Anticipating and Reducing Risk Business Preparedness for an Avian Influenza Pandemic

Transcription

1 Anticipating and Reducing Risk Business Preparedness for an Avian Influenza Pandemic February 9, 2006

2 Business Preparedness for an Avian Flu Pandemic Today s Speakers: Philip L. Polakoff, M.D., MPH, National Practice Leader for Clinical Consulting & Lifetime Health Strategy Principal, Buck Consultants Connie Harden, J.D. Tax & Legal Consultant Principal, Buck Consultants 2

3 Agenda Evolving Health & Welfare Landscape Series Business Preparedness for Pandemic Influenza What is a pandemic? What is avian flu, and how it differs from seasonal flu? Why is avian influenza of special concern? How are governments and public health organizations preparing? What can businesses do to prepare? Buck Pandemic Flu Survey results 3

4 Evolving Health and Welfare Landscape Series

5 Evolving Health and Welfare Landscape Series To date, our complimentary webcast series has addressed Medicare Modernization Act Part D: What We Need to Know and Do A two-part sequence addressing strategic and tactical issues organizations must understand and plan for well in advance of the January 1, 2006 effective date Lifetime Health: A Model for Change A strategy designed to help manage health care costs and engage employees as active health consumers Beyond Health Savings Accounts: The Future of First Party Payment A thoughtful approach to Consumer Directed Health Plans including a first-party payment strategy and the stacking of multiple health care expense purses Health Management: Securing results in a challenging environment A diagnostic approach to reducing the increasing burden of healthcare expenses Making Up For Lost Time: Controlling the costs of employee absence through targeted interventions and a continuous improvement mindset 5

6 Evolving Health and Welfare Landscape Series Upcoming Webcast topics: Medicare Part D March 2, 2006 Pharmacy Update March 16, 2006 Data-Driven Approaches to Health Care Cost Management April 6, 2006 Health Technology May 18, 2006 Severance Solution June 15, 2006 To learn more about our Evolving Health and Welfare Landscape Series please contact Lorraine Smith at Lorraine.M.Smith@buckconsultants.com 6

7 A Comprehensive Approach to Lifetime Health Health Management Absence Management Lifetime Health Health Technology Business Management 7

8 Current Understanding

9 Pandemic Influenza: Definition Global outbreak of influenza involving: Virus strain that is new to humans Virus is efficiently transmissible between humans Illness occurs over wide geographic area Pandemic flu compared to seasonal flu: Both cause same basic symptoms of fever, chills, body aches, sore throat, non-productive cough, runny nose and headache Pandemic flu can be much more severe because it involves novel virus strain to which humans lack immunity Viruses change through mutation, reassortment or recombination with other viruses Virus originating in other animals (e.g., birds) can eventually be passed by animals to humans Increased incidence of human cases increase likelihood of humanto-human transmission 9

10 Avian Influenza Most likely cause of pandemic Avian flu H5N1 Avian Influenza virus (H5N1 influenza or bird flu ) causes severe disease almost exclusively affecting poultry Present in increasing number of countries in Asia and eastern Europe; spreading along migratory bird flyway Unprecedented in pathogenicity and virulence Not readily transmissible from human to human In humans, H5N1 virus causes severe disseminated disease affecting multiple organs and systems Human death rate is over 50% Hundreds of millions of birds have died through virus or culling 10

11 Business Preparedness for Pandemic Influenza The signs are clear that another pandemic is near at hand, even though the timing cannot be predicted with certainty. Based on our knowledge of past pandemics, this would result in incalculable human misery. LEE Jong-wook Director General WHO November,

12 Business Preparedness for Pandemic Influenza Pandemics are global in nature, but their impact is local. When the next pandemic strikes, as it surely will, it is likely to touch the lives of every individual, family, and community. Our task is to make sure that when this happens, we will be a Nation prepared. Michael Leavitt Secretary, U.S. Dept. of Health & Human Services January,

13 20 th Century Influenza Pandemics Spanish Flu Between 40 million and 100 million deaths globally 500,000 deaths in United States; 20 million were sick May have led to early end of WW I American deaths greater than in any war in our history Killed more in 24 months than AIDS has killed in 24 years Killed more in 1 year than Black Death of Middle Ages killed in 100 years See following maps showing spread in US (Source: CDC) Asian Flu 70,000 deaths in United States Two waves, with second beginning 3 months after first Hong Kong Flu 36,000 deaths in United States Two waves, 12 months apart Swine Flu 8,300 deaths in United States National vaccination program, but pandemic never developed 13

14 The spread of the 1918 Influenza Pandemic 14

15 The spread of the 1918 Influenza Pandemic Before Sept

16 The spread of the 1918 Influenza Pandemic Before Sept. 14 Between Sept

17 The spread of the 1918 Influenza Pandemic Before Sept. 14 Between Sept Between Sept

18 The spread of the 1918 Influenza Pandemic Before Sept. 14 Between Sept Between Sept Between Sept Oct. 5 18

19 The spread of the 1918 Influenza Pandemic Before Sept. 14 Between Sept Between Sept Between Sept Oct. 5 After Oct. 5 19

