Strategies for seasonal influenza spreading prevention across the worlforce

It analyses changing corporate perceptions in the US and western Europe about the impact of seasonal infl uenza and the prevention measures companies are putting in place.. Being able to

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Contents

About the report

Strategies for seasonal infl uenza: 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 infl uenza and the prevention measures companies are

putting in place

This report draws on two main sources for its research and

fi ndings:

 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 fi nancial services or manufacturing

Around one-half of these companies have more than 500

employees or more than US$500m in annual revenue

 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):

• William Fried, senior medical director, Aetna (US)

• Frank Fox, head of occupational health, Anglo American

• Stefan Lang, chief medical offi cer and head of occupational

medicine and health protection department, BASF

• 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

• Helen Darling, president and chief executive, National Business Group on Health (US)

• Philippe Aeschlimann, spokesman, Nestle SA (Switzerland)

• Gill Macleod, chief executive, RoonLane Medical (UK)

• Amy Costello, senior benefi ts analyst, Staples (US)

• Lisa Hamblet, vice president, Staples Facility Solutions, Staples (US)

• Judy Harvey, manager, corporate industrial hygiene and workplace safety program, United Technologies (US)

• Jonathan Van-Tam, School of Community Health Sciences, University of Nottingham (UK); consultant on pandemic infl uenza to the World Health Organization

• Janice Hartgens, global occupational health manager, UPS (US)

• Tim Stevenson, head of medical services, Virgin Atlantic Airways (UK)

• Tom Sondergeld, director of team member health benefi ts 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

Executive summary

Seasonal infl uenza 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 fl u

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

Diffi culties in diagnosing seasonal infl uenza 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 infl uenza or lack confi dence in the data they do collect As a result, it is tough for senior business leaders to assess adequately the success or failure of corporate infl uenza prevention initiatives Such knowledge gaps are compounded by a paucity of third party literature

on the economic impact of seasonal infl uenza

While employers and employees tend to be more aware than they were several years ago about the threat posed by seasonal infl uenza, this has more to do with the “pandemic effect” created

by regular warnings about potential global outbreaks, rather than any change in strategy

In order to better understand the perception of seasonal infl uenza 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.The key fi ndings of this research include the following:

Few companies know the business impact of seasonal infl uenza: As most cases of suspected

infl uenza are not offi cially diagnosed, many managers fi nd it diffi cult to assess its frequency

in their organisations A sizeable minority of companies (47%) rate their data collection efforts “poor” or lower—with one in fi ve (22%) collecting no data at all There is also a distinct lack of third party information available on the business impact of seasonal infl uenza 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 infl uenza would raise prevention as a business priority

Southern European businesses are feeling fewer “symptoms” of the virus: Absenteeism is

by far the biggest business cost associated with

infl uenza, but there is a split in how countries perceive trends in infl uenza-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 infl uenza compared with three years ago, based largely in the UK, Germany and the US This contributes to a higher risk profi le for infl uenza overall in the US, the

UK and particularly Germany than in the more southern European countries

Most companies conduct infl uenza mitigation, although some lack a coordinated approach:

Three-quarters of companies communicate with employees about infl uenza, with poster campaigns and email newsletters being the favoured method Fully 84% of companies conduct some form of seasonal infl uenza prevention activity, such as on-site vaccinations and an elevated focus on workplace hygiene during the infl uenza season Yet only one-half (50%) of companies have a formal strategy in place to mitigate the virus The gap between these fi gures suggests that a signifi cant minority

of infl uenza activities, such as vaccinations or messaging, do 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: Offi cial recommendations

from public health bodies and perceived risks

of pandemic infl uenza are the top two factors likely to raise the status of infl uenza as a business priority Therefore, regular warnings about potential pandemic infl uenza outbreaks have unsurprisingly raised the status of general infl uenza prevention as a business priority Many companies now feel better prepared to deal with infl uenza in general Still, as the memories of the

last offi cial pandemic in 2009 are fading, focus

is tapering and the potential for complacency

is building Experts also say that there is an artifi cial distinction between pandemic and epidemic infl uenza, leading to a tendency for businesses to concentrate on the former and give insuffi cient attention to the latter

