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Jose S, Geller G, Bollinger J, Mathews D, Kahn J, Garibaldi BT. The ethics of using COVID-19 host genomic information for clinical and public health decision-making: A survey of US health professionals. HGG ADVANCES 2024; 5:100255. [PMID: 37978805 PMCID: PMC10746522 DOI: 10.1016/j.xhgg.2023.100255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023] Open
Abstract
Several genetic variants linked to COVID-19 have been identified by host genomics researchers. Further advances in this research will likely play a role in the clinical management and public health control of future infectious disease outbreaks. The implementation of genetic testing to identify host genomic risk factors associated with infectious diseases raises several ethical, legal, and social implications (ELSIs). As an important stakeholder group, health professionals can provide key insights into these ELSI issues. In 2021, a cross-sectional online survey was fielded to US health professionals. The survey explored how they view the value and ethical acceptability of using COVID-19 host genomic information in three main decision-making settings: (1) clinical, (2) public health, and (3) workforce. The survey also assessed participants' personal and professional experience with genomics and infectious diseases and collected key demographic data. A total of 603 participants completed the survey. A majority (84%) of participants agreed that it is ethically acceptable to use host genomics to make decisions about clinical care and 73% agreed that genetic screening has an important role to play in the public health control of COVID-19. However, more than 90% disagreed that it is ethically acceptable to use host genomics to deny resources or admission to individuals when hospital resources are scarce. Understanding stakeholder perspectives and anticipating ELSI issues will help inform policies for hospitals and public health departments to evaluate and perhaps adopt host genomic technologies in an ethically and socially responsible manner during future infectious disease outbreaks.
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Affiliation(s)
- Sheethal Jose
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD 21205, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Gail Geller
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD 21205, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Juli Bollinger
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Debra Mathews
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD 21205, USA; Department of Genetic Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Jeffrey Kahn
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD 21205, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Brian T Garibaldi
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
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Scudeller L. Infectious diseases and inborn errors of immunity. Clin Microbiol Infect 2022; 28:1409-1410. [PMID: 35654314 DOI: 10.1016/j.cmi.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 05/09/2022] [Indexed: 11/20/2022]
Affiliation(s)
- Luigia Scudeller
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Reseach and Innovation Unit, Bologna, Italy.
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Walker A, Bonham VL, Boyce A, Clayton EW, Garcia D, Johnson S, Laeyendecker O, Lewis M, Margolick JB, Mathews D, Parker MJ, Spicer P, Thio CL, Geller G, Kahn J. Ethical Issues in Genetics and Infectious Diseases Research: An Interdisciplinary Expert Review. ETHICS, MEDICINE, AND PUBLIC HEALTH 2021; 18:100684. [PMID: 34263019 PMCID: PMC8274576 DOI: 10.1016/j.jemep.2021.100684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE Research in genetics and infectious diseases (ID) presents novel configurations of ethical, legal, and social issues (ELSIs) related to the intersection of genetics with public health regulations and the control of transmissible diseases. Such research includes work both in pathogen genetics and on the ways that human genetics affect responses to ID. This paper identifies and systematizes the unique issues at this intersection, based on an interdisciplinary expert review. BASIC PROCEDURES This paper presents results of a formal issue-spotting exercise among twenty experts in public health, law and genomics, biobanking, genetic epidemiology, ID medicine and public health, philosophy, ethics and ID, ethics and genomics, and law and ID. The focus of the exercise was on the collection, storage, and sharing of genetic information relating to ID. MAIN FINDINGS The issue-spotting exercise highlighted the following ELSIs: risks in reporting to government authorities, return of individual research results, and resource allocation - each taking on specific configurations based on the balance between public health and individual privacy/protection. PRINCIPAL CONCLUSIONS The public health implications of interactions between genomics and ID frame considerations for equity and justice. In the context of the COVID-19 pandemic, these issues are especially pressing.
