Health & Safety Group Meeting

11th February 2008

Provision of Tamiflu for staff, partners & dependents

With HCC you are working with the experienced pandemic professionals

About usAbout us

• Occupational Health Providers – est. 1996

• Forward-thinkingForward-thinking, innovativeinnovative and value addedvalue added services

• Well known for excellence in serviceexcellence in service – medicals and drug & alcohol

• Professional managementProfessional management expertise & clinical excellence

• Used to the management of large contractslarge contracts

Pandemic InfluenzaPandemic Influenza

• HCC identified the issue for our own businessHCC identified the issue for our own business

• Offering extended to existing and new clientsOffering extended to existing and new clients

• Service extends across the globeService extends across the globe

• Servicing high profile FTSE 100 and BlueChip organisationsServicing high profile FTSE 100 and BlueChip organisations

• Consultants on government paperConsultants on government paper

Pandemic InfluenzaPandemic Influenza

Today’s Discussion:Today’s Discussion:

What is the threatWhat is the threat??

Pandemic assessmentPandemic assessment

Business preparednessBusiness preparedness

&&

The HCC SchemeThe HCC Scheme

Pandemic Influenza – What is the Pandemic Influenza – What is the threat?threat?Worldwide experts believe a highly Worldwide experts believe a highly infectious and particularly virulent influenza infectious and particularly virulent influenza virus is likely to emerge, infecting the virus is likely to emerge, infecting the population and causing many deaths on a population and causing many deaths on a global scale. global scale.

Being prepared and aware is key to effective planning

Pandemic Influenza – What is the Pandemic Influenza – What is the threat?threat?

o An influenza virus achieves pandemic status An influenza virus achieves pandemic status when the virus emerges or mutates into a form that when the virus emerges or mutates into a form that can easily escape the defences of the human can easily escape the defences of the human immune systemimmune system

o Pandemic influenza is different to normal Pandemic influenza is different to normal seasonal influenza. It does not just infect the seasonal influenza. It does not just infect the weaker sections of society, but all ages, children weaker sections of society, but all ages, children and otherwise fit adultsand otherwise fit adults

Being prepared and aware is key to effective planning

o A pandemic is a disease that A pandemic is a disease that causes infection on a global causes infection on a global scalescale

Under pressure . . . Under pressure . . .

• Health Services - A pandemic influenza virus can spread rapidly putting severe strain on existing health services

• Economy - High mortality and great social and economic disruption is experienced across the globe, leading to recession

• Businesses - Workers will be absent for extended periods – caring for loved-ones, experiencing sickness and becoming part of the ‘stay-at-home worried well’

• People - The human body has little natural defence (immunity): Health complications arising from a pandemic influenza infection can include severe pneumonia, respiratory distress and organ failure

The infrastructure of the country would be seriously impaired

CURRENT PHASE OF ALERT IN THE CURRENT PHASE OF ALERT IN THE WHO GLOBAL INFLUENZA WHO GLOBAL INFLUENZA

PREPAREDNESS PLANPREPAREDNESS PLAN

Source:http://www.who.int/csr/disease/avian_influenza/phase/en/index.html

Consider the evidence:Consider the evidence:

Professor John Oxford’s (Prof. of Virology & world renowned influenza expert) opening quote at a Pandemic Summit in June 2007 stated:

“1916 = 145 deaths1918 = 50 million deaths (and)

2006 = 147 deaths2008 = ?????”

Closer than ever to the next pandemic?

Where will it come from?Where will it come from?

It is impossible to predict exactly how, when and where the next pandemic virus will emerge. An immediate risk is posed by the avian influenza virus (bird flu or virus H5N1).

The H5N1 virus is highly infectious and fatal for birds.

Experts virologists around the globe are watching the H5N1 virus

The virus can transfer directly from a bird to a human causing an extreme case of influenza – often resulting in death (c.60% mortality).

So, is there really a threat?So, is there really a threat?

