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Suggested Citation:"Welcome and Opening Remarks." 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:"Welcome and Opening Remarks." 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:"Welcome and Opening Remarks." 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:"Welcome and Opening Remarks." 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:"Welcome and Opening Remarks." 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:"Welcome and Opening Remarks." 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:"Welcome and Opening Remarks." 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:"Welcome and Opening Remarks." 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:"Welcome and Opening Remarks." 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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Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

7Welcome and Opening Remarks Katherine Andrus, Air Transport Association Ken Staley, White House Homeland Security Council Til Jolly, Department of Homeland Security Andrew Plummer, Centers for Disease Control and Prevention Kate Lang, Federal Aviation Administration Laura Valero, Federal Aviation Administration Terry Lowe, US Airways Lydia T. Kellogg, Airports Council International–North America At the beginning of the workshop, the chair of theplanning committee officially welcomed the par-ticipants and provided a summary of the devel- opment and purpose of the workshop. Officials from federal agencies, airports, and airlines were then invited to discuss briefly the status of their pandemic planning activities relevant to aviation. Their individual remarks are presented in this section. WELCOME Katherine Andrus It is a pleasure to welcome you to the Interagency–Avia- tion Industry Collaboration on Planning for Pandemic Outbreaks Workshop. The workshop is sponsored by the Airport Cooperative Research Program (ACRP) and TRB. I would like to thank the FAA, in particular Kate Lang, for providing funding for the workshop through ACRP. I have the privilege of serving as chair of the Workshop Oversight Committee. I would like to recog- nize and thank the members of the Committee, Christine Gerencher, and other TRB staff for their outstanding work organizing the workshop. I learned a great deal from Committee members over the past 6 months. I would also like to recognize a few individuals who contributed to planning this workshop but were unable to attend. Jean Watson and Rob Sweet, FAA; Joan Har- ris, U.S. Department of Transportation; and Christie Reed, Centers for Disease Control and Prevention, all helped plan the workshop. I am an attorney with the Air Transport Association. For those of who do not know, we are a trade associa- tion representing the major commercial airlines—pas- senger and cargo. We have a broad and diverse group of participants for the workshop. It is encouraging to see the different agen- cies, organizations, and specialty areas of expertise rep- resented. That was by design. The Planning Committee attempted to include all the agencies and groups involved in planning for pandemic events. As is always the case, a few invited participants were not able to attend because of scheduling conflicts. Let me begin the workshop by providing some back- ground information to establish a common base for dis- cussion over the next 3 days. The intersection of aviation and public health has been in the news lately. The case of an individual with extreme drug-resistant tuberculosis flying on a commercial airline drew a lot of publicity. The incident pointed out some of the gaps in the current system of dealing with individuals with communicable diseases on aircraft. Most of the media attention focused on the flights that he took, the other passengers, and the flight attendants who might have been exposed, rather than the people who might have been exposed to him at

work or other locations. I think that tells us something both about the real risks and about the perceived risks. For whatever reason, people focus on airplanes and on aviation. The World Health Organization recently released its annual report, which addresses many threats to public health including security, infrastructure, military con- flicts, and mutation of viruses. The media, however, focused on the role air travel may play in spreading infec- tious diseases. There was a headline a few weeks ago— “Air Travel Spreads Disease Faster Than Ever.” Again, that tells you something about the actual risk but also about the perceived risk and the fact that, like it or not, aviation becomes a focal point when we are talking about the spread of any disease. This is not a new phenomenon. We spent a lot of time in the 1990s dealing with the threat of tuberculosis spreading on aircraft. There were a number of extensive studies examining the risk of transmission on aircraft, which led to the development of guidance that has been used in recent planning efforts. A number of factors con- tributed to the focus on air travel: the speed of air travel, the fact that people can go around the world in a rela- tively short time and take their disease and pathogens with them, and the fact that you are in relatively close quarters on an airplane. There is also a sort of an intan- gible fascination that people have with air travel. More recently, severe acute respiratory syndrome (SARS) brought attention to the role air travel could and did play in taking a disease that was fairly isolated geo- graphically and transporting it halfway around the world. Toronto was not an obvious place for an out- break absent air travel. We learned a lot from both situ- ations. For the past 2 years, the focus has been on pandemic influenza. This situation is different from what we have dealt with in the past. We