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Interagency-Aviation Industry Collaboration on Planning for Pandemic Outbreaks (2008)

Chapter: Stakeholder Comments on Workshop Discussions and Next Steps

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Suggested Citation:"Stakeholder Comments on Workshop Discussions and Next Steps." 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:"Stakeholder Comments on Workshop Discussions and Next Steps." 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:"Stakeholder Comments on Workshop Discussions and Next Steps." 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:"Stakeholder Comments on Workshop Discussions and Next Steps." 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:"Stakeholder Comments on Workshop Discussions and Next Steps." 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:"Stakeholder Comments on Workshop Discussions and Next Steps." 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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25 Stakeholder Comments on Workshop Discussions and Next Steps Francisco Averhoff, Centers for Disease Control and Prevention Susan McDermott, U.S. Department of Transportation Kate Lang, Federal Aviation Administration Jim White, Federal Aviation Administration Scott Middlekauff, Department of Homeland Security Megan Walket-Tighe, U.S. Department of State Tara Foley, Department of Homeland Security Debby McElroy, Airports Council International–North America Lydia T. Kellogg, Airports Council International–North America Steven Brown, National Business Aviation Association Dinkar Mokadam, Association of Flight Attendants, CWA, AFL-CIO Katherine Andrus, Air Transport Association, Moderator At the conclusion of the workshop, an overview ofthe session discussions was presented and senior-level officials from the federal agencies and indus- try associations had an opportunity to comment on these discussions. Their comments are provided in this section. Using information gathered throughout the workshop and in these summary discussions, several follow-up steps were noted for future consideration. STAKEHOLDER COMMENTS ON WORKSHOP DISCUSSIONS Centers for Disease Control and Prevention Francisco Averhoff Thank you very much for the opportunity to participate in this session. I am sorry I was not able to attend other parts of the workshop. From the summary this morning, it appears you had a very productive 3 days. You have covered the major issues. Our group, the Quarantine Branch of the Division of Global Migration and Quarantine, is committed to par- ticipating in these types of discussions and in coordinat- ing with other agencies and organizations. Our group is still relatively new and most of our staff are located at quarantine stations throughout the country. Historically, the various stations have worked somewhat indepen- dently and the approaches to illness response have been station specific. We are expanding our capabilities and focusing on a national approach to illness-response pre- paredness. As in many agencies, it is easy for different divisions and groups to focus on specific topics or areas of exper- tise. We need to ensure that these groups do not become “silos” but rather coordinate and cooperate with other parts of the agency as well as with other agencies and groups. We have an air investigation team and a port pre- paredness team. We have been working with airports, local communities, states, and other groups on response planning issues. To date, we have not worked as closely with airlines and the airline industry. The discussion this morning points out the need to include these groups in our ongoing activities. Enhancing communications among all groups would also be of benefit. Workshops, such as this one, provide opportunities for dialogue across agencies and industry groups. I am glad there was discussion of scaling

responses to the nature and severity of a pandemic event. This concept is important, as pandemic events will be different. We have learned from recent experiences with airline passengers displaying flu-like symptoms. We can build on these experiences as we move forward with more detailed planning. Additional research related to disease transmission on aircraft would be beneficial. Currently, data on influenza transmission on aircraft is lacking. For example, there was an outbreak of mumps this past year. We examined available information on reported passengers with mumps and found little evidence of transmission to other passengers. Understanding more about this issue would assist with refining a risk-based response approach. We would be interested in partnering with other agencies and groups on research in this area. Additional research would enhance evidence-based responses. Thank you again for the opportunity to provide com- ments on the workshop. I look forward to continued dis- cussions on these topics and to working with other agencies and groups on the suggested research and other activities. U.S. Department of Transportation Susan McDermott Good morning. Thank you for the opportunity to par- ticipate in this session. I commend TRB for organizing this workshop. The discussion has been very interesting and very beneficial. The U.S. Department of Transporta- tion (DOT) is very involved in various pandemic pre- paredness planning activities. U.S. DOT and FAA are dealing with potential economic impacts to airports and air carriers and the operational aspects of responding to a pandemic event. Planning has evolved over the past few years. There is a realization that plans need to be flexible and scalable. Risk-based and all-hazards approaches make sense. We need to be able to respond to a variety of scenarios, including those dealing with infectious diseases. The concept of degree is important. A toolbox approach makes more sense than a cookbook