Asian Pacific Journal of Tropical Medicine 2021; 14(9): 381-382 381

apjtm.org

Commentary
Asian Pacific Journal of Tropical Medicine
Downloaded from http://journals.lww.com/aptm by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW

doi: 10.4103/1995-7645.326258 5-Year Impact Factor: 2.285

Healthy tourism initiative in the age of COVID-19 in Indonesia

I Md Ady Wirawan1,2 , I Nyoman Sutarsa1,3, Putu Ayu Swandewi Astuti1,2

nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 04/27/2024

Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
1

Travel Medicine Research Group, Health Research Centre, Udayana University, Bali, Indonesia
2

Rural Clinical School, ANU Medical School, Australian National University, Canberra, Australia
3

The severity of COVID-19 epidemic is more salient for regions These data signify the challenges of balancing economic benefits
that are heavily reliant on tourism industry. The pandemic along and public health risks from tourism industry including air travel.
with travel restrictions, border closures and social distancing Systemic risks posed by the pandemic require systemic responses
requirements pose serious threats for the sustainability of tourism from all sectors and societies. Organising public health measures at
sectors in many regions of Indonesia, putting livelihoods for the tourist destinations necessitate concerted actions of broader policy
whole societies at risk. communities and implementers beyond the health and tourism
In May 2020, the Ministry of Tourism and Creative Economy of sectors. The pandemic invites an integrated policy framework
Indonesia proposed a Cleanliness, Health, Safety, and Environmental to promote safe, resilient and sustainable tourism industry. This
Sustainability Program[1] to accelerate the recovery of the ‘dying’ policy framework must include regulations on border control,
tourism sector amid COVID-19 epidemic. This program sets out infrastructure policies such as the provisions of clean water and
practical solutions to balance economic and public health risks sanitation, health facilities and safety in tourist destination (i.e.
through certification of hotels, restaurants and tourist attractions. the Cleanliness, Health, Safety, and Environmental Sustainability
Key elements of the certification process include: provision of hand Program), outreach and enforcement programs to engage tourism
washing facilities, temperature screening, adjustment of layout industry in implementing healthy tourism initiatives, and community
to allow physical distancing, regular disinfection, and mandatory system strengthening activities at tourist destinations to improve
use of masks at tourist attractions. While these COVID-19 safe participation of local communities. Regulations on border control,
measures are essential, they are insufficient when the national and for instance, must incorporate a decision support mechanism of
local responses to control the pandemic remain fragmented. New exit and entry screening for airline travellers during a pandemic by
COVID-19 cases increased by 58%-118% following each of four employing algorithm and framework of infectious disease control
long holidays throughout 2020[2] as local and domestic tourism measures in air travel [4]. Engaging tourism industry and local
remains open. communities to support the realisation of healthy tourism initiatives
Tourism industry intersects intricately with air travel policies. is crucial considering the benefits offered by sustainable tourism for
During the early phase of the pandemic, the Bali Government local economies and livelihoods. Indeed, tourism actors have always
implemented repatriation flights for approximately 22 000 Balinese wanted to be involved in travel health promotion[5].
migrant workers, mainly those working for cruise ships[3]. They were The COVID-19 pandemic offers a new political responsibility
required to undertake COVID-19 screening test at the international where tourism, health, local community and other stakeholders
gate and followed by mandatory isolation at government facilities. may come together to create integrated institutions or mechanisms
This strategy, however, was hampered by incomplete migrant
worker database, leading to difficulties in predicting the actual 
To whom correspondence may be addressed. E-mail: [email protected]
number of workers and in obtaining information about the departing This is an open access journal, and articles are distributed under the terms of the
Creative Commons Attribution-Non Commercial-ShareAlike 4.0 License, which
country and the arrival airport in Indonesia. Many of these workers allows others to remix, tweak, and build upon the work non-commercially, as long
had gone through without the screening test or mandatory isolation, as appropriate credit is given and the new creations are licensed under the identical
terms.
contributing to an increase of locally transmitted cases in the For reprints contact: [email protected]
villages where the migrant workers reside. Additionally, conflicting ©2021 Asian Pacific Journal of Tropical Medicine Produced by Wolters Kluwer-
policies regarding international travel exemptions or testing Medknow. All rights reserved.

