International Civil Aviation Organization ICAO and Public Health Emergencies Dr. Anthony Evans Chief, Aviation Medicine Section ICAO, Montreal Frankfurt, July 2012 Acknowledgement Mr Michiel Vreedenburgh ICAO Deputy Regional Director (Mexico Office) & CAPSCA project coordinator Provided some images for this presentation 1
Plan Background to ICAO Aviation related health issues Multi sector preparedness Way forward high level Way forward technical level ICAO UN specialized agency created in 1944. Strategic Objectives: Safety Security Environmental protection 2
International Civil Aviation Organization HQ and its seven Regional Offices ICAO HQ Montreal Paris Mexico Lima Dakar Cairo Nairobi Bangkok Why worry about aviation? Medical health Spread of disease by travellers Other issues: Transport of samples e.g. biological/radioactive Transport of vectors Transport of personnel to/from affected areas Risk to individuals on aircraft Economic health Airlines Supporting businesses Governments 3
Some aviation health related issues Bennett, JS NIOSH, 2009 Some aviation economic related issues 3500 Passengers of Hong Kong International Airport, January to August 2003 International arrivals, Mexico, 2008 2010 Courtesy: Dr Jose Valente Aguilar Zinser, Ministry of Transport, Mexico No. of passengers (' 000) 3000 2500 2000 1500 1000 500 0 12 March, WHO Atypical pneumonia alert 2 April 23 May WHO travel Travel advisory lifted advisory Ja n Fe b Ma r Ap r Ma y Ju n Ju l Au g Month Courtesy: Dr Henry Kong, past Chief Port Health Officer, Hong Kong 4
Challenges Aviation is: Focused primarily on prevention of accidents Personnel not generally knowledgeable about public health Public health is: Focused primarily on non transport related health issues Personnel not generally knowledgeable about aviation And so.. Preparedness planning in aviation can fall between two stools. One answer: Multi sector preparedness planning WHO/public health cannot alone provide necessary resources Many sectors involved to varying degrees Private industry involvement vital 5
Interlinking guidelines Guide to Hygiene and Sanitation in Aviation Case management of Influenza A(H1N1) in air transport WHO global Preparedness ICAO Standards & Guidelines for aviation IHR 2005 Airports Council International: airport guidelines www.capsca.org International Air Transport Association: airline guidelines Multi sector involvement: A challenge to achieve 6
Fukushima nuclear accident: ICAO Transport Task Force Weekly teleconference call ICAO IAEA WHO IMO WMO UNWTO ILO ICAO International Civil Aviation Organization IAEA International Atomic Energy Agency WHO World Health Organization IMO International Maritime Organization WMO World Meteorological Organization UNWTO UN World Tourism Organization ILO International Labour Organization IATA International Air Transport Association ACI Airports Council International IATA ACI Output Three News releases during the initial weeks Way forward high level High level management buy in Role of UN Resources allocated to multi sector collaboration Combined agendas Public and private involvement 7
Way forward technical level: CAPSCA (Cooperative Arrangement for the Prevention of Spread of Communicable Disease through Air Travel) 8
CAPSCA programme implementation Meetings Annual regional meeting e.g. this meeting in Frankfurt Update in preparedness planning in the aviation sector Multi sector communication/networking platform Annual global meeting, regional meeting is designated global On rotation: 2010, Asia Pacific; 2011, Africa; 2012, Americas; 2013, Middle East; 2014, Europe Assistance Visits To individual States/airports Assist with implementation of ICAO health related Standards and Recommended Practices (SARPs) WHO International Health Regulations 9
CAPSCA Resources Donors UN Central Fund for Influenza Action ($1.3 m for all five projects Asia Pacific; Africa; Americas; Europe; Middle East) CAA Singapore (Dr Jarnail Singh, technical advisor) Partners: Principal International Organization partner WHO Member States Technical Advisors Meeting Hosts (ICAO Regional Offices and States) 10
11
12
Asia Pacific Africa Americas Europe Middle East Year of Establishment No. Member States State Technical Advisors Trained by ICAO (OJT completed) State & Airport Assistance Visits Completed 2006 2007 2009 Sept. 2011 Dec. 2011 17 17 30 6 7 1 4 12 0 2 9 5 22 0 2 13
