Memorandum by the International Civil
Aviation Organization (ICAO)
Question 1: A recent
report on Communicable Diseases by the UK Department of Health
stated that "post-war optimism that their conquest was near
has proved dramatically unfounded". What is your assessment
of the overall position? More specifically, is it simply that
not enough progress is being made in reducing the spread of such
diseases? Or is the global situation actually deteriorating? Would
it be an exaggeration to talk of a crisis?
N/A
Question 2: What reliable data exist regarding
the numbers of people infected globally with the four diseases[26]
on which the Committee is focusing particular attention? What
trends are discernible in both the numbers infected and the patterns
of infection? And what are the main underlying causes of infection
and of any changes in its incidence and pattern?
2.1 In 2005, the world's airlines exceeded
the figure of two billion passengers carried on scheduled air
services. Given predicted levels of growth, this figure is likely
to more than double, to 4.5 billion passengers, by 2025.
2.2 It is not known how many airline travellers
are suffering from the four communicable diseases of interest
at the time of their air travel.
2.3 Although experience has shown that the
on-board diagnosis of a traveller who is suffering from a communicable
disease is uncommon in comparison to other on board medical events,
reliable statistics are unavailable as there is currently no system
in place for collecting and analysing data from different airlines.
2.4 To avoid delay, travellers may choose
to withhold information concerning a communicable disease.
2.5 Influenza and TB are of particular significance
to the aviation sector because they can potentially be transmitted
from one person to another during casual contact during (and after)
air travel. Malaria is also of interest mainly because of the
need to disinsect the aircraft cabin when required by the government
at destination. The need to use chemicals for disinsection purposes
has been challenged recently.
Question 3: What intergovernmental surveillance
systems exist to give early warning of outbreaks of infectious
diseases? Are these systems adequate? And what improvements might
be made?
N/A
Question 4: Given the continuance of current
or planned intergovernmental programmes to prevent or control
the four diseases, what predictions can be made of their likely
spread and pattern over the next 10 years?
N/A
Question 5: What do you consider to be the
principal blockages to achieving progress in the prevention or
control of the four diseases? And how might these blockages be
removed by more, or better-targeted or better-coordinated intergovernmental
action?
5.1 Mass screening of travellers for disease
eg by temperature measurement or questionnaire at points of departure
and entry is probably not very effective at detecting disease
in travellers. However, it is not known to what extent such screening
might have on deterring from travel potential travellers who are
aware they have a communicable disease.
5.2 Although the diagnosis of a communicable
disease in travellers is not their main role, airline operators
have a part to play in detecting travellers who are obviously
unwell and who may put other travellers at risk. They should collaborate
with airport and public health authorities to develop a plan to
deal with a case of suspected communicable disease should one
be identified. The International Civil Aviation Organization (ICAO),
the International Air Transport Association (IATA) and Airports
Council International (ACI) provide guidance on this topic, and
others relating to the spread of communicable disease on their
websites.
5.3 ICAO has collaborated with the WHO,
IATA, ACI, the United States Centers for Disease Control and Prevention,
the European Civil Aviation Conference (ECAC) and some other government
agencies to provide guidelines concerning the spread of communicable
disease by air that are specific to the aviation sector and which
are in line with the International Health Regulations (2005).
(see http://www.icao.int/icao/en/med/guidelines.htm)
5.4 ICAO also requires governments, as part
of their compliance with the Convention on International Civil
Aviation, to put in place a preparedness plan to manage, in the
aviation sector, the risk from a public health emergency of international
concern. This should be integrated with the general national preparedness
plan.
5.5 The response of the aviation sector
to the ICAO guidelines is patchy. In some countries, particularly
in Asia where impact of the Severe Acute Respiratory Syndrome
was most acute, preparedness is very good. In some developed countries
outside Asia preparedness is also relatively well developed. In
many other countries, especially those with few financial resources,
preparedness planning is less well developed.
5.6 An important step forward, at least
in the aviation sector, is improved integration of all involved
stakeholders at a national, regional and global level.
Question 6: What role does your organisation
play in combating the four diseases? Do you believe that it is
correctly configured and adequately resourced to do the job? With
which other organisations do you collaborate? How would you assess
the degree of synergy?
6.1 Article 14 of the Convention on International
Civil Aviation obliges each Contracting State (government) to
the convention to take effective measures to prevent the spread
by means of air navigation of communicable diseases.
6.2 The ICAO Assembly has resolved 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".
6.3 As the focal point for aviation standard
setting, ICAO is well placed to coordinate and collaborate with
of health- and aviation-related organisations. It has a good and
developing working relationship with WHO, and the IHR(2005) has
many aspects related to points of entry and conveyance operators.
ICAO also works closely with stakeholders in the aviation sector,
particularly the trade associations of the International Air Transport
Association and Airports Council International, that provide technical
knowledge relating to aircraft and airport operations.
6.4 ICAO has only one staff member (a doctor)
that has this topic as a major component of his work programme.
His time is divided between safety related aspects of aviation
eg medical standards for aircrew and air traffic controllers,
and health related aspects, such as the management of diseases
spread by air travel. There are significant resource constraints,
related to both time and finance, that can be allocated to aviation
health related topics.
6.5 The degree of synergy between the stakeholders
mentioned above is important, has been effective and continues
to develop in the aviation sector.
Question 7: What are the main non-health causes
(eg global warming, poverty, changes in land use, international
travel, lifestyle, population) of the spread of the four diseases?
To what extent can intergovernmental action in non-health fields
contribute to alleviation of their spread? What action is taking
place or planned in these areas? And what more needs to be done?
Do you consider that there is sufficient "joined-up"
thinking in approaching the problem?