are being asked to prepare proactively for something that we think is coming, but we do not know for sure when. We are not just reacting to an event or a series of events, we actually have an opportunity at this point to plan ahead. Another differ- ence is that we are seeing a governmentwide effort and an international effort. The response is much more coor- dinated than anything that I am aware of in the past. That is very promising, although it brings with it its own challenges. Anytime you are trying to work between agencies and between governments, it is a little bit more difficult. The other thing that is different about the current planning activities is that we have some clearly stated goals. The U.S. government has come out with a national plan, a strategy, and an implementation plan for that strategy. The plan includes three overarching goals. The first goal is stopping, slowing, or otherwise limiting the spread of a pandemic event to this country. The second goal is limiting the domestic spread of a pandemic event. The third goal is sustaining infrastructure and mitigating impacts to the economy. Aviation is right in the middle of the first and third goals and also has a role in the second goal. The aviation sector has a dual role. Airplanes carry people who may spread a disease. Airports and air carri- ers are also part of the critical infrastructure and a key element of the economy. Sometimes those two roles are in conflict. What is needed to help limit the spread of an infectious disease does not necessarily promote the eco- nomic well-being of the aviation industry. We have structured this workshop to address these conflicting issues and concerns. Topics for discussion today focus on the spread of an infectious disease and aviation’s role in this issue. The discussion tomorrow will focus on the role of aviation as part of our nation’s critical infrastructure and part of the world economy. Those two topics overlap and interrelate in ways that we are not even cognizant of, but hopefully we will find out more about that over the next couple of days. This workshop emerged from recognition of the role the aviation industry plays in planning, preparing, and responding to a pandemic event. There was also some frustration that many of us on the industry side felt in not having good guidance, not really knowing how we should go about planning or preparing, either as compa- nies or as airports, and what would be expected of the aviation sector if a pandemic event occurred. Although a tremendous amount of work has been accomplished over the past 2 years within agencies and interagency groups, stakeholder input has sometimes been missing. There have been good examples of coordinated efforts to get input from industry, airports, airlines, and other players within the aviation sector, but those examples have been isolated. None of us within the aviation industry has full-time pandemic planning staff. So we are not necessarily able to attend every meeting, workshop, or conference or read every article that is published. We rely very much on what we pick up at conferences here and there. It seems there has not been a real, organized method for us to get the information or for the agencies that are involved in planning to obtain stakeholder input. We do not have the resources to participate in working groups for every subissue. We thought this workshop would be a way of beginning dialogue or continuing that dialogue. We are trying to determine what is already occurring, what we can tap into, and where the gaps are. What more do we need to be doing as airlines or airports? We hope the agencies represented at the workshop will share information on current activities and discuss ideas from the air carriers, airports, and other groups participating. We all share a common goal of a plan that makes sense and that can be implemented when needed. Hopefully, 8 INTERAGENCY–AVIATION INDUSTRY COLLABORATION ON PLANNING FOR PANDEMIC OUTBREAKS

we will not need to implement the plan, but one will be available. Let me touch on a few things we do not intend to cover during the workshop. We will not discuss the specifics of avian influenza, pandemic influenza, and var- ious diseases. Resources are available for those interested in learning more about specific diseases. We are not going to be reliving the 1918 flu pandemic. We also do not intend to discuss the whole national plan. We plan to focus on the elements in the national plan that deal directly or indirectly with the aviation sector. In addition, I would like to suggest that the discussion not be limited to the official planning assumptions. We are talking about pandemic events that may take differ- ent forms. As SARS taught us, we may not know where the next outbreak will come from. It may be a novel virus; it may not be a virus at all. It may a drug-resistant strain of an old disease. I think it is important that we talk broadly about communicable diseases. Plans should be adaptable to deal with all types of threats. We are talking about a disease with near-universal susceptibility, which may cause 30% of the population to become ill. I think we also have to keep in mind that we may end up facing something that turns out not to be that easily transmissible or to have the same kind of fatality rate that a severe pandemic scenario would have. I remind people that swine flu was originally thought to be the 1918 virus. In 1976, the scientific knowledge that we have now with DNA testing was not available, so many experts at the time believed they were facing the beginning of another pandemic event on the scale of 1918. That turned out to be wrong, but before they real- ized it was wrong they had stood up an incredible, unprecedented government program. Some 40 million people were inoculated in less than 6 months. The fact that it