International law for public health in aviation: the challenges of harmonisation

International laws for commercial aviation have achieved an exceptional degree of harmonisation and greatly improved passenger safety. Yet, despite much international guidance, enforceable laws for public health protection in aviation are mainly the responsibility of national authorities. As a result, public health laws may be incoherent, in conflict with other countries and/or based on disputed scientific evidence. The COVID-19 pandemic has highlighted the responsibility of airlines and regulatory authorities to protect not only air passengers but also populations in destination countries. While the greatest risk to global public health is the potential spread of disease by infected passengers or vectors, lesser-known risks include food contamination, inadequate sanitary facilities and poor air quality within the cabin. In preparedness for inevitable future disease outbreaks and pandemics, an urgent review of international law as it applies to public health in commercial aviation is needed, with greater investment in scientific research to enable more accurate and effective risk assessment and management, supported by enforceable laws and clear responsibility.