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Suggested Citation:"Discussion Sessions." 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:"Discussion Sessions." 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:"Discussion Sessions." 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:"Discussion Sessions." 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:"Discussion Sessions." 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:"Discussion Sessions." 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:"Discussion Sessions." 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:"Discussion Sessions." 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:"Discussion Sessions." 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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16 Discussion Sessions Discussion Facilitators: Laura Valero, Federal Aviation Administration Alan Black, Dallas–Fort Worth International Airport Jack Wells, U.S. Department of Transportation Kathie McCracken, Department of Homeland Security Bonnie Wilson, Jackson Municipal Airport Authority Rich Golaszewski, GRA, Inc. The central portion of the workshop was a facilitateddiscussion on seven general topics under the twomajor themes of minimizing the spread of disease via air travel and maintaining air service as a critical infrastruc- ture during a pandemic event. The topics addressed under minimizing the spread of disease via air travel were risk- based screenings at airports, in-flight measures, and airport responses. The topics discussed under maintaining air ser- vice as a critical infrastructure during a pandemic event included the economic impacts of a pandemic event on the aviation sector, air transportation as critical infrastructure, workforce issues in the aviation industry, and mitigating economic impacts and preserving air service. Members of the workshop planning committee led the dis- cussion on different elements associated with each of the broad topic areas. Various issues were discussed during the sessions. Some topics were discussed in multiple sessions. In addition, different groups of individuals participated in the sessions, resulting in some issues being discussed from different per- spectives. This section summarizes the main topics of discus- sion in the different sessions and highlights major points and issues raised by various individuals during the discussions. MINIMIZING THE SPREAD OF DISEASE VIA AIR TRAVEL Risk-Based Screening at Airports Laura Valero, Discussion Facilitator Topics discussed associated with risk-based screening at airports included the roles and responsibilities of various agencies and groups, how screening would be imple- mented, and identifying the signs of illness. Other topics were the possible impacts of denying boarding, the lia- bility associated with screening decisions, and the impact on operations. • Regulatory and legal authority and responsibility for illness-based screening of passengers at airports: Because of the complexity of this issue, it was noted that more work is needed to determine the authority, roles, and responsibilities of federal, state, and local agencies to conduct illness-based screening and to deny boarding and detain passengers. The Transportation Security Administration has responsibility for screening passen- gers at airports for security purposes, but they do not screen passengers for infectious diseases. Customs and Border Protection and the Department of Agriculture conduct entry screenings on passengers arriving on international flights. Because airports are typically established as state, regional, or local entities, state leg- islation or local authorities may have to give airport personnel the authority to screen, deny, or detain pas- sengers. The link to state public health legislation is important, as in some states local health officials have the authority to detain passengers on the basis of public health concerns. • Legal implications of denied boarding: Airlines have the ability to deny boarding, and the final authority over the matter rests with the aircraft captain. Most air- lines have processes to address these types of situations, including holding a passenger off a flight and arranging for another flight after the specific concern has been examined. However, airlines may face legal action if a

passenger is not ill or if an individual thinks he or she has been discriminated against. The complexity and the potential legal concerns of restricting travel of an indi- vidual was discussed as well as the need to base the deci- sion to restrict travel on community well-being and public health aspects of these situations in a consistent and standard manner. • Situational changes during a pandemic event: With 65 international airports in the United States and many more that serve international charter flights, screening might be critical during a pandemic event to try to detain infected individuals from entering the country. Airports may also be identified for use in diverting flights with ill passengers. • Review of current legislation and regulations in light of a pandemic event: Existing U.S. Department of Transportation regulations focus on nondiscrimination and protecting individual rights, not on public health- related concerns and protecting the public interest. These regulations may need to be modified if the goal is to pre- vent the transmission of an infectious disease. • Centers for Disease Control and Prevention (CDC) state legislation or local authority health-related travel notices: These notices are currently issued using different levels of severity. The first level is “in the news,” the sec- ond level is an “outbreak notice,” the third level is a “travel caution,” and the highest level is a “travel health warning.” These travel notices are updated daily and posted on the CDC website. • Passive and active