was a false alarm should not cloud our ability to learn some lessons from that experience. We may well find ourselves in the early stages of an outbreak without full knowledge of the transmissibility of the disease, the severity, the death rate, and the attack rate. In those early days, we have to be prepared with a scalable response. We also need the ability to scale down the response if warranted. Many of the things we will be talking about in terms of measures would be imple- mented in the early stages of a pandemic outbreak and would affect aviation. Actions such as entry screening (and potentially quarantining people at an airport) will affect the aviation industry. Those actions would be taken in the early stages when there may be less than per- fect knowledge about a disease. Therefore, I do not think we should be bound by the planning assumptions. We should feel free to explore what might happen if things do not follow the script. We have asked representatives from various agencies and organizations to provide a brief summary of their roles, responsibilities, and current planning activities. I hope you find the discussion over the next 3 days inter- esting and productive. Thank you. STATUS OF PANDEMIC PLANNING ACTIVITIES RELEVANT TO AVIATION White House Homeland Security Council Ken Staley Thank you, Katherine. I appreciate the invitation to par- ticipate in this session. My comments focus on the roles and responsibilities of the Homeland Security Council, accomplishments of the Council and other groups to date, and future activities. The Homeland Security Council at the White House is similar in function to the National Security Council. It serves as the coordinating board for the federal govern- ment. In November 2005, President Bush directed the Homeland Security Council to create a pandemic pre- paredness strategy. The Council is in a good position to develop a strategy that incorporates the capabilities of the various federal departments and agencies. The pandemic preparedness strategy was released in November 2005, and the implementation plan was released in May 2006. The pandemic preparedness strategy represents the first time the federal government has committed the use of all instruments of national power against a disease— actually a potential disease, one that may not currently exist. It is important to realize this point, as it represents an important change as well as a significant commitment from the federal government. I think our preparedness to respond to a pandemic event has implications for improving our ability to respond to all types of natural and man-made disasters. It is also important to remember that we do not know what the next pandemic event will be. We do not know the type of disease, when and where the outbreak will occur, the rate at which it will spread, and many other factors. An infectious disease like severe acute respira- tory syndrome will have a much different impact and require different responses than an isolated case of exten- sively drug-resistant tuberculosis. Many of the health system capabilities and the transportation system capa- bilities needed to respond to any type of pandemic event are similar, however. There have been extensive discussions at the national level on the best approaches to respond to pandemic events outside our borders. We have a commitment to protect lives and to maintain the movement of people and cargo across our borders. We will work with our Canadian and Mexican partners to create a North Amer- ica perimeter to respond to a pandemic virus that origi- 9WELCOME AND OPENING REMARKS

nates outside North America. Screening stations will be established for maritime and air travel. Although the exact screening tools may vary by country, the stations will help slow the spread of a pandemic event. We are realistic about the potential effectiveness of this approach. We do not think it will be able to stop a pandemic illness from entering the country. We do think it can delay the arrival by a few days or a few weeks. The delay time can be used to initiate other measures to coun- teract the spread of the disease and to ensure that essen- tial services continue to be provided. We need to communicate to the public the important role of air transportation in responding to a pandemic event. Americans living and working abroad may wish to return home during a pandemic event. Ensuring access to air services and safe passage at international borders will be important. Discussion has also focused on the appropriate response after identifying an individual with an infectious disease. The community mitigation strategies focus on nonpharmaceutical interventions that can be used in response to a pandemic event. Individually these inter- ventions may be only partially effective, but used together they may have a synergistic effect on the spread of a dis- ease and on death rates. The community migration strate- gies are an integral part of the planned border policies. These elements provide a broad policy framework for managing our borders during a pandemic event. As noted, a focus is to direct infectious individuals away from transportation centers to seek medical attention and to care for themselves. A concept of operations is being developed for entry and exit screening at all ports of entry based on this policy framework. In the coming months the concept of operations will be discussed with the various agencies, airports, air carriers, and other groups. Outreach, interaction, and collaboration are critical to a successful approach, but no single govern- ment level or entity can do it alone. An effective response depends on a coordinated and collaborative effort. As I noted earlier, the response capabilities we are developing for pandemic events are appropriate for all types of emergencies. Our work on