The effectiveness of current infl uenza initiatives are under the microscope: Despite

increased employee awareness of infl uenza over the past few years, low employee receptiveness

to seasonal infl uenza 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 infl uenza 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 infl uenza initiatives Therefore, enabling executives to judge the fi nancial merits of investing in infl uenza 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%) do not have metrics to measure the effectiveness of prevention initiatives than those that say they do (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 infl uenza mitigation efforts

Few would deny that seasonal infl uenza has an annual impact on the populations of the US and Europe In the US, between 5% and 20% of the population gets infl uenza each season; there are some 36,000 deaths, and more than 200,000 are hospitalised annually as a result of seasonal

fl u-related complications, according to the Centers for Disease Control and Prevention (CDC)

in Atlanta, Georgia.1 In Europe, the number of annual deaths from infl uenza 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 infl uenza is far smaller

Yet getting an accurate picture of the prevalence

of infl uenza can be diffi cult, as the measurements themselves are frequently the subject of

disagreement One of the fi rst diffi culties in assessing the impact of seasonal infl uenza is defi ning and diagnosing it Seasonal infl uenza

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, infl uenza experts say it is often diffi cult to accurately determine the extent of a given seasonal epidemic

Introduction Picking infl uenza out of

of Nottingham’s School of Community Health Sciences, and consultant to the World Health Organization (WHO) on pandemic infl uenza

While most people severely affected by seasonal infl uenza 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 infl uenza 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: infl uenza in numbers) The fi gures

give a taste of the magnitude of the impact, but assessing the business cost of seasonal infl uenza

is an imperfect science at best As we will see later on, this lack of clarity exists at company level too, so that infl uenza strategies—to the

Even for experts,

extent that they exist—are largely based on perceptions rather than hard data

Different prescriptions in the US and Europe

The population of the US is 314m, according to our 2012 fi gures—roughly the same size as the

fi ve western European economies covered by this report: Germany, France, the UK, Italy and

Spain The standout difference between these two geographical regions, separated by the Atlantic Ocean, is who pays for healthcare The US healthcare system is largely privatised and based

on health insurance linked with employment for all but the most indigent populations and those over 65 By contrast, national governments are more actively involved in the provision of both healthcare and health insurance in many European countries

US adult population reporting influenza in January from 2009 to 2013

(% of respondents reporting influenza)

Age group

US adult population reporting influenza during January 2013 by select groups

(% of respondents reporting influenza in each group)

Chart 1: January blues

January 2009 January 2010 January 2011 January 2012 January 2013

January average: 4.7% Below average

Source: Gallup-Healthways Well-Being Index (calculated by asking 1000 Americans each day whether they had a cold or influenza the previous day)

Within this context it is important to understand the varying approaches in the US and western Europe, in terms of how prescriptive they are with regard to the annual threat from seasonal infl uenza This is because respondents to our survey cited recommendations from public health authorities and updates to offi cial advice as the factors most likely to raise the status of seasonal infl uenza as a business priority.

The US provides more centralised guidance

to businesses and employers via a set of CDC guidelines that cover both pandemic and epidemic threats They also include a number of recommendations, among them: that employees with fl u-like illness stay home until 24 hours after their fever has disappeared The CDC guidelines also advise employers to review sick-leave policies and try to provide fl exible leave policies for employees who are sick or caring for sick household members.3 The European Centre for Disease Prevention and Control (ECDC),

by contrast, offers more general guidelines regarding hygiene, with no tailored guides for businesses, although individual countries, such

as the UK, often provide their own advice through national health bodies

The US is the only country to recommend universal infl uenza vaccinations In February

2013 the Advisory Committee on Immunization Practices’ (ACIP) called for infl uenza vaccines for anyone six months or older (35% of the country’s adult population had had the vaccine for the most recent fl u season by November 20124) Meanwhile, individual European countries vary

in the extent to which they advocate or provide vaccinations to those outside the at-risk groups, with none going nearly as far as the US

