Public Health Genomics Research Articles

Unveiling pharmacogenomics: insights from Portuguese pharmacists on quaternary prevention

Abstract Background Public health genomics recognises the potential of genomic knowledge for enhancing population health. Adverse drug reactions (ADR) and lack of efficacy have significant clinical and economic burdens, which can be mitigated by pharmacogenomics (PGx) testing. Pharmacists can play a vital role in facilitating the implementation of PGx into routine clinical care. This will promote quaternary prevention, to protect individuals from medical intervention that can cause more harm than good. Objectives To assess attitudes, opinions, expectations, practices, and concerns of Portuguese pharmacists regarding PGx implementation. Methods An observational cross-sectional web-based survey was developed based on literature review, adapted to the national context, and validated in a focus group. The target population were adults residing in Portugal with a degree in Pharmaceutical Sciences or equivalent, with convenience sampling. Descriptive statistics were performed. Results From 303 participants, 98% believe that PGx is an important area of pharmaceutical sciences and 97% indicate that PGx should be included in continuing education. Almost all (99%) anticipate that PGx implementation will prevent the administration of ineffective drugs and inappropriate doses, 98% expect PGx will reduce ADR. Major concerns are related with direct-to-consumer sale of PGx tests via internet (78%) and unauthorized access to test results (91%). Currently, 25% are familiar with reliable sources of information on PGx, but only 11% feel qualified to recommend PGx testing, and 10% have analysed PGx reports. Conclusions There are positive opinions and expectations regarding the potential benefits of PGx tests. However, there are regulatory concerns and lack of readiness for immediate application. Pharmacists express interest in learning more about PGx, highlighting the need for continuous education and training to integrate it effectively into routine pharmaceutical practice. Key messages • Pharmacists recognize the benefits of PGx implementation for quaternary prevention. • Regulatory concerns and readiness gaps in PGx emphasise a need for training and life-long education of pharmacists.

Concept of a medical and public health cancer genomics platform

Abstract Background This study aims to produce the concept of an open-access medical and public health cancer genomics platform aimed at aggregating and sharing documentation of ongoing initiatives and data resulting from the CAN.HEAL project, available for EU researchers, healthcare professionals, policy makers, citizens and patients. Methods The context (reference sector, stakeholders and research evidences), feasibility (privacy management and data processing), and platform’s end users were analysed; the CAN.HEAL project deliverables were listed and clustered; aspects related to the definition of the overall platform architecture and modules integration were studied. Results The project deliverables were catalogued into 8 categories which could be the platform’s cloud interface main labels: results from events, policy papers, newsletters, mapping results and reports, datasets, recommendations and guidelines, use cases, courses and training activities. To define the overall system architecture, the following key activities should be implemented: content management system choice, hosting configuration and setup of the development domain, content management system installation, development of HTML web pages, data entry, data visualisation and graphic layout, and test and debug. To the modules integration purposes the following items should be addressed: creation of a server analytics account; social network integration; activation of additional system for sending newsletters. Conclusions Cloud-based data platform allows to securely manage, integrate, analyse and share large datasets. Establishing an infrastructure to help researchers access, store and analyse large amounts of biological data is of paramount importance both to enable advances in research and support health policy making processes. The CAN.HEAL platform could help aligning clinical and population-based interventions for integrating the genome of Europe biobanking initiative into public health genomics for cancer. Key messages • Connecting healthcare data can support the challenge of accessing the relevant information needed for the policy and decision making processes to effectively promote population health and wellbeing. • The set-up of a medical and public health cancer genomics platform promotes the effective translation of genome-based knowledge and technologies into public policy and health services.

Molecular Tumor Boards impact on patients’ health: towards a policy brief in the Can.Heal project