pandemic event pre- paredness planning allows us to be more responsive to other man-made hazards and natural disasters. I look forward to a productive discussion at this workshop on topics of interest to all groups. Thank you. Department of Homeland Security Til Jolly Thank you very much for inviting me to participate in this workshop. My comments will focus on the roles and responsibilities of the Department of Homeland Security (DHS) related to pandemic events. I will also highlight some of our current activities. With approximately 208,000 employees, DHS is a large agency. We are also still a relatively new agency. DHS has three major responsibilities related to planning for pandemic events. First, DHS has responsibility for responding to large- scale incidents of national significance, which a pan- demic event would be. We tend to think of major incidents as terrorist attacks, natural disasters, and other significant events. A pandemic event is a different type of incident, but it has far-reaching implications. The second responsibility related to a pandemic event is protection of the nation’s infrastructure. The third responsibility is protection of the country’s borders. DHS has numerous other responsibilities. The Customs and Border Patrol and the Transportation Security Administration have specific responsibilities related to the movement of peo- ple and goods into and out of the country. The DHS Office of Health Affairs is responsible to the Secretary for all medical and health issues and for coor- dinating these issues within DHS and throughout the federal government. Dr. Jeff Runge, Assistant Secretary for Health Affairs, heads the office, which is also respon- sible for planning for biological incidents, including pan- demic events. The opportunity exists to build on the planning activities undertaken for pandemic events to improve the nation’s readiness for biological and other incidents. Most of the planning efforts to date have focused on addressing a pandemic event that begins in another part of the world. We also need to be prepared to respond if a pandemic event begins in this country, however. In that case, under international health regulations, screening of exiting passengers would be required. Airlines, airports, and other air industry groups will play important roles in responding to a pandemic event. Screening passengers in other countries before they board an aircraft will be needed. Onboard passenger screening may also be needed. Airlines have experience dealing with ill passengers, but responding to poten- tially large numbers of infectious passengers is another matter. Numerous uncertainties surround planning for a pan- demic event. We do not know the exact disease, the speed at which it will spread, the intensity of the disease, the death rate, and other factors. The recently completed community mitigation guidance includes a pandemic event severity index, which mirrors hurricane categories, ranging from 1 for the least severe type of pandemic event to 5 for the most severe. The planning efforts to date have focused primarily on the most severe scenarios. Although we need to be prepared for a major pandemic event, we also need to be 10 INTERAGENCY–AVIATION INDUSTRY COLLABORATION ON PLANNING FOR PANDEMIC OUTBREAKS

ready to respond to an Index 1 or 2 event. These types of events might be similar to seasonal flu, which typically causes about 36,000 deaths a year. Communicating with air passengers, employees, and the public represents an important element of respond- ing to a pandemic event regardless of its severity. Man- aging the message will be critical. Providing accurate information on the nature of the infectious disease, the anticipated transmission rate, and the response measures used will be challenging given the potential uncertainty surrounding an event. We are developing strategies to respond to diseases that do not exist today. I am an emergency physician, and I still practice in a local emergency medical department. I receive numerous questions from health workers about possible pandemic diseases and responses. I try to provide realistic responses based on what we currently know about various infec- tious diseases. A number of DHS personnel will participate in this workshop. We work closely with representatives from the Department of Health and Human Services, the U.S. Department of Transportation, the Homeland Security Council, and the Centers for Disease Control and Pre- vention on the various planning efforts under way. I look forward to a productive discussion at the workshop and to continuing to work with the various agencies and organizations. Thank you. Centers for Disease Control and Prevention Andrew Plummer Thank you for the opportunity to discuss some of the activities under way at the Centers for Disease Control and Prevention (CDC), especially those related to the aviation industry. The CDC Division of Global Migra- tion and Quarantine (DGMQ) has significant interface with different aviation groups. We recently participated in an agencywide pandemic flu scenario in which the avi- ation sector played a significant role. The after-action report is being used to assess how the various participat- ing groups responded. We have also focused on all-hazards planning. We have developed and conducted table-top exercises at many of the quarantine stations throughout the country. After-action reports were also prepared on these exer- cises and distributed to participating groups. We will continue these types of exercises with state and local health agencies, airports, air carriers, and other organi- zations. These exercises allow all groups to work together in a coordinated manner. Through an iterative process, we learn from each exercise with the goal of all groups being better prepared for an actual event. We have also