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cent died from the illness.5 In historical terms this was not an important disease, at least as far as the
number infected and who subsequently died was concerned. Influenza, for example, causes death in
an estimated 250 000 to 500 000 individuals annually. During the SARS outbreak, however, it
became very clear that the international spread of disease was primarily by air travel. It also became
clear that, potentially, unwell air travelers could be identified by airport screening and prevented from
departing, thereby reducing the risk of spreading the disease.
ICAO was requested by some States in Asia to develop guidelines for port health authorities and
airport operators to identify travelers with SARS before they embarked an aircraft. Such guidelines
were developed by the Aviation Medicine Section of ICAO, assisted, amongst others, by WHO and
IATA.
An international airport was considered as having adequate protection against SARS if eight
protective measures were adopted.6 Guidelines for inspectors and an inspector’s checklist were also
included. The development of guidelines enabled airports to announce publicly that they were in
compliance with such ICAO guidelines and that the risk of catching SARS during air travel, as well as
importing it from States in which it had been identified, was minimal. At this time, thermal scanning
of travelers (to identify those with raised body temperature) was introduced by some States. Although
theoretically useful for detecting infectious cases of SARS (since an individual suffering from this
disease becomes infectious at about the same time as his body temperature increases) very few SARS
cases were identified by this method during the outbreak, and the value of such screening was later
questioned.
2005 – Avian influenza
In 2005 avian influenza posed (and does still, in 2010 pose) a major threat to human health. WHO
therefore produced several guideline documents for States concerning the systems that needed to be
implemented in order to plan for a possible human influenza pandemic. However, when read from an
aviation perspective, these guidelines appeared to provide insufficient detail to enable the aviation
sector to adequately manage individual cases that might be detected on board an aircraft in flight; nor
did the guidelines explain how aviation could continue to operate in the event that staffing at airports
i The IHR (2005) defines “competent authority” as “an authority responsible for the implementation and
application of health measures under these Regulations” i.e. under the IHR (2005).
ICAO Preliminary Unedited Version — March 2010 III-18-4
and on aircraft was dramatically reduced because of the effects of illness. ICAO felt that more
detailed guidance should be developed for the aviation sector.
2006 to 2009 – Development of ICAO SARPs and guidance material
Guidance Material
The non-specific nature of the WHO IHR (2005) and the focus of public health officials on providing
guidance for mainstream public health activities such as surveillance, health care provision,
vaccination and treatment led ICAO to consider how it might provide information specific to the
aviation sector on management of communicable disease. Using remaining funds from the
development of the SARS guidelines in 2003, it convened meetings in Singapore to consider how best
to advise States, airport and aircraft operators. In addition, it was recognized from the outset that
ICAO needed assistance from WHO and from airport and aircraft operators in order to produce
guidelines that were not only accurate from the public health viewpoint but also of practical relevance
to operators. Assistance was therefore sought from WHO, IATA and ACI. The United States Centers
for Disease Control and Prevention also provided support.
These activities led to the ICAO “Guidelines for States concerning the management of communicable
disease posing a serious public health risk”, which were posted on the ICAO public website in 2006.7
The guidelines have been updated a number of times since then, facilitated by their electronic format.
As the title indicates, these guidelines were aimed at States, and whilst they were being developed,
additional documents were developed that were of particular interest to airport and aircraft operators.
These were subsequently posted on the websites of ACI8 and IATA9 respectively. In fact, IATA had
already developed guidelines for operators, so all that was needed was to update and harmonize these
with other guidelines.
Standards and Recommended Practices (SARPs)
The traditional ICAO manner of addressing an emerging problem, such as spread of communicable
disease by air transport, is to develop SARPs and, at the same time, develop guidance material to
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Manual of Civil Aviation Medicine 2(118)