Abstract Background Molecular Tumor Boards (MTBs) are pivotal in the current management of oncological patients, integrating molecular diagnostics with clinical expertise to tailor precise treatments. Within the framework of EU-funded ‘Building EU Cancer and Public Health Genomics platform’ (Can.Heal) project that aims at streamlining genomics implementation in public health, we are developing a policy brief to promote MTBs’ adoption across the EU. Methods A two-step approach was employed to delineate strategies for MTB implementation. Firstly, we conducted a systematic review and meta-analyses (if feasible) up to November 2023, on studies assessing the MTBs’ clinical impact. Secondly, based on the results of the review, we conducted an expert consultation to identify key areas to improve MTBs implementation and impact. Results 48 studies were included, whose results were heterogeneous in terms of organizational aspects and number of experts involved (mean n: 6, range: 2-19). Average implementation rate of the recommendations issued by the MTB was 43.1% (3.2%-92%), with a turnaround time from testing to recommendation of 36 days (15-58). By pooling data from 12 studies (n = 1623), a favorable overall survival [HR = 0.63 (95% CI 0.53-0.76), I2 42.0%] was reported for patients managed in hospitals with MTBs versus not. Similar estimates were reported when the outcome was progression free survival [HR = 0.63 (95% CI 0.54-0.72), I2 = 0.0%], based on 8 studies (n = 1106). The subsequent expert consultation identified 5 key areas for MTB implementation: genetic data sharing, standards for results’ interpretation, equitable access to MTB, optimization of the testing process, and funding and reimbursement. Conclusions The policy brief underscores the significant clinical benefits of MTB-recommended therapy, improving patients’ outcomes. Nevertheless, addressing resource allocation and infrastructure development is essential to optimize MTB utilization and enhance patient outcomes. Key messages • Our results highlight that MTBs-recommended therapy translates into tangible clinical benefits. • More fundings and resources are needed to optimize and fully implement MTBs in clinical practice.

Clinical recommendations for polygenic risk score-enhanced breast cancer screening: Can.Heal project

Abstract Background The application of polygenic risk score (PRS) in breast cancer (BC) screening presents promising opportunities. Developing recommendations for future use and research on this topic is a key focus of the EU4Health project: Building the EU cancer and public health genomics platform (Can.Heal). We aim to provide these recommendations based on the analysis of available evidence through a transparent and rigorous development process. Methods The recommendations adopt the GRADE evidence to decision methodology, leveraging an evidence review team and a multidisciplinary panel of nine experts. A systematic review is being conducted to evaluate the evidence for PRS in BC screening, in the domains of benefits and harms, acceptability, feasibility, equity and cost-effectiveness. Results Regarding benefits and harms of adding PRS to BC standard screening, we identified 63 relevant articles. Forty-five (71%) discussed benefits, while 14 (22%) addressed harms. Forty-two (67%) were observational studies, 18 (28%) modeling studies and 1 non-randomised control trial (2%) that examined the diagnostic accuracy of PRS-enhanced screening for relative BC risk prediction using measures such as net reclassification index and area under the curve. Lastly, two modeling studies (3%) assessed the clinical utility of PRS-enhanced screening in terms of life years gained, BC deaths averted. The other domains are under examination. The panel convened to redefine the research question and outcomes of interest and will reconvene to assess the certainty of evidence collected, and subsequently to draft recommendations. Conclusions The integration of PRS into BC screening shows potential benefits in improving risk prediction. Ongoing trials, such as Wisdom and MyPEBS, are studying the clinical utility of integrating PRS in BC screening. The approach taken by the Can.Heal aims to ensure that the recommendations are based on a thorough and balanced evaluation of the available evidence. Key messages • The Can.Heal project aims to formulate policy and research recommendations for breast cancer screening using PRS through a thorough evidence review. • Upcoming PRS recommendations rely on expert opinion and modeling studies.

Identifying factors that influence the use of pathogen genomics in Australia and New Zealand: a protocol.

Pathogen genomics, where whole genome sequencing technologies are used to produce complete genomic sequences of pathogens, is being increasingly used for infectious disease surveillance and outbreak response. Although proof-of-concept studies have highlighted the viability of using pathogen genomics in public health, few studies have investigated how end-users utilize pathogen genomics in public health. We describe a protocol for a study that aims to identify key factors that influence the use of pathogen genomics to inform public health responses against infectious diseases in Australia and New Zealand. We will use qualitative comparative analysis (QCA), a case-oriented methodology that systematically compares and analyses multiple cases (or 'units of analysis'), to identify multiple pathways leading to the use of pathogen genomics results in public health actions. As part of the process, we will develop a rubric to identify and define the use of pathogen genomics and individual factors affecting this process. Simultaneously, we will identify cases where pathogen genomics has been used in public health across Australia and New Zealand. Data for these cases will be collected from document review of publicly available and confidential documents and semi-structured interviews with technicians and end-users and summarized in a case report. These case reports will form the basis for scoring each case on the extent of the use of pathogen genomics data and the presence or absence of specific factors such as the ease of extracting essential information from pathogen genomics reports and perceptions toward pathogen genomics. Using the scores, cases will be analyzed using QCA techniques to identify pathways leading to the use of pathogen genomics data. These pathways will be interpreted alongside the cases to provide rich explanations of the use of pathogen genomics in public health. This study will improve our understanding of the key factors that facilitate or hinder the use of pathogen genomics to inform public health authorities and end-users. These findings may inform ways to enhance the use of pathogen genomics data in public health.