focused on improving data collection methods. DGMQ’s Quarantine Activity Reporting Sys- tem (QARS), a secure web-based electronic system, enables quarantine stations to track ill passengers on inbound airlines and vessels and at land border crossings as well as infectious disease threats and actions related to imported pathogens. QARS will allow DGMQ to better track, quantify, and respond to public health threats at ports of entry. We learned during the outbreak of severe acute respi- ratory syndrome that it is a challenge to contact passen- gers after potential exposure to a communicable disease onboard an aircraft. More often than not, persons are willing to share personal information; however, not everyone has a cell phone, and not everyone has a per- manent address. Being able to collect and disseminate critical information efficiently is important. We are also examining the current contact information forms to ensure that the focus is on the data elements that will optimally facilitate passenger contact. We will continue to work with airlines, customs, and other federal part- ners and agencies on coordinating data-collection activi- ties and sharing information. Additional work is needed on identifying the best methods to communicate with passengers after a flight that included infectious passen- gers. We realize there are differences in the information needs of various groups as well as privacy concerns, and we take these concerns very seriously. We are working with state agencies to develop effec- tive methods of communicating public health informa- tion. We have developed and implemented a software application, E manifest, which exists within a secure elec- tronic information-sharing system that will facilitate improved communication of relevant public health infor- mation with participating state public health agencies. Identifying the best methods and the appropriate mes- sages to communicate with the public is also important. The CDC website includes health information for travel- ers (wwwn.cdc.gov/travel/default.aspx), including at-risk countries and the appropriate public health and medical countermeasures travelers should take as part of travel preparation. We also prepare and distribute up-to-date health travel alert notices. In addition, there is a section on the website that has information specific to the travel industry, including special guidance for air crews and maintenance crews. Promoting the availability of this information with the public and the media is important. Future outbreaks of infectious diseases may require global public health authorities to screen domestic and international arriving and exiting passengers. More research is required to determine what modali- ties are effective and practical. A research study exam- ining the potential use of thermal scanning as part of the air passenger screening process is planned. It will 11WELCOME AND OPENING REMARKS

assess the effectiveness of thermal scanning and the resource requirements to implement the process. We will work with the airline industry as the research pro- ject develops. Again, thank you for the opportunity to participate in this workshop. I look forward to a productive discussion on numerous topics. Federal Aviation Administration Kate Lang I am delighted to participate in this session. Let me begin by thanking Katherine Andrus from the Air Transport Association and Jim Crites from the Dallas–Fort Worth International Airport for identifying the need for enhanced communication and coordination among the airline and airport communities and federal agencies related to planning for possible pandemic events. They brought these concerns to the Airport Cooperative Research Program Oversight Committee, of which they both are active members. TRB agreed that a workshop would be beneficial to promote communication and col- laboration among the various groups. Christy Gerencher and other TRB staff, along with the work- shop oversight group, have done an excellent job orga- nizing this workshop. It is important to understand the roles and responsi- bilities of the various federal agencies, airlines, airports, and local and state agencies. The terrorist attacks of Sep- tember 11, 2001 (9/11), taught us that roles and respon- sibilities must be clearly defined before an emergency. As you are all well aware, the aviation industry experienced a crisis after 9/11. Laura Valero will provide additional information on FAA activities, but I would like to highlight a few efforts under way at the Office of Airports. We have been work- ing with airports and state and local governments in planning for a pandemic event. We have focused on some of the basic questions, including those related to main- taining an adequate workforce if absenteeism rates reach the projected 40%, providing a safe environment for workers and passengers, and obtaining and distributing essential supplies. Maintaining a viable aviation industry is critical to this country. Part of our charter in the Office of Airports is to help communities and airports meet their aviation require- ments. We are also responsible for safety oversight of air- ports. In developing our pandemic response plan, we had to consider how the office would continue to provide assistance to airports if we experienced high levels of absenteeism. Telecommuting is a major component of the office’s response plan. As part of the planning process, we identified key personnel and their backups. We tested the computer system to ensure access from dif- ferent locations. We also conducted table-top exercises based on different pandemic scenarios. We are working with our partners at the Airport Council International, the American Association of Air- port Executives, and the National Association of State Aviation Officials on numerous activities. We have learned from