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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.


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.

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Transportation
Priority Rec.
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.
DOT has not developed a national aviation-preparedness plan to respond to communicable disease threats from abroad. Initially, DOT partially concurred with our recommendation and agreed that an aviation preparedness plan is needed but continued to suggest that HHS and 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. In June 2020, we urged Congress to take legislative action to require the Secretary of Transportation to work with relevant agencies and stakeholders to develop a national aviation-preparedness plan to limit the spread of communicable disease threats and minimize travel and trade impacts (see GAO-20-625). The Consolidated Appropriations Acts of 2023 included a requirement for the Secretary of Transportation, in coordination with the Secretary of Health and Human Services, the Secretary of Homeland Security, and the heads of other federal departments or agencies as the Secretary of Transportation considers appropriate, to develop a national aviation-preparedness plan for communicable disease outbreaks, as we had recommended. Subsequently, DOT changed its position and, according to agency officials, efforts are underway within FAA to develop a national aviation-preparedness plan. In April 2024, FAA officials told us they are drafting the plan and coordinating it internally within the FAA. Final coordination with other entities, including DHS and HHS and industry stakeholders, among others, will be completed by end of September 2024 with a target delivery date of December 29, 2024, for submission to Congress, according to agency officials. GAO will continue to monitor and report on DOT's actions in response to this recommendation.

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Air transportationAircraftAirline regulationAirlinesAirportsAviationDisease detection or diagnosisDiseasesEmergency preparednessInfectious diseasesEpidemicsInternational travelPassengersPublic healthQuarantineTravelPublic health emergencies