Precision public health - hopes and threats.

The article formulates the following theses and conclusion: (1) the development processes of precision medicine and precision public health (PPH) are correlated; (2) the development of public health genomics depends not only on an increasingly complete exploration of the principles of the human genome, but also on a fundamentally better investigation of how broad environmental factors can alter gene expression or structure; (3) a necessary condition for the development of both precision medicine and precision public health is the collection of increasingly broader and more complete information about pro- and anti-health factors; (4) the above necessary condition is only possible in a situation of strong authoritarianism with regard to taking health-promoting measures. It is likely that in the near future public health will be shaped by health-promoting authoritarianism. There are two main problems in the development of precise public health (PPH). The first, is maintaining the right proportions between actions based on the genomic data, and actions determined by better understanding of the effect of environmental factors. The second, is the necessity to subject individuals and populations to increasingly closer pro-health surveillance, which must be increasingly more effective, forcing specific health-promoting behaviours on individual and social scales. PPH in full can only exist in conditions of complete information concerning health determinants of an individual, and each distinguished group of individuals, as well as fully pro-health organization of individual and social life, i.e. in conditions of full individual and social medicalization. However, such a full medicalization cannot be achieved in any way other than authoritarian.

Phenomics in Livestock Research: Bottlenecks and Promises of Digital Phenotyping and Other Quantification Techniques on a Global Scale.

Bottlenecks in moving genomics to real-life applications also include phenomics. This is true not only for genomics medicine and public health genomics but also in ecology and livestock phenomics. This expert narrative review explores the intricate relationship between genetic makeup and observable phenotypic traits across various biological levels in the context of livestock research. We unpack and emphasize the significance of precise phenotypic data in selective breeding outcomes and examine the multifaceted applications of phenomics, ranging from improvement to assessing welfare, reproductive traits, and environmental adaptation in livestock. As phenotypic traits exhibit strong correlations, their measurement alongside specific biological outcomes provides insights into performance, overall health, and clinical endpoints like morbidity and disease. In addition, automated assessment of livestock holds potential for monitoring the dynamic phenotypic traits across various species, facilitating a deeper comprehension of how they adapt to their environment and attendant stressors. A key challenge in genetic improvement in livestock is predicting individuals with optimal fitness without direct measurement. Temporal predictions from unmanned aerial systems can surpass genomic predictions, offering in-depth data on livestock. In the near future, digital phenotyping and digital biomarkers may further unravel the genetic intricacies of stress tolerance, adaptation and welfare aspects of animals enabling the selection of climate-resilient and productive livestock. This expert review thus delves into challenges associated with phenotyping and discusses technological advancements shaping the future of biological research concerning livestock.

The dawn of a cure for sickle cell disease through CRISPR-based treatment: A critical test of equity in public health genomics.

Equity in access to genomic technologies, resources, and products remains a great challenge. This was evident especially during the coronavirus disease 2019 (COVID-19) pandemic when the majority of lower middle-income countries were unable to achieve at least 10% population vaccination coverage during initial COVID-19 vaccine rollouts, despite the rapid development of those vaccines. Sickle cell disease (SCD) is an inherited monogenic red blood cell disorder that affects hemoglobin, the protein that carries oxygen through the body. Globally, the African continent carries the highest burden of SCD with at least 240,000 children born each year with the disease. SCD has evolved from a treatable to a curable disease. Recently, the UK medical regulator approved its cure through clustered regularly interspaced short palindromic repeat (CRISPR)-based treatment, whereas the US Food and Drug Administration has equally approved two SCD gene therapies. This presents a remarkable opportunity to demonstrate equity in public health genomics. This CRISPR-based treatment is expensive and therefore, a need for an ambitious action to ensure that they are affordable and accessible where they are needed most and stand to save millions of lives.

Public health genomics research in Italy: an overview of ongoing projects.