recent hurricane response experiences. These experiences reinforce the importance of maintain- ing updated 24-hour personnel lists. Knowing how to contact key personnel at each airport is important. The recent hurricane response experience also high- lighted the importance of having critical information available for decision makers, especially real-time infor- mation. We have been working with the airport commu- nity to identify information needs. Examples of critical information are staffing levels to maintain safe operating requirements, fuel availability, the quarantine status, the availability of on-site health personnel, and the status of air carriers. Airport personnel are also identifying responses to quarantines, employee absenteeism, and obtaining critical supplies. A pandemic event will have a significant economic impact on airports. The FAA is concerned about the financial health of airports, including their ability to con- tinue to meet their financial obligations. The aftermath of 9/11, the severe acute respiratory syndrome epidemic, and the recent hurricanes illustrate the potential negative impacts and the vulnerability of airports. The FAA has financial aid programs that can provide assistance in these situations. We can also work with Congress on emergency legislation if needed. We are capable of responding quickly with a variety of assistance. I think there are a number of important topics to be addressed related to airport operations during a pan- demic event. These topics include how infectious passen- gers will be handled; what quarantine facilities will be available at individual airports; what entity will be in charge; and the roles and responsibilities of the various federal, state, and local agencies and public health offi- cials. Other important topics are maintaining safe oper- ations with anticipated absenteeism levels and obtaining needed supplies. Another issue is how to fund on-site air- port quarantine facilities if they are necessary. It is important to remember that a pandemic event may last 6 to 8 months, or longer. We know that airports along the Gulf Coast experienced lower levels of opera- tion, and thus lower revenues, after Hurricanes Katrina and Rita. Providing realistic expectations of the potential economic impact of a pandemic event, as well as possible sources of financial assistance, is important. I am impressed with the level of participation at this workshop. The FAA is well represented, and we look forward to hearing from others and participating in the discussion over the next 3 days. Thank you. 12 INTERAGENCY–AVIATION INDUSTRY COLLABORATION ON PLANNING FOR PANDEMIC OUTBREAKS

Federal Aviation Administration Laura Valero It is a pleasure to participate in this opening session. Joan Harris, who served on the workshop oversight commit- tee, sends her regrets for not being able to attend the workshop due to a previous commitment. Joan heads a team at the U.S. Department of Transportation (DOT), Office of the Secretary, charged with implementing the 71 tasks in the implementation plan assigned to U.S. DOT in May 2006. In addition to the aviation sector, the U.S. DOT team is also focusing on the trucking, rail, public transportation, and shipping industries. Joan is the primary U.S. DOT representative to the Sub-Policy Coordinating Committee (Sub-PCC) at the Homeland Security Council led by Ken Staley. The Sub- PCC is working with other agencies and groups to ensure we are prepared for a pandemic. This is a challenging responsibility as we cannot fully predict the exact nature, extent, and duration of these types of events. I will highlight some of the recent activities the FAA has undertaken. First and foremost, the FAA is the lead on all the aviation-related tasks assigned to U.S. DOT. We are very focused on the aviation tasks in the implementation plan. We have also provided input and suggestions on the nonaviation tasks based on experience with other events. We have been focusing on internal planning and oper- ational response planning and have been working on business continuity planning, also known as continuity of operations or COOP. Within the FAA, the air traffic operations, aviation safety, and airports lines of busi- nesses have been working on contingency plans for shift- ing resources and responsibilities, as needed, to keep the National Airspace System operational in a pandemic event. Chapter 5 of the National Strategy for Pandemic Influenza: Implementation Plan identifies the National Airspace System as one of the critical areas that must be kept operational during a pandemic. We have been working on our air traffic control contingency plans, as well as aviation safety inspector contingency plans, to address anticipated employee absenteeism. A critical element of the initial guidance mirrors the Occupational Safety and Health Administration work- place protection policy. Air traffic controllers cannot be readily replaced. They cannot control aircraft and the national airspace from the comfort of their homes. It is also not possible to maintain the recommended 6-foot spacing between controllers in towers and centers. In such a close working environment, it is difficult to pro- tect controllers from the potential spread of communica- ble diseases. We are examining possible solutions, how the solutions would be implemented, and the costs of different options. Providing controllers with powered air-purifying respirators (PAPRs) is one possible approach. At a cost of approximately $1,000 per PAPR, equipping 15,000 air traffic controllers would cost in the range of $15 million. Funding to purchase these respira- tors has not been identified. The FAA took the lead in developing an interagency avi- ation operational concept of operations. This effort will be discussed in more detail in a session this afternoon. The