passenger screening methods: These methods include using advanced technologies to help identify infectious individuals. Applying different approaches to determine the health of passengers and focusing on those that provide the best opportunities to identify and detain infectious passengers were noted as important. Determining the use and effectiveness of advanced technologies—such as thermal scanning and other technologies—to help identify infectious individu- als also was noted as important, along with the need for funding to purchase the systems and train personnel to operate machinery. • Entry and exit screening: The need for screening, who would authorize it, and how it would be conducted at airports are some questions under discussion. If a pan- demic event started in this country, exit screening might be necessary to meet World Health Organization requirements, and the requirement for screening would be linked to the level and severity of a pandemic event. Many of these topics are still being worked on in the dif- ferent planning activities, and specific elements have not been determined. • Public notification and outreach: Information would need to be provided to the public about the rea- sons for screening and screening protocols using differ- ent outreach and information dissemination techniques. Identifying the agency or group most appropriate to pre- sent these messages and the desirability of using multiple methods and sources to communicate with the various target audiences were noted. Some people may be more likely to listen to health officials, whereas others may be more likely to respond to information from government agency personnel. • State-level pandemic response planning activities: Different planning activities are under way, including the requirements for states to develop pandemic response plans. Personnel in state public health departments inter- act regularly with CDC staff, and this interaction might be considered during development of the state plans. • Difficulties in identifying signs and symptoms of infectious diseases: Airlines and airports train employees to help them recognize ill passengers. It was noted that additional training would be needed for airline, airport, and other aviation industry personnel to identify poten- tially ill passengers during a pandemic event. • Level of effort needed for screening and quaranti- ning infectious passengers: The initial purpose of these activities is to delay the entry and spread of a disease, taking into account possible multiple waves of a disease. Once a disease has entered the country, however, a dif- ferent approach may be taken. The pandemic severity index can be used to identify appropriate responses, including possible layered approaches with multiple lay- ers of surveillance, screening, and contact tracing. Sur- veillance and screening may be used to identify potentially ill passengers before they board an aircraft. Contact tracing provides follow-up communication with passengers who may have been exposed to ill passengers on a flight. There is also the potential use of a no-fly health-related passenger list as has been done in cases related to infectious tuberculosis. • Differences in pandemic and nonpandemic responses: Airlines and airports regularly deal with sick passengers and medical emergencies. Responding to a pandemic event is different, as it would probably involve a lengthy period of time and a large number of passen- gers. Having trained health professionals on site was noted as important. • Managing and protecting passenger data: There are advantages and disadvantages to different methods of contacting passengers after a flight based on the roles and responsibilities of airlines and agencies, including privacy concerns related to contact tracing. If a disease were spreading rapidly during a pandemic event, contact tracing might not be beneficial. • Enhanced communication and coordination between industry and agencies: During the development of different plans, screening strategies, and other mea- sures, aviation industry officials expressed interest in the opportunity to review draft documents and to better understand their potential roles in different activities. 17DISCUSSION SESSIONS

In-Flight Measures Laura Valero, Discussion Facilitator Topics discussed related to in-flight measures includ- ing identifying and responding to communicable dis- ease incidents in flight, airline reporting methods, infection control, and passenger and crew contact trac- ing. The interagency concept of operations (CONOPS) for managing flights with infectious passengers was also discussed. • Existing procedures and protocols for responding to ill passengers in flight: Flight attendants, pilots, air traffic control, airports, and the Centers for Disease Con- trol and Prevention (CDC) have different roles in responding to ill passengers. The exact procedures may vary by air carrier and airport. Additionally, a memo- randum of understanding between air carriers and the CDC could be beneficial to help outline the roles and responsibilities of different groups. • Identifying infectious passengers in flight: It is difficult to recognize symptoms of different diseases, especially those that are not currently known. It was noted that airline and airport personnel would need training in recognizing the symptoms of different infec- tious diseases. • Providing airline crews with essential equipment and protection devices: It is important for airline person- nel to have access to masks, gloves, and other protection devices that would be effective against pandemic disease, but current “grab-and-go” kits available to some airline personnel may not contain suitable personal protective equipment for pandemic diseases and may need to be reviewed, approved, and updated. • Procedures for dealing with in-flight medical situa- tions: Flights may