Aims of this meeting Update on preparedness planning in aviation Networking multi sector, public and private Select a CAPSCA Europe chair (normally three year term) Encourage more States to join CAPSCA No cost Identify States/Airports for Assistant Visits Intention, no cost: may not be possible (CFIA grant ends December 2012, & funds are low) Identify CAPSCA Europe Technical Advisors (TAs) Commence TA training (presentation from Frankfurt Airport and walkthrough/debrief) Identify host for 2013 CAPSCA Europe meeting 14
ICAO and Public Health Emergencies Dr. Anthony Evans aevans@icao.int Chief, Aviation Medicine Section International Civil Aviation Organization Frankfurt, Germany, July 2012 Fukushima Daiichi Nuclear Power Plant 11 March 2011 What if: An aircraft flies through the plume? An aircraft is parked overnight downwind? An exposed individual wants to fly for treatment? Screening: Should Japan be screening departures? Cargo? People? Should other countries be screening for arrivals? Cargo? People? What levels are acceptable? What equipment/training/ppe is needed? Etc. 15
ICAO Transport Task Force Weekly teleconference call ICAO IAEA WHO IMO WMO UNWTO ILO ICAO International Civil Aviation Organization IAEA International Atomic Energy Agency WHO World Health Organization IMO International Maritime Organization WMO World Meteorological Organization UNWTO UN World Tourism Organization ILO International Labour Organization IATA International Air Transport Association ACI Airports Council International IATA ACI Output Three News releases during the initial weeks Plan ICAO International Civil Aviation Organization Convention on International Civil Aviation ( Chicago Convention ) and its Annexes Standards and Recommended Practices ICAO Guidelines on Public Health Emergencies ICAO Assembly Resolutions ICAO Audits UN crisis management 16
ICAO HQ Montreal, Canada Chicago Convention (1944) 191 signatories 96 Articles 18 Annexes to the Convention Standards and Recommended Practices SARPs Governments Regulatory Aviation Authorities e.g. Federal Aviation Administration (US) Transport Canada UK CAA 17
Basis for Action health Article 14, Convention on International Civil Aviation: Each contracting State agrees 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. Basis for Action health Article 14, International Convention on Civil Aviation:.and to that end contracting States will keep in close consultation with the agencies concerned with international regulations relating to sanitary measures applicable to aircraft. 18
18 ICAO Annexes to the Convention contain SARPs Annex 1 Personnel Licensing Annex 2 Rules of the Air Annex 3 Meteorological Service for International Air Navigation Annex 4 Aeronautical Charts Annex 5 Units of Measurement to be Used in Air and Ground Operations Annex 6 Operation of Aircraft Annex 7 Aircraft Nationality and Registration Marks Annex 8 Airworthiness of Aircraft Annex 9 Facilitation Annex 10 Aeronautical Telecommunications Annex 11 Air Traffic Services Procedures for Air Navigation Services Air Traffic Management (PANS ATM) Annex 12 Search and Rescue Annex 13 Aircraft Accident and Incident Investigation Annex 14 Aerodromes Annex 15 Aeronautical Information Services Annex 16 Environmental Protection Annex 17 Security: Safeguarding International Civil Aviation Against Acts of Unlawful Interference Annex 18 The Safe Transport of Dangerous Goods by Air ICAO Standards are audited: Results posted on ICAO public website 19
International Passengers to Mexico, 2009 2011 (25 April WHO announced PHEIC) International Arrivals 3500 Passengers of Hong Kong International Airport, January to August 2003 3000 No. of passengers (' 000) 2500 2000 1500 1000 500 0 12 March, WHO Atypical pneumonia alert 2 April WHO travel advisory Ja n Fe b Ma r Ap r Ma y Ju n Ju l Au g Month 23 May Travel advisory lifted Courtesy: Dr Henry Kong, past Chief Port Health Officer, Hong Kong 20
Fukushima nuclear powerplant accident 11 March 2011 Fukushima Daiichi Nuclear Power Plant 11 March 2011 What if: An aircraft flies through the plume? An aircraft is parked overnight downwind? An exposed individual wants to fly for treatment? Screening: Should Japan be screening departures? Cargo? People? Should other countries be screening for arrivals? Cargo? People? What levels are acceptable? What equipment/training/ppe is needed? Etc. 21
How does it work in practice? An example determination of a case of communicable disease on board an aircraft in flight notification to the public health authority at destination further communication with the aircraft how to manage the aircraft s arrival at destination NOTIFICATION OF EVENT TO DESTINATION AIRPORT Aircraft gen. declaration Health Part (WHO & ICAO docs) A/C ID Dep. Dest. ETA POB No. cases Nature of risk AIRLINE OPERATING AGENCY PHA AIRPORT OPERATOR OTHER AGENCY Air traffic controller Destination aerodrome tower 22
