ISTM and the Travel Industry: A Saga

Karl Neumann, MD, FAAP

Ever since its inception more than 20 years ago, the International Society of Travel Medicine has set itself a mission to establish meaningful relationships with the travel industry. The purpose of the mission: to make the industry more health conscious and to make them aware of travel medicine in general and the ISTM in particular. Obviously, for travel medicine professionals, the travel industry is a natural ally, a well-defined, easily accessible, and--in theory, at least--a ready-to-tap-into conduit, leading straight to the traveler. But while in most areas ISTM endeavors have been resounding successes, this is not the case in its overtures to the travel industry. With few exceptions, the overtures have been met with disinterest, especially in North America.

Last month, the editors of NewsShare sent an e-mail query to ISTM members on the ISTM listserv asking for their opinions on this issue. The query read:

Attempts in the past by ISTM to interest travel agents and the travel industry in becoming more receptive to travel health issues and to the ISTM have been largely unsuccessful. Do you think that ISTM should renew its effort in this area? Is this a proper mission for a Society such as ours? If so, how can we improve our public relations/communications skills? Do you or your colleagues in your country have successful programs in this area?

Twenty-eight individuals responded. Here are some of the more interesting comments:

“On the subject of travel agents… definitely a sore point in our clinic as well as with many others I talk to at our ISTM meetings. Our efforts with travel agents have been vigorous, prolonged and totally to no avail. I have personally visited and talked with over 200 travel agents in our market area. I have twice given talks at annual meetings of travel agent groups using, in part, materials provided by ISTM. For over two years I kept up with a weekly e-mail newsletter highlighting every week a different issue in travel medicine and sent out to over 50 local travel agents. All of this effort garnered me not a single referral. In fact, one patient going to a yellow fever endemic area of the Amazon and having been told both by us and the local Public Health department that he needed the yellow fever vaccine was then told by his travel agent that he did NOT need it. He did not get the shot and nor did he take any malaria prophylaxis—also on the advice of his travel agent.”

“I have become convinced that the ONLY thing that will make travel agents see the value of travel medicine is when the plaintiff’s lawyers start holding them as accountable for the advice they give as they currently hold physicians accountable.”

“After seeing the presentation by the Madison Avenue advertising firm at the ISTM meeting in New York, I think we might do better to bypass the travel agents and go straight to the traveling public. After all, many if not most international travelers now bypass the travel agent and buy their tickets on-line. But on the other hand, a carefully planned, POSITIVE approach to travel agents might have some benefit.”

“Our Travel Medicine Center has for the past 20 years maintained a mailing list of travel agents in our catchment area. The list also includes hospitals, pharmacies and libraries, since patients often consult these places for information about travel health matters. We send out a quarterly bulletin with information on current Travel Health topics and once a year send out a mailing with a poster and a bunch of business cards. Since fax machines became available we started sending out the bulletin by fax. The theme of the mailings to travel agents is ‘Travelers who are aware and prepared for travel related medical issues are more likely to travel, and travel . . .and travel!’ We also send out a mailing to physicians and have a standard form that we use to inform patient’s personal physicians of their visit and what was given in the way of immunizations and prescriptions. All of this seems to be good for our business. Maybe ISTM could develop a program that could be given to members to use locally, including flyers and consult report forms.”

“My experience is that many travel agents are reluctant to make referrals because they are afraid their clients will be overly concerned both about the possibility of disease and the cost of the immunizations which may make the client reluctant to book the trip.”

“I found that the only influence I ever had after a lot of tries was when I offered to teach travel health in a travel agent school. If there was some way to develop a good, short and effective curriculum in travel health specifically for travel agent students (or graduates) that was free and fast (they do not want to spend much time on it), that might eventually lead to some sensitivity to the health issues…”

“Journal of Travel Medicine (vol. 11, no. 1, Jan/Feb, 2004, pp. 64-66) had an article by Oliver Hart on ‘severe high-altitude cerebral edema on the Inca trail’ that once again illustrates the need that the travel industry and trip organizers have in learning the basics of travel health and what to recognize in various situations. Despite having a doctor on the trip, the group was too spread out for the doctor to examine the person that became ill until very late in the course of her illness. And the trip organizers were not prepared ahead of time to recognize serious signs of HACE. Evacuation efforts cannot be organized for immediate needs and generally take longer than most trip organizers or tourist travelers appreciate.”