approach. Flexibility is needed to scale up quickly or slowly depending on the nature of an event. The various federal agencies are working together on different pandemic response planning activities. U.S. DOT is working with the Homeland Security Council, the Department of Homeland Security (DHS), and the Department of Health and Human Services (HHS) on papers related to these different planning activities. These papers will be available soon for review and com- ment by other agencies and industry groups. Our experi- ence is that we receive better comments and feedback when we provide a draft document for others to review. We look forward to receiving your comments and to continuing dis- cussions on these topics. We are focusing on the potential impacts to airports, air carriers, and communities. As a regulatory agency, U.S. DOT deals with airports, air carriers, labor unions, communities, and other sec- tors of the aviation industry on a regular basis. We also interact on an international level with governments, air carriers, and organizations in other countries. Providing forums such as this workshop is very beneficial. We hope to enhance communication among all groups and look forward to participating in future events. U.S. DOT will continue to work with DHS, HHS, and other agencies on the various planning activities. We are mindful of the potential financial and economic impacts a pandemic event could have on air carriers, airports, and communities. A toolbox approach that provides flexibility in response to match the nature, scale, and spread of an infectious disease appears to make sense. Again, thank you for the opportunity to participate in this workshop. I look forward to continuing to work with you on these important topics. Federal Aviation Administration Kate Lang As I noted in the opening session, I would like to thank Katherine and Jim Crites for taking the initiative to develop the concept for this workshop. I would also like to thank TRB for organizing the workshop. It has been very beneficial to bring representatives from the various agencies and organizations together to share informa- tion and discuss common concerns. We have much to learn from each other. There were a number of encouraging points made by speakers, including representatives from the Centers for Disease Control and Prevention discussing a risk-based approach to quarantines. It is a daunting task to think of the response at airports if the passengers on a full plane or multiple planes need to be quarantined. The facility and personnel requirements to quarantine one or multiple air- planes would stress most airports. The concept of a scal- able risk-based response appears to be more manageable. The discussion of potential impacts on airports and airlines from employee absenteeism during a pandemic event was interesting. Airports may be in a slightly better position than airlines in addressing absenteeism. Exam- ining approaches that airports and airlines can use to respond to high levels of employee absenteeism in more detail would be beneficial. A number of comments were made related to main- taining the financial health of airlines, airports, and the aviation industry as a whole. Ensuring the vitality of the aviation sector is a key concern of the FAA in all emer- gencies. We are committed to working with all groups to maintain a financially viable aviation system. 26 INTERAGENCY–AVIATION INDUSTRY COLLABORATION ON PLANNING FOR PANDEMIC OUTBREAKS

It was also interesting to hear the discussion related to essential supplies. Given the experience during Hurri- cane Katrina, I agree that it is important to ensure that needed supplies are available. Additional conversations on this topic would be useful, as we have good connec- tions with suppliers and can help ensure that essential items are available. Developing a common list of essen- tial supplies would be of help to all groups. This workshop has been very beneficial. I hope the dia- logue will continue among participants and agencies. We in the FAA are committed to participating in ongoing activi- ties, and I look forward to future meetings. Thank you. Federal Aviation Administration Jim White I appreciate the opportunity to participate in this work- shop. The discussion on the different topics was very enlightening. Although we have been working on these issues for the past 2 years, there is still much to learn. It is especially beneficial to hear about the activities of other agencies and groups. The discussion of the uncertainty associated with plan- ning for these types of events was very productive. There is a desire for specific answers on how the various agen- cies and groups will react, but much will depend on the extent of a specific pandemic event, the illness and fatal- ity rates, and the duration. These factors, as well as other issues, will influence the response from federal agencies. The toolbox approach makes sense, as it allows agencies and groups to match appropriate responses with the nature of an event and the needs of specific areas. Building on the discussion at this workshop is impor- tant. Maintaining open and ongoing communication should certainly be a priority. There are also opportunities to pursue needed research. The suggestion from Centers for Disease Control and Prevention personnel concerning research on disease transmission rates on aircraft and flights of different lengths would be an appropriate topic for the Airport Cooperative Research Program (ACRP). Developing a problem statement and submitting it to ACRP would be a logical next step. Thank you. Department of Homeland Security Scott Middlekauff Thank you for the opportunity to provide a few com- ments. I am pleased to be able to participate in this ses- sion for Til Jolly, who spoke at the opening sessions. The Department of Homeland Security (DHS) is collaborat- ing with other agencies on