Health & Safety Group Meeting 11 th February 2008

1. Health & Safety Group Meeting11th February 2008 Provision of Tamiflu for staff, partners & dependents

2. About us • Occupational Health Providers – est. 1996 • Forward-thinking, innovative and value added services • Well known for excellence in service – medicals and drug & alcohol • Professional management expertise & clinical excellence • Used to the management of large contracts • Pandemic Influenza • HCC identified the issue for our own business • Offering extended to existing and new clients • Service extends across the globe • Servicing high profile FTSE 100 and BlueChip organisations • Consultants on government paper With HCC you are working with the experienced pandemic professionals

3. Pandemic Influenza Today’s Discussion: What is the threat? Pandemic assessment Business preparedness & The HCC Scheme

4. Pandemic Influenza – What is the threat? Worldwide experts believe a highly infectious and particularly virulent influenza virus is likely to emerge, infecting the population and causing many deaths on a global scale. Being prepared and aware is key to effective planning

5. Pandemic Influenza – What is the threat? • A pandemic is a disease that causes infection on a global scale • An influenza virus achieves pandemic status when the virus emerges or mutates into a form that can easily escape the defences of the human immune system • Pandemic influenza is different to normal seasonal influenza. It does not just infect the weaker sections of society, but all ages, children and otherwise fit adults Being prepared and aware is key to effective planning

6. Under pressure . . . The infrastructure of the country would be seriously impaired Health Services - A pandemic influenza virus can spread rapidly putting severe strain on existing health services Economy - High mortality and great social and economic disruption is experienced across the globe, leading to recession Businesses - Workers will be absent for extended periods – caring for loved-ones, experiencing sickness and becoming part of the ‘stay-at-home worried well’ People - The human body has little natural defence (immunity): Health complications arising from a pandemic influenza infection can include severe pneumonia, respiratory distress and organ failure

7. CURRENT PHASE OF ALERT IN THE WHO GLOBAL INFLUENZA PREPAREDNESS PLAN Source:http://www.who.int/csr/disease/avian_influenza/phase/en/index.html

8. Consider the evidence: Closer than ever to the next pandemic? Professor John Oxford’s (Prof. of Virology & world renowned influenza expert) opening quote at a Pandemic Summit in June 2007 stated: “1916 = 145 deaths 1918 = 50 million deaths (and) 2006 = 147 deaths 2008 = ?????”

9. Where will it come from? The virus can transfer directly from a bird to a human causing an extreme case of influenza – often resulting in death (c.60% mortality). Experts virologists around the globe are watching the H5N1 virus It is impossible to predict exactly how, when and where the next pandemic virus will emerge. An immediate risk is posed by the avian influenza virus (bird flu or virus H5N1). The H5N1 virus is highly infectious and fatal for birds.

10. So, is there really a threat? • The World Health Organisation (WHO) believe a pandemic is imminent • Experts at WHO & virologists believe that the world is closer to another influenza pandemic than at any time since 1968 • If the H5N1 avian virus mutates to allow easy human-to-human transmission a pandemic influenza could take less than 1 month to spread to the UK from source • Numbers of deaths in the UK alone have been estimated up to 750,000 (1 million+ hospitalisations) and the UK Cabinet Office have released a paper to address the issue of ‘Mass Fatalities’ in the UK • Global economic impact could be $2-4.4 trillion (World Bank) • The 1918 pandemic killed c.40 million – this pandemic also started life as an avian influenza virus Being aware of the risk is essential

11. Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO5th February 2008 Total number of cases includes number of deaths. WHO reports only laboratory-confirmed cases. All dates refer to onset of illness. Even though more recent cases have seen a lower death rate, this is not necessarily good news: This sort of pattern has often preceded a pandemic. Cases increase, whilst the viruses virulence is seen to reduce in proportion.

