Air Travel and Communicable Diseases: Status of Research Efforts and Action Still Needed to Develop Federal Preparedness Plan
Released: 2020-06-23T00:00:00

Letter

Background

In the United States, the roles and responsibilities related to preparing for, assessing, and responding to communicable disease threats in the civil aviation system require immense coordination among a number of federal agencies and aviation stakeholders. Each federal agency has a different mission, which affects its responsibilities for protecting against communicable disease threats. The DHS and HHS are the lead agencies for responding to a communicable disease threat. They focus on protecting our borders at ports of entry, including airports, from threats from abroad and protecting the nation from domestic and foreign health, safety, and security threats, respectively. FAA is responsible for civil aviation and commercial space transportation flight safety in the United States and the safe and efficient movement of air traffic in the national airspace system, as well as for the safety of U.S. airlines, other U.S. operators, and FAA-certificated aircrews worldwide. As part of this responsibility, FAA regulates and certificates airports, airlines, and airmen and provides guidance.

In the case of a communicable disease threat, numerous federal, state, and local entities may be called upon to respond, depending on their legal authority and whether the threat is identified before, during, or after the flight. For example, before boarding, HHS and DHS may identify travelers who are not allowed travel, based on public health threats. The CDC can prohibit the introduction of nonresident foreign nationals into the United States from designated countries or places, but only for such time as the CDC deems necessary for public health. During a flight, CDC regulations require pilots to immediately report to CDC any deaths or the occurrence of any travelers with signs or symptoms that may indicate a communicable disease infection during international flights coming to the United States. And, once an aircraft with a suspected ill passenger approaches an airport, federal or local public health officials, first responders (e.g., fire or emergency medical technicians), airport authorities, air traffic control personnel, or a combination of these stakeholders may make decisions about and lead certain aspects of the response based on the situation and available response protocols or preparedness plans. In addition, some response-related roles and responsibilities are established in law or by interagency agreements, and others may be defined in FAA-required airport-emergency plans, although those plans are not required to address communicable disease threats.

In addition, FAA supports and coordinates a range of R&D activities for the civil aviation system. The inventory of FAA’s R&D activities is expressed in the National Aviation Research Plan (NARP) and in FAA’s Fiscal Year R&D Annual Review. FAA is required to submit both of these documents annually to Congress. According to FAA’s most recent NARP, FAA’s research budget from all accounts in FY 2017 was $422.3 million. FAA’s research budget supports activities conducted by FAA as well as a range of partners, including other government agencies, universities, and private sector organizations.

FAA’s process for developing its commercial aviation research portfolio spans the agency. To develop the NARP and its R&D portfolio, FAA’s program planning teams, which focus on specific research program areas, identify R&D projects to meet one of DOT’s three strategic goals and FAA’s five R&D goals. Further, an executive board in FAA provides guidance and oversight over the agency’s portfolio development process, and a statutorily created advisory committee—consisting of individuals that represent corporations, universities, associations, and others— conducts external reviews of FAA’s R&D programs for relevance, quality, and performance. This advisory committee also makes recommendations to FAA on the proposed R&D portfolios and budgets.

In the Continued Absence of a Comprehensive National Plan, the U.S. Aviation System Remains Insufficiently Prepared to Respond to Communicable Disease Threats

In 2015, we found that the United States lacked a comprehensive national aviation-preparedness plan to limit the spread of communicable diseases through air travel, though some individual airport and airline preparedness plans did exist. Accordingly, we recommended that DOT work with relevant stakeholders, such as HHS, to develop a national aviation- preparedness plan for communicable disease outbreaks. We emphasized that a comprehensive national plan would provide a coordination mechanism for the public-health and aviation sectors to more effectively prevent and control a communicable disease threat while also minimizing unnecessary disruptions to the national aviation system. Additionally, U.S. airports and airlines are not required to have individual preparedness plans for communicable disease threats and no federal agency tracks which airports and airlines have them. As such, the extent to which U.S. airports and airlines have such plans is unknown. However, all 14 airports and 3 airlines we reviewed in 2015 had independently developed preparedness plans for responding to communicable disease threats from abroad. These plans generally addressed the high-level components that we identified as common among applicable federal and international guidance for emergency preparedness, such as establishment of an incident command center and activation triggers for a response. While the 14 airports and 3 airlines had plans that address communicable diseases, representatives from these airports and airlines reported facing multiple challenges in responding to threats. Identified challenges that included obtaining guidance; communication and coordination among responders; and assuring employees have appropriate training, equipment, and sanitary workplaces. As we stated in our 2015 report, a national aviation preparedness plan to respond to communicable disease outbreaks could help address these challenges.

