THE POSTAL HISTORY OF ICAO

 

ICAO and the World Health Organization

 

Up to the middle of the nineteenth century, so far as international travel was concerned, sanitary measures were applied by countries only when pestilence arrived at their shores. Quarantine practices were primitive and differed widely from one place to another. Port administrations decided in each case what measures should be imposed. Decisions were, therefore, arbitrary and depended on the whims and caprices of local officials.

 

European nations first recognized the need for a cooperative approach to the management of disease, and in the mid-nineteenth century, the chief health concern was the epidemics that swept through the Old World. The Black Plague had shaped the history of the European continent for centuries; cholera was the principal scourge at the time of the International Sanitary Conferences in Europe. The rapid expansion of international trade and travel resulting from the advent of steam navigation and the great variety of quarantine practices led the French Government to convene, in Paris in 1851, the first of a long series of international conferences. The purpose of this conference was to work out an agreement between the various countries for the application of the best preventive measures against cholera, plague and yellow fever, and to discuss the adoption of a uniform sanitary code to govern international traffic. Reluctance to adopt a common code, however, was strong and the conference did not meet with the success it deserved. It was the first of 14 International Sanitary Conferences to standardize international quarantine regulations, against the spread of cholera, plague, and yellow fever. These conferences played a major role in the formation of the World Health Organization in 1948:

1.    Paris, France: from 23 July 1951 to 19 January 1852.

2.    Paris, France: from 9 April to 30 August 1859.

3.    Constantinople, Turkey: from 13 February to 26 September 1866.

4.    Vienna, Austria: from 1 July to 1 August 1874.

5.    Washington, D.C., USA: from 5 January to 1 March 1881.

6.    Rome, Italy: from 20 May to 13 June 1885.

7.    Venice, Italy: from 5 January to 31 January 1892.

8.    Dresden, Germany: from 11 March to 15 April 1893, held as a result of the cholera pandemic.

9.    Paris, France: from 7 February to 3 April 1894.

10. Venice, Italy: from 16 February to 19 March 1897. Note that the appearance of plague in Bombay caused uneasiness in Europe and led to hold this meeting in Venice.

11. Paris, France: from 10 October to 3 December 1903.

12. Paris, France: from 7 November 1911 to 17 January 1912.

13. Paris, France: from 10 May to 21 June 1926.

14. Paris, France: from 28 to 31 October 1938.

 

During the 19th century, however, lengthy debates focused mainly on cholera. The first conferences, however, were unsatisfactory for the participants from the New World, because the Europeans focused primarily on cholera, whereas the Americans were confronting different problems. By the time the Fifth International Conference was held, it was clear that world health concerns could not be limited to the Old World. The Fifth Conference was held early in 1881 in Washington, D.C., and control of yellow fever was one of the conference’s central concerns. Thus, the world had to wait till 1892 to see the first International Sanitary Convention (addressing cholera) to be adopted (and signed on 30 January 1892), at the 7^th International Sanitary Conference in Venice, Italy. Further conferences in Dresden in 1893 and Paris in 1894 resulted in two additional conventions relating to cholera. The next conference in Venice in 1897 adopted a new international convention dealing with prevention of the spread of plague. All four of these conventions were consolidated into a single International Sanitary Convention at the 11^th Conference in Paris in 1903 and later revised in 1926.

 

Also at this 11^th Conference in 1903, it was agreed that a permanent health bureau should be created; at a meeting of government representatives in Rome, Italy in 1907, the final decision was taken to set up the Office International d’Hygiène Publique (OIHP, Office of International Public Hygiene, which was the forerunner of the World Health Organization), which had no authority to do field work within a particular country, but developed an effective organization for disseminating knowledge on communicable diseases and their control.

 

Moreover, scientific discoveries made it clear that an organization specific to the Americas was needed. In 1890, the First International Conference of American States met in Washington to discuss issues pertinent to the hemisphere; the Second Conference was convened in Mexico City in October 1901. Because of the need for a region-specific organization, the conference recommended the formation of a bureau to represent the American republics, one that would be specifically charged with the formulation of sanitary or health agreements and regulations. The first International Sanitary Convention of the American Republics (as opposed to the International Sanitary Conferences of the nineteenth century) met in Washington from 2 to 5 December 1902 (with representatives of eleven countries present) and created the International Sanitary Bureau of the Americas, officially known as the Pan American Sanitary Bureau (PASB, later known as the Pan American Health Organization, PAHO), which would have a permanent executive board headquartered in Washington, D.C.

