Precision medicine unlocks precision public health, which is key to pandemic response and prevention

Precision public health (PPH) is an emerging focus area. It can be described as providing the right intervention to the right population at the right time.Citation41 The advances in new technologies such as the availability of individual and ethnic level genetic risk information, Citation42 socioeconomic data,Citation43 the implementation of artificial intelligence to large medical datasets Citation44 and community social media posts Citation45 allow better direction of public health efforts to appropriate populations in the most acceptable format. This may lead to precision vaccines for smaller numbers of people and/or patient-groups. Indeed, Dr. Stanley Plotkin who is often referred to as the “Godfather of Vaccinology” emphasized that the next revolution in vaccinology is the development of vaccines for individuals (groups), rather than the population, that currently administered vaccines are not fully protective in certain populations, and that there is a need to evaluate vaccine safety and efficacy in specific populations.Citation26 During pandemics, mass policies are needed to quickly induce immunity among large populations to stop the spread of the pathogen. Early on during the COVID-19 pandemic, the European Commission introduced a vaccination certificate called the “Digital Green Certificate” (DGC) which has been shown to be very effective in slowing down the spread of the virus.Citation46 In the United States, the majority of early COVID-19 initiatives focused on large-scale policies like physical distancing, business and school closures, face-mask mandates, and mass vaccination of the elderly and the immunocompromised.Citation47 While these policies were effective for decelerating viral spread, hospitalization, and mortality among the most vulnerable, other more targeted and precise approaches, like equitable vaccine delivery, were needed to provide protection for essential workers, for those in low-income neighborhoods and among Latinx and Black communities who were less likely to work remote jobs.Citation47 During the early stages of the pandemic, these individuals were largely unprotected by policies like physical distancing and closures and thus, disproportionately affected by COVID-19 disease.Citation30 In addition, a few states in the United States, such as California, implemented precision public health measures, such as mass vaccination events in sports arenas, colleges and designated “hot-spot” zip codes to improve the access to the COVID-19 vaccine.Citation47 Recently, Fourati and colleagues conducted a large transcriptomic study (namely, microarray and RNA sequencing) to characterize the host pre-vaccine immune profile that is associated with the strongest antibody responses across 13 different vaccines.Citation48 They characterized the pre-vaccination peripheral blood immune transcriptional signature among 820 healthy individuals and observed that there was significant inter-individual heterogeneity in the inflammatory state of the peripheral immune system before the vaccination. They grouped the patients as inflam.hi, imflam.mid and imflam.lo by blood transcriptional signatures and a distinct distribution of cell subsets before vaccination. They observed that people with baseline high level activation of inflammatory genes, specifically those associated with IL-1 and NF-kB signaling, mounted a stronger antibody response.Citation31 In this study, the investigators did not evaluate the relationship between the transcriptional signatures and safety signals; however, transcriptomics may also be used to identify individuals who are at higher risk for vaccine adverse effects.Citation48 When clinical trials do not provide a sufficient amount of benefit data for a routine age or risk group, the Advisory Committee on Immunization Practices (ACIP) of the CDC may recommend “shared clinical decision-making (SCDM)” for vaccine administration.Citation49 During SCDM, the primary care provider and the patient (or parent of the patient) make a personalized vaccination decision based on the provider’s broader knowledge of the patient’s characteristics including risk factors, values, preferences and the family medical background.Citation49 The COVID-19 pandemic made it clear that we are moving from “herd” immunity of healthy infants to precision vaccination of smaller groups. Active communication between a trusted provider and the patient/caregiver and SCDM may help achieve precision in public health and vaccines. In 1892, Sir William Osler stated, “if it were not for the great variability among individuals, medicine might as well be a science and not an art.” Artificial intelligence (AI) has the computational power to collect, analyze and potentially identify the biological and socioeconomic profile of smaller groups within a large community and may be used to support precision in infectious diseases, vaccines and public health. AI, however, has limitations.Citation50 Granted that data security and patient privacy are achieved, the quality of data generated by AI is restricted with the amount and quality of input data and quality of the model. Similar to clinical trials, there is a need for data from a diverse range of people from different racial/ethnic and socioeconomic backgrounds, especially vulnerable populations, which is often challenging. AI findings need to be tested and confirmed, but most importantly, new interventions need to be designed and scientifically tested to fully achieve the benefits of AI. In conclusion, precision in infectious diseases and vaccine development will lead to the development of safer and more effective vaccines, and precision in AI and public health will improve the efficiency and prioritization to deliver the right vaccines to the most appropriate populations, leading to the restoration of trust in vaccines, healthcare, science and public health.