Supporting employee health in the workplace in 3 steps

Established in 2018, Immunize.io is a Registered BC Non-profit organization dedicated to improving community and global immunization rates. With the mission statement "Taking our best SHOT to IMMUNIZE the WORLD", the team strives to address all domains of vaccine hesitancy and improve immunization rates worldwide. With a focus on providing education about the impact of diseases and eliminating complacency around vaccinations, Immunize.io instils confidence in the benefit and effectiveness of vaccinations with the benefits of protection against diseases.

Why Vaccines are an important health intervention for the workplace

Historically, vaccines have had a tremendous role in increasing life expectancy by drastically reducing the morbidity and mortality of childhood diseases. In the 20th century, we saw the eradication of diseases like smallpox and a dramatic reduction in childhood diseases like diphtheria, tetanus, polio, measles, mumps, rubella, and Haemophilus influenzae (B (1)). The Canadian public health system provides a strong infrastructure to support childhood immunization. However, a similar framework has not been developed for adult immunization. As a result, most Canadian adults are not up to date on their recommended vaccinations (2,3). As goes the saying "you don't know what you don't know", there is a dire need to educate and facilitate access to adult vaccinations.

Workplaces can benefit from high vaccination rates against communicable diseases like influenza, as this would reduce the incidence of disease outbreaks in the workplace and the number of employee sick days. A Canadian Labour force survey estimated that approximately 20 workdays are lost per 100 full time employees annually due to influenza (4). Given the current challenges of staffing in the labour market, employers and workplaces must leverage any interventions possible to mitigate this risk.

While death is certainly a possible outcome from a vaccine preventable disease, "morbidity" or disability to employees is more costly to the workplace. Employees who are hospitalized from a vaccine preventable disease like influenza or pneumonia may never regain their baseline function (5). Employees with shingles may develop debilitating chronic pain and require multiple healthcare specialist visits and medications to help manage this (6). An employee with HPV-related cancer will require time off work to attend specialist appointments, get lab work done, and procedures to biopsy and or remove the cancer (7). We also can't discount the detriments to the employee's mental health and well-being when navigating these unfortunate yet preventable scenarios.

Here are how workplaces can take a more proactive approach than the current health care system.

Step 1: Identify the needs of your employee demographic

Vaccine recommendations are based on age, medical risk, and lifestyle risk. With an aging population the burden of vaccine preventable diseases has shifted to older adults. Especially with people living longer, they often accumulate medical conditions which further increase their risk of having severe outcomes from vaccine preventable diseases. While older employees may be more experienced, or have less turnover, they're also more susceptible to age-related vaccine preventable diseases. Age-based recommended vaccinations such as shingles and pneumococcal are important to maintain productivity in the aging workforce. Younger and middle-aged employees, primarily those over age 26, can benefit from the cancer preventing HPV vaccination. Depending on the age demographics of your workforce a targeted vaccination campaign to address specific immunization gaps can be very effective.

Step 2: Talk to your plan sponsor about reimbursing recommended vaccines

Private plans should certainly reimburse vaccines for their benefit holders. Recognizing that the public health program covers the "basics", but due to limitations of public health spending power the coverage is not as comprehensive as it should be. Private plans can cover this "gap". When we look at the "value" of various health interventions on an individual's well-being, there is no greater yield across the lifespan than a vaccination. Insurers and Employers have the luxury to be more proactive than the current healthcare system. Not reimbursing recommended vaccines is a tremendous waste of this opportunity.

Step 3: Advocate vaccine access through immunization specialty pharmacies

Vaccinations are only beneficial if they are administered into the arm, so they can elicit a long-lasting immune response to protect its recipients. Therefore, it is simply not enough for plan sponsors to cover these vaccines if the beneficiary cannot receive them.

For the past decade pharmacists have played an increasing role in recommending and administering vaccinations. In fact, most Canadians receive their annual influenza vaccination at a community pharmacy (8). For pharmacists in British Columbia, it is within their scope of practice to dispense and administer a vaccine without a doctor's prescription. Many Canadians do not have a family physician, and if they do vaccination is not often discussed due to other presenting health concerns. Finding a pharmacy partner who can provide all recommended immunizations facilitates much better access to vaccinations.

Workplaces can encourage their employees to update their recommended vaccines, work with their plan sponsor for reimbursement, and partner with community pharmacies to facilitate access.

Ajit Johal is a practicing clinical pharmacist and assistant professor at the UBC Faculty of Pharmaceutical Sciences. He is the co-founder and director of Immunize.io Health Association, a BC-based not for profit organization dedicated to global immunization efforts. He speaks locally, nationally, and globally about the benefits of vaccinations and how to address barriers to accessing recommended vaccinations.

References

1. Romanow_Immunization (cpha.ca)

2. Parkins MD, McNeil SA, Laupland KB. Routine immunization of adults in Canada: Review of the epidemiology of vaccine-preventable diseases and current recommendations for primary prevention. Can J Infect Dis Med Microbiol. 2009 Fall;20(3):e81-90. doi: 10.1155/2009/474035. PMID: 20808459; PMCID: PMC2770305.

3. Vaccine uptake in Canadian Adults: Results from the 2016 Adult National Immunization Coverage Survey HP40-222-2018-eng.pdf (publications.gc.ca)

4. Schanzer DL, Zheng H, Gilmore J. Statistical estimates of absenteeism attributable to seasonal and pandemic influenza from the Canadian Labour Force Survey. BMC Infect Dis. 2011 Apr 12;11:90. doi: 10.1186/1471-2334-11-90. PMID: 21486453; PMCID: PMC3103439.

5. Letellier MC, Amini R, Gilca V, Trudeau G, Sauvageau C. Herpes Zoster Burden in Canadian Provinces: A Narrative Review and Comparison with Quebec Provincial Data. Can J Infect Dis Med Microbiol. 2018 Oct 21;2018:3285327. doi: 10.1155/2018/3285327. PMID: 30420904; PMCID: PMC6215583.

6. Brown J, Sato R, Morley JE. Effect of Inpatient and Outpatient Pneumonia on Mobility Disability, Gait Speed, and Physical Activity in Older Adults. J Clin Med. 2021 Mar 16;10(6):1236. doi: 10.3390/jcm10061236. PMID: 33809731; PMCID: PMC8002307.

7. Szymonowicz KA, Chen J. Biological and clinical aspects of HPV-related cancers. Cancer Biol Med. 2020 Nov 15;17(4):864-878. doi: 10.20892/j.issn.2095-3941.2020.0370. Epub 2020 Dec 15. PMID: 33299640; PMCID: PMC7721094. 8. Flu shot season and pharmacies: a national survey Utilities - English (pharmacists.ca)