Mix and Match mRNA Boosters May Be a Good Idea

 The two mRNA vaccines authorized in the U.S. prompt different immune responses -- and that could suggest a benefit for mixing and matching booster shots, researchers said.

Galit Alter, PhD, of Harvard Medical School in Boston, and colleagues set out to investigate the immune responses driven by three doses of Pfizer or Moderna in a cohort of 73 healthcare workers. Both vaccines induced robust functional humoral immune responses, but there were clear differences, they reported in a paper in Science Translational Medicine.

Moderna appeared to have an advantage in mucosal immunity, as measured by immunoglobulin (Ig) A, while Pfizer had a "really functional IgG response," Alter told MedPage Today.

"The mRNA vaccines are inducing different flavors of immunity," Alter said. "That suggests the immune system is seeing them in slightly different ways. And we know that 'different' is incredibly important for training the immune system."

Clinicians on medtwitter quickly interpreted the findings as supporting mixing and matching mRNA boosters -- a strategy that may become even more relevant as certain groups are now eligible for second boosters.

While that wasn't the intention of the study, Alter said it was a "creative" response and agreed that heterologous boosting could be advantageous, based on these findings.

"By slightly changing the way that the immune system sees the COVID antigen, we could essentially not only improve the overall quality and levels of the antibodies we induce, like the amount of neutralizing antibodies, but it could give us better mucosal immunity, or better affinity maturation," Alter said.

In their study of healthcare workers -- 28 received Moderna and 45 had Pfizer -- Alter and colleagues found that those who received Moderna had higher concentrations of IgA binding titers targeting the receptor binding domain (RBD) and the N-terminal domain (NTD). They also had higher levels of antibodies that elicit neutrophil phagocytosis and natural killer cell activation.

When looking specifically at variants of concern, they again found similarly robust functional antibody responses, but vaccination with Pfizer was associated with an IgM- and IgG-biased profile, whereas Moderna prompted an IgA- and IgG-driven profile, they reported.

Alter and colleagues noted that there's an "emerging appreciation" of the importance of antibody functions aside from neutralization, especially with the rise of new variants. Mutations can affect specific regions on the spike protein targeted by neutralizing antibodies, but functional antibodies can target the whole surface of the spike protein, and thus aren't compromised in the same way.

Earlier data have suggested that mixing and matching vaccines was safe and induced robust immune responses, said Christine Johnston, MD, MPH, of the University of Washington School of Medicine in Seattle, who was involved in an NIH-funded study of various boosting strategies published in the New England Journal of Medicine. That study supported an FDA recommendation in October allowing for mixing and matching boosters.

"It makes sense ... that if you're stimulating slightly different parts of the immune system, you would get better overall coverage from the version of SARS-CoV-2 that's circulating, or from variants that are emerging," Johnston said of the interpretations of Alter's data.

While Moderna "looks a little bit better for IgA," or mucosal immunity, Johnston said, she warned that "we don't know the real correlate of immunity -- the overall profile of immune response that's going to give us the best protection against infection or severe disease."

Because that correlate is still unknown, Alter said, "I think the suggestion [of mixing and matching mRNA vaccines] is brilliant, to get the best of both."

"You can diversify your immune response as much as possible to get maximal protective immunity," Alter said. "And then one day when we have the mechanistic correlate of protection, we'll be able to design vaccines that specifically give you that response."

Johnston said studies are ongoing to determine whether mixing and matching various vaccines can lead to clinical benefit, though these will never be at the same scale as the initial vaccine trials. "It's going to be a hard question to answer," she said.

Robert Schooley, MD, of the University of California San Diego, noted that both mRNA vaccines are "highly efficacious" and that any difference in immune profile, "if real, is not sufficiently great to make a recommendation of one over the other."

"If someone is in line for a booster vaccination," Schooley said, "the vaccines are so similar in efficacy that it would be a mistake to delay being vaccinated with whichever of the two is available."

Primary Source

Science Translational Medicine

Source Reference: Kaplonek P, et al "mRNA-1273 and BNT162b2 COVID-19 vaccines elicit antibodies with differences in Fc-mediated effector functions" Sci Transl Med 2022; DOI: 10.1126/scitranslmed.abm2311.

https://www.medpagetoday.com/special-reports/exclusives/97979

Substance Use Disorder Symptoms Follow Teens Into Adulthood

 Adolescents with substance use disorder (SUD) were more likely to have subsequent prescription drug use and symptoms of SUD in adulthood, revealed a longitudinal analysis that followed high school seniors to the age of 50.

