About Special Topics: Swine Flu

Special Issue: H1N1: Swine Flu
Updated: June 11, 2009

Swine Flu: Issues to Consider for Study Abroad Programs

by Gary Rhodes, Ph.D., Director, SAFETI Clearinghouse

Most institutions have positive experiences with their study abroad programs. College presidents and government leaders continue to emphasize the importance of study abroad. Swine Flu is not the first health and safety issue to come to the attention of the study abroad field. The field has recently responded to other potential "worst-case scenarios", which have (so far) been localized problems, including:

• The possibility of a similar situation with the spread of SARS or Avian Flu.
• The possibility of all technology around the world failing, resulting in a worldwide crisis at the end of the millennium (Y2K).

Health and safety issues have continued to grow in importance for institutions, students, and parents. One of the health issues that is gaining in attention and could affect our programs in Mexico, in the U.S. and other countries abroad in a significant way is the possibility of a Swine Flu pandemic.

The Current Situation:

Concerns about Swine Flu have been impacting study abroad programs currently in Mexico and those with plans to begin through the summer. At this time, it is important to bring your campus crisis management team (including health center and risk management/insurance representatives) together to make sure there is collaboration to monitor the situation and develop a plan for students already in Mexico as well as what to do about programs that will be leaving for Mexico. I would suggest contacting your emergency assistance and insurance providers to confirm support for students, faculty, and staff who may come down with the flu to find out how they will be treated in Mexico. Another possibility is to bring them home after they are infected and decide how that would be supported. Find out what other colleges and universities in your area are doing to provide local guidance. I would also suggest communicating with your international partners in Mexico to confirm the situation in the city where your program takes place.

Plans and information continue to change on a regular basis. The World Health Organization raised the alert from level five (5) to level six (6) on June 11th after raising it from level four (4) to level five (5) on April 29th (http://www.who.int/csr/disease/swineflu/en). As of this date, they noted that 74 countries had officially reported 27,737 cases of influenza A(H1N1) infection, including 141 deaths (http://www.who.int/csr/don/2009_06_10a/en/index.html).

The most significant change to support U.S. college and university study abroad program development and implementation was published by the U.S. Centers for Disease Control and Prevention (CDC) on May 15, 2009, when they removed the “Travel Health Warning” suggesting against travel to Mexico. It has been revised to be a "Travel Health Precaution" for Mexico.

Travel Health Precaution

“CDC’s Travel Health Warning recommending against non-essential travel to Mexico, in effect since April 27, 2009, has now been downgraded to a Travel Health Precaution for Mexico” CDC Mexico Travel Health Precaution.
“At this time, CDC has removed its recommendation that U.S. travelers avoid travel to Mexico. CDC continues to recommend that travelers visiting Mexico take steps to protect themselves from getting novel H1N1 flu. (Posted to the CDC website on May 15th).

As of May 7th, the U.S. Embassy in Mexico resumed normal operations (Consular Services) at the Embassy and Consulates across Mexico. (U.S. Embassy in Mexico - Press Releases '09)

The following statement from the U.S. Embassy in Mexico suggests that not all flu is swine flu and that going to a hospital or health clinic may provide exposure to others with swine flu. That reinforces the importance of pre-planning for potential medical care in Mexico at this time:

“The U.S. Embassy reminds U.S. citizens in Mexico that most cases of influenza are not “swine flu”; any specific questions or concerns about flu or other illnesses should be directed to a medical professional. Mexico City medical authorities urge people to avoid hospitals and clinics unless they have a medical emergency, since hospitals are centers of infection; instead, those with health concerns are encouraged to stay home and call their physicians to avoid potential exposure.”(U.S. Embassy in Mexico - Public Announcement)

The U.S. Department of State removed its Travel Alert for Mexico related to H1N1, (U.S. Department of State Travel Alert No Longer in Effect), although it maintains a Travel Alert for Mexico related to security issues in Mexico (U.S. Department of State Travel Alert - Mexico - Security).