Public health genomics (PHG) aims to integrate advances in genomic sciences into healthcare for the benefit of the general population. As in many countries, there are various research initiatives in this field in Italy, but a clear picture of the national research portfolio has never been sketched. Thus, we aimed to provide an overview of current PHG research projects at the national or international level by consultation with Italian institutional and academic experts. We included 68 PHG projects: the majority were international projects in which Italian researchers participated (n = 43), mainly funded by the European Commission, while the remainder were national initiatives (N = 25), mainly funded by central government. Funding varied considerably, from € 50,000 to € 80,803,177. Three main research themes were identified: governance (N = 20); precision medicine (PM; N = 46); and precision public health (N = 2). We found that research activities are preferentially aimed at the clinical application of PM, while other efforts deal with the governance of the complex translation of genomic innovation into clinical and public health practice. To align such activities with national and international priorities, the development of an updated research agenda for PHG is needed.

Public attitudes, knowledge and educational needs toward genetic testing and omics sciences: a pilot survey conducted in Italy.

Advancements in genomics have significant implications for public health, making citizens' education vital for informed decision-making. Based on two literature reviews' findings and a survey conducted with experts from the Italian Network of Genomics in Public Health, we conducted a pilot survey on Italian citizens' attitudes, knowledge and educational needs toward genetic testing and omics sciences. Our results demonstrate a widespread interest in genetic testing and uncertainties regarding associated risks, with 99% of participants acknowledging insufficient knowledge of genetic testing. There is an urgent need for educational tools to improve citizens' literacy and engagement in this rapidly evolving field.

Precision Medicine for the Population—The Hope and Hype of Public Health Genomics

Public health is the most recent of the biomedical sciences to embrace “precision.” Advocates for “precision public health” (PPH) call for a data-driven, computa¬tional approach to public health, leveraging genomic and other data to inform public health decision-making. Yet, like precision medicine, PPH risks overselling the value of genomic data to deter¬mine health outcomes, but on a population level. History has shown that over-emphasizing heredity tends to disproportion¬ately harm underserved minorities and disadvantaged communities. Comparing and contrasting cur¬rent PPH with an earlier attempt at using genetics to inform pub¬lic health during the Progressive era (1890–1920) highlights some potential risks of genotype-driven preventive public health.

Age-Based Genomic Screening during Childhood: Ethical and Practical Considerations in Public Health Genomics Implementation.

Genomic sequencing offers an unprecedented opportunity to detect inherited variants that are implicated in rare Mendelian disorders, yet there are many challenges to overcome before this technology can routinely be applied in the healthy population. The age-based genomic screening (ABGS) approach is a novel alternative to genome-scale sequencing at birth that aims to provide highly actionable genetic information to parents over the course of their child's routine health care. ABGS utilizes an established metric to identify conditions with high clinical actionability and incorporates information about the age of onset and age of intervention to determine the optimal time to screen for any given condition. Ongoing partnerships with parents and providers are instrumental to the co-creation of educational resources and strategies to address potential implementation barriers. Implementation science frameworks and informative empirical data are used to evaluate strategies to establish this unique clinical application of targeted genomic sequencing. Ultimately, a pilot project conducted in primary care pediatrics clinics will assess patient and implementation outcomes, parent and provider perspectives, and the feasibility of ABGS. A validated, stakeholder-informed, and practical ABGS program will include hundreds of conditions that are actionable during infancy and childhood, setting the stage for a longitudinal implementation that can assess clinical and health economic outcomes.

Pathogen genomics in public health laboratories: successes, challenges, and lessons learned from California's SARS-CoV-2 Whole-Genome Sequencing Initiative, California COVIDNet.

The capacity for pathogen genomics in public health expanded rapidly during the coronavirus disease 2019 (COVID-19) pandemic, but many public health laboratories did not have the infrastructure in place to handle the vast amount of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequence data generated. The California Department of Public Health, in partnership with Theiagen Genomics, was an early adopter of cloud-based resources for bioinformatics and genomic epidemiology, resulting in the creation of a SARS-CoV-2 genomic surveillance system that combined the efforts of more than 40 sequencing laboratories across government, academia and industry to form California COVIDNet, California's SARS-CoV-2 Whole-Genome Sequencing Initiative. Open-source bioinformatics workflows, ongoing training sessions for the public health workforce, and automated data transfer to visualization tools all contributed to the success of California COVIDNet. While challenges remain for public health genomic surveillance worldwide, California COVIDNet serves as a framework for a scaled and successful bioinformatics infrastructure that has expanded beyond SARS-CoV-2 to other pathogens of public health importance.

