Presenteeism And The True Cost Of Respiratory Illness At Work 

An Evidence-Led Case For Employer-Funded Flu And COVID Vaccination At Work

Respiratory infections are estimated to cost UK businesses around £44 billion each year in lost productivity (Office of Health Economics, 2024). A substantial share of that burden sits in presenteeism, the productivity loss that occurs when employees work while unwell and operate below their usual capacity (Pfizer, 2025a). Because presenteeism is less visible than recorded sickness absence, it is often under-measured and underweighted in senior funding decisions (CIPD, 2025a).

Workplace flu vaccination programmes are familiar because influenza follows a more predictable winter pattern, which supports clearer planning and justification (UKHSA, 2025a). COVID does not always follow the same seasonal rhythm and protection reduces over time, so disruption can occur outside the core flu window (UKHSA, 2025a; UKHSA, 2025b). When an employer vaccinates for flu only, they reduce one component of the respiratory burden but leave a meaningful share of productivity loss uncovered (Office of Health Economics, 2024).

More than half of the productivity cost sits in presenteeism. If you only measure absence, you can understate the true business burden.

Why This Topic Matters Now

Most organisations track sickness absence and use those figures in senior risk and budget discussions. Reduced performance while employees work through illness is measured far less consistently, including the growing pattern of working from home while unwell (CIPD, 2025a). This can lead to an underestimation of total productivity loss and an undervaluation of prevention measures.

In parallel, UKHSA surveillance continues to monitor influenza, COVID and other respiratory viruses across the season, drawing on community, primary care, secondary care and mortality data. For occupational health and healthcare leaders, this ongoing surveillance supports a more realistic planning assumption that respiratory disruption is not confined to one narrow winter peak (UKHSA, 2025a).

When organisations measure absence but not at-work impairment, the case for prevention is weakened on paper even when operational impact is material (CIPD, 2025a).

Defining The Terms

Clear definitions matter because they shape what gets recorded, what gets reported and what receives investment. Absence is visible and routinely tracked. Sickness presenteeism is less visible, but it can account for a substantial share of the total productivity burden from respiratory infections (Office of Health Economics, 2024).

Two practical examples illustrate how presenteeism shows up operationally.

• A call centre agent works while febrile, makes more errors and has longer call handling times, which drives queue length, repeat contact and customer dissatisfaction.
• A warehouse supervisor attends while symptomatic, slows throughput and increases coordination overhead, while also raising the likelihood of onward transmission in a high-contact environment.

What Informed This Piece

This article draws on two occupational health documents shared internally that synthesise three inputs.

• Employer interviews exploring what drives workplace vaccination uptake, barriers to uptake and what evidence is required to justify investment (Pfizer, 2025b).
• YouGov survey findings capturing employee sentiment and stated likelihood of uptake when vaccination is offered through employers (Pfizer, 2025b).
• Office of Health Economics estimates quantifying the productivity burden of respiratory infections and the distribution across absenteeism and presenteeism (Office of Health Economics, 2024).

The Office of Health Economics analysis referenced in the materials was commissioned and funded by Pfizer (Office of Health Economics, 2024).

For balance, the argument below triangulates key points with independent sources, particularly on the definition and downstream impacts of sickness presenteeism (Skagen and Collins, 2016; Society of Occupational Medicine, 2025).

Independent Evidence Corroborating Presenteeism Risk

A systematic review reports that sickness presenteeism at baseline is commonly associated with increased risk of future sickness absence and decreased self-rated health (Skagen and Collins, 2016). This supports a business case framing where presenteeism is not only a short-term productivity issue, but also a marker of longer-term workforce capacity risk.

The Real Cost Of Respiratory Infections For Employers

The employer-focused estimates are useful because they translate respiratory illness into board-level measures. They present a national annual cost, a per-employee estimate and an operational framing in working days affected per employee each year.

Crucially, the same estimates split impact into absenteeism and presenteeism, with presenteeism accounting for roughly 54 to 55 percent of the cost (Office of Health Economics, 2024).

This matters because many organisations can quantify absence, but struggle to quantify at-work output loss.

Why Presenteeism Is The Hidden Cost

Presenteeism is often absent from standard reporting systems. Operationally, it presents as diffuse drag rather than discrete absence days. Slower throughput, more errors, lower service levels, longer decision cycles, higher pressure on colleagues and higher likelihood of onward transmission. When organisations rely primarily on absence metrics, the true productivity burden can be understated (CIPD, 2025a).

Independent evidence also suggests sickness presenteeism is associated with longer-term consequences, including later sickness absence and poorer self-rated health (Skagen and Collins, 2016). This strengthens the business case for prevention because it links day-to-day underperformance with future capacity risk.

Why Flu-Only Protection Leaves A Gap

Influenza activity in the UK typically peaks in late December, January or February and is not usually significant before mid-November (UKHSA, 2025c).

This predictability supports workplace clinics in the autumn, with public health materials noting that most vaccinations should be completed by the end of November to provide best protection going into winter.

COVID Is Not A Second Flu Season

UKHSA surveillance reports monitor COVID circulation and other respiratory viruses across the season. The COVID Green Book chapter also notes waning protection over time, particularly for symptomatic disease after boosters, reinforcing the need for programme timing and eligibility to remain under review.