be diverted to nearby airports in the case of medical emergencies; typically, the goal is to get the passenger on the ground as quickly as possible so that he or she can receive necessary medical treatment. The captain makes the decision to divert, based on input from the airlines’ on-the-ground medical experts. This situation could change during a pandemic event, includ- ing how to identify ill passengers in flight, what agency would decide to divert an aircraft containing suspected or confirmed infectious passengers, and the location of the airport where the aircraft would be diverted. The availability of a CDC presence at the airports targeted for diverted aircraft is also a consideration. The U.S. gov- ernment CONOPS for managing flights with ill passen- gers, including approaches to diverting aircraft, is still being developed. More involvement from the aviation industry could assist in the discussion of possible approaches. Airport Response Alan Black, Discussion Facilitator Topics discussed in this session included addressing inbound flights with potentially infectious passengers, coordinating response activities at airports, and manag- ing passengers and crew. Other topics discussed focused on maintaining airport operations during a pandemic event and cleaning and disinfecting aircraft and airports. Some participants discussed the economic impacts of a pandemic event on airports. The session on the economic impacts of a pandemic event in the aviation sector cov- ered this topic in more detail. • How airports will remain solvent during a pan- demic event: If airports are not receiving revenues from landing fees, parking, and terminal concessions, it was suggested that they would likely need financial support. Possible financing sources include short-term loans, fed- eral and state emergency funding, financing from local governments, and other sources. More discussion is needed on this topic with the involvement of all affected groups. • Procedures for coordinating responses at airports during a pandemic event: It was noted that identifying the roles and responsibilities of all groups is critical, as are coordination and communication among all groups. Building on the current working relationships among agencies and organizations and establishing who is in charge and the roles of local agencies and federal offi- cials were identified as key elements to successful responses. For example, a coordinated approach is used at airports involving airline, airport, emergency medical service, fire, and other personnel that includes notifying the Centers for Disease Control and Prevention and local health officials about passengers with potential infec- tious diseases. However, different approaches may be needed at different airports based on the type of airport and community served, the number and type of air carri- ers and aircraft, the size of the airport, the local organi- zational structure, existing institutional arrangements, and available facilities and services. • Availability of trained medical personnel and space to attend to the anticipated number of ill passengers: Facilities for isolating or quarantining passengers are limited at most airports. Using a section of a terminal or a separate nearby building are possible alternatives. • Potential need to clean and disinfect aircraft and airport facilities during a pandemic event: Although the Environmental Protection Agency has information on the use of various cleaning products, further guidance is needed on the cleaning methods and protocols, fre- quency of disinfecting areas during a pandemic event, 18 INTERAGENCY–AVIATION INDUSTRY COLLABORATION ON PLANNING FOR PANDEMIC OUTBREAKS

and funding for these activities. Communicating to the public that aircraft and airports are clean and safe from infectious diseases is also a concern. According to previ- ous research on airflow circulation in aircraft cabins, the aircraft environment is safer than is commonly thought, although more research is needed on the potential trans- mission of influenza. • Determining appropriate responses based on vari- ous conditions at different airports: Airports vary in size, type of community served, number and type of air carri- ers, institutional structures, and other characteristics. As a result, a “one size fits all” response to a pandemic would probably not meet the needs of individual airports. It was suggested that layered or stratified approaches could provide the flexibility needed to respond to local conditions at various airports as well as the characteris- tics of the different types of influenza and illnesses that may be encountered during a pandemic event. MAINTAINING AIR SERVICE AS CRITICAL INFRASTRUCTURE DURING A PANDEMIC EVENT Economic Impacts of a Pandemic Event on the Aviation Sector Jack Wells, Discussion Facilitator Topics discussed in this session included the potential economic impacts of a pandemic event on different ele- ments of the aviation sector and possible reactions from passengers, airline and airport personnel, and cargo ship- pers. The impacts on the broader travel industry and local communities were also explored. The experiences from recent health threats, natural disasters, and the aftermath of the attacks of 9/11 on the aviation sector were also discussed. • Impact of severe acute respiratory syndrome (SARS): SARS had a significant negative effect on air car- riers, especially those serving markets in Asia. Passenger volumes declined during the SARS event, and the volume of air cargo also declined. Airlines in Asia and Canada and other parts of the world had difficulty convincing the public it was safe to fly. As a result of the SARS expe- rience, all groups are more prepared to provide timely and accurate information and have learned the impor- tance of developing a coordinated public information plan now that can be implemented if