Contact Tracing for Air Travel: CDC's Data System Needs Substantial Improvement
Fast Facts
The U.S. Centers for Disease Control and Prevention collects information on air passengers to help local public health authorities trace the potential spread of communicable diseases (e.g., COVID-19).
But some of the ways in which CDC collects and manages passengers' information make it harder to effectively facilitate contact tracing. For example, the outdated data management system CDC uses doesn't allow it to connect related cases or easily report the number of passengers exposed to a single infected person on a flight.
We recommended ways to improve CDC's air passenger data system.
Highlights
What GAO Found
The Centers for Disease Control and Prevention (CDC) plays a key role in contact tracing for air travel—the process of identifying and notifying passengers who may have come into contact with a person infected with a communicable disease during a flight. However, 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.
Overview of Process for Collecting Air Passengers' Contact Information
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.
However, limitations in how CDC collects and manages air passengers' contact information—including CDC's use of an outdated data management system—hinder the agency's ability to monitor public health risks and facilitate contact tracing. The data management system—developed in the mid-2000s—was not designed for rapid assessment or aggregation of public health data across individual cases. For example, CDC is unable to quickly and accurately identify the number of passengers exposed to a specific infected passenger on a flight. Nor does the system 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. Consequently, CDC is not positioned to efficiently analyze and disseminate data to inform public health policies and respond to disease threats. Nor is it positioned to evaluate its performance in collecting and sharing quality passenger information.
Why GAO Did This Study
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. Given this potential, contact tracing for air passengers is an important measure for protecting public health.
GAO was asked to examine CDC's process for collecting and managing air passengers' contact information to facilitate contact tracing. This report addresses: (1) the factors that affect CDC's ability to collect this information, (2) recent actions CDC has taken to improve the quality of the information it collects, and (3) how effectively it collects and manages this information.
GAO reviewed relevant federal documentation, including regulations, orders, technical guidance, and public comments, as well as available CDC data. GAO also interviewed officials from CDC, U.S. Customs and Border Protection, and the Federal Aviation Administration, and selected representatives from the aviation, travel, and public health industries.
Recommendations
GAO is making three recommendations, including that CDC redesign its data management system for air passenger information or deploy a new one. CDC concurred with the recommendations.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Centers for Disease Control and Prevention | The Director of CDC should implement controls for the entry of data into its Quarantine Activity Reporting System (QARS), including by providing adequate training and standard operating procedures that are documented and institutionalized for system users and by conducting consistent validation checks. (Recommendation 1) |
As of August 2024, CDC has taken steps to address this recommendation, according to CDC officials. For example, CDC officials stated that they created an automated system for checking the quality of data entered into the new Public Health Activity Report System (PHARS) (formerly known as QARS) allowing CDC staff to monitor critical data entered into the system. Using this system, CDC officials reported that they have been able to review over 100,000 records and address more than 2,000 data entry errors. In addition, CDC officials told us that they have created an online repository of training and onboarding resources related to data quality and that new users are required to affirm they have taken the trainings prior to being allowed access to PHARS. According to CDC officials, once the new PHARS interface is complete, CDC plans to update the PHARS operations manual. We will continue to monitor CDC's efforts to implement this recommendation.
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| Centers for Disease Control and Prevention | The Director of CDC should assess additional opportunities to improve the quality of air passenger information it collects and manages— including opportunities to increase automation by adopting or establishing data exchange standards—and take action, as appropriate, based on this assessment. (Recommendation 2) |
In August 2024, CDC told us that they are working to develop a comprehensive plan to coordinate and prioritize actions between CDC and state, local, and territorial health departments. According to CDC officials, CDC is working to build and test a platform that will allow for more secure, automated, and user-friendly data exchange. This effort is still at a developmental stage, according to CDC officials, and will ultimately depend on decisions about CDC's enterprise-wide information systems. Therefore, this recommendation remains open. We will continue to monitor CDC's efforts to implement this recommendation.
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| Centers for Disease Control and Prevention | The Director of CDC should re-design QARS or deploy a new data system that would allow CDC to more effectively facilitate contact tracing for air passengers and conduct disease surveillance for air travel. (Recommendation 3) |
As of August 2024, CDC officials told us the Public Health Activity Reporting System (PHARS) (formerly known as QARS) modernization project is underway. The first two modules of PHARS are online, but other modules are still in development. We will continue to monitor CDC's progress implementing this recommendation.
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