concept of operations addresses coordinated responses to inbound aircraft with sick passengers who may have pan- demic flu or other contagious diseases. The concept of operations establishes a specialized aviation response cell at the Transportation Security Administration’s Freedom Center in Herndon, Virginia, which was formerly called the Transportation Security Operations Center. The intera- gency aviation concept of operations will be included in the broader concept of operations under development. The FAA will continue to support the National Response Plan during a pandemic. For example, we have focused on ensuring priority handling of air shipments from the strategic national stockpile to areas where they are needed. We are also reaching out to other countries to better coordinate responses on an international level. The trilateral aviation concept of operations recognizes the critical roles Mexico and Canada will play in responding to a pandemic. Both countries have participated in plan- ning activities. The North American Avian and Pandemic Influenza Plan addresses responses by all three countries in North America. When we started working with our counterparts in Mexico and Canada, we found that they had not yet considered how to protect their air traffic controllers from potential contagious diseases. The plan- ning process has been beneficial for all three countries. We are also active in promoting communication, coordination, and cooperation on an international basis. We are reaching out to the European Civil Aviation Con- sortium, the Asia Pacific Air Traffic Forums, and other groups as part of this effort. Finally, we are contributing to a number of other activities, including developing the draft aircraft disin- fection guidance, the draft sector-specific guidelines, and stakeholder meetings. We will participate in a series of meetings after the draft aviation concept of operations for health screening is released. I appreciate the opportunity to participate in the workshop and look forward to interesting and produc- tive discussions on a variety of topics. Thank you. Airline Perspective: US Airways Terry Lowe Thank you, Katherine. I appreciate the opportunity to participate in this session. I do not speak for all airlines, but an ad hoc group of airline representatives has been 13WELCOME AND OPENING REMARKS

meeting on a regular basis over the past year to discuss many of these issues. While it is not a formal body, the ad hoc group provides the opportunity for airline repre- sentatives to share information and discuss common issues. Individual airlines are developing their own plans and processes. Airlines are also working with airport personnel, the Centers for Disease Control and Preven- tion (CDC) and local health officials, and state and local government representatives on various activities. Until the recent concerns about pandemic flu, airlines were primarily addressing unique events, such as a pas- senger with meningitis or tuberculosis. If a passenger exhibits the symptoms in flight, assistance is provided. In other cases, symptoms are not documented until after a flight. Passengers on a flight with a reported contagious individual are notified after the fact. There has not been a great deal of preplanning with these types of events. When US Airways and America West merged about 2 years ago, we realized that we were not prepared for a major event, such as pandemic flu. Our occupational safety and health group took the lead in developing a response plan, working with the emergency planning and response group and our medical group. Our initial activity focused on gathering information, which proved to be challenging. There is a lot of avail- able information, but determining what is valuable and useful is not always easy. We found some good tools and we developed an outline for a pandemic preparedness plan for the company. We brought together representa- tives from 20 to 25 different departments throughout the airline to assist with developing the plan. As the group discussed different possible scenarios relating to the extent and duration of a pandemic event, it became apparent that we were not prepared for high levels of absenteeism. The group considered personnel needs to maintain a viable airline. Pilots, flight atten- dants, ground crews, baggage handlers, ticket agents, maintenance personnel, and reservation agents are all needed to operate an airline. An operations plan was needed that would allow for reductions in service as well as for returning to full operation. Development of the plan led to additional detailed dis- cussions about the impacts of different scenarios. We also discussed the roles information technology and telecom- muting could play in helping meet staffing needs. Telecom- muting can play a part in responding to a pandemic event, but you cannot operate an airline by telecommuting. We have also examined the need for essential supplies and have purchased some items. We have not stockpiled extensive supplies, however, so it would be difficult to respond to a major event. The group is considering the appropriate level of supplies to maintain given the uncer- tainty surrounding possible events and concerns over expiration dates on vaccines and other related items. We developed a video on communicable diseases for internal use. It is not specific to pandemic events. Instead, it addresses exposure to all types of diseases that work- ers might face. We have also conducted initial training of some employees. We have conducted internal training and we have participated in different exercises at air- ports throughout the country. We have tried to reconvene the group on a regular basis after the plan was completed. It is difficult to main- tain a high level of interest in pandemic planning when there is not a crisis or