Corporate Pandemic Planning: Business Continuity Meets Healthcare

©2006, International SOS Assistance Inc.


Corporate Pandemic Planning: Business Continuity Meets Healthcare

Myles Druckman, MD VP Medical Services

International SOS



Corporate Preparation

Balancing the Needs of People and the Business

People Focus

• Awareness / Education• Reducing Illness• Mitigating Anxiety• Assisting with Hardship

Business Focus

• Customer Support• Maintaining Supply Chain• Preserving Revenue• Rebounding Quickly



Traditional vs. Pandemic BCP

InfrastructureIT

Financial

WORKFORCE

SupplyChainInf

Fin. CusIT

Workforce

Supply Chain

Customer

Pandemic BC Planning RequirementsTraditional BCP Requirements

Intl.SOS Expertise

Non-Intl.SOS

HealthExpertise

BCP



Pandemic Theory 101

Risk Mitigation and Rationale



Pandemic Influenza PhasesThe Pandemic influenza will develop in a series of “phases” – linked to the evolution of the virus:

Phase 1 – No virus presentPhase 2 – Virus in animals, not transmitted to humansPhase 3 – Human infection from virus, no human-to-human spreadPhase 4 – Small clusters of human-to-human spreadPhase 5 – large clusters, virus adaptingPhase 6 – PANDEMIC – wide spread transmission



Pandemic Waves

1. Flu “waves” last 2-12 weeks2. Waves fade, then recur multiple

times3. “Peak” of wave lasts 1-3 weeks

Implication:• Some locations will be affected

when others are not• Major travel hubs may be affected

first, remote areas later



Waves of the Spanish Flu in USA



Pandemic Implications1) Duration

Prolonged crisis lasting months and years (6-18 months), multiple waves

2) Health Impact30% of persons affected, 1% mortality

Illness possibly lasting 7-14 days, recovery period could be prolonged

Most persons will be treated at home (healthcare overwhelmed), social support key

3) AbsenteeismUp to 50% absent at “peak” of wave

Family members ill, children at home (schools closed), elderly, no public transport, anxiety

4) Business ImpactMany businesses closed, many services shut down, transportation / travel severely reduced, health systems overwhelmed, civil unrest

Identification of “business critical” personnel and operations

“Do not come to work” unless business critical…?



Pandemic Interventions1) Vaccines

The “gold standard” and definitive protectionWill not be available until at least 6 months AFTER pandemic declared, and even then, in limited distributionCompanies can do little to improve access to vaccines…

2) Antiviral Medications (e.g. Tamiflu)May reduce “severity” and “duration” of illness. Unproven.May be used to treat infection (given within 48hrs)May be used to protect against getting infectedCompanies may consider “stockpiling”

3) Non-Pharmacological Interventions (NPI)Activities that “reduce” one’s exposure to the virusInclude: social distancing, auarantine, entry screening, PPE, etc.Companies main focus in a pandemic plan



1. School Closures – children major “spreaders”

2. Social Isolation – ill persons home, no public gatherings

3. Personal Hygiene – hand wash, cough etiquette

4. Personal Protective Equipment (PPE) – masks, etc.

5. Home Quarantine – stay home if family member ill

6. Quarantine – likely to be voluntary, or short mandatory

7. Social Distancing

8. Travel Restrictions

9. Entry Screening

Examples of NPI’s



0

5

10

15

20

25

30

35

40

45

1 2 3 4 5 6 7 8 9 10 11 12

Weeks

% A

ffect

ed City 1City 2City 3

Implemented NPI

Data from the Spanish Flu in North AmericaPhiladelphia had a parade, then implemented NPI at 12% infected

Montreal implemented NPI’s when 6% were infected

St. Louis at 2% infected

Does EARLY intervention improve outcomes…?

*Recreated, conceptual graph from CDC research



Targeted Layered Containment (TLC)

Non-Pharmacological Intervention RoOutbreak – no intervention 2.1Add: School Closures early 1.9Add: Social Isolation – stay home if possible 1.5Add: Home Quarantine – if member ill, stay home 1.2Add: Social Distancing 0.9

Theoretical use of multiple NPI’s simultaneously to reduce Ro Trying to reduce ability of the virus to spread:



What Companies are Doing Today



Organizations are planning…



Poll on Pandemic Planning: What Corporations are Doing

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Implementing PlanInvestigating OptionsPandemic Will Not be an Issue



History of Corporate Planning2004 – H5N1 outbreaks in Asia• Corporations in Asia begin planning (SARS)• USA based corporations begin investigating pandemic• First companies begin pandemic plan2005 – More H5N1 outbreaks in Asia, expanding• More industry leading companies begin pandemic planning• 1st generation companies finish first drafts of corporate plans• 1st generation companies begin localization2006 – Outbreaks in Asia, Europe, Africa• 2nd generation companies finish first draft of corporate plans• 2nd generation companies begin localization• 1st generation companies begin implementation, drills and audits• 1st generation companies review antiviral plans – new availability2007 – Outbreaks begin anew in Asia, Africa, Europe• 3rd Generation companies begin corporate plans



