To: Ned Holland, Assistant Secretary for Administration Ellen Murray, Assistant Secretary for Financial Resources Bill Schultz, Acting General Counsel From: Sally Howard, Chief of Staff Kate Wolff, Dizector of Scheduling and Advance Subject: Request for Approval of Use of Charter Aireraft Date: December 5, 2011 ‘This memorandum is to request approval for Secretary Sebelius and accompanying staff to travel on a charter aircraft leased by the Department. Background A visit to India by Secretary Sebelius will highlight the significance and breadth of the U.S.-India relationship while advancing important objectives for the Department of Health and Human Services and its operating divisions. Additionally, Indian Ministry of Health and Family Welfare officials have repeatedly requested a visit by Secretary Sebelius. Priority issues to be incorporated in the visit include: 1) US-India Health Initiative. The Secretary's visit will provide leadership and direction for the nascent U.S.-India bilateral Health Initiative. 2) Polio, Several of the Secretaiy’s site visits will highlight India’s tremendous achievements in moving toward polio eradication. 3). GDD Center. The Secretary's visit will reinforce the commitment to the U.S.- India partnership toward establishment of a Global Disease Detection Center in India. 4) NIH Research. The Secretary will acknowledge the opportunities for continued expansion of scientific collaboration in biomedical and behavioral research. 5) Non-Communicable Diseases. In continuation of the Secretary's on-going work ‘with the intemational community in combating non-communicable diseases, her visit will expand the partnership with India as the health system responds to the challenges of NCDs. 6) FDA. The Secretary’s visit will also acknowledge the importance of FDA’s presence in India and advancing FDA's relationships with the Government of India,In consideration of the size and scope of India and U.S.-India activities, a visit to five cities has been recommended by the HHS Office of Global Affairs. tis proposed that Secretary Sebelius travel to India for a wide variety of events and site visits from Sunday, January 8 to Tuesday, January 17, 2012. Her trip will begin in New Delhi, where she will meet with Ministry of Health and Family Welfare officials, interact with local groups who have been working with the Centers for Disease Control and Prevention on polio eradication, and visit the National Centre for Disease Control. While in the Delhi area she will also travel to Agra to do a site visit (likely to the Mertygold hospital). From Delhi the Secretary will travel to Pune for a series of sites visits focusing on AIDS research and treatment as well as drug manufacturing. The Secretary will also travel to ‘Belgaum to see firsthand the challenges of delivering health care in a rural, resource poor setting, with site visits focusing on matemal and child health. Finally, the Secretary will do a series of site tobacco related disease and other FDA issues. its in Mumbai focusing on cancer care, Belgaum, the fourth city proposed in the schedule does not currently have commercial travel available. The only commercial airtine that flies into Hubli, the next closest airport, is Kingfisher Airlines, which has made interiational headlines over the past few weeks with stories of a possible bankruptcy and numerous canceled flights. Kingfisher Airlines is not believed to be a reliable cartier et this time. ‘The draft schedule of events is 23 follows — please note events will be finalized and added following the staf pre-advance trip in December: ‘Sunday, January & Washirigton, DC + New Delhi, India 5:20-7:05pm WHEELS UP DULLES EN ROUTE TO NEWARK, NJ 37pm WHEELS UP NEWARK EN ROUTE TO NEW DELHI, INDIA Monday, January 9 9:20pm, WHEELS DOWN NEW DELHI, INDIA. RON ‘New Delhi, India‘Tuesday. January 10 11:30am-12:00pm = MEET AND GREET WITH HHS INDIA STAFF US Embassy, Room TBD 12:00-1:00pm_ HEALTH BRIEFING WITH INDIA TEAM US Embassy, Room TBD Participants: Ambassador Peter Burleigh 1:45-3:00pm LUNCH WITH POLIO PARTNERS: Location PM. TBD SITE VISIT RON ‘New Delhi, India ‘Wednesday, January 11. 