Public Health and Aviation
Public Health and Aviation
In past centuries, millions have died from diseases imported from other countries. Such risks remain a significant threat to health and safety. Nowadays, pandemics are likely to:
- Be promulgated by air transport
- Adversely affect the efficiency and potentially, the safety of aviation operations
- Impact national economies and private enterprises that rely on aviation
- Expose aviation workers and travellers to health risks
Personnel working in the aviation sector should be aware of how public health events might affect the industry, as well as their own health. They should know how to respond to a public health event. Such events include an influenza pandemic or a widespread outbreak of a new type of disease e.g. a new type of SARS (Severe Acute Respiratory Syndrome) virus.
The Convention on International Civil Aviation has been signed by 191 States (governments). Titled “Prevention of Spread of Disease”, Article 14 of this Convention commits signatory States to prevent “by means of air navigation” the spread of communicable disease and to consult on this subject with other involved agencies. To assist with the implementation of Article 14, International Civil Aviation Organisation (ICAO) works with the World Health Organization (WHO), the International Air Transport Association (International Air Transport Association (IATA)), Airports Council International (ACI) and several other interested bodies. Effective preparedness planning requires a multi-sector, multi-stakeholder approach and it often involves a different way of working from usual – this can provide a major challenge.
Annexes containing public health related SARPs
To help promote uniform implementation by States of the Convention on International Civil Aviation, 18 Annexes to the Convention provide the Standards and Recommended Practices (SARPs), and a number of these address the implementation of Article 14 of the Convention. They are:
- Annex 6 – Operations
- Annex 9 – Facilitation
- Annex 11 – Air Traffic Services (and associated Procedures for Air Navigation Services – Air Traffic Management, PANS-ATM)
- Annex 14 – Aerodromes
- Annex 18 – The Safe Transport of Dangerous Goods by Air
Scenarios to consider
There are two main scenarios that should be anticipated. Some of the relevant aspects are outlined below (further references are provided in “Further Reading”).
a. Aircraft in flight with a suspected case of communicable disease on board
- Cabin crew guidance on how to identify a possible communicable disease are provided in Annex 9 – Facilitation and the health part of the aircraft General Declaration
- Cabin crew procedures for managing travellers with a communicable disease by IATA:General Guidelines for Cabin Crew: SUSPECTED COMMUNICABLE DISEASE (Dec, 2017)
- Communication procedure for the pilot-in-command to notify the arrival (and departure) aerodromes of a public health event (in accordance with ICAO Procedures for Air Navigation Services – Air Traffic Management). Following this procedure will not only comply with public health and aviation regulations, but will also accelerate procedures on landing and reduce unnecessary delays.
PANS-ATM DOC 4444, Chapter 16, Miscellaneous Procedures:
16.6.1 The flight crew of an en-route aircraft shall, upon identifying a suspected case(s) of communicable disease, or other public health risk,... on board of the aircraft, promptly notify the ATS unit with which the pilot is communicating, the information listed below:
a) Aircraft identification
b) Departure aerodrome
c) Destination aerodrome
d) Estimated time of arrival
e) Number of persons on board
f) Number of suspected case(s) on board; and
g) Nature of the public health risk, if known.
16.6.2 The ATS unit, upon receipt of information from a pilot regarding suspected case(s) of communicable disease, or other public health risk, on board the aircraft, shall forward a message as soon as possible to the ATS unit serving the destination/departure, unless procedures exist to notify the appropriate authority designated by the State and the aircraft operator or its designated representative.
16.6.3 When a report of a suspected case(s) of communicable disease, or other public health risk, on board an aircraft is received by an ATS unit serving the destination/departure, from another ATS unit or from an aircraft or an aircraft operator, the unit concerned shall forward a message as soon as possible to the public health authority (PHA) or the appropriate authority designated by the State as well as the aircraft operator or its designated representative, and the aerodrome authority.
- Communication procedure at the arrival and departure aerodromes when notification of a public health event on an inbound aircraft is received (a local procedure needs to be developed in collaboration with the public/port health authority and included in the aerodrome emergency plan)
- Parking position of the affected aircraft. Note that the appropriate parking position for an affected aircraft is probably not a remote stand, unlike most other emergency situations that involve arriving aircraft (see guidelines on the ACI website).
- Management of aircraft arrival including: chain of command, personal protective equipment requirements, information to be provided to passengers, crew and staff, customs and immigration, baggage handling (procedures should be developed jointly by stakeholders in the aviation sector, together with public/port health authority)
- Anticipated delay for a non-serious case – most in-flight health events will not result in declaration of a public health emergency, and thought needs to be given to the acceptable delay to passengers, crew and the affected aircraft that may be involved in such non-serious cases (a standard operating procedure should be developed jointly by stakeholders in the aviation sector, in coordination with the public/port health authority)
- Disinfection of aircraft after carriage of an infectious traveller. Note that many common disinfectants, such as products containing bleach, cannot be used on aircraft due to their corrosive properties (guidance is provided in WHO Guide to Hygiene and Sanitation in Aviation)
- Passenger tracing for close contacts - the passenger locator form is available from:
- Involvement of security personnel, in the event of a suspected bioterrorism event (a local procedure should be developed in collaboration with the relevant security agency)
b. A local outbreak affecting aviation services due to non-availability of personnel
- Management of large numbers of travellers who rapidly wish to leave the outbreak area: departing aircraft are likely to be overbooked, whereas arriving aircraft may be relatively empty. Terminal buildings are likely to be overcrowded, filled with those wishing to depart and their relatives/friends, in itself posing a risk of spreading disease
- Absence of airport staff, including air traffic controllers, pilots, security personnel etc. (due to illness, requirement to look after ill relatives or children whose schools are closed or fear of becoming infected if they attend work). The effect on flight safety of significant numbers of safety critical personnel being unavailable for work needs consideration
- Lack of support services – ground transport, communications, IT, water, electricity etc. due to absence of staff. Such a situation may continue for weeks or more - business continuity plans need to specifically address public health emergencies, which have certain characteristics that are different from other crises that may be encountered (see business continuity guidelines from IATA and ACI)
- Provision of health and travel advice to travellers and potential travellers, and aviation workers
- Passenger screening requirements
Further information and general guidelines are available on the ACI website
Novel Coronavirus 2019 (COVID-19)
The most recent public health emergency of international concern is the novel coronavirus outbreak in Wuhan, China., which was first reported on 31 Dec. 2019, and came to wide international attention in January 2020. In February 2020, the World Health Organization (WHO) named the disease caused by the virus “coronavirus disease 2019,” which is abbreviated as COVID-19. On 11 March 2020 WHO declared COVID-19 a pandemic and said it was the first time that a pandemic has been sparked by a coronavirus. See Coronavirus Disease 2019 (COVID-19) for updated information and guidance.
