Ethical issues in infectious disease genomics

19 September 2013

A US centre has received new funding from the National Human Genome Research Institute (NHGRI) to examine the ethical, legal and social implications (ELSI) of genomic research in infectious disease treatment and prevention.
 
The John Hopkins Berman Institute of Bioethics is to establish GUIDE: Genomic Uses in Infectious Disease & Epidemics, a centre that will use ‘expertise in the ethics of human genomics and public health’ to study genomics and infectious disease.
 
The centre will focus initially on two areas, pandemic influenza and Hepatitis C. Research into pandemic influenza will include examination of how human genome variation influences individual responses to flu infections and vaccines, with a view to potential stratification of populations to identify those with different levels of infection risk. Research into ELSI arising from Hepatitis C investigations will examine issues of clinical disclosure and decision-making related to genetically determined variation in response to Hepatitis C virus (HCV) infection and treatment; in particular, should those most likely to respond well and clear infection be prioritised for treatment?
 
Comment: Infectious disease genomics are certainly a current priority for public health genomics, and the case studies the new centre will examine provide examples of some important clinical and public health ethical issues that human genomic variation may provoke in this context – identifying different subpopulations and tailoring vaccination or treatment accordingly. This is a form of personalised medicine that we can expect to see much more of in the future.

However, infectious disease genomics is a much wider area than this, and in fact the emerging capacity to rapidly sequence and analyse the genomes of infectious agents themselves is arguably a more pressing clinical and public health issue. Practitioners can use pathogen genomics for precise diagnosis of microbes, and to determine their susceptibility to different antibiotics. This is important not only for controlling disease in the patient, but also for monitoring and controlling the spread of disease in hospitals and communities, and of the growing tide of antimicrobial resistance (see previous news). Moreover, the movement of genome sequencing into infectious disease practice calls for urgent consideration of clinical, economic and logistic issues – as well as ethical, legal, social implications. 

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