The COVID-19 pandemic has underscored the importance of public health measures aimed at controlling the transmission of communicable diseases. Air travel can play a role in quickly spreading communicable diseases across the world and throughout communities. Consequently, contact tracing for air passengers is a vital public health tool as well as enabling travel to continue during global pandemics.
The U.S. Centers for Disease Control and Prevention (CDC) can collect information on air passengers to help local public health authorities trace the potential spread of communicable diseases, such as COVID-19. But a new report from the Government Accountability Office (GAO) says that some of the ways in which CDC collects and manages passengers’ information make it harder to effectively facilitate contact tracing.
A review by the government watchdog has found that several factors affect CDC’s ability to collect timely, accurate, and complete air passenger information to support contact tracing by local public health authorities. For example, airlines may not have accurate and complete information about passengers to share with CDC because the contact information provided to book a ticket may be for a third party, like a travel agent, not for passengers. Further, because no single, complete, and reliable source of passenger information exists, CDC often conducts research to fill in gaps, extending the time it takes to share information with local public health authorities.
CDC has reported that prior to COVID-19, it often took airlines longer than the requested timeframe of 24 hours to provide passenger information and that in some cases, airlines took up to three days to respond. Representatives from all six airlines spoke GAO with said they “consistently provide CDC with passenger information within the requested timeframe of 24 hours”. However, representatives from two of the six airlines told GAO that delays may occur when they do not receive complete or accurate information about the infected traveler from CDC, such as an incorrect flight number, travel date, or misspelled name—information airlines need to retrieve the appropriate manifest and identify passengers seated in the contact zone. For example, a representative from one airline said that CDC may only provide a name and date of travel, with no flight number, and that it can take the airline several days to retrieve the manifest with such limited information. On the other hand, this representative said the airline could provide the requested information in 2 to 3 hours when CDC provides the flight number in addition to the passenger’s name and date of travel. In response to this concern, CDC officials told GAO that information on infected passengers comes directly from local public health authorities, and that CDC is limited by what those authorities are able to provide. Due to gaps or obvious errors in data provided by airlines, CDC often must seek supplemental information from additional sources, such as from U.S. Customs and Border Protection (CBP), adding further time to the contact tracing process.
GAO found that since the start of the COVID-19 pandemic, CDC has taken some actions to improve the quality of information it collects. For example, since November 2021, CDC has required airlines to collect certain information—including name, phone number, email, and physical address—no more than 72 hours before departure from passengers traveling on flights into the United States and to transmit the information to CDC in a defined format.
In addition, CBP built automated rules within its Automated Targeting System such that, without waiting for CDC requests for individual passengers, CBP officials can identify travelers who are subject to travel restrictions due to an outbreak in their departure country, but who are permitted to travel to the United States under an approved exemption. CBP has also expanded the number of federal datasets it searches for relevant information to share with CDC.
However, GAO’s review also found limitations in how CDC collects and manages air passengers’ contact information—including CDC’s use of an outdated data management system—hinder the agency’s ability to monitor public health risks and facilitate contact tracing. GAO’s report notes that the data management system—developed in the mid-2000s—was not designed for rapid assessment or aggregation of public health data across individual cases.
While CBP has recently automated portions of the process for contact investigations pertaining to passengers traveling on international inbound flights, CDC’s process for entering the passenger information from CBP may include numerous non-automated steps between requesting and receiving the data.
It is conceivable then, that CDC could struggle to quickly and accurately identify the number of passengers exposed to a specific infected passenger on a flight.
GAO has also said that the CDC system also does not contain the necessary data fields to assess the quality of air passenger information CDC receives, such as a field to determine the timeliness of airlines’ responses to CDC’s request. GAO has determined therefore that CDC is “not positioned to efficiently analyze and disseminate data to inform public health policies and respond to disease threats”.
CDC officials told GAO that the agency has recently begun to take steps to evaluate its process for collecting and managing air passenger information. These officials added however that constrained resources and competing priorities have limited CDC’s ability to advance these efforts.
GAO has recommended that CDC implement data entry controls, including the provision of adequate training and standard operating procedures. The watchdog also wants CDC to assess additional opportunities to improve the quality of air passenger information and consider deploying a new data system that would allow it to more effectively facilitate contact tracing for air passengers and conduct disease surveillance for air travel.
The COVID-19 pandemic has revealed shortcomings in the process for facilitating contact tracing by state and local public health authorities for passengers potentially exposed to communicable diseases during flights. It will not be the last communicable disease to take its toll and as such can provide a ‘lesson learned’ for CDC going forward.