Why Don't More People Get Flu Shots at Work?

The frontline battle station in the just-started influenza season is the workplace flu vaccine clinic. The problem: fewer than half of employees take advantage of them. John Beshears discusses why location makes a difference.
by Roberta Holland

With a yearly price tag of roughly $87 billion in lost productivity and adverse health consequences, the flu is nothing to sneeze at. It’s no surprise that workplace flu vaccination clinics have gained popularity as employers try to keep the illness from decimating their workforces. October marks the start of the influenza season in the United States.

“It’s quite strong evidence that just the natural course of your day bringing you by the flu shot clinic increases your likelihood of getting a flu shot”

Getting employees to go to the clinics is another matter, though. Fewer than half of workers with access to free vaccination clinics take advantage of them. (Overall, about 20 percent of vaccines are administered at work.)

To boost the number of employees taking advantage of vaccination clinics, companies should think carefully about where to place them, says John Beshears, assistant professor in Harvard Business School’s Negotiation, Organizations & Markets Unit. Beshears is an expert in behavioral economics, which uses insights from psychology and economics to explain individual decision making and help people make wiser choices.

“You’re familiar with the movie Field of Dreams, right? ‘If you build it, they will come.’ You might think flu shot clinics work that way,” says Beshears. “Many employers believe that by just making a clinic available on the premises that people will flock to it because everyone wants a flu shot.”

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It’s not that easy, it turns out. One of the prime reasons is sheer forgetfulness, he says. Many of us have every intention of getting vaccinated, but forget when the actual date rolls around. Locating the clinic in an empty conference room in the basement doesn’t help us remember.

Beshears and colleagues tracked 1,801 employees of a health benefits administrator, Express Scripts, during the 2011-2012 flu season. Their goal was to determine whether there was any link between getting vaccinated and how far the clinic was from someone’s office, or how their daily routine brought him or her near the clinic location.

Beshears’s co-authors of the study were James J. Choi, professor of finance at Yale University’s School of Management; David I. Laibson, chair of Harvard University’s economics department and the Robert I. Goldman Professor of Economics; Brigitte C. Madrian, Aetna Professor of Public Policy and Corporate Management at the Harvard Kennedy School; and Gwendolyn I. Reynolds, with the National Bureau of Economic Research in Cambridge, MA. The team has completed numerous projects together, including a related project that increased the number of workers getting their flu shots by prompting them to form concrete plans for attending a clinic.

Fewer than 50 percent of employees take advantage of workplace
influenza vaccinations. Credit: simarik

Roughly 40 percent of the company’s employees were vaccinated at the clinic during the 2011-2012 flu season, compared to 46 percent of all adults nationwide.

“They were a great partner,” Beshears says of Express Scripts. “But even they, who are so attuned to the importance of these preventive measures, didn’t have as high an attendance rate for their free workplace influenza clinics as one would have thought.”

Beshears and his colleagues used building blueprints to measure base proximity, or how far workers had to walk to get to the clinic from their offices or desks. They used badge swipes at a passageway near the clinic to determine functional proximity, or how often employees were passing by the clinic location on a typical day. Each employee was assigned an anonymous ID code, which allowed Beshears to match the data with whether that individual got a flu shot without identifying workers by name.

The team’s findings showed that putting the clinic in a location where employees pass by naturally increased the likelihood of getting vaccinated by 6.4 percent. The study was published in the June 2016 edition of Medical Care, a journal produced by the American Public Health Association.

“In a way it’s a very simple analysis, but we think it’s a powerful one for really drawing out this distinction,” Beshears says. “We found that pure proximity as measured relative to your desk or office didn’t really seem to make the difference. What did make the difference though was this functional proximity; how frequently did your day-to-day routine take you in the vicinity of the clinic.”

“It’s quite strong evidence that just the natural course of your day bringing you by the flu shot clinic increases your likelihood of getting a flu shot”

The research could help employers with other wellness initiatives, Beshears says, adding that engagement in those initiatives typically isn’t as high as employers—or the CDC—would like.

“Whenever you are thinking about promoting these investment-type activities like preventive health care, you need to make it as easy as possible, and the best way to do that is to make it something that people bump into during the everyday course of their lives,” Beshears says. “It’s not merely a matter of building it and then people will come. You actually need to place it right front and center. Otherwise it’s very easy for people to ignore.”

Related Reading:

The Business of Behavioral Economics
Want Your Employees to Plan Better for Retirement? Don't Do This
How Consumers and Businesses are Reshaping Public Health

About the Author

Roberta Holland is a writer based in Boston.

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