Airports and Airlines That We Reviewed Have Plans, but a Comprehensive National Aviation- Preparedness Plan Does Not Exist

		Airports and Airlines That We Reviewed Generally Have Communicable- Disease Preparedness Plans

			Airports and Airlines We Reviewed Have Preparedness Plans

All of the 14 airports and three airlines we reviewed have plans—often  contained in multiple documents—in place for responding to  communicable disease threats from abroad. The plans in place for each  airport and airline generally address the high-level components that we  identified as common among applicable federal and international  guidance. Establishment of an incident command center. 3. 2. In 2010, ICAO, by resolution,  further urged member states to ensure that the public health sector and  the aviation sector collaborate to develop a national preparedness plan  for aviation to help prevent the spread of communicable diseases through  air travel, and that member states establish requirements for the  involvement of stakeholders, such as airport operators and airlines, in the  development of the plan. While the United States has not developed a national aviation- preparedness plan for communicable disease outbreaks, DOT and CDC  officials contend that some elements of such a plan already exist. However, FAA reported to ICAO in 2010—by way of  answering an ICAO questionnaire on member states’ fulfillment of this  standard—that individual airport plans are intended to handle one or two  flights with inbound passengers and not respond to a full epidemic, which  may require a response involving multiple airports on a national level. An adaptable and scalable framework would subsequently  improve harmonization of individual plans across airports and airlines— helping ensure that the individual plans work in accordance with one  another for a national level response effort—and serve as the basis for  training airport and airline staff and crew. To address these challenges, aviation stakeholders reported  taking actions such as developing communication tools and strategies;  reviewing, exercising, and improving response plans; and providing  training, equipment, and cleaning supplies. A national aviation- preparedness plan could serve as the basis for testing communication  mechanisms among responders to ensure those mechanisms are  effective prior to addressing a communicable disease outbreak. It could  also serve as the basis to ensure that airport and airline staff have  received appropriate training and access to properly maintained  equipment to reduce the risk of exposure to communicable diseases  during an outbreak. Airport and airline representatives we spoke with identified actions they  took to provide information about the Ebola threat to better inform the  public. Furthermore, Annex 9 to the Chicago  Convention obligates member states to establish a national aviation- preparedness plan—a plan intended to provide a mechanism for the  public health sector to coordinate with the aviation sector in the event of a  communicable disease threat. Such a plan could help maximize an effective response to a  public health threat, while minimizing potential inefficiencies in the  national response effort and unnecessary disruptions to the national  aviation system. Recommendation

To help improve the U.S. aviation sector’s preparedness for future  communicable disease threats from abroad, we recommend that the  Secretary of Transportation work with relevant stakeholders, such as the  Department of Health and Human Services, to develop a national  aviation-preparedness plan for communicable disease outbreaks. GAO staff who made key contributions to this  report are listed in appendix V.

Appendix I: Objectives, Scope, and Methodology

	Objectives

GAO was asked to review the preparedness of the U.S. aviation system  in responding to communicable disease threats from abroad. This report  examines:  1. The extent to which selected U.S. airports and airlines have  preparedness plans to respond to communicable disease threats from  abroad and the extent to which a national aviation-preparedness plan  guides preparedness. Selected airports and airlines: We selected for review 14 airports—which  accounted for about 53 percent of total international arriving passengers  in 2014—that met one or more of the following criteria (see table 1): have enhanced passenger entry-screening procedures in place for  international passengers arriving from the three current or past Ebola- affected countries in West Africa;  received the first and second largest number of international  passengers from each of five world regions in 2014;  large hub airports with a Centers for Disease Control and Prevention (CDC) quarantine station on site at the time of our review; large hub airports without a CDC quarantine on site, but still receiving a larger number of international passengers relative to other large hubs without a CDC quarantine station on site; experienced a confirmed Ebola case; have a station manager from one of the three U.S. airlines in our review; and are located within proximity to a GAO office. We identified and  reviewed applicable federal requirements and international obligations,  including the International Civil Aviation Organization’s (ICAO) Standards  and Recommended Practices, and guidance for U.S. airports and airlines  with international air traffic. We reviewed available  documents from the five selected federal departments and their relevant  components and interviewed officials from these departments. To examine challenges that U.S. airports and airlines, including  contractors, have faced when responding to communicable disease  threats, including Ebola, and the actions they have taken to help address  those challenges, we first identified challenges through interviews with  selected airports and airlines as discussed above, as well as interviews  with representatives from the labor union representing airport- and airline- service employees, and airport- and airline-contract employers of service  employees.
Why GAO Did This Study