other event. We have also worked with international airlines and have learned from their experiences over the past few years. Additional commu- nication and coordination with international carriers would benefit all airlines. A number of issues and topics need further discussion and clarification. Examples of these issues include releas- ing passenger information from a flight after a passenger on the flight has been found to have an infectious dis- ease, denying boarding to a passenger who appears to have an infectious disease, and dealing with passengers displaying symptoms of an infectious disease in flight. Communicating with passengers and the public is also a concern. Airlines want to be prepared, and we want our passengers to know we are prepared. We do not want to scare off potential passengers by publicizing these activities too much, however. Communicating this type of information might be a role for the Air Transport Association or some other group. Logistics is another area that additional communication and cooperation would benefit. Ensuring that airlines, airports, federal agencies, and local communities work together to pro- vide food, medical supplies, fuel, and other essential items requires additional planning. Additional guidance is also needed on responding to infectious passengers in flight. The role of flight atten- dants, potential diversion of the aircraft to an airport with a CDC facility, quarantine facilities at various air- ports, providing medical attention for other passengers and in-flight crews, and cleaning the aircraft represent just a few of the issues that need additional discussion. We have made a lot of progress in the past few years related to pandemic planning and response. The infor- mal group of airline representatives provides a forum for sharing information. This workshop provides the oppor- tunity to share additional information, to discuss issues of mutual concern, and to develop stronger working relationships. Creating an ongoing forum for communi- cation and coordination would benefit all groups. Airports Perspective: Airports Council International–North America Lydia T. Kellogg Thank you, Katherine and TRB, for the opportunity to participate in this workshop. This topic is of great inter- 14 INTERAGENCY–AVIATION INDUSTRY COLLABORATION ON PLANNING FOR PANDEMIC OUTBREAKS

est and importance to airports, including members of the Airports Council International (ACI). I also appreciated the opportunity to serve on the workshop oversight group. Airports have always had a public service mission. They are custodians of air transportation, which is a crit- ical element of the nation’s infrastructure. As public enti- ties, airports are expected to maintain their facilities, particularly in times of national emergencies. They do not have the luxury of closing their doors, as critical response personnel and supplies must be able to reach their destinations as rapidly as possible. ACI recently conducted a survey of its members related to pandemic planning activities. Approximately 20% of 147 airports have responded. The survey results indicate that a wide range of planning activities are under way at airports throughout the country. Many airports have bio- logical and pandemic response plans based on the National Incident Management System (NIMS) National Response Plan, and others are developing plans. Some airports have developed business continuity plans. The survey results indicate that most airports anticipate being able to operate with up to 40% staff absenteeism. Staff would still be able to support critical job functions, which include airfield maintenance, air- port security, and fire fighting. Information provided by the airports also indicates that telecommuting would be allowed for some noncritical job functions. Airport operations would be affected at higher absen- tee levels. Possible actions identified if lower staffing lev- els are encountered include reducing the number of operating runways, prohibiting general aviation, reduc- ing the number of gates in use, and restricting airport operations to daylight hours. The survey responses also reveal that airports are con- ducting table-top exercises to discuss best practices and to ensure business continuity. Representatives from fed- eral, state, local, health, and emergency response agen- cies are involved in these table-top exercises. Many airports have made arrangements to provide employees and other workers with personal protection equipment such as masks, gloves, and gowns. Airport response plans also address deploying sanitization stations and increasing the cleaning and disinfecting of common areas. Airports would also extend operating hours for stranded traveler services if needed. The NIMS National Response Plan and the National Strategy for Pandemic Influenza have been used as mod- els for most airport plans. In addition, many airport plans use an emergency unified command to coordinate response activities. Questions raised by survey respondents included how individuals with symptoms of influenza will be identified and at what point airport personnel will be notified. The level and nature of response at individual airports will depend on when information is received and the type of disease. For example, different actions would be taken if information on a possible infectious passenger were received before a plane landed or when a plane arrived at a gate. It is a pleasure to have the opportunity to participate in this workshop. I look forward to learning more about what other agencies and groups are doing and how we can be more proactive in planning activities. Thank you. 15WELCOME AND OPENING REMARKS

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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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