needed. • The importance of managing the message: Travel- ers are influenced by what they hear and read in the media. There are advantages and disadvantages of dif- ferent agencies providing information during a pandemic event, but providing accurate and credible information in all cases was noted as important. The public will expect information on the health aspects of the situation, the availability of air services, requirements for travel, and actions that are being taken to address preventing spread of the disease. The fear of exposure to the disease will be a factor in the public’s reaction, and having a measured response using an appropriate messenger with credible information would help to counteract this fear. In addition to providing information to the general pub- lic, it was noted that the airlines would have a role to play in providing information to pilots, flight attendants, ticket agents, other personnel, and passengers. • Economic impact on international and domestic air carriers: International carriers would probably expe- rience more significant economic negative effects, espe- cially if the pandemic event originates outside the United States. Domestic airlines would also feel the impacts as the pandemic event spreads. • Economic link between air carriers and airports: Financially healthy air carriers make for financially healthy airports. When air carriers are struggling finan- cially, airports feel the impacts. The effects would be dif- ferent for major commercial airports, smaller commercial airports, and general aviation airports; plan- ning efforts for responding to a pandemic event would also be different. It was suggested that coordinating plan- ning with surrounding communities, state agencies, and other local groups would be important. • Unique impacts of a pandemic event: A pandemic event is worldwide and during a worldwide event, inter- national and domestic carriers, as well as the airports they serve, will be negatively affected. The duration of a pandemic event will influence the ability to maintain an economically healthy aviation industry; the longer a pan- demic event lasts, the more severe the economic effects will be on all sectors of the aviation industry. However, the initial impact of a pandemic event could be particu- larly severe because all elements of society, not just the aviation sector, would be affected—in particular, the financial sectors of the economy, including the banking industry. • Difficulty in planning for an event with so much uncertainty: When and where an outbreak will occur, the nature of the infectious disease, the rate at which it will spread, the ability to provide a medical response, and other factors are not known. As a result, it is difficult to forecast how individuals, airlines, government agencies, and other groups will respond. If a pandemic event orig- inates outside the United States, American citizens living and traveling abroad may wish to return home. Main- taining air services to accommodate them will be impor- tant. At the same time, there may be a demand to curtail international service to prevent or delay the spread of the disease to the United States. 19DISCUSSION SESSIONS

• Effects on business, leisure, and recreational travel: During a pandemic event, corporate and governmental travel policies regarding nonessential travel will proba- bly be canceled or postponed. There may also be travel restrictions placed on serving some markets, depending on where the pandemic occurs. Short-haul carriers to specific vacation destinations would probably experi- ence significant declines in passenger volumes; the busi- nesses and communities serving tourists would also experience significant economic losses. It will be impor- tant to keep travel agents and the travel insurance indus- try informed. • Impacts of a pandemic event on air cargo services: Cargo does not get sick; however, pilots, crews, ground support, and air traffic controllers can get sick. Keeping supply chains open for medical supplies and other criti- cal items will likely be a priority during a pandemic event, particularly during the early phase of the incident. As a result, air cargo businesses may need to be able to continue to provide relatively normal operations. Pas- senger airlines may also be able to focus more on cargo to provide a revenue stream and to maintain some level of service during a pandemic event. A number of factors could influence the ability of airlines to increase cargo shipments. These factors include the availability of air- craft and crews, airport infrastructure and services to accommodate cargo, and local infrastructure and ser- vices. For example, trucks are not allowed on the George Washington Parkway in the Washington, D.C., area, which poses limitations for air cargo shipments at Ronald Reagan Washington National Airport. Addition- ally, there may be a disruption in air cargo from certain parts of the world during the major portion of an event if flights are restricted. • Air cargo effects from social distancing: In an effort to prevent catching a disease, many individuals may socially distance themselves. As a result, shopping from home may increase during a pandemic event, contribut- ing to a possible increasing trend in air shipments. • Impacts of antitrust laws: These laws may influ- ence the ability of airlines to coordinate and cooperate during a pandemic event. It was suggested that examin- ing the potential to relax some antitrust provisions dur- ing a pandemic event now could be beneficial to prepare for any changes during an event. • Types of measures passengers may require to con- tinue to travel by air during a pandemic event: These measures include the messages airlines and government agencies could send to encourage air travel. A major issue will be to protect passengers from potential infec- tious diseases and communicate to the