title: Genomics and infectious disease: a call to identify the ethical, legal and social implications for public health and clinical practice.
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.
authors.affiliation: Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD 21205 USA ; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205 USA ; Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205 USA ; Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205 USA.
authors.forename: Gail
authors.initials: G
authors.lastname: Geller
authors.affiliation: Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD 21205 USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Dvoskin
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205 USA.
authors.forename: Chloe L
authors.initials: CL
authors.lastname: Thio
authors.affiliation: Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205 USA.
authors.forename: Priya
authors.initials: P
authors.lastname: Duggal
authors.affiliation: Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD 21205 USA.
authors.forename: Michelle H
authors.initials: MH
authors.lastname: Lewis
authors.affiliation: Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD 21205 USA ; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205 USA.
authors.forename: Theodore C
authors.initials: TC
authors.lastname: Bailey
authors.affiliation: Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205 USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Sutherland
authors.affiliation: Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205 USA ; Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205 USA.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Salmon
authors.affiliation: Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD 21205 USA ; Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205 USA.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Kahn