10:00-11:00am MEETING WITH MINISTRY OF HEALTH AND FAMILY. ‘WELFARE OFFICIALS AND US-INDIA HEALTH INITIATIVE Format: This event would feature progress reports from bilateral ‘working groups on maternal and child health; infectious diseases; ‘nofcommunicable diseases; and strengthening health systems and services, 1:00-4:30pm POLIO SITE VISITS NEAR NEW DELHI a Format: The Seoretary will visit a few sites related to polio in ‘urban New Delhi where she will: (i) lean about India’s polio eradication efforts and tentatively give polio vaccine drops to children at an immunization booth; (ji) meet with vaceinators, supervisors and medical staff at the health center; (ii) see how vvaceines are stored; iv) walk through an adjacent slum and interact with families and polio affected children; (v) and possibly interact with the local media. TBD RECEPTION HOSTED BY AMBASSADOR BURLEIGH Ambassador's Residence RON ‘New Delhi, India ‘Thursday, January 12 ‘New Delhi, India —> Agra, India New Delhi, India8:00am-12:00pm 12:00-1:30pm 2:00-4:00pm 4:00-8:00pm RON Friday, Jam 10:30am-12:30pm 3:00-3:45pm 3:45-4:30pm RON ‘Saturday, January 14 DEPART HOTEL EN ROUTE TO AGRA, INDIA (DRIVING) VISIT TAS MAHALILUNCH MERRYGOLD HOSPITAL SITE VISIT Format: Merrygold hospital is part of the Merrygold Health ‘Network which provides reproductive and child health services at 50-60% of private sector prices to rural, semi- urban and urban slum populations. This 20 bed Merrygold hospital provides maternal emergency obstetric care and receives funding from USAID, the State Innovations in Family Planning Project Services ‘Agency and Government of Uttar Pradesh. DEPART AGRA EN ROUTE TO HOTEL (DRIVING) ‘New Delhi, India BALABGHAR COMMUNITY-BASED INFLUENZA SURVEILLANCE SITE VISIT Format: This is an All India Institute of Medical ‘Sciences and CDC field site for an influenza vaccine efficacy trial, conducting impressive longitudinal studies. The Secretary will see some ‘combination of a secondary hospital, primary health clinic, participate in a home visit and/or go to a village vaccine camp. ‘NATIONAL CENTRE FOR DISEASE CONTROL SITE VISIT Topic: CDC is actively collaborating with NCDC to establish a Global Discase Detection Center and to implement a sophisticated ‘training program. REMARKS AT NATIONAL CENTRE FOR DISEASE CONTROL Participants: Audience would include scientists, epidemiologists, students and press interested in public health and ‘capacity development in India. New Delhi, India ‘New Delhi, India — Pune, India + Mumbai, India7:48-9:50am 5:40-6:20pm RON = « WHEELS UP NEW DELHI EN ROUTE TO PUNE, INDIA Jet Airways Flight 365 Flight time: 2h 05m SITE VISIT TO EMCURE PHARMACEUTICAL, Emcure is one of FDA’s “tentative approval” process ‘manufacturers under PEPFAR. Emcure has launched several of the world’s first ARV combination drug products. As such, they are an important component of the USG global efforts around HIV. SITE VISIT TO BJ MEDICAL COLLEGE ‘teaching hospital aligned with the Sassoon General Hospital, a 1500 bed state run hospital. Considered one of the premier medical institutions in India, itis also the place where Mahatma Gandhi was operated on for acute appendicitis in 1924, and as such is a histofic site, WHEELS UP PUNE EN ROUTE TO. MUMBAI, INDIA Jet Airways flight 617 Flight time: 40m, ‘Mumbai, India Mumbai, India — Belgaum, India — Mumbai, India 7:45-9:15am 10:00am-11:30pm 11:30-1:00pm. 1:00-2:30pm . WHEELS UP MUMBATEN ROUTE TO BELGAUM ‘Tentative: Charter flight SITE VISIT TO KLE UNIVERSITY Format: KLE was the recipient of NIH/NICHD and NIH/FIC ‘grants, including the Public-Private Partnership of the Global ‘Network for Women’s and Children Health Research. LUNCH WITH STUDENTS AND STAFF WORKING ON NIH GRANTS SITE VISIT TO PRIMARY HEALTH CENTER AND CHILD DEVELOPMENT CENTER Format: Thirty-two primary health centers serve a rural population ‘of over 670,000 people. The area community health workers through the Global Network conduct ethical research and data collection while saving mothers and baby’s lives. In addition, theyhave expanded beyond the scope of the grants when needed, ie. ambulance services for women in labor. 