Genetic variant testing can identify influenza vaccine response, susceptibility to influenza infection, and infection severity among individuals. A commentary piece published in the AMA Journal of Ethics explored the ethical and legal underpinnings of hypothetical “mandatory genetic testing” for healthcare employees in the event of an influenza pandemic.1

Michelle Huckaby Lewis, MD, JD, from the Johns Hopkins Berman Institute of Bioethics in Baltimore, Maryland, described hypothetical Health Care Organization A, which mandates genetic testing in employees as a structured means of containing the influenza virus. An occupational mandate from 1970 requires that employers provide a workplace “free from recognized hazards.”2 During an influenza pandemic, genetic testing could allow for more susceptible employees to be placed with lower-risk patients as a protective measure concordant with this mandate. Genetic testing protocol could also minimize the likelihood of nosocomial infections and prevent transmissions from employees to patients. In a pandemic scenario, the protective advantages for the workforce and patient population support the use of genetic variant testing.

However, mandatory genetic testing may also constitute an undue threat to employee autonomy and privacy. Competent individuals typically have the right to withhold personal information as they choose; mandatory genetic testing infringes on this autonomy. Employees may also have concerns about the security of their genetic information or worries that employers could discriminate based on genotype. Moreover, assigning genetically less susceptible employees to high-risk patients may be perceived as an unfair burden, particularly given that lower susceptibility does not constitute total immunity. These concerns require due consideration from institutions considering genetic testing, Dr Lewis wrote.

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The Genetic Information Nondiscrimination Act of 2008 prohibits the use of genetic information in an employment setting, although the Secretary of Health and Human Services may bypass this directive in the case of a public health emergency.3,4 The 1918 Spanish influenza pandemic had an estimated death toll of 50 to 100 million people, or 3% to 5% of the global population,5 and the prospect of a modern-day pandemic of similar proportions has mobilized many scientists to consider the protective advantages of genetic variant testing. Although a scientifically useful measure, Dr Lewis warns of the ethical drawbacks, including potential violations of autonomy and privacy. In preparing for public health emergencies, scientists must proceed with caution and keep in mind the ethical foundations of mandatory genetic testing of any capacity for healthcare employees.


  1. Lewis MH. Should genetic testing for variants associated with influenza infection be mandatory for health care employees? AMA J Ethics. 2018;20(9):E819-E825.
  2. Occupational Safety and Health Act of 1970, Pub L No. 91-596, §5(a), 84 Stat 1590.
  3. The Genetic Information Nondiscrimination Act of 2008, Pub L No. 110-233, 122 Stat 881.
  4. Oregon Revised Statute §659A.300 (2017).
  5. Barry JM. The great influenza: the story of the deadliest pandemic in history. New York, NY: Penguin Books; 2009.