Blockchain and homomorphic encryption for genomic and health data sharing: An ethical perspective

Background: Sharing genomic data is crucial for public health research, yet it poses significant privacy risks, necessitating innovative solutions to balance data accessibility with individual protection. This study investigates the ethical dimensions of a hybrid system integrating blockchain and homomorphic encryption for secure genomic data sharing in health contexts. Methods: We conducted a literature review of studies in MEDLINE and Google Scholar, and used the eight peer-reviewed studies uncovered to construct an in-depth description of the hybrid system. We then assessed its performance in achieving public ethics objectives using a framework derived from published public health ethics principles pertaining to data sharing in public health. The evaluation involved conducting a thematic analysis of the information relevant to each objective from the published studies. Results: We find that the hybrid system aligns well with tenets of public health ethics, including accountability, fairness, respect for persons, privacy, and public health goals, through mechanisms like transparent record-keeping, secure data access, and privacy-preserving computation. However, scalability poses a major challenge, hindered by computational overhead and insufficient stakeholder comprehension. Conclusions: Our results imply that while the hybrid system can support data sharing while safeguarding individual rights, its practical implementation is limited without addressing scalability. This study underscores the need to highlight scalability as a fundamental ethical principle in evaluating digital public health technologies.