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Suggested Citation:"Overview." National Academies of Sciences, Engineering, and Medicine. 2008. Interagency-Aviation Industry Collaboration on Planning for Pandemic Outbreaks. Washington, DC: The National Academies Press. doi: 10.17226/23266.
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Suggested Citation:"Overview." National Academies of Sciences, Engineering, and Medicine. 2008. Interagency-Aviation Industry Collaboration on Planning for Pandemic Outbreaks. Washington, DC: The National Academies Press. doi: 10.17226/23266.
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Suggested Citation:"Overview." National Academies of Sciences, Engineering, and Medicine. 2008. Interagency-Aviation Industry Collaboration on Planning for Pandemic Outbreaks. Washington, DC: The National Academies Press. doi: 10.17226/23266.
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Suggested Citation:"Overview." National Academies of Sciences, Engineering, and Medicine. 2008. Interagency-Aviation Industry Collaboration on Planning for Pandemic Outbreaks. Washington, DC: The National Academies Press. doi: 10.17226/23266.
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3Overview Over the course of the 3 days in September 2007when this workshop took place, representativesfrom more than nine federal agencies, the airline and airport community, and several related associations representing numerous aviation interests provided their thoughts on pandemic planning in the United States as it relates to the aviation industry. At the beginning of the workshop, the chair of the workshop planning commit- tee, Katherine Andrus of the Air Transport Association, provided background information to establish a com- mon base for the discussion to take place during the workshop. Ms. Andrus explained that aviation and public health draw a lot of media attention. Whether the risk is real or perceived, air travel has a role in spreading disease. Con- sequently, the industry is being asked to prepare for a possible event involving an as- yet- unknown disease that will come at some indefinite point in the future. The task is daunting, but there is a coordinated governmentwide effort, both domestically and internationally, to prepare an effective plan. The U.S. government has issued a national strategic plan and a related implementation plan that includes three overarching goals: (a) stopping, slowing, or other- wise limiting the spread of a pandemic event to the United States; (b) limiting the spread of a pandemic event domestically; and (c) sustaining infrastructure and miti- gating impacts to the economy. The aviation industry has a role to play in all three goals; however, sometimes these goals are in conflict, and what is needed to limit the spread of disease may affect the economic well- being of the aviation industry. This workshop was structured to address these conflicting issues and concerns in the con- text of those parts of the plan that deal directly or indi- rectly with the aviation sector. After this background discussion, officials from the various agencies and the airline and airport community briefly summarized their roles and responsibilities and current pandemic planning activities. These summaries were followed by detailed session discussions that expanded on their comments. Ken Staley of the White House Homeland Security Council was the first to speak; he explained that, in November 2005, the Homeland Security Council created a pandemic preparedness strat- egy followed by an implementation plan that was released in May 2006. This strategy represented the first time the federal government has committed the use of all instru- ments of national power against a potential disease. The Council is also working with Canadian and Mex- ican partners on a North American Avian and Pandemic Influenza Plan that will create a perimeter to respond to a pandemic virus originating outside of North America. This perimeter will not be able to stop a pandemic illness from entering North America, but it may delay the arrival by a few days or weeks, allowing time to initiate appropriate measures against its spread. As part of this perimeter strategy, a community mitigation strategies concept is being discussed to focus on nonpharmaceuti- cal interventions after identifying an individual with an infectious disease. This and the other elements of the plan will provide a broad policy framework for manag- ing borders during a pandemic event. Til Jolly of the Department of Homeland Security (DHS) next discussed the three major responsibilities