For employers, the point is practical. Flu-only coverage aligns to influenza risk, but it does not fully address respiratory disruption where COVID contributes to productivity loss outside the influenza peak window (UKHSA, 2025a; UKHSA, 2025b).

Vaccination As A Workplace Intervention

Respiratory infection control is strongest when interventions reinforce each other. Ventilation, hygiene, staying home when unwell and vaccination each reduce risk through different mechanisms (UKHSA, 2023).

Vaccination has particular value for business continuity because it can reduce infection risk and reduce severity where infection occurs, supporting both lower sickness absence and lower at-work performance loss.

Co-Administration And Operational Efficiency

Delivery design often determines uptake. Co-administration can reduce friction by consolidating appointments and reducing time away from work. WHO interim guidance notes that coadministration of seasonal inactivated influenza and COVID vaccines has potential operational advantages and was acceptable in available evidence (World Health Organization, 2021).

UK guidance also supports co-administration where operationally expedient, noting it is generally well tolerated with no meaningful reduction in immune responses in the cited evidence base (UKHSA, 2021).

Demand And Uptake

The employer materials report a positive employee demand signal for employer-funded vaccination, with stated likelihood of uptake high among those who view it favourably (Pfizer, 2025a).

For senior leaders, demand signals matter because they affect value, efficiency and delivery planning. Across settings, three practical drivers consistently influence uptake.

• Convenience through on-site clinics, flexible scheduling or voucher models aligned to working patterns.
• Trust and clear clinical messaging grounded in clinical governance and consistent communications.
• Removal of cost barriers, particularly relevant for lower-paid workforces.

Delivery Models That Make Programmes Work

On-site clinics

Best for concentrated workforces with predictable attendance patterns and visible leadership support.

Pharmacy vouchers

Best for distributed workforces, shift patterns, higher turnover and hybrid working where attendance is less predictable.

Hybrid models

Best where organisations have multiple sites or mixed patterns and need to maximise coverage without unnecessary complexity.

ROI Toolkit For Employer Decision Makers

This section sets out a simple way to quantify the productivity impact of respiratory infections in your workforce and to compare what is covered by a flu-only programme versus a combined flu and COVID programme.

A Repeatable Calculation

Use the employer estimate as a starting point, then refine it using your internal data where available.

1. Define the workforce in scope. Confirm the number of employees you intend to cover.
2. Apply an annual productivity cost per employee. Use £852 per employee per year as the default estimate (Office of Health Economics, 2024).
3. Convert cost into an operational measure. Use 5.2 working days impacted per employee per year as the default, comprising 2.4 absenteeism days and 2.8 presenteeism days in the employer material (Pfizer, 2025a).

How To Read The Output

For most organisations, the most material insight is the split. A significant share of the burden is not sick leave. It is reduced performance when employees continue working while unwell. This is why absence figures alone can understate the true cost of respiratory illness.

In business case terms, vaccination is best assessed as a capacity protection measure. It is intended to reduce both recorded sickness absence and the productivity loss associated with presenteeism. A flu-only programme addresses part of the disruption profile. Adding COVID vaccination extends coverage to a broader share of respiratory-related productivity loss, particularly where disruption occurs outside the traditional flu peak period.

Worked Examples Using Standard Inputs

These examples illustrate scale and risk coverage. They do not claim a guaranteed saving.

Practical Implementation Considerations For Occupational Health Teams

• Governance and clinical oversight with clear clinical accountability, documentation standards and escalation pathways.
• Eligibility and booking aligned to workforce profile, with booking designed to reduce friction.
• Communications that support informed vaccination decisions and reduce sickness presenteeism culture, aligned with health protection guidance on behaviours when unwell (UKHSA, 2023).
• Timing aligned to autumn planning and winter peaks, with public health materials supporting completion of most vaccinations by end of November (UKHSA, 2025d).
• Data collection and evaluation focused on absence trends, operational disruption indicators, outbreaks, near-miss staffing pressure and staff feedback.

How Employers Can Apply These Findings With Doctorcall

For organisations reviewing their winter wellbeing and continuity plans, offering influenza and COVID vaccination through a single workplace programme can help address both recorded sickness absence and the less visible productivity loss associated with presenteeism. This aligns vaccination with a wider objective that senior leaders recognise, protecting workforce capacity during periods of heightened respiratory risk.

In practice, programme value depends on delivery fit. On-site clinics can work well where employees are concentrated and attendance is predictable. Voucher routes can suit distributed teams, shift patterns, higher turnover and hybrid working arrangements. Many organisations use a combined approach to improve access across different employee groups. Planning early supports access to preferred clinic dates within the core vaccination window. Where required, egg-free flu options can be incorporated into clinical planning.

For occupational health and benefits teams, the most effective next step is usually a brief scoping discussion focused on practical inputs. Workforce size and site footprint, working patterns, current flu arrangements, recent indicators of respiratory-related disruption and decision timelines. With this information, it is possible to recommend a programme structure and delivery model that is proportionate, operationally feasible and aligned with the organisation’s continuity priorities.