numerous activities related to planning for pandemic events. An interagency group is completing the first draft of the federal contingency plan. The plan outlines the response of each federal department during different stages of a pandemic event. As you can imagine, devel- oping one plan that addresses the roles and responsibili- ties of the major federal agencies is a challenge. All federal departments including the State Department, the Department of Health and Human Services (HHS), the Centers for Disease Control and Prevention (CDC), and the U.S. Department of Transportation (DOT) have been involved in developing the plan. We will be seeking stakeholder review of the draft plan very soon. The border management plan is also in the final stages of development. It will be incorporated into the contin- gency plan. Representatives from the State Department, U.S. DOT, CDC, and other departments have been involved in developing the border management plan. It addresses a number of elements, including screening pro- tocols and controlling the borders. The development of the community mitigation strate- gies has been another significant activity involving DHS, HHS, CDC, and other agencies. As a public health ser- vice office, we typically focus on helping people get well after they become sick. We often do not focus enough attention and resources on preventing an illness to begin with. The main goal of the community mitigation strate- gies is to delay the onset of a communicable disease and to keep most people from contracting the disease. Information on the community mitigation strategies will be available soon. A major communication effort will be needed to explain the reasons for the strategies to the public, policy makers, businesses, and other groups. Depending on the characteristics of the disease, possible strategies include dismissing schools and keeping chil- dren at home, allowing workers to telecommute, and distributing and using antiviral medications and masks. Possible response strategies continue to evolve. Some of the assumptions contained in the implementation plan, which was completed a year ago, have changed. These changes reinforce the need for flexible and scal- able plans that are responsive to different diseases and levels of severity. I participated in a meeting yesterday in North Car- olina discussing the community mitigation strategies and responses. Topics such as identifying key personnel to receive antivirus vaccines, masks, and other equipment were discussed. Funding issues and financing various response strategies were also topics of discussion. The National Response Framework permits the Sec- retary of DHS to designate a National Principal Federal Official (PFO) to coordinate the federal response in an incident of national significance. DHS Secretary Chertoff has designated Coast Guard Vice Admiral Vivien Crea as the National PFO. As the National PFO, Admiral Crea will be responsible for coordinating the federal response to a pandemic event. She will be working with the appro- 27STAKEHOLDER COMMENTS AND NEXT STEPS

priate federal agencies to ensure ongoing communica- tion. The interagency response will be based on previ- ously established roles and responsibilities. The draft screening protocols that have been men- tioned during the workshop are currently being reviewed at the Homeland Security Council. After the draft is approved by the Council, it will be released for review by the various stakeholder groups. It is anticipated that the Sector Coordinating Council (SCC) through the National Implementation Protection Plan will lead the stakeholder outreach process to obtain feedback on the screening pro- tocols. Chris Bidwell from the Air Transport Association currently chairs the SCC, which also includes representa- tives from private-sector organizations. U.S. Department of State Megan Walket-Tighe Thank you. I appreciate the opportunity to participate in this session. The Avian Influenza Action Group at the State Department is dedicated to working on influenza and pandemic planning and related activities. I am with the Office of Transportation Policy, which is working with the Avian Influenza Action Group to ensure that economic interests are considered in developing pan- demic event response and recovery plans. In addition to coordinating with other federal agen- cies, we are reaching out to our international partners to ensure there is communication and cooperation on a worldwide basis. We want to make sure there is consis- tency among plans at the international level and that we are not working at cross-purposes. As you can imagine, coordinating pandemic response plans from different countries has been challenging. Ongoing communication with international stakeholders is important. Numerous efforts related to pandemic planning, avia- tion security, and response are under way. We have been involved in developing the National Strategy for Avia- tion Security. The Air Transport System Recovery Plan represents another related activity. We have also been working on the screening protocols. As noted in the sum- mary comments, being sensitive to possible overlap and duplication is important. Continuing conversations at meetings and workshops is very useful for keeping all groups involved as well as for avoiding potential dupli- cation of efforts. Thank you. Department of Homeland Security Tara Foley I wanted to mention that Department of Homeland Security staff have been attending the National Gover- nors Association Pandemic Workshops that are being held throughout the country. The workshops are being coordinated with the Department of Health and Human Services. There have been representatives from airlines, airports, and related groups at many of the workshops. The workshops provide another good example of the outreach and coordination efforts under way. We need to continue