What It Takes to Set Up Travel Health Services: A Review From Countries With Established Service

Last reviewed: March 2026

Background and Context

International travel has grown exponentially in the modern era. The United Nations World Tourism Organization estimated that international tourist arrivals exceeded 1.4 billion globally prior to the COVID-19 pandemic, with the Asia-Pacific region accounting for a substantial and growing share. Malaysia itself received over 25 million tourist arrivals annually in the years preceding the pandemic, positioning it among the most visited countries in Southeast Asia.

Travel medicine, as a discipline, has evolved from a niche concern of tropical medicine specialists into a recognised area of practice that intersects infectious disease, preventive medicine, and public health. The International Society of Travel Medicine (ISTM), founded in 1991, currently has over 2,500 members across more than 75 countries and administers a Certificate of Knowledge examination that serves as a professional benchmark for travel medicine practitioners.

Yet despite the growth of international travel to, from, and through Malaysia, the country’s formal travel health services remain relatively underdeveloped compared to those in Europe, North America, and Australasia. This review, published in the Malaysian Journal of Public Health Medicine, aimed to identify the essential components for establishing travel health services by examining the experiences and models of countries with mature systems.

Components of Travel Health Services

Trained Personnel and Certification

Countries with established travel health services typically have clear certification pathways for practitioners. In the United States and Europe, the ISTM Certificate of Knowledge in Travel Medicine is widely recognised, while the UK has its own diploma programmes through institutions such as the Royal College of Physicians and the London School of Hygiene and Tropical Medicine. A 1996 survey of ISTM members found that the majority of travel medicine clinics were private and physician-run, with care frequently provided by nurses and physician assistants who had completed specialised training.

Travel medicine practitioners require a broad knowledge base encompassing vaccine-preventable diseases, malaria prophylaxis, travellers’ diarrhoea management, altitude sickness, occupational exposures during travel, and mental health considerations for long-term travellers and expatriates.

Information Systems and Epidemiological Intelligence

Effective travel health services depend on access to real-time epidemiological data. Resources such as the Centers for Disease Control and Prevention (CDC) Travelers’ Health website, the World Health Organization’s International Travel and Health publication, the GeoSentinel surveillance network, and the Global TravEpiNet pretravel network provide clinicians with current information on disease outbreaks, vaccine requirements, and destination-specific health risks.

Several countries have also developed national travel health websites that provide destination-specific advice for their citizens. These platforms require ongoing investment in data management and regular content updates to remain clinically relevant.

Vaccine Supply and Cold Chain Management

Travel-specific vaccines — including those for yellow fever, Japanese encephalitis, typhoid, rabies, meningococcal disease, and hepatitis A — may not be part of routine national immunisation programmes. Establishing travel health services requires reliable supply chains for these specialty vaccines, along with appropriate cold chain management and trained vaccinators. Yellow fever vaccination centres, in particular, must be approved by the WHO and meet specific storage and administration requirements.

Integration With Primary Care

In many countries, primary care physicians remain the most common medical source of pretravel advice. A study of outbound travellers at Boston Logan International Airport in 2011 found that general practitioners were the most frequently consulted health source for travellers to low-income destinations. This highlights the importance of integrating travel health knowledge into primary care training, even in countries with specialised travel clinics.

International Models of Service Delivery

The review identified several models of travel health service delivery across countries with established systems. These range from hospital-based travel clinics staffed by infectious disease specialists to community pharmacies offering travel vaccinations, to telemedicine-based consultations for travellers in remote areas. Each model has strengths and limitations, and the optimal approach for any given country depends on factors such as healthcare infrastructure, workforce capacity, and the volume and patterns of outbound travel.

The United Kingdom model, for example, integrates travel health into general practice with additional support from specialist clinics for complex itineraries. Australia has a network of designated yellow fever vaccination centres alongside dedicated travel clinics in major cities. The United States relies heavily on private-sector travel clinics, with the CDC providing an authoritative advisory framework.

Relevance to Malaysia

Malaysia occupies a unique position as both a major source and destination for international travellers. Its status as a leading medical tourism hub — with the Malaysia Healthcare Travel Council reporting hundreds of thousands of international patients annually — further underscores the need for robust travel health infrastructure. Additionally, Malaysia’s proximity to countries with endemic tropical diseases, its role as a transit hub for Hajj pilgrims, and its participation in international business and educational exchanges all create demand for pretravel health services.

The review suggests that Malaysia could develop a phased approach to travel health service establishment, beginning with the integration of travel health modules into medical and nursing curricula, followed by the designation of travel health clinics at tertiary hospitals, and eventually expanding to a network of community-based travel health providers.

Limitations

This review was limited by the predominance of English-language literature from Western countries, potentially overlooking models from other Asian or developing nations. The rapid evolution of travel patterns post-pandemic may also have altered some of the assumptions and recommendations made in the original 2017 publication. Additionally, the review did not include a formal systematic search protocol, relying instead on a narrative approach that may have introduced selection bias.