12. Historical Concern Why the concern? Historic and current evidence points towards a pandemic influenza outbreak An influenza virus of pandemic proportion has the potential to be a global killer Influenza pandemics occur periodically, about three or four times in each century (c.30 year gaps) Three influenza pandemics have occurred in the last century causing more than 53 million deaths Pandemic influenza can hit at any time of the year – not just in the winter months as with seasonal influenza We are working with national and international professionals

13. Vaccinations Why can’t we just vaccinate? ‘All business sectors will need to plan to survive without vaccinations’ UK Resilience Guide 2006 A vaccination that can be guaranteed to cover against a pandemic influenza virus cannot be finalised until the exact strain is identified Manufacture, distribution and administration could take many months, following the virus strain identification It is highly unlikely that a vaccination will be available during the ‘first wave’ of a pandemic The Vaccine Development Process: during this time it is widely accepted that a pandemic would have ample opportunity to sweep the globe 120 million doseswould be required in the UK alone

14. The Antiviral Alternative • In the absence of a deliverable vaccination, antiviral medication provides a ‘best-fit’ protection • Antiviral drugs work on the influenza virus directly • They can be taken both as a symptomatic treatment for influenza and as a prevention (prophylactic) against actually contracting the virus • Tamiflu is a neuraminidase inhibitor, it works to prevent an influenza A or B virus from replicating in the human body • A pandemic influenza stems from an influenza A virus • The antiviral medication Tamiflu, manufactured by Roche, is being stockpiled by governments across the globe • The WHO has called the role of antiviral drugs “unquestionable” & the “principle medical intervention” Antiviral drugs give the human body a fighting chance

15. Stockpiling Governments across the globe are stockpiling antiviral drugs following recommendation by the WHO. Other countries have varying stockpiles of antiviral medication. The French government has a proportionately double stockpile to the UK resource. The UK government has stockpiled c.14.6 million doses of Tamiflu. Exact distribution plans are not defined but priority treatment looks set for frontline health workers and the essential services. UK businesses are urged to form their own business continuity plans. HCC are working with many businesses planning for 50% employee absenteeism for extended time periods. Business must take steps to protect themselves

16. Business Impact Consider a ‘What If’ scenario: FLU INFECTION CONTROL AREA KEEP OUT ! • Supply Chains have broken down • Transport & distribution networks are ceased • Schools close and parents stay at home • General services and amenities experience heavy disruption • Employees disappear through sickness, to care for loved-ones and do not wish to risk exposure • Employees become frightened, whilst rumours and bad information spreads fear Could your business survive? HCC can help you to plan your entire continuity plan

17. A Business Requirement • Workforce education & health care • You must sufficiently educate a workforce to understand the strategy: • Reducing panic • Making plans work • Promoting good hygiene • Caring for employee health: • Minimum antiviral coverage for ‘key workers’, or • Maximum antiviral coverage to include all workers, family, friends and your key supply chains • Consider implementing: • Health check points • Antibacterial & alcohol hand rubs • Masks

18. The HCC Scheme Guaranteed supplyof antiviral medication Series of delivery modelsfor your convenience Three years experiencein pre-pandemic health planning Face-to-facedelivery andclinics Wide-reaching scheme:Workforce, Dependents, FamilyandSupply Chain Experienced Account Managers and patient servicing teams Our unique Scheme has been called ‘groundbreaking’

19. The HCC Scheme All Inclusive Scheme Membership– The HCC model favoured by our FTSE 100 clients The all inclusive scheme provides the total package – ensuring your employees have the medication for when they need it most. This scheme can be offered to your employees and extended out to their family members and to your supply chain, as necessary. Stock and Store Scheme- Under this service, we store medication under climate controlled pharmaceutical conditions until required. When you need the Medication, HCC can assist you in one of two ways – HCC nurses can attend onsite to perform dispensary clinics, or you can elect to upgrade to our All Inclusive Scheme at a later date.

20. Stock and Store Pricing The following pricing structure is based on one pack of antiviral medication per employee: No. of Persons Price per Person 0 - 1,000 £35.00 1,001 - 2,500 £32.75 2,501 - 5,000 £30.25 5,001 - 10,000 £28.00 10,000 and over £26.00 Storage and Insurance: Under this service you can be assured that your stock is very well cared for, we store medication under climate controlled pharmaceutical conditions and our insurance package is extensive (marine). The resulting storage and insurance cost to you is just an additional 25p per pack of medication per year.