20 Why Scientists Are Very Concerned History of pandemic influenza suggests a devastating pandemic is near Influenza A mutates frequently and H5N1 is already showing signs of changes that tend to increase human transmissibility There are troubling parallels between the H5N1virus and previous flu pandemics We don t have the vaccines, antiviral medications and other tools needed to prevent or mitigate a new pandemic 20

21 Tangential Consequences of Worst-Case Pandemic Commerce disruption Transportation Communications Bankruptcy Economic Depression Health care disruption Hospital overload Shortage of staff Shortage of supplies Food shortages Famine Disruption of supplies to poor Deaths from shortages Public safety disruption Lawlessness Violence Public panic Political unrest Loss of trust in government Wars over shortages Global terrorism Social fabric disruption Human suffering and loss Migration Long-term effects Demographic Psychological From Larry Brilliant, MD, MPH, Meeting on Effective Response and Business Continuity for UN and Humanitarian Agencies Tufts University, Boston, 1/12/06 21

22 Current Statistics

23 Projected Toll of Avian Flu Pandemic CDC projections are conservative: Do not assume worstcase scenario such as occurred in 1918 Between 15% and 35% of the population are likely to become ill U.S. deaths: 89, ,000 U.S. hospitalizations: 314, ,000 U.S. deaths could exceed 1 million if avian flu virus remains highly pathogenic and retains current virulence Some scientists believe major pandemics (such as 1918) strike about every 75 years There have been at least 10 pandemics in past 300 years 23

24 Potential Macroeconomic Consequences World Health Organization (WHO) estimate: Mild pandemic would result in between 2 million and 7.4 million deaths worldwide; major pandemic could cause over 100 million deaths; Other experts expect million deaths Experts predict between 650 million and 2.8 billion will be ill Most immediate impact Potential for panic Demand shock affecting service sectors such as travel and tourism Supply shock caused by workplace absenteeism and disruption of production Costs of hospitalization and medical treatment Total economic consequences of a mild pandemic: ~U.S.$800 billion, according to World Bank Social cost will likely exceed direct cost of morbidity and mortality 24

25 WHO Stages of Pandemic Alert Interpandemic phase Low risk of human cases 1 New virus in animals, no cases in humans Higher risk of human cases 2 Pandemic alert No or very limited human-to-human transmission 3 New virus causes human cases Evidence of human-to-human transmission Evidence of significant human-to-human transmission 4 5 Pandemic Efficient and sustained human-to-human transmission 6 25

26 Current Status of the Disease As of 1/30/06, confirmed human cases (according to WHO) 160 cases with 85 deaths Recent spread to Turkey (21 cases, 5 deaths) and Iraq Recent spread in birds to Cyprus and possibly Algeria Evidence of virus mutations in patients in Turkey Reports that virus seems to be gaining resistance to Tamiflu in East Asian cases Still no significant human-to-human transmission Still WHO phase 3; some observers urge move to phase 4 due to events in Vietnam and Turkey 26

27 Global Governmental Response

28 Governmental & Public Health Actions Outside U.S. WHO focus on control of bird outbreaks, identification of disease, coordination of resources and efforts, particularly in countries lacking veterinary and medical resources Countries where H5N1 is present destruction of sick birds, vaccination of healthy birds (14 billion in China), identification of human cases; difficulty of task depends in large part on prevalence of small rural poultry operations and ability to compensate farmers for lost chickens and ducks Over 120 countries now have preparedness plans New Zealand: Plan includes materials addressing business continuity 28

29 U.S. Preparedness Efforts Homeland Security Council National Strategy for Pandemic Influenza HHS Pandemic Influenza Plan detailed federal response Centers for Disease Control (CDC): Scientific study of the virus and its spread, monitoring of domestic and international situation, communication to government and public, provides various planning materials including business planning checklist State and local governments and public health agencies: Planning for possible quarantine and other social distancing measures, hospital and other health care surge, will provide guidance and assistance to local authorities National Institutes of Health (NIH) Vaccine development 29

30 Vaccine Development and Production Present global manufacturing capacity for seasonal influenza virus is 420 million doses per year WHO projects development of a prototype virus strain for use in vaccine production within three weeks following identification of human transmissibility New techniques economize on use of antigen in vaccine manufacturing, so 900 million doses of vaccine could be produced within about 8 months It could take 4 to 5 years to achieve a significant increase of vaccine manufacturing capacity sufficient to provide vaccine to everyone 30

31 Timetable for Influenza Vaccine Production and Use in the United States Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Eggs Production of Concentrates Formulation-Testing FDA Release Filling-Testing Packaging Need to Know Distribution One or more strains in formula * All strains in formula Precise formulation ACIP recommendations for use Administration * The characteristics of the strains circulating the previous season provide the basis for selecting virus strains for the next year s vaccine. Courtesy of the Centers for Disease Control and Prevention. From Tufts University United Nations presentation by Larry Brilliant, MD, MPH 31

