Ethical and policy implications of vaccinomics in the United States: community members' perspectives

Jennifer E Gerber; Janesse Brewer; Rupali J Limaye; Andrea Sutherland; Gail Geller; Christine I Spina; Daniel A Salmon

doi:10.1080/21645515.2020.1859318

Ethical and policy implications of vaccinomics in the United States: community members' perspectives

Hum Vaccin Immunother. 2021 Jul 3;17(7):2133-2144. doi: 10.1080/21645515.2020.1859318. Epub 2021 Feb 24.

Authors

Jennifer E Gerber¹, Janesse Brewer¹, Rupali J Limaye^{1

2

3

4

5}, Andrea Sutherland¹, Gail Geller^{4

6

7

8}, Christine I Spina⁷, Daniel A Salmon^{1

2

4

9

10}

Affiliations

¹ Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
² Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
³ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁴ Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public, Baltimore, MD, USA.
⁵ International Vaccine Access Center, International Vaccine Access Center, Baltimore, MD, USA.
⁶ Department of Medicine, Johns Hopkins School of Medicine.
⁷ Department of Health Policy, Johns Hopkins Bloomberg School of Public, Baltimore, MD, USA.
⁸ Berman Institute of Bioethics, Deering Hall, Baltimore, MD, USA.
⁹ Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
¹⁰ Children's Hospital Colorado, Aurora, CO, USA.

Abstract

Objectives: We aimed to elucidate public values regarding the use of genomics to improve vaccine development and use (vaccinomics).Methods: Adults ≥18 years-old were recruited through social media and community organizations, and randomly assigned to one of four nested discussion groups in Boulder, CO and Baltimore, MD. Participants rated their confidence in vaccine safety and effectiveness prior to and after discussing vaccinomics. Before departing, they prioritized funding for vaccinomics versus federal priorities (vaccine safety and efficacy, new vaccines, and free vaccines) and chronic diseases (cancer, heart disease, and diabetes). Grounded Theory-influenced methods were used to identify themes.Results: Participants broadly supported vaccinomics. Emergent themes: concerns about reduced privacy/confidentiality, increased genetically based stigma/discrimination, and reduced agency to make vaccine-related decisions through genetically based prioritization. Participants supported vaccinomics' potential for increased personalization. Some participants favored prioritizing others over themselves during a vaccine shortage, while others did not. Some participants worried health insurance companies would discriminate against them based on information discovered through vaccinomics. Participants feared inequitable implementation of vaccinomics would contribute to discrimination and marginalization of vulnerable populations. Discussing vaccinomics did not impact perceptions of vaccine safety and effectiveness. Federal funding for vaccinomics was broadly supported.Conclusion: Participants supported vaccinomics' potential for increased personalization, noting policy safeguards to facilitate equitable implementation and protect privacy were needed. Despite some concerns, participants hoped vaccinomics would improve vaccine safety and effectiveness. Policies regarding vaccinomics' implementation must address public concerns about the privacy and confidentiality of genetic information and potential inequities in access to vaccinomics' benefits.

Keywords: Genomics; Infectious disease; Vacccinomics; Vaccines; Values.

Publication types

Randomized Controlled Trial
Research Support, N.I.H., Extramural

MeSH terms

Adolescent
Adult
Biomedical Research*
Genomics
Humans
Policy
United States
Vaccines*

Substances

Vaccines

Grants and funding

RM1 HG009038/HG/NHGRI NIH HHS/United States