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support these SARPs. On this occasion time was of the essence and it was quicker to produce
guidance initially, since guidance material does not require formal consultation with States. It was
clear, however, that the guidance material could not stand alone – it required SARPs to be developed
in the relevant Annexes to give the subject a more formal grounding.
ICAO Annex 9 – Facilitation, was the first Annex to the Convention on International Civil Aviation
to be amended in light of the contemporary threat from communicable disease. This Annex deals
primarily with global harmonization of customs and immigration procedures and associated health
related topics. Some changes to the Annex were made, including the addition of new SARPs. An
important new Standard and Note was introduced:
8.16 A Contracting State shall establish a national aviation plan in
preparation for an outbreak of a communicable disease posing a
public health risk or public health emergency of international concern.
Note.— Guidance in developing a national aviation plan may be
found on the ICAO website on the Aviation Medicine page.
This Standard and its associated Note is the single most important ICAO Standard concerning
preparedness planning in the aviation sector. All the other related SARPs cover particular aspects of
preparedness planning.
ICAO Preliminary Unedited Version — March 2010 III-18-5
Included in Annex 9, in Appendix 1 to the Annex, is the aircraft General Declaration, commonly
abbreviated to “Gen Dec”6. This document forms an official record of the arrival of an aircraft at an
airport and includes a section on aircraft registration, crew number and names, airport of departure
and, most importantly, a “Declaration of Health”. The Declaration of Health requires the pilot in
command to identify individuals on board who may be suffering from a communicable disease. The
recommended method for identifying such an individual is contained in the Declaration of Health:
“a fever – temperature 38°C/100°F or greater – associated with one
or more of the following signs or symptoms, e.g. appearing obviously
unwell; persistent coughing; impaired breathing; persistent diarrhoea;
persistent vomiting; skin rash; bruising or bleeding without previous
injury; or confusion of recent onset, increases the likelihood that the
person is suffering a communicable disease”
Not all States require a General Declaration to be completed by an arriving aircraft, but all crew
members should be aware of the document and its contents, what it is used for, and its importance in
providing guidance in identifying cases of communicable disease. If all States train their crew to use
the guidance in the Declaration of Health, this will greatly improve the consistency of information
passed to the public health authority at destination with respect to notification of a suspected case of
communicable disease on board.
Another appendix to Annex 9, Appendix 13, includes the Public Health Passenger Locator Card.6
This can also be found on the websites of WHO and IATA: it provides a standardized method of
collecting details of passengers who may have been exposed to a fellow traveler with a communicable
disease. Whilst recording such information on paper can be useful, a better way would be to utilize
electronic systems, with the potentially infected traveler completing the required information on line.
Thus far, the resources needed to develop such a system have not been allocated.
In 2009, a number of changes to other Annexes became applicable. Annex 610 now has as a
recommended practice that a universal precaution kit (UPK) should be carried on flights with a cabin
crew member (two kits for aircraft with more than 250 passengers). Whilst Annex 6 for many years
has had recommendations concerning first aid and medical kits, this was the first time that a UPK was
recommended to be carried on-board. The recommended contents of such a kit are listed in
Attachment B to Annex 6:
– Dry powder that can convert small liquid spill into a sterile granulated gel
– Germicidal disinfectant for surface cleaning
– Skin wipes
– Face/eye mask (separate or combined)
– Gloves (disposable)
Annex 11 – Air Traffic Services11 and Annex 14 – Volume I — Aerodrome Design and
Operations12 were also amended in 2009. These Annexes require air traffic services providers and
airport operators to have a contingency plan to address the possibility of an incident or accident or
other event occurring that could affect aviation safety. However, the list of scenarios that these plans
should consider did not, until 2009, include public health emergencies. Now Annex 11, Attachment C,
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Manual of Civil Aviation Medicine 2(119)