As of June 2020, DOT, DHS, and HHS stated that the federal government still has not developed a national aviation-preparedness plan to respond to communicable disease outbreaks. In making our recommendation in 2015, we pointed to Annex 9 to the Chicago Convention—an international aviation treaty to which the United States is a signatory—which contains a standard that obligates International Civil Aviation Organization (ICAO) member states to develop a national aviation-preparedness plan for communicable disease outbreaks. DOT and CDC officials in 2015 stated that some elements of a national aviation-preparedness plan already exist, including plans at individual airports. However, as we discussed in our 2015 report, individual airport plans are often contained in multiple documents, and FAA reported that the plans are intended to handle communicable disease threats posed by passengers on one or two flights, 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 concert with one another.

DOT and CDC officials agreed in 2015 and continue to agree today that a national aviation-preparedness plan could add value. DOT, however, maintains that those agencies that have both legal authority and expertise for emergency response and public health—namely DHS and HHS—are best positioned to take the lead role in developing such a plan within the existing interagency framework for national-level all-hazards emergency preparedness planning. We continue to believe that DOT would be in the best position to lead the effort because FAA and DOT have stronger and deeper ties to, as well as oversight responsibility for, the relevant stakeholders that would be most involved in such a broad effort, namely airlines, airports, and other aviation stakeholders. In addition, DOT’s Office of the Secretary is the liaison to ICAO for Annex 9 to the Chicago Convention, in which the relevant ICAO standard is contained.

In response to the current COVID-19 pandemic and in the absence of a national aviation-preparedness plan, DOT officials pointed to ongoing efforts to engage with interagency partners at DHS and HHS, as well as industry stakeholders, to better collaborate on the aviation sector’s communicable disease response and preparedness. For example, DOT told us that it has facilitated conference calls between federal and private sector stakeholders and has collaborated with CDC to update interim guidance for airline crews related to communicable diseases, specifically COVID-19. While these actions are helpful, some aviation stakeholders have publicly highlighted piecemeal response efforts that may have led to some of the confusion among stakeholders and chaos at certain airports that occurred earlier this year following the COVID-19 travel bans and increased screening efforts. For example, stakeholders described actions taken by individual airlines in the absence of FAA guidance, such as to cease operations to certain countries, and a piecemeal approach to establishing standards for safely continuing or expanding service, such as various airline and airport policies regarding facemasks. This piecemeal approach points to the continued need for DOT to implement our 2015 recommendation to develop a coordinated effort to plan for and respond to communicable disease threats. We have included this open recommendation as one of 16 high priority recommendations to DOT.

FAA Has Taken Steps to Improve Its R&D Portfolio Management, but Has Conducted Limited Research on Disease Transmission in Aircraft and Airports FAA is Taking Steps to Improve the Formulation and Management of its R&D Portfolio Based on GAO Recommendations

While a national aviation-preparedness plan can help better manage the response to the next aviation pandemic, other efforts such as research and development are also key. In 2017, we found that FAA’s actions related to the management of its R&D portfolio were not fully consistent with statutory requirements, agency guidance, and leading practices. As part of that work, we assessed FAA’s actions to manage its R&D portfolio in three key areas: (1) developing its portfolio of R&D projects, (2) tracking and evaluating those projects, and (3) reporting on its portfolio. We found that FAA could be more strategic in how it develops its R&D portfolio, chiefly in identifying long-term research needs and in improving disclosure of how projects are selected. As a result of these deficiencies, we found that FAA management could not be assured that the highest priority R&D was being conducted. We also found that while FAA tracks and evaluates its research projects consistent with leading practices, it did not fully address all statutory reporting requirements, such as identifying long-term research resources in the National Aviation Research Plan (NARP) or preparing the R&D Annual Review in accordance with government performance-reporting requirements. These reporting deficiencies can limit the usefulness of the reports to internal and outside stakeholders. Accordingly, in 2017, we recommended that DOT direct FAA to (1) take a more strategic approach to identifying long- term R&D research priorities across the agency, (2) disclose how research projects are prioritized and selected, and (3) ensure that the NARP and R&D Annual Reviews meet statutory requirements for content. DOT agreed with all three recommendations.

As of June 2020, FAA has fully addressed one of our recommendations and taken partial action on two other recommendations. Specifically, FAA fully responded to our recommendation that FAA disclose the process it uses for prioritizing and selecting research projects by updating in 2018 its internal guidance documents to allow better transparency over project selection. In partially responding to our recommendation to take a more strategic approach to identifying research priorities across the agency, in June 2019, FAA issued a redesigned National Aviation Research Plan (NARP) for 2017-2018. The redesigned plan is a good first step. Also as part of an effort to be more strategic, FAA is beginning to take actions to understand emerging aviation issues requiring FAA’s research attention. This recommendation has not been fully addressed as, according to FAA officials, the agency is still developing guidance to ensure that future NARPs take a strategic approach and incorporate emerging issues into future plans. FAA officials told us they plan to finalize the guidance by the end of 2020. Similarly, with respect to our recommendation aimed at achieving compliance with statutory reporting requirements, the redesigned 2017-2018 NARP included a list of agreements with federal and nonfederal entities on research activities, resource allocation decisions, and a description of technology transfer to government, industry, and academia, among other items. Officials told us that they are finalizing the 2019 R&D Annual Review, which has been redesigned to address other statutory reporting requirements, and will develop guidance to ensure that future documents meet those requirements.