3:00-4:30pm WHEELS UP BELGAUM EN ROUTE TO MUMBAI Tentative; Charter flight 7:30-9:30pm DINNER WITH FDA AND INDUSTRY LEADERS Topic: This will be an opportunity to discuss vaccine and pharmaceutical issues with leaders of Indian pharmaceutical firms ‘who are members of the Indian Pharmaceutical Alliance, an invited ‘membership association of the top (by value/volume) 12-15 Indian pharmaceutical firms. The invitees would include a mix of Indian and multinational firms. RON ‘Mumbai, India Monday, January 16 ‘Mumbai, India Washington, DC 11:00am-12:30pm SITE VISIT TO TATA MEMORIAL HOSPITAL Location TBD i Format: Nearly 43,000 new cancer patients visit TATA annually from India and neighboring countries many of which are treated fice of cost. In addition, over 1,000 patients visit the outpatient department daily for medical advice, comprehensive care or for follow-up treatment. This visit may include a tour of the outpatient facility; a discussion on NIH funded research, and interaction with patients and/or researchers. In addition, the director of TATA is a ‘member of the NCD U.S.-India Health Initiative Working Group. 2:00-3:30pm WORKPLACE SITE VISIT/HEALIS-SEKHSARIA INSTITUTE FOR PUBLIC HEALTH Format: The Secretary may visit a manufacturing site and watch Healis, as they pilot a study on tobacco intervention. This visit ties in nicely with the work done at HHS to implement a tobacco-free campus and with the initiative she launched at the UN HLM on CDs in September on global smoke-free workspaces. 11:40pm WHEELS UP MUMBAI EN ROUTE TO NEWARK, NJ Continental flight 49 Flight time: 16h 05m Time change: -10.5 hoursTuesday, January 17 5:15am WHEELS DOWN NEWARK, NI 6:32-7:44am_ WHEELS UP NEWARK EN ROUTE TO DCA Continental flight 4326 ‘Legal Standard Title 41 CER. Parts 101-37, 300-3, 301-10, and 301-70 contains approval requirements for authorized travel on Government aircraft (Government aircraft include contracted, leased ot other charter aircraft). Pursuant to 41 C.F-R 301-10.261 (a)(1), Government aircraft may be used in cases where no scheduled commercial airline service is reasonably available to fulfill the travel requirement. Pursuant to 41 C.F.R 301-10.261 (@)(2), Government aircraft may be used in cases where the cost of using a Government aircraft is less than the cost of the city-pair fare for scheduled commercial airline s or the cost of the lowest available full coach fare if. city-pair fare is not available. (The ‘cost of non-productive or lost work time while in travel status and certain other costs should be considered when comparing the cost of using a Government aircraft in lieu of scheduled commercial airline service.) ‘The Chief of Staff and the Director of Scheduling and Advance hereby certify that the agency travel requirements identified in this memo for the travel segments from Mumbai to Belgaum cannot be accomplished through the use of regularly scheduled commercial airline flights, and no reasonable alternative is available, thus requiring the use of charter aircraft. ‘Travel Manifest Mumbai, India to Belgaum, India (15 passengers) Kathleen Sebelius, Secretary Deborah Auter, Director, Office of Compliance, FDA Tom Frieden, Director, CDC Nils Daulaire, Director, Office of Global Affairs Roger Glass, Director, Fogarty International Center, NIH ‘Anand Parekh, Deputy Assistant Secretary for Health Erika Elvander, Office of Global Affairs Jessica Hancock, Office of Global Affairs Steve Smith, Health Attaché, Office of Global Affairs Tim Granholm, Office of the Chief of Staff Hollis Chappell, Advance Staff, Immediate Office of the Secretary Eli Fleet, Advance Staff, Immediate Office of the Secretary Patrick Salazar, Security Detail Michael Lonetio, Security Detail ‘TBD USAID/CDC StaffBelgaum, India to Mumbai, India (18 passengers) Kathleen Sebelius, Secretary Deborah Auter, Director, Office of Compliance, FDA ‘Tom Frieden, Director, CDC Nils Daulaire, Director, Office of Global Affairs Roger Glass, Director, Fogarty Intemational Center, NIH Anand Parekh, Deputy Assistant Secretary for Health Erika Elvander, Office of Global Affairs Jessica Hancock, Office of Global Affairs Steve Smith, Health Attaché, Office of Global Affairs ‘Tim Granholm, Office of the Chief of Staff Hollis Chappell, Advance Staff, Immediate Office of the Sctretary Eli Fleet, Advance Staff, Immediate Office of the Secretary ~ Patrick Salazar, Security Detail : Michael Lonetto, Security Detail Dennis Rude, Security Detail Chris Phillips, Security Detail Robert Murphy, Security Detail ‘TBD USAIDICDC Staff Travel I Aircraft type: UNKNOWN Distance: ‘Approximately 300 miles (drive time: 7 hours) WHEELS UP. MUMBAI EN ROUTE TO BELGAUM WHEELS UP BELGAUM