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A summary of presentations from the weekly Summit partner webinars

March 6, 2025 – The latest Summit Summary

Occupational Health Update – Roslyn Stone, MPH, CEO and Founder, Zero Hour Health

Roslyn Stone, MPH, gave an update about efforts to immunize in the occupational health arena.

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Occupational Health Update – Roslyn Stone, MPH
Zero Hour Health started as Corporate Wellness about 30 years ago to be the medical department for companies that did not have their own. Their first client was Outback Steakhouse, providing on-site flu shots at 40 restaurants. Eventually, the business grew to provide a more broader range of services, but still has workplace vaccination as a core function. The flu vaccine market has been through many changes over 30 years, including changes in policy about the return of unused flu shots, for example, and significant growth in the size of the flu summit events and the number of partners who participate.

Influenza
There have been significant changes in flu shots given in the workplace over the past year.

  • As of March 2025, 30% of employees now work from home at least part of the time and no longer get their flu shots at work.
  • There are significant employer economic and budget constraints, and flu shots are an easy thing to cut from the budget because employees can go elsewhere for them.
  • There is growing employee vaccine hesitancy, so even within workplaces still doing on-site flu shots, numbers are down.

Looking at Walmart as a barometer, administration numbers are down and on-site demand and participation is down. As a result, the minimum vaccinations to reach cost effectiveness are higher, and as an employer, Walmart may discontinue onsite vaccination in 2025. Walmart also provides vaccination services for several major players in the market, and these trends are very concerning.

Hepatitis A Infections
Hepatitis A brings complexity to the workplace. When a case of hepatitis A comes to the workplace, vaccinated employees can continue to work, whereas those who haven’t been vaccinated and have symptoms cannot continue to work. However, more employees are working while sick (reasons for this include more distrust of public health, a lack of paid time off, and a lack of health insurance). Currently, there is increased vaccine refusal in outbreak situations. Thus, there is a real-time impact of vaccine hesitancy on workplaces, workforces, and the public.

Whooping Cough
There is increased incidence, often in those who are unvaccinated, and waning vaccination coverage and more unvaccinated workers complicate the situation. Notably, during the COVID-19 pandemic, there were no norovirus, few whooping cough, and few tuberculosis outbreaks in the workplace, owing to masking and people not working while sick.

Current Measles Outbreaks
Employers are concerned nationwide, due to the outbreaks in Texas and New Mexico, but also within states where there are smaller outbreaks. An increasing number of people are seeking exemptions, which impacts the workplace because employers may not know how many vulnerable employees they have. There are also increasing issues with international travel. Finally, there is misinformation in the public regarding disease, vaccine development and approval, and funding.

Current Challenge for Employers

  • Distrust of public health
    • Employers have a new role/opportunity to become a trusted source of information on health and, specifically, vaccination.

Zero Hour Health: The Executive Briefing
Twice weekly, on Tuesdays and Fridays, Zero Hour Health provides an executive briefing, a 5-minute read via email, to their clients about a variety of health issues. Subscription to the briefing is free at www.zerohourhealth.com.

Resources/Articles Recommended in This Session

QUESTIONS & ANSWERS

Q: Over the last 20 years, in some cases, employers have been concerned about offering vaccination onsite because, if they have an employee insurance program, vaccines are included in their health insurance. So the concern has been about double paying both at the workplace and through their insurance. With increased vaccine hesitancy and more employer concerns about vaccination rates among employees, what are you seeing regarding that concern?
Roslyn Stone (Zero Hour Health): There are ways to address those concerns. One way to handle it is, for clients with providers who will provide a billing statement that can be submitted to their insurer, they can make arrangements with their insurer to pay for the onsite vaccination costs. A second way to handle it is essentially a cost shifting; because, whether you pay through your insurer or you pay for the vaccines directly, you’re still paying, in many ways, no matter how the numbers work out — it’s a cost plus basis and your insurance company isn’t actually paying for your vaccines, you’re paying for your vaccines, and you’re paying for them another way through the back door.
With that said, we’re not necessarily hearing that as a concern, but there are many hybrid programs out there. The Walmart program is a good example of one. There are employers that offer onsite vaccinations that get some small percentage of the population, and then they provide flu vouchers through their insurers, and then employees go into Walmart, CVS, Costco, Long’s, whoever their retail providers are, to get flu shots. There are ways that employers are pushing towards more retailers, in part because their employees also getting other vaccinations at that time, and that’s incredibly helpful. So we’re not seeing that as a big pushback, but we’re seeing it as a separate budget line item being an issue when there are budgetary pressures.