Students with two or more SUD symptoms at age 18 had higher odds of medical prescription drug use and prescription drug misuse in adulthood, and 61.6% of adolescents with the most severe SUD symptoms (six or more) had at least two SUD symptoms in adulthood, reported Sean Esteban McCabe, PhD, of the University of Michigan in Ann Arbor, and colleagues.

"This finding reinforces that the long-term sequelae are more deleterious for those with more severe SUD symptoms during adolescence," the study group wrote in JAMA Network Open. "Notably, most adolescents with severe SUD symptoms do not mature out of symptomatic substance use during the transition from adolescence to adulthood."

Writing in an accompanying commentary, Nora Volkow, MD, and Eric Wargo, PhD, of the National Institute on Drug Abuse in North Bethesda, Maryland, said: "Critics of the chronic disease model of addiction have argued that people frequently recover on their own, unaided, from SUDs, but [McCabe and colleagues] show that SUDs in adolescence often carry over into adulthood and may last decades."

"Consequently, screening in this age group could be leveraged to help estimate adult SUD and the risk of adverse health outcomes, including overdoses," Volkow and Wargo added.

In 2020, the U.S. Preventive Services Task Force recommended drug screenings for adults, but said that evidence on the benefit of drug screening adolescents was insufficient.

McCabe and co-authors said their study was the first national investigation to examine the long-term association of SUD symptoms in adolescence with prescription drug use, prescription drug misuse, and SUD symptoms in adulthood.

Using multivariable analysis, the team found that adolescents with the highest SUD symptom severity were one and a half times more likely to use prescription drugs in adulthood compared with those without SUD symptoms in adolescence (adjusted odds ratio 1.55, 95% CI 1.11-2.16).

Adolescents with four or more SUD symptoms were nearly twice as likely to have prescription drug misuse in the past year as adults compared with those without SUD symptoms in adolescence, the researchers added.

Notably, while SUD symptoms decreased overall between ages 35 and 50, prescription drug use and misuse increased in that same age group, McCabe and co-authors said. In addition, approximately half the adults prescribed opioids, sedatives, or tranquilizers had reported two or more SUD symptoms at age 18.

"Prescribers should be aware that many adults prescribed opioids, sedatives, or tranquilizers had multiple SUD symptoms during adolescence and require careful assessment and monitoring," the researchers wrote. "Importantly, the cohorts of adolescents who were high school seniors between 1976 to 1986 and were followed over the 32-year study time frame (ending 2018) [run] parallel to the emergence and steep increase in the opioid crisis, largely associated with the widespread overprescribing of opioids."

"These prescribing practices may be associated with the high rates of prescription drug use and PDM [prescription drug misuse] as these cohorts aged into middle adulthood," the team added. "Although the association between adolescent SUD symptom severity and adult prescription drug use and PDM would still stand, it is important to acknowledge that the opioid crisis has led to changes in prescribing practices over the past several years that warrant more research that reexamines these associations over time."

The multi-cohort Monitoring the Future study used questionnaires to assess SUD symptoms over a 32-year period from ages 18 (when participants were high school seniors) to 50, beginning in 1975. Enrollees participated in 10 follow-up surveys in that period, and the baseline response rates ranged from 77% to 84% over the study period.

This analysis included 5,317 respondents, of whom 51.2% were women and 77.9% were white. One-fifth of respondents reported having two to three SUD symptoms, 12% reported four to five, and 11.5% reported six or more SUD symptoms at baseline.

The researchers acknowledged that school dropouts and institutionalized populations, who have higher rates of severe SUD symptoms, were excluded from the study, which may have resulted in underestimates. In addition, Volkow and Wargo noted that prescription stimulant use and smoking history were not studied.

Disclosures

The study was supported in part by grants from the National Institute on Drug Abuse (NIDA).

McCabe and co-authors reported no conflict of interest disclosures.

Volkow reported being the Director of the NIDA; Wargo reported no disclosures.

Primary Source

JAMA Network Open

Source Reference: McCabe SE, et al "Longitudinal analysis of substance use disorder symptom severity at age 18 years and substance use disorder in adulthood" JAMA Netw Open 2022; DOI: 10.1001/jamanetworkopen.2022.5324.

