25 Years of Travel Medicine: then, now & the future

In many respects Nomad actually started at the same time as ‘Travel Medicine’ become a formally recognised discipline at the end of the 1980s. Previous to that point as a medical speciality it was considered to be a branch of Tropical Medicine and there were virtually no specialist clinics like Nomad, with GPs and nurses simply concerned with administering the vaccines. There were no training courses in the subject anywhere in the world. When I started to specialise in the area at that time there was no single medical textbook and I picked up most of my knowledge from reading Richard Dawoods first edition of ‘Travel Health’. I was honoured to contribute myself to the second edition and published my own textbook in 2003.

In fact there was virtually no regulation of those private clinics that did start to appear towards the end of 80s and the National Travel Health Network and Centre (NaThNaC), which began to regulate yellow fever centres as well as giving guidelines and policy on Travel Medicine in England, was founded in the mid 90s. The Scottish public Health Service through Travax predated this and by coincidence they are also celebrating their 30th anniversary this September.

The first ever conference of International Travel Medicine was held in 1988 and from around that point it developed into the discipline we see today with a large number of specialist travel clinics, pharmacies and GP surgeries offering a service.
In the 1980s the vaccines and other medicines that we used were very different from today. For instance, the Hepatitis A vaccine did not exist and we used a large injection of immunoglobulins extracted from human plasma injected straight into the buttocks, which only lasted for a month or two. Now the vaccine is just two small jabs in the arm that will give lifetime protection. Typhoid and Cholera came together as one jab that was not particularly effective and often caused pain and fever. I experienced all of these vaccines and it was not too pleasant! Meningitis vaccine did not have all the strains in the modern ones. Polio vaccine from the patient’s point of view was better than now perhaps being given by mouth on a nice cube of sugar. In those days, a certificate of Cholera vaccination was required for entry to many countries.

We did not know as much then about managing many of the common travel ailments such as traveller’s diarrhoea and mountain sickness as well as how to properly access the health risk to travellers and supply the appropriate advice, medicines and vaccinations – something that we now do so well at Nomad

Also, in the 80’s, we did not have the same range of tablets to protect against malaria. The most widely used was chloroquine and proguanil but by the end of the decade most strains of falciparum malaria were resistant to these. Larium appeared in the early 90s and we started to use doxycycline, with Malarone coming on the market for prophylaxis in early 2000s. Even DEET based repellents were not that easy to obtain and for many years Nomad had their own brand. We did not know as much then about managing many of the common travel ailments such as traveller’s diarrhoea and mountain sickness as well as how to properly access the health risk to travellers and supply the appropriate advice, medicines and vaccinations – something that we now do so well at Nomad.
So what will the next 25 years see developing? In terms of vaccines and medicines, we are already seeing the benefits of research and improved understanding of the risks to travellers. The modern vaccines are certainly safer and many seem to offer good lifelong protection after completing a course. There should be a vaccines against dengue very soon and I expect another against chikungunya at some point. There are early signs that the incidence of travellers diarrhoea to some countries is reducing, though it remains a likely and unpleasant experience for many travellers. Also the need to take malaria prophylactic tablets to regions outside of Sub-Saharan Africa seem to be on the decline. I don’t think a malaria vaccine suitable for travellers will appear in the next 25 years but we may at some point have tablets that only need to be taken as a few doses before travel.

In terms of where you go for your travel medicine services I predict that over the next 25 years this will not be a service offered through the GP. It is not logical that with so much pressure on GPs and that many travel vaccines are not on the NHS anyway, that this should not be delivered privately. There is a strong argument that even those on the NHS should be given only privately. So pharmacies and private travel clinics will be the place for people to go. Pharmacies could be convenient but it will be important to differentiate from those that offer a vaccination administration service and those that can give a full and specialised travel clinic. The latter I believe will always be in the minority and a reputable private travel clinic can competently look after more complex cases such as those on longer itineraries, with existing medical condition or complex needs. I argue that there is no reason why every traveller should not seek to come to Nomad as the consultation with specialist nurses is free. You pay no more and often less than you would for your vaccines and antimalarials as well as being able to obtain almost every conceivable item for a medical kit whether tourist, backpacker or on expedition. Even more you can purchase any travel item from walking boots to mosquito nets all price matched to any other retailer.

Prof. Larry Goodyer, MPharm Phd MRPharmS FFTM RCPS(Glasg) FRGS
Medical Director

As well as being the Nomad Medical Director he is currently Professor of Pharmacy Practice at Leicester School of Pharmacy at De Montfort University.

He is one of the leading international pharmacist experts in the field of travel medicine and a Fellow of the Faculty of Travel Medicine at the Royal College of Physicians and Surgeons, Glasgow. Prof Goodyer is currently the Vice Chair of the British Travel and Global Health Association and editor of their Journal. He is a council member and past Chair of the Pharmacist Professional Group of the International Society of Travel Medicines. He has researched and written widely on areas of Travel Medicine as well as appearing on radio and television on the subject