Q: Have you heard, or have there been discussions about, whether providing vaccine-covering insurance is more cost effective than paying for sick employees, medical expenses, absence, skill, loss, and so on. Are employers getting into the cost effectiveness data for their employees when it comes to vaccination?
Roslyn Stone (Zero Hour Health): There are lots of numbers and studies out there. None of them is recent, and none of them is great, but we believe that if you look at the studies that are out there, there is anywhere from a $3 to a $7 return on investment for every dollar spent on flu shots. And this year, people were particularly sick with flu. So what we’re hearing, anecdotally, is that people with flu were out for a significantly longer time than in some other years, and particularly later in the flu season. This was a flu season where for some reason, the people who got sick later in the flu season were more ill and sicker longer, and they were out of work for longer. So, what do we take into account when we look at a $3 to $7 return on investment for every dollar spent on flu shots? We’re looking at direct cost of illness and medical care and medications, but we’re also looking at both lost time and coverage: when you’re paying someone for sick time and covering their shift, it’s costing you twice. So, we haven’t had a good study in a while on return on investment and flu shots, but the return on investment, historically, has been significant.
Carolyn Bridges (Immunize): Right and presenteeism: we’ve had a lot of discussion about that over the years, too. You may be present when you’re sick, but you’re not working to your full potential.
Roslyn Stone (Zero Hour Health): We’re hearing a lot less about presenteeism now, which is interesting, and we haven’t seen any studies on what presenteeism means. And what all of this means is people are working from home; people are not necessarily calling out sick in the same ways they did when they were going into the office. Are they working sick? Are they not working but are at home? Are they working slower or making mistakes? Which is what we document in presenteeism. It’s hard to document presenteeism in the work-from-home setting.

Q: Regarding mandates, in my state and others, we’re seeing bills introduced that prohibit employers from requiring vaccinations. Are you seeing more of that as an issue: that lack of employers’ ability to make mandates as part of the problem?
Roslyn Stone (Zero Hour Health): We are not. We are seeing vaccine hesitancy on many levels where fewer and fewer employers, even in outbreak situations, are willing to mandate vaccinations. They’re trying to navigate some really tricky political waters, they’re trying to navigate some really tricky customer waters and employee feedback. So we are not seeing vaccine mandates in the workplace even in an outbreak situation. What we’re seeing in an outbreak situation is a willingness to make accommodations, and I don’t say “reasonable” accommodations, because they’re not necessarily under the ADA. There are some health departments that will allow employees to continue to work if they work 100% gloved. There are restaurants that don’t want employees, particularly servers or bartenders, wearing gloves because they don’t like the perception or guests don’t like the perception, and they’re allowing those employees to stay out for whatever the length of time of the incubation period is and then come back to work. So, we are not seeing workplace vaccine mandates. I expect to see fewer workplace vaccine mandates than I’ve seen in the past, unless this climate changes dramatically.
Q [follow up]: The term “political exemptions to vaccination,” is that a term that you’re hearing?
Roslyn Stone (Zero Hour Health): We are hearing that term; it is, basically, when someone does not have a religious exemption but doesn’t believe in vaccination or doesn’t believe that someone has the right to mandate vaccination. We’re particularly hearing it for the pediatric age group. And we’re hearing from employers about the risks they are taking: if you choose not to vaccinate your children, that has an impact on my workplace. So it’s a complicated set of issues and complicated waters to navigate. And unfortunately, politics is playing an increasingly larger role in all of this.

Q: Are you seeing requests or what do you think about the potential impact of the self-administered live attenuated flu vaccine, and how might that impact workplace flu vaccination?
Roslyn Stone (Zero Hour Health): We are not hearing anything at all on that subject.
There is an important question, though, about employees during the COVID-19 pandemic staying home when they were sick and wearing masks in the past. In the past, it was a badge of honor to work while you were sick, are we seeing that change? We are seeing more people work sick now than we did a couple of years ago. In the first couple of years after the COVID-19 pandemic, people were extremely hesitant to have a coworker come in who had the sniffles or was sneezing or coughing. We’re seeing less of that: we’re seeing some more tolerance or some more leeway given to people coming in while they have respiratory symptoms. But we do not think that we’ve returned to the pre-COVID-19 level. It is not as much of a badge of honor as it was pre-COVID to work sick, and that is one of the benefits that we have longer term, a benefit that we’ve achieved through COVID-19; people do not necessarily want a server waiting on them who’s coughing or blowing their nose, they don’t want someone working at the next workstation, and there’s a lesser tolerance for that badge of honor.