GUIDELINES assist with interpretation of ICAO SARPs and the IHR (2005) To help States develop and implement national preparedness plans we have CAPSCA Cooperative Arrangement for the Prevention of Spread of Communicable Disease through Air Travel 23
ICAO Assembly Resolutions September/October 2010 And now CAPSCA! CAPSCA WP Resolution The Assembly: 1. Urges Contracting States and Regional Safety Oversight Organizations to ensure that the public health sector and the aviation sector collaborate to develop a national preparedness plan for aviation which addresses public health emergencies of international concern and which is integrated with the general national preparedness plan; 2. Urges Contracting States to develop a national preparedness plan for aviation that is in compliance with the World Health Organization International Health Regulations (2005) and which are based on scientific principles and on the guidelines from ICAO and the World Health Organization; 3. Urges Contracting States, and Regional Safety Oversight Organizations as appropriate, to establish requirements for the involvement of stakeholders such as airport operators, aircraft operators and air navigation service providers in the development of a national preparedness plan for aviation; and, 4. Urges Contracting States to join and participate in the Cooperative Arrangement for the Prevention of Spread of Communicable Disease through Air Travel (CAPSCA) project, where available, to ensure that its goals are achieved, unless equivalent measures are already in place. 24
To ensure States implement the ICAO SARPs ICAO audits civil aviation regulatory authorities UN Humanitarian Response to crises The Cluster System Camp Coordination Early Recovery Education Emergency Telecommunications Food Security Health Logistics transport cell proposed Nutrition Protection Water and Sanitation 25
Summary ICAO and Convention on International Civil Aviation ( Chicago Convention ) and its Annexes Standards and Recommended Practices within the Annexes Guidelines on Public Health Emergencies CAPSCA implementing project ICAO Assembly Resolution ICAO Audits UN crisis management ICAO ICAO and Public Health Emergencies Dr. Anthony Evans Chief, Aviation Medicine Section International Civil Aviation Organization Cairo, December 2011 26
CAPSCA: A37 WP/58 Technical Commission Agenda Item 42: (Cooperative Arrangement for the Prevention of Spread of Communicable Disease through Air Travel (CAPSCA)) WP/58 Title: Improved management of communicable disease in the aviation sector through multi sector collaboration Result: Resolution 42/1: Prevention of spread of communicable disease through air travel CAPSCA Resolution Resolution 42/1: Prevention of spread of communicable disease through air travel Whereas Article 14 of the Convention on International Civil Aviation states that Each contracting State agrees 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, and to that end contracting States will keep in close consultation with the agencies concerned with international regulations relating to sanitary measures applicable to aircraft ; Whereas Article 14(1) of the World Health Organization International Health Regulations (2005) states that WHO shall cooperate and coordinate its activities, as appropriate, with other competent intergovernmental organizations or international bodies in the implementation of these Regulations, including through the conclusion of agreements and other similar arrangements ; Whereas ICAO Resolution A35 12 states that the protection of the health of passengers and crews on international flights is an integral element of safe air travel and that conditions should be in place to ensure its preservation in a timely and cost effective manner ; Whereas Article 44 of the Convention on International Civil Aviation states that The aims and objectives of the Organization are to develop the principles and techniques of international air navigation and to foster the planning and development of international air transport so as to...[m]eet the needs of the peoples of the world for safe, regular, efficient and economical air transport ; Whereas Annex 6 Operation of Aircraft, Annex 9 Facilitation, Annex 11 Air Traffic Services, Annex 14 Aerodromes, Volume I Aerodrome Design and Operations to the Convention on International Civil Aviation and the Procedures for Air Navigation Service Air Traffic Management (Doc 4444) contain several Standards and Recommended Practices and Procedures relating to health measures that should be taken by Contracting States to manage public health emergencies of international concern and to prevent the spread of communicable disease by air travel; Whereas the ICAO Cooperative Arrangement for the Prevention of Spread of Communicable Disease through Air Travel (CAPSCA) project is an appropriate measure to improve and harmonize preparedness plans; 27
