ICAO and Public Health Emergencies Meetings Seminars...addresses public health emergencies of...

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7/4/2012 1 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 CAPSCAFrankfurt July 2012

Transcript of ICAO and Public Health Emergencies Meetings Seminars...addresses public health emergencies of...

Page 1: ICAO and Public Health Emergencies Meetings Seminars...addresses public health emergencies of international concern and which is integrated with the general national preparedness plan;

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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

CAPSCA‐Frankfurt July 2012

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Plan

• Background to ICAO

• Aviation–related health issues

• Multi‐sector preparedness

• Way forward – high level

• Way forward – technical level

CAPSCA‐Frankfurt July 2012

ICAO – UN specialized agency created in 1944. Strategic Objectives: 

• Safety • Security • Environmental protection

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Mexico

Lima

Dakar

Paris

Cairo

NairobiBangkok

ICAO HQMontreal

International Civil Aviation Organization  ‐HQ and its seven Regional Offices

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

CAPSCA‐Frankfurt July 2012

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Some aviation health‐related issues

Bennett, JS – NIOSH, 2009

CAPSCA‐Frankfurt July 2012

Some aviation economic‐related issues

Passengers of Hong Kong International Airport, January to August 2003

0

500

1000

1500

2000

2500

3000

3500

Jan Feb Mar Apr May Jun Jul Aug

Month

No.

of

pass

enge

rs (

' 000

)

Courtesy: Dr Henry Kong, past Chief Port Health Officer, Hong Kong

12 March, WHO Atypical pneumonia alert

2 AprilWHO traveladvisory

23 MayTravel advisory lifted

International arrivals, Mexico, 2008‐2010Courtesy: Dr Jose Valente Aguilar Zinser, Ministry of 

Transport, Mexico

CAPSCA‐Frankfurt July 2012

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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.   

CAPSCA‐Frankfurt July 2012

One answer:

• Multi‐sector preparedness planning– WHO/public health  cannot alone provide necessary resources

– Many sectors involved to varying degrees

– Private industry involvement vital

CAPSCA‐Frankfurt July 2012

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Interlinking guidelines 

WHO global Preparedness

ICAOStandards & Guidelines

for aviation

Airports Council International:

airport guidelines

International Air Transport Association: 

airline guidelines

IHR 2005

Guide to Hygiene and Sanitation in Aviation

Case managementof Influenza A(H1N1) in air transport

www.capsca.org

Multi‐sector involvement:A challenge to achieve

CAPSCA‐Frankfurt July 2012

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Fukushima nuclear accident:ICAO Transport Task Force

Weekly teleconference call

ICAOIAEAWHOIMOWMOUNWTOILO

IATAACI

ICAO – International Civil Aviation OrganizationIAEA – International Atomic Energy AgencyWHO – World Health OrganizationIMO – International Maritime OrganizationWMO – World Meteorological OrganizationUNWTO – UN World Tourism OrganizationILO – International Labour Organization

IATA – International Air Transport AssociationACI – Airports Council International

Output ‐ Three News releases during the initial weeks

CAPSCA‐Frankfurt July 2012

Way forward – high level

• High level management buy‐in

– Role of UN

• Resources allocated to multi‐sector collaboration

• Combined agendas

• Public and private involvement

CAPSCA‐Frankfurt July 2012

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Way forward – technical level: CAPSCA(Cooperative Arrangement for the Prevention of Spread of Communicable Disease through Air Travel)

CAPSCA‐Frankfurt July 2012

CAPSCA‐Frankfurt July 2012

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CAPSCA programme implementation

• Meetings– Annual regionalmeeting e.g. this meeting in Frankfurt

• Update in preparedness planning in the aviation sector 

• Multi‐sector communication/networking platform

– Annual globalmeeting, 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 

CAPSCA‐Frankfurt July 2012

CAPSCA‐Frankfurt July 2012

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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)

CAPSCA‐Frankfurt July 2012

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Asia‐Pacific Africa Americas Europe Middle East

Year of Establishment

2006 2007 2009 Sept. 2011 Dec. 2011

No. MemberStates

17 17 30 6 7

State  Technical Advisors Trained by ICAO (OJT completed)

1 4 12 0 2

State & Airport AssistanceVisits Completed

9 5 22 0 2

CAPSCA‐Frankfurt July 2012

CAPSCA‐Frankfurt July 2012

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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

CAPSCA‐Frankfurt July 2012

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ICAO and Public Health Emergencies

Dr. Anthony [email protected]

Chief, Aviation Medicine SectionInternational Civil Aviation Organization

Frankfurt, Germany, July 2012

Fukushima Daiichi Nuclear Power Plant11 March 2011

CAPSCA‐Frankfurt July 2012

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….