 

The International Sanitary Convention held its fourth meeting in San José, Costa Rica, from December 1909 to January 1910 and changed its name to the International (or Pan American) Sanitary Conference. In November 1924, delegates to the Seventh Pan American Sanitary Conference agreed on the first international sanitary treaty for the American States, called the Pan American Sanitary Code, approved and signed in Havana, Cuba and still in effect today. This instrument, which was ratified as an international convention by all 21 participating Members States in succeeding years, became the basis for the development of the Pan American Sanitary Bureau as an international institution, with resources made available through the apportionment of its budget among these States according to the scale of assessments established within the Pan American system.

 

Beginning in World War I and until the end of World War II, there were three recognized health authorities in the world: the Office of International Public Hygiene, the health section of the League of Nations, and the Pan-American Sanitary Bureau.

 

The development of air travel, still a relative newcomer to international traffic (the Atlantic was first flown in 1919, and in the same year the pioneer flight was made from England to Australia), showed the need for a comparable code of practice to apply to aerial navigation.

 

Label issued for the 1st International Congress on Sanitary Aviation (actually held from 14 to 20 May 1929)

The development of aviation in the 1930s had greatly increased the rapidity of transport (passengers, freight and mail) between countries and brought various parts of the word closer together as regards time; at the same time, the danger of aircraft conveying diseases was foreseen by the health authorities with the result that the first International Congress on Sanitary Aviation (Congrès international de l’aviation sanitaire) was held in Paris, France from 14 to 20 May 1929 (Note: Marie Marvingt, from France, 1875-1963, was one of the organizers behind the success of this Congress) and that the first International Sanitary Convention for Aerial Navigation was signed at The Hague on 12 April 1933 (without a conference) and came into force on 1 August 1935 to protect communities against diseases liable to be imported by aircraft and to protect flying personnel against diseases due to flying; it contained numerous regulations consisting of measures to prevent the spread of plague, cholera, yellow fever, typhus and smallpox. This Convention was amended in Washington on 15 December 1944 and open for signature; it came into force on 15 January 1945. The protocol signed on 23 April 1946 prolonged the 1944 Convention. Note that the second of these Congresses on Sanitary Aviation was held in Madrid from 1 to 5 June 1933 and the third in Brussels from 10 to 15 June 1935. The last International Sanitary Conference was held in Paris in 1938 with a very limited scope; these Conferences provided a spirit of international cooperation and a forum for medical administrators and researchers to discuss not only cholera, but also other communicable diseases.

 

During the first half of the twentieth century, there were no less than thirteen conventions or arrangements of a diplomatic character relating to health control measures to be taken at frontiers. Unfortunately, however, none of these conventions had ever completely superseded all its predecessors. The multiplicity of the obligations undertaken by States-some being party to certain of these diplomatic instruments but not to others-has always been a cause of trouble and confusion in international traffic. Further, the procedure by which conventions had to be signed subject to ratification did not allow the rapid simultaneous application of the agreed texts everywhere, nor could they readily and easily be brought up to date to consider the changing epidemiological situation, the experience gained or the progress of science and technique.

 

7 April 1964 United Arab Republic World Health Day

The Second World War was to prove a catalyst for international health.

 

The question of the revision of the International Sanitary Conventions and their consolidation into one text applicable to all means of transport was considered in March and April 1946 by the Technical Preparatory Committee of the International Health Conference. It was again taken up by the conference itself in June and July of the same year, and the universal recognition of the need for unification of international sanitary arrangements found expression in the inclusion, among the constitutional functions of the World Health Organization, of that of proposing conventions and regulations and making recommendations with respect to international health matters.

 

The Constitution of the World Health Organization (WHO) was approved at the International Health Conference held in New York from 19 June to 22 July 1946; created by the Conference, the WHO Interim Commission was to exist until the 26^th of the 61-member states (which attended the New York Conference in 1946) deposited their formal instrument of acceptance with the Secretary-General of the United Nations. The WHO Constitution came into force on 7 April 1948; 7 April is now marked as World Health Day each year. The functions of the OIHP were gradually taken over by the WHO in periods of 1946-1948. The International Sanitary Convention for Aerial Navigation of 1944 was transferred to the Interim Commission of WHO.