All of the distinctions above do not, however, generally result in two distinctive approaches to mitigating seasonal infl uenza in the two regions The most signifi cant differences are that in the US employees are more aware of seasonal infl uenza, the virus is more likely to have become an increased business priority and senior managers tend to be more involved in infl uenza initiatives than their European peers If anything, there

is more of a divide between the US, the UK and Germany on the one hand and Italy, Spain and France on the other hand

3 Preparing for the Flu

(Including 2009 H1N1 Flu);

A communication toolkit for

Businesses and employers;

US Department of Health

and Human Services,

Centers for Disease Control

and US Department of

Homeland Security

4 CDC National Early Season

Flu Vaccination Coverage,

United States, 2012-13 Flu

 The same study found that lost earnings from illness and death related to infl uenza epidemics cost around US$16.3bn a year on average, or 20% of the total burden of infl uenza.7

 A study by a US pharmaceutical chain, Walgreens, from September 2011, found

that infl uenza was responsible for 100m lost workdays in the 2010-11 fl u season

 A September 2010 report from the US National Business Group on Health identifi ed 24.7m cases of seasonal infl uenza each year, resulting in 3.1m hospitalised days and annual direct medical costs of around US$10.4bn.8

 In Europe, infl uenza accounts for around 10% of sickness absence from work, with the cost of lost productivity in France and Germany estimated at around US$9.3bn and US$14.1bn annually.9

The business cost: infl uenza in numbers

6 Ibid.

7 Ibid.

8 Ibid.

9 OECD (2011), “Influenza

vaccination for older

people”, Health at a Glance

2011: OECD Indicators, OECD

Publishing.

5 Molinari NA,

Ortega-Sanchez IR, Messonnier ML,

et al The annual impact of

seasonal influenza in the US:

Measuring disease burden

and costs Vaccine 2007;25

(27): 5085-5096.

US, German and British adult populations reporting influenza or cold during 2012

(% of respondents reporting cold or influenza)Influenza

Common cold

Chart 2: Atlantic chill

0 1 2 3 4 5 6

0 1 2 3 4 5

6 UK Germany

US

UK Germany

US

Dec Nov Oct Sep Aug Jul Jun May Apr Mar Feb Jan

0 2 4 6 8 10 12

0 2 4 6 8 10 12

Dec Nov Oct Sep Aug Jul Jun May Apr Mar Feb Jan

Source: Gallup-Healthways Well-Being Index.

Seasonal infl uenza is not viewed as a signifi cant business risk by the majority of European and

US companies While few (7%) see it as a existent risk, the majority (54%) characterise the risk as minimal “I don’t see [seasonal infl uenza]

non-as a signifi cant threat, but one of the renon-asons

is because we have such awareness of what fl u

or fl u-like sickness can do, so it’s not as big a concern as it was in the past few years,” says Al Smith, director for safety at a US bus operator, Greyhound

This majority opinion is generally consistent across the US and western Europe There are,

nonetheless, some signifi cant variations by country: in Spain, more than eight in ten (83%) respondents report minimal or no risk from the virus; whereas Germany is the only country in the sample where a majority of respondents (52%) view seasonal infl uenza as a moderate or high risk, rather than minimal or no risk On average, 39% of respondents see seasonal infl uenza as moderate or high risk The UK and the US join Germany above this average, while France and Italy join Spain below this average

The perception of business risk tends to be higher among larger companies, particularly those that operate internationally, or have employees who travel frequently or work in remote locations

“It’s sensible to think about seasonal fl u in [the UK] but it’s not a very big deal,” says Rod Ratsma, head of UK business continuity for a consulting

fi rm, Marsh Risk Consulting “But there are parts

of the world where there is less access to fl u jabs and anti-virals A lot of fi rst world companies rely

on the Indian sub-continent for support work The world is a small place when you talk about supply chain.”

