bonaire travel restrictions covid 19

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Travel health notices, vaccines and medicines, non-vaccine-preventable diseases, stay healthy and safe.

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After Your Trip

There are no notices currently in effect for Bonaire.

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Check the vaccines and medicines list and visit your doctor at least a month before your trip to get vaccines or medicines you may need. If you or your doctor need help finding a location that provides certain vaccines or medicines, visit the Find a Clinic page.

Routine vaccines

Recommendations.

Make sure you are up-to-date on all routine vaccines before every trip. Some of these vaccines include

• Chickenpox (Varicella)
• Diphtheria-Tetanus-Pertussis
• Flu (influenza)
• Measles-Mumps-Rubella (MMR)

Immunization schedules

All eligible travelers should be up to date with their COVID-19 vaccines. Please see  Your COVID-19 Vaccination  for more information. 

COVID-19 vaccine

Hepatitis A

Recommended for unvaccinated travelers one year old or older going to Bonaire.

Infants 6 to 11 months old should also be vaccinated against Hepatitis A. The dose does not count toward the routine 2-dose series.

Travelers allergic to a vaccine component or who are younger than 6 months should receive a single dose of immune globulin, which provides effective protection for up to 2 months depending on dosage given.

Unvaccinated travelers who are over 40 years old, immunocompromised, or have chronic medical conditions planning to depart to a risk area in less than 2 weeks should get the initial dose of vaccine and at the same appointment receive immune globulin.

Hepatitis A - CDC Yellow Book

Dosing info - Hep A

Hepatitis B

Recommended for unvaccinated travelers of all ages traveling to Bonaire.

Hepatitis B - CDC Yellow Book

Dosing info - Hep B

Cases of measles are on the rise worldwide. Travelers are at risk of measles if they have not been fully vaccinated at least two weeks prior to departure, or have not had measles in the past, and travel internationally to areas where measles is spreading.

All international travelers should be fully vaccinated against measles with the measles-mumps-rubella (MMR) vaccine, including an early dose for infants 6–11 months, according to  CDC’s measles vaccination recommendations for international travel .

Measles (Rubeola) - CDC Yellow Book

Dogs infected with rabies are not commonly found in Bonaire.

If rabies exposures occur while in Bonaire, rabies vaccines are typically available throughout most of the country.

Rabies pre-exposure vaccination considerations include whether travelers 1) will be performing occupational or recreational activities that increase risk for exposure to potentially rabid animals and 2) might have difficulty getting prompt access to safe post-exposure prophylaxis.

Please consult with a healthcare provider to determine whether you should receive pre-exposure vaccination before travel.

For more information, see country rabies status assessments .

Rabies - CDC Yellow Book

Recommended for most travelers, especially those staying with friends or relatives or visiting smaller cities or rural areas.

Typhoid - CDC Yellow Book

Dosing info - Typhoid

Yellow Fever

Required for travelers ≥9 months old arriving from countries with risk for YF virus transmission; this includes >12-hour airport transits or layovers in countries with risk for YF virus transmission. 1

Yellow Fever - CDC Yellow Book

Avoid contaminated water

Leptospirosis

How most people get sick (most common modes of transmission)

• Touching urine or other body fluids from an animal infected with leptospirosis
• Swimming or wading in urine-contaminated fresh water, or contact with urine-contaminated mud
• Drinking water or eating food contaminated with animal urine
• Avoid contaminated water and soil
• Avoid floodwater

Clinical Guidance

Avoid bug bites.

• Mosquito bite
• Avoid Bug Bites
• An infected pregnant woman can spread it to her unborn baby

Airborne & droplet

• Breathing in air or accidentally eating food contaminated with the urine, droppings, or saliva of infected rodents
• Bite from an infected rodent
• Less commonly, being around someone sick with hantavirus (only occurs with Andes virus)
• Avoid rodents and areas where they live
• Avoid sick people

Tuberculosis (TB)

• Breathe in TB bacteria that is in the air from an infected and contagious person coughing, speaking, or singing.

Learn actions you can take to stay healthy and safe on your trip. Vaccines cannot protect you from many diseases in Bonaire, so your behaviors are important.

Eat and drink safely

Food and water standards around the world vary based on the destination. Standards may also differ within a country and risk may change depending on activity type (e.g., hiking versus business trip). You can learn more about safe food and drink choices when traveling by accessing the resources below.

• Choose Safe Food and Drinks When Traveling
• Water Treatment Options When Hiking, Camping or Traveling
• Global Water, Sanitation and Hygiene (WASH)
• Avoid Contaminated Water During Travel

You can also visit the Department of State Country Information Pages for additional information about food and water safety.

