Influenza vaccine for healthy adult workers: An issue for health authorities or employers?

Objective To contribute to the debate whether extending public coverage of influenza vaccination to healthy workers is cost-effective, particularly in the perspective of EU countries.Methods First, we reviewed the recent international literature on the extension of vaccination to subjects aged 50-64 years in highly developed countries. Second, we estimated the broad economic impact of influenza vaccination on the Italian healthy adult working population. Finally, we ran a pilot observational study to assess the healthcare and labour outcomes of influenza vaccination on the employees of our organization.Results The methodological weaknesses of the studies reviewed, all built on models, undermine the credibility of their optimistic results. The more cautious the model design, the less favourable the final results, as our conservative analysis on the Italian setting confirmed. The only common result was a steady relationship between potential vaccination benefits and indirect costs of absenteeism from work. This "modelling-based evidence" was confirmed by our internal survey: vaccinated workers showed less tendency to stay at home during influenza-like illness episodes and their relapses.Conclusions The economic advantage of extending public influenza vaccination to healthy adult workers is still uncertain and mainly relates to the indirect costs of productivity losses, making the extension strategy more a labour than a health issue.