New Challenges: International Travel for U.S. Study Abroad Students to Countries Around the World: As many of the cases of Swine Flu have impacted U.S. citizens, countries around the world are on a heightened alert with concerns that U.S. citizens traveling abroad may be infected by Swine Flu. The CDC has suggested that U.S. citizens with symptoms of influenza-like illness should not travel. There is concern that if a student or anyone on a flight is found to have symptoms of H1N1, that all the passengers could be delayed. (Announcement: Possible International Travel Delays Due to Novel H1N1 Flu Screening Procedures )

It is critical that faculty, staff, students, and parents put appropriate perspective on the possibility of the spread of Swine Flu. While there have been no reported cases of study abroad participants being ill or dying because of Swine Flu, it is critical for institutions to analyze the issues and risks for their faculty, staff, and students. We have developed a document on our Study Abroad Student Handbook, offering perspective and resources for students and parents: Special Issue: Swine Flu. In the article, we direct students to communicate with the study abroad office staff, a physician, and to check on their emergency assistance plan and coverage:

Putting Swine Flu Into Perspective

One suggestion is that institutions should consider reviewing their emergency planning methods using a potential Swine Flu pandemic as a "worst-case scenario". Study abroad administration is complex and involves administering the responsibilities of a full university in another part of the world. As a result, responding to any serious health and safety issue is best done if it is a part of an effectively run program that receives institutional support and has colleagues to assist in the various issues that come up during a crisis. The possibility of a Swine Flu pandemic falls into this category.

Preparing for the worst-case scenario requires a broad-ranging review on issues from medical care abroad, emergency evacuation policies and options, refund policies, separation of faculty, staff, and students if on-site administrators are the ones who become sick, having 24-hour support in the U.S. and abroad, maintaining updated information about Swine flu’s impact in any place where a program takes place, where excursions go, and where students go during independent travel.

If an institution integrates this into their crisis management planning, this can become and opportunity to be prepared for other crises not foreseen by faculty and staff. This is also an opportunity for study abroad administrators to take on a an active role in on-campus crisis management planning as this is a problem that could just as easily affect the city where your campus is in the U.S. This is an opportunity to prepare on campus and prepare abroad in an integrated fashion.

Key personnel to involve in planning, for a comprehensive university, could include:

• U.S. college or university/Study abroad program support team
• Student affairs administrators
• Study abroad administrators
• Campus security/police officer
• Risk manager/insurance coordinator
• Legal counsel
• Health center
• Counseling center
• Public relations
• President or chancellor’s office
• Other on-site staff
• Student representative
• Support Abroad
• On-site program administrator
• Other on-site staff
• On-site health provider
• On-site counseling provider
• Insurance representative
• 24-hour assistance company
• U.S. government representative (Embassy or Consular official)
• Local police
• Local emergency assistance provider

In developing an effective preparation for this or any other possible crisis abroad, it would be good to have a Crisis Management Team in the U.S., a Crisis Management Plan, and policies and procedures which have been tested abroad. 

Crisis Management

As you consider the response to Swine Flu and put it into the perspective of preparing for or responding to potential or real crises abroad, following are ten steps to consider:

• Ten Steps for Effective Crisis Response Planning
  1. Centralized Support and Planning: Include Cross-Campus Planning for All International Programs (Study Abroad, Research, Internships, Service-Learning, Athletic Teams, etc.) and Decision-Making
  2. Develop a Balanced Campus-wide Response – Don’t Over- or Under- react - Leadership Needs to Be Organized, Consistent, On Message, Calm, and Appropriate to the Incident
  3. Keep Campus Response Team Current With Relevant Data
  4. Monitor Broad Ranging Data/Situation Regularly Using Resources Including:
     • US Govt (CDC, State dept.);
     • International Institutions (WHO);
     • Country(ies) Impacted (Mexican govt, US Embassy, Mexico);
     • Field-based (NAFSA, URMIA, ACHA); and
     • Regional – other study abroad programs based near your US or International Campus
  5. Provide Information for Faculty, Staff, Students, and Parents with Perspectives, Links, and Advice on Response
  6. Have Emergency Communication Plans in Place
  7. Maintain Quality Insurance and 24 Hour Emergency Assistance Coverage
  8. Have a Contingency Fund for Special Support and Extra Costs Associated With Emergencies, Including Program Cancellation
  9. Have Emergency Cards and Other Emergency Information Readily Available in Multiple Locations for Faculty, US and International Staff, and Students
  10. Develop Emergency Action Plan, Practice Your Plan (with All Partners – Faculty, Staff, Students, etc.), Update Your Plan, Practice Again