Secondary Source

JAMA Network Open

Source Reference: Volkow ND, Wargo EM "Association of severity of adolescent substance use disorders and long-term outcomes" JAMA Network Open 2022; DOI: 10.1001/jamanetworkopen.2022.5656.

https://www.medpagetoday.com/psychiatry/addictions/97993

HHS Claws Back $100 Million in Provider Pandemic Relief Money

 The Department of Health and Human Services (HHS) is collecting $100 million in pandemic assistance money from providers who failed to comply with the agency's reporting requirements, a Bloomberg Law report found.

On March 10, HHS's Health Resources and Services Administration (HRSA) sent notices to providers who received more than $10,000 in relief money but weren't compliant with reporting requirements, notifying them that they have 30 days to return the funds. Those who do not return the money will be excluded from future payments, the agency stated.

Funding recipients were required to "submit reports as the Secretary determines are needed to ensure compliance with conditions that are imposed on this Payment," HHS said.

Any provider who received more than $10,000 had to report to HHS how they had spent the money by the end of September 2021. The agency pushed the initial deadline by 60 days, and also granted providers a 60-day grace period to come into compliance before beginning enforcement.

Approximately 10,000 providers who did not comply with reporting requirements are being asked to return provider relief by April 10, with amounts ranging from $30,000 to $250,000, according to the Medical Group Management Association (MGMA), a group that represents healthcare providers.

All providers who received the money had to agree to HRSA's terms and conditions, but they could have accepted without signing off. If they retained a payment for more than 90 days without contacting HHS, the agency deemed them to have accepted the terms and conditions.

The money was allocated to recipients through the Provider Relief Fund, an HRSA-supported fund that was created to aid hospitals and other healthcare providers for financial losses and unanticipated costs incurred during the pandemic. The money was not meant to be repaid, HHS said.

Congress allocated $178 billion to the Provider Relief Fund, which was authorized as a part of the bipartisan Coronavirus Aid, Relief, and Economic Security (CARES) Act. The legislation requires recipients to use the money only for lost revenue and expenses associated with COVID-19.

The funding was distributed in several waves, and the current clawbacks are being collected from those who received payments during the first round of funding. But many of the providers who accepted the funds may not have been aware that there were requirements attached to the money at all, especially those who received smaller payments, experts told Bloomberg.

Last week, HHS distributed the fourth round of Provider Relief Fund Phase 4 payments, allocating $413 million to more than 3,600 providers across the U.S.

https://www.medpagetoday.com/special-reports/exclusives/98003

Unwinding Medicaid's Pandemic Protections Won't Be Easy

 When the public health emergency (PHE) ends, pandemic-era protections that allowed Medicaid enrollees to remain in the program regardless of changes to their eligibility, will also end. Will states and the federal government be ready for the transition, or will beneficiaries fall through the cracks?

"The stakes couldn't be higher," said Kinda Serafi, JD, a partner for healthcare consultancy firm Manatt Health.

Unwinding protections in the Medicaid program represents "one of the biggest coverage events" since the Affordable Care Act's (ACA) implementation, but in reverse, Serafi told MedPage Today. "Then, we were seeing considerable enrollment, and now we're really worried about the potential coverage loss of eligible people," she said.

According to a recent study from researchers at the Urban Institute, if the PHE ends after the second quarter of 2022 more than 14 million people could lose Medicaid coverage; if it ends after the third quarter it could be close to 16 million enrollees.

But "this is not going to be 16 million people who lose healthcare coverage," clarified Matt Salo, executive director of the National Association of Medicaid Directors, who spoke at a recent Bipartisan Policy Center (BPC) webinar focused on the transition away from the PHE. In other words, enrollees are expected to move to employer-sponsored health plans or to the ACA's marketplace plans.

So, while concern is in order, "I think it is also appropriate to say, 'You know what? The system worked,'" said Salo. "It ensured that a very large number of low-income individuals -- who were worried about the pandemic, worried about their jobs, worried about their health -- have been covered and have remained covered throughout much of these troubling couple of years."

Background

On Jan. 31, 2020, then-HHS Secretary Alex Azar declared a PHE over a "novel coronavirus." It has since been renewed eight times (each time for an additional 90 days), with the latest declaration set to expire on April 15. However, it is widely believed that the declaration will be renewed at least one more time, given that HHS pledged to give states 60 days notice before announcing an end to the emergency -- no such notice has been given.