Typical examples of these kinds of “at risk” companies can be found in industries such as travel & leisure, natural resources, and logistics

“Our business is dependent on our people, who are on the road for our customers practically every day,” says Dr Andreas Tautz, chief medical offi cer for Deutsche Post DHL in Bonn, Germany

“The challenge is to maintain our supply chain,

so it’s important to protect all of our employees, but the main focus is on people working in the operational business.”

Business perceptions of seasonal infl uenza

Dr Andreas Tautz, chief

medical offi cer, Deutsche Post

DHL

or prevention measures such as vaccinations, attracting roughly twice the number of votes from respondents, or in some cases even more so This

is true for US and western European companies of all sizes

Compared with three years ago, there has only been a marginal net increase of 6% in the number

of companies reporting an increase in employee absenteeism with infl uenza or infl uenza-like symptoms (the overall business impact of the virus during that time has grown similarly incrementally) That being the case overall, the

UK, the US and Germany report double-digit

fi gures above the average, whereas Spain, Italy and France either post a net increase below average or report a net decrease

Notwithstanding these trends, it is important to keep in mind the extent to which employees are under pressure to come to work at a time when concerns about job security are on the minds of many workers in both Europe and the US When asked about the factors that have restricted or are most likely to restrict company initiatives around seasonal infl uenza, a company culture

of “presenteeism” is among the top half of this list of factors Individual companies, however, adamantly deny that such pressures exist in their own workplaces One of the most popular prevention steps undertaken by companies is to send home any employee displaying infl uenza-like symptoms

“If people are under the weather, we encourage them to stay home and not come into work when they aren’t feeling well,” says Mr Smith of Greyhound “We don’t want to put them or our customers at risk due to their not feeling well.”For others, however, the corporate position on absenteeism is not so black and white Narrow benefi t policies that limit sick days can dissuade employees from staying at home For Dr Van-Tam, direct pressure from employers is more common than it might appear—and far more critical to business than is currently perceived

“The biggest issue for employers is not their infection control procedures and not their vaccination policies, although clearly these matter, but the extent to which they tolerate workplace absence or understand what

‘presenteeism’ might actually mean,” says Dr Van-Tam “The underlying sentiment, ‘oh, it’s only a cold, why aren’t you in work?’ doesn’t hold true if you think about viral load I might well get

a couple more days productivity [out of someone working for me] if they come in with a cold, but they might destroy my productivity for longer by passing the virus to me and other colleagues.”

Change in the air?

For the majority of companies the last infl uenza season brought no dramatic changes from the

Chart 4: Sick days

What is the biggest cost to your business associated with

seasonal influenza?

(% respondents)

Source: Economist Intelligence Unit survey, June 2013.

Operational costs (loss of

business, drop in productivity,

costs to the business from

becoming a pandemic “If newspapers are full of stories, people come and want the vaccination If newspapers don’t write anything about infl uenza then people forget about it That’s quite normal,” says Stefan Lang, chief medical offi cer at BASF, a German chemical company “We do advertising every year, but when swine fl u was going on the number [of employees getting vaccinated] was the highest we ever had.”

With each new pandemic strain, government agencies on both sides of the Atlantic have issued reminders and advice to employers with the aim of discussing the differences between pandemic infl uenza and the seasonal variety, as well as suggesting the continuum between them This combination has a clear impact on business perception of infl uenza in general, since the two factors most likely to raise the status of seasonal infl uenza prevention as a business priority are updates to offi cial advice from public health bodies and the perceived threat of a pandemic infl uenza outbreak

United Technologies, a US multinational conglomerate, conducts a variety of activities around seasonal infl uenza, from posters, emails and educational campaigns, to sanitiser stations and on-site vaccination clinics Judy Harvey,

a manager in the corporate industrial hygiene and workplace safety department, pinpoints the

season three years before The most notable trend during this time—by a considerable amount—is a boost in employee awareness about seasonal infl uenza Exactly one-half of respondents (50%) say that awareness has increased and 38% say it has remained the same (the percentages are even greater in larger companies than in smaller ones)

Companies from the US are most likely to report greater employee awareness, with nearly two-thirds of US companies (65%) citing increased awareness, followed by the UK (56%), France (48%) and Germany (42%) By contrast, just 26% of Italian companies and 34% of Spanish companies report increased employee awareness during the most recent infl uenza season

Much of this raised awareness is the result of a regular drumbeat of public health and media warnings about new strains of the infl uenza virus

How have the following changed at your organisation during the latest influenza season compared with three years ago?