Following are links to several resources that may help your institution develop its Crisis Management Team, Crisis Management Plan, and policies and procedures.

• SAFETI Audit Checklist: 
  
  Crisis and Risk Management
• SAFETI Adaptation of Peace Corps Resources:
• Crisis Management Handbook
• Developing an Emergency Action Plan
• Emergency Action Plan Outline
• Crisis Management Workbook
• National/Regional Crises
• The Crisis Management System
• SAFETI Resources for Crisis Management :
• Developing an Emergency Action Plan
• Developing a Campus Crisis Management Team
• Student Study Abroad Safety Handbook
• Crisis Management
• Emergency Planning
• Emergency Card
• Personal Emergency Action Plan
• Emergency Action Plan Step

Impact on Students

The Center strongly suggests that institutions provide information to parents and students, including travel and country-specific warnings provided by the U.S. Department of State, the U.S. Centers for Disease Control and Prevention and the World Health Organization (WHO). The Center also suggests you seek alternative information from international sources in the European Union, United Kingdom, Canada, Australia, and from the World Health Organization. (Please see below for links to these resources).

As program support varies from institution to institution, develop a method monitoring the situation daily, reviewing the possible impact of Swine Flu on students and programs, and updating emergency plans accordingly. Develop a process for deciding whether or not to cancel programs in affected areas, reviewing transportation plans, or postponing pending study abroad programs in certain areas due to a potential health risk. For students returning from affected regions, inquire to see if your institution encourages you to get a check-up at your campus health center and remember to report any Swine Flu-like symptoms.

Other Information Resources

The U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) have both provided resources and information to help you understand Swine Flu. 

CDC Swine Flu Info
WHO Swine Flu Info

U.S. Government Resources:

U.S. Department of State

• Swine Flu Travel Alert
• Pandemic Flu Fact Sheet
• Travel Warnings and Consular Information Sheets
• Crisis Awareness and Preparedness
• Help for Americans Abroad
• Medical Information for Americans Traveling Abroad
• Tips for American Students Studying Abroad
• U.S. Embassies and Consulates General

U.S. Centers for Disease Control and Prevention (CDC)

• Swine Flu Main page
  Find more links to other Swine Flu-related information including Key Facts, Outbreak Information, and Professional Guidance
• Travelers’ Health
• Advice for Travelers about the Flu

International Resources:

World Health Organization (WHO)

• Updates on Swine Flu
  Lists most current information on outbreaks, including regional information.

CONAHEC (Consortium for North American Higher Education Collaboration) H1N1 Flu and International Education Information and Resources Website
Advice for international educators to help in developing an appropriate response.

European Centre for Disease Prevention and Control
Advice for travelers regarding Swine Flu

Canadian Government-Current Health Issues
Provides updated information on Swine Flu, including Public Health Agency of Canada recommendations

United Kingdom Foreign and Commonwealth Office
Provides travel advice and fact sheet on Swine Flu

Australian Government Department of Foreign Affairs and Trade
Travel bulletin for health, with specific information and links about Swine Flu

The Center for Global Education’s Resources:

• SAFETI Adaptation of Peace Corps Resources
• Crisis Management Handbook
• Study Abroad Student Handbook
• Medical Care and Insurance
• Basic Health and Safety
• Crisis Management
• Emergency Planning

Other Resources:

• Higher Education Association Information
• NAFSA: Association of International Educators
• Health and Safety Good Practices
• Media Resources:
• BBC News
• CNN: Health
• Los Angeles Times: Health
• New York Times: Swine Flu