• The World Health Organisation (WHO) believe a pandemic is imminent

• Experts at WHO & virologists believe that the world is closer to another influenza pandemic than at any time since 1968• If the H5N1 avian virus mutates to allow easy human-to-human transmission a pandemic influenza could take less than 1 month to spread to the UK from source

• Numbers of deaths in the UK alone have been estimated up to 750,000 (1 million+ hospitalisations) and the UK Cabinet Office have released a paper to address the issue of ‘Mass Fatalities’ in the UK

• Global economic impact could be $2-4.4 trillion (World Bank)

• The 1918 pandemic killed c.40 million – this pandemic also started life as an avian influenza virus

Being aware of the risk is essential

cases deaths cases deaths cases deaths cases deaths cases deaths cases deaths cases deathsAzerbaijan 0 0 0 0 0 0 8 5 0 0 0 0 8 5Cambodia 0 0 0 0 4 4 2 2 1 1 0 0 7 7

China 1 1 0 0 8 5 13 8 5 3 0 0 27 17

Djibouti 0 0 0 0 0 0 1 0 0 0 0 0 1 0

Egypt 0 0 0 0 0 0 18 10 25 9 0 0 43 19Indonesia  0 0 0 0 20 13 55 45 42 37 9 8 126 103

I raq 0 0 0 0 0 0 3 2 0 0 0 0 3 2Lao People's Democratic Republic 0 0 0 0 0 0 0 0 2 2 0 0 2 2Myanmar 0 0 0 0 0 0 0 0 1 0 0 0 1 0

Nigeria 0 0 0 0 0 0 0 0 1 1 0 0 1 1

Pakistan 0 0 0 0 0 0 0 0 1 1 0 0 1 1

Thailand 0 0 17 12 5 2 3 3 0 0 0 0 25 17

Turkey 0 0 0 0 0 0 12 4 0 0 0 0 12 4

Viet Nam 3 3 29 20 61 19 0 0 8 5 1 1 102 48

Total 4 4 46 32 98 43 115 79 86 59 10 9 359 226

Country

2003 2004 2005 2006 2007 2008 Total

Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO5th February 2008

Even though more recent cases have seen a lower death rate, this is not necessarily good news:

This sort of pattern has often preceded a pandemic. Cases increase, whilst the viruses virulence is seen to reduce in proportion.

Total number of cases includes number of deaths. WHO reports only laboratory-confirmed cases. All dates refer to onset of illness.

Historical ConcernHistorical Concern

We are working with national and international professionals

Why the concern?Why the concern?

Historic and current evidence points towards a pandemic influenza outbreak

An influenza virus of pandemic proportion has the An influenza virus of pandemic proportion has the potential to be a global killerpotential to be a global killer

Influenza pandemics occur periodically, about three or four times in each century (c.30 year gaps)

Three influenza pandemics have occurred in the last century causing more than 53 million deaths

Pandemic influenza can hit at any time of the year – not just in the winter months as with seasonal influenza

VaccinationsVaccinations

120 million doses would be required in the UK alone

Why can’t we just vaccinate?Why can’t we just vaccinate?

‘‘All business sectors will need to plan to survive without All business sectors will need to plan to survive without vaccinations’ vaccinations’ UK Resilience Guide 2006 UK Resilience Guide 2006

A vaccination that can be guaranteed to cover against a A vaccination that can be guaranteed to cover against a pandemic influenza virus cannot be finalised until the pandemic influenza virus cannot be finalised until the exact strain is identifiedexact strain is identified

The Vaccine Development Process: during this time it is The Vaccine Development Process: during this time it is widely accepted that a pandemic would have ample widely accepted that a pandemic would have ample opportunity to sweep the globeopportunity to sweep the globe

It is highly unlikely that a vaccination will be available It is highly unlikely that a vaccination will be available during the ‘first wave’ of a pandemic during the ‘first wave’ of a pandemic

Manufacture, distribution and administration could take Manufacture, distribution and administration could take many months, following the virus strain identificationmany months, following the virus strain identification

The Antiviral The Antiviral AlternativeAlternative

Antiviral drugs give the human body a fighting chance

• In the absence of a deliverable vaccination, antiviral medication provides a ‘best-fit’ protection

• Antiviral drugs work on the influenza virus directly

• They can be taken both as a symptomatic treatment for influenza and as a prevention (prophylactic) against actually contracting the virus

• Tamiflu is a neuraminidase inhibitor, it works to prevent an influenza A or B virus from replicating in the human body

• A pandemic influenza stems from an influenza A virus

• The antiviral medication Tamiflu, manufactured by Roche, is being stockpiled by governments across the globe

• The WHO has called the role of antiviral drugs “unquestionable” & the “principle medical intervention”

Stockpiling Stockpiling

Business must take steps to protect themselves

Governments across the globe are stockpiling antiviral drugs following recommendation by the WHO.