During the pandemic, Congress intentionally established flexibilities for the Medicaid program in which virtually no one who enrolled in Medicaid or who was already in the program could lose their coverage for the duration of the emergency, Salo explained during the BPC webinar.

Congress used a continuous coverage provision in the Families First Coronavirus Response Act to temporarily increase the federal government's share of Medicaid spending, known as the federal medical assistance percentage (FMAP), while also blocking states from disenrolling people involuntarily, with exceptions for those who moved out of state.

As Hemi Tewarson, JD, MPH, president and executive director for the National Academy for State Health Policy, explained during a webinar in early March, continuous coverage requirement ends on the last day of the month in which the PHE ends (the increased FMAP is slated to expire at the end of the quarter in which the PHE ends).

While there is no definitive end date for the PHE , many experts are feeling "increasingly comfortable" with the idea that the emergency declaration could be extended one last time and end in mid-July -- meaning continuous coverage requirements would end August 1, Serafi said.

CMS recently updated its guidance for states aimed at promoting continuity of coverage when the PHE does end. In that guidance, CMS extended the deadline for processing eligibility renewals for Medicaid and the Children's Health Insurance Program (CHIP) from 12 to 14 months following the end of the PHE; urged states not to initiate renewals for more than one-ninth of their caseload in a given month; and recommended they adopt a "risk-based approach" designed to "prevent inappropriate terminations and promote smooth transitions" to other plans, for those no longer eligible for Medicaid or CHIP.

In addition to issuing guidance, CMS has asked states to submit a report summarizing their plans for prioritizing and distributing renewals, "no later than the 45th day before the end of the month in which the PHE ends," a CMS spokesperson wrote in an email to MedPage Today.

"CMS has provided an updated operational plan and self-assessment tool that the agency is recommending all states use to create an operational plan," the spokesperson noted, adding that the agency is "collaborating extensively with states" to prepare for a return to normal operations. In addition to online tools and resources, the agency has created work groups, biweekly all-state calls, and provided individualized state technical assistance.

Challenges for States/Beneficiaries

Prior to the pandemic, approximately 71 million Americans were enrolled in Medicaid and CHIP. As of September 2021, according to CMS, roughly 85 million Americans were enrolled in the programs.

Salo said that states' top priorities are: first, that no one who is still eligible for Medicaid loses their coverage, and second, providing a "warm handoff" to other plans for those who are no longer eligible.

This transition process will require collaboration between state and federal programs and public and private partnerships as well as support from managed care, providers groups, and community based organizations, he noted.

"There's a couple of key places where we know we're going to lose eligible individuals," Serafi said.

Renewal requirements mandate that states start with an "ex parte" process first. This means, instead of asking individuals to complete a form or provide documentation, states look to available data sources to confirm eligibility, such as from the Supplemental Nutrition Assistance Program, or the Women, Infants, and Children program.

"A best practice state is at 60% to 70% ex parte," said Serafi. States with a lower reliance on this process have a larger pool of enrollees from whom they must request documentation by mail. This is problematic because over the last 2 years, people have moved, their life circumstances have changed, and they haven't contacted their Medicaid agencies, she noted.

"And once we get returned mail, we won't be able to find the person to say, 'Please help us understand what your eligibility is so that we can keep you covered,'" Serafi said.

Jeff Bahr, MD, chief medical group officer for Advocate Aurora Health, who also spoke during the BPC webinar, said he's very concerned about Medicaid beneficiaries losing coverage. Unless states and stakeholders "seal the cracks" through which Medicaid enrollees might fall, "we're going to have a secondary pandemic of unaddressed chronic disease. We're going to have people who are going without routine cancer screenings, or routine cardiovascular screenings, [or] routine immunizations unrelated to COVID."

For all of these reasons, many state agencies have begun reaching out to confirm mailing addresses and contact information, so that when notices regarding renewals are sent out they reach the intended individuals, Tewarson noted.

But for those states without a strong "return mail set-up ... we're really ... anticipating loss," Serafi said.

"There is going to be some ... natural churn that happens when people don't reply [to renewal notices]. But if it's a higher number than what's expected, we'd love to see states implement a circuit breaker," she added.

