International Travel: OGH Policy for Special International Travel

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Protocol Concerning Travel to Countries Under U.S. State Department Travel Warnings and U.S. Centers for Disease Control Travel Notices

As University of Massachusetts Medical School (“UMMS”) trainees, faculty and staff travel, they may be subject to risks including war, terrorism, political unrest, and natural catastrophes in host countries. In addition, a disease outbreak in another country may pose a risk of infection for the trainee or employee traveling to the affected area, as well as a risk that the student or employee may transmit the disease or health condition to others upon returning to the United States. Given the above, UMMS relies on information, including the Travel Warnings and Travel Alerts issued by the U.S. Department of State, and Travel Notices issued by the U.S. Centers for Disease Control. Consequently, UMMS has developed this protocol governing travel by UMMS faculty and staff.

I. U.S. DEPARTMENT OF STATE TRAVEL WARNINGS AND TRAVEL ALERTS

The U.S. Department of State issues Travel Warnings and Travel Alerts. Generally, Travel Warnings describe long-term, protracted conditions that may threaten the safety and security of U.S. citizens traveling to a particular country or region, while Travel Alerts characterize short-term circumstances. Furthermore, elaboration of Travel Warnings and Travel Alerts distinguishes warnings between two basic categories: (1) warnings of conditions that heighten the ordinary risk of travel to a particular country (“heightened risk”) and (2) more urgent warnings that forbid, restrict or otherwise urge U.S. citizens to defer travel to a particular country.

A. Protocol for Students, Residents and Post-doctoral Fellows traveling to countries or regions for which the State Department has issued a Travel Warning or Travel Alert

1. No student, resident, or post-doctoral fellow shall be required to travel to countries or regions for which the State Department has issued a Travel Warning or Travel Alert.

2. Students, residents, or post-doctoral fellows are not permitted to travel under UMMS auspices or supervision to countries or regions for which the State Department forbids or otherwise recommends avoidance of travel under any circumstance.

3. Under limited circumstances residents, or post-doctoral fellows who wish to travel under UMMS auspices, to a country for which the State Department has issued a “heightened risk” travel warning may do so, provided the following conditions are met:

    a. The resident, or post-doctoral fellow must review the Travel Warning and the U.S. Department of State Consular Information Sheet for the country in question. These documents are available on the web at http://www.state.gov.

    b. The resident, or post-doctoral fellow must carefully consider the conditions and risks described in the Travel Warning or Travel Alert and in consultation with the respective program advisor, must make a decision regarding whether or not to continue with plans for the proposed activity. In making a decision, the trainee and advisor must balance anticipated benefits with potential risks. The trainee and advisor should recognize that the existing warning might change at any time to a more urgent warning; if this occurs, policies applying to more urgent warnings would be triggered and the trainee may have to leave the country or make other plans. The trainee and advisor should also take into consideration that UMMS, the U.S. State Department, and local U.S. Embassy or Consulate may not be able to assist the individual in case of crisis or difficulties. Ultimately, the resident, or post-doctoral fellow understands and agrees that it is their decision, alone, to undertake such travel.

    c. If the resident, or post-doctoral fellow decides to travel to the country after discussion with the advisor, the trainee must obtain travel clearance from the Office of Global Health. In addition to the procedures required by all residents, or post-doctoral fellows traveling internationally, the resident, or post-doctoral fellow traveling to a country or region with a Travel Warning or Travel Alert will be required to:

      i. Sign and complete OGH’s International Travel Liability Release Form, acknowledging the existence of the State Department Travel Warning or Travel Alert and his/her decision to continue with the planned activity despite that warning, and releasing the University from potential liability.

      ii. Complete OGH’s Special Travel Waiver Request and Registration Form, providing a description of the proposed project, the rationale for continued plans to travel, an in-country emergency plan, and emergency contacts.

      iii. If provided with clearance to travel, the resident, or post-doctoral fellow must contact and provide updates by mutually agreeable venue (e-mail or phone) to the UMMS advisor at least weekly at a designated time while in country.