Other ongoing work with WHO/other stakeholders Aircraft disinsection Aircraft disinfection International Civil Aviation Organization ICAO SARPs 28
Relevant ICAO SARPs/Guidelines see Health Related Documents on CASPCA website Annex 6 Operation of Aircraft Annex 9 Facilitation Annex 11 Air Traffic Services Procedures for Air Navigation Services Air Traffic Management (PANS ATM) Annex 14 Aerodromes ICAO Guidelines for States ICAO Standards and recommended Practices 29
Other potential crises International Civil Aviation Organization Questionnaire on preparedness 30
Communicable Disease Questionnaire State letter (EC 6/22 10/51, 22 June 2010) National Aviation Plan: Communicable Diseases Responses from Americas = 13 North Am. 5 South Am. 8 Deadline for replies: 30 th June 2011 (extended from October) State letter 31
Funding UN Central Fund for Influenza Action Primary funding States (countries) Audit protocol questions CMA SAAQ RE F. S A A Q SAAQ QUESTION INFORMATION PROVIDED BY STATE COMMENTS ORG Has the State identified a clear contact point at national aviation level, with identified individual(s), for policy formulation, operational Yes No If yes, provide name and contact details New question organization of preparedness and coordination of a national plan in order to respond to a communicable disease with the potential to pose a serious public health risk? 32
Audit protocol questions A9 8.15 PANS ATM Doc 4444 16.6.1 Does the aircraft operations organization ensure that the air operator has established procedures for the pilot in command to report promptly to ATC a suspected communicable disease? Yes No Review operations inspectors procedures to ensure they check air operators related procedures Sample an air operator procedure in operations manual Ensure, in the procedure, that the following information is transmitted by the crew: 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. Satisfactory Not satisfactory 6 Audit protocol questions ICAO ref. Protocol question Reply Guidance for review of protocol question Status of implementation Evidence/Notes/Comments CE A9 8.15 Note 1 A9 2.10 & App1 A6 6.2 and AttB Does the aircraft operations Yes organization ensure that the No air operator has established a procedure for the crew to evaluate a traveller with a suspected communicable disease, based on the presence of a fever and certain other signs or symptoms? Review operations inspectors procedures to ensure they check air operators related procedures Sample an air operator procedure in operations manual or cabin crew manual Check the procedure includes the transmission, as required, of a General Declaration form to the State authorities. Satisfactory Not satisfactory 6 33
Does the aircraft operations organization ensure that the air operator has established a procedure for the crew to evaluate a traveller with a suspected communicable disease, based on the presence of a fever and certain other signs or symptoms? ICAO Standards and Recommended Practices + Guidelines for States www.capsca.org 34
Audit Protocols Questions on preparedness planning will be included in ICAO Universal Safety Oversight Audit Programme questions: Protocol questions Undergoing testing in selected States To be introduced from 2013 Audit Example 1 Has the State identified a clear contact point at national aviation level, with identified individual(s), for policy formulation, operational organization of preparedness and coordination of a national plan in order to respond to a communicable disease with the potential to pose a serious public health risk? 35
Audit Example 2 Does the aircraft operations organization ensure that the air operator has established a procedure for the crew to evaluate a traveller with a suspected communicable disease, based on the presence of a fever and certain other signs or symptoms? Audit Example 3 Does the aircraft operations organization ensure that the air operator has established procedures for the pilot in command to report promptly to ATC a suspected communicable disease? 36