public that it is safe to fly—with action supporting the message that pas- sengers are safe from contamination if this effort is to be successful. • Flexibility of airline and airport personnel in responding to a pandemic event: Representatives from various unions and other employee groups have been involved in developing response plans at airlines and air- ports, and the ongoing involvement of all employee groups was noted as critical to the success of planning efforts as well as actual response and recovery efforts. Employees and passengers are asking questions about different aspects of planning, responding, and recovering from a pandemic event. Well-informed employees are important to the successful operations of all elements of the air industry. Airline and airport personnel also play a key role in communicating accurate information to trav- elers and shippers. • Maintaining essential employee functions: The avi- ation system and industry may be subject to vulnerabil- ity during a pandemic event and various approaches may need to be taken to mitigate potential problems in main- taining a vibrant and competitive industry, including options for redeploying personnel and equipment during a pandemic event. • Roles and responsibilities: Federal, state, and local agencies, as well as airports and air carriers, have differ- ent roles and responsibilities in responding to a pan- demic event and in addressing potential economic impacts. Consequently, it was suggested that enhanced communication and coordination among all groups could benefit all parties, including surrounding commu- nities, which will also experience the economic impacts of a pandemic event. Air Transportation as Critical Infrastructure Kathie McCracken, Discussion Facilitator A variety of topics were discussed in the session on air transportation as critical infrastructure. The first topic focused on identifying the essential services provided by the aviation sector to maintain its economic viability and the nation’s economic and social stability, as well as to directly support pandemic preparedness, response, and recovery. The essential system components, functions, assets, and equipment that must be maintained during a pandemic event to sustain the delivery of essential avia- tion services were discussed. • Distribution of medical and other essential sup- plies: Maintaining air cargo service was identified as important to ensure that medical and other essential sup- plies can be delivered where they are needed during a pandemic event. Of particular concern to airlines and airports is obtaining needed supplies for personnel to be able to maintain services. It was noted that FAA and 20 INTERAGENCY–AVIATION INDUSTRY COLLABORATION ON PLANNING FOR PANDEMIC OUTBREAKS

other federal agencies could play a role in helping to secure essential supplies, specifically through their con- tacts with suppliers and their experience responding to emergencies. • Lessons learned from Hurricane Katrina: Although it is an example of a localized situation, lessons can be learned from the post-Katrina experience. Maintaining continuity of operations was identified as important, as learned in the chaotic experience at the New Orleans air- port and other airports along the Gulf Coast after Hur- ricane Katrina, where it was difficult to get medical supplies and medical personnel into areas through the airports. • Short- and long-term disruptions to service: Air carriers experience disruptions regularly because of weather conditions and other situations. Some airlines have also experienced labor disruptions, including strikes by some employee groups. Air carriers have plans for dealing with these types of disruptions, which are typically relatively short in duration. Most segments of the air industry are not prepared to deal with these types of situations over the long term, however. Domestic and international carriers would face similar issues, although some airlines may be more prepared, and better able, to handle a short-term decline in revenues than others. • Planning at the international level: One outreach activity under way is the North American Avian and Pan- demic Influenza Plan involving the United States, Canada, and Mexico. This plan aims to create a North American perimeter to delay the arrival of a pandemic disease that originates outside of North America. Other international outreach activities are being pursued to help strengthen the ability to respond to a worldwide pandemic event. • Impacts of a pandemic event on rural areas and small communities: There are different perspectives on the possible impacts on air service to airports in rural regions. Some suggest that air service to these areas will decline during a pandemic event, with the major focus on providing essential and emergency supplies. Others suggest that service to some of these areas could increase if airports and air service in major metropolitan areas experience the major impact of a pandemic event. Trav- elers and shippers may turn to smaller airports as safer and functional alternatives. • State-level responsibilities: Each state is responsible for its own planning activities related to responding to a pandemic event and state governors have been identified as the responsible parties for decisions during the event. The states are also responsible for allocating resources during the response and recovery periods and may approach air carriers to assist with transporting essential supplies, which might include food to rural and remote areas. • What are essential services? There are two defini- tions of essential services used in planning documents: those services essential for businesses to function and those services essential to the nation. It was suggested that it is also important to distinguish essential cargo and essential passengers from all cargo and passengers. • Maintaining key