The ethics of using COVID-19 host genomic information for clinical and public health decision-making: A survey of US health professionals

Sheethal Jose; Gail Geller; Juli Bollinger; Debra Mathews; Jeffrey Kahn; Brian T Garibaldi

doi:10.1016/j.xhgg.2023.100255

The ethics of using COVID-19 host genomic information for clinical and public health decision-making: A survey of US health professionals

HGG Adv. 2024 Jan 11;5(1):100255. doi: 10.1016/j.xhgg.2023.100255. Epub 2023 Nov 17.

Authors

Sheethal Jose¹, Gail Geller², Juli Bollinger³, Debra Mathews⁴, Jeffrey Kahn⁵, Brian T Garibaldi⁶

Affiliations

¹ 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. Electronic address: sheethal.jose@jhu.edu.
² 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.
³ Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD 21205, USA.
⁴ Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD 21205, USA; Department of Genetic Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA.
⁵ 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.
⁶ Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA.

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.

Keywords: COVID-19; clinical; ethical; ethics; health professionals; host genomics; infectious disease; legal and social issues (ELSI); public health; stakeholders; survey.

MeSH terms

COVID-19* / epidemiology
Communicable Diseases*
Cross-Sectional Studies
Genomics
Humans
Public Health

Grants and funding

RM1 HG009038/HG/NHGRI NIH HHS/United States