to work together on the numerous planning activities to ensure a coordinated response. Thank you. Airports Council International–North America Debby McElroy Thank you, Katherine. I would like to echo the com- ments others have made this morning about the value of the discussions at the workshop. I was only able to attend yesterday afternoon and this morning, but Lydia Kellogg participated in the full workshop. I was impressed by both the information provided by partici- pants and by the commitment to continue working together on this important topic. I was also struck by how little we know about the potential magnitude of possible outbreaks and about how much of an airport’s response to these situations will be determined by actions at the federal and state levels. It is critical to continue the involvement of all stake- holders in the planning process for possible pandemic events. Airports are in a unique position in that they have a clear and important role in the national transportation system but are part of state or local governments. This situation imposes additional responsibilities, as well as extra reporting, for most airports. There are also numerous differences among airports. These differences will influence the response capabilities and approaches to pandemic events. An airport located in a state capital will typically be working closely with the governor and state officials. An airport that is colo- cated with the National Guard or a military base will have different response capabilities than one that is not. It is important to ensure that the airports have flexibility to craft a pandemic response plan that is appropriate for their unique circumstances. We recently conducted a survey of our members to obtain information on the status of pandemic planning activities. The responses indicate that many airports have plans in place for responding to pandemic events. In many cases, however, it appears the pandemic response plan is part of a larger emergency response plan. I think it is important to recognize that this approach may not provide the necessary focus on the unique aspects of a pandemic event, including the unknowns related to the length of the disruption or the level of the disruption. The survey results also indicated that many airport representatives are looking to Airports Council Interna- 28 INTERAGENCY–AVIATION INDUSTRY COLLABORATION ON PLANNING FOR PANDEMIC OUTBREAKS

tional to provide additional information on the federal response, regulatory relief, and critical issues. We are committed to participating in the various planning activ- ities. Again, I appreciate the opportunity to participate in this workshop and I look forward to continuing to work with you on this important topic. Airports Council International–North America Lydia T. Kellogg I would like to reiterate Debby’s comments. We look for- ward to actively participating in these types of sessions and obtaining critical information for our airport mem- bers. Airports will play a key role in responding to pan- demic events. Involving airport representatives in the planning process is important. Airports Council Interna- tional can assist in linking airports with federal and state planning activities. We look forward to working with you in future workshops and other activities. National Business Aviation Association Steven Brown I appreciate the opportunity to participate in this session and I apologize for not being able to attend the full work- shop. The National Business Aviation Association (NBAA) is interested in the topics discussed at the work- shop. I look forward to working with you on future activities. By way of background, the NBAA represents some 8,000 businesses and corporations that operate aircraft for business purposes. NBAA members operate a wide range of air services. Most NBAA members focus on air operations in the United States. Only about 20% of our members operate international services. Most of the international air service focuses on destinations in Canada and Mexico. Probably less than 10% of the international air service is to destinations outside of Canada and Mexico. This international service tends to be operated by large companies using larger airplanes. Most companies that fly internationally have internal policies related to emergency response. Most have thought about the potential of responding to a pandemic event. International business aviation operations tend to be very secure. Planes are attended at all times and are maintained in secure areas. International business flights often carry top company officials, entertainment or sporting industry personnel, or other notable people. This type of travel could possibly be reduced during a pandemic event. In many regards, business aviation is similar to com- mercial aviation. There is not a lot of scalability or excess capacity in business aviation. The number of pilots, atten- dants, and other personnel is limited. There are flight and duty time limitations. Business aircraft are not designed to fly the number of hours commercial aircraft fly. Business airplanes are designed for 1,000 flight hours a year com- pared with 4,000 flight hours for commercial aircraft. As a result, the capacity of corporate aviation is limited. General aviation reflects smaller operations. General aviation is focused almost exclusively within the United States. There is a small amount of general aviation travel to Canada, Mexico, and the Caribbean. The length of stay for these trips is typically only a few days, however. There is some available capacity in general aviation but not enough to accommodate large volumes of passengers. Again, I appreciate the opportunity to participate in this session and I look forward to future activities. Association of Flight Attendants, CWA, AFL-CIO Dinkar Mokadam I would like to thank Katherine and TRB for the oppor- tunity