Disease Transmission Research Has Received Limited FAA Focus in Recent Years

FAA has sponsored limited federal research into disease transmission onboard aircraft and in airports. FAA’s research goals focus on areas like improving airport operations and air space management, and developing new technologies, which FAA has aligned to DOT’s strategic goals related to safety, infrastructure, and innovation. Based on our prior work and interviews with FAA officials, we found that FAA’s research in cabin safety for crew and passengers does not focus on disease transmission. For example, according to FAA officials, as of June 2020, ongoing research that most closely relates to disease contamination is research related to monitoring the quality of “bleed air,” which is outside air that is drawn through jet engines into an aircraft cabin. FAA officials said that its Civil Aerospace Medical Institute is participating in this research.

Even so, FAA has funded some programs that are relevant to mitigating communicable disease transmission at airports and on aircraft. For example, in 2015 the Transportation Research Board’s Airports Cooperative Research Program (ACRP), which is funded by FAA’s Airport Improvement Program (AIP), decided to hold a series of workshops on topics that are of significance to airports and that are not being addressed by other federal research programs. The decision to hold the first ACRP workshop on communicable disease occurred toward the end of the Ebola virus outbreak. ACRP has also issued reports on reducing communicable disease transmission at airports and aircraft. These reports have provided information and guidance to airports and airlines on infectious disease mitigation onboard aircraft and ways to respond to a communicable disease in airports. For example, a 2013 ACRP report recommends reducing the amount of time aircraft ventilation systems are shutdown at the gate, so that an aircraft’s high efficiency particulate air (HEPA) systems, which can capture more than 99 percent of the airborne microbes, continue to operate. ACRP also has a research project currently under way for publication early next year on effective collaboration to prevent, respond to, and mitigate disease threats.

Prior to 2014, FAA also funded some research on disease transmission on aircraft through its Centers of Excellence research consortium. Specifically, in 2004, FAA established the Airliner Cabin Environment Research (ACER) Center of Excellence, which conducts research on, among other things, the safety and health of passengers and crew inside the cabin. In 2010 and 2012, ACER published research on air quality in airline cabins and disease transmission in aircraft. A researcher we interviewed who is affiliated with ACER said that the Center established a laboratory in 2006, called ACERL, which is currently conducting research on the dispersion of airborne particles (including viruses) in the aircraft cabin for CDC’s National Institute of Occupational Safety and Health. As of 2014, ACER began operating independently as a consortium academia, government, and others and is no longer being funded solely by FAA.

FAA and DOT principally look to HHS and the CDC for guidance on passenger health issues. HHS has statutory responsibility for preventing the introduction, transmission, and spread of communicable diseases into the United States and among the states. Within HHS, CDC has defined its mission as protecting America from health, safety and security threats, both foreign and domestic. CDC alerts travelers about disease outbreaks and steps they can take to protect themselves. CDC also has the authority to quarantine passengers traveling from foreign countries, if necessary, to prevent the introduction, transmission, or spread of communicable disease. CDC’s National Institute for Occupational Safety and Health has conducted research and issued guidance in the past on disease transmission in aircraft and cabin crew health and, as previously noted, is funding current research through the ACER Center. CDC has also issued COVID-19 guidance for cabin crew safety.

Some Technologies Could Be Useful to Reduce the Risks of Communicable Disease in Air Travel

There are a variety of technologies that could help address infectious disease transmission associated with air travel, but these technologies are at various stages of maturity. For example, the initial screening of passengers for fevers is typically done with handheld infrared thermometers and has been reportedly discussed for use by Transportation Security Agents. Reports also state that the mass screening of crowds using thermal cameras has been used in some airports in Asia, but such scanners are still being tested for standalone use in the United States, with some concerns reported about the accuracy of the results. Aircraft disinfection has traditionally been done by cleaning crews, but a number of methods are being developed using heat, chemicals, and UV light, and are under examination by researchers.

Chairwoman Horn, Ranking Member Babin, and Members of the Subcommittee, this completes my prepared remarks. I would be pleased to respond to any questions that you or other Members of the Subcommittee may have at this time.

GAO Contact and Staff Acknowledgments

If you or your staff have any questions about this statement, please contact me at (202) 512-2834 or krauseh@gao.gov. Contact points for our Offices of Congressional Relations and Public Affairs may be found on the last page of this statement.

GAO staff who made key contributions to this testimony are Jonathan Carver, Assistant Director; Paul Aussendorf; Roshni Davé; Hayden Huang; Delwen Jones; Molly Laster; Cheryl Peterson; Gretchen Snoey; and Elizabeth Wood.

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