CK AVE SICK LEAVE SICK LEAVE SICK LEAVE SICK LEAVE SICK LEAVE SICK LEAVE SICK LEAVE SICK LEAVE SICK LEAVE SICK LEAVE SICK LEAVE SICK LEAVE SICK LEAVE SICK LEAVE SICK LEAVE SICK LEAVE SICK LEAVE SICK LEAVE SICK LEAVE SICK LEAVE SICK LEAVE SICK LEAVE SICK LEAVE SICK LEAVE SICK LEAVE SICK LEAVE SICK LEAVE SICK LEAVE Strategies for seasonal influenza Spreading prevention across the workforce Contents About the report Executive summary Introduction: Picking influenza out of a crowd Chapter 1: Business perceptions of seasonal influenza Chapter 2: Preventing seasonal influenza 14 Chapter 3: Fighting mistrust, misunderstanding and misinformation 20 Conclusion 25 Appendix: Survey results 26 © The Economist Intelligence Unit Limited 2013 Strategies for seasonal influenza Spreading prevention across the workforce About the report Strategies for seasonal influenza: spreading prevention across the workforce is an Economist Intelligence Unit report, sponsored by Novartis It analyses changing corporate perceptions in the US and western Europe about the impact of seasonal influenza and the prevention measures companies are putting in place This report draws on two main sources for its research and findings: • Al Smith, corporate director, safety, Greyhound Lines (US) • Doug Quarry, medical director, medical information and analysis, International SOS (UK) • Rod Ratsma, head of UK business continuity management practice, Marsh Risk Consulting • Jenny Hawker, health management consultant, Mercer UK  In June 2013, The Economist Intelligence Unit surveyed 418 senior business executives from the US, the UK, Germany, France, Italy and Spain—one-half of whom are from the board or C-level (CEO, CFO, CIO, etc) Twenty industries are represented in this sample, with just over one-quarter (28%) of companies coming from financial services or manufacturing Around one-half of these companies have more than 500 employees or more than US$500m in annual revenue • Helen Darling, president and chief executive, National Business Group on Health (US)  Alongside the survey, we conducted a series of in-depth interviews with senior executives, academics and other experts, supplemented by the desk research of relevant third party publications Our thanks are due to the following for their time and insights (listed alphabetically by organisation): • Judy Harvey, manager, corporate industrial hygiene and workplace safety program, United Technologies (US) • William Fried, senior medical director, Aetna (US) • Janice Hartgens, global occupational health manager, UPS (US) • Frank Fox, head of occupational health, Anglo American • Stefan Lang, chief medical officer and head of occupational medicine and health protection department, BASF (Germany) • Graham Johnson, clinical lead, nursing, for Bupa Health Clinics (UK) • Andreas Tautz, chief medical officer, Deutsche Post DHL (Germany) • Angus MacGregor, director of human resources, Eversheds (UK) • Philippe Aeschlimann, spokesman, Nestle SA (Switzerland) • Gill Macleod, chief executive, RoonLane Medical (UK) • Amy Costello, senior benefits analyst, Staples (US) • Lisa Hamblet, vice president, Staples Facility Solutions, Staples (US) • Jonathan Van-Tam, School of Community Health Sciences, University of Nottingham (UK); consultant on pandemic influenza to the World Health Organization • Tim Stevenson, head of medical services, Virgin Atlantic Airways (UK) • Tom Sondergeld, director of team member health benefits and well-being, Walgreens (US) • Tim Brne, director of immunization services, Walgreens (US) The report was written by Andrea Chipman and edited by James Chambers © The Economist Intelligence Unit Limited 2013 Strategies for seasonal influenza Spreading prevention across the workforce Executive summary Seasonal influenza is a reliably regular blight on the working age populations of the US and western Europe Employee absenteeism is generally perceived to be the biggest cost of flu to businesses in these regions Yet for such a common and recurring adversary, there continue to be plenty of knowledge gaps among employers and employees, from understanding the virus to measuring and mitigating its impact In order to better understand the perception of seasonal influenza among businesses in the US and western Europe, the Economist Intelligence Unit surveyed over 400 business leaders in those regions and conducted a series of in depth interviews with executives and experts, supplemented by extensive desk research Difficulties in diagnosing seasonal influenza and distinguishing it from other common viruses— even for doctors—means it is challenging for managers to keep an accurate record on employee absences Understandably therefore, many companies either fail to collect data on the impact of influenza or lack confidence in the data they collect As a result, it is tough for senior business leaders to assess adequately the success or failure of corporate influenza prevention initiatives Such knowledge gaps are compounded by a paucity of third party literature on the economic impact of seasonal influenza Few companies know the business impact of seasonal influenza: As most cases of suspected influenza are not officially diagnosed, many managers find it difficult to assess its frequency in their organisations A sizeable minority of companies (47%) rate their data collection efforts “poor” or lower—with one in five (22%) collecting no data at all There is also a distinct lack of third party information available on the business impact of seasonal influenza This general lack of data is seen as one of the top three obstacles restricting the success of company initiatives around prevention Being able to quantify the business cost of seasonal influenza would raise prevention as a business priority While employers and employees tend to be more aware than they were several years ago about the threat posed by seasonal influenza, this has more to with the “pandemic effect” created by regular warnings about potential global outbreaks, rather than any change in strategy © The Economist Intelligence Unit Limited 2013 The key findings of this research include the following: Southern European businesses are feeling fewer “symptoms” of the virus: Absenteeism is by far the biggest business cost associated with Strategies for seasonal influenza Spreading prevention across the workforce influenza, but there is a split in how countries perceive trends in influenza-related absenteeism to be developing: Germany, the UK and the US all report double-digit increases in employee sick days in recent years, whereas businesses in Spain, Italy and France report either a negligible increase or a net decrease Alongside this trend there has been an overall net increase in the business priority of seasonal influenza compared with three years ago, based largely in the UK, Germany and the US This contributes to a higher risk profile for influenza overall in the US, the UK and particularly Germany than in the more southern European countries Most companies conduct influenza mitigation, although some lack a coordinated approach: Three-quarters of companies communicate with employees about influenza, with poster campaigns and email newsletters being the favoured method Fully 84% of companies conduct some form of seasonal influenza prevention activity, such as on-site vaccinations and an elevated focus on workplace hygiene during the influenza season Yet only one-half (50%) of companies have a formal strategy in place to mitigate the virus The gap between these figures suggests that a significant minority of influenza activities, such as vaccinations or messaging, not form part of a structured prevention strategy, nor are they led from the top Pandemic warnings have made companies better prepared, but have increased the risk of complacency: Official recommendations from public health bodies and perceived risks of pandemic influenza are the top two factors likely to raise the status of influenza as a business priority Therefore, regular warnings about potential pandemic influenza outbreaks have unsurprisingly raised the status of general influenza prevention as a business priority Many companies now feel better prepared to deal with influenza in general Still, as the memories of the © The Economist Intelligence Unit Limited 2013 last official pandemic in 2009 are fading, focus is tapering and the potential for complacency is building Experts also say that there is an artificial distinction between pandemic and epidemic influenza, leading to a tendency for businesses to concentrate on the former and give insufficient attention to the latter The effectiveness of current influenza initiatives are under the microscope: Despite increased employee awareness of influenza over the past few years, low employee receptiveness to seasonal influenza prevention initiatives is the most commonly mentioned factor restricting the success of those initiatives Health experts and occupation health executives report a persistent level of employee misunderstanding about seasonal influenza and mistrust of prevention methods This suggests that companies need to become more informative, more creative and more involved in engaging employees, rather than simply relying on signs and posters to get the message across; particularly when there are no elevated concerns about a potential pandemic Justifying the cost of prevention is not an exact science: High costs of prevention measures are believed to restrict the success of influenza initiatives Therefore, enabling executives to judge the financial merits of investing in influenza prevention is important at a time when budgets remain under strain and ageing employers are bringing other illnesses and ailments into the workplace Yet far more companies (47%) not have metrics to measure the effectiveness of prevention initiatives than those that say they (28%): measuring the level of employee uptake of vaccination initiatives is the one metric that most companies use, if anything Being able to collect accurate data about the business impact of the virus is a preliminary step to measuring the return on investment (ROI) of influenza mitigation efforts Strategies for seasonal influenza Spreading prevention across the workforce Introduction Picking influenza out of a crowd Even for experts, [making] the distinction between influenza and respiratory viral infections is incredibly difficult Dr Jonathan Van-Tam, Professor of Health Protection, University of Nottingham CDC Seasonal Influenza Questions & Answers, http://www.cdc.gov/flu/ about/qa/disease.htm Commission of the European Communities, Council Recommendation on seasonal influenza vaccine, July 13 2009, Brussels, Belgium Few would deny that seasonal influenza has an annual impact on the populations of the US and Europe In the US, between 5% and 20% of the population gets influenza each season; there are some 36,000 deaths, and more than 200,000 are hospitalised annually as a result of seasonal flu-related complications, according to the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia.1 In Europe, the number of annual deaths from influenza are estimated to be around 40,000 in a moderate year and 220,000 in a particularly severe epidemic, based on the EU population of around 500m in 2008, although the number of recorded deaths from influenza is far smaller Yet getting an accurate picture of the prevalence of influenza can be difficult, as the measurements themselves are frequently the subject of disagreement One of the first difficulties in assessing the impact of seasonal influenza is defining and diagnosing it Seasonal influenza is a respiratory illness with symptoms that often include a high fever, headache, fatigue, coughs, sore throat, nasal congestion, muscle aches or upset stomach Since many of these symptoms are also associated with the common cold and other respiratory infections, influenza experts say it is often difficult to accurately determine the extent of a given seasonal epidemic © The Economist Intelligence Unit Limited 2013 “The fundamental problem is that, even for experts, [making] the distinction between influenza and respiratory viral infections is incredibly difficult,” says Dr Jonathan Van-Tam, professor of health protection at the University of Nottingham’s School of Community Health Sciences, and consultant to the World Health Organization (WHO) on pandemic influenza While most people severely