This editorial I would like to start with the great news that the joint action received the MedCruise Honorary Award 2021. This is an enormous encouragement and approval of the project’s activities.
The time was full of different activities. The Joint action consortium organized web-based trainings about preparedness and response to public health events at ground crossings. Taking the opportunity on behalf of myself and Janusz Janiec from The National Institute of Public Health - National Institute of Hygiene (Poland) I would like to thank the organizational team for all the help and support: especially the University of Thessaly - Laboratory of Hygiene and Epidemiology (Greece), National Institute of Public Health and the Environment (Netherlands), Department of Health - Public Health England (United Kingdom) and National Institute of Public Health (Slovenia)
Also, representatives of joint action were invited to webinar series on COVID-19 organized by MedPorts and MedCruise associations and had the possibility to share their experience, best practices and advices with stakeholders.
Our colleagues from Hamburg, Germany, submitted the article about Kiribati sailors stranded in Hamburg after up to 18 months on board and the challenges they were facing in returning home during the COVID-19 pandemic.
Don’t miss the links to updated recommendations “Advice for preparedness and response to cases of COVID-19 on board ferries after lifting restrictive measures in response to the COVID-19 pandemic” and “EASA ECDC COVID-19 Aviation Health Protocol”.
Stay healthy, enjoy the reading and don’t forget to find the time for summer vacation!
Advisor of Quality Management and Communication Department
National Public Health Centre under The Ministry of Health
Prof. Christos Hadjichristodoulou
EU HEALTHY GATEWAYS Joint Action Coordinator, Professor of Hygiene and Epidemiology, Department of Hygiene and Epidemiology, Medical Faculty, University of Thessaly, Greece.
The EU HEALTHY GATEWAYS partnership has been hard at work for the last year under high pressure to complete all of the joint action’s regular activities, in addition to the emergency mode tasks that have been conducted and the support provided to competent authorities in Member States to respond to this crisis. Every partner’s continued efforts and dedication are highly appreciated not only internally by the consortium, but also by personnel at competent authorities who implement and apply the tools and advice developed, the European organisations and the transport industry. During the recent EU HEALTHY GATEWAYS Advisory Board meeting in May, the added value of the joint action was continuously highlighted by the members. They commented on the joint action’s value especially during the COVID-19 pandemic, where the expert network in the health transport field which has been collaborating for several years now has managed to rapidly develop ad hoc technical advice and guidelines in short timeframes to support points of entry and all means of transport. Moreover, the hard efforts were recognised also by MedCruise association that gave the
MedCruise Honorary Award 2021 to EU HEALTHY GATEWAYS for supporting MedCruise members and the cruise sector in general during the COVID-19 pandemic. In an online ceremony with the participation of a large number of European ports representatives, Mr Maik Schmahl from DG MOVE congratulated Healthy Gateways commenting that the joint action’s work has been fundamental in the reply to the COVID-19 crisis.
The sustainability of this network and all other deliverables and tools developed by EU HEALTHY GATEWAYS was also discussed in detail during the last Sustainability Working Group meeting, attended by international organization and European Commission agencies. Over the summer months, all joint action stakeholders will be asked to support the work of defining a sustainability strategy and express their opinions by answering an external evaluation questionnaire and a questionnaire focused on development of national sustainability plans. The external evaluation questionnaire which will support work carried out under the sustainability work package will ask stakeholders to identify and assess the strengths, weaknesses, opportunities and threats of the joint action. The sustainability questionnaire will be focusing on the deliverables and outputs of the joint action aims to identify the structures, collaborations or activities developed or implemented under the EU Healthy Gateways Joint Action that will persist beyond the end of the project in each EUMS and at European level.
In the meantime, the work on developing new guidance documents and revising existing documents based on new scientific evidence, the production of training materials and courses, and operation of the European digital Passenger Locator Form system will continue over the next months.
Covid-19: Kiribati seafarers stranded far away from home.
Author: Dr. Kea-Sophie Weber, Medical Doctor, Hamburg Port Health Authority, Germany
The small island nation of the Republic of Kiribati stays free of COVID-19 from the beginning of the pandemic. Their seafarers are stranded thousands of miles away from home.
The Republic of Kiribati (pronounced: Kiribass) consists of 32 atolls and the solitary island of Banaba (1). Being the only country that is situated within all four hemispheres its total area stretches over 5.2 million square kilometre. Since the ratification of the United Nations Convention on the Law of the Sea in 2003 by Kiribati, the insular state generates the most of its income by fishery licence fees and the wages of the internationally working Kiribati seafarers (2).
The Marine Training Center Tarawa (MTC) in Betio was founded in 1967 by German ship-owners and is still supervised and supported by SPMS (South Pacific Marine Services GbR) and German experts. Currently more than 600 seafarers, who were trained there, are deployed at their partners shipping companies Hamburg Süd/Maersk, Reederei Aug. Bolten, F. Laiesz, Fisser & van Doornum, Leonhardt & Blumberg and Reederei Nord (3).
Since 1967, more than 5.000 seafarers were trained there. Those seafarers are of great importance for Kiribati’s economy. Their annual total wages of about 5 million USD are generating around ten percent of Kiribati’s total income (4).
Kiribati is one of the few countries, which has still recorded no positive cases of Covid-19 since the start of the pandemic (5). To preserve this condition and to protect the 120.000 I-Kiribati (as the inhabitants of Kiribati are called) from the virus Kiribatis government sealed off borders at the start of the pandemic – even to its own citizens (6).
By March 2021, around 200 Kiribati sailors were stranded in Hamburg after up to 18 months on board. Their shipping companies – mostly based in Hamburg – had tried to get them home via Hamburg.
The situation of the I-Kiribati is not unique: According to the International Maritime Organization (IMO) more than 400.000 seafarers globally are trapped on ships or far away from home because of the pandemic’s travel restrictions (7; 8).
IMO – of which Kiribati is a member – launched a 12-step plan with a blueprint to facilitate crew changes and to implement procedures to repatriate stranded seafarers despite of the pandemic (9; 10).
According to the Maritime Labour Convention of the International Labour Organization (ILO) seafarers are to be relieved after 11 month of work on board of a ship. A crew change respectively repatriation to their home countries has to be facilitated by their ship-owners (11).
Difficulties of the repatriation
The repatriation of the Kiribati seafarers is difficult due to a various circumstances. The government of Kiribati has published a detailed guideline for the repatriation process, which requires incoming seafarers to spend 14 days in quarantine, both before and after entering Kiribati (12). Among other organizational issues, this means, finding a so-called quarantine-hub in one of the transit countries to ensure the pre-entry quarantine.
Additionally all repatriates will need to provide a negative Covid-19 test within 72 hours prior to their departure.
The challenges for the repatriation progress included, besides from the very limited flight capacities, the administrational efforts to obtain the approvals of Fiji (the last transit stop before Kiribati) in time and the average duration of a PCR-analysis of 12 hours. The time difference between Germany and Kiribati of 11 hours (UTC+12) even made matters worse.
The repatriation flights offered by the government of Kiribati were regularly cancelled at short notice (18). Leaving the entire organisation in the responsibility of the shipping companies.
Emotional stress of the stranded I-Kiribati
The very cold temperature in Hamburg and the accommodation in a youth-hostel with shared rooms is very stressful to the seafarers. The sailor’s mission tries to provide the essentials: especially warm clothing and a stable internet connection.
The most stressful burden for the I-Kiribati is the longing for home and their families. Some of them have not been at home for two years due to the difficulties in crew changes during the global outbreak of the pandemic. Some have missed the births of their children, others are not recognized by their children anymore. Due to the time difference, the men can only contact their beloved at night. Overall an enormous emotional and even physical stress for them. The hope to finally return home is fading with every cancelled flight.
And even after a successful repatriation, the fate of this extraordinary seafaring nation is uncertain (12). Without a vaccination the risk of stranding far away from home is omnipresent with every deployment. Even the shipping companies that have traditionally worked with I-Kiribati for decades are hesitating to re-employ Kiribati seafarers due to the resulting uncertainties.
As of February 2021 a total of 143 seafarers of Kiribati were accommodated in the youth hostel in Hamburg Bahrenfeld. 43 more were accommodated in the sailor’s mission in Altona. The shipping companies Nord, Leonhardt & Blumberg and F. Laiesz decided to relieve the sailors and accommodate them in Hamburg. Despite of the organisational and financial costs.
The I-Kiribati were accommodated in two buildings of the youth hostel divided according to their shipping companies and – as far as possible – to their ships. The Hamburg Port Health Center provided medical consultation possibilities and the Institute for Occupational Medicine and Maritime Medicine (ZfAM) adapted their program “e-healthy ship” especially to the seafarers needs (14). Valuable support was organized and granted by the sailor’s mission from Pastor Matthias Ristau and Deacon Jörn Hille.
However, a strict separation of the individual crew members at all times was almost impossible. In the case of an infection or positive test-result all persons would be considered to be one household. Which would result in quarantine for every single crew member. In order to generate as few contacts as possible, the Hamburg Port Health Center developed a concept for voluntary isolation in coordination with the public health department in charge. The seafarers, that were to be repatriated next, spent 7-14 days in voluntary isolation in cohorts of 2-3 persons. The idea was to prevent the whole youth hostel from quarantine in the case of a single positive test.
To finalize the repatriation a close cooperation of all parties involved was necessary. First of all, the shipping companies blocked or even booked as many flights as available. The disappointment was understandably huge, if seafarers, who had already voluntarily self-isolated, were told, that flights were cancelled due to overbooking/limited capacity.
At the same time, the shipping company applied through the government of Kiribati for the “first approval” of Fiji, to be able to book the transit and quarantine there.
All flights started on Tuesdays. So every booked and approved I-Kiribati had to be tested for Covid-19 on the weekend before. Luckily – and thanks to the very successful pre-isolation management – all test results were negative. Those results were again reported to Fiji with a request for the “final approval”. As soon as this approval was received, the seafarers could be informed, that they are finally flying home – respectively to Fiji.
Again, the whole process was enabled by the good cooperation between the shipping companies, HPHC and the Federal Border Police at the airports.
At last, the first group of I-Kiribati could start their journey back home on March 9th, 2021 after weeks and months of hopes and efforts. Three days later, after a long and exhausting journey via Frankfurt, Doha, Brisbane and Auckland, the first seafarers reached Fiji on March 11th, 2021 to start their first quarantine.
Three weeks later, the first 150 I-Kiribati were allowed to leave for Kiribati – to start another quarantine there.
Conclusion and Outlook
Currently around 60 I-Kiribati are isolated in a quarantine ward in their own country. The Marine Training Centre was converted into a temporary quarantine ward. The men are sleeping in one dormitory on the floor only equipped with pillows and sheets individually organized by their relatives.
Lately, one of the men died in this quarantine ward – just a few steps away from his home and family.
170 seafarers from Kiribati are awaiting their final repatriation in Fiji. Due to the current Covid cases in Fiji their departure is – once again – uncertain.
150 other seafarers have already arrived at their homes safely. 20 more are awaiting their repatriation in Hamburg. Due to the limited capacity of the quarantine hub in Fiji, it is unsure if, or hopefully when, they can be repatriated.
Globally approximately 100 more seafarers from Kiribati are stranded.
All those involved – especially the seafarers – were extremely grateful for the good cooperation between the collaborating parties. This case shows the importance of the good cooperation not only of the partners involved, but also of the combination of medical and psycho-social support.
Nevertheless, the fate of the seafarers of Kiribati remains uncertain. If the seafarers don’t get the urgently needed Covid-19 vaccination, their future at sea is doubtful.
Hopefully the COVAX initiative of the WHO and the recognition of seafarers as persons of systemic relevance rapidly supports the joint call of priority COVID-19 vaccination for seafarers (15; 16; 17).
1. Wikipedia. [Online] 09. April 2021. https://de.wikipedia.org/wiki/Kiribati.
2. Auwärtiges Amt. Deutschland und Kiribati: Bilaterale Beziehungen. [Online] 11. September 2020. https://www.auswaertiges-amt.de/de/aussenpolitik/laender/kiribati-node/bilateral/220370.
3. Hamburger Hafen. 50 Jahre Marine Training Centre Tarawa. [Online] 31. Juli 2017. https://www.hafen-hamburg.de/de/news/50-jahre-marine-training-centre-tarawa---35366.
4. Wikipedia. [Online] [Zitat vom: 08. April 2021.] https://de.wikipedia.org/wiki/Kiribati.
5. Word Health Organization Coronavirus (Covid-19) Dashboard. [Online] [Zitat vom: 5. April 2021.] https://covid19.who.int/table.
6. Government of Kiribati. Covid-19. [Online] [Zitat vom: 09. April 2021.] https://covid19.gov.ki/docroot/.
7. International Maritime Organization (IMO). Standing up for stranded seafarers on UN Human Rights Day. [Online] 10. Dezember 2020. https://www.imo.org/en/MediaCentre/PressBriefings/pages/45-Human-Rights-Day.aspx.
8. Sentient Media. As Borders Closed, Thousands of Seafarers were left stranded. [Online] 11. Februar 2021. https://sentientmedia.org/as-borders-closed-thousands-of-seafarers-were-left-stranded/.
9. Circular Letter No.4204/Add.14/Rev.1. International Maritime Organization. London : s.n., 2020.
10. SWZ Maritime. IMO launches plan to repatriate stranded seafarers. [Online] 08. May 2020. https://www.swzmaritime.nl/news/2020/05/08/imo-launches-plan-to-repatriate-stranded-seafarers/.
11. Maritime Labour Convention, 2006, as amended. Including 2018 amendments. International Labour Organization. [Hrsg.] International Labour Conference.
12. Government of Kiribati. Repatriation Process. [Online] 7. August 2020. https://covid19.gov.ki/docroot/repatriation-process.
13. Kiribatische Seeleute bangen nach Corona-Odyssee um Jobs. Welt Hamburg & Schleswig Holstein. Hamburg : Axel Springer SE, 13. März 2021.
14. Zentralinstitut für Arbeitsmedizin und Maritime Medizin. e-healthy ship. [Online] [Zitat vom: 17. 05 2021.] https://www.e-healthy-ship.eu/en/partners/zfam/.
15. ILO. Seafarers and aircrew need priority COVID-19 vaccination. [Online] 26. März 2021. https://www.ilo.org/global/about-the-ilo/newsroom/news/WCMS_776797/lang--en/index.htm.
16. WHO. COVAX-Initiative. [Online] [Zitat vom: 12. April 2021.] https://www.who.int/initiatives/act-accelerator/covax.
17. NTV. Seemannsmission: Rasche Corona-Impfung für alle Seeleute . [Online] 07. April 2021. https://www.n-tv.de/regionales/hamburg-und-schleswig-holstein/Seemannsmission-Rasche-Corona-Impfung-fuer-alle-Seeleute-article22474679.html.
18. Kiribati, Ministry of Foreign Affairs & Immigration. Facebook. [Online] [Zitat vom: 19. Februar 2021.] https://m.facebook.com/mfa.gov.ki/.
PREVIOUS EVENTS OF THE JOINT ACTION
3rd SUSTAINABILITY WORKING GROUP MEETING - 20th May 2021
The objectives of the meeting are to discuss internal sustainability issues of EU HEALTHY GATEWAYS, including sustainability options to identify long-term/permanent solutions for continuous operation and maintenance of joint action outputs. The working group including members of the consortium (work package leaders) and representatives from DG SANTE, DG MOVE, HaDEA, ECDC, EASA discussed the continuation of the joint action network expert, provision of scientific support to EU MS and European Commission services, the European digital Passenger Locator Form (EUdPLF) and the role of the EU SHIPSAN Association in supporting sustainability.
3rd ADVISORY BOARD MEETING - 20th May 2021
The 3rd advisory board meeting’s objective was to advise and collaborate with the Steering Committee and sustainability working group regarding Joint Action planning, evaluation, sustainability of outputs/deliverables and future areas for cooperation. A total of 28 participants joined the meeting (all work package leaders and representatives from US CDC, ICAO/CAPSCA, WHO EURO, WHO HQ, EMSA, ERA, EASA, ECDC, HaDEA, DG MOVE, DG SANTE. In particular and overview was given of the EU HEALTHY GATEWAYS activities in the context of COVID-19 and emergency mode operation and then the Advisory Board members participated in a roundtable discussing links with EU HEALTHY GATEWAYS, perceived needs related to joint action work and areas of future collaboration. Finally the meeting concluded with the presentation of the EU HEALTHY GATEWAYS evaluation results and results from the Sustainability Working Group meeting outcomes conducted at the same day.
Web-based training of the trainers’ course: Preparedness and response to public health events at ground crossings - 26th May 2021
The web-based training of the trainers’ course: “Preparedness and response to public health events at ground crossings” was organised on 26 May 2021. The training was organised by is organised by the National Institute of Public Health - National Institute of Hygiene (NIPH-NIH), Poland, the National Public Health Centre under the Ministry of Health, Lithuania, Public Health England, UK and the National Institute of Public Health (NIJZ), Slovenia in collaboration with the University of Thessaly – Laboratory of Hygiene and Epidemiology (UTH), Greece, National Institute of Public Health and the Environment (RIVM), Netherlands.
The purpose of the web-based training of the trainers’ programme is to increase competence and capacity for managing public health events in ground transport including risk assessment, decision-making and crisis communication. The training course will address issues of decision making for implementing evidence based health measures proportionate to the health risks. Moreover, a session dedicated to managing public health events due to chemical agents at ground crossings was included as part of the programme. The workshop was organised by the Public Health England (PHE), UK and the National Institute of Public Health (NIJZ), Slovenia. The purpose of the workshop is to identify gaps, opportunities and raise awareness of best practice for chemicals at ground crossings and improve understanding of existing arrangements in Member States. It will address, at a national level, the plans for preparedness and action for dealing with a chemical incident at ground-crossings.
level, the plans for preparedness and action for dealing with a chemical incident at ground-crossings.
A total of 60 people participated in the course from 19 European region countries (14 EUMS and 5 non-EU countries). Out of those, 55 participated in Sessions 1 to 4 and 40 persons participated in Session 5: Management of public health event due to chemical agent
In addition at total of 14 presenters/ facilitators and 6 observers from DGSANTE, ECDC and WHO EURO participated in the course.
OTHER PREVIOUS EVENTS
15 June 2021 - Webinar series on COVID-19 main challenges and the way forward (Implementation of new legislation, protocols, tools and legislation) organised by MEDports and MedCruise associations.
EU HEALTHY GATEWAYS was invited to present in a webinar series on COVID-19 main challenges and the way forward (Implementation of new legislation, protocols, tools and legislation) organised by MEDports and MedCruise associations. The webinar took place on 15th June 2021 and Prof. Christos Hadjichristodoulou (EU HEALTHY GATEWAYS Joint Action Coordinator) and Assoc. Prof. Barbara Mouchtouri (Leader work package 7 “Maritime sector”) presented the EU HG tool for contingency plan development and assessment at ports with a focus on each stakeholder’s actions.
10 June 2021 – CLIA Webinar – EU HEALTHY GATEWAYS Updated advice for cruise ships operations and operators
EU HEALTHY GATEWAYS – updated advice for restarting cruise ship operations was presented to the members of the Cruise Line International Association on 10th June by Prof. Christos Hadjichristodoulou (EU HEALTHY GATEWAYS Joint Action Coordinator) and Assoc. Prof. Barbara Mouchtouri (Leader work package 7 “Maritime sector”).
EU Healthy Gateways Joint Action received the
MedCruise Honorary Award 2021
The joint action has received this award from MedCruise for supporting MedCruise members and the cruise sector in general during the COVID-19 pandemic, especially through the development of the EU HEALTHY GATEWAYS tool for contingency plan assessment and development at ports (available here: https://www.healthygateways.eu/Tool-for-contingency-plan-development-and-assessment-for-ports).
The coordinator would like to thank each of the partners and stakeholders as this honour is because of all their hard work and contributions to the joint action activities, especially at this time.
EU HEALTHY GATEWAYS PUBLICATIONS
Advice for preparedness and response to cases of COVID-19 on board ferries after lifting restrictive measures in response to the COVID-19 pandemic. (VERSION 2, May 2021)
This guidance is addressed to ferry companies, as well as competent public health authorities at ports. The objective of these general guidelines is to provide recommendations on preventive measures that ferries should implement to protect passengers, crew members and onshore personnel, as well as to create an environment of trust in the maritime transport of passengers by ferry. These guidelines should be adapted to each particular ship according to their own characteristics, traffic and any other factor that could be taken into consideration.
Available here: https://www.healthygateways.eu/Portals/0/plcdocs/Advice_Passenger_Ferry.pdf?ver=2021-06-08-142902-883
Advice for restarting river cruise ship operations after lifting restrictive measures in response to COVID-19 pandemic
The purpose of this document is to provide general guidance to EU/EEA MS and to river cruise ship operators about options for measures on river cruise ships (of any capacity or flag state that sail on an international voyage) that could be applied after lifting the restrictive measures implemented in response to the COVID-19 pandemic in 2021.
Available here: https://www.healthygateways.eu/Portals/0/plcdocs/EU_HEALTHY_GATEWAYS_COVID-19_RESTARTING_INLAND_CRUISES.PDF?ver=2021-06-29-122347-310
Systematic Review on Outbreaks of SARS-CoV-2 on Cruise, Navy and Cargo Ships
Ann-Christin Kordsmeyer, Natascha Mojtahedzadeh, Jan Heidrich, Kristina Militzer, Thomas von Münster , Lukas Belz , Hans-Joachim Jensen , Sinan Bakir, Esther Henning, Julian Heuser , Angelina Klein , Nadine Sproessel, Axel Ekkernkamp, Lena Ehlers, Jens de Boer , Scarlett Kleine-Kampmann, Martin Dirksen-Fischer , Anita Plenge-Bönig , Volker Harth , Marcus Oldenburg
The confined environment of a ship promotes the transmission of the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) due to close contact among the population on board. The study aims to provide an overview of outbreaks of SARS-CoV-2 on board of cruise, navy or cargo ships, to identify relevant outbreak management techniques, related problems and to derive recommendations for prevention. Four databases were searched. The study selection included reports about seroprevalences or clinically/laboratory confirmed infections of SARS-CoV-2 on board ships between the first of January, 2020 and the end of July, 2020. A total of 37 studies were included of whom 33 reported outbreaks of SARS-CoV-2 on cruise ships (27 studies referred to the Diamond Princess). Two studies considered outbreaks on the Grand Princess, three studies informed about Nile River cruises and one study about the MS Westerdam (mention of multiple outbreaks possible in one study). Additionally, three studies reported outbreaks of SARS-CoV-2 on navy vessels and one study referred to a cargo ship. Problems in handling outbreaks resulted from a high number of asymptomatic infections, transportation issues, challenges in communication or limited access to health care. Responsible operators need to implement infection control measures which should be described in outbreak management plans for ships to prevent transmission risks, including, e.g., education, testing strategies, communication lines, social distancing and hygiene regulations.
EASA ECDC COVID-19 Aviation Health Safety Protocol
The European Union Aviation Safety Agency (EASA) and the European Centre for Disease Prevention and Control (ECDC) have updated their joint Aviation Health Safety Protocol providing clear operational guidance and risk-based recommendations for health-safe air travel to complement the European Union’s initiatives, such as the EU Digital COVID Certificates. This third version of the protocol takes into account new evidence and information such as the circulation of variants of concern (VOCs) and the rollout of COVID-19 vaccination programmes. The protocol is intended to provide support to national authorities in Member States and to aviation stakeholders.
Available here: https://www.easa.europa.eu/document-library/general-publications/covid-19-aviation-health-safety-protocol