Genomic analysis of SARS-CoV-2 variants of concern circulating in Hawai'i to facilitate public-health policies.

Using genomics, bioinformatics and statistics, herein we demonstrate the effect of statewide and nationwide quarantine on the introduction of SARS-CoV-2 variants of concern (VOC) in Hawai'i. To define the origins of introduced VOC, we analyzed 260 VOC sequences from Hawai'i, and 301,646 VOC sequences worldwide, deposited in the GenBank and global initiative on sharing all influenza data (GISAID), and constructed phylogenetic trees. The trees define the most recent common ancestor as the origin. Further, the multiple sequence alignment used to generate the phylogenetic trees identified the consensus single nucleotide polymorphisms in the VOC genomes. These consensus sequences allow for VOC comparison and identification of mutations of interest in relation to viral immune evasion and host immune activation. Of note is the P71L substitution within the E protein, the protein sensed by TLR2 to produce cytokines, found in the B.1.351 VOC may diminish the efficacy of some vaccines. Based on the phylogenetic trees, the B.1.1.7, B.1.351, B.1.427, and B.1.429 VOC have been introduced in Hawai'i multiple times since December 2020 from several definable geographic regions. From the first worldwide report of VOC in GenBank and GISAID, to the first arrival of VOC in Hawai'i, averages 320 days with quarantine, and 132 days without quarantine. As such, the effect of quarantine is shown to significantly affect the time to arrival of VOC in Hawai'i. Further, the collective 2020 quarantine of 43-states in the United States demonstrates a profound impact in delaying the arrival of VOC in states that did not practice quarantine, such as Utah. Our data demonstrates that at least 76% of all definable SARS-CoV-2 VOC have entered Hawai'i from California, with the B.1.351 variant in Hawai'i originating exclusively from the United Kingdom. These data provide a foundation for policy-makers and public-health officials to apply precision public health genomics to real-world policies such as mandatory screening and quarantine.

Implementation of Public Health Genomics in Africa: Lessons from the COVID-19 pandemic, challenges, and recommendations.

Public Health Genomics (PHG) is a relatively new field. The wide application of genomic technologies played a pivotal role in elucidating the full genomic sequence of the SARS-CoV-2 virus. This breakthrough proved to be the starting point in the manufacture of diagnostic kits and the subsequent making of vaccines. Beyond the COVID-19 pandemic, many African countries can take advantage of the various investments in genomic technologies to introduce and intensify the use of genomics for public health gain. Public Health Genomics effectively monitors, prevents, and manages non-communicable and infectious diseases. However, there are several challenges to implementing PHG in Africa. In this perspective article, we discuss the utilization of PHG during the COVID-19 pandemic, the lessons learned from using PHG to manage and contain the COVID-19 pandemic, as well as potential challenges Africa may face when putting PHG into practice compared to challenges of other regions. We also discuss our recommendations for overcoming these challenges.

Public health genomics capacity assessment: readiness for large-scale pathogen genomic surveillance in Canada’s public health laboratories

BackgroundAlong with rapid diagnostic testing, contact tracing, and public health measures, an effective pandemic response incorporates genomics-based surveillance. Large-scale SARS-CoV-2 genome sequencing is a crucial component of the global response to COVID-19. Characterizing the state of genomics readiness among Canada’s public health laboratories was necessary to inform strategic planning and deployment of capacity-building resources in the early stages of the pandemic.MethodsWe used a qualitative study design and focus group discussions, encompassing both technical and leadership perspectives, to perform an in-depth evaluation of the state of pathogen genomics readiness in Canada.ResultsWe found substantial diversity in the state of readiness for SARS-CoV-2 genomic surveillance across Canada. Despite this variability, we identified common barriers and needs in the areas of specimen access, data flow and sharing, computing infrastructure, and access to highly qualified bioinformatics personnel.ConclusionsThese findings enable the strategic prioritization and deployment of resources to increase Canada’s ability to perform effective public health genomic surveillance for COVID-19 and prepare for future emerging infectious diseases. They also provide a unique qualitative research model for use in capacity building.

Impact of Genomics on the Future of Healthcare

Genomics has become an increasingly mature discipline, but there are still many problems to be solved. One of them is how to use genomics to personalize precision therapy for the population. This paper introduces the potential application of genomics in the prediction, prevention, diagnosis, and treatment of diseases. Discusses the frontier problems of genomics research, difficulties in the development of genomics, and puts forward new thinking for the application of genomics in public health.