Prevent bug bites

Bugs (like mosquitoes, ticks, and fleas) can spread a number of diseases in Bonaire. Many of these diseases cannot be prevented with a vaccine or medicine. You can reduce your risk by taking steps to prevent bug bites.

What can I do to prevent bug bites?

• Cover exposed skin by wearing long-sleeved shirts, long pants, and hats.
• Use an appropriate insect repellent (see below).
• Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents). Do not use permethrin directly on skin.
• Stay and sleep in air-conditioned or screened rooms.
• Use a bed net if the area where you are sleeping is exposed to the outdoors.

What type of insect repellent should I use?

• FOR PROTECTION AGAINST TICKS AND MOSQUITOES: Use a repellent that contains 20% or more DEET for protection that lasts up to several hours.
• Picaridin (also known as KBR 3023, Bayrepel, and icaridin)
• Oil of lemon eucalyptus (OLE) or para-menthane-diol (PMD)
• 2-undecanone
• Always use insect repellent as directed.

What should I do if I am bitten by bugs?

• Avoid scratching bug bites, and apply hydrocortisone cream or calamine lotion to reduce the itching.
• Check your entire body for ticks after outdoor activity. Be sure to remove ticks properly.

What can I do to avoid bed bugs?

Although bed bugs do not carry disease, they are an annoyance. See our information page about avoiding bug bites for some easy tips to avoid them. For more information on bed bugs, see Bed Bugs .

For more detailed information on avoiding bug bites, see Avoid Bug Bites .

Stay safe outdoors

If your travel plans in Bonaire include outdoor activities, take these steps to stay safe and healthy during your trip.

• Stay alert to changing weather conditions and adjust your plans if conditions become unsafe.
• Prepare for activities by wearing the right clothes and packing protective items, such as bug spray, sunscreen, and a basic first aid kit.
• Consider learning basic first aid and CPR before travel. Bring a travel health kit with items appropriate for your activities.
• If you are outside for many hours in heat, eat salty snacks and drink water to stay hydrated and replace salt lost through sweating.
• Protect yourself from UV radiation : use sunscreen with an SPF of at least 15, wear protective clothing, and seek shade during the hottest time of day (10 a.m.–4 p.m.).
• Be especially careful during summer months and at high elevation. Because sunlight reflects off snow, sand, and water, sun exposure may be increased during activities like skiing, swimming, and sailing.
• Very cold temperatures can be dangerous. Dress in layers and cover heads, hands, and feet properly if you are visiting a cold location.

Stay safe around water

• Swim only in designated swimming areas. Obey lifeguards and warning flags on beaches.
• Practice safe boating—follow all boating safety laws, do not drink alcohol if driving a boat, and always wear a life jacket.
• Do not dive into shallow water.
• Do not swim in freshwater in developing areas or where sanitation is poor.
• Avoid swallowing water when swimming. Untreated water can carry germs that make you sick.
• To prevent infections, wear shoes on beaches where there may be animal waste.

Keep away from animals

Most animals avoid people, but they may attack if they feel threatened, are protecting their young or territory, or if they are injured or ill. Animal bites and scratches can lead to serious diseases such as rabies.

Follow these tips to protect yourself:

• Do not touch or feed any animals you do not know.
• Do not allow animals to lick open wounds, and do not get animal saliva in your eyes or mouth.
• Avoid rodents and their urine and feces.
• Traveling pets should be supervised closely and not allowed to come in contact with local animals.
• If you wake in a room with a bat, seek medical care immediately. Bat bites may be hard to see.

All animals can pose a threat, but be extra careful around dogs, bats, monkeys, sea animals such as jellyfish, and snakes. If you are bitten or scratched by an animal, immediately:

• Wash the wound with soap and clean water.
• Go to a doctor right away.
• Tell your doctor about your injury when you get back to the United States.

Consider buying medical evacuation insurance. Rabies is a deadly disease that must be treated quickly, and treatment may not be available in some countries.

Reduce your exposure to germs

Follow these tips to avoid getting sick or spreading illness to others while traveling:

• Wash your hands often, especially before eating.
• If soap and water aren’t available, clean hands with hand sanitizer (containing at least 60% alcohol).
• Don’t touch your eyes, nose, or mouth. If you need to touch your face, make sure your hands are clean.
• Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.
• Try to avoid contact with people who are sick.
• If you are sick, stay home or in your hotel room, unless you