 

ICAO and WHO were soon destined to cooperate. The necessary health precautions must be taken in such a way as not to delay international air transport operations; this matter was considered at the work of PICAO’s Division on Facilitation (FAL), which met for the first time in Montreal from 24 January to 2 February 1946, and it was expected to develop more specific health provisions for inclusion in the FAL standards. Moreover, during its first session held from 15 to 23 January 1946, PICAO’s Division on Personnel Licensing (PEL), which was given the responsibility for establishing standards for the licensing of operational and mechanical personnel, recommended the establishment of a Medical Division at ICAO. Thus, considerable thoughts were given at ICAO to the means by which medical problems of concern to aviation should be dealt with and the Air Navigation Committee decided to recommend the appointment to the Secretariat of an expert in aviation medicine (i.e., Medical Advisor), so that ICAO’s aviation medical programme could start to address problems of particular aeromedical character for flying personnel and problems of sanitation on aerodromes.

 

A Medical Advisor, Dr. Fanz E. de Tavel, was appointed to ICAO in 1949. He represented the Organization on various Committees and Assemblies held by WHO and remained with ICAO until 1961 for a transfer to WHO. The Medical Section (later renamed Aviation Medicine Section) was officially created at ICAO in 1959. Many of the problems handled by ICAO technical Divisions had medical problems; they were not so distinct and separable from other aspects of aviation. As WHO adopted new sanitary regulations, ICAO standards were revised to include the new medical standards of the public health requirements.

 

Two Annexes to the Chicago Convention specifically deal with aviation medicine:

1. Annex 1: Personnel Licensing (Chapter 1: Medical Fitness and Chapter 6: Medical Provisions for Licensing); and

2. Annex 13: Aircraft Accident and Incident Investigation (Chapter 5: Investigation: Autopsy Examination, Medical Examination).

The medical provisions in Annex 1 are supported by guidance material developed in the Manual of Civil Aviation Medicine. This manual gives background information, explains the requirements in detail, gives guidance on how to examine applicants and how to investigate various medical conditions, and gives advice on how to interpret pathological findings in the context of an aeromedical disposition.

 

Although discussed in the early days of PICAO and ICAO, no formal agreement was felt necessary to establish the necessary cooperation between ICAO and WHO. The primary problem which ICAO and WHO had in common at that time was the preparation and application of a revised International Sanitary Convention for Aerial Navigation to preserve the chief benefit of aviation (i.e., speed) by eliminating unnecessary forms and procedures which unduly delay aircraft and their passengers, while preventing the spread of diseases by international air transport. Revised International Sanitary Regulations were adopted by WHO in May 1951; the 22^nd WHO Assembly (held in 1969) adopted, revised and consolidated the International Sanitary Regulations, which were renamed the International Health Regulations. As the magnitude of air transport operations grew, continued attention was given by WHO to public health requirements in aviation and a Guide to Hygiene and Sanitation in Aviation was first published in 1960 and updated regularly thereafter. This guide has the ultimate goal of assisting all types of airport and aircraft operators and all other responsible bodies in achieving high standards of hygiene and sanitation, to protect travellers and crews engaged in air transport.

 

PAHO Emblem

The XII Pan American Sanitary Conference, held in Caracas in 1947, created the Pan American Sanitary Organization (PASO) and designated the Pan American Sanitary Bureau as its operating agency or Secretariat. This Conference also approved the general terms of an agreement with the WHO; on 24 May 1949, an agreement was signed between WHO and PASO by which the latter Organization would serve as the Regional Office for the Americas of the World Health Organization.

PASO brings together health authorities from the Americas; the Pan American Sanitary Conference is the Organization’s highest decision-making body to determine general policies of the Organization to improve the health and well-being of the population in the region. The XIV Pan American Sanitary Conference was held in Santiago, Chile, 7-22 October 1954. The stamp issued by Chile shows Alejandro del Río Soto-Aguilar (1867-1939), eminent bacteriologist and immunologist. The first Chair of Microbiology in Chile was created in the School of Medicine of the Cañadilla at the University of Chile in 1892. Dr. Alejandro del Río Soto-Aguilar was its first Professor. For almost three decades, it was the only educational center for microbiologists in Chile.

 

The XV Pan American Sanitary Conference, held in San Juan, Puerto Rico, in 1958, modified the name of the Pan American Sanitary Organization to the Pan American Health Organization (PAHO; in Spanish: Organización Panamericana de la Salud, OPS), which now provides technical cooperation and mobilizes partnerships to improve health and quality of life in the countries of the Americas. PAHO is the specialized health agency of the Inter-American System.

 

XIV Pan American Sanitary Conference

ICAO developed a set of protective measures for use at international airports to prevent the spread of Severe Acute Respiratory Syndrome (SARS). The measures, based on guidelines issued by the WHO, consist of specific procedures for screening of passengers at the departure and on arrival, and for screening of airport workers. Included is information to all passengers about SARS and guidance on handling of suspected cases on board and at the destination. The set of measures and the evaluation criteria were finalized during a meeting held in Singapore from 2 to 4 June 2003.