4. In the event that the State Department issues a new or updated advisory to avoid travel immediately preceding or during a student’s, resident’s, or post-doctoral fellow’s travel to an affected country or region, the following will occur:

    a. UMMS programs that involve students, residents, or post-doctoral fellows in that country or region will be suspended.

    b. Students, residents, and post-doctoral fellows will not be allowed to travel to that country or region under UMMS auspices.

    c. Any UMMS funding provided to date for planned activities or projects must be returned to UMMS. If some funds have already been expended, the student or trainee must work with his/her program advisor to determine the amount to be returned.

    d. If the student or trainee is already in the country or region, the program advisor, in consultation with the Associate Provost for Global Health (or in her absence, the OGH Co-Director), and individuals knowledgeable with the situation must decide whether the student, resident, or post- doctoral fellow must leave the country and return to the U.S. Whenever possible, UMMS will assist the trainee in making arrangements for his/her return.

    e. If a student, resident, or post-doctoral fellow elects to travel and participate in the activity despite the travel warnings or advisories without clearance from the OGH, the student or trainee will not receive UMMS funding, academic credit, or travel insurance coverage.

B. Protocol for Faculty or Staff traveling to countries or regions for which the State Department has issued a Travel Warning or Travel Alert

Faculty and staff may have ongoing advisory, clinical, or research activities in countries or regions of countries for which Travel Warnings or Travel Alerts are in effect or newly issued. In addition, UMMS recognizes that, in times of international crisis, its employees may have valuable expertise that is needed to assist with the resolution of the crisis. Consequently, UMMS does not prevent its employees from traveling to countries for which the State Department has issued a Travel Warning or Travel Alert, but it also does not sanction and/or assume any responsibility or liability with respect to same. In addition, the following rules and conditions apply to faculty/staff traveling under UMMS auspices:

1. No UMMS faculty or staff shall be required to travel to a country or region for which a Travel Warning or Travel Alert has been issued.

2. UMMS faculty and staff are not guaranteed UMMS travel insurance coverage for travel to designated war risk territories. A faculty or staff must submit his or her travel itinerary and destination information as early as possible to OGH (jessica.chang@umassmed.edu) and the President’s Office (Matthew Wamback, mwamback@umassp.edu) to determine whether his or her trip will be covered.

3. UMMS faculty or staff must review the Travel Alert or Warning and the U.S. Department of State Consular Information Sheet for the country in question. These documents are available on the web at http://www.state.gov.

4. UMMS faculty or staff must carefully consider the conditions and risks described in the Travel Alert or Warning and must make a decision regarding whether or not to continue with plans for the proposed activity. In making a decision, faculty or staff must balance anticipated benefits with potential risks. Faculty or staff should recognize that the existing warning may be changed at any time to a more urgent warning; they should also take into consideration that UMMS, the U.S. State Department, and local U.S. Embassy or Consulate may not be able to assist individuals in case of crisis or difficulties.

5. Prior to travel, faculty /staff must complete the following:

II. CENTERS FOR DISEASE CONTROL (CDC) TRAVEL NOTICES

There are three categories of CDC Travel Notices that are relevant for purposes of this policy: (1) Outbreak Notice—issued when there is an outbreak of a contagious disease in a limited geographic area; (2) Travel Health Precaution—issued when a disease outbreak of a greater scope is occurring in a more widespread geographic area; and (3) Travel Health Warning—issued when there is a widespread, serious outbreak of a disease of public health concern. (At this warning level, the CDC recommends against non-essential travel to the area.)

A. Protocol for Students, Residents, or Post-doctoral Fellows traveling to a country or region for which the CDC has issued a Travel Notice.

1. No student, resident, or post-doctoral fellow shall be required to participate in an educational activity under UMMS auspices in a country for which the CDC has issued any of the Travel Notices set out above.

2. Students, residents, or post-doctoral fellows are not permitted to travel under UMMS auspices to a country or region for which the CDC has issued a Travel Health Warning under any circumstance.

