| by Dr. Ruwantissa Abeyratne

( April 4, 2014, Montreal, Sri Lanka Guardian) Unfortunately, the answer is yes, from an aviation perspective. There is heartening news that the International Civil Aviation Organization is in touch with the World Health Organization on the situation of an outbreak of Ebola in Western Africa. Of course each country is obligated to take effective measures to prevent the spread by means of air navigation of communicable diseases and to that end to keep in close consultation with the agencies concerned with international regulations relating to sanitary measures applicable to aircraft. Such consultation has to be without prejudice to the application of any existing international convention on the subject to which the States may be parties. This requirement is one prescribed by the Chicago Convention of 1944 which regulates international civil aviation.

Illustration of the Ebola virus. Visual Science.
Aviation is a dangerous business when it comes to communicable diseases. One does not forget the SARS (Severe Acute Respiratory Syndrome) outbreak of 2002, which brought a deadly disease all the way from Hong Kong to Toronto. The ICAO Assembly has adopted a Resolution urging Member States to develop a national preparedness plan for aviation that is in compliance with the World Health Organization International Health Regulations (2005) and based on scientific principles as well as guidelines from ICAO and the World Health Organization. Member States, and regional safety oversight organizations, as appropriate, were also urged to establish requirements for the involvement of stakeholders such as airport operators, aircraft operators and air navigation service providers in the development of a national preparedness plan for aviation. Member States were further requested to join and participate in the Collaborative Arrangement for the Prevention and Management of Public Health Events in Civil Aviation (CAPSCA) project, where available, to ensure that its goals are achieved, unless equivalent measures are already in place.

No one can deny that ICAO is playing a leadership role in the field of air navigation and aviation medicine. For example, on the premise that in a pandemic that kills 100,000 people, a contribution to risk reduction by the aviation sector of just one percent would potentially save 1000 lives, strengthens public health preparedness at the global, regional, national, and operational levels through a sustained program of regional meetings, training events, and assistance visits. The CAPSCA program provides an opportunity for public health personnel to work directly with aviation personnel to develop effective public health preparedness plans for aviation.

The benefits of CAPSCA to States include: multi-sector collaboration within the State, between States, and between international organizations; improved communication, coordination, cooperation, and collaboration between all stakeholders; synergistic and harmonized development of guidance by international organizations, especially between ICAO, WHO, IATA, and ACI; improved public health emergency prevention and response in aviation; reduced impact of public health emergencies on population health through reduced, delayed and/or mitigated health effects; mitigation of economic and social effects caused by public health events; a faster return to normal operations when the health threat subsides; and improved management of risk perception for the general public, air travelers, service providers, and aviation personnel.

Civil aviation has traditionally been used not only as the speediest means of communication and commercial transport between and beyond national boundaries, but also as a means of solace, particularly in providing relief to communities in distress whether from natural disaster, famine and ill health or war. Unfortunately, aviation has also been used as a weapon of mass destruction, particularly in the context of the catastrophic events of 11 September 2001. The latest concern of the international community may well be that, although aviation cannot be matched by other means of transportation in view of the speed inherent in air transport, it nonetheless portends certain threats to human health which may emerge as a result of its very nature, requiring the cloistering of a large number of humans in a limited space where ventilation and air pressure have to be provided in a contrived manner.

In this regard, SARS had an alarmingly high and increasing morbidity rate, which approached 6 per cent at its peak. Although the spread of the disease abated to a manageable degree in a few months of its outbreak, the threat of a pandemic lingered on and it would not be surprising if it were to resurface after a lapse of time. Some experts on communicable diseases went to the extent of predicting a global pandemic, along the lines of the Influenza which afflicted the world in 1919-20 killing 20 million worldwide despite its low morbidity rate of 1 per cent. The threat posed by SARS was compounded by the fact that already large countries such as China were severely affected, along with countries that had a high rate of trans-border communication such as Hong Kong and Singapore. It could be envisioned that, unless contained, the disease could spread to other large countries such as Australia, Canada ( which has already shown susceptibility) and the United States, along with the States of Europe. Stringent measures were taken by the countries afflicted such as enforcement of quarantines on thousands of hospital employees and patients, together with isolation of those not ill but have had some contact with afflicted individuals.

One of the major preoccupations of the World Health Organization (WHO) is to ensure the international prevention of disease. Quarantine regulations, which was the first step toward this aim, has a long history, having been introduced during the tenth Century. WHO adopted International Health Regulations in 1951, the philosophy of which was recognized subsequently as the purpose of International Health Regulations is to prevent international spread of disease, and in the context of international travel, to do so with the minimum of inconvenience to the passenger. This requires international collaboration in the detection, reduction or elimination of the sources from which infection spreads rather than attempts to prevent the introduction of disease by legalistic barriers that over the years have proved to be ineffective.

Of course, the purpose of this philosophy will be defeated if individual States have no willingness or the political will to notify the outbreak of communicable diseases to WHO, particularly in the absence of a monitoring body, incentives for States to notify or sanctions. Therefore the preeminent obligation of States is to ensure that the outbreak of any communicable disease is notified in a manner that would benefit the world and help prevent the spread of the disease across national boundaries. Regrettably, there have been instances recorded where WHO reports that no new instances of a communicable disease has been recorded while the news media give contrary information simultaneously. One of the reasons adduced for the lack of interest on the part of States to report the incidence of communicable diseases to a world body such as WHO has been identified as the lack of importance attributed to International Health Regulations (IHR) by States who consider the regulations as an obsolete relic.

With the air transport network being what it is, transporting 2.2 billion persons every year internationally, the likelihood of deadly diseases being communicated across boundaries is a grave probability. States have to be vigilant and collaborate with the international bodies with responsibility and selflessness.

Images credit to: Technabob.com