Air Travel and Communicable Diseases:
Comprehensive Federal Plan Needed for U.S. Aviation System's Preparedness
GAO-16-127: Published: Dec 16, 2015. Publicly Released: Dec 16, 2015.
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What GAO Found
All of the 14 airports and 3 airlines GAO reviewed have plans for responding to communicable disease threats from abroad, although the United States lacks a comprehensive national aviation-preparedness plan aimed at preventing and containing the spread of diseases through air travel. U.S. airports and airlines are not required to have individual preparedness plans, and no federal agency tracks which airports and airlines have them. Consequently, it is not clear the extent to which all U.S. airports and airlines have such plans. The plans GAO reviewed generally addressed the high-level components that GAO identified as common among applicable federal and international guidance, such as establishment of an incident command center and activation triggers for a response. GAO identified these components to provide a basis for assessing the breadth of the plans. The plans GAO reviewed for each airport were developed by, or in collaboration with, relevant airport stakeholders, such as Centers for Disease Control and Prevention's (CDC) airport staff. As provided in Annex 9, the Chicago Convention, an international aviation treaty to which the United States is a signatory, obligates member states to develop a national aviation-preparedness plan for communicable disease outbreaks. The Department of Transportation (DOT) and CDC officials contend that some elements of such a plan already exist, including plans at individual airports. However, FAA has reported that individual airport plans are often intended to handle one or two flights with arriving passengers, rather than an epidemic, which may require involvement from multiple airports on a national level. Most importantly, a national aviation-preparedness plan would provide airports and airlines with an adaptable and scalable framework with which to align their individual plans—to help ensure that individual airport and airline plans work in accordance with one another. DOT and CDC officials agree that a national plan could add value. Such a plan would provide a mechanism for the public-health and aviation sectors to coordinate to more effectively prevent and control a communicable disease threat while minimizing unnecessary disruptions to the national aviation system.
Aviation stakeholders GAO spoke with identified multiple challenges in responding to communicable disease threats and actions they took or would take in response. For example, airline and airport representatives told GAO they sometimes experienced difficulties sharing timely and accurate information about threats, and some reported that they improved communication by developing tools, such as standardized forms, to collect and share relevant information. Employees at aviation services firms that GAO spoke with—including contract workers who clean aircraft—raised concerns about the availability of training and access to equipment to control exposure to communicable diseases. Some airports GAO reviewed developed additional mechanisms to ensure adequate training and preparation during the Ebola threat. A national aviation-preparedness plan could serve as the basis for testing communication mechanisms among responders to ensure those mechanisms are effective prior to a communicable disease outbreak as well as to provide the basis for ensuring that airport and airline staff receive appropriate training and equipment to reduce their risk of exposure to communicable diseases during an outbreak.
Why GAO Did This Study
Past communicable diseases, such as the recent Ebola epidemic, have resulted in many deaths and highlight the potential economic cost of disruptions to air travel and the U.S. and global economies.
GAO was asked to review the preparedness of the U.S. aviation system to respond to communicable diseases. This report examines (1) the extent to which selected U.S. airports and airlines have plans for responding to communicable disease threats from abroad and to which a national aviation-preparedness plan guides preparedness, and (2) the challenges that U.S. airports and airlines have faced when responding to threats and any actions taken to address them.
GAO reviewed available documents and interviewed representatives from 14 U.S. international airports—selected to reflect a range of activities and facilities—and the 3 major U.S. airlines. GAO also reviewed applicable federal requirements and international obligations and guidance for U.S. airports and airlines, and interviewed officials and reviewed documents from federal agencies and aviation stakeholder groups.
What GAO Recommends
GAO recommends that DOT work with relevant stakeholders, such as the Department of Health and Human Services, to develop a national aviation-preparedness plan for communicable diseases. DOT agrees a plan is needed, but suggests public health agencies lead the effort. GAO continues to believe the recommendation is correctly directed to DOT, as discussed in this report.
For more information, contact Gerald Dillingham, Ph.D., (202) 512-2834, DillinghamG@gao.gov.
Recommendation for Executive Action
Comments: As of April 2020, the Department of Transportation (DOT) has not developed a national aviation-preparedness plan to respond to communicable disease threats from abroad. DOT partially concurs with our recommendation and agrees that an aviation preparedness plan is needed, but continues to suggest that the Department of Health and Human Services (HHS) and the Department of Homeland Security (DHS) have responsibility for communicable disease response and preparedness planning, respectively, and that these departments should lead any efforts to address planning for communicable disease outbreaks, including for transportation. DOT would be in the best position to lead the effort because FAA and DOT have stronger and deeper ties to the relevant stakeholders that would be involved in such a broad effort and is responsible for overseeing the aviation sector. While the DOT and HHS may not agree on which agency should lead the development of a national aviation-preparedness plan, DOT's Office of the Secretary is the liaison to the International Civil Aviation Organization (ICAO) for Annex 9 to the Chicago Convention, an international aviation treaty. Annex 9 obligates each ICAO member state to establish a national aviation-preparedness plan for communicable disease outbreaks that pose a public health risk or public health emergency of international concern. In the absence of a national aviation-preparedness plan, DOT officials point to ongoing efforts to engage with interagency partners at DHS and HHS, as well as industry stakeholders, to better collaborate on communicable disease response and preparedness as they relate to civil aviation. For example, in response to the Coronavirus Disease 2019 (COVID-19) outbreak, DOT reported that it has facilitated conference calls between stakeholders, including federal agencies and aviation stakeholders, and it has collaborated with the Centers for Disease Control and Prevention (CDC) within HHS to update interim guidance for airline crews related to communicable diseases, specifically COVID-19, among other things. While these efforts are helpful, we continue to believe that DOT is in the best position to take the lead in working with its relevant stakeholders to develop a national aviation-preparedness plan, which could guide preparation for communicable diseases nationally and for individual airlines and airports, as well as establish a framework for communication and response for the next communicable disease outbreak. Such a plan should help government minimize and quickly respond to future communicable disease events and garner international cooperation in addressing pandemic issues.
Recommendation: To help improve the U.S. aviation sector's preparedness for future communicable disease threats from abroad, the Secretary of Transportation should work with relevant stakeholders, such as the Department of Health and Human Services, to develop a national aviation-preparedness plan for communicable disease outbreaks. Such a plan could establish a mechanism for coordination between the aviation and public health sectors and provides clear and transparent planning assumptions for a variety of types and levels of communicable disease threats.
Agency Affected: Department of Transportation