“I think we should continue to try to talk to travel agents. Firstly, they are the hands that rock the cradle when it comes to first contact. With recent competition from the Internet, they are a harried and stressed out group. I try to approach the different agencies to give a quick 50 minute talk on basic travel health (including any specialty travel topics they may have). On a local level it makes them more comfortable with us and more familiar. If we can show them there are ways their clients can be safe, most will be more open to travel medicine education. I also advertise at the Travel Agents convention (in Canada this is the Addison’s Trade Show), geared specifically for travel agencies. In order to reach this audience I think it is more effective to use meetings and advertisements that they are already familiar with.”

“As a travel medicine practitioner, a travel agency owner, and Certified Travel Counselor, I have been able to train the 12 agents in my agency rather well regarding advising travelers to high risk areas. However, as hard as I have tried I have made no inroads in educating the rest of the travel industry in my locale. I have offered evening seminars, even offering to go to the agencies offices. I have sent letters and brochures to local agency managers with essentially no response. I believe we will need to work through the travel organizations--American Society of Travel Agents, Cruise Line International Association, and Institute of Certified Travel Agents, for example--to develop an ongoing relationship with such organizations and get them to help distribute the information that travel agents badly need. They may be more likely to pay attention to their own organizations and house organs than to us.”

“It is obvious that the travel industry should already follow guidelines defined and provided by ISTM, and I can’t understand how the travel industry covers the millions of travelers without any rule at all. The approach of the Society should be more active in this field. Some ideas can be discussed but the main thing to be done is to transform society in order to be more powerful in a global environment. We can discuss only the method(s) to succeed a more active role…”

“The few times that I have found travel agents receptive to teaching were either because they had been burnt or it was through the junior college we have here that teaches courses on how to be a travel agent. A short course (maybe a few hours long) that is to the point and free will help to reach them.”

“Yes I would strongly support information to encourage travel agents to be more proactive. I think there may be an obligation in fact; currently they can claim lack of knowledge. In the U.S., the Occupational Safety and Health Administration has, in fact, created a document recommending (not mandating) companies send their employees going overseas for travel medicine assistance. I would be happy to discuss more, even working together to craft a questionnaire/study vehicle.”

“I do feel strongly that this is an area that ISTM should pursue. We have never done anything with this in our community, but I suspect that some (certainly not all) travel agents would be receptive to providing information to their clients. They really have no idea what is ‘necessary’ as they regularly tell my clients that there is nothing required (which may be the case from the foreign country’s standpoint, but not from the traveler’s). We have had some travel agents come themselves, so we know that at least some have an interest in protection. I wish I had a logical way to approach this, but I guess it would require a committee of interested persons to discuss this topic. I would be willing to participate.”

“It is probably difficult to convince small to medium travel agencies that travel medicine advice is actually useful for all travelers, even for those in good health and/or traveling to countries with no significant health hazard. Major agencies might be easier to convince and it might be useful for them and their clients to include within their brochures, catalogues or websites a reference to the ISTM website (as well as other very good travel medicine websites available worldwide), with a strong recommendation to visit one of them before leaving. Professional travelers are an easier target since it is easy for their organization to ask the travel agent (usually one contracted travel agent arranging travels for all staff, sometimes within the same building) to display medical information brochures and various advices issued by the organization’s medical center, or to attach health reminders to the plane ticket.”

“I do think you should get involved with travel agents to help them understand the necessity of the vaccines travel clinics give. So many times our travel clients tell us ‘well the travel agent told me I didn’t need anything’. This needs to change to protect the traveler while traveling and the community when they return.”

“I have saved a number of brochures from travel companies--one series of three, for travel to Ecuador, is part of my lecture on Preparing The Traveler. I call this series, The Good, The Bad, and The Ugly (apologies to Sergio Leone and Clint Eastwood). The Good lists many health issues relating to travel to Ecuador including the need to visit with a travel health professional for advice. The Ugly simply states, ‘No shots required’. That sums it all up and certainly indicates the magnitude of the work ahead of us.”

“We have not been successful in this arena in our area either but as part of ISTM I think efforts should be renewed!”