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©2007, International SOS Assistance Inc.
Corporate Pandemic Planning: Business Continuity Meets Healthcare
Myles Druckman, MD VP Medical Services
International SOS
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©2007, International SOS Assistance Inc.
©2006, International SOS Assistance Inc.
©2007, International SOS Assistance Inc.
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
©2006, International SOS Assistance Inc.
©2007, International SOS Assistance Inc.
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
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©2007, International SOS Assistance Inc.
Pandemic Theory 101
Risk Mitigation and Rationale
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©2007, International SOS Assistance Inc.
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
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©2007, International SOS Assistance Inc.
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
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©2007, International SOS Assistance Inc.
Waves of the Spanish Flu in USA
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©2007, International SOS Assistance Inc.
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…?
©2006, International SOS Assistance Inc.
©2007, International SOS Assistance Inc.
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
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©2007, International SOS Assistance Inc.
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
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©2007, International SOS Assistance Inc.
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
©2006, International SOS Assistance Inc.
©2007, International SOS Assistance Inc.
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:
©2006, International SOS Assistance Inc.
©2007, International SOS Assistance Inc.
What Companies are Doing Today
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©2007, International SOS Assistance Inc.
Organizations are planning…
©2006, International SOS Assistance Inc.
©2007, International SOS Assistance Inc.
Poll on Pandemic Planning: What Corporations are Doing
0%
10%
20%
30%
40%
50%
60%
70%
80%
Sep-05 Dec-05 Feb-06 Apr-06 Sep-06
Implementing PlanInvestigating OptionsPandemic Will Not be an Issue
©2006, International SOS Assistance Inc.
©2007, International SOS Assistance Inc.
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
©2006, International SOS Assistance Inc.
©2007, International SOS Assistance Inc.
Pandemic Preparedness
The Best Practices Lifecycle
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©2007, International SOS Assistance Inc.
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
©2006, International SOS Assistance Inc.
©2007, International SOS Assistance Inc.
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
©2006, International SOS Assistance Inc.
©2007, International SOS Assistance Inc.
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
©2006, International SOS Assistance Inc.
©2007, International SOS Assistance Inc.
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
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©2007, International SOS Assistance Inc.
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…
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©2007, International SOS Assistance Inc.
Action Tables
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©2007, International SOS Assistance Inc.
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
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• Clear
• Concise
• Audience targeted
• Pre-scripted
• “Ready to Go”
Examples
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©2006, International SOS Assistance Inc.
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©2006, International SOS Assistance Inc.
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©2006, International SOS Assistance Inc.
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©2006, International SOS Assistance Inc.
©2007, International SOS Assistance Inc.
Life Cycle of Pandemic Preparedness
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
©2006, International SOS Assistance Inc.
©2007, International SOS Assistance Inc.
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
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©2007, International SOS Assistance Inc.
Risk Assessment Landscape
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©2007, International SOS Assistance Inc.
Sample Absenteeism
Analysis
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©2007, International SOS Assistance Inc.
Life Cycle of Pandemic Preparedness
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
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©2007, International SOS Assistance Inc.
Implementation of Plan
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©2007, International SOS Assistance Inc.
Online Learning• Simple English, interactive, multimedia format
• 10 subject courses can be completed in 45 minutes
• Management can track questionnaire outcomes
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Distributed Learning
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©2007, International SOS Assistance Inc.
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
©2006, International SOS Assistance Inc.
©2007, International SOS Assistance Inc.
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
©2006, International SOS Assistance Inc.
©2007, International SOS Assistance Inc.
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
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©2007, International SOS Assistance Inc.
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.
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©2007, International SOS Assistance Inc.
Life Cycle of Pandemic Preparedness
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
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©2007, International SOS Assistance Inc.
Pandemic Exercises and Drills
1. Pandemic Scenarios to Educate the Crisis Team
2. Real-time Pandemic Drills to Exercise your Plan
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©2006, International SOS Assistance Inc.
©2007, International SOS Assistance Inc.
Life Cycle of Pandemic Preparedness
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
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Audit ToolsAudit - To Ensure Plan Compliance
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©2007, International SOS Assistance Inc.
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
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©2007, International SOS Assistance Inc.
So Where does a Pandemic Plan fit into our Corporate Plans and Programs?
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©2007, International SOS Assistance Inc.
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
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©2007, International SOS Assistance Inc.
Health Incident Planning
Mass Casualty Events
Infectious Disease
Outbreak PlansPandemic Plan
TB Management
Program
Health Incident Planning
Audi
t / M
odify
Dril ls
Implementation
Local ize/Ops
Corporate Plan
Integration with Crisis and BCP
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©2007, International SOS Assistance Inc.
Health Incident PlanningPlanning to address “from Trickle to Flood”
1. Drops and Puddles
2. Splashes
3. Waves
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©2007, International SOS Assistance Inc.
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
©2006, International SOS Assistance Inc.
©2007, International SOS Assistance Inc.
International Corporate Health Programs
Occupational Exposures and Illness / Injury
Medical Emergency Response
Traveler and Expatriate
Health
Health Insurance,
Disability and Compensation
Health Incident Planning
Absenteeism Management
Medical Data Management
Health Program Cost/Benefit
Analysis
Health Promotion &
Wellness
Health Communication
Access to Medical Care
Corporate Social
Responsibility
©2006, International SOS Assistance Inc.
©2007, International SOS Assistance Inc.
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
©2006, International SOS Assistance Inc.
©2007, International SOS Assistance Inc.
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.
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