Message from the President

Dear Members,

The September terrorist attacks and the ongoing deliberate release of biological agents have shaken us and made a reality of what we would have thought could occur only in second rate horror films. This tragedy, intended to hit at the very heart of the western world, particularly the United States, has been successful in generating terror and distrust and eroding confidence in governments, and challenging our way of living, especially our freedom of mobility.

Terrorism is part of the dark side of globalization, and we are entering an age where we will have to learn how to live with it. For the many of us who live in the security of western countries, these are new risks we shall have to adjust to. We will have to learn how to deal with the risks, without underestimating or exaggerating them _ even when the media tends to amplify them. Many members of our Society are confronted with insecurity every day in their own countries, and have been able to cope with it. These attacks reveal the vulnerability of globalization, as based on the extensive mobility of people, goods and information. Travel medicine is also shaken as it is intimately linked to the mobility of individuals and populations. People are afraid of boarding airplanes, are canceling domestic or oversees travel, and reorienting their priorities.

While we are still under the shock of the New York attack, it is difficult to predict how much our way of living will change, and how fast things will return to normal. We are in a defensive and reacting phase, aiming at retaliation, searching for the individuals and groups responsible for the attacks in order to neutralize them and prevent them from causing further terror. In the face of such a diffuse threat, it is better not to seek total victory over the devil, but rather his containment and reduction of his ability to do harm.

Soon we'll have to look at the root causes of terrorism. It can be generated by madly insane individuals, but in the majority of cases it emerges in countries and places where poverty, social exclusion, unemployment, despair of the future, and humiliation are predominant. These scourges lead to the emergence of militant and fanatic groups, which may engage in desperate actions and create martyrs. Improving health and access to care are essential to counter this downward spiral. In many parts of the world rich countries are perceived as arrogant and unconcerned with the everyday difficulties faced by poor countries. Very often, tourists from the western world are the only ambassadors seen there. As travel medicine specialists we have essentially concentrated our efforts on protecting and promoting the health of travelers. While we immunize travelers and prescribe malaria prophylaxis for them to reduce their risk of acquiring diseases prevalent in the visited countries, we have not raised the local immunization coverage rate or addressed the health needs of the people living in these countries.

Should this continue? Or, as health professionals, do we have some responsibility for improving local conditions in host countries? The magnitude of the problems may be overwhelming and discourage us from doing anything. Nonetheless, we can play a significant role in making travelers more aware of local needs and undertaking concrete activities. As a significant number of our members practice in host countries, there may be opportunities to identify targeted interventions that would make a difference and link travel medicine with local initiatives. There are many possibilities: providing support to local health services, offering additional training to local doctors and nurses, generating specific projects for groups at risk, and participating actively in the promotion of sustainable tourism, for example.

ISTM has a committee on host countries lead by Dr. Santanu Chatterjee from Calcutta. Those of you who have innovative ideas should share them with us. In the coming months the board is certainly going to explore possibilities to diversify and expand areas of activities. This could be one of the new programs to be looked at.

This crisis challenges us all. As the travel industry and airlines are seriously hit by the current situation, many of us have experienced a sharp reduction in activities and income, both in countries from which travelers depart and in visited countries. Some may even face closing their practice. Nobody knows how long this crisis will last.

This is not the first time that we have gone through such a critical time. Remember the Gulf War, the explosion of the Pan Am aircraft over Lockerbee or the waves of hijackings of airplanes in the 60s and 70s.

I strongly believe that eventually things will return to normal. This is not to say that we should return to our previous attitude; we should grow from the lessons learnt. ISTM needs to diversify the scope of its activities both in terms of groups of people we are concerned about and where we are active. Many of our members have skills that can be used in providing care for other groups, such as humanitarian workers and NGO personnel who are involved in relief operations or working with migrants domestically. We should pay more attention to the care of immigrants and refugees as they are becoming more of our daily life and practice, and promote migration medicine. Being in the forefront of vaccination programs, we can be more active in promoting them domestically and in the education of primary care providers. Many of us have skills in promoting health care, which can be used for the benefit of local communities.

At the same time as we are considering new horizons for our Society, we are actively working on the 8^th CISTM, scheduled for May 2003, in New York. Board members will meet in mid-November in New York with the conference organizer, Dr. Brad Connor, who is hard at work on the conference. At this point we do not intend to change the location of the conference. New York remains very attractive with a vast array of possibilities for a very successful conference. The 8^th CISTM is a good opportunity to explore new opportunities for travel medicine. Your suggestions are invaluable to make the ISTM grow.

To conclude, I would like to bring hope for those facing a difficult situation. I would like to say that I am convinced that travel medicine is not collapsing, and will continue to thrive. This crisis offers us an opportunity to make the ISTM stronger with each member playing an important role.

As members of our Society may have lost friends or relatives in the destruction of the Twin Towers in New York, let me express again personally and on behalf of all of us in the ISTM a sense of grief and condolence for all their suffering and pain. We extend deep feelings of solidarity with them.

Vaccine Shortages

The ISTM executive board is very concerned about this situation. The ISTM industry liaison person, Prof. Robert Steffen, has contacted our industry partners and shared our concern with them. At the next conference we intend to hold talks with industry representatives on the various issues related to production and regular supply of vaccines. This will allow for a better understanding of each other's constraints and concerns, and, hopefully improve the current situation.

Best regards,

Louis Loutan