7.1 Horizontal communication, between the
disparate and numerous stakeholders is essential, yet is not always
easy for organizations used to communicating vertically. Resources
to allocate to a "new" topic are scarce.
7.2 ICAO has found that, with respect to
the aviation sector, national public health authorities may regard
aviation as a relatively low priority when compared to their more
pressing responsibilities involving population health care. On
the other hand, aviation authorities do not see health as a pressing
responsibility for themselves. The subject can therefore fall
between two stools.
7.3 Public health authorities could involve
the aviation sector to a greater extent in developing their plans
for dealing with communicable disease, and vice versa.
Question 8: Cases of Tuberculosis fell progressively
in the UK until the mid-1980s but started to rise again in the
early 1990s. Around 6,500 cases are now reported each year, an
increase of about a quarter since the early 1990s. What are the
main factors of the revival of Tuberculosis infections in Britain?
And how could intergovernmental action help to reverse the trend?
N/A
Question 9: Tuberculosis is potentially curable
by long-term antimicrobial therapies. Yet the numbers of reported
cases worldwide seem to be rising. Are the necessary medicines
not getting through to patients? What are the barriers to effective
long-term therapy? Are we now seeing infections which stem from
other conditions—eg HIV/AIDS? Or are there other reasons
why a treatable disease should be spreading? How might intergovernmental
action help to deal with this situation?
N/A
Question 10: To what extent do you believe
that the 2004 Stockholm Convention limiting the use of DDT against
Malaria-carrying mosquitoes has been a factor of increases in
the spread of the disease? Has any risk analysis been carried
out comparing the relative dangers to human health posed by DDT
and Malaria?
N/A
Question 11: What intergovernmental action
is planned or in hand for early detection of the transmission
of Avian Flu from birds to humans and of human-to-human transmission
in potential source countries? Is this proving sufficiently effective
to prevent an Influenza pandemic? What more could be done?
N/A
Question 12: To what extent do you consider
that the rise in infections in the four diseases is attributable
to increased microbial resistance to antibiotics? What intergovernmental
action is taking place in this area?
N/A
Question 13: In a number of countries, including
the UK, there is a problem with hospital-acquired infections.
What intergovernmental sharing of knowledge is taking place to
help bring this problem under control?
N/A
Question 14: Are there any difficulties with
regard to patents or intellectual property which are impeding
the flow of medicines or other control methods to those infected?
Is intergovernmental action needed to improve the situation?
N/A
Question 15: What interchange exists between
States in regard to knowledge of and training in the diagnosis
and treatment of the four diseases or regarding preparations for
dealing with outbreaks? What improvements might be made through
intergovernmental action?
N/A
Question 16: The International Health Regulations
2005 are intended to provide a global framework for the rapid
identification and containment of public health emergencies. How
effective do you consider this response system to be? Do improvements
need to be made?
16.1 The International Health Regulations
(IHR) (2005) contains many references to requirements at ports
of entry, including airports, and to conveyance operators, including
aircraft. They came into force in June 2007, so it is not yet
possible to evaluate their impact. However, they have generated
interest from public health bodies with respect to the aviation
sector and ICAO's initial impression is that they will have a
highly beneficial effect on preparedness planning in the sector.
16.2 For 18 months, ICAO has been managing
a project entitled "Cooperative Arrangement for Preventing
the Spread of Communicable Disease by Air" (CAPSCA) in Asia,
and this has recently been extended into Africa. Eventually, CAPSCA
is planned to become a global initiative. It trains personnel
and evaluates airports against the ICAO preparedness guidelines
for a public health emergency. The IHR includes an element that
requires airport assessment, to check compliance against the IHR
for designated airports for States that request it. It is therefore
possible that ICAO and WHO will cooperate in the area of airport
evaluation in the future.
16.3 CAPSCA is currently funded by interested
States and grant aid by the United Nations Central Fund for Influenza
Action (CFIA). ICAO has encountered some reluctance from States
to participate in, and fund, the CAPSCA project and so the CFIA
grant has been very useful. A joint approach from WHO and ICAO
is considered important to engage the local public health and
the aviation authorities in preparedness planning.
16.4 There is currently a lack of available
expertise to undertake training of local airport and airline staff,
and to undertake airport evaluations. As the importance of such
work becomes more apparent, and if funds are made available, this
will hopefully become less of a problem.
Question 17: What intergovernmental planning
has been undertaken to cope with the impact of an outbreak of
infectious disease caused by deliberate release of micro-organisms
into the environment? Is there adequate liaison between the various
agencies involved, including intelligence, law enforcement and
health care professionals? How could action by intergovernmental
bodies help further?
17.1 ICAO participated in an international
coordination exercise on bioterrorism in 2006, organized by the
United States Department of State and the Swiss Federal Department
of Foreign Affairs. It is willing to cooperate with international
organizations on this topic in the future.
Question 18: Though our remit is focused specifically
on known infectious diseases, we would be interested to know how
you view the global threat from new or previously unrecognised
ones and from the transmission of infections from animals to humans.
N/A
Question 19: What resources (subscriptions,
staff, training, medicines etc) does the UK Government commit
to intergovernmental bodies to help in the fight against the four
diseases listed?
19.3 Along with 189 other Contracting States,
the UK contributes to the funding of ICAO. A proportion is used
to fund the activities that are relevant to this subject area.
This is primarily the portion of funding for the salary, travel
and subsistence of ICAO's medical officer that is designated for
this purpose.
Question 20: Do you wish to provide any other
relevant information in addition to what you have said in answer
to the above?
21 February 2008
26 HIV/AIDS, Tuberculosis, Malaria and Avian Influenza. Back
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