Pandemic Preparedness

The Best Practices Lifecycle



The Corporate Pandemic PlanThe Team – reps from:

– Medical, Security, HR, HSE, BCP, Risk Mgmt, Travel, Communications, Operations

The Timeline– Typical Corporate Plan will take aver. 4 months (6 wks – 1yr+)

The Challenges– Executive sponsorship– Harnessing appropriate internal resources– Accessing medical expertise– Personal Protective Equipment (PPE) – yes/no, who, how much– Antivirals – yes/no, who, how much– Communications – what to say, when, how



Life Cycle of Pandemic Preparedness

Corporate Plan

Develop an adaptable Corporate pandemic plan to protect employees and business assets:

1. Corporate Policies or guidance to business units2. Practical Actions to guide Crisis Management Team(s)3. Corporate Information and Communication Documents

WHO Phase based plan, including post-wave recovery

The Corporate Plan becomes the TEMPLATE for local plans



Corporate Pandemic Plan

Consistent across the company:

Consistent in communications

Consistent in HR policies

Consistent office and operational management processes

Consistent travel processes

Consistent trigger points matched to Pandemic Phases



1. Policy and Rationale Step

Develop a customized document that describes the specific policies or “guidance” that your company will follow in a pandemic

– Policies define “What” and “Why” the company is planning

– SOS will provide a walk-through of the relevant topics, and then produce a draft document for your review

– You may then take this document internally for further development and finalization

– Policies lead to specific ACTIONS: Pandemic Action Table



2. Pandemic Action TableCrisis Management Tool to help direct the CMT to make the best decisions

– Includes checklists to ensure effective Crisis Management

Actions are “Specific Instructions or Processes” that commence when certain criteria are met:

– When we move to a new Pandemic “Phase” and;

– Whether the location is in an “Affected” region or not (more on this later)

– Embedded in the Action Table are “Information Sheets” – a Communications stockpile…



Action Tables



3. “Communications Stockpile”

Targeted, clear communications:– Frequently Asked Questions (FAQ)– Posters– Guidance / Instructions

Must be accurate and rapidly implemented to:– Reduce anxiety– Maintain control– Give clear direction / defuse misinformation



• Clear

• Concise

• Audience targeted

• Pre-scripted

• “Ready to Go”

Examples




Local ize/Ops

Corporate Plan

Local Plans assess:

1) Local business critical working groups2) Redundancy of working groups3) Exposure risk of working groups4) Risk reduction for key working groups5) Operationalize local processes6) Interface with Public Health Authorities



Management of the impact of personnel on Business Continuity

1. Risk Assessment of Workforce Groups• Business criticality• Redundancy• Exposure Risk

Develop Benchmark “Risk Profiles” per workforce role

2. Risk Mitigation Strategy Per Workforce Group• Targeted impact assessment of NPI and antiviral strategies

on Risk Profile (impact of pandemic plan)

Medical Business Continuity Planning



Risk Assessment Landscape



Sample Absenteeism

Analysis




Imple

mentatio

n

Local ize/Ops

Corporate Plan

Implementation of Plan includes:

1) Training of personnel• Business critical• HR• Management

2) Procurement of supplies (AvM, PPE, etc.)3) Healthcare network development4) Door screening implementation



Implementation of Plan



Online Learning• Simple English, interactive, multimedia format

• 10 subject courses can be completed in 45 minutes

• Management can track questionnaire outcomes


Distributed Learning



Antivirals – a complex issue

1. Antiviral effectiveness and clinical limitations

2. Rationale for Antiviral Use in a Pandemic

3. Country-specific limitations for distribution

4. Provider-specific limitations for distribution

5. Antiviral Distribution Models

6. Antiviral Cost Models



Country-specific Limitations

Local Governments can limit ability to provide antivirals:

1. Antivirals may not be licensed in-country2. Antivirals may not be available in-country3. Antivirals may not be licensed for corporate stockpiling4. Pre-screening and/or pre-distribution may not be allowed5. Prophylactic dosing may not be allowed6. Government may legislate access to corporate stockpiles



Samples of Country LimitationsSUMMARY OF COUNTRY ANTIVIRAL DISTRIBUTION PROCESSES

# Country Corporate Stockpile Distribution Model Tamiflu

1 Hong Kong Allowed All Treatment & Prophylaxis

2 Russia Allowed, but unstable All Treatment & Prophylaxis

3 Thailand Allowed, but discouraged All Treatment & Prophylaxis

4 China Allowed, but discouraged B,C, no pre-screening Treat & Prophylaxis (only if contact)

5 Turkey Treatment ONLYA, B, no immediate distribution Treatment & Prophylaxis

6 Vietnam Treatment ONLYA, B, no immediate distribution Treatment ONLY

7 Taiwan Very restricted, very limitedB only, no prescreen, dispense only when ill Treatment ONLY

8 India NOT ALLOWED NONE (hand carry in) NONE

Distribution Models

A= Stockpile with pre-screeningB= Stockpile without pre-screeningC= Immediate distribution



Provider LimitationsProviders – Doctors, Clinics, Pharmacies – may not be willing to meet your storage/prescription/distribution demands:

1. Unwilling to write prescriptions in advance, even if legally allowed to do so

2. Unwilling to store medications3. Unwilling to commit to be being available to prescribe

during a pandemic4. Unwilling to distribute medications

MUST have local agreements and relationships.