In other words, hit the pause button and investigate the problem.

While there is no such "circuit-breaker" language in CMS's guidance, the agency has asked states to submit monthly data on renewals for at least 14 months.

"If state data suggests that a higher than usual number of people are losing coverage than expected, CMS will work directly with the state to identify the root cause(s) of such losses to develop effective mitigation strategies to address any problems identified while a permanent solution is implemented," a CMS spokesperson told MedPage Today by email.

But there are other challenges, beyond the procedural hurdles, noted Salo.

Medicaid beneficiaries have gotten used to a plan with "robust" benefits that doesn't require any premiums, co-pays, or deductibles. Marketplace plans may have, for example, a $5,000 deductible and significant premiums, he said.

Someone who has just exited the Medicaid program may say, "'Sure, I'm eligible for it, but I can't afford that,'" Salo said.

So, it's important to ensure that marketplace subsidies provide enough support so that plans represent, "a legitimate form of coverage," and an option accessible to people leaving the Medicaid program.

Impact of Federal Match Declines

Financially, the unwinding also creates challenges for state Medicaid agencies themselves. The increase in the federal match was a major reason the program covered so many people during the PHE.

"You don't want this cliff," said Salo, where at a certain point federal dollars flowing into Medicaid drop off in a significant way. "That is disruptive."

Regardless of the speed at which the FMAP is phased out, the increased federal dollars are expected to run out "well before" the obligation to provide continuous coverage ends, Salo said. So as states try to ensure the transition is "as humane and effective as possible," they also face these added tensions.

"There are going to be some serious fiscal challenges if Congress does not reconcile that problem and force[s] states into a dynamic [where] we're keeping people on [Medicaid] for an additional 9, 12, 14 months, without any kind of sufficient federal support," he said.

https://www.medpagetoday.com/publichealthpolicy/medicaid/98005

UK hits record COVID-19 levels; nearly 5 million infected

 The prevalence of COVID-19 in the U.K. has reached record levels, with about 1 in 13 people estimated to be infected with the virus in the past week, according to the latest figures from Britain’s official statistics agency.

Some 4.9 million people were estimated to have the coronavirus in the week ending March 26, up from 4.3 million recorded in the previous week, the Office for National Statistics said Friday. The latest surge is driven by the more transmissible omicron variant BA.2, which is the dominant variant across the U.K.

Hospitalizations and death rates are again rising, although the number of people dying with COVID-19 is still relatively low compared with earlier this year. Nonetheless, the latest estimates suggest that the steep climb in new infections since late February, when British Prime Minister Boris Johnson scrapped all remaining coronavirus restrictions in England, has continued well into March.

The figures came on the same day the government ended free rapid COVID-19 tests for most people in England, under Johnson’s “living with COVID” plan. People who do not have health conditions that make them more vulnerable to the virus now need to pay for tests to find out if they are infected.

“The government’s ‘living with COVID’ strategy of removing any mitigations, isolation, free testing and a considerable slice of our surveillance amounts to nothing more than ignoring this virus going forwards,” said Stephen Griffin, associate professor at the University of Leeds’ medical school.

“Such unchecked prevalence endangers the protection afforded by our vaccines,” he said. “Our vaccines are excellent, but they are not silver bullets and ought not to be left to bear the brunt of COVID in isolation.”

More than 67% of people 12 years old and above in the U.K. have been vaccinated and had their booster or a third dose of the coronavirus vaccine. Beginning Saturday, parents can also book a low-dose vaccine for children between 5 to 12 years old in England.

James Naismith, a biology professor at the University of Oxford, said he believed that except for those who are completely shielded or not susceptible to the virus, most people in the country would likely be infected with the BA.2 variant by the summer.

“This is literally living with the virus by being infected with it,” he said.

https://thehill.com/news/3257162-uk-hits-record-covid-19-levels-nearly-5-million-infected/

Junior Goldman Sachs bankers threaten to quit over ‘5 days a week’ office rule

 Junior bankers at Goldman Sachs are threatening to quit over demands that they show up to the office five days a week as the pandemic wanes — and some gripe that their bosses have been quietly checking attendance.

As bonuses across Wall Street hit record highs, underlings at Goldman — headed by hard-charging Chief Executive David Solomon — are nevertheless stepping up complaints of “hellhole” working conditions that have notoriously included 100-hour weeks.

