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international flights.
ICAO Preliminary Unedited Version — March 2010 III-18-2
Public health officers, therefore, need assistance of experts in aviation medicine and for this reason a
collaborative effort by the public health and aviation sectors is essential in order to manage the
aviation-related public health risk posed by communicable disease.
At an international level, ICAO collaborates with the World Health Organization (WHO) to help
produce requirements and guidelines. Such collaboration between the aviation and public health
sectors should also occur at regional, national and local levels, and medical officers working in the
field of aviation medicine are encouraged to help forge the necessary communication links to foster
effective cross-organizational collaboration.
The role of WHO and the national public health authorities in managing public health issues related to
international aviation is considered in the next section, followed by an outline of the role of ICAO and
an overview of relevant international Standards and Recommended Practices (SARPs).
INTERNATIONAL HEALTH REGULATIONS
In 2005, WHO published a revised edition of the International Health Regulations (IHR). This second
edition came into force in 2007. The purpose and scope of the IHR (2005)2 are “to prevent, protect
against, control and provide a public health response to the international spread of disease in ways that
are commensurate with and restricted to public health risks, and which avoid unnecessary interference
with international traffic and trade.” The IHR (2005) sets out the roles and responsibilities of different
entities with respect to minimizing the risk of spread of disease by transport of people and cargo
across international borders, many of which apply to “points of entry” (international airports) and
“conveyance operators” (aircraft operators). It also provides instructions for dealing with “public
health emergencies of international concern”. The IHR (2005) is a legally binding document but, as
with other United Nations agencies (including ICAO), the WHO has no power of enforcement over
States that do not comply with the relevant Articles. Nevertheless, by means of international pressure
from UN agencies and other States, influence can be brought to bear on non-compliant States which,
for the most part, do their best to comply.
It required ten years to revise the 1969 edition of the IHR and obtain the World Health Assembly’s
approval of the new edition: the IHR (2005) should be implemented by States (countries) no later than
2012, unless particular difficulties in implementation are encountered. The document has been
adopted by the 194 States Parties (member countries) of the World Health Assembly, the governing
body of WHO. As with most internationally agreed documents, in order to gain consensus the
requirements are general in their scope and lack details – to attempt otherwise would be too time
consuming and too difficult a task, given the great variety of health related conditions experienced by
different countries worldwide. Therefore, the IHR (2005) sets out general requirements such as
Article 24, 1(c) which states that conveyance operators shall:
permanently keep conveyances for which they are responsible free of
sources of infection or contamination, including vectors and
reservoirs. The application of measures to control sources of
infection or contamination may be required if evidence is found.
To understand how, in practice, such conveyance operators might comply with this Article in the IHR
(2005), reference to guidance material is necessary.
ICAO Preliminary Unedited Version — March 2010 III-18-3
WHO COMMITTEES
In order to provide “competent authorities”i with guidance on implementation of the IHR (2005), the
WHO established a number of committees to address particular aspects. Key industry stakeholders
were invited to participate in such meetings, including the major aviation related trade associations,
the International Air Transport Association (IATA) and Airports Council International (ACI), as well
as ICAO. Work by these committees has resulted in important guidance being provided in two
specific areas: management of cases of Influenza A(H1N1) on board aircraft3, and recommendations
concerning cleaning and disinfection of commercial aircraft4. Other guidance material is currently
(2010) being developed.
ICAO WORK CONCERNING COMMUNICABLE DISEASE
2003 – Severe Acute Respiratory Syndrome (SARS)
In the second quarter of 2003, the severe acute respiratory syndrome (SARS) was believed to pose a
major threat to human health. Eventually, around 8 000 individuals were infected and of these 10 per
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Manual of Civil Aviation Medicine 2(117)