that organization has related to planning for pandemic events. DHS is responsible for responding to large- scale incidents of national significance, protecting the nation’s infrastructure during a pandemic event, and protecting the country’s borders. Most planning efforts to date have focused on addressing a pandemic event that begins in another part of the world as well as those events that are classified as most severe according to the recently com- pleted community mitigation guidance’s severity index. Andrew Plummer of the Centers for Disease Control and Prevention (CDC) then discussed the role of the Division of Global Migration and Quarantine (DGMQ) and its interface with different aviation groups, including an agencywide pandemic flu scenario in which an after- action report is being used to assess how the various groups responded. In addition to this scenario, the DGMQ is focused on all- hazards planning through the development of table- top exercises at many of the quar- antine stations throughout the country that allow all groups to work together in a coordinated manner. The DGMQ has also focused on improving data collection methods through the Quarantine Activity Reporting Sys- tem, a secure web- based electronic system that enables quarantine stations to track ill passengers on inbound airlines and vessels and at land border crossings as well as infectious disease threats or actions related to imported pathogens. A software application known as E-manifest has also been implemented that will facilitate improved communication of relevant public health infor- mation with participating state health agencies, and the CDC website is available to communicate health infor- mation to travelers and the travel industry. The DGMQ is also planning a research study examining the potential use, effectiveness, and resource requirements of thermal scanning as part of the screening of domestic and inter- national arriving and exiting passengers. Kate Lang and Laura Valero from the FAA explained their role in leading all aviation- related tasks from the National Implementation Plan assigned to the U.S. Department of Transportation. The FAA has focused on internal business continuity planning and operational planning to ensure a viable aviation industry, which is critical to this country. It is examining the implementa- tion and costs of possible solutions for air traffic control contingency plans as well as aviation safety inspector contingency plans to address anticipated employee absenteeism. As with the CDC, the FAA has conducted table- top exercises based on different scenarios and is working with the airport community to identify critical information needs such as staffing levels to maintain safe operating requirements, fuel availability, quarantine sta- tus, availability of on- site health personnel, and the sta- tus of the air carriers. The FAA has also taken the lead in developing an interagency aviation concept of opera- tions to address coordinated responses to inbound air- craft with sick passengers who may have pandemic flu or other contagious diseases and has contributed to other activities including developing the draft aircraft disinfec- tion guidance, draft sector- specific guidelines, and stake- holder meetings. Terry Lowe of US Airways summarized his company’s activities related to pandemic planning. He indicated that an ad hoc group of airline representatives from var- ious companies have been meeting regularly for the past year to address pandemic planning issues. Whereas indi- vidual airlines are developing their own plans and processes, this forum has given the airline community the opportunity to share information and discuss com- mon issues. When US Airways’ Occupational Safety and Health Group took the charge to develop a pandemic response plan, they quickly learned that a lot of infor- mation is available to them but that it is not always easy to determine what is valuable and useful. Through this exercise, they learned they were not prepared for high levels of absenteeism, which led to discussions on per- sonnel needs to maintain a viable airline; they examined the need for essential supplies and have purchased some items; they developed a video on communicable diseases for internal use to address the types of diseases workers might face; and they learned it is difficult to keep a high level of interest in pandemic planning within the organi- zation in the absence of a crisis or other event. Lydia Kellogg of the Airports Council Interna- tional–North America (ACI- NA) concluded the opening remarks by providing an overview of the activities of her organization and its constituents. Preliminary results of a survey conducted by ACI- NA of its membership indicate that a wide range of planning activities are under way at airports throughout the country. Many airports have biological and pandemic response plans based on the National Incident Management System National Response Plan. Some airports have also developed busi- ness continuity plans to address support of critical job functions in the event of a 40% projected staff absen- teeism rate. The survey also revealed that airports are conducting table- top exercises in coordination with fed- eral, state, local, health, and emergency response person- nel to discuss best practices and to ensure business continuity. Many airports have made arrangements to provide employees and other workers with personal pro- tective equipment such as masks, gloves, and gowns; have developed response plans that address deploying sanitization stations and increasing the cleaning and dis- infecting of common areas; and have examined the potential to extend operating hours for stranded traveler services if needed. The detailed discussion sessions following these open- ing remarks gave the attendees an opportunity to explore the issues of pandemic planning under two main themes and seven general topic areas. 4 INTERAGENCY–AVIATION INDUSTRY COLLABORATION ON PLANNING FOR PANDEMIC OUTBREAKS