aviation infrastructure and pro- viding essential services: Key infrastructure elements include airports, aircraft, and other fixed facilities. Dur- ing a pandemic event, the demands on the infrastructure may shift to airports becoming gathering places for indi- viduals trying to leave an area or arranging for incoming passengers as well as serving as field hospitals, with a mix of sick and healthy people. • Public travel behavior during a pandemic event: The experience during the aftermath of 9/11 indicates that people are willing to drive long distances to return home. A similar desire would likely be experienced dur- ing a pandemic event. Significant elements of the popu- lation—such as college students, temporary workers, and individuals traveling on business or vacation— would probably want to return home, whether they are abroad or just in a different part of the country. Hourly wage earners may respond differently than other employees. It was suggested that, in general, individuals are likely to do what they consider to be in their own best interest; as a result, human behavior may be a “wild card” during a pandemic event. • Effects of regional hot spots of the disease: Some areas of the country may become hot spots for the disease, depending on where it begins or where it enters the coun- try and how quickly it spreads. There could be a need to relocate aircraft from these areas on a temporary or long- term basis. Given the uncertainty surrounding a pandemic event, participants noted the need for flexibility in response plans and being prepared for multiple scenarios. • Different approaches to quarantining passengers: Most airports have limited capacity to accommodate quarantined passengers. In addition to the limited space, both in existing terminals and in nearby buildings, other concerns include the availability of trained medical per- sonnel, medical and other essential supplies, food and water, and other necessary items. The duration of possi- ble quarantines is also an issue, as are the costs associ- ated with quarantining passengers and who would be responsible for paying these costs. • Critical partnerships between the Centers for Dis- ease Control and Prevention and local health officials: Many of these partnerships, through memorandums of understanding and other mechanisms, are in place today, but additional cooperation and coordination would probably be needed during a pandemic event. • Needs of the utility aviation sector: The utility avia- tion sector often operates from smaller airports and heli- 21DISCUSSION SESSIONS

pads and uses smaller aircraft and helicopters to service oil, gas, coal, and other utility and mining businesses, both onshore and offshore. Ensuring that the demand for oil, gas, and electricity is met during a pandemic event would entail maintaining these types of services. Workforce Issues in the Aviation Industry Bonnie Wilson, Discussion Facilitator Topics covered in the discussion on workforce issues in the aviation industry included identifying essential per- sonnel, protecting employees, and providing personnel with needed medical supplies. Participants also discussed how the projected 40% absenteeism during a pandemic event would affect different sectors of the aviation indus- try and how various sectors would increase staff after an event. Workforce issues also emerged during the discus- sions in other sessions. The major workforce topics dis- cussed in all sessions are summarized in this section. • Workforce absenteeism during a pandemic event: A 40% absenteeism rate has been projected; however, this is a peak estimate—not for the duration of a pan- demic event—used for planning purposes. Other factors, such as social distancing in which people avoid contact with others for fear of contracting the disease, will influ- ence the actual percentage. Human behavior is also likely to play an important role in how different segments of the population react. For example, hourly wage earners may be more likely to try to work than salaried workers, even if they are sick. Additionally, there are questions about how various sectors of the aviation industry would be able to respond to the 40% absenteeism projected during a pandemic event. Specific questions include what this 40% level means, when it would occur during an event, what the recovery period might be, and what the 60% of employees anticipated to be working would need to perform their duties in a safe and effective manner. If a 40% absenteeism rate is experienced, the industry will not be able to function at a 100% percent level. • Alternatives to addressing the estimated 40% absenteeism rate: Some employees would be able to telecommute, but most employees in the aviation indus- try have to be on site. Pilots, flight attendants, gate agents, caterers, ground crews, cleaners, and other per- sonnel cannot telecommute. Although some redeploy- ment and job sharing may be possible, the specialized expertise and skill level associated with many airport and aviation jobs limit these approaches. Further, although many airports have mutual-aid agreements with surrounding communities, fueling an aircraft is dif- ferent than fueling a truck and responding to a fire on an aircraft is different than responding to a house fire. How- ever, participants noted that providing opportunities to cross-train personnel to enhance job sharing during a pandemic event could be initiated now. • Distribution of essential supplies: There is a need to determine who essential employees are and whether priority will be given to them in the distribution of vac- cines, masks, gloves, and other essential supplies. Who will make these decisions, how people will be notified, how the vaccines will be administered, and how other medical supplies will be distributed also need to be addressed. It was noted that more information is needed from federal