Most recently, some junior Goldmanites claim that they are being “bullied” into showing up in person “5-0” — meaning five days working in the office, zero from home — and that the bullying is being orchestrated by top managers armed with spreadsheets.

Goldman CEO David Solomon has called remote work an “aberration.”

Bloomberg via Getty Images

“In GS, the top management says it’s employees choice but internally they track which team has most in office attendance,” one Goldman employee wrote on the corporate message board Blind, which verifies users’ place of employment with the help of their company email accounts.

“It’s f**ing bulls**t from top management saying they are people first,” the miffed Goldman underling added. “In our team meeting, manager showed us the excel where the MDs are tracking which department has not met in-office commitments,” the staffer wrote, referring to the high-level managing directors.

Goldman employees gripe their in-office attendance is being monitored by management.

Another Goldman employee chimed in: “Apparently they are tracking everyone’s attendance and managers are getting lists of people who have low attendance so they can bully them into coming in.”

Last year, Solomon called working from home a pandemic “aberration,” even as he drew bitter comments over his habit of working from the Hamptons and spending long weekends in the Caribbean.

But after asking all employees to return to the office five days a week in June, Goldman Sachs had to walk it back after the outbreak of Omicron in December. The bank called all employees back again in February.

David Solomon has been DJing across the country while demanding employees work from the office.

["Getty Images for Safe & Sound"

“David Solomon sucks,” one user griped on Blind. “Nobody wants to be in 5-0 and plenty of companies are willing to allow hybrid/remote.” 

Indeed, some younger staffers say they are looking to “GTFO” of Wall Street as they interview with tech companies which offer better compensation and more flexibility. One said she was “negotiating with two FAANGs” — a comment referring to Facebook, Amazon, Alphabet, Netflix and Google that prompted other users to ask to connect offline in the hopes they might jump to tech companies themselves.

A Goldman spokesperson declined to comment for the record. A person close to the bank disputed there was widespread frustration. “Far from a scientific survey, The Post has chosen a handful of comments submitted to an online forum no one has heard of.”

JPMorgan, meanwhile, has taken a more relaxed approach than Goldman. The mega-bank headed by Jamie Dimon offers some hybrid options and many employees are allowed to work from home at least one day a week.

JPMorgan, headed by Jamie Dimon, offers some employees hybrid working conditions.

Nevertheless, employees continue to kvetch. One said he’s working remote until “I get fired.” Others asked whether they’d be punished if they simply refused to return to the office.

“I don’t feel like traveling to office and I want to continue WFH. Anyone facing any action from manager or HR for not returning to office?” one user asked.

Another JPMorgan employee said she doesn’t plan to go into the office even if it means getting cut: “Yeah… I’m working remote until I get fired.”

JPMorgan declined to comment.

During the pandemic, banks have ramped up efforts to keep junior employees happy, doling out the biggest bonuses on record — an average of $257,500, according to the state of New York — even as they have pledged to hire more staff to help with the workload.

Goldman and JPMorgan increased first-year pay by roughly 30 percent — to $110,000. Morgan Stanley said it would boost first-year pay to $110,000, while boutique investment bank Evercore raised first-year salaries to $120,000.

https://nypost.com/2022/03/30/junior-goldman-sachs-bankers-threaten-to-quit-over-5-days-a-week-office-rule/

Percent Who Feel Employer Cares About Their Wellbeing Plummets

 Fewer than one in four U.S. employees feel strongly that their organization cares about their wellbeing -- the lowest percentage in nearly a decade.

This finding has significant implications, as work and life have never been more blended and employee wellbeing matters more than ever-- to employees and the resiliency of organizations. The discovery is based on a random sample of 15,001 full and part-time U.S. employees who were surveyed in February 2022.

Prior to COVID-19, in 2014, about the same percentage (25%) of employees strongly agreed that their employer cares about their overall wellbeing. Then at the onset of the pandemic in 2020, employers responded quickly with a plan, communication, and what many employees believed was genuine concern for them, their work, and their lives. The percentage who felt cared about nearly doubled, reaching a high of 49% in May of that year. Since 2020, the perception has plummeted to the previous low levels.

