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August 17, 2010

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Is flu immunisation worth the investment?

Consultant Tony Bough describes research he carried out to evaluate the business case for seasonal flu vaccinations.

Seasonal flu is a highly-infectious respiratory illness, which affects virtually every business at some point. As you might expect, it appears every winter over a short period of a few weeks, resulting in a high number of coinciding absences. 

At-risk groups
It’s coming up to the time of year when we all have to decide whether to have a flu jab or not. Some of us may fall into the NHS ‘at-risk’ groups and get the injection free of charge. Such people include:

  • those aged 65 and over;
  • those who have a serious medical condition;
  • those who live in a residential or nursing home;
  • those who are the main carer for an elderly or disabled person, whose welfare may be at risk if they fall ill;
  • health-care or social-care professionals, directly involved in patient care; and
  • poultry-workers, as they are at a slightly greater risk of catching bird flu if there is an outbreak.1

If you are not in an at-risk group, then you need to decide for yourself whether to get the flu injection. As a safety and health practitioner, you may also need to decide whether to provide the flu vaccine for your employees free of charge or encourage your workforce to get the jab by some other means.

Encouraging your workforce to take the vaccine is often as simple as putting up a few posters, or sending an e-mail. Plenty of companies supply money-off vouchers for company employees at a cost of about £10 per person. That’s not a massive cost to individuals, but is it a cost your workforce will pay, particularly during these tough economic times? Plus, where employees have good benefits and sick pay they may be more disinclined to pay for their own flu jab.

An alternative but more expensive way to get your workforce to take the vaccine is to use an occupational health provider to administer the injection to your staff on site during working hours. Costs include all fees associated with equipment and hiring a nurse, and whether the provider uses a mobile vehicle as the location to deliver the injection, or a facility on your site. With this approach, take-up of the flu jab is likely to be higher.

But how effective is the seasonal flu jab? Various studies exist that look at the sickness-absence rates due to seasonal flu in the workplace. The CBI, for example, in its latest absence and workplace health survey, reported that nearly 95 per cent of survey respondents (around 241 employers) stated that minor illnesses, such as colds and flu, were the main cause of short-term sickness absence.2

If we take into consideration the NHS’ claim that flu vaccines “give 70 to 80-per-cent protection against infection”,3 the benefits of providing the flu jab in the workplace would seem attractive. It is essential however, to consider that the flu virus changes every year, so you need to have an annual vaccination to make sure you are protected against the latest strain of the virus. This results in the need to adopt an annual programme of flu jabs and therefore becomes a retained cost for your business. To justify your expenditure on such items, you need to refer to research, or gather statistics of your own.

Evaluating a workplace flu-jab service
So, if a person receives the flu jab, does it reduce the likelihood of that individual being absent from work on account of flu? I decided to put this to the test by providing the flu vaccination to a client’s workforce through an occupational-health provider. To ensure the largest return in relation to take-up numbers, employees received the vaccination free of charge at their place of work during standard working hours, and were given time off away from their usual duties to receive the jab (approximately 15 minutes).

To promote the free flu jabs, e-mails and communications were sent out to the whole workforce, giving various days when they could attend and offering plenty of notice to them in relation to the dates of the jabs.

I made it clear that those who already receive the flu jab free of charge from their GP, owing to their high-risk group status, should continue to do so. I also made clear that individuals should not have the seasonal flu vaccine in any event if:

  • they had a previous allergic reaction to a flu vaccine (rare), or have a serious allergy to hens’ eggs (very rare), because the vaccine is prepared in such eggs;
  • they are ill with a fever; and
  • they are pregnant and also in a high-risk group, but should talk to their GP.

Out of a workforce of approximately 4500 people, 432 people took up the offer and received the jab during the middle of September. The individuals were notified that, as a means of identifying the efficiency of the jab, they would be monitored following the injection to identify how many were absent with the flu. They were also informed that this would not be connected to any sickness/absence management processes.

A time period from October until July was set aside to measure how many people who had received the jab would be absent with what they recorded as ‘flu’. The reason for the slight delay between receiving the jab and monitoring sickness levels was because of the time the human body requires before it starts making antibodies to the virus.

Monitoring of those taking the jab would identify whether it was working among those who received it and to judge whether or not running a seasonal flu jab on an annual basis was in the best interests of the business.

The results
Out of the 432 people, 41 of them were absent due to the flu on one or more occasions during the test period. This equates to 9.69 per cent of those who received the jab.

In addition, the percentage of sickness absence related to the flu was recorded for the equivalent period for the year prior to the flu jab and for the test period. The percentage of people off sick with flu reduced from 22 per cent of the workforce during the year prior to the test period to 18 per cent during the test period itself. This figure is based on the number of people absent during the test period rather than the amount of days lost due to flu.