To address the above issues, the following three key components are essential for adequate preparedness planning:
- Multi-stakeholder involvement - relevant stakeholders should be involved prior to an event. In particular, the aviation sector stakeholders, including both operators and regulators, need to communicate, coordinate and collaborate with the public health sector, in advance of the next public health emergency. At governmental level this may require the support of both the Minister of Health and the Minister of Transport.
- Initial actions in the event of a public health emergency or potential emergency should be well known by the key players. It is during the initial stages of an event, when accurate information is often lacking, that stakeholders need to quickly establish good communication channels. News releases should be coordinated to avoid inconsistencies. A pre-established network is fundamental to an efficient response.
- Preparedness plans should be tested by table top or realistic scenarios
To assist States implement public health related SARPs and prepare for the ICAO Universal Safety Oversight Audit Programme (that was fully launched as of January 2013), ICAO has established an assistance programme called the Collaborative Arrangement for the Prevention and Management of Public Health Events in Civil Aviation (CAPSCA). An annual CAPSCA meeting, that brings together all stakeholders to facilitate the growth of multi-sector networks and to develop or amend guidance material, is held in each of the five regions (Asia Pacific; Africa; Americas; Europe; Middle East). In addition, CAPSCA provides assistance visits to individual States and international airports. In such visits, a small team of experts (two or three individuals, ideally including both aviation and public health personnel) visit an airport, usually over two days, and undertake a gap analysis of national/local preparedness plans against the relevant ICAO SARPs, the WHO International Health Regulations (2005) (which contain many articles of relevance to airport and aircraft operators) and associated guidance material. A confidential report is provided to help the State to develop is preparedness plans. More information on CAPSCA is available on the CAPSCA website.
CAPSCA is being extended to cover public health emergencies other than those relating to communicable disease; i.e. nuclear and chemical events. The Fukushima accident raised questions concerning the health and operational risks involved should an aircraft inadvertently fly through a radioactive plume, the correct procedure if a parked aircraft is covered by radioactive dust, or risks to other passengers if an individual exposed to radiation needs to travel by air in order to obtain specialised treatment. Experience during this accident demonstrated that the network already established for communicable disease preparedness was useful in helping to manage the aviation aspects and was able to provide up to date, authoritative and generally reassuring news releases that were jointly written by all major agencies involved (including seven UN specialized agencies and two trade associations).
Public health emergencies or potential emergencies are not new, but the increase in aviation activity in recent decades has made it more likely than before that air travel will promulgate the international spread of disease, and that aviation itself and the economies that rely on it will be affected on a wider scale.
States should develop and test aviation related public health preparedness plans that are integrated with a State’s general preparedness plans. At a governmental level this will require communication and collaboration between the Ministries of Health and Transport, which experience has shown could be better developed.
Coordination is also required at an inter-State level within regions and also globally, since public health threats are rarely limited by international borders. A harmonized approach, based on scientific best practice, is more likely to be effective and to instil confidence in the travelling public. Regional and international organizations have a major part to play in facilitating such coordination.
ICAO has established links with WHO, ACI, IATA and other stakeholders and is working towards joint preparedness planning at a global and regional level. The CAPSCA programme is available to help States develop plans at a national and operational level. Good planning will help ensure that the response to the next public health emergency is timely and appropriate, will reduce the likelihood of inappropriate “knee-jerk” reactions and will promote a prompt return to normal operations when the threat to health has passed.
- Bio Hazards - Guidance for Cabin Crew
- Food Poisoning
- The Common Cold
- Coronavirus Disease 2019 (COVID-19)
- Collaborative Arrangement for the Prevention and Management of Public Health Events in Civil Aviation (CAPSCA)
- ICAO Council's Aviation Recovery Task Force (CART)
- Airports Council International - Transmission of Communicable Diseases
- Flight Safety Foundation, Pandemic: Non-Medical Operational Safety Aspects, Supplemental Materials, 27 March 2020.
- United States Centers for Disease Control and Prevention - Infection control guidelines for cabin crew members on commercial aircraft
- Guidelines on Health and Safety and link to Public Health Emergencies/Business Continuity Planning
- Air Transport and Communicable Diseases
- Guidelines for Cabin Crew: SUSPECTED COMMUNICABLE DISEASE (Dec, 2017)
- Assembly Resolutions in Force (as of 8 October 2010)
- Collaborative Arrangement for the Prevention and Management of Public Health Events in Civil Aviation (CAPSCA)
- Convention on International Civil Aviation, ninth edition (2006)
World Health Organization