 

Public health events are often multi-sectoral and international in nature, and should therefore be managed at several different levels: operational, national, regional and global. While Article 14 of the Chicago Convention requires that Member States take measures to prevent the spread of communicable disease and ICAO Assembly Resolution A35-12 (35^th Session of the Assembly, 28 September to 8 October 2004) states that the protection of the health of passengers and crews on international flights is an integral element of safe air travel, ICAO expanded during 2006 its role in assisting States to mitigate the risk from pandemic disease, developing the work that was initiated for the pandemic influenza in 2005. ICAO coordinated an international effort to write guidelines for States. The Air Navigation Bureau and the Technical Cooperation Bureau worked closely together, in cooperation with the Regional Offices, and set up a programme entitled Cooperative Arrangement for Preventing the Spread of Communicable Diseases Through Air Travel (CAPSCA).

 

CAPSCA is a global, collaborative programme established between many international organizations, including ICAO, World Health Organization (WHO), United Nations World Tourism Organization (UNWTO), International Air Transport Association (IATA), Airports Council International (ACI), International Federation of Air Line Pilots' Associations (IFALPA), etc. to improve preparedness planning and response to public health events (not only communicable disease) that affect the aviation sector, such as an influenza pandemic or a nuclear power-plant accident. ICAO has worked with States and the aforementioned partners to develop relevant provisions in a number of Annexes to the Chicago Convention. Guidance material has been produced to support these provisions.

 

The title of the CAPSCA programme was changed in 2013 to the Collaborative Arrangements for the Prevention and Management of Public Health Events in Civil Aviation, while retaining the same acronym, to reflect the increased scope of the programme beyond that of communicable disease, for example, radio-nuclear accidents or chemical events.

 

Signed by ICAO Secretary General Juan Carlos Salazar and WHO Director General Dr. Tedros Adhanom Ghebreyesus on 13 December 2022, a new agreement between ICAO and the World Health Organization (WHO) calls for the two United Nations bodies to further maintain and strengthen their cooperation on the provision of advice and assistance to Member States and industry stakeholders on policy and technical matters, in accordance with their respective mandates. A joint work plan will guide the implementation of this agreement, including a monitoring and evaluation framework to regularly take stock of the collaboration and joint activities, define and reorient priority areas of collaboration, as needed. The two agencies will use this agreement to establish a closer collaboration on matters related to civil aviation and public health as part of their commitment to the United Nations 2030 Agenda for Sustainable Development.

“The WHO has been collaborating with ICAO on public health matters in civil aviation for decades, including in the context of its Collaborative Arrangement for the Prevention and Management of Public Health Events in Civil Aviation (CAPSCA) implementation support programme established in 2009. This collaboration has intensified since the onset of the COVID-19 pandemic within the framework of the UN-wide response,” remarked Secretary General Salazar. “It builds on our successful cooperation within the context of the ICAO Council Aviation Recovery Task Force (CART), which has delivered a harmonized and optimized approach for the safe and resilient restart and recovery of the global flight network.”

 

To help countries better prepare for future pandemics, ICAO contributed to a new initiative that was launched in May 2023 by the World Health Organization to provide guidance on integrated planning for “responding to any respiratory pathogen such as influenza or coronaviruses”. The new Preparedness and Resilience for Emerging Threats Initiative (PRET) incorporates the latest tools and approaches for shared learning and collective action established during the COVID-19 pandemic and other recent public health emergencies. PRET provides a platform for national, regional and global stakeholders to collaborate to strengthen preparedness. Technical resource packs, a peer learning network and a community of practice are coming soon to help stakeholders update their preparedness plans and share experiences. ICAO has cooperated with the WHO on health issues related to aviation for decades; this cooperation focuses on the aviation aspects of pandemic response, including issues related to coordination and collaboration, preparedness planning, mitigating transmission, managing suspected cases on board, maintaining inflight safety and facilitating border crossing.

 

The World Mental Health Day is observed on 10 October and is supported by WHO through raising awareness on mental health issues and mobilizing efforts in support of mental health by using its strong relationships with the Ministries of health and civil society organizations across the globe. It was first celebrated in 1992 at the initiative of the World Federation for Mental Health, a global mental health organization with members and contacts in more than 150 countries. In 1994, World Mental Health Day was celebrated with a theme for the first time at the suggestion of then WHO Secretary General Eugene Brody.

 

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