(% of respondents)

Chart 5: Going viral

Source: Economist Intelligence Unit survey, June 2013.

Worker absences with influenza

really helps because

people are starting

to really catch on

and learn some of

the lessons without

having to be told all

the time.

Judy Harvey, corporate

industrial hygiene and

workplace safety manager,

United Technologies.

‘An epidemic occurring worldwide, or over

a very wide area, crossing international boundaries and usually affecting a large number of people.’

Dictionary of Epidemiology

What makes a pandemic?

company-wide formalisation of this approach

to fi ve years ago, when offi cial communications around the pandemic threat began to pick up

This convinced management about the benefi ts

of investing in infl uenza prevention on an annual basis “Repeated education really helps, because people are starting to really catch on and learn some of the lessons without having to be told all the time,” says Ms Harvey

Since then a general level of preparedness has been evident on both sides of the Atlantic, which could partly explain why companies are not generally concerned about the risk of seasonal infl uenza At Eversheds, a UK-based law fi rm, employees remain well informed, with higher activity prompted by reports of pandemic threats, according to the human resources director, Angus MacGregor “There has been no signifi cant change in absence due to seasonal fl u and the awareness level is generally good,” he says

Dr William Fried is senior medical director for

a US insurer, Aetna, and clinical lead for the company’s pandemic core team, which was set up

in the wake of the 2006 avian fl u outbreak “We had the plan in place for three years before we had to implement it for swine fl u/H1N1 We pull it off the shelf and update it on an annual basis, as advice from the CDC and WHO changes,” says Mr Fried

Going global

Yet this heightened awareness carries its own risks too Each time a new strain of infl uenza

is identifi ed as a potential pandemic but

subsequently remains localised, the level of complacency among employers and employees continues to grow Contrary to what the public perception may be, there has been one offi cial infl uenza pandemic in recent years, the H1N1 swine fl u pandemic in 2009, and four pandemics

in the last 100 years (see Mass panic: Breaking news of pandemic fl u) “Avian fl u has certainly

raised consciousness among organisations about the potential impact that the seasonal fl u can have,” says Jenny Hawker, a health management consultant for a consulting group, Mercer “But because that potential pandemic didn’t come to fruition, some of that concern has eased again.”

To some extent, this low level concern is refl ected

in the survey A slight majority of respondents (52%) across the sample say that there has been

no change in the business priority of seasonal infl uenza today compared with three years ago Meanwhile, just over one-third of those surveyed (37%) say that their businesses are now putting greater priority on seasonal infl uenza compared with the one in ten (10%) that are paying less attention to it, representing a net increase of just over one in four (27%)

By country, the US reports the biggest net increase (41%) in respondents now making seasonal infl uenza a higher priority than before, ten times higher than the equivalent fi gure for France (4%) Similar double-digit increases are reported in the UK (34%) and Germany (28%), compared with single digit increases in Italy (8%) and Spain (9%)

A century of pandemic infl uenza—four outbreaks in 100 years

Many businesses interviewed for this report blame the lack of a broader urgency to tackle seasonal infl uenza in part on the media’s high profi le coverage of potential pandemic infl uenza strains, which subsequently remain localised

An idea of the intensity of this media coverage can be seen from a brief review of the 2009-10 outbreak of the H1N1 virus, more commonly known as swine fl u—the only actual infl uenza pandemic since 1970 (for now)