to participate in this workshop. It has been an excellent learning experience and very beneficial. As the only representative from labor, I do feel somewhat alone, however. It would be good to have more representatives from aviation labor groups participating in workshops such as these. I would be pleased to help identify other labor organizations to include in future workshops. It is important to remember that flight attendants inter- act directly with air passengers. They are the face of the air- lines and the aviation industry to the public. Flight attendants and other airline and airport personnel should be treated fairly and with respect in developing a pandemic response plan and in reacting to actual situations. Open lines of communication are critical. Flight attendants need to be kept informed about planning activities at all levels as well as their roles in reacting to possible scenarios. The flow of information to flight attendants and other employees could have been better during the severe acute respiratory syndrome epidemic. We need to learn from that situation and in the future do a better job of keeping all groups informed on the status of outbreaks and the actions being taken. I appreciate the opportunity to participate in the workshop and look forward to working with you on future activities. I will be happy to help with outreach efforts to other labor groups. Thank you. NEXT STEPS The activities described in this section were among those participants identified as opportunities to build on the 29STAKEHOLDER COMMENTS AND NEXT STEPS

dialogue and information sharing initiated at the work- shop. • Share workshop information with others in an organization or agency: A number of participants noted that they would share the information from the work- shop with other individuals in their agency or organiza- tion as well as other groups. Providing updated information to members of associations, trade groups, labor unions, and other organizations was identified as important to help enhance a common understanding of current efforts and activities. • Continue dialogue among all groups: Methods to continue the dialogue started at the workshop were iden- tified and discussed as well as approaches to provide all appropriate groups with the opportunity to review the various plans and programs being developed by federal agencies. Using existing committees and groups, includ- ing the TRB Task Force on Aviation Security and Emer- gency Management and other TRB committees, was suggested as a good method to focus future efforts for sharing information. • Promote and conduct additional research: Partici- pants reviewed some topics for further research identi- fied during the workshop. These topics included assessing the transmission of infectious diseases in air- craft cabins, techniques for cross-training essential air- port and local community personnel, defining essential services, and developing communication methods and messages to disseminate information to the public. Par- ticipants volunteered to develop problem statements for the Airport Cooperative Research Program (ACRP) and other research programs. • Assist with reviewing agency plans and programs: Participants discussed approaches to provide the various aviation industry groups and organizations with the opportunity to review and comment on the various plans and programs being developed by federal agencies. Par- ticipants from different organizations and groups at the workshop volunteered to help with the review process. Federal agency personnel expressed interest in working with these organizations, as well as other groups, to maximize stakeholder review of the various plans and programs. Participants stressed the importance of pro- viding opportunities for stakeholder review and mean- ingful and useful comments on the draft documents. Workshops and table-top exercises were also discussed as methods to help disseminate information on the dif- ferent plans and programs. • Conduct additional workshops: Participants dis- cussed opportunities for future workshops on different topics related to the aviation industry and pandemic events. The ACRP, which sponsored this workshop, rep- resents one potential funding source. Other related TRB committees might also be interested in sponsoring or cosponsoring a workshop or session at a conference. There may also be opportunities for workshops or ses- sions associated with various aviation industry meetings. • Leverage resources and build on existing relation- ships: Participants discussed the need to leverage resources among the various groups and agencies. Avoiding dupli- cation of effort and maximizing personnel and financial resources were noted as important, as was using existing organizations and channels of communication to share information. The ability to build on existing relationships was also discussed. Airports typically have strong working relationships with local, regional, and state governments. Air carriers interact more with federal agencies and typi- cally do not have strong relationships at the local, regional, and state levels. It was suggested that the existing working relationships of all these groups could be enhanced by ongoing coordination and cooperation. • Use TRB as a catalyst for communication: Partici- pants discussed using TRB to help promote ongoing communication among all groups and to coordinate future workshops and other activities. The ability to maintain and expand on the conference website, along with other methods to provide updated information of interest to all groups, could be useful. Involving different committees in follow-up activities, organizing annual meeting sessions on key topics, and planning future workshops were also mentioned as possibilities. 30 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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