affected by seasonal influenza are the elderly, the young, and those with pre-existing health conditions, it also has an annual impact on the working-age population in these regions, most noticeably in terms of employee absenteeism But getting an accurate impact of seasonal influenza on the US and European economies can be even harder to pin down There is substantially more information available for the US than for Europe; yet even here, much of the data cited by agencies—ranging from the US Department of Health and Human Services to the CDC—comes from the same source (see The business cost: influenza in numbers) The figures give a taste of the magnitude of the impact, but assessing the business cost of seasonal influenza is an imperfect science at best As we will see later on, this lack of clarity exists at company level too, so that influenza strategies—to the Strategies for seasonal influenza Spreading prevention across the workforce Chart 1: January blues US adult population reporting influenza in January from 2009 to 2013 (% of respondents reporting influenza) 2.9% 2.4% January 2009 January 2010 4.7% 3.2% 2.6% January 2011 January 2012 January 2013 US adult population reporting influenza during January 2013 by select groups (% of respondents reporting influenza in each group) January average: 4.7% Above average Below average Age group 5.34% 4.91% 4.42% 4.19% 18-29 30-44 45-64 65+ Monthly income Gender 6.51% 4.51% 4.88% Male Female Smoking 3.70% 3.14% [...]... either the US or the UK for eight months during 2012 (see Chart 2) Strategies for seasonal influenza Spreading prevention across the workforce Nonetheless, the high cost of prevention measures is generally seen as the second-biggest obstacle to mitigating the impact of influenza prevention initiatives across the sample At a time of tight financial budgets, with many companies reviewing the benefits that they... in the young before spreading to the rest of the family There is some regional divergence, nonetheless Companies in the US are twice as likely as western European companies (22% and 11%, respectively) to extend vaccinations to family members, even though US companies are the Strategies for seasonal influenza Spreading prevention across the workforce least likely to offer vaccinations to employees in the. .. turn, this information could be passed on to employees, so that they can understand the “business case” for engaging with influenza prevention measures Strategies for seasonal influenza Spreading prevention across the workforce Influenza by industry Companies in the healthcare sector (including pharmaceuticals & biotech) are generally at the forefront when it comes to the prioritisation of seasonal influenza... employee participation in company's prevention efforts 8 Other (please specify) 1 We do not conduct activities focused on seasonal influenza 16 Don't know 1 28 © The Economist Intelligence Unit Limited 2013 Strategies for seasonal influenza Spreading prevention across the workforce Which of the following factors have raised or would most likely raise the status of influenza prevention as a business priority... Offer vouchers, gifts or other incentives to encourage employee participation in company's prevention efforts We do not conduct activities focused on seasonal influenza Source: Economist Intelligence Unit survey, June 2013 16 © The Economist Intelligence Unit Limited 2013 8% 16% Strategies for seasonal influenza Spreading prevention across the workforce compared with 25% for the general company sample... confusion alluded to above, over the medical definition and diagnosis of seasonal influenza, together with the fact that most cases of suspected influenza are not officially diagnosed Strategies for seasonal influenza Spreading prevention across the workforce Chart 9: Return on influenza How well is your organisation collecting and using data about the impact of seasonal influenza on your business? Agree... current form.”15 Seven years on, there is some evidence that the media is losing interest in influenza: the most recent avian flu outbreak in China earlier this year, this time of the H7N9 variety, has met more muted press coverage, despite the deaths of nearly one-third of those with reported cases of the disease.16 Strategies for seasonal influenza Spreading prevention across the workforce 2 Preventing seasonal. .. after they have produced a pandemic They re-circulate as seasonal flu, as H1N1 is doing at present The intervals between totally new pandemic viruses can be very short or very long Suddenly, you get to the point where one virus peters out, and is replaced by a new Strategies for seasonal influenza Spreading prevention across the workforce type and the cycle begins anew There is no real difference in the. .. and hypertension 23 © The Economist Intelligence Unit Limited 2013 Whatever the reason for this deficit of data, the overall group of respondents to our survey deem it to be the third most significant barrier hampering the success of their influenza initiatives—and the highest for respondents in the UK The difficulty for companies to accurately judge the full impact of seasonal flu in their workplace is compounded... Brazil, the niobium and nickel operations have a 100% uptake It’s a cultural thing Brazilians listen to their healthcare advice a little better than the rest of us.” He adds that the initial result was a large drop in absenteeism, although the programme has now been running for a number of years, so the benefit is no longer visible Strategies for seasonal influenza Spreading prevention across the workforce ... Unit Limited 2013 Strategies for seasonal influenza Spreading prevention across the workforce About the report Strategies for seasonal influenza: spreading prevention across the workforce is an Economist... saying they use them, Strategies for seasonal influenza Spreading prevention across the workforce Chart 7: Spreading the word What communication does your organisation undertake around seasonal influenza? ... either the US or the UK for eight months during 2012 (see Chart 2) Strategies for seasonal influenza Spreading prevention across the workforce Nonetheless, the high cost of prevention measures