Drills

Implemen

tation

Localize/Ops

Corporate Plan

Exercising the Plan

Pandemic Scenario Drills• Ensure Crisis Mgmt team knowledge• Exercising the CMT – “real life”• Debriefing• Modify plan if required• Keep knowledge fresh



Pandemic Exercises and Drills

1. Pandemic Scenarios to Educate the Crisis Team

2. Real-time Pandemic Drills to Exercise your Plan





Audi

t / M

odify

Drills

Imple

mentation

Local ize/Ops

Corporate Plan

Auditing and Updating

• Ensure planComplianceGlobally

• Maintainplan withregularreview

• Expectyour planto changeregularly asnew informationbecome available


©2007, International SOS Assistance Inc.©2006, International SOS Assistance Inc.

Audit ToolsAudit - To Ensure Plan Compliance



Corporate Pandemic Planning ProcessLo

caliz

eT

rain

/ Im

plem

ent

Exe

rcis

eA

udit

/ upd

ate

Cor

pora

te

Corporate Pandemic Policies

Corporate Pandemic Antiviral

Policy / Plan

Corporate Pandemic Action

Table

Corporate Communications

Stockpile

Modify Policies to meet Local

requirements

Detail Action Table to meet local

operational needs

Modify Communications

to meet local / cultural / language

Ensure Corporate AVM Policy can be

met locally

Train key Operational personnel

Procure and store PPE

Process to Orient local staff

in Corp Plan

Process to globally train /

educate in plan

Educate key Pandemic and CM members

On-Line Training Tools Procure AVM Contract with AVM

providers

Corporate level Tabletop Exercises

Regional and Local Level Exercises

Multi-level Exercises

Audit facility pandemic

preparedness

Maintain surveillance , plan update process

Periodic Pandemic Plan Review

IF YES



So Where does a Pandemic Plan fit into our Corporate Plans and Programs?



Pandemic and Crisis Management Plan

Crisis Management Plan

Major Accidents Natural DisasterSystems Failure Terrorist Attack Disease Threats

Traditional BCP

Traditional BCP

Health and Personnel Plan

Traditional BCPHealth and

Personnel Plan

Audi

t / M

odify

Drills

Imple

mentation

Local ize/Ops

Corporate Plan



Health Incident Planning

Mass Casualty Events

Infectious Disease

Outbreak PlansPandemic Plan

TB Management

Program


Audi

t / M

odify

Dril ls

Implementation

Local ize/Ops

Corporate Plan

Integration with Crisis and BCP



Health Incident PlanningPlanning to address “from Trickle to Flood”

1. Drops and Puddles

2. Splashes

3. Waves



Types of Health Incidents

2 4 6 8 10 12 14 16 18 20 22

200

150

100

50

25

10

Natural Disaster / Terrorist attack

Pandemic

TB Outbreak

TIME

PE

RS

ON

NE

L IM

PA

CTE

D



International Corporate Health Programs

Occupational Exposures and Illness / Injury

Medical Emergency Response

Traveler and Expatriate

Health

Health Insurance,

Disability and Compensation


Absenteeism Management

Medical Data Management

Health Program Cost/Benefit

Analysis

Health Promotion &

Wellness

Health Communication

Access to Medical Care

Corporate Social

Responsibility



Corporate Health Program Development

Assess Risks and Needs

Corporate Med Resources Sample Corporate Health Programs

Corporate Medical Director

Regional Medical Director

Wellness

Program

Corporate Health

Manager

First Aid Training Program

AED

Program

Pre- deploy

Program

Pandemic & Incident

Plans

Occ Health

Program

Social Resp

Program

On-site Health

Program

Health Risk

Assess

WkmanComp

Program

Drug & ETOH

program

IEAP

Program



Summary1. An effective Pandemic Plan is now considered a standard

component of Corporate Business Continuity and Crisis Management planning.

2. A Pandemic Plan requires the same quality assurance processes as other corporate programs, namely plan development, training, testing, auditing and on-going maintenance.

3. A Pandemic Plan is only one small piece of an organization’s overall corporate health programs.

4. There will be a Pandemic - like there will be earthquakes and hurricanes – we just don’t know when, we don’t know how severe – all we can do is best prepare.

Corporate Pandemic Planning: Business Continuity Meets Healthcare

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