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Affiliation(s)
- Alexis Walker
- Berman Institute of Bioethics, Johns Hopkins University, 1809 Ashland Avenue, Baltimore MD 21205 USA
| | - Vence L. Bonham
- Social and Behavioral Research Branch, National Human Genome Research Institute, 31 Center Drive, Bethesda MD 20894 USA
| | - Angie Boyce
- Berman Institute of Bioethics, Johns Hopkins University, 1809 Ashland Avenue, Baltimore MD 21205 USA
| | - Ellen Wright Clayton
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville TN 37232 USA
| | - Debra Garcia
- International Society for Biological and Environmental Repositories, 750 W Pender St #301, Vancouver BC V6C 1G8 Canada
| | - Stephanie Johnson
- Wellcome Centre for Ethics and the Humanities and Ethox Centre, University of Oxford, Oxford OX1 2JD UK
| | - Oliver Laeyendecker
- Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore MD 21205 USA,National Institute of Allergy and Infectious Diseases, National Institutes of Health, 5601 Fishers Ln, Bethesda, MD 20892 USA
| | - Michelle Lewis
- Berman Institute of Bioethics, Johns Hopkins University, 1809 Ashland Avenue, Baltimore MD 21205 USA
| | - Joseph B. Margolick
- Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore MD 21205 USA
| | - Debra Mathews
- Berman Institute of Bioethics, Johns Hopkins University, 1809 Ashland Avenue, Baltimore MD 21205 USA,Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore MD 21205 USA
| | - Michael J. Parker
- Wellcome Centre for Ethics and the Humanities and Ethox Centre, University of Oxford, Oxford OX1 2JD UK
| | - Paul Spicer
- Department of Anthropology and the Center for Applied Social Research, University of Oklahoma, 455 W Lindsey St, Norman OK 73069 USA
| | - Chloe L. Thio
- Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore MD 21205 USA
| | - Gail Geller
- Berman Institute of Bioethics, Johns Hopkins University, 1809 Ashland Avenue, Baltimore MD 21205 USA,Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore MD 21205 USA
| | - Jeffrey Kahn
- Berman Institute of Bioethics, Johns Hopkins University, 1809 Ashland Avenue, Baltimore MD 21205 USA,Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore MD 21205 USA
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Geller G, Duggal P, Thio CL, Mathews D, Kahn JP, Maragakis LL, Garibaldi BT. Genomics in the era of COVID-19: ethical implications for clinical practice and public health. Genome Med 2020; 12:95. [PMID: 33168072 PMCID: PMC7649891 DOI: 10.1186/s13073-020-00792-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/26/2020] [Indexed: 12/26/2022] Open
Abstract
Genomic studies of patients with COVID-19, or exposed to it, are underway to delineate host factors associated with variability in susceptibility, infectivity, and disease severity. Here, we highlight the ethical implications-both potential benefits and harms-of genomics for clinical practice and public health in the era of COVID-19.
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Affiliation(s)
- Gail Geller
- Berman Institute of Bioethics, Johns Hopkins University, Deering Hall, Room 202, 1809 Ashland Ave., Baltimore, MD, 21205, USA. .,Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA.
| | - Priya Duggal
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Chloe L Thio
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins School of Medicine Hepatitis Center, 855 N. Wolfe St. Rangos Room 533, Baltimore, MD, 21205, USA
| | - Debra Mathews
- Berman Institute of Bioethics, Johns Hopkins University, Deering Hall, Room 202, 1809 Ashland Ave., Baltimore, MD, 21205, USA.,Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeffrey P Kahn
- Berman Institute of Bioethics, Johns Hopkins University, Deering Hall, Room 202, 1809 Ashland Ave., Baltimore, MD, 21205, USA.,Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Lisa L Maragakis
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins School of Medicine Infection Control, 600 N. Wolfe St., Osler 425, Baltimore, MD, 21205, USA
| | - Brian T Garibaldi
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins University School of Medicine Pulmonology, 5501 Hopkins Bayview Circle, Baltimore, MD, 21224, USA
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