requirements for domestic air travel mandated by the national and How to cite this article: Wirawan IMA, Sutarsa IN, Astuti PAS. Healthy tourism
initiative in the age of COVID-19 in Indonesia. Asian Pac J Trop Med 2021; 14(9):
local governments have led to confusion and inconsistencies during 381-382.
the implementation. Article history: Received 30 July 2021 Revision 14 September 2021
Accepted 16 September 2021 Available online 28 September 2021
 382 I Md Ady Wirawan et al./ Asian Pacific Journal of Tropical Medicine 2021; 14(9): 381-382

● Pre-travel health services ●Public health measures

● During-travel health services ●Environmental health and safety
● Post-travel health services ●Health promotion
●Capacity to test, trace and treat

Travel health services Integrated surveillance

Downloaded from http://journals.lww.com/aptm by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 04/27/2024

Integrated policy Site-specific risk assessment

●Border control ●Geomapping of health and safety hazards

●Exit and entry screening ●Health and safety risk assessment
●Sea, land, and air travel policies ●Determining control measures
●Tourism sector involvement in health ●Continuous monitoring

Figure 1. Conceptual framework for healthy and sustainable tourism in Indonesia during and after COVID-19 pandemic.

to promote a healthy, sustainable and resilient tourism industry in the manuscript. All authors contributed to the final version of the
Indonesia (Figure 1). The provision of travel health services at tourist manuscript.
destinations must be coherently implemented with relevant public
health initiatives (e.g., diseases surveillance, health promotion,
environmental health and safety) to protect the wellbeing of travellers References
and local communities. In the past year, decisions on closing and
re-opening tourist attractions or destinations were sporadic and [1] Ministry of Tourism and Creative Economy of Indonesia. Program CHS di
multiple guidelines for different types of tourism industry have Sektor Pariwisata dan Ekonomi Kreatif. [Online]. Available from: https://
been introduced. While these guidelines provide temporary solution pedulicovid19.kemenparekraf.go.id/program-chs-di-sektor-pariwisata-
for the recovery of tourism industry, the implementation strategies dan-ekonomi-kreatif/. [Accessed on 20 July 2021].
must be designed based on site-specific health, social and safety [2]COVID-19 Response Acceleration Task Force of Indonesia. Distribution
assessment for each tourist attractions or destinations[6]. map of COVID-19 in Indonesia (live update). [Online]. Available from:
Systemic risks need comprehensive responses. Tourism sector https://covid19.go.id/peta-sebaran. [Accessed on 20 July 2021].
needs a paradigmatic shift, moving away from a siloed model to [3] The Provincial Government of Bali. Update Penanganan Covid-19 di
an integrated approach to promote healthy, safe, sustainable and Provinsi Bali tanggal 21 Maret 2020. [Online]. Available from: https://
resilient tourism. This shift should facilitate inclusive economy and infocorona.baliprov.go.id/2020/03/21/update-penanganan-covid-19-di-
non-exploitative tourism industry. Such actions may enable a more provinsi-bali-tanggal-21-maret-2020/. [Accessed on 21 July 2021].
optimistic and sustainable future for tourism industry and local [4] Khan K, Eckhardt R, Brownstein JS, Naqvi R, Hu W, Kossowsky D, et
economies in Indonesia. al. Entry and exit screening of airline travellers during the A(H1N1) 2009
pandemic: A retrospective evaluation. Bull World Health Organ 2013;
91(5): 368-376.
Conflict of interest statement [5] Wirawan IMA, Wirawan DN, Kurniasari NMD, Merati KTP. Travel agent
and tour guide perceptions on travel health promotion in Bali. Health
The authors declare that there is no conflict of interest. Promot Int 2020; 35(1): e43-e50.
[6] Wirawan IMA, Putri WCWS, Kurniasari NMD, Mulyawan KH,
Hendrayana MA, Suharlim C. Geo-mapping of hazards, risks, and travel
Authors' contributions
health services in Bali: Results from the first stage of the integrated travel

I.M.A.W. conceptualized the study, developed the conceptual health surveillance and information system at destination (TravHeSID)
framework, and prepared the original draft of the manuscript. I.N.S. project. Travel Med Infect Dis 2020; 37: 101698.
and P.A.S.A. performed literature review, reviewed and edited