The sudden emergence of the virus in Mexico

in spring 2009 and initial reports of its high mortality rate prompted headlines in a UK free

tabloid circular, Metro, that swine fl u “could kill

up to 120m,” quoting leading medical experts who warned the virus looked more similar to the lethal Spanish fl u of 1918 than the H5N1 avian fl u that had preceded it three years earlier.10 As panic mounted over the summer, a

UK newspaper, The London Evening Standard,

reported that the UK government was preparing

to create mass graves to cope with a surge of swine fl u victims in the autumn.11

To be sure, not all news outlets shared this view;

at the same time as the UK tabloids were raising

the temperature, a US newspaper, Los Angeles Times, was reporting that scientists studying the

virus closely appeared to agree that the hybrid strain of H1N1 originating in Mexico did not look likely to be as lethal as previous pandemics,

or even have the morbidity levels of the average seasonal infl uenza variant.12

By autumn 2009, a news agency, Agence Presse, appeared to be looking for a middle ground, with a report quoting the head of the

France-CDC, Thomas Frieden, who confi rmed a death toll of around 10,000 during the fi rst seven months of the outbreak in the US; a “much higher” fatality rate than in a usual fl u season, although the number of hospitalisations was the same.13

A little more than a year later, a medical correspondent for the BBC, Fergus Walsh, pointed out the tendency of overwrought headlines to obscure the actual threat posed by swine fl u Although the UK had recorded nearly

500 deaths in the fi rst 12 months of the swine

fl u outbreak, the initial media saturation of the

fi rst few weeks of the outbreak had evaporated However, there were higher numbers in intensive care with fl u by winter 2010.14

Nonetheless, media apathy could be as dangerous as mass pandemonium During the avian fl u outbreak in China and East Asia in

2006, an article in a US magazine, The Nation,

decried a recently-aired US TV movie, Fatal Contact: Bird Flu in America, for the way it

“capitalizes on fear by depicting a crippling loss

of basic services and mass graves.” Up to that point, avian fl u had resulted in 114 deaths in nine years What is more, the H5N1 strain in its current form “cannot routinely affect humans in its current form.”15

Seven years on, there is some evidence that the media is losing interest in infl uenza: the most recent avian fl u 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

Mass panic: Breaking news of pandemic fl u

10 Metro, 26 April 2009.

11 “Mass Graves could be

used in autumn bout of

swine flu,” Kiran Randhawa,

The London Evening

Standard, 19 August 2009

12 “Scientists see this flu

strain as relatively mild,”

Karen Kaplan and Alan

Zarembo, latimes.com, 30

April 2009.

13 “10,000 swine flu deaths

in US: estimates”, Agence

France-Presse, 20 December

2009.

14 “Fergus’s Medical

Files: Keeping a sense of

proportion about swine

flu,” www.bbc.co.uk, 31

December 2010.

15 “The False Bird Flu

Scare,” Dr Marc Siegel, The

Nation, 18 May 2006.

16 US Centers for Disease

Control and Prevention fact

sheet on Avian Influenza A

Virus, http://www.cdc.gov/

flu/avianflu/h7n9-virus.

htm, August 13 2013.

Exactly one-half of all respondents to our survey say that they have a formal policy for dealing with seasonal infl uenza The likelihood of a company having an umbrella approach to dealing with infl uenza increases with the size of a company:

over one-half (55%) of those with revenue over US$500m and a similar percentage (56%)

of those with 500 or more employees report having a formal strategy in place Typically these companies tend to be multinationals with greater geographical exposure to the virus

A UK airline, Virgin Atlantic, has a series of protocols in place, which includes regular monitoring of disease activity in the parts of the world in which it operates DHL has set

up a group-wide “master plan” that involves

Preventing seasonal infl uenza

2

year-round information campaigns in all the global locations where the group operates and where infl uenza is present Anglo American, a British mining company, has a similarly active surveillance programme The company belongs

to a number of travel medicine societies that pick up and disseminate information from the WHO and the CDC “We are a company that has international operations and lots of travel; [infl uenza] is a risk to us and it is part of our overall approach to risk management,” says Frank Fox, head of occupational health at Anglo American

