise. We argue that these considerations - even as the science is still developing - should become part of the agenda of researchers, clinicians, policymakers and public health officials so that the benefits of genomic applications to infectious disease are maximized while potential harms to individuals and populations are minimized
We briefly describe some of the epidemiologic characteristics and recent genomic advances associated with four particular infectious diseases - Ebola, pandemic influenza, hepatitis B and tuberculosis - that have large-scale public health consequences but differ in terms of ease of transmission, chronicity, severity, preventability and treatability, factors which affect a range of ELSI issues
Summary
Genomic information offers the opportunity for more personalized treatment and prevention [1] in clinical practice and public health settings. As our knowledge of the role of pathogen and host genomic factors in the prevention and treatment of infectious disease expands, it is critical that we evaluate current legal frameworks to determine the extent to which current genetic privacy laws - for example, both state and federal in the US - may hinder our ability to use genetic information to protect the health of both individuals and the general public. Illustrative ELSI issues in genomic applications for particular infectious diseases Ebola The potential severity of Ebola virus disease, coupled with the absence of effective prevention or treatment, generates interest in determining whether there are host factors that protect people from, or increase their susceptibility to, contracting or spreading the infection. Those infected by that individual could be pressured to undergo genetic testing and to agree to regular follow-up if they are at increased risk of active infection
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