International rescue – the OH challenges of responding globally to Covid-19

The scope of occupational health professionals has grown as a result of Covid-19, and this is no more apparent than when navigating with the health concerns, challenges and priorities facing global and multinational employers. Dr Anthony Renshaw outlines how OH can successfully manage a global response to the pandemic.

In the past year, fresh focus has fallen on the actions and activities of occupational health (OH). We’ve seen how senior leadership, up to the C-suite, have taken a hands-on interest in the impacts that health and wellbeing can have on organisational success.

Across industries, OH professionals have found themselves at the forefront of ensuring business resilience. Those in already highly regulated industries, such as oil and gas, have long understood this, yet they have been equally challenged with managing the uncertainties that the pandemic has brought.

Many white-collar firms may have previously seen ‘duty of care’ as a tick-box exercise, and health risks in particular as being rather distant. We now see that almost all companies now starkly realise the potential financial, legal and personal impacts of not protecting their employees adequately in this rapidly changing environment.

For many OH practitioners, this has meant stepping into a leadership role at the core of their organisation. Having insight on how the pandemic is developing globally, whether in a single location or across countries and territories, along with an understanding of how to inform and advise a diverse employee base has become crucial. This will continue to grow in complexity as key elements, including regulations and vaccination roll-out programmes, differ around the world and control over the pandemic has diverged.

Providing global leadership

The most successful return-to-operations programmes see OH practitioners successfully engaging the entire workforce, helping frame and communicate key company aims, supporting business resilience as well as protecting individual employee health.

They lead on key, up-to-the-minute, trusted information and combine this with planning, regular reviews and external validation of planning assumptions. The social media ‘infodemic’ the pandemic has caused means that practitioners now need to reference both the general external geopolitical environment and integrate granular local epidemiological insights on how their particular workforce populations are likely to be impacted by the pandemic.

At International SOS, our engagement with clients has indicated that flexibility and agility must be inherent in plans – to be able to swiftly respond, and get ahead of, any change in environment.

Increasingly, firms are valuing a more holistic and global view of health and security from crisis management gap analysis to ensuring that all considerations are covered for returning to a workplace, as in our ‘WORKSAFE’ guidance published last year.

It is important to remember that many internal constituents play a role to in creating a sustainable and successful programme. Partnerships with other business units, such as HR, remain vital but, increasingly, OH is also interacting elsewhere.

Increasingly, we see direct engagement with the C-suite, with occupational health providing reporting that resonates and ensuring that employee health and wellbeing remains high on the corporate agenda.

OH professionals work in partnership to make sure they have their finger on the pulse of the workforce and to continuously seek out the most appropriate support.

Effective communications

We argue that health communications across a global workforce has never been more essential. There is however not a one-size-fits-all approach; health advisors should take into consideration communication tools that employees are already familiar with and utilising.

This can work alongside new forms of communication, such as apps for wellbeing programmes, or may simply utilise novel techniques that may have never previously been trialled, such as the use of employee advocates to help increase awareness of health screening, which has fallen by the wayside in many countries post-pandemic.

Alternatively, it may involve the use of language-specific Covid vaccine sessions with a credible local physician.

With a globalised economy, it is ever-more critical that information reaches the whole workforce, near or far, in a timely manner. In some companies the solo OH practitioner can struggle to reach or relate to their entire population – a light push to fill in gaps in a particular country can make all the difference.

For example, we recently helped one company increase vaccination uptake in Russia, a country that continues to be beset with vaccine hesitancy.

Many employers are also engaging OH to help prepare them if and when the requirement or recommendation comes for a Covid-19 vaccine programme to be made available in a workplace, which has now opened up in a number of countries, from Kazakhstan to Indonesia.

Many organisations are also looking ahead at what’s next. Vaccine programmes are delayed in many countries for routine diseases such as diphtheria or polio – in remote locations in low income countries especially, employers can help fill this gap.

Across the world we also face potentially significant hospital pressures this year because of reduced immunity against seasonal flu. The OH practitioner can play a vital role in communicating the value of workplace flu vaccine drives and help navigate this increasingly complex process, ever more critical whilst the pandemic still puts pressures on national healthcare systems.

There also continues to be a lack of clarity in many countries of the level at which Covid-19 vaccination is, or will become, mandatory, to enable, for example, access to certain services, or in certain occupational settings.

Health advisors are regularly asked to provide clarity on the ethics surrounding difficult clinical questions, a challenge made ever-more complex by the myriad regulatory positions a global workforce will be privy to. With a global view that is able to tap easily into local networks, a global OH advisor can help their organisations explore these issues.