3. Under limited circumstances residents, or post-doctoral fellows who wish to travel under UMMS auspices to a country or region for which the CDC has issued an Outbreak Notice or a Travel Health Precaution may do so, provided following conditions are met:

    a. The resident, or post-doctoral fellow must review the Outbreak Notice or Travel Health Precaution as well as the Travel Notice Definitions, Criteria, and Rationale for such notices and warnings. These documents can be accessed on the web at http://wwwn.cdc.gov/travel/default.aspx.

    b. The resident, or post-doctoral fellow must consider carefully the conditions and risks described in the Outbreak Notice or Travel Health precaution and in consultation with the respective program advisor, must make a decision regarding whether or not to continue with plans for the proposed activity. In making a decision, the trainee and advisor must balance anticipated benefits with potential risks. The trainee and advisor should recognize that the existing warning may change at any time to a more urgent warning; if this occurs, policies applying to more urgent warnings would be triggered and the trainee may have to leave the country or make other plans. Such instances may also affect the trainee’s ability to receive a refund of monies already expended for the activity. The trainee and advisor should also take into consideration that UMMS, the U.S. State Department, and local U.S. Embassy or Consulate may not be able to assist the individual in case of crisis or difficulties. Additionally, the trainee may be obliged to “shelter in place” in the event that commercial airlines drastically curtail or even cease operations, and/or travel restrictions prevent people from returning to the United States or leaving the affected country. “Shelter-in-Place” information can be found at the U.S. government’s pandemic influenza website www.pandemicflu.gov, the World Health Organization website (www.who.int/en), and the Centers for Disease Control website (www.cdc.gov). Ultimately, the student, resident, or post-doctoral fellow understands and agrees that it is their decision, alone, to undertake such travel.

    c. If the resident, or post-doctoral fellow decides to travel to the country after discussion with the advisor, the trainee must obtain travel clearance from the Office of Global Health. In addition to the procedures required by all residents, or post-doctoral fellows traveling internationally, the resident, or post-doctoral fellow traveling to a country or region with a Travel Warning or Travel Alert will be required to:

      i. Sign and complete OGH’s International Travel Liability Release Form, acknowledging the existence of the Outbreak Notice or Travel Health Precaution and his/her decision to continue with the planned activity despite that warning, and releasing the University from liability.

      ii. Complete OGH’s Special Travel Waiver Request and Registration Form, providing a description of the proposed project, the rationale for continued plans to travel, an in-country emergency plan, and emergency contacts.

      iii. . If provided with clearance to travel, the resident, or post-doctoral fellow must contact and provide updates by mutually agreeable venue (e-mail or phone) to the UMMS advisor at least weekly at a designated time while in country.

4. Residents or post-doctoral fellows who travel to a country for which the CDC has issued an Outbreak Notice or Travel Health Precaution may be requested to monitor their health upon return, or be subject to screening at the port of entry, a process that may include voluntary or involuntary isolation or quarantine of the traveler.

5. In the event that a Travel Health Warning is issued immediately preceding or during student, resident, or post-doctoral fellow travel to an affected country or region, the following will occur:

    a. UMMS programs that involve students, residents, or post-doctoral fellows in that country or region will be suspended.

    b. Students, residents, and post-doctoral fellows will not be allowed to travel to that country or region under UMMS auspices.

    c. Any UMMS funding provided to date for planned activities or projects must be returned to UMMS. If some funds have already been expended, the student or trainee must work with his/her program advisor to determine the amount to be returned.

    d. If the student or trainee is already in the country or region, the program advisor, in consultation with the Associate Provost for Global Health (or in her absence, the OGH Co-Director), and individuals knowledgeable with the situation must decide whether the student, resident, or post-doctoral fellow must leave the country and return to the U.S. Whenever possible, UMMS will assist the student in making arrangements for his/her return.

    e. Upon return to the United States, the student, resident, or post-doctoral fellow may be subject to screening at the port of entry, a process that may include voluntary or involuntary isolation or quarantine of the traveler. Additionally, the student will not be permitted to return to campus until he/she has completed appropriate health monitoring and/or screening to determine that he/she is not infected with the disease in question. The monitoring and screening required will be decided on a case by case basis by the Office of Global Health in consultation with appropriate UMMS, UMMHC, and public health officials.

    f. If a student, resident, or post-doctoral fellow elects to travel and participate in the activity despite the warnings, the student will not receive UMMS funding, academic credit, or travel insurance coverage.