agencies concerning plans to provide med- ical supplies to the aviation sector, along with training in the use of protective masks, gloves, and other equipment. • Multiregional coordination of supplies during a pandemic event: The ability to obtain necessary medical and essential supplies, including vaccines, masks, gloves, fuel, and other items, will require maintaining regional and local supply chains. Different vaccines, of which some 80% are manufactured outside the United States, are being stockpiled, but there are questions related to the shelf life of some vaccines. Participants noted that assistance from the federal government will be impor- tant in obtaining needed medical supplies. • Employee relations and union rules in the planning process: The advantages of discussing pandemic event planning issues with unions and other labor groups were noted, as compared to doing so in the middle of an event. For example, drafting contract clauses relating to a pan- demic event might be appropriate. Flight attendants, ticket agents, and other personnel regularly interact with passengers. Ensuring they are aware of planned activities and potential responses through ongoing communica- tion was noted as important. • Modifying operating standards during a pandemic event: Regulatory agencies may not be able to give advance notice of modifying some operating require- ments, but a pandemic event is not a normal situation and changes in operation may be necessary as long as safety is not compromised. The lessons learned from the situation in New Orleans during and after Hurricane Katrina indicate that it could be helpful to establish min- imum standards that could be put in place for short peri- ods of time when there is a “safety-of-life” situation. The federal government, however, would have to make the decision about changes in normal requirements and standards. • Importance of open and ongoing communication with employees in all segments of the aviation industry: Developing protocols for providing critical information could help address the spread of misinformation during a pandemic event. It was suggested that sharing infor- mation now on the various planning activities currently under way would be beneficial for airport and airline employees and would support the maintenance of open 22 INTERAGENCY–AVIATION INDUSTRY COLLABORATION ON PLANNING FOR PANDEMIC OUTBREAKS

lines of communication that are critical during a pan- demic event. • Staffing levels during and after an event: In addi- tion to possible reductions in staffing levels during a pan- demic event, there could be a need to increase staff after an event. The provisions of labor contracts, benefit pack- ages, and other employee agreements may need to be considered during and after a pandemic event to attract employees back to the aviation industry. More thought could be given now to what these efforts might entail. Mitigating Economic Impacts and Preserving Air Service Rich Golaszewski, Discussion Facilitator Various topics were discussed related to mitigating the economic impacts of a pandemic event and preserving air service. These topics included maintaining the finan- cial viability of the air industry, reducing operating levels that place airlines and airports at risk financially, and communicating with the public and other groups to maintain confidence in the aviation industry. • Financial health of the aviation industry: Aviation is a global industry and its financial health is based on numerous factors. The aviation industry is generally in a better financial position than it was shortly after 9/11, but it is still vulnerable and a pandemic event that lasts 6 months or more could have greater financial ramifica- tions for the aviation sector. There are questions about whether there would be a viable aviation sector left after a major pandemic event. Some airlines trimmed to the basics after 9/11, with the result that not much more can be reduced. Dealing with the anticipated absenteeism, the ability to obtain fuel and other supplies, responding to possible requests for quarantining passengers, and the potential fear of the public to return to flying after a pan- demic event combine to paint a grim picture for the eco- nomic viability of air carriers. • Industry revenue effects: Airports operate based on revenues from numerous sources. In addition to the income generated by actual flight operations, airports receive significant revenues from parking and in-termi- nal restaurants, shops, and other businesses. A pandemic event would negatively affect all these revenue-generat- ing sources. • Example of the local economic impact of the avia- tion industry: The closure of Ronald Reagan Washing- ton National Airport for some 23 days after 9/11 provides an example of the important role airports play in the economy of an area and what might happen dur- ing a pandemic event. With no air traffic, most busi- nesses in the airport closed temporarily or reduced hours. Cleaning and support services were reduced. With no air travel, rental car companies had very little busi- ness. Some people in the community came to the airport for lunch to help businesses and to show support. The closing had a ripple effect on the tourism industry in the Washington, D.C., area. • Impacts of different scenarios on the air industry: It was suggested that the duration of a pandemic event will be the key to determining the extent of the impact to the industry. Even if airlines are able to increase cargo to off- set declines in passengers, or provide contract service for the government, an event that lasts multiple months will likely have a significant negative effect on the industry. A need could conceivably arise for the federal government to take action and provide financial assistance to airlines and airports. • Attracting customers after a pandemic event: Many airlines used