Health as a Continuing Priority in Travel and Tourism

One of the legacies of the COVID-19 pandemic is the increased attention given to the relationship between health and tourism. Air travel, and tourism more broadly via passenger cruise ships and other border crossings, was a major contributor to the spread of COVID-19, recognized as the worst pandemic in scale and speed of geographic spread this century [1]. As of 6 September 2023, there have been 770,437,327 confirmed cases of COVID-19, including 6,956,900 deaths, reported to the World Health Organization (WHO) [2].

The transmission of infectious disease by travelers is not a new concern. Indeed, the specialty field of travel medicine has a long history. However, the list of infections imported by returned travelers continues to grow, with many capable of causing local epidemics [3]. Among the concerning emerging and re-emerging infectious diseases transmitted via air travel in particular are severe acute respiratory syndrome (SARS), Middle East Respiratory Syndrome (MERS), Measles, Ebola Virus, Influenza and mosquito-borne diseases such as Malaria, Dengue, Chikungunya, Yellow Fever and West Nile Virus [3,4].

The huge increase in international travel demand following the COVID-19 shutdowns has seen many destinations struggling with over-tourism and the additional burden visitors place on local resources, including health services. This situation is set to continue, with the UN World Tourism Organization (UNWTO) [5] reporting that travel has recovered to 80% of pre-COVID-19 levels in the first quarter of 2023. That is, an estimated 235 million tourists travelled internationally in the first three months, more than double of the same period of 2022.

The pandemic has brought into clear focus the reliance or even dependence many countries have on tourism to support their economies [6], how vulnerable they are to communicable diseases and the importance of resilient health systems in preparing and responding to public health emergencies [7]. Adopting the One Health model, which is an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals and ecosystems, the WHO now proposes that “there is no sustainability without health at the heart of tourism development” [8]. Further, tourism has real potential to improve health and well-being for both tourists and host communities.

There is considerable evidence that health services and hygiene standards provide a major competitive advantage for a tourist destination [9] and while tourism arrivals may negatively influence residents’ health in the short term, they can have positive impacts on long-term health outcomes [10].

Evidence from the COVID-19 pandemic shows that those countries with existing health system capacity in place and, importantly, preparedness, responded most effectively to the pandemic [11]. Recognizing the very real possibility of future pandemics [12] health authorities have recommended that tourism should be prioritized in the development of national health-emergency planning and management structures [8].

This is an approach taken by the Asian Development Bank (ADB) which allocated $20 billion to COVID-19 response and recovery and continues with a multisectoral health and tourism program to strengthen health knowledge and skills among workers in the travel and hospitality sectors. A unique aspect of the program is mapping primary health care facilities (and other health-related infrastructure, services and activities) near tourist hotspots in order to enhance health system capacity to prevent, detect, and respond to health risks, and strengthen travel-related disease surveillance [13].

Capacity building is also the focus of a current Asia-Pacific Economic Cooperation (APEC) tourism and health project that includes industry and government discussions, a workshop, and case studies resulting in the recent publication of a detailed handbook for tourism destination stakeholders to manage health crises [14].

Together these projects illustrate the One Health approach to protecting the health of people and nature, by developing new public health infrastructure and a skilled workforce to strengthen priority areas of disease prevention, detection, and response as part of the transformation of global travel [13].

One Health also represents a shift in the traditional crisis and recovery model seen throughout the COVID-19 pandemic to a broader consideration of health in sustainable tourism based on six key principles [15]:
A. Promote and protect the health of humans and other species.
B. Proactively manage health threats in ways that minimize degradation of ecosystems or produce co-benefits for nature.
C. Take into account context when designing or adapting disease risk reduction and resilience approaches.
D. Empower visitors and tour operators to be good stewards of their health and the health of the local communities and ecosystems they visit.
E. Ensure the equitable sharing of knowledge and benefits from tourism-based research and surveillance.
F. Coordinate and collaborate across sectors to support prevention, detection, response, and recovery from disease threats.

In summary, as a result of COVID-19 there is a greater appreciation of the complex relationship between health and travel and tourism, not just in relation to the transfer of infectious disease but encompassing the health of destinations for visitors, local residents, animals, and the environment. The adoption of One Health principles for sustainable tourism marks a dramatic shift from the traditional crisis and recovery approach to one of preparedness, where tourism is included in national and local health-emergency planning and management.

The author declares that he has no competing interests in the drafting of this paper.

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