Managing Communicable Disease in Aviation

 

Article 14 of the 1944 Convention on International Civil Aviation (often referred to as the "Chicago Convention") obliges Contracting States "to take effective measures to prevent the spread by means of air navigation of cholera, typhus (epidemic), smallpox, yellow fever, plague, and such other communicable diseases as the Contracting States shall from time to time decide to designate". ICAO coordinates global efforts to ensure that all Contracting States have a preparedness plan to mitigate the risks from a communicable disease with the potential to cause a public health emergency, by reducing the risk of dissemination of disease through air transport.

The primary strategy of the World Health Organization (WHO) to mitigate the risks from a communicable disease is to contain the disease within the outbreak area. The main containment activities include heightened awareness of the public, mobilization of risk mitigation efforts by the community, including social distancing in the outbreak area (isolation and quarantine) and the application of prophylactic medication and vaccination. To increase the effectiveness of this approach, the aviation sector can assist by reducing the likelihood of individual with a communicable disease travelling outside the outbreak area. This may require the establishment of traveller screening procedures at airports, medical assessment of travellers determined by screening as potentially infected by the disease in question, and communication with the public so that they are aware of the risks before setting out on their journey.

ICAO has reviewed its Standards and Recommended Practices (SARPs) of relevance to Article 14 of the Chicago Convention and has updated them in view of the contemporary risks to human health from communicable diseases. New SARPs have been written that are in alignment with the latest revision of the WHO International Health Regulations (2005) (PDF). Although the SARPs describe the obligations on Contracting States, they do not explain in detail how they can be met. Accordingly, ICAO sought the assistance of specialist organizations such as the WHO, Centers for Disease Control and Prevention (CDC), Airports Council International and International Air Transport Association in order to formulate guidelines for States that would assist them in developing their own, national, preparedness plans. More detailed guidance, directed specifically towards airports and airlines, has also been developed.

The WHO, like ICAO, is a specialized agency of the United Nations. However, whereas WHO concentrates on health related issues, ICAO's main area of interest concerns aviation. With respect to reducing the risk of spread of disease by air transport, neither organization can efficiently act alone, because detailed knowledge of relevant aspects of both health and aviation is required to develop an effective strategy.

ICAO and WHO work closely to complement each other in creating awareness of the risk of disease and its adverse effects. By jointly, developing technical guidance and operational procedures, the aviation sector should to be better prepared to respond to potential health risks which could spread through air transport and adversely affect the population health and aviation interests of different countries.

The WHO's International Health Regulations (2005) [IHR (2005)] provides a framework for reducing the risk to human health from communicable diseases with the potential for causing a public health emergency. The relevant provisions of the IHR (2005) have been used to develop ICAO Standards and Recommended Practices and supporting guidelines to ensure that there are no areas of conflict between the IHR (2005) and ICAO's work.

The WHO takes the lead in determining the level of risk and in providing information concerning the necessary international health measures. The national public health authorities have a key role and they will normally be in overall charge of the national response. Airport and airline operators and the national aviation authority are also important players and need to coordinate effectively with the public health authority. Many other entities, in both the public and private sectors will be involved, such as those dealing with customs, security and baggage handling. The media can play a key role in informing the public of the situation as an outbreak develops and in advising of any risks associated with air travel.

ICAO's role is primarily one of coordination and the provision of guidance and information. In order to mount an effective mitigation strategy a timely, coordinated and proportionate response from national public health authorities and stakeholders in the aviation community is essential. ICAO strives to reduce the possibility that one State initiates stringent requirements to mitigate the perceived risk, whereas another chooses a more liberal approach, when the threat to both States is similar. Apart from the desirability of States putting into place a response that is proportionate to the risk, a dissimilar approach is likely to cause confusion in the public's mind as to the actual risk they face when travelling.

National aviation authorities need to ensure that they are fully involved in the planning process to ensure that their expertise is available to the national public health authority. The chief medical officer of the national aviation authority is likely to be an important resource as he/she will have knowledge of most aspects of health and aviation operations that are relevant to developing a preparedness plan for aviation. An area where specific expertise from the national aviation authority will be required is that of air traffic management. Several issues will need to be considered, such as procedures to ensure flight safety when aircraft are diverted because of a suspected case on board, the reliable notification of the national public health authority by air traffic control after receiving information of a suspected case from a pilot, and how air traffic operations can be sustained when many personnel are simultaneously absent from work, possibly for several weeks.

The medical department of a national aviation regulatory authority is primarily concerned with ensuring that licence holders i.e. aircrew and air traffic controllers, are medically fit. However, because it has expertise in both aviation and health, such a department can play an important role in providing the link between public health and aviation interests. The regulatory authority's medical department is well placed to ensure that health risks are managed in a consistent and proportionate manner across the airports in its State. Further, during public health emergencies the chief medical officer can be a valuable source of information for the national IHR focal point with respect to the aviation sector, and can assist in the efficient management of such an emergency.

 

ICAO is working towards global harmonization in the aviation sector with respect to managing health risks triggered by communicable diseases. One method for achieving this is to work in regions of the world that have common characteristics and established communication networks. By establishing a regional network of experts comprising representatives from the national pubic health and civil aviation authorities, airport and airline operators, and other stakeholders and partners such as the local WHO and ICAO representatives, a system for providing ongoing advice to the aviation sector is facilitated. Once such networks have been set up in more than one region, coordination between such regions should enable global harmonization of preparedness and response plans. The first such network of experts is currently being established in the Asia Pacific region.

Although aviation is an international activity, there are at present limited opportunities for developing a globally harmonized preparedness plan to mitigate the health risks posed by the spread of communicable diseases. Whilst WHO has established procedures for mitigating the general health risks, these do not yet fully address the role associated with air transport in spreading such disease. Likewise, the aviation sector has not yet consistently implemented harmonized procedures that adequately address the risk. At global level, coordination between ICAO and WHO continue to improve to ensure that expertise between the health and aviation sectors are adequately represented in the development of a harmonized global strategy and plan. A similar move at national level between aviation and public health authorities will help to evolve well coordinated national strategy and preparedness plan against spread of communicable diseases through air travel/transportation.

The main challenge to developing a management plan is to ensure that communication between the relevant stakeholders and partners is easy and rapid. Traditionally, many organizations have worked in a vertical manner, meaning that inter-organizational communication links may not have been developed to the level necessary to adequately manage any health risk. In particular, the national public health authority may not have developed efficient lines of communication with the national aviation authority (particularly with its medical department), with airport and airline operators, or with the media. ICAO is working at an international level with the WHO to develop such communication links and is encouraging States to develop reliable communication networks between stakeholders and partners.