Return on investment of preventive medicine in the workplace
I STILL have my immunisation card from my childhood days, thanks to my mom. My parents understood that immunisation was serious business. In the workplace, not much is said about taking advantage of vaccines in preserving health.
Vaccines are among the most cost-effective and impactful tools for preserving health, and vaccination is a key strategy in preventive medicine. The American College of Preventive Medicine defines preventive medicine as promoting preventive health to improve well-being by preventing disease, disability and death. Because we spend a lot of time at work, the workplace presents an opportunity for preventive medicine, including vaccinepreventable diseases.
Some employers support workplace immunisation programmes as part of health promotion for staff. About one in 10 working-age persons gets the flu each year. A worker with the flu could lose more than three workdays. However, whereas the benefits of the flu vaccine in decreasing infections, hospitalisations, and deaths among the elderly and persons with chronic illnesses are well documented, we question whether there are health and economic benefits of immunisation programmes that also target working-age persons with no medical conditions.
RETURN ON PREVENTION
For low- and middle-income countries like Jamaica, cost-benefit considerations could start with looking at the possible worst-case scenario. Studies of this issue are mainly carried out in high-income countries, primarily the US, with highly privatised healthcare, which is different from countries in which health systems are fully or partially nationalised. A conservative approach considers costs related to workdays, vaccines, doctor’s visits, medications, and hospitalisation regardless of who pays – insurer, employer and/or worker. One such study was published in the highly regarded Journal of the American Medical Association.
Conducted across two influenza seasons among 18-64-year-olds with no medical conditions, this study yielded invaluable insights. They found that the flu vaccine decreased illness and absenteeism by a third and decreased doctor’s visits by 42 per cent compared to unvaccinated workers. Benefits were observed during the flu season when there was a good match between the flu vaccine and circulating flu strains. The year without a good match showed no protection. They concluded that there was no economic benefit from a workplace flu vaccine programme for most years for working-age adults with no chronic medical conditions.
This may be just where we would want to start a conversation about the cost-benefit impact of immunisation programmes delivered in workplaces across Jamaica. Chronic medical conditions are a growing concern affecting all age groups and associated with increased vulnerability to infectious diseases.
A benefit of vaccination is reducing the spread of infections. The negative impact of vaccinepreventable diseases on quality of life and productivity, even after recovery, should be considered. These factors are likely to tip the equation in favour of a positive return on investment.
A systematic review of studies on this issue published in the European Journal of Public Health in 2023 lends support. A collaboration between French scientists and Malakoff-Humanis, a private insurance group in France, highlighted that 40 per cent of randomised clinical trials (RCTs), the gold standard for health research, showed positive costbenefit ratios or what they termed positive ‘return-on-prevention’ (ROP). Only 15 per cent of RCTs reviewed showed a negative ROP; others were neutral or inconclusive. In countries like Jamaica, where government-supported health services are widely available, immunisation programmes delivered in the workplace setting through private-public partnerships are likely to have positive return-on-prevention.
EMPLOYERS’ ROLE IN PREVENTIVE MEDICINE
To foster vaccine uptake by workers, the Community Preventive Services Task Force in the US recommends that employers implement occupational health services, schedule reminders, reduce out-ofpocket costs by covering vaccine costs, and include immunisations in health plans. In Jamaica, health insurance typically does not cover immunisations unless employers request special arrangements. Organisations could prioritise vaccines for staff and their dependents that address the most pressing public health needs of our time. For example, the vaccine against human papillomavirus (HPV) is effective in preventing cancer of the cervix and may be appropriate for younger staff and dependents. Cervical cancer is the second leading cause of cancerrelated deaths among women in Jamaica. Additionally, promoting the annual flu vaccine, as well as ‘catch-up’ vaccines for adults with incomplete immunisation, including against measles, would be timely in light of rising cases of vaccine-preventable diseases globally.