Dr. Muin Khoury is the Director at the Office of Genomics and Precision Public Health at the CDC. The Office of Genomics and Precision Public Health was formed in 1997 to assess the impact and advantages of human genetics and the Human Genome Project on public health and disease prevention. Over the decades, the office has served CDC programs as well as other federal agencies, state health departments, and external partners by identifying, evaluating, and implementing evidence-based genomics practices to prevent and control the country’s leading chronic, infectious, and environmental, and occupational diseases.
We recently spoke to Dr. Khoury to learn more about the important work of his office in the fields of genomics and precision public health.
ASHG: How would you define public health genomics, and what is the role of your office in the integration of human genomics into public health?
Dr. Khoury: Public health genomics is a multidisciplinary field concerned with the effective and responsible translation of genome-based knowledge and technologies to improve population health. It emerged as a result of advances in genomics and other fields. The CDC of Public Health Genomics was created in 1998 in response to the human genome project to help CDC and public health program integrate genomics into surveillance, policy and programs. The Office functions are to identify, inform and integrate:
- The Office identifies genomic testing, family health history, and other -omic applications that are ready to impact health if implemented effectively.
- The Office informs programs, providers, researchers and the public about evidence-based genomic and precision health applications to impact population health
- The Office integrates evidence-based genomic and precision health applications into practice and programs:
More details about office functions can be found in the CDC “Genomics and Precision Public Health At a Glance” page.
ASHG: You recently changed the name of your office from the Office of Public Health Genomics to the Office of Genomics and Precision Public Health. What led to the name change and does it reflect a change in the scope of the office’s work?
Dr. Khoury: The term precision medicine is now well accepted and refers to new approaches to treatment and prevention that take into account differences in lifestyle, environment, and biology. Precision medicine starts with the individual. It has a firm foundation in genomics, and other ‘omic’ fields (such as epigenomics and metabolomics). More recently, the term “precision” has made its way to the realm of public health. For some, the term precision medicine is used interchangeably with genomic medicine, and precision public health is viewed as the application of precision medicine in populations.
We think there is a bigger role for “precision” in measuring population health and disease beyond genomics. Increasingly, a large volume of health and non-health related data (“big data” and associated analytics) from multiple sources are becoming available. Precision public health is about using the best available data by place, time, and persons, to target more effectively and efficiently interventions of all kinds to those most in need. Precision in public health is rooted in multiple determinants of health and disease, with an emphasis on social and environmental determinants that drive health outcomes and health inequities in the population.
A more detailed explanation of this change can be found in the 2019 CDC blog post “What’s in a name? Introducing the CDC Office of Genomics and Precision Public Health”.
ASHG: What are the major barriers and opportunities for advancing public health genomics and precision public health, and how can the human genetics and genomics research community support progress in these areas?
Dr. Khoury: Major barriers often include the lack of robust and sustainable capacity to apply advances in genomics and precision health to population health. This includes the need for a diverse workforce and training at the intersection of public health and genomics, applied translational research and programs. A major challenge is health disparities in health and healthcare. Ensuring the diversity of the public health and genomics workforce provides an opportunity for the field to help ensure that advances in genomics, big data and other predictive analytics reach all communities and can benefit health across all populations.
In 2021, our office launched a new initiative in public health genomics to strengthen CDC’s capacity to integrate human genomics into both public health surveillance and applied research. The initiative will enhance the ability to identify populations at risk for infectious and chronic diseases, enhance effective prevention efforts, and help guide effective and equitable implementation of human genomic discoveries. See more description here. More details on this public health initiative can be found in the December 2021 blog post “Genomics and Precision Medicine, 2021: Progress in Implementation, A Focus on Health Equity, and a New Public Health Initiative”.
ASHG: You have spoken publicly about how the COVID-19 pandemic has highlighted some of the challenges of precision public health. How has the pandemic informed your work and impacted the priorities of the Office of Genomics and Precision Public Health?
Dr. Khoury: The pandemic has really put into sharp focus the need for genomics and precision public health tools to combat COVID-19. More precise data by time, place and persons is needed to help with mitigation measures, understand who is at risk from infection, severe complications, and response to vaccines. Just like the rest of CDC, our office sharpened our stated “identify, inform and integrate” functions into our daily work on COVID-19. For example, in 2020 our office launched the COVID-19 Genomics and Precision Health (GPH) portal – an online, continuously updated, searchable database of published scientific literature and other information that capture the emerging discoveries and applications of genomics, molecular and other precision health tools in the investigation and control of COVID-19.
ASHG: When training the next generation of human genetics researchers, clinicians and public health professionals, what do we need to be teaching them about public health genomics and precision public health? How can education improve in this regard?
Dr. Khoury: Public health sciences and practice are crucial on the translational research continuum from discovery to epidemiology, implementation science, behavioral sciences, etc… As genomics becomes more mainstream in clinical practice and public health programs, we need more people trained at the intersection of genomics, big data and public health. Right now, the field is thin. We need more training across the board. Over the years, our office has welcomed students, fellows and faculties on sabbatical interested in public health applications and impact of their genomic work. We would like to continue this tradition in the next year by engaging the ASHG community at large, especially the younger generations. We need a new batch of leaders in precision public health.
More examples of implementation and information on the evolution of precision public health can be found in the video “From Public Health Genomics to Precision Public Health, a 20-Year Journey”.