A number of company executives interviewed said that they have a formal plan to combat potential pandemics, elements of which can be applied

to seasonal infl uenza planning as well “I think there is more of a balance emerging because organisations have reacted very strongly to recent pandemic threats and that has triggered some very structured planning, a lot of episodes

of alert, and there is now a sense that there

is a better level of preparedness,” says Gill Macleod, chief executive of RoodLane Medical,

a London-based primary care and occupational health company

Some large multinational companies, meanwhile, effectively delegate infl uenza policy to regional

or individual company units A Swiss food conglomerate, Nestle Group, has no global corporate policy but makes a prevention and treatment brochure available internally

According to a company spokesman, Philippe Aeschlimann, the group “encourages its markets

to provide voluntary vaccinations against the

Does your company have a formal strategy to reduce the spread of seasonal influenza among employees?

(% respondents)

Chart 6: Corporate prescriptions

Source: Economist Intelligence Unit survey, June 2013.

50%

seasonal fl u and encourages its employees to take up this offer.” Generally, companies in France (62%) and Italy (56%) are more likely to have a formal policy in place than those in the UK (38%) or even the US (50%)

Getting the message across

Around three-quarters (74%) of companies communicate with employees about seasonal infl uenza in some respect, using various methods

of raising awareness and imparting education during the infl uenza season Large companies are more likely to use infl uenza awareness communications than smaller ones, although the intensity of focus on these campaigns tends to ebb and fl ow in between alerts and coverage of the next possible pandemic infl uenza outbreak

At Anglo American, for instance, the company conducted a large information campaign on hygiene around the H1N1 outbreak, says Dr Fox Although these messages have been less intense in recent years, hand sanitizer dispensers remain in all offi ces, around lifts and toilets

BASF undertakes a global health promotion campaign each year on a topical subject such as smoking cessation or obesity During the “swine

fl u” pandemic, the company made its annual infl uenza vaccination campaign the topic of its global campaign

Communications around seasonal infl uenza are often linked in with other viruses and illnesses related to general hygiene At Virgin Atlantic, the company posts regular reminders about hygiene and hand washing to mitigate the spread of infl uenza and to help to ward off gastrointestinal and upper respiratory infections

As Tim Stevenson, head of medical services at Virgin, explains, the company is also able to target messages at specifi c communication lines used by pilots and fl ight crews, as well as by other departments

Other companies in the business-to-business (B2B) environment run parallel education programmes about infl uenza prevention for both

employees and customers Speaking to large corporate customers about the importance of cleaning is a regular part of the working day ahead of the infl uenza season, says Lisa Hamblet,

vi ce-president of Staples Facility Solutions, a unit

of the company’s B2B arm, Staples Advantage

“We really encourage them to increase the cleaning of areas that are commonly used during fl u season—doorknobs, etc—and really encourage employees to clean their own workspaces,” she says, noting that the company sees a spike in sales of tissues, hand sanitisers, gloves and masks during the fl u season Part of this education programme includes counseling businesses to encourage sick employees to work from home “We recently did a survey and f ound that 80% of employees are coming into the workplace even when they have the fl u,” says Ms Hamblet

The most popular method of communication

is putting up signs and posters around the workplace, followed by company-wide newsletters or emails From a geographical perspective, 66% of French companies said that they used signs and posters, compared with 34%

of companies in the UK and just 32% in Spain French companies were also much more likely to employ messages from senior management in their infl uenza campaigns, with 46% saying they use such messages, double the overall average

US companies are close to the overall average

A pharmacy chain, Walgreens, uses manager communications and messages on time clocks and e-mail to drive home the hygiene message, while Greyhound conducts annual employee hygiene training programmes Aetna operates

a corporate intranet site with links to specifi c infl uenza prevention programmes and has a “very robust work at home and telework plan”, says

Dr Fried

Meanwhile, UK companies are more likely to use e-learning or webinars to communicate with employees, with 40% saying they use them,

Lisa Hamblet, vice president,

Staples Facility Solutions

What communication does your organisation undertake around seasonal influenza? (Select all that apply)

(% respondents)

Source: Economist Intelligence Unit survey, June 2013.