promotional fares to attract people back to flying after 9/11. There were mixed comments on whether this strategy would be effective after a pandemic event. It may be more difficult to attract travelers who have other options, such as driving or taking a train, back to flying. The impacts, however, would likely be felt differently by different air carriers and airports. For example, smaller airports could be hurt more. Govern- ment could play an important role in helping to reestab- lish the feeling that it is safe to fly and helping to build the public’s confidence in traveling by air. • Funding sources available to airports: Many air- ports have bonding authority and use Airport Improve- ment Program funds for capital projects. Additional financing measures to assist airports were implemented after 9/11 and Hurricane Katrina, including flexibility in the use of passenger facility charges. During a pandemic event, funding would likely be needed for ongoing oper- ations and maintenance. Most airports do not have large cash reserves to draw on during a long-term event, espe- cially airports—including those in the Washington, D.C., region—that have major capital projects under way. • Use of aircraft in emergency response: Most airlines have contingency plans for weather, natural disasters, and major incidents and aircraft can be relocated to other air- ports in response to changing conditions. Air carriers, air ambulances, and other emergency response air services may be called on to assist with emergency evacuations or other relief services. During these situations, coordinating with existing emergency response efforts is important. For example, the Helicopter Association International’s first responder’s network is composed of operators who have agreed to share information and other resources. • Effects of hot zones in certain parts of the country: As no area wants to be identified as unsafe, addressing hot spots would likely be a public policy issue. The potential for international flights to be funneled to spe- cific airports outside of a hot zone might limit the indus- 23DISCUSSION SESSIONS

try’s ability to service some markets. A government limi- tation on service to some areas due to public health needs would likely be temporary, participants suggested, although the duration would depend on the nature of the disease. • Ability of airports and airlines to share informa- tion, coordinate, and cooperate during a pandemic event: Many airports have formal and informal agreements with other airports to share information and resources. These networks would probably be strained if a pandemic event lasted 6 to 12 months or longer. Antitrust legislation and a competitive environment may also limit the ability of airlines to work together. The National Response Plan, however, provides some flexibility during a pandemic event and there are possible roles the different airline alliances, associations, unions, and other groups could play to help promote information sharing and communi- cation in addition to the coordination roles of the FAA and state and local governments. • Possible scenarios during the recovery phase of a pandemic event: With regard to how quickly people will return to flying, it was noted that various market seg- ments would probably respond differently; business and government travel would probably return first, followed by leisure travel. The ability of airlines to communicate and cooperate during the recovery phase based on antitrust laws and the competitive nature of air service could influence recovery. Government agencies at the federal, state, and local levels, as well as trade associa- tions, airlines, airports, and other groups, each would have a role to play during the recovery phase. It was sug- gested that the development of a “toolkit” to contain measures that can be implemented to aid in recovery could be helpful. • Impact of a pandemic event on general aviation: There are mixed views on the effects to general aviation, but it was recognized that there is a potential for an increase in general aviation activity, with some travelers switching from commercial airlines to charter services. The available capacity of general aviation is a limiting factor to significant increases, however, and general avi- ation could experience the same absenteeism rates as commercial airlines. • Long-term viability of the airline industry: Airlines and airports are cash-intensive operations. As a result, the scope and duration of a pandemic event was noted as key to the long-term viability of the airline industry. The abil- ity to maintain basic levels of service, the ability to return to normal operations, and the potential need for financial assistance from the federal government during a lengthy pandemic event could affect the long-term outcome. • Assessing the current financial situation of the var- ious airlines: There are differences among the airlines and, as a result, each airline could experience different short- and long-term effects from a pandemic event. The various elements of the aviation industry will respond according to their own self-interest. Having better infor- mation on the current status of different sectors of the aviation industry would be beneficial. Currently, most airlines and airport recovery plans are more short term; some participants noted a need for longer-term plans. • Plans to return to normal operations: There are con- cerns related to clearly defining the roles and responsibili- ties of different groups, maintaining open and ongoing communication, and coordinating efforts. Specifically identifying the agency, individual, or group with the most credibility with the public to promote the return to normal operations was noted as important to the planning process. 24 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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