This finding is critical for organizations because employees who strongly agree that their employer cares about their overall wellbeing, in comparison to others, are:

• 69% less likely to actively search for a new job
• 71% less likely to report experiencing a lot of burnout
• five times more likely to strongly advocate for their company as a place to work and to strongly agree they trust the leadership of their organization
• three times more likely to be engaged at work
• 36% more likely to be thriving in their overall lives

Gallup's research has also found that teams who are most likely to feel the organization cares about their wellbeing achieve higher customer engagement, profitability, productivity, lower turnover, and have fewer safety incidents.

Considerations:

• The one-year decline in employees' perceptions that their organizations care about their overall wellbeing was generally consistent across employee job types -- from production and front-line to white-collar professionals. The decline was especially high among managers -- 11 percentage points.
• Gallup found increases in manager burnout in 2021 and declining employee engagement. The ongoing COVID-19 spikes combined with increased employee resignation rates in 2021 made it difficult for leaders to design and communicate a predictable course of action.
• The percentage of employees who are extremely satisfied with their organization as a place to work dropped from 23% to 18% from late 2021 to the first quarter of 2022. Perceptions of the overall organization correlate highly with perceptions of leadership.
• "My organization cares about my overall wellbeing" reached its highest point in 2020 following organizational changes in response to the COVID-19 pandemic. Of employees who strongly agreed that their employer communicated a clear plan of action in response to the coronavirus, 73% strongly agreed their organization cares about their overall wellbeing. Of those who strongly agreed that their supervisor kept them informed about what was going on in the organization, 78% strongly agreed their organization cares about their overall wellbeing. Communication matters.
• Employee expectations of work may have fundamentally changed after the experiences of 2020 and 2021. Many learned new ways of working and may have an updated definition for what an employer caring about their overall wellbeing means. The work-life intersection has new meaning. Gallup finds those who prefer remote work now cite reduced commute times and better work-life balance as the key reasons. These may be new and more serious considerations for many employees, upping the bar for employers.
• Many organizations have built and maintained great cultures where employees do feel their organization cares about their overall wellbeing. In Gallup's global database, top organizations have six in 10 employees or more reporting they strongly agree their organization cares about their overall wellbeing -- two to three times the overall national rate.

What's Next? Here's What Some Organizations Did.

Gallup found patterns in organizations that consistently improved their cultures-- even during the tumultuous last two years. Some of these patterns include:

• Using their aspired-to organizational culture and values to guide business decisions. Employees need to see the intended culture and values lived out daily. It is important to listen to people and act based on employees' work-life needs.
• Embracing flexible work environments while developing future-of-work plans. Flexibility can take on different meanings for employees depending on the type of work they do and where they need to be located to have outstanding individual performance, team collaboration, and customer value.
• Focusing on employee wellbeing and acknowledging the whole person. Since work and life are blended for many, consider the demands of life inside and out of the workplace. Consider career, social, financial, physical, and community wellbeing impacts and resources.
• Tailoring communication to reach their team where they are. Transparent and creative omnichannel communication to employees and customers is more likely to reach and resonate with a wide variety of people in many different work-life situations.
• Enabling managers to manage through times of change with their immediate teams. Consistently upskill managers to coach their employees through their strengths. Every person has a different work-life situation and only managers can understand these nuances and make adjustments based on how each person is wired, how they best perform, collaborate, and bring value to customers.

With new variants of COVID-19 emerging in 2020 and 2021, back-to-workplace planning included many frustrating starts and stops for organizational leaders. With the rates of COVID-19 now at a low and decreasing rate in the U.S., the removal of many social restrictions and mask mandates affords organizational leaders the opportunity to set predictable workplace plans in motion.

This new freedom may present itself as a big opportunity for organizations to differentiate themselves based on what they have learned from the "great forced working experiment" of the past two years. How organizations respond to this opportunity will have a substantial impact on whether employees feel their organization cares about their overall wellbeing.

AUTHOR(S)

Jim Harter, Ph.D., is Chief Scientist for Gallup's workplace management practice. He recently coauthored Wellbeing at Work, a book that explores how to build resilient and thriving teams in organizations. He is also coauthor of the No. 1 Wall Street Journal bestseller It's the Manager and New York Times bestsellers 12: The Elements of Great Managing and Wellbeing: The Five Essential Elements.

Sangeeta Agrawal contributed analysis to this article.

https://www.gallup.com/workplace/390776/percent-feel-employer-cares-wellbeing-plummets.aspx