B. Protocol for Faculty or Staff traveling to a country or region for which the CDC has issued a Travel Notice

Faculty and staff may have ongoing advisory, clinical, or research activities in countries or regions of countries for which a CDC Travel Notice is in effect. In addition, UMMS recognizes that, in times of international health crisis, its employees may possess valuable expertise that is needed to assist with the resolution of the crisis. Consequently, the University does not prevent its employees from traveling to countries for which the CDC has issued an Outbreak Notice, Travel Health Precaution or Travel Health Warning. However, the following rules and conditions apply to faculty/staff traveling under UMMS auspices:

1. No UMMS faculty or staff shall be required to travel to a country for which any of the CDC Travel Notices listed above has been issued.

2. UMMS faculty or staff who wish to travel to such a country are urged to review the Travel Notice and the CDC Travel Health Warning, Definitions, Criteria and Rationale at http://wwwn.cdc.gov/travel/default.aspx, as well as other available material about the conditions in the country in question, and to consider carefully whether the value of the travel to them outweighs the risks they will face if they choose to travel.

3. UMMS faculty or staff who travel to a country for which there is an Outbreak Notice, a Travel Health Precaution, or a Travel Health Warning are urged to prepare to “Shelter-in-Place” in the event that commercial airlines drastically curtail or even cease operations, and/or travel restrictions impede people from returning to the United States or leaving the affected country. “Shelter- in-Place” information can be found at the U.S. government’s pandemic influenza website www.pandemicflu.gov, the World Health Organization website www.who.int/en, and the Centers for Disease Control website www.cdc.gov.

4. UMMS faculty or staff shall take precautions with respect to their personal safety, recognizing that UMMS and even the U.S. Department of State may be unable to help in the event employees encounter difficulty abroad.

5. UMMS faculty or staff who travel to a country or region for which the CDC has issued an Outbreak Notice or a Travel Health Precaution may, and in cases where the CDC has issued a Travel Health Warning, will, be requested to monitor their health upon return, or be subject to screening at the port of entry, a process that may include voluntary or involuntary isolation or quarantine of the traveler. Additionally, an employee will not be permitted to return to campus until he/she has completed appropriate health monitoring and/or screening to determine that he/she is not infected with the disease in question. The monitoring and screening required will be decided on a case by case basis by the Associate Provost for Global Health in consultation with appropriate UMMS, UMMHC, and public health official.

6. Prior to travel, faculty/staff must complete the following:

III. AUTHORITY OF THE OFFICE FOR GLOBAL HEALTH

Where it is not clear from its wording whether a Department of State Travel Warning falls into category (1) or (2) as set out above, the Associate Provost for Global Health (or in her absence, the Co-Director, Global Health) shall have the discretion to decide the issue, after appropriate consultation.

In any situation involving a Travel Warning or a CDC Travel Notice, the special conditions that caused the warning or notice to be issued may result in further rules and responses by UMMS. The Office for Global Health shall have the authority to establish such rules and responses in consultation with other UMMS faculty and staff as the Associate Provost and Co-Director deem appropriate under the circumstances.

For areas designated in a CDC Travel Health Warning, the rules and procedures issued by the Office for Global Health may differ for employees traveling to the area on business not connected with the disease outbreak, and employees traveling to the area to assist and/or study the disease outbreak.

Warnings similar in effect to Travel Warnings may be issued by other organizations such as the World Health Organization. In such situations UMMS may impose additional travel guidelines as appropriate.

Additional information regarding travel safety and precautions can be accessed on the Office of Global Health’s website: http://www.umassmed.edu/globalhealth/.