In supporting our clients, we have compiled some of the main approaches we recommend global organisations consider (and see below for more on this). Success in this context comes back to: how best to educate the workforce; how to help them actively navigate the infodemic and misinformation; how vaccination might impact upon testing and quarantine protocols; and what impact the vaccine could have on international and domestic travel. We know that education is key and this is not just for now but will be ongoing.

Most critical, in our experience, the role of the occupational health advisor is not to dictate or cajole, but to empower the right decisions based on science and a rational approach to risk, to leave the door open and provide an opportunity to re-examine a decision not to be vaccinated.

Looking to the longer term

An OH professional must keep their finger on the pulse, keeping up with the changing nature of duty of care. Varying working environments will need different solutions and approaches.

The pandemic highlighted, for instance, the differing protections in place for domestic employees compared with those travelling on business or away as assignees. In some cases, workers were far less protected while working in their domestic environment.

What the pandemic has also shown is that everyone is at risk of health or security issues – regardless of location. Whereas previously we might confidently state that we could rely on public services to protect our workforces, this is no longer always the case.

We’ve seen time and again this year how public services even in the most developed countries have left domestic employees wanting in many countries, from the provision of basic public health support like contact tracing, to making PCR tests available in a timely fashion, or arranging emergency hospital admissions or at-home oxygen.

With many organisations now considering a working from home or hybrid working environment, occupational health will need to play a more active role in evaluating how to futureproof the workforce.

Practitioners will lead the way in advising on best practices to protect the physical and mental health of the workforce in these agile new environments.

For instance, at-home ergonomics evaluations – and responsibilities to ensure that checks are carried out – vary from country to country. Home working and its impacts on mental health will need to be better understood.

The cultural differences between countries will need to be appreciated in the context of global mental health provision, which varies widely. The health advisor can increasingly need to help navigate business through this complexity.

Businesses will also have to have a position on return to travel, who will be able to travel, when and where. And we still have a number of unknowns, including the potential serious impact of ‘long Covid’.

In all, the scope of occupational health professionals has grown as a result of the pandemic. There is a need to have robust processes and an agile approach to address the current pressures of return to operations, and proactively address the future health issues we strongly suspect will affect workforces post-pandemic, like mental ill health or a rise in cardiovascular disease.

There is a risk, however, that the to-do list for in-house OH professionals is growing ever longer. It is our view that business needs to step back and recognise where support is needed to ensure that organisations can return to normality in a resilient and sustainable way.

How global organisations can respond

At International SOS, we have compiled some of the main approaches that we recommend global organisations consider below.

1) Assisting in defining local guidelines. Organisations play an important role in communicating these instructions and can help defining these guidelines by:

• Providing communication materials to the local workforce on priority groups and the steps local employees should take to receive the vaccine recommended by health authorities.
• Emphasising the importance and benefit of the local recommended vaccine(s).
• Offering an opportunity for question and answer with a trained health professional.
• Providing materials on the recommended vaccine in their country, how many doses are required, or the need for boosters.
• In some countries, creating positive incentives to receive a vaccine may be permissible, based on local legislation (for example vaccination tracker, recognition and so on).
• In some countries, employers may be permitted (or expected) to identify those in higher priority groups that should be given access to vaccination first.
• In some countries, requesting vaccine certificates may be permissible, or may even be required in future under health and safety regulations.

2) Providing employees tools to navigate the system. Providing employees and managers with the latest information on vaccine developments can help ease concern and allay anxiety. This can take the form of:

• Providing employees and managers with assistance on how to access a vaccine in their location to help speed up access.
• Facilitating employees accessing vaccination, either in terms of flexible working arrangements or paid time off.
• Reducing logistical challenges by offering administrative support to relieve pressure on managers.
• Assisting employees to resolve any language barriers which can be especially helpful for international assignees.
• Providing access to medical advice to help employees decision-make especially if choices are needing to be made on the type of vaccine, or in which country a vaccine could be accessed.

3) Assisting with vaccine procurement and enabling access. With the risk of fake vaccines and forged vaccination passports ever present, enabling quality oversight of any vaccine programme has never been more important. Employers can address this by:

• Providing a verified global overview of current vaccination availability and strategies being rolled out.
• Assisting managers to navigate potential issues around vaccine quality and identify suitable local providers.
• Providing access to the vaccine through a reputable external provider (e.g. nurse on site or office vaccination clinics), which may become available in some countries.
• Understanding where international assignees might be able to avail of national vaccination programmes in their country of residence, and assisting them to enable access.