The societal and indirect economic burden of seasonal influenza in the United Kingdom

Out of focus person in the background blowing her nose with a cluttered coffee table in the foreground covered in used tissues, photo by Tom Merton/Getty Images

RAND Europe researchers estimated that 2.4 million working adults could be infected with influenza, resulting in 4.8 million working days lost annually.

What is the issue?

Seasonal influenza is a significant public-health issue. In the United Kingdom (UK), the influenza season (approximately from October to March) is associated with an increased demand for and pressure on the nation’s healthcare system, the National Health Service (NHS). The direct health and economic impacts (i.e. costs related to healthcare utilisation) of seasonal influenza have received much attention. However, less attention has been given to its broader societal burden, including its indirect economic impact (i.e. costs that are not-related to healthcare utilisation).

How did we help?

  • We first conducted a rapid evidence assessment (REA) of the literature to understand the societal burden of seasonal influenza in the UK.
  • Secondly, we conducted analyses of publicly available, aggregated data from NHS England and NHS Digital to better understand the impact of seasonal influenza on the provision of NHS services both before and after the novel coronavirus disease 2019 (COVID-19) pandemic.
  • Thirdly, we conducted a geographically representative survey of 1,000 working-age adults (18-64 years) across the UK, who reported having influenza or caring for a dependent with influenza during at least one of the past four influenza seasons (between 2018-2019 and 2021-2022) to understand impacts related to absenteeism and presenteeism in the workplace, lost wages and out-of-pocket costs.
  • Fourthly, we conducted interviews with 20 key stakeholders within the NHS from primary care and secondary care across the four UK nations (England, Wales, Scotland and Northern Ireland). Interviews focused on the impact of seasonal influenza, both before and during the COVID-19 pandemic, on the provision of NHS services.
  • Lastly, we used an epidemiologic-economic framework to estimate the number of influenza cases and then applied a macro-economic computable general equilibrium (CGE) model to estimate the indirect economic costs associated with lost economic productivity among working-age adults who become ill with influenza.

What did we find?

The influenza season in the UK is associated with a substantial societal burden, including out-of-pocket costs and absenteeism, resulting in lost wages for many individuals, as well as presenteeism resulting in lower productivity at work and an increased risk of transmitting influenza to others. In addition, an increase demand on NHS services during the influenza season, coupled with an increase in NHS staff absenteeism and presenteeism, is associated with disruptions to routine services, especially in the secondary-care setting.

Our epidemiologic-economic modelling framework estimated that 2.4 million working adults could be infected with influenza, resulting in 4.8 million working days lost annually. This equates to a loss of £644 million to the UK’s economy (0.04% GDP). Modelling further showed that increasing vaccination rates in working adults by 10-percentage points from current rates within each employment sector could increase the national GDP by £258 million.

What can be done?

  • Policies should be considered to better protect workers against lost wages when absent from work due to influenza and that workplaces could benefit from fostering cultures that discourage presenteeism.
  • Improving influenza vaccine uptake - in groups recommended by the UK’s NHS vaccine programme - could reduce avoidable healthcare visits during the influenza season.
  • More research is needed to understand the benefits of widening the vaccine programme more broadly to working-age adults and its impact on the economic output of the UK.
  • More research is also needed to understand how the NHS can alleviate the pressure on the provision of services that has increased over time and has been exacerbated by seasonal influenza and COVID-19 and to prepare for future public health threats.