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ICAO Transport Task Force

Weekly teleconference call

ICAOIAEAWHOIMOWMOUNWTOILO

IATAACI

ICAO – International Civil Aviation OrganizationIAEA – International Atomic Energy AgencyWHO – World Health OrganizationIMO – International Maritime OrganizationWMO – World Meteorological OrganizationUNWTO – UN World Tourism OrganizationILO – International Labour Organization

IATA – International Air Transport AssociationACI – Airports Council International

Output ‐ Three News releases during the initial weeks

CAPSCA‐Frankfurt July 2012

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

CAPSCA‐Frankfurt July 2012

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ICAO HQ – Montreal, Canada

18 Annexes to the Convention ‐‘Standards and Recommended Practices’  SARPs

•Governments 

Regulatory Aviation Authorities

e.g. 

•Federal Aviation

Administration (US)

•Transport Canada

•UK CAA

96 Articles

‘Chicago’ Convention (1944) – 191 signatories

CAPSCA‐Frankfurt July 2012

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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….

CAPSCA‐Frankfurt July 2012

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.’

CAPSCA‐Frankfurt July 2012

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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

CAPSCA‐Frankfurt July 2012

ICAO Standards are audited:Results posted on ICAO public website

CAPSCA‐Frankfurt July 2012

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International Passengers to Mexico, 2009‐2011 (25 April WHO announced PHEIC)

CAPSCA‐Frankfurt July 2012

International Arrivals

Passengers of Hong Kong International Airport, January to August 2003

0

500

1000

1500

2000

2500

3000

3500

Jan Feb Mar Apr May Jun Jul Aug

Month

No.

of

pass

enge

rs (

' 000

)

Courtesy: Dr Henry Kong, past Chief Port Health Officer, Hong Kong

12 March, WHO Atypical pneumonia alert

2 AprilWHO traveladvisory

23 MayTravel advisory lifted

CAPSCA‐Frankfurt July 2012

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Fukushima nuclear powerplantaccident – 11 March 2011

CAPSCA‐Frankfurt July 2012

Fukushima Daiichi Nuclear Power Plant11 March 2011

CAPSCA‐Frankfurt July 2012

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….

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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

CAPSCA‐Frankfurt July 2012

PHA

AIRPORTOPERATOR OTHER 

AGENCY

NOTIFICATION OF EVENT TO DESTINATION AIRPORT

Air traffic controller

AIRLINE OPERATING AGENCY

Destination aerodrome tower

A/C IDDep.Dest.ETAPOBNo. casesNature of risk

Aircraft gen. declaration –Health Part (WHO & ICAO docs)

CAPSCA‐Frankfurt July 2012

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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

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ICAO Assembly ResolutionsSeptember/October 2010

CAPSCA‐Frankfurt July 2012

And nowCAPSCA!

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.

CAPSCA‐Frankfurt July 2012

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To ensure States implement the ICAO SARPs ICAO auditscivil 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

CAPSCA‐Frankfurt July 2012

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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

CAPSCA‐Frankfurt July 2012

ICAO and Public Health Emergencies

Dr. Anthony EvansChief, Aviation Medicine Section

International Civil Aviation Organization

Cairo, December 2011

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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‐Frankfurt July 2012

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;

CAPSCA‐Frankfurt July 2012

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Other ongoing work with WHO/other stakeholders

• Aircraft disinsection

• Aircraft disinfection

CAPSCA‐Frankfurt July 2012

International Civil Aviation Organization

ICAO SARPs

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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

CAPSCA‐Frankfurt July 2012

ICAO Standards and recommended Practices

CAPSCA‐Frankfurt July 2012

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Other potential crises

CAPSCA‐Frankfurt July 2012

International Civil Aviation Organization

Questionnaire on preparedness

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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: 30th

June 2011 (extended from October)

CAPSCA‐Frankfurt July 2012

State letter

CAPSCA‐Frankfurt July 2012

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Funding

• UN Central Fund for Influenza Action

– Primary funding

• States (countries)

CAPSCA‐Frankfurt July 2012

Audit protocol questions

CAPSCA‐Frankfurt July 2012

CMA SAAQ

SAAQ

REF.

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

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?

Yes No

If yes, provide name and contact

details

New question

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Audit protocol questions

CAPSCA‐Frankfurt July 2012

A9 8.15PANS

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) destinationaerodrome;d) estimated time ofarrival;e) number of persons onboard;f) number of suspectedcase(s) on board; andg) nature of the publichealth risk, if known.

□ Satisfactory□ Not satisfactory

6

Audit protocol questions

CAPSCA‐Frankfurt July 2012

ICAO ref. Protocol question Reply Guidance for review of protocol question

Status of implementation Evidence/Notes/CommentsCE

A9 8.15 Note 1

A9 2.10 & App1

A6 6.2 and AttB

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?

□ Yes□ No

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

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CAPSCA‐Frankfurt July 2012

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

CAPSCA‐Frankfurt July 2012

www.CAPSCA.org

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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

CAPSCA‐Frankfurt July 2012

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?” 

CAPSCA‐Frankfurt July 2012

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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?”

CAPSCA‐Frankfurt July 2012

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?” 

CAPSCA‐Frankfurt July 2012