Do the figures add up?
In conducting this trial, 432 employees received the flu jab at a cost of £9.50 per jab, totalling £4104. The flu jabs occurred over a three-day time period to factor in part-time staff being able to attend. Labour costs were £25 per hour (for a nurse), over a total period of 24 hours – a total cost of £600. The total cost of the trial was therefore £4704. 

This organisation allocates a cost of £93.51 per person per day to sickness absence in the workplace. If we presume a worse-case scenario where all 432 of those who received the jab were absent due to flu, the cost to the business would have been £40,396. To break even on providing the flu jab we would need to reduce sickness caused by flu by 51 people (based on the cost of £93.51 for a single day of absence).  As 391 of the 432 people who received the injection were not absent during the test period, the trial was successful on a pure cost basis.

In addition, the costs are based on one day’s sickness per person, despite the organisation’s sickness average of two days per person for flu. Consequently, in the year prior to the trial the cost of sickness absence due to flu was £185,336, and £151,299 during the trial. 

Conclusion
For most people, seasonal flu is unpleasant but not serious, and recovery takes around a week. So, if as a business you can accept a shortfall in employees on account of short-term flu, then maybe the cost out-weighs the risk, or perhaps you should encourage employees to obtain the flu jab at zero cost to your business by advertising local vaccination service-providers at your workplace. Conversely, if your business cannot accept a period of increased absence during winter, then the outlay may not seem too high.

The research itself was simple; nonetheless, it suggests that where people do take the seasonal flu jab they are less likely to be absent on account of flu. However, it can’t be guaranteed that the individuals would have caught the flu if they had not received the jab.

Bearing in mind that the trial period was during the ‘swine flu pandemic’, a 4-per-cent reduction in sickness from the flu is encouraging and the savings indicated earlier also help prove to employers that flu injections are as worthwhile as any health-promotional activity in the workplace. 

However, to truly look to reduce the instances of flu-related absence in the workplace, people need to be encouraged to take the flu jab. Promotional activities are one method but if human-resources teams and line managers were to look at those who have been absent because of flu and discuss it with them on an individual basis, perhaps the numbers taking the vaccination would increase.

References
1 http://www.nhs.uk/Conditions/Flu-jab/Pages/Whyitshouldbedone.aspx
2 http://www.cbi.org.uk/pdf/20100607-cbi-pfizer-absence-report.pdf
3 http://www.nhs.uk/Conditions/Flu-jab/Pages/Introduction.aspx

About the author
Tony Bough is currently working as a health and safety consultant. He has worked in manufacturing and extensively in the public sector. He is a chartered member of IOSH and has been a safety professional since 2001. He is also an active member of the Tyne and Wear branch.

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David
David
13 years ago

I think that to assume a worst case scenario of all the 432 guinea pigs catching flu without the jab is misguided. Surely a more realistic assumption would be 22% of that number. Does this not then make a very significant difference to the cost/benefit calculation?

David
David
13 years ago

A few thoughts
The vaccine was for seasonal flu and not swine flu.
Less than 10% of the workforce took up the offer of the vaccine. No figures for those who received the vaccine elsewhere e.g. from their GP – not likely to be any higher though. Although an interesting article, the numbers make the study inconclusive to say the least.
There is also a fair debate to be had re side effects of these vaccines – esp for those classed as low risk i.e. the majority of the workforce / population.

Macleodgol
Macleodgol
13 years ago

To miscalculate the benefits of any proactive health and safety measure is to discredit it, particularly in the eyes of those already most likely critise. Only the data from the year of the trial should be used. Providing the jab resulted in 50% reduction in incidences of flu (19% to 9.5%). In round figures the cost of treating all employees with the flu jab is £49K. The saving from the reduced flu occurrence is £80K. Potential net saving £31K realitively significant and importantly realistic.

Matthewbarry
Matthewbarry
13 years ago

When you look at the article he says that he only needs 51 people to not be on the sick due to giving out the jab for the trial to break even and as 22% of 432 would be 95 people it looks like your estimate would still justify the case to give out the jab. I agree its unlikely that the worst case scenario would occur, but I’d guess that he’s just trying to show how big the numbers can get? Certainly when I present figures to the board I give them the best cost to worst cost scenarios.

Thehills12
Thehills12
13 years ago

On the subject of flu jabs, it seems that the urge
to “protect everyone” socialist style, may have
engendered lots of NHS expense for no reason.
Personally I adopted a health diet back in the 1980s, and have never had flu since 1983.
Perhaps we should begin again to consider that an ounce of prevention is worth a ton of treatment.
Encouraging citizens to be dependent upon the state for their own health is not a good idea, not least among those who have severe adverse effects from jabs!