EN ROUTE TO MUMBAI ‘Tentative: Charter flight Total charter travel cost for 1/15 travel: UNKNOWN NOTE: The Secretary’s Office is still waiting for information from PSC regarding total costs. If only one plane is chartered for just a portion of the delegation, it is estimated the trip will cost approximately $16,000. Cor tial Of Prior to November 2011, Kingfisher Airlines was the only commercial carrier that flew into Belgaum. Due to recent financial difficulties, Kingfisher has since canceled allflights into Belgaum. In order to reach Belgaum via commercial travel the delegation would need to fly into Hubli, India on Saturday, January 14 and drive one hour to ‘Belgaum that evening and spend the night. The delegation would then spend an entire day in Belgaum and have another overnight before the being able to fly out the morning ‘of Monday, January 16. Airfare for all proposed travelers would total approximately $4,100 for all legs. Proposed Commercial itinerary Saturday, January 15 6:25-7:50pm KINGFISHER AIR FLIGHT 2121 FROM MUMBAI, INDIA TO. HUBLI, INDIA 8:00-9:00pm DEPART HUBLI EN ROUTE TO BELGAUM (DRIVING) RON Belgaum, India Sunday, January 15 All Day Belgaum Site Visits RON Belgaum, India Monday, January 16 7:30-8:30am DEPART BELGAUM EN ROUTE TO HUBLI 9:35-11:00am KINGFISHER AIR FLIGHT 2122 FROM HUBLI, INDIA TO MUMBAI, INDIA ‘Charter Justification Each city recommended by the Office of Global Affairs for the Secretary’s visit to India has been chosen to address particular public health concems of HHS. Belgaum will be the only opportunity during her visit to observe health care delivery in a rural, resource poor setting. Further, the proposed sites in Belgaum are all developing innovative approaches to women, infant, and child health, directly saving lives of women and babies and improving the lives of rural children in India. These sites have received considerable funding for their work as vital partners in the Global Network for Women’s and Children Health Research (Global Network), a research network jointly funded by the Bill and Melinda Gates Foundation and the NIH/National Center for Child Health and Human Development. In addition, the Primary Health Care site, using data collected from their Global Network funded research, determined that childbirth related deaths would be 9reduced if women actually got to clinics to deliver their babies. As a result, on their own, the health care workers developed an ambulance service specifically for women in labor, saving women and their babies in the process. The Secretary will also meet with a team that has developed novel community based approaches to addressing developmental delays in infants that will improve the lives of these children as they grow into adulthood. ‘Because the sites are connected to the Global Network, this innovative evidence based approaches to health care delivery in rural and resource poor settings are being shared around the world. While a Secretarial visit to Belgaum is a high priority for this visit to India, the site visits will not take more than one normal working day. Traveling to Belgaum via commercial flights would limit the amount of time the delegation would spend on other, equally valuable aspects of the trip in Pune and Mumbai. ‘There are also concerns regarding the stability of Kingfisher Airlines, the only commercial airline that flies to Hubli, the airport closest to Belgaum (one hour drive). As reported in the Wall Street Journal on November 11, 2011, Kingfisher canceled more than 120 flights in one week as salaries for pilots and crew were delayed. Tt has also been reported that leasing companies want the airline to return their planes after the company fell behind on payments, ‘Recommendation For the reasons discussed in this memo, the agency's travel requirement in this case is that the Secretary travel to the above-referenced locations to attend scheduled events to further the mission of the Department. The requirements of the Federal Travel Regulation are satisfied here because no commercial flights are reasonably available to the Secretary to complete her travel in the time allotted. Our office requests ASA approval forall travelers, as well as OGC approval for Senior Federal Travelers on the attached forms. Concurrence from the ASFR is also requested. ‘See Attachments. 10