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Partnership for Vaccine Access in Community Health Centers – Sarah Price, MSN-Ed, BSN, RN, Director, Public Health Integration and Innovation, The National Association of Community Health Centers (NACHC) and Katie Lewis, Regional Director, U.S. Direct Relief

Sarah Price, MSN-Ed, BSN, RN, and Katie Lewis gave an update their partnership to increase vaccine access in community health centers.

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Partnerships to Increase Immunization Access – Sarah Price, MSN-Ed, BSN, RN and Katie Lewis
The National Association of Community Health Centers (NACHC) is a member and advocacy body for anyone in the community health center space, founded in 1971. America’s health centers serve more than 32.5M patients, regardless of insurance status.

Risk Less Do More Campaign
The Risk Less Do More campaign was a national campaign to increase awareness of, confidence in, and uptake of vaccines for flu, COVID-19, and RSV.

  • The campaign was funded by the Department of Health and Human Services from October 2024 into 2025.
  • NACHC recruited 4 community health centers and 3 primary care associations to promote the campaign.
  • Impacts
    • Direct = 2 states, 4 health centers
    • Indirect = all community health centers in all states through social media, blogs, and conference tabling
  • Results
    • 25 vaccine clinics
    • 1,669 people attended in-person events
    • 485 individuals received vaccines
    • 120,000 people were reached through media efforts

COVID-19 Vaccine Access Initiative
From the Risk Less Do More campaign and social media efforts — and considering the end of the Bridge Access program, increasing costs of vaccinations, and access issues for the underinsured — NACHC reached out to partners on a new initiative. The COVID-19 Vaccine Access initiative was in partnership with Direct Relief and the Association of Immunization Managers and, having started in October 2024, is ongoing.

The COVID-19 Vaccine Access initiative was a three-step process:

  • Step 1: Communication initiative to guide health centers in accessing free COVID-19 vaccines for uninsured patients, via partnership with Direct Relief for coordination and distribution
  • Step 2: Connected supply with demand and demand with supply
  • Step 3: Collect impact data and stories
  • Results
    • 25,000 doses of vaccine
    • 240 organizations
    • Additional support included 17,700 flu vaccines and 7,500 doses of antiviral medications

Direct Relief: Background
Direct Relief is a nonprofit organization that works globally to improve health around the world. The organization is non-sectarian, apolitical, and privately funded. The organization is essentially a licensed nonprofit wholesale pharmacy that works with pharmaceutical manufacturers around the world to supply communities that need resources. Direct Relief is active in 100 countries and licensed to distribute prescription drugs in all 50 of the United States. Everything the organization does is free of charge to the individuals they provide care to. In the United States, Direct Relief has provided more than $1B of aid in the last 20 years. Annually and collectively, Direct Relief provides care to more than 34 million people.

QUESTIONS & ANSWERS

Q: What goes into determining your global participation? How do you pick which countries you’re going to work with, and what qualifies the countries?
Katie Lewis (U.S. Direct Relief): Internationally, it is generally lower- to middle-income countries. And, responding to the war in Ukraine. We’re expanding a bit but not doing much, for example, in Great Britain or Canada; I think we did some things during the pandemic there. We have such an easy way of validating and qualifying organizations: 501(c)3 and other ways to check. I have a whole team of colleagues who focus internationally. If there are specific questions about specific countries or the type of the work we do, you can contact us through our website (www.directrelief.org) or to me, directly, and we can make sure to connect you to the right person, if there’s more follow up. Basically, we’re trying to work anywhere we can, with some restrictions. For example, there are some countries that are really hard to ship into: Cuba, South Korea, North Korea. We don’t go everywhere, but we try to go most places.

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Announcements
  • Registration is open for the Adult and Influenza Immunization Summit: Looking Back, Moving Forward, May 13–15, 2025. This summit will be held at the Crowne Plaza Atlanta Perimeter at Ravinia.
    • Registration is open at https://www.izsummitpartners.org/2025-naiis-registration-form/.
    • Registration requires a case-sensitive password from NAIIS. Registrants for the meeting must be members of the Summit; a membership form is available at the Summit website.
    • Please book a room at the Crowne Plaza Ravinia hotel within the Summit rooming block to help defray costs for the meeting.

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