The Great Flu Debate!

With Autumn and Winter ahead, attention often turns to the potential for winter bugs to cause employee illness and absence. Influenza or Flu inevitably gets the most attention and it is worth being clear that flu can be a very serious and debilitating illness. Even for healthy people flu can cause incapacitating high temperatures, severe aches and pains, over whelming headaches and extensive fatigue. Vulnerable individuals with pre-existing conditions such as asthma or heart disease have increased risk of developing severe infections such as pneumonia and severe flu can be a killer!

However, many of the winter illnesses ascribed to flu are not caused by influenza virus, the common cold, other respiratory viruses and other flu like illnesses also abound in winter and much of the burden of sickness attributed to flu is actually not so. Add to this media interest and headlines about flu and it can be very tempting to succumb to a more minor illness and take time off from work – certifying absence as flu.

This makes it very tempting for employers to see flu vaccination campaigns as vital to avoid the costs of sickness absence associated … BUT the cost/ benefit decision of providing flu vaccines through workplace schemes is unfortunately far from a simple one.

Firstly, as described above, many of the wintry infections are something other than true flu – flu vaccination does not protect against other illnesses. Secondly flu vaccination is not 100% effective, there are medical reasons for this – flu is a clever virus which adapts quickly and changes its characteristics regularly. Flu vaccine producers try to predict the nature or type of flu ahead from many different choices, but if the prediction is wrong or the flu changes at the last minute the vaccine becomes less effective and you may still get flu despite having the jab.

Another issue relates to critical numbers – to eradicate a disease you need to get very high levels of immunity to prevent the disease spreading. From my own experience of workplace vaccination programmes uptake can be very variable and most programmes are necessarily voluntary. The NHS is an example of an employer that actively targets and promotes flu vaccine uptake – to protect staff and also with intent to reduce transmission of flu to patients. Much effort has been made to get front line NHS staff to have the vaccine each year – yet many NHS organisations have uptake rates below 50% and even the best struggle to get above 70% vaccinated. This can mean in a significant flu outbreak the disease can still circulate and spread.

I have read and watched many academic studies looking at whether worker flu vaccination is effective or not and again this can be a complicated analysis. For example, some studies have shown lower absence rates after flu vaccination campaigns, but the effect may not be due to reduced flu infection! (Workers may feel that their employer cares about their health more, are less likely to attribute non flu infection symptoms to being a need for absence and may have higher engagement – a powerful driver of absence behaviours). In these examples there may be a return on investment even despite not lowering true flu infection rates.

Overall the best way of looking at academic research is to get in a helicopter and look from the heights at the overall combination of research – there are number of academic ways of combining research data to ask what the combined knowledge shows us. In 2014 one of the best of these “a Cochrane review” looked at the combined results of nearly 100 high quality studies of a number of different technical designs. Their overall conclusion was that,

“Influenza vaccines have a very modest effect in reducing influenza symptoms and working days lost in the general population, including pregnant women. No evidence of association between influenza vaccination and serious adverse events was found in the comparative studies considered in the review”.

In a nutshell they found that for most healthy workers the impact was quite small. For those who have conditions that flu vaccination can be important for the NHS already offers free vaccination via GPs and GPs contact patients to offer such.

As already described this does not mean flu vaccination campaigns aren’t appropriate but simply that employers should consider carefully why they are being offered and be realistic about their impacts.

What is far more important is understanding employee health and managing absence during high risk periods. Winter (and holiday periods such as Christmas) carry other reasons that people may find it harder to come to work and when I worked in a large national service provider I was able to show that absence rates went up when media coverage of flu increased (even when measured flu virus levels were low!). Having systems to recognise absence early and offering advice and support quickly can reduce the length of these absences and make significant savings. For service providers reducing absence is important to maintain service levels and quality and keeping more people happy, healthy and in work can be a huge competitive advantage.

Simple advice like regular hand washing, particularly before eating, and promoting the public health advice to reduce spread of respiratory viruses (“Catch it, bin it, kill it” – with many free promotion resources easily accessible) are important measures that can be taken and which will reduce infections more widely than just flu.
Promoting awareness is something managers can actively do to prepare for the winter season and if a flu vaccination programme is chosen then good systems to manage the delivery or programmes and avoid delay can increase effectiveness.