scope:

FOREWORD

This manual has been prepared by aviation health experts led by the International Civil Aviation Organization (ICAO) with support from the United States Centers for Disease Control and Prevention (CDC), European Centre for Disease Prevention and Control (ECDC), Aerospace Medical Association (AsMA), and others, and it has been reviewed by the World Health Organization (WHO). Contributions from other United Nations organizations, governments and industry stakeholders ensured the practical applicability of this guidance in the aviation sector, no matter how big or small the State and no matter what scale of COVID-19 challenge they face. Together, these experts and stakeholders form the ICAO Collaborative Arrangement for the Prevention and Management of Public Health Events in Civil Aviation (CAPSCA) programme. CAPSCA brings together international, regional, national and local organizations to work together to improve preparedness planning and response to public health events that affect the aviation sector.

CAPSCA developed this guidance in close collaboration with the ICAO Council Aviation Recovery Task Force (CART), which requested updated guidance on the inclusion of COVID-19 testing, vaccination and its interdependencies with other risk mitigation tools for those States that choose to include testing and vaccination as elements of their overall COVID-19 risk management process.

The CART has published updated recommendations to States in the High-Level Cover Document (HLCD) including Recommendations 13 and 17 on testing, respectively quoted below:

"While testing is not universally recommended by public health authorities as a routine health screening method, States contemplating testing in their COVID-19 risk management strategy should apply the approach outlined in the ICAO Testing and Cross-Border Risk Management Measures Manual."

"Member States should implement testing certificates based on the protocol, minimum data set and implementation approaches outlined in the Manual on Testing and Cross-Border Risk Management Measures (Doc 10152) to facilitate air travel. States are encouraged to request evidence of testing that is secure, trustworthy, verifiable, convenient to use, compliant with data protection legislation and internationally/globally interoperable. Existing solutions should be considered and could incorporate a visible digital seal. This may be applicable to vaccination certificates."

The CART has also published new Recommendations 18 and 19 in the HLCD concerning vaccination, as follows:

"Member States should facilitate access for air crew to vaccination as quickly as possible within the World Health Organization (WHO) Strategic Advisory Group of Experts on Immunization (SAGE) Stage III recommendations."

"Vaccination should not be a prerequisite for international travel. If and at such time as evidence shows that vaccinated persons would not transmit the SARS-CoV-2 virus or would present a reduced risk of transmitting the virus, Member States could consider exempting such persons from testing and/or quarantine measures, in accordance with a State's accepted risk threshold, national framework, the COVID-19 situation and the multilayered risk mitigation framework described in the Take-off: Guidance for Air Travel through the COVID-19 Public Health Crisis."

In addition, the CART revised Recommendation 14 in the HLCD concerning Public Health Corridors (PHCs) as follows:

"States considering the formation of a Public Health Corridor (PHC) should actively share information with each other to implement PHCs in a harmonized manner. To facilitate the implementation, the ICAO Implementation Package (iPack) on establishing a PHC is available to States, in addition to PHC-specific tools published on the ICAO website and the App providing a template PHC arrangement between States."

As part of its CART endeavours, CART has updated the third edition of the Take-off Guidance for Air Travel through the COVID-19 Public Health Crisis (TOGD), originally issued in June 2020 and revised in November 2020. The third edition of the TOGD reflects technological and medical advancements and provides the latest operational and public health guidance related to air travel reflecting technological and medical advancements. The recommended multilayer risk management strategy has been supplemented with considerations on testing protocols and proof-of-results certification interoperability, crew considerations for testing and vaccination, as well as including evidence of vaccination for crew and passengers. Guidance on the establishment of PHCs as well as guidance on the need for appropriate masks during air travel, were also updated.

The second edition of this manual was revised in close collaboration with CAPSCA. It provides updated detailed guidance on risk management, PHCs, information on recent scientific developments regarding COVID-19 testing, as well as a new section on vaccination and its interdependencies with other tools of a State's multilayer risk management framework. This guidance supplements the measures already outlined in the CART HLCD and TOGD and provides a risk management process to facilitate States' assessments of the applicability of a combination of measures available today.

COVID-19 testing, and in the future, vaccinations, if applied according to the guidance contained in this manual, could reduce reliance on measures that restrict air travel and the movement of persons arriving in a country, such as quarantine, which evidence suggests is a disincentive to several important categories of travel, of which the following list is nonexhaustive: pilot certification, pilot simulator training, essential business flights and tourism for some States that are dependent on inbound tourism for economic sustainability. Restoring confidence in aviation is a key priority. Quarantine may still apply for persons with symptoms consistent with COVID-19 and known close contacts of persons diagnosed with COVID-19, while self-isolation or other measures could be applied for non-symptomatic persons in accordance with a State's assessed risk tolerance.

In implementing testing as a component of States' overall COVID-19 multilayered risk management strategy, they are advised that an effective application of a multilayered risk strategy, including testing, is one in which:

a) States perform a risk assessment¹ using epidemiologic criteria including, but not limited to, disease prevalence, new variants, disease trajectory, national testing strategy², screening capabilities, hospital capacity and robustness of contact tracing and (potentially) status of national vaccination strategy;

b) States share the results of the risk assessments, the local epidemiology and transmission scenarios in the departure and destination countries or areas, as well as the public health and health system capacity and performance to detect and care for returning travellers and their contacts with other States to facilitate the opening of air routes;

c) States consider their risk tolerance, and issues such as socio-economic and human rights, as a part of their risk assessment;

d) States use risk assessment and risk tolerance in determining the application of a multilayered risk management strategy;

e) States that choose to utilize testing for screening purposes in aviation after consideration of national testing capacity, apply a cut-off value, based on evidence generated from asymptomatic individuals, for sensitivity and specificity as high as possible (with a minimum of 95 per cent sensitivity and specificity for molecular tests; and a minimum of 80 per cent sensitivity and specificity (with a minimum ≥ 97 per cent and ideally > 99 per cent for rapid antigen tests) to reduce inaccurate test results, although these values might change as science matures³;

f) States take into account the test result, and in the future, vaccinations, when considering the need for and duration of isolation or quarantine when addressing higher risk scenarios and applying testing as part of the multilayer risk management strategy; and

g) States harmonize their procedures to the extent possible.

This manual describes the risk management measures that can be applied; how epidemiology can be used to advise States in developing a risk management strategy; possible testing protocols that might be put in place where there is differential prevalence and therefore risk; and a series of examples to help States in their decision-making processes.

¹. WHO guidance on Considerations for implementing a risk-based approach to international travel in the context of COVID-19

². Scientific brief on COVID-19 diagnostic testing in the context of international travel

³. SARS-CoV-2 antigen-detecting rapid diagnostic tests