HomeArticlesTicket to ride: How the coronavirus outbreak could change air travel

Ticket to ride: How the coronavirus outbreak could change air travel

When a pandemic strikes, scientists are left scrambling to find new vaccines to curb it. The latest coronavirus outbreak may become a testing ground for how to roll out new jabs quickly at the most unlikely of places.


As the coronavirus spreads, the United States’ leading health official told a Senate committee on Feb. 25 that “we cannot hermetically seal off the United States to a virus.”

The comments from Alex Azar II, head of Health and Human Services, heightened concerns about the effects of the coronavirus in the U.S., which so far has sickened a relatively small number – 57 – of people in the U.S.

And with hundreds of new cases of the coronavirus reported in South Korea, a spike of deaths in Iran, and a 10-town lockdown in Italy, the rapidly spreading the virus the World Health Organisation (WHO) has called severe acute respiratory syndrome coronavirus 2 may be on the verge of becoming a pandemic. The WHO now says the disease has “pandemic potential”.

The virus, which is also known as SARS-CoV-2, causes coronavirus disease or COVID-19.

This is only the latest outbreak to show how quickly pathogens can spread in a changing world. The worldwide response is a testament to the immediate need for intervention and containment: flights cancelled, cruise ships quarantined, travel banned, and a rigorous monitoring of the Chinese response.

What is now beyond dispute is that airplanes are giving the virus a big boost. As legal and public health scholars, we study how airline travel contributes to the spread of infectious agents, and how potential vaccines could limit it.

Hopping on a flight? So are pathogens

The 2002 SARS epidemic cost airlines an estimated US$7-billion. After factoring in suspended flights, the impingement on trade, and the transport of Chinese-made medical supplies, the cost of COVID-19 will likely be much larger.

This is nothing new. Air travel is a way to spread many virulent infectious diseases, including diphtheria, hepatitis A, influenza A and B, measles, mumps, meningococcus, rubella, TB, norovirus – the list goes on. In the US, airlines move more than two-and-a-half million people per day, squeezing them into long metal cylinders where all share the same air, the same restrooms, and take meals shoulder-to-shoulder for hours and hours.

Measles outbreaks have begun at airports. One plane carrying a single symptomatic Sars patient saw the disease develop in at least 16 others. Transmission of seasonal influenza during flights is well documented; after 9-11, when US airline travel stopped abruptly, the pattern of mortality associated with it or pneumonia dramatically shifted. Consistently, the research finds the single most significant predictor of influenza spread is domestic airline volume.

There is no doubt that close contact, especially when prolonged, spreads contagion. This is true for respiratory droplets, direct skin contact, and sometimes, fecal or oral spread. Making matters much worse: Airlines, taking people from place to place, turn what might otherwise be local outbreaks into worldwide crises.

It’s hard to conceive a more efficient way to spread infectious disease.

At Incheon International Airport in South Korea, a poster warns about coronavirus as passengers wear masks in a departure lobby. (AP Photo, Ahn Young-joon)

Check-in, drop your bags, go through security and… line up for a jab?

The CDC maintains a “do-not-board” list prohibiting people with a communicable disease from flying. Yet these policies only work for patients already diagnosed, or with overt symptoms, and viral disease transmission typically begins days, even weeks, before symptoms appear. For example, the incubation period for SARS-CoV-2 is believed to be between two days and two weeks; for many people, fever is the first and only sign of infection. In these situations, our current policies don’t work.

One suggestion: Airlines could require vaccination for passengers, or at least make them show a medical exemption as to why they cannot be vaccinated. Perhaps now is the time to consider this.

Right now, scientists are urgently working to develop a SARS-CoV-2 vaccine. If they succeed, a vaccine dissemination strategy will be needed immediately. Also, just this month, the FDA approved a new vaccine for pandemic influenza (H5N1). As for the seasonal flu vaccines, they are already here.

All this provides an excellent test bed for finding a way to vaccinate the broad population during a pandemic. Vaccines could be available at airports (as some are now doing for existing vaccines). But we believe a longer-term term goal is to create a database to identify who has been vaccinated, for future seasonal flu episodes and epidemics. This supports the public health approach to deal with future pandemics when new vaccines are quickly developed.

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Are vaccination databases in our future?

Clear legal authority exists to link a vaccination mandate to air travel. After 9-11, the US courts emphasised that airlines are duty-bound to protect their passengers and those on the ground from risks. In that country, the CDC or Surgeon General could exercise authority to “make and enforce such regulations … to prevent the spread of communicable diseases.” Under the US Constitution, the federal government indisputably has the power to act when regulating “channels of interstate commerce.” That includes the airlines.

What about the rights of individuals who refuse to vaccinate? Courts have long upheld vaccination mandates for schools, where close and prolonged contact is inevitable. Even though there is a “right to travel”, and there are laws protecting religious practices from government encroachment, our courts have explicitly declared vaccination is a government interest; they’ve upheld vaccine mandates for more than a century.

These basic legal principles, along with the facts, suggest that airlines and airports are key to stopping the spread of disease. Public health interventions should obviously focus on them. After all, it’s where the impact is likely to be greatest.

Christopher Robertson, Professor of Law, University of Arizona and Keith Joiner, Professor of Medicine, Economics and Health Promotions Science, University of Arizona. This article is republished from The Conversation under a Creative Commons license. Read the original article.

[10 March 2020 5pm: This story was updated to reflect that the new coronavirus is called severe acute respiratory syndrome coronavirus 2, while the illness it causes is referred to as COVID-19]

Christopher Robertson is Associate Dean for Research and Innovation and Professor of Law at the University of Arizona. He is affiliated faculty with the Petrie Flom Center for Health Care Policy, Bioethics and Biotechnology at Harvard, and a reporter for the Health Law Monitoring Committee of the Uniform Law Commission.

Keith Joiner joined the Eller College of Management in 2010 as co-director of the Center for Management Innovations in Healthcare. He was appointed professor of economics in 2012. His vast professional experience includes founding the Investigative Medicine Program at Yale University and serving as the dean of the University of Arizona College of Medicine from 2004 to 2008.