The UK government has stockpiled c.14.6 million doses of Tamiflu. Exact distribution plans are not defined but priority treatment looks set for frontline health workers and the essential services.UK businesses are urged to form their own business continuity plans.

HCC are working with many businesses planning for 50% employee absenteeism for extended time periods.

Other countries have varying stockpiles of antiviral medication.

The French government has a proportionately double stockpile to the UK resource.

Business Impact Business Impact

HCC can help you to plan your entire continuity plan

• Supply Chains have broken down• Transport & distribution networks are ceased• Schools close and parents stay at home• General services and amenities experience heavy

disruption• Employees disappear through sickness, to care for

loved-ones and do not wish to risk exposure• Employees become frightened, whilst rumours and bad

information spreads fear

Consider a ‘What If’ scenario:Consider a ‘What If’ scenario: FLU INFECTION FLU INFECTION CONTROL AREACONTROL AREA

KEEP OUT !KEEP OUT !

Could your business surviveCould your business survive? ?

A Business A Business RequirementRequirementWorkforce education & health careWorkforce education & health care

• You must sufficiently educate a workforce to understand the You must sufficiently educate a workforce to understand the strategy: strategy:

Reducing panicReducing panicMaking plans workMaking plans workPromoting good hygienePromoting good hygiene

• Caring for employee health:Caring for employee health:Minimum antiviral coverage for ‘key workers’, orMinimum antiviral coverage for ‘key workers’, orMaximum antiviral coverage to include all workers, Maximum antiviral coverage to include all workers,

family, friends family, friends and your key supply chainsand your key supply chains

• Consider implementing:Consider implementing:Health check pointsHealth check pointsAntibacterial & alcohol hand rubsAntibacterial & alcohol hand rubsMasksMasks

The HCC Scheme The HCC Scheme

Our unique Scheme has been called ‘groundbreaking’

Wide-reaching scheme: WorkforceWorkforce, DependentsDependents, FamilyFamily and Supply Supply ChainChain

Series of delivery modelsSeries of delivery models for your convenience

Three years experienceThree years experience in pre-pandemic health planning

Face-to-faceFace-to-face delivery and clinicsclinics

Guaranteed supplyGuaranteed supply of antiviral medication

Experienced Account Managers Experienced Account Managers and patient servicing teams

The HCC Scheme

All Inclusive Scheme Membership– The HCC model favoured by our FTSE 100 clients

The all inclusive scheme provides the total package – ensuring your employees have the medication for when they need it most. This scheme can be offered to your employees and extended out to their family members and to your supply chain, as necessary.

Stock and Store Scheme-Under this service, we store medication under climate controlled pharmaceutical conditions until required.When you need the Medication, HCC can assist you in one of two ways – HCC nurses can attend onsite to perform dispensary clinics, or you can elect to upgrade to our All Inclusive Scheme at a later date.

Stock and Store PricingStock and Store PricingThe following pricing structure is based on one pack of The following pricing structure is based on one pack of

antiviral medication per employee:antiviral medication per employee:

No. of Persons Price per PersonNo. of Persons Price per Person 0 - 1,000 £35.000 - 1,000 £35.00

1,001 - 2,500 £32.751,001 - 2,500 £32.75

2,501 - 5,000 £30.252,501 - 5,000 £30.25

5,001 - 10,000 £28.005,001 - 10,000 £28.00

10,000 and over £26.0010,000 and over £26.00

Storage and Insurance:Storage and Insurance:

Under this service you can be assured that your stock is Under this service you can be assured that your stock is very well cared for, we store medication under climate very well cared for, we store medication under climate controlled pharmaceutical conditions and our insurance controlled pharmaceutical conditions and our insurance package is extensive (marine). The resulting storage and package is extensive (marine). The resulting storage and insurance cost to you is just an additional 25p per pack of insurance cost to you is just an additional 25p per pack of medication per yearmedication per year. .

