Table 1 Examples of infectious diseases of varying characteristics, relevant host genomic discoveries and anticipated ELSI issues
Disease example | Characteristics | Host genetic association(s) | Illustrative ELSI issue | ||||
|---|---|---|---|---|---|---|---|
Chronicity | Contact | Severity | Treatability | Preventability | |||
Ebola | Acute | Close | Unknown; high case fatality in epidemics | No | No | None right now | Restricting civil liberties by using genomic information to inform quarantine policy or travel restrictions |
Fairness implications of genotype-based triage decisions in resource-limited settings | |||||||
Pandemic influenza | Acute | Casual | Variable | Yes, but variable | Yes, but variable | Markers associated with increased susceptibility to infection, severity of disease and response to vaccine | Imposing workforce restrictions on healthcare personnel or selectively excluding students who are more likely to be super-spreaders from educational settings during a pandemic |
Hepatitis B | Chronic form | Close | Often Severe | Yes, but no cure | Yes (vaccine is 95% effective) | Markers associated with vaccine non-response | Prioritizing access to therapy for vaccine non-responders based on genotype, particularly in resource-limited settings |
Exempting vaccine non-responders from job-dependent mandatory vaccination | |||||||
Tuberculosis | Chronic, active form | Casual | Variable | Yes, but low efficacy, side effects and multidrug resistance | Vaccine only 20% effective | Markers associated with susceptibility to active disease in particular ethnic or geographic populations | Targeting specific, marginalized subgroups for genotyping (for example, prisoners, native populations, inner city communities) and then treating individuals differentially based on their genetic susceptibility to active infection |