Past communicable diseases, such as the recent Ebola epidemic, have resulted in many deaths and highlight the potential economic cost of disruptions to air travel and the U.S. and global economies.
GAO was asked to review the preparedness of the U.S. aviation system to respond to communicable diseases. This report examines (1) the extent to which selected U.S. airports and airlines have plans for responding to communicable disease threats from abroad and to which a national aviation-preparedness plan guides preparedness, and (2) the challenges that U.S. airports and airlines have faced when responding to threats and any actions taken to address them.
GAO reviewed available documents and interviewed representatives from 14 U.S. international airports—selected to reflect a range of activities and facilities—and the 3 major U.S. airlines. GAO also reviewed applicable federal requirements and international obligations and guidance for U.S. airports and airlines, and interviewed officials and reviewed documents from federal agencies and aviation stakeholder groups.

What GAO Found

All of the 14 airports and 3 airlines GAO reviewed have plans for responding to communicable disease threats from abroad, although the United States lacks a comprehensive national aviation-preparedness plan aimed at preventing and containing the spread of diseases through air travel. U.S. airports and airlines are not required to have individual preparedness plans, and no federal agency tracks which airports and airlines have them. Consequently, it is not clear the extent to which all U.S. airports and airlines have such plans. The plans GAO reviewed generally addressed the high-level components that GAO identified as common among applicable federal and international guidance, such as establishment of an incident command center and activation triggers for a response. GAO identified these components to provide a basis for assessing the breadth of the plans. The plans GAO reviewed for each airport were developed by, or in collaboration with, relevant airport stakeholders, such as Centers for Disease Control and Prevention's (CDC) airport staff. As provided in Annex 9, the Chicago Convention, an international aviation treaty to which the United States is a signatory, obligates member states to develop a national aviation-preparedness plan for communicable disease outbreaks. The Department of Transportation (DOT) and CDC officials contend that some elements of such a plan already exist, including plans at individual airports. However, FAA has reported that individual airport plans are often intended to handle one or two flights with arriving passengers, rather than an epidemic, which may require involvement from multiple airports on a national level. Most importantly, a national aviation-preparedness plan would provide airports and airlines with an adaptable and scalable framework with which to align their individual plans—to help ensure that individual airport and airline plans work in accordance with one another. DOT and CDC officials agree that a national plan could add value. Such a plan would provide a mechanism for the public-health and aviation sectors to coordinate to more effectively prevent and control a communicable disease threat while minimizing unnecessary disruptions to the national aviation system.
Aviation stakeholders GAO spoke with identified multiple challenges in responding to communicable disease threats and actions they took or would take in response. For example, airline and airport representatives told GAO they sometimes experienced difficulties sharing timely and accurate information about threats, and some reported that they improved communication by developing tools, such as standardized forms, to collect and share relevant information. Employees at aviation services firms that GAO spoke with—including contract workers who clean aircraft—raised concerns about the availability of training and access to equipment to control exposure to communicable diseases. Some airports GAO reviewed developed additional mechanisms to ensure adequate training and preparation during the Ebola threat. A national aviation-preparedness plan could serve as the basis for testing communication mechanisms among responders to ensure those mechanisms are effective prior to a communicable disease outbreak as well as to provide the basis for ensuring that airport and airline staff receive appropriate training and equipment to reduce their risk of exposure to communicable diseases during an outbreak.

What GAO Recommends

GAO recommends that DOT work with relevant stakeholders, such as the Department of Health and Human Services, to develop a national aviation-preparedness plan for communicable diseases. DOT agrees a plan is needed, but suggests public health agencies lead the effort. GAO continues to believe the recommendation is correctly directed to DOT, as discussed in this report.