Managing the introduction of genomic applications into the National Health Service: A special challenge for health technology assessment in Italy.

In recent years, the rapid proliferation of genomic tests for use in clinical practice has prompted healthcare systems to use a health technology assessment (HTA) approach to distinguish valuable from unwarranted applications. In this study, we narratively review the Italian HTA mechanisms for medical devices (MDs), both at the national and regional levels, and discuss the opportunity and benefits of extending them to genomic technologies, for which a dedicated assessment path was advocated by the National Plan for Public Health Genomics in 2017. We found that the National Health Technology Assessment Program for MDs, completed in 2019, had developed a structured pathway for the HTA of MDs; it established a hub-and-spoke structure, run by a governmental institution, and put in place transparent methodological procedures to cover all four HTA phases (i.e., proposal and prioritization, assessment, appraisal, and dissemination). However, several factors have hindered its adoption, and the regions are at different stages of its implementation. For these reasons, efforts should be made to ensure its effective deployment, both at national and regional levels. In addition, we argue that to harmonize the institutional roles and methodological procedures adopted, the time has come to concentrate resources on a single pathway for the assessment of all technologies that include both MDs and genomic applications.

Proficiency testing for SARS-CoV-2 whole genome sequencing

Extensive studies and analyses into the molecular features of severe acute respiratory syndrome related coronavirus 2 (SARS-CoV-2) have enhanced the surveillance and investigation of its clusters and transmission worldwide. The whole genome sequencing (WGS) approach is crucial in identifying the source of infection and transmission routes by monitoring the emergence of variants over time and through communities. Varying SARS-CoV-2 genomics capacity and capability levels have been established in public health laboratories across different Australian states and territories. Therefore, laboratories performing SARS-CoV-2 WGS for public health purposes are recommended to participate in an external proficiency testing program (PTP). This study describes the development of a SARS-CoV-2 WGS PTP. The PTP assessed the performance of laboratories while providing valuable insight into the current state of SARS-CoV-2 genomics in public health across Australia. Part 1 of the PTP contained eight simulated SARS-CoV-2 positive and negative specimens to assess laboratories' wet and dry laboratory capacity. Part 2 involved the analysis of a genomic dataset that consisted of a multi-FASTA file of 70 consensus genomes of SARS-CoV-2. Participating laboratories were required to (1) submit raw data for independent bioinformatics analysis, (2) analyse the data with their processes, and (3) answer relevant questions about the data. The performance of the laboratories was commendable, despite some variation in the reported results due to the different sequencing and bioinformatics approaches used by laboratories. The overall outcome is positive and demonstrates the critical role of the PTP in supporting the implementation and validation of SARS-CoV-2 WGS processes. The data derived from this PTP will contribute to the development of SARS-CoV-2 bioinformatic quality control (QC) and performance benchmarking for accreditation.

Chief Medical Officers meeting on implementing a public health genomics approach

During the Italian Presidency of the Council of European Union, on October, 2014, the Italian Ministry of Health invited the Chief Medical Officers in Rome for a meeting on the European policies of public health genomics. Following reports on the current policies of public health genomics in Italy and Europe, the policy implications for health systems of advancements in genomics were discussed. Specifically, participants at the CMOs’ Meeting acknowledged the challenge faced in effectively and responsibly integrating genomics into public health research, policy and practice. Additionally, the participants agreed that the translation process need to be supported by empirical evidence of effectiveness and cost-effectiveness. The participants agreed that the application of genome-based technologies and information for the prevention, diagnosis and treatment of diseases of public health significance still holds a great promise. These advances also raise certain ethical, legal and social issues concerning the potential of genomics to undermine the collectivistic approach in public health and thus equity. The CMOs also acknowledge the importance of research on genomics to improve patienttargeted care and for technological development in EU Member States, and appreciate the role that EU research programs can contribute to this field. • Those present also argued that public health professionals and those who are responsible for designing health systems should engage with the genomics agenda in order to ensure proper balance, and to make policy makers aware of its relevance; • That the financial burden imposed by genomic-related technologies has the potential to overwhelm the available resources for health systems and to broaden health inequalities, highlighting the need for careful planning; • Member States could, in line with their-own national policies on health, take additional steps to: develop and implement comprehensive strategies or plans in the field, also (1) Section of Hygiene-Institute of Public Health-Faculty of