1. Minimizing the spread of disease via air travel • Risk- based screening at airports – Regulatory and legal authority and responsi- bility for illness- based screening of passengers at airports – Legal implications of denied boarding – Situational changes during a pandemic event – Review of current legislation and regulations in light of a pandemic event – CDC health- related travel notices – Passive and active passenger screening methods – Entry and exit screening – Public notification and outreach – State- level pandemic response planning activities – Difficulties in identifying signs and symptoms of infectious diseases – Level of effort needed for screening and quar- antining infectious passengers – Differences in pandemic and nonpandemic response – Managing and protecting passenger data – Enhanced communication and coordination between industry and agencies • In- flight measures – Existing procedures and protocols for responding to ill passengers in flight – Identifying infectious passengers in flight – Providing airline crews with essential equip- ment and protection devices – Procedures for dealing with in- flight medical situations • Airport response – How airports will remain solvent during a pandemic event – Procedures for coordinating responses at air- ports during a pandemic event – Availability of trained medical personnel and space to address the anticipated number of ill passengers – Potential need to clean and disinfect aircraft and airport facilities during a pandemic event – Determining appropriate responses based on various conditions at various airports 2. Maintaining air service as critical infrastructure during a pandemic event • Economic impacts of a pandemic event on the aviation sector – Impact of severe acute respiratory syndrome – Importance of managing the message – Economic impact on international and domestic air carriers – Economic link between air carriers and airports – Unique impacts of a pandemic event – Difficulty of planning for an event with so much uncertainty – Effects on business, leisure, and recreational travel – Effects of a pandemic event on air cargo services – Air cargo effects from social distancing – Impacts of antitrust laws – Types of measures passengers may require to continue to travel by air during a pandemic event – Flexibility of air carrier and airport personnel in responding to a pandemic event – Maintaining essential employee functions – Roles and responsibilities • Air transportation as critical infrastructure – Distribution of medical and other essential supplies – Lessons learned during Hurricane Katrina – Short- and long- term disruptions to service – North American avian and pandemic influenza plan – Impacts of a pandemic event on rural areas and small communities – State- level responsibilities – What are essential services – Maintaining key aviation infrastructure ver- sus providing essential services – Public travel behavior during a pandemic event – Effects of regional hot spots of the disease – Different approaches to quarantining pas - sengers – Critical partnerships between CDC and local health officials – Needs of the utility aviation sector • Workforce issues in the aviation industry – Workforce absenteeism during a pandemic event – Alternatives in addressing the estimated 40% absenteeism rate – Distribution of essential supplies – Multiregional coordination of supplies dur- ing a pandemic event – Employee relations and union rules in the planning process – Modifying operating standards during a pan- demic event – Importance of open and ongoing communi- cation with employees in all segments of the avi- ation industry – Staffing levels during and after an event • Mitigating economic impacts and preserving air service 5OVERVIEW

– Financial health of the aviation industry – Industry revenue effects – Example of the local economic impact of the aviation industry – Effects of different scenarios on the air industry – Attracting customers after a pandemic event – Funding sources available to airports – Use of aircraft in emergency response – Effects of hot zones in certain parts of the country – Ability of airports and airlines to share infor- mation, coordinate, and cooperate during a pandemic event – Possible scenarios during the recovery phase of a pandemic event – Impact of a pandemic event on general aviation – Long- term viability of the airline industry – Assessing the current financial situation of the various airlines – Plans to return to normal operations The workshop concluded with a brief recap of earlier discussions for invited senior- level officials from the var- ious federal agencies and industry associations with a role in pandemic planning for the aviation industry. These individuals were then given an opportunity to express their thoughts on the workshop and any other information relevant to the discussions. Items men- tioned include the soon- to- be- completed first draft of the federal contingency plan that outlines the response of each federal department during different stages of a pandemic event and that will include the border man- agement plan establishing screening protocols and con- trol of the borders. This plan was developed in coordination with DHS, the Department of State, the Department of Health and Human Services, CDC, and the U.S. Department of Transportation. Other planning activities under way include the national strategy for aviation security, the air transport system recovery plan, and the National Governors Association pandemic workshops in coordination with the Department of Health and Human Services. On the basis of information gathered throughout the workshop and in these summary discussions, a number of potential next steps were noted for future considera- tion. These steps include the following: • Share workshop information with others within an organization or agency. • Continue dialogue among all groups. • Promote and conduct additional research. • Assist with reviewing agency plans and programs. • Conduct additional workshops. • Leverage resources and build on existing relationships. • Use TRB as a catalyst for communication. 6 INTERAGENCY–AVIATION INDUSTRY COLLABORATION ON PLANNING FOR PANDEMIC OUTBREAKS

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TRB's Conference Proceedings 41: Interagency-Aviation Industry Collaboration on Planning for Pandemic Outbreaks summarizes a September 5-7, 2007, workshop that took place in Washington, D.C. Among the issues explored in the proceedings are the current state-of-the-practice for pandemic planning by airports and airlines, coordination among various agencies and the aviation sector to implement these plans, and the potential areas for public-private sector cooperation in pandemic planning.

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