32 Critical Business Planning Issues

33 Business Pandemic Planning Education Illness Surveillance Pandemic Planning Facility Preparedness Business Operations 33

34 Survey Results on Current Preparedness Business Continuity Plans Don t consider impact of pandemic illness on HR operations (61%) Senior management (57%) Sales activities (59%) Call centers and customer support (52%) Management succession plans 54% don t address incapacity or death of multiple executives Force majeure ( Act of God ) provisions 77% of respondents don t know whether provisions cover pandemic illness Buck Consultants Survey online survey administered December

35 Business Pandemic Planning Establish Pandemic Planning Team Buy in from Senior Management Appoint planning leader and team members Include representatives from critical corporate departments, including legal and finance Role of Pandemic Planning Team Evaluate and prioritize risks and critical elements for business continuity Evaluate impact of pandemic on increase or decrease in demand for products/services Plan using multiple scenarios, including worst-case Take into account potential for multiple waves of illness Identify essential employees and cross-training opportunities Assess supply lines and potential alternatives 35

36 Role of the Pandemic Planning Team Evaluate and prioritize risks and critical elements for business continuity (continued) Assess impact of travel restrictions Identify sources of reliable information and create strategy for monitoring status Develop emergency communications plan Develop evacuation plans for high risk locations Ask outsourcing providers about their plans Corporate legal should evaluate force majeure provisions in standard contracts Revise as necessary in newly negotiated contracts Identify major existing contracts (both customer and supplier) to determine major vulnerabilities 36

37 Role of Pandemic Planning Team (continued) Develop scenarios Include mild, moderate and worst case Anticipate two or three waves of illness Expect multiple (probably all) locations to be affected within a short period Evaluate critical inventories; modify just in time approach, if necessary Plan for transportation interruptions and other social distancing measures Determine impact of possible public panic 37

38 Additional Survey Responses Expand telecommuting 83% said it s possible Flexible work schedules 42% said they have Preschool and school aged children Majority of respondents say that 20 to 30% of employees have 51% of respondents said their sick pay/sick leave programs would need modification 63% of respondents have no health care professionals on staff 38

39 Educate Key Groups Employees Disease transmission, symptoms, hygiene, cough/sneeze etiquette Employer s mitigation and control efforts What to do if they become ill at work or home Importance of emergency contact information Employer s communication plan in event of crisis Any modification of sick leave or benefit plans Communication plans 39

40 Educate Key Groups Managers and supervisors Emergency chain of command Internal communication plans Communication with suppliers and customers Telecommuting and flexible work arrangements What to do when an employee becomes ill at work Available health care alternatives How and when to distribute hand sanitizers, masks, gloves Monitoring of absence rates and patterns Inform Customers/Clients about the response plan Be honest and timely 40

41 Plan for Impact on Employees Evaluate potential impact of high absentee rates on various operations Determine potential impact of school closures and other social distancing measures Determine whether sick pay benefits should be liberalized Take measures necessary to facilitate telecommuting and use of flexible scheduling Encourage employees to get annual flu vaccine Plan how to communicate with employees during period of pandemic Communicate in ways that mitigate fear and inform honestly Be sure that emergency contact information is current 41

42 Steps to Take During a Pandemic Early Stages Provide hand sanitizers, surgical gloves, masks Remind managers and employees about: Disease transmission Hand hygiene Cough and sneeze etiquette Symptoms Employer policies regarding absences Who to contact if they become ill Implement travel restrictions Track illness patterns within the organization Keep informed regarding global and domestic patterns of illness and recommendations of health officials 42

43 More Survey Responses Actions Employers took for SARS or plan to take for avian flu: SARS Avian Flu Masks 25% 42% Antivirals 7% 16% Hand Sanitizers 28% 57% Rubber Gloves 27% 41% Education 32% 61% Restrict International Travel 38% 56% Restrict Domestic Travel 14% 44% 43

44 While a Pandemic is at its Height Implement flexible work schedules and telecommuting plans Continually monitor supply chain Continually monitor ability to meet contractual commitments Continually re-stock hand sanitizers, masks and gloves Follow directions of public health authorities Monitor CDC, WHO and other official websites Make workplace vaccination available if possible Communicate with customers and suppliers Communicate with employees Assess financial impact and communicate with markets 44

45 Summary Educate key stakeholders Develop and empower multi-disciplinary team Design a strategic comprehensive preparedness plan Implement surveillance program Execute with flexibility and responsiveness 45

46 Q&A Thank You Phillip Polakoff, MD, MPH Principal, National Clinical Consulting and Lifetime Health Strategy Leader Connie Harden, J.D. Principal, Tax & Legal Consultant

47 Web Resources Helpful information is available through these sources: