Maritime Public Health Cross Border Cooperation: Principality of Monaco and Italian Liguria Health Port Authority Best Practices ^†

Abstract

The French and Italian Riviera are one of the most important areas in the world for yachting and cruise activity. Even though ports and airports of this area make up a single network, they insist on the territory of two different EU countries (Italy and France), and of one non-EU (Principality of Monaco), that have different health systems and legislations. In this context, a collaboration between maritime port health authorities became essential to perform an effective public health action in order to prevent the spread of infectious diseases. In this paper are illustrated the best practices in the domain of maritime public health collaboration between Italy and Monaco during the Covid-19 pandemic, and programs for future developments that should be a benchmark for other cooperation programs between eropean health port authorities.

1. Introduction

The French and Italian Riviera are one of the most important areas in the world for yachting and cruise activity. In the pre-Covid-19 period (2019), the total number of international passengers reached 2,741,000 with 734 cruise ship calls in Ligurian ports (1) and 183,468 with 163 calls in Monaco ports (2). Therefore, there is a massive yacht flow between ports of this area which are only an hour of navigation from each other. This indicates a great embarkation/disembarkation movement, including crews and passengers from non-EEC countries via the international Cote d’Azur airport, which is the second largest in France. In addition, over 1.9 million passengers (data from 2019) have embarked in the ports of Liguria on ferries heading to the largest Mediterranean islands (Corsica, Sardinia and Sicily).

Last but not least, the Monaco Ports management company has inaugurated a large tourist port (Cala del Forte, Ventimiglia, Italy) in 2020. This suggests a potential lack of harmonization between different national administrations, which might cause issues with maritime traffic and weaken the response to Covid-19 (e.g., different procedure to allow free pratique, quarantine regulations and health entry requirements).

In fact, even though the ports and airports of this area make up a single network of POE, they insist on the territory of two different EU countries (Italy and France), and of one non-EU (Principality of Monaco), that have different health systems and legislations. In this context, a collaboration between maritime port health authorities became essential to perform an effective public health action in order to prevent the spread of infectious diseases at points of entry and onboard.

The aim of this paper is to illustrate the best practices in the domain of maritime public health collaboration between Italy and Monaco during the Covid-19 pandemic, and programs for future developments.

2. Material and Method

From February 2020 to nowadays the cooperation project with the actions to face Covid-19 pandemic emergency has been identified and managed by an interdisciplinary group with the cooperation of the Monaco and Liguria Health Port Authorities, Local Health Services and Port Management Companies. Public health actions have been taken in compliance with IHR, National Legislations, WHO and Healthy Gateways advices, ECDC recommendations, and the IMO documents. Epidemiological data from ECDC have been used continuously to support risk analysis. EU Commission Guidelines concerning the protection of health, repatriation, and travel arrangements for seafarers, passengers, and other persons on board ships (2020/C 119/01), exercise of the free movement of workers during COVID-19 outbreak (2020/C 102 I/03), and implementation of the Green Lanes under the Guidelines for border management measures to protect health and ensure the availability of goods and essential services (2020/C 96 I/01) have been applied.

3. Results

The cooperation actions taken are listed below:

(a)

Uniform procedure to allow free pratique to cruise ships and yacht sailing between ports of the area

(b)

Creation of health corridors for seafarers and passengers between Liguria ports/airports (Genoa and Albenga) and the Principality of Monaco

(c)

Placing in service of the Covid Free Shuttle boat Monaco One (connecting Monaco and Ventimiglia ports) with preboarding Italian health check valid to enter Monaco. This shuttle has been very useful on the occasion of mass gate events like F1 Grand Prix.

(d)

Simplified procedures for seafarers’ embarkation/disembarkation

(e)

Optimal management of Covid-19 outbreaks onboard in synergy collaboration with ashore health care services (laboratory and imaging facilities, care departments, intensive care units) and ashore Covid hotels.

(f)

Priority for seafarer’s Covid testing (antigenic rapid and PCR) performed on board and in port areas.

(g)

Possibility for seafarer’s, regardless their nationality, to be full vaccinated against Covid19 and to complete vaccination series started abroad with priority.

4. Discussion and Conclusions

The Monaco–Italian cooperation during the Covid 19 pandemic has made possible: (1) the continuity of maritime and port activities; (2) the possibility for seafarers, regardless of their nationality, to transit and travel to ensure continued professional activity; (3) to manage ship Covid-19 outbreaks; (4) to perform an effective priority action of testing and vaccination for crew and passengers.

The program born as a response to Covid-19 pandemic emergency will continue into the future to promote maritime public health, the enhancement of health staff skills and cultural resources, and the development of adequate facilities at POE. Actions in these priority areas will be complemented by efforts to foster closer and more effective cooperation of administrations (the inclusion of this cooperation program in the EU action Interreg Maritime is ongoing).

Among the main actions identified for the future, there are: (1) the creation of a study group on maritime medicine and an international course for qualification of ship’s health staff, (2) a closer collaboration with healthy gateways projects, (3) a common training program for public health inspectors, (4) joint inspections on board to deliver ship sanitation health certificates, (5) and a control project on crew compliance with regulation A 1/9 STCW (possession of a valid medical fitness certificate).

In conclusion, the cross-border maritime public health cooperation of Liguria (Italy)–Principality of Monaco is the best practice to achieve the goals of an effective prevention of infectious diseases spread according to the EU Healthy Gateways Strategy in the Northern Mediterranean area by promoting new innovative operating ways. It is definitely a benchmark for other cooperation programs between the maritime health public authority and health port authorities with the main objective to prevent the spread of infectious diseases and to make the sea a more healthy safety space.