All Inclusive Scheme All Inclusive Scheme Options Options

Providing you with a flexible working model

Option 1Option 1Elect to pay for a treatment course for each Elect to pay for a treatment course for each

employee employee

Option 2Option 2Cover each employee, as above, and includesCover each employee, as above, and includesup to X close family/friends in the offeringup to X close family/friends in the offering

Option 3Option 3Pay for all employees and allow employees to Pay for all employees and allow employees to

nominate and nominate and pay for their own family/friendspay for their own family/friends

Option 4Option 4Operate a subsidised scheme for all employees Operate a subsidised scheme for all employees

(and (and family/friends) family/friends)

Option 5Option 5Company purchases a contingency stockpile in Company purchases a contingency stockpile in

addition to addition to any of the above options for prophylactic any of the above options for prophylactic useuse

All Inclusive Scheme Costs

Standard Scheme: a treatment course to include 1 pack of Tamiflu (10 x 75mg capsules) per employee Per employee member scheme inclusion

£57.00Postage & packaging*

£6.95

Prophylactic Scheme: a prophylactic course typically including 4 packs of Tamiflu (40 x 75mg capsules) per employeePer employee member scheme inclusion£142.05Postage & packaging*

£6.95

Stock and Store Option

What Happens When We Need the Medication?: HCC can assist you in one of two ways – HCC nurses can

attend onsite to perform dispensary clinics, or you can elect to upgrade to our All Inclusive Scheme at a later date.

Nurse Clinics:We can send out our nurses to your premises to operate a dispensary clinic. Time/Price per Nurse

Half Day (3.5 hrs) £150.00 / Full Day (7 hrs) £300.00

All Inclusive Upgrade:You can elect to pay the difference in price per employee (& employee family member) to upgrade to the full occupational health service provided in the All Inclusive Scheme package.

(Please note, subject to timely availability)

The Registration Site for The Registration Site for All Inclusive OptionAll Inclusive Option

HCC offers our clients a unique web-based patient interface HCC offers our clients a unique web-based patient interface which provides:which provides:

• Wide reaching patient accessibility Wide reaching patient accessibility

• Removal of the client involvement for you: Dr-to-PatientRemoval of the client involvement for you: Dr-to-Patient

• Extensive and thorough patient information ‘central hub’Extensive and thorough patient information ‘central hub’

• A legal registration process with excellent levels of A legal registration process with excellent levels of securitysecurity

• An extremely effective customer and patient serviceAn extremely effective customer and patient service

All Inclusive (A.I.) All Inclusive (A.I.) Scheme OperationScheme Operation

Our Scheme is formatted with the client and patient firmly in mind

Employee logs on to Employee logs on to bespoke website: bespoke website: www.pimsreg.co.ukwww.pimsreg.co.uk

Goes through the Goes through the education materialeducation material

Registers with the schemeRegisters with the scheme

Nominates family Nominates family members*members*

The HCC operational The HCC operational process begins………process begins………

* If option chosen by employer* If option chosen by employer

A.I. Seven Steps to the A.I. Seven Steps to the Process Process

HCC fits with your model and mirrors the required process

Step 1Step 1 Identification of Eligible StaffIdentification of Eligible StaffHCC works with you to help you finalise your HCC works with you to help you finalise your

offeringoffering

Step 2Step 2 Registration ProcessRegistration ProcessWe can handle this for you & assist your HR We can handle this for you & assist your HR

teamteam

Step 3Step 3 Suitability ScreeningSuitability ScreeningOur internal process to screen the patients & Our internal process to screen the patients &

inform GPsinform GPs

Step 4Step 4 AllocationAllocationWe assign the medication to the patientWe assign the medication to the patient