21. All Inclusive Scheme Options • Option 1 • Elect to pay for a treatment course for each employee • Option 2 • Cover each employee, as above, and includes • up to X close family/friends in the offering • Option 3 • Pay for all employees and allow employees to nominate and pay for their own family/friends • Option 4 • Operate a subsidised scheme for all employees (and family/friends) • Option 5 • Company purchases a contingency stockpile in addition to any of the above options for prophylactic use Providing you with a flexible working model

22. All Inclusive Scheme Costs Standard Scheme:a treatment course to include 1 pack of Tamiflu (10 x 75mg capsules) per employee Per employee member scheme inclusion £57.00 Postage & packaging* £6.95 Prophylactic Scheme:a prophylactic course typically including 4 packs of Tamiflu (40 x 75mg capsules) per employee Per employee member scheme inclusion £142.05 Postage & packaging* £6.95

23. Stock and Store Option What Happens When We Need the Medication?: HCC can assist you in one of two ways – HCC nurses can attend onsite to perform dispensary clinics, or you can elect to upgrade to our All Inclusive Scheme at a later date. Nurse Clinics: We can send out our nurses to your premises to operate a dispensary clinic. Time/Price per Nurse Half Day (3.5 hrs) £150.00 / Full Day (7 hrs) £300.00 All Inclusive Upgrade: You can elect to pay the difference in price per employee (& employee family member) to upgrade to the full occupational health service provided in the All Inclusive Scheme package. (Please note,subject to timely availability)

24. The Registration Site for All Inclusive Option • HCC offers our clients a unique web-based patient interface which provides: • Wide reaching patient accessibility • Removal of the client involvement for you: Dr-to-Patient • Extensive and thorough patient information ‘central hub’ • A legal registration process with excellent levels of security • An extremely effective customer and patient service

25. All Inclusive (A.I.) Scheme Operation Employee logs on to bespoke website: www.pimsreg.co.uk Goes through the education material Registers with the scheme Nominates family members* The HCC operational process begins……… * If option chosen by employer Our Scheme is formatted with the client and patient firmly in mind

26. A.I. Seven Steps to the Process Step 1 Identification of Eligible Staff HCC works with you to help you finalise your offering Step 2 Registration Process We can handle this for you & assist your HR team Step 3 Suitability Screening Our internal process to screen the patients & inform GPs Step 4 Allocation We assign the medication to the patient Step 5 Distribution Timing & Process Working together achieves the best process for you Step 6 Patient Support We offer excellence in customer and patient service Step 7 On-Going Process Working with you for leavers, joiners and renewal HCC fits with your model and mirrors the required process

27. A.I. Scheme Process • HCC contacts patient’s General Practitioners (GPs) and advises of the intent to provide Tamiflu under an Occupational Health Scheme (PGD / SO) • By this point a secure Dr-to-patient relationship is established by HCC with your employee • Records are checked, verified by our Patient Services team. Customer service is on-going • Once the eligibility of the patient has been established and verified the medication is picked / packed and dispensed ready for distribution • The distribution method is dependent on your own • preferred model – a bespoke and secure solution Providing you with a flexible working model

28. A.I. Delivery model YOU have the option to choose which delivery model YOU require and which is best for YOUR business continuity and recovery: HCC recommends a doctor to patient relationship that ensures the patient has the medication in their medicine cabinet prior to an outbreak….. Why? Because no one can predict how severe the impact of a pandemic influenza outbreak will be, or when it will happen. Patient-facing delivery models can be operated (clinic style) however the infective risk and timing issues are great. HCC favours a direct patient delivery model. Delivery and implementation of service is quick and easy for YOU

29. Stock HCC is fortunate to have excellent stock levels and order flows: With our stock of Tamiflu, we can fulfil even large orders, and immediately place the drugs in your name HCC can extend this not only to the employees but comfortably to the extended family members Our stock is sold on a first come first served basis. . . TAMIFLU SOLD OUT ? The importance of securing stock is clear

30. Patient Support • All employees can rely on • great patient support: • Prior to registration • During registration • Post registration • During a pandemic • Aftercare • HCC Resources: • Dr’s, Pharmacists, Nurses and • trained patient service • assistants. • Online information hub & • patient information. HCC guide our patients through every step of the process

31. Logistics & Overseas Deliveries • HCC offers a Dr-to-patient service in more than 92 countries around the world, each country has different rules and regulations regarding the drug registration process, dispensing, storage and distribution. • Examples of differing international services: • Procure medication in the UK, use Dr-to-patient service • Ship medication to all EU countries, using ‘track & trace’ • delivery and HCC’s binding tariff code • Procure medication at local level to avoid all import/ • export charges • Local law requires: Dr, pharmacy, storage and distribution • at local level Our logistics model is fully operational and successful

32. Summary • HCC occupational health scheme is: • Robust and experienced • Tired and tested • Fully operational • With a proven end-to-end delivery model • 500,000+ scheme members we help you care

33. Thank you we help you care