Increase focus on workplace hygiene during influenzaseason (make hand gels/masks available, increase

frequency of disinfecting common areas)

Signs & posters around the workplaceCompany-wide emails/newslettersFace-to-face training about prevention

(hand washing etc)E-learning/webinars about preventionMessages from senior management promotinginfluenza reduction as a business prioritySurveying employees to understand workplace

perceptions of influenzaMonitoring guidance from WHO, CDC,

Google flu tracker etcBringing in external health experts to give talksAppoint employees as volunteer "flu champions"

We do not communicate with employees on

seasonal influenza

What conduct does your organisation undertake around seasonal influenza?

(Select all that apply)(% respondents)

Provide on-site seasonal influenza vaccinations

or to infected areas/officesMake vaccinations available to employees' familiesOffer vouchers, gifts or other incentives to encourageemployee participation in company's prevention efforts

We do not conduct activities focused on

seasonal influenza

Chart 7: Spreading the word

43% 34%

compared with 25% for the general company sample Yet UK companies are also the most likely

of any of the six countries surveyed to say that they do not communicate with employees about infl uenza at all Over one-third say that they do not do so, compared with just 18% in each of France and Germany

Giving prevention a shot in the arm

The vast majority of companies (84%) conduct some form of prevention activity each infl uenza season This is signifi cantly higher than the even one-half of companies that have a formal infl uenza policy, suggesting that for a sizeable minority of respondents (34%) corporate efforts

to mitigate infl uenza do not form part of a structured prevention strategy led from the top

Often multinational companies with multiple sites in various countries tend to devolve infl uenza activities to regional or local levels

In the absence of an overall strategy for dealing with seasonal infl uenza, companies risk a patchwork approach that could undermine the objective of making employees receptive to corporate infl uenza policies “What happens if people show up for work sick? Are you going to supply antivirals? Are you going to ask those with

a temperature to take off a week? Mishandling these issues is something that really affects

a company’s reputation afterwards,” says Mr Ratsma of Marsh Risk Consulting

Providing on-site vaccinations is the most popular measure companies are taking to prevent seasonal infl uenza among their employees, closely followed by increased focus

on workplace hygiene, sending employees home with infl uenza-like symptoms and reimbursing employees for private vaccinations Larger companies are more likely to conduct these activities than smaller companies; all except for sending employees home, which is the most popular measure for small companies to put in place

French companies are the most likely to provide vaccinations on-site (60%), with the US (32%)

the least likely to do so—despite being the only country in this study with a nationwide recommendation for universal vaccination against infl uenza This could be related to the fact that the cost of vaccinations is less likely to

be subsidised in the US It is also partly a matter

of greater choice and fl exibility: US companies are more likely to reimburse employees for the cost of private vaccinations than the overall survey average

UK companies are similarly above average in this regard Ms Hawker of Mercer UK notes that on-site vaccinations are increasingly becoming

a part of the broader health and wellness programmes that many European companies are beginning to offer Even so, not all companies are willing to undertake comprehensive on-site vaccination campaigns in the absence of convincing evidence of their cost-effectiveness

Dr Stevenson of Virgin Atlantic says that his company does not have a regular infl uenza vaccination programme in place, as it assumes that high-risk employees are getting the vaccine

at their GP’s offi ce With thousands of employees, Virgin has to think carefully before taking on the cost of such an option, says Dr Stevenson, although he does undertake a regular risk assessment around seasonal infl uenza “We offered it a few years ago and were left with hundreds of doses that weren’t used,” he adds

Extending vaccinations to family members

of employees is less common Only 16% of companies across the sample offer this as part

of their infl uenza prevention initiatives, despite there being more of an understanding nowadays that infl uenza is very much bound up in children, circulating 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

What happens if

people show up for

work sick? Are you

going to ask those