Step 5Step 5 Distribution Timing & ProcessDistribution Timing & ProcessWorking together achieves the best process for Working together achieves the best process for

youyou

Step 6Step 6 Patient SupportPatient SupportWe offer excellence in customer and patient We offer excellence in customer and patient

serviceservice

Step 7Step 7 On-Going ProcessOn-Going ProcessWorking with you for leavers, joiners and Working with you for leavers, joiners and

renewalrenewal

A.I. Scheme A.I. Scheme Process Process

Providing you with a flexible working model

• HCC contacts patient’s General Practitioners (GPs) HCC contacts patient’s General Practitioners (GPs) and advises of the intent to provide Tamiflu under and advises of the intent to provide Tamiflu under an Occupational Health Scheme (PGD / SO)an Occupational Health Scheme (PGD / SO)

• By this point a secure Dr-to-patient relationship is By this point a secure Dr-to-patient relationship is established by HCC with your employeeestablished by HCC with your employee

• Records are checked, verified by our Patient Records are checked, verified by our Patient Services team. Customer service is on-goingServices team. Customer service is on-going

• Once the eligibility of the patient has been Once the eligibility of the patient has been established and verified the medication is picked / established and verified the medication is picked / packed and dispensed ready for distributionpacked and dispensed ready for distribution

The distribution method is dependent on your own preferred model – a bespoke and secure solution

A.I. Delivery model

Delivery and implementation of service is quick and easy for YOU

YOU have the option to choose which delivery model YOU require and which is best for YOUR business continuity and recovery:

HCC recommends a doctor to patient relationship that ensures the

patient has the medication in their medicine cabinet prior to an outbreak…..

Why?

Because no one can predict how severe the impact of a pandemic influenza outbreak will be, or when it will happen.

Patient-facing delivery models can be operated (clinic style)

however the infective risk and timing issues are great. HCC favours a direct patient delivery model.

Stock Stock

The importance of securing stock is clear

HCC is fortunate to have excellent stock levels HCC is fortunate to have excellent stock levels and order flows:and order flows:

With our stock of Tamiflu, we can fulfil even large orders, and

immediately place the drugs in your name

HCC can extend this not only to the employees butcomfortably to the extended family members

Our stock is sold on a first come first served Our stock is sold on a first come first served basis. . .basis. . .

TAMIFLUTAMIFLU

SOLD OUT ?SOLD OUT ?

Patient Support Patient Support

HCC guide our patients through every step of the process

All employees can rely on All employees can rely on great patient support:great patient support:

• Prior to registrationPrior to registration

• During registrationDuring registration

• Post registrationPost registration

• During a pandemicDuring a pandemic

• AftercareAftercare

HCC Resources:HCC Resources:Dr’s, Pharmacists, Nurses and Dr’s, Pharmacists, Nurses and trained patient service trained patient service assistants.assistants.

Online information hub & Online information hub & patient information.patient information.

Logistics & Overseas Logistics & Overseas Deliveries Deliveries

Our logistics model is fully operational and successful

HCC offers a Dr-to-patient service HCC offers a Dr-to-patient service in more in more than 92 than 92 countries countries around the world, each around the world, each country has country has different rules and regulations different rules and regulations regarding the drug registration process, regarding the drug registration process,

dispensing, storage and distribution.dispensing, storage and distribution.

Examples of differing international services:Examples of differing international services:

• Procure medicationProcure medication in the UK, use in the UK, use Dr-to-patient Dr-to-patient serviceservice

• Ship medication to Ship medication to all EU countriesall EU countries, using ‘track & trace’ , using ‘track & trace’ delivery and delivery and HCC’s binding tariff codeHCC’s binding tariff code

• Procure Procure medication at local levelmedication at local level to avoid all import/ to avoid all import/export chargesexport charges

• Local law requires: Local law requires: DrDr, , pharmacypharmacy, , storagestorage and and distribution distribution at local levelat local level

SummarySummary

we we helphelp you you carecare

HCC occupational health scheme is:HCC occupational health scheme is:

• Robust and experienced Robust and experienced

• Tired and testedTired and tested

• Fully operationalFully operational

• With a proven end-to-end delivery With a proven end-to-end delivery modelmodel

• 500,000+ scheme members500,000+ scheme members

Thank you Thank you

we we helphelp you you carecare