Amid widespread public concern about the threat of Ebola, a number of major universities have placed tight restrictions on travel to West Africa in recent weeks, aiming to protect their campuses and personnel, though at the possible risk of reducing the flow of volunteers to help fight the epidemic.

Cornell University and the State University of New York (SUNY) system are among schools with the strictest policies, issuing a general ban on staff and student travel to the three countries hit hardest by the Ebola epidemic.

Some other schools, including Columbia and Harvard, strongly discourage travel and require staff members seeking to do so to obtain permission. Still others only advise potential travelers to be aware of the risks and, in many cases, require them to register their trip with the school before they go.

"Cornell students, faculty, and staff may not travel for study abroad, research, internships, service, conferences, presentations, teaching, performances, recruiting or athletic competitions in the West African nations under CDC [Centers for Disease Control and Prevention] travel warnings," the Cornell administration said in an Oct 16 message to students (bolding retained).

It added, however, that students could apply for an exemption from the ban. It said a similar message had been sent to the faculty and staff.

In the SUNY system, which includes 64 campuses around the state, Chancellor Nancy L. Zimpher wrote in an Oct 17 memo, "We are continuing to prohibit campus-sponsored or approved travel to countries with CDC Level 3 travel warnings," meaning Liberia, Guinea, and Sierra Leone. The statement does not mention appeals or exemptions.

In their policy statements, universities are citing the CDC's Level 3 travel warning, which advises against nonessential travel to the three countries. The CDC's advice for colleges, universities, and students suggests that education-related travel to the countries be postponed, both to protect would-be travelers' health and to enable the affected countries to respond effectively to the epidemic.

Difficult decisions

"Every university is struggling with this," said Craig Roberts, PA-C, MS, a University of Wisconsin-Madison epidemiologist and chair of the American College Health Association's Emerging Public Health Threats and Emergency Response Coalition.

"Our people working in our student travel office, legal, the provost are thinking about this a lot," he said. "To what degree should we restrict travel by faculty? It looks like what some schools are doing is requiring the chancellor to sign off."

Roberts said Wisconsin is not banning travel to West Africa but is requiring any employees or students to notify the school if they intend to go there. He said he was not aware of any faculty or staff members who planned to make such a trip, though one graduate student who had intended to go to West Africa this fall decided on his own not to do so.

In talking with officials at other universities' student health centers, Roberts said, "I've not come across a school that has not put in some kind of restriction, but mostly for students. There are not a lot of people going to those countries to start with." But the problem could become a bigger concern for student health if Ebola reaches certain other African countries, such as Nigeria and Ghana, that draw more US students.

He said he was not aware of anyone who wanted to go help with the Ebola response in West Africa but was prevented by university restrictions.

Three general approaches

Stacey Tsantir, JD, a University of Minnesota official who polled about 20 other schools last week on their travel policies in light of the CDC's Level 3 warning regarding the Ebola epidemic, said she found that most institutions took one of three general approaches:

Advising against travel

Limiting travel but allowing petitions for individual exemptions, or exempting certain groups

Banning all travel regardless of the population or purpose

"Most universities are taking the first two approaches above, with only a few universities banning all travel regardless of population or purpose," wrote Tsantir, who is director of international health, safety, and compliance in the university's Global Programs and Strategy Alliance.

She also said most schools are informing their entire population about Ebola-related warnings from the CDC, World Health Organization, and state health departments. Some are also sending targeted messages to international students and scholars from Ebola-stricken countries. As of last week only a few schools, she said, were instituting their own screening for returned travelers.

Service versus safety

Columbia University's policy statement on travel to the Ebola-affected countries acknowledges the need to balance safety concerns with the university's mission to help solve global problems.

"Mindful both of the University's service mission and of its responsibility to protect our community from the Ebola threat, the University has determined to restrict student, faculty, and staff travel to three West African countries for any purpose other than to contribute to efforts to contain and eliminate the Ebola outbreak," the statement says.

It says that students, faculty, and staff "must avoid" travel to the affected countries, but adds that employees who want to help fight the epidemic can submit a request to the appropriate dean. If approved by the dean, the request must also win the provost's approval.

Evacuation seen as big worry

The Columbia policy includes a very tough proviso: any request for permission to travel "must include confirmation of an evacuation plan in case of need." It notes that Columbia's own travel evacuation provider, International SOS, "has advised the University that evacuation of patients with Ebola-like symptoms may not be achievable."

(An official with Samaritan's Purse, the mission organization that employed Kent Brantly, MD, one of the first two Americans to be evacuated from West Africa because of Ebola, said recently that it cost $200,000 to fly him back to the United States in a specially equipped air ambulance.)

In addition, the Columbia policy bars visitors to the campus if they have been in one of the three Ebola-stricken countries in the preceding 21 days.

Harvard University's policy advises strongly against travel to West Africa and, like Columbia's stance, warns about the difficulty of arranging evacuation if one gets sick.

"Our partners operating in the region report that medical evacuation is virtually impossible," said an Oct 16 letter from Harvard Provost Alan M. Garber, MD, PhD, and Paul Barreira, MD, director of Harvard Health Services. "Individuals who show any signs of fever, whether they have been exposed to the disease or not, face significant challenges leaving these countries and risk being quarantined together with Ebola patients.

"In addition, security in this region of West Africa has deteriorated, and health risks do not appear to be diminishing. For all of these reasons, we strongly discourage travel to Sierra Leone, Guinea, and Liberia."

The policy indicates that Harvard-sponsored travel to the Ebola-affected region can be permitted in "exceptional circumstances" and when deemed "absolutely necessary," but only with the provost's approval. The letter did not suggest what the circumstances might be.

Also discouraging travel to West Africa, but not banning it, is Johns Hopkins University (JHU), according to an Oct 20 report in the university's Hub newsletter. It says Hopkins personnel who plan to make such a trip should notify their dean and department chair or unit leader.

On their return, travelers will be assessed by university health officials and the Maryland Department of Health and Mental Hygiene to judge their level of exposure and decide if they can return to school or work immediately or should stay at home in quarantine, the story said.

It cited an e-mail message from Gabor D. Kelen, MD, director of the JHU Office of Critical Event Preparedness and Response, and Trish Perl, MD, MSc, senior epidemiologist and a professor of medicine and infectious diseases at the JHU schools of Medicine and Public Health.

"The potential for someone in our community to acquire Ebola and to place others in danger weighed heavily in the university's decision to provide this guidance," they wrote.

Variations on a theme

Tsantir's informal survey of universities' travel policies revealed some small variations on the three general approaches she found (advising against travel, limiting travel but allowing petitions for exemption, and banning travel).

For example, an official at Indiana University said the school was suspending all faculty and staff travel to the affected countries and also was halting visits by scholars from those countries. Also, the university's Ebola information Web page says travelers returning from personal trips to the countries are barred from university property during the 21-day Ebola incubation period.

New York University said it was barring student, faculty, and staff travel to the three countries for university purposes but that exceptions could be made in some cases, such as for faculty members wishing to help fight the epidemic.

On the less restrictive side, Ohio State University was not limiting faculty and staff travel to the affected countries and was not requiring employees to register their trips in advance, according to Tsantir's research. The university was using its travel reimbursement request system to monitor trips to the region.

Northwestern University "strongly advises" all employees and students to postpone nonessential trips to the Ebola-hit countries, but it does not ban such travel, according to a university statement. A Northwestern official told Tsantir that the school would have no way to monitor or enforce a travel ban.

At the University of Minnesota, meanwhile, a recent message from the administration to faculty and staff did not warn against travel to Ebola-hit countries, but it reminded people of the requirement to register their travel with the university and urged them to check travel warnings and alerts.

The message, signed by Brooks Jackson, MD, dean of the Medical School, said, "The situation in West Africa makes it particularly important for travelers to register when visiting Liberia, Sierra Leone, and Guinea."

See also:

Oct 16 Cornell travel restriction message to students (similar message sent to staff)

Oct 17 SUNY statement

Oct 13 Columbia University policy statement

Oct 16 Harvard University statement

Oct 22 CDC advice for colleges, universities, and students on Ebola in West Africa

Related Oct 17 statement on CDC travel advice

Oct 20 Johns Hopkins Hub news story about policy

Oct 10 Northwestern University statement on Ebola, including travel warning

Oct 23 Stanford University guidelines