Flu - to jab or not to jab?
Occupational health adviser Lindsey Hall asks: Is offering the flu vaccine to employees a sensible business decision that will keep staff healthy, or simply a costly perk without any benefits to the company?
We are now approaching the time of year when many occupational health (OH) departments, mostly those in the NHS, are preoccupied with flu jabs. Flu - or influenza, to use its full name - is an acute viral infection of the respiratory tract characterised by fever, chills, headache, muscle and joint pain and fatigue. It is a difficult condition to clinically diagnose without laboratory back up, and is the curse of many HR departments that have been given the job of collating self- or GP-certified fit notes. Many people say they have had a few days off with flu when they have really just had a bad cold.
What I often refer to in very non-clinical terms as "proper flu" is an order of magnitude worse than a cold, and despite the difficulties in clinical diagnosis, there is one test that works every time. If you are lying in bed with a bad cold and someone tells you that a suitcase containing £5,000 is on your doorstep, and it is yours to keep if you go and get it now, you will be out of bed quicker than you can sneeze.
If you have proper flu, you'll pull up the duvet, roll over and won't give a damn. However, flu is usually self-limiting for most healthy individuals, with recovery within two to seven days.
Getting the jab
The list of who should be offered the flu jab either by or via the NHS is clear, and further details can be found in the Public Health England and Department of Health's (DH) Flu plan - winter 2013 to 2014 or the DH's Green Book.
The rationale for NHS and other care staff receiving the jab is also clear regarding patient safety. But the debate that often rages in OH circles is whether or not it should be offered to the rest of the working-age population, and does it save the employer any money when it is? Will your company be raking in the business with a full quota of hankie-free staff when your competitors are staggering to the local chemist before taking to their beds for a week?
This is one of those fairly polarised arguments devoid of much decent long-term research. Some companies believe in offering the vaccine to staff, where others see it as a costly perk with no real organisational benefit. Many providers come up with all sorts of figures to prove the benefit, but when you realise they get considerable annual business from providing flu jabs, the scepticism starts to kick in.
About 10 to 12 years ago, I was asked to look at this issue for a large government agency. The operations director stated that if the floods of one year had coincided with the peak of flu the following year, the organisation would, to use his words, "have been screwed".
We looked at all the arguments for and against in an organisation that has a wide demographic and geographic base. Geography alone meant there would be a large cost from staff being away from their workplaces, which was just as likely to be a river bank or remote pumping station as an office building. We eventually concluded against, thinking that the cost of the vaccines, time and cost of administration, possible limited uptake, various set-up costs and a small percentage of side effects that may increase rather than decrease absence would outweigh the benefits, and that at best it would be an insurance policy that might save the organisation some public embarrassment once every 20 to 30 years.
Pros and cons
Roll forward 10 years, and I am now an independent provider. New and existing clients often ask me about vaccination schemes - which is an awkward conversation, as this is something I can make money on. On discussion of the pros and cons some have decided against, yet two have gone for it - one of which was caught out very badly by flu the year before they started with me, and I am now approaching the third year of providing a vaccine service to them. Others still express an interest, but a couple of winters of low flu numbers have kept them on the "no" side of the debate.
It seems everyone wants to do this when the flu numbers will be high, but as we all know, that is almost impossible to predict. The debate will linger for some years yet, as all the research I have seen tends to concentrate on one winter and I think this can only be truly measured over a much longer period. A minimum of 10 years is probably needed to properly evaluate the costs and benefits in a workplace of employees who mostly do not fall into the standard "at risk" groups.
All you can do at present is debate the arguments for and against with your client or employer, with one of the factors being the available OH time and resources, and then make a decision. If you provide flu jabs regularly, my own feeling is that in most winters you will marginally lose - but occasionally, it will be one of the best decisions you ever made. Whether or not the benefits of that one winter will be enough to cancel out the costs of the others remains to be seen. Some long-term research anyone?
The author: Lindsey Hall is director and independent occupational health adviser at Split Dimension Ltd.