Flu Absences Likely to Rise

Employers calling off flu shot programs in light of the nation’s severe vaccine shortage should prepare for possible surges in absenteeism and plunges in productivity among their employees, experts say.

    The federal government had projected that Americans would require a supply of about 100 million influenza boosters this flu season and was relying on Emeryville, California-based Chiron Corp. to produce between 46 million and 48 million of those doses, according to the U.S. Department of Health and Human Services. But, earlier this month, Chiron announced that the United Kingdom’s Medicines and Healthcare Products Regulatory Agency had suspended its license to manufacture the vaccine Fluvirin in its Liverpool, England, facility, citing a breach of U.K. Good Manufacturing Practices regulations. Chiron has not disclosed the nature of the breach.

    With Chiron now barred from distributing its drug this year, HHS expects it will be able to secure only approximately 54 million flu shot immunizations–just over half of the anticipated supply–from the only other American-approved manufacturer, the Lyon, France-based Aventis Pasteur.

    The U.S. Centers for Disease Control and Prevention in Atlanta estimates that up to 20 percent of the U.S. population contracts the flu each year, with over 200,000 people each year hospitalized from flu-related complications and as many as 36,000 dying from influenza. Groups at high risk for flu complications include children under two years of age, adults age 65 years and older, women who will be pregnant during influenza season, persons with underlying chronic medical conditions and residents of long-term care facilities.

    The CDC cites vaccination as the best defense against contracting the flu, but, given this season’s shortfall, those not in priority groups are being asked to forgo the vaccine.

    “Most of the people are following the CDC’s guidelines, and that’s what we’re recommending to clients,” said Jennifer Lim, national director of Vienna, Virginia-based Comprehensive Health Services, a company that manages occupational health programs for large organizations, including several Fortune 200 firms and federal agencies.

Absences and disabilities
    Thousands of companies across the country have canceled onsite programs that immunize workers in an effort to ensure that high-risk individuals can obtain flu shots.

    Boeing, for example, which has for several years offered flu shots to employees free of charge, has canceled its program for this season and donated its vaccine supply to a local health department, a company spokesman said. General Motors, which has over 320,000 workers, also made the decision to forgo its immunization program this year, a spokesman confirmed. And Atlanta-based BellSouth Corp., which earlier this month informed its 64,000 employees that free shots would not be offered this season, is grappling with how “to gauge the costs related to canceling the flu shot,” a company spokesman said.

    While it may be too soon for companies to calculate the losses related to the lack of flu vaccine, experts say that businesses should expect to feel the impact.

    “Employers should brace themselves for increased absences and, in severe cases, short-term disability, because of the lack of availability of the vaccine,” said Shelly Wolff, national practice leader for health and productivity for Watson Wyatt Worldwide in Stamford, Connecticut.

    A study published in 1999 in the Journal of the American Medical Assn. found that recipients of the influenza vaccine experienced up to 27 percent fewer days of illness, up to 28 percent fewer days of work lost and up to 40 percent fewer days making health care provider visits.

    In recent years, “more and more companies have been offering the flu vaccine, because there has been a proven connection between the flu vaccine and reduced illness, which translates into less use of sick leave,” Wolff said.

    A June survey conducted by the Society for Human Resource Management showed that 60 percent of U.S. companies provide flu shot programs for their employees. “It works both ways,” said a spokeswoman for SHRM. “Organizations are hoping that they’ll see a decrease in sick days. Employees are very happy to have this benefit because they don’t want the flu.”

Effect on health costs
    According to Sharon Kaleta, chief executive officer of the San Diego-based Disability Management Employer Coalition, which assists employers in developing cost-saving programs and returning workers to productive employment, those companies that vaccinate their employees are not only “reporting a decrease in sick time” but “some employers have indicated that there’s been a decrease in their health care costs.”

    CCH Inc., a Riverwoods, Illinois-based firm that tracks human resources statistics, estimates unscheduled absences cost organizations, on average, $610 per employee annually. “For those organizations that did not get the vaccine early,” Kaleta predicted there will be “an increase in the absence rate, and in corresponding dollars. There will be a lesser impact on those employers that are able to vaccinate their high-risk employees but there will still be some impact,” she said. “We just don’t know to what degree yet.”

    The cost of the flu shot shortage for employers will depend, in part, on the severity of the flu season, which, according to the CDC, varies in intensity and begins as early as October and ends as late as May. “We don’t have enough data yet to tell if it’s going to be a mild, moderate or severe flu season this year,” a CDC spokeswoman said.

    Still, businesses can put into place some absence and productivity management strategies to mitigate the effects of not being able to immunize workers.

    As an alternative to onsite vaccination, companies should “encourage their employees who are at high risk to get their flu shot from their physician or other health care provider,” said Dr. Ron Davis, a Detroit-based physician who is also an AMA board member.

    Doctors and benefit consultants recommend that employers communicate the importance of maintaining good hygiene in the workplace, using simple techniques such as hand washing and covering the mouth and nose when sneezing. Employers should also allow contagious employees to work from home so they do not spread the virus, they say.

    Additionally, Gaithersburg, Maryland-based Medimmune Inc. has made available 1 million to 2 million doses of FluMist, a nasal spray vaccine not recommended for higher-risk individuals but suitable for healthy patients between the ages of five and 49. Hartford, Connecticut-based insurer Aetna Inc. and Woodland Hills, California-based managed health care company Health Net Inc. announced they will cover the cost of FluMist.

    “Larger employers that have self-insured plans” might find it “prudent to cover the FluMist,” said Kathleen Strukoff, a vice president with Chicago-based Aon Consulting, which provides risk management, human resource and employee benefit consulting. An alternative for smaller employers might be a vaccine reimbursement process through accounts payable departments, she suggested.

    There are also three antiviral prescription drugs–amantadine, rimantadine and oseltamivir–that are approved and commercially available in the United States for preventing flu. While the CDC stresses that these drugs are not substitutes for the flu vaccine, they are 70 percent to 90 percent effective in preventing illness in healthy adults, the agency claims.

    In the meantime, companies currently not licensed to sell the flu vaccine in the United States–such as Vancouver, British Columbia-based I.D. Biomedical, which supplies Canada with 75 percent of its flu vaccine–are in talks with the federal Food and Drug Administration to gain approval to supply additional doses. I.D. Biomedical has a stockpile of between 1 million and 1.5 million doses that have not been allocated, a company spokesman said.

    Looking ahead, Chiron–which is now under investigation by the U.S. Securities and Exchange Commission to determine if the company had attempted to cover up problems at its vaccine plant in England–says it is committed to providing the flu shot next year.

    “We take our responsibility to protect human health very seriously,” Howard Pien, president and chief executive officer of Chiron, said in a statement, “and we are committed to taking all necessary actions to ensure an adequate vaccine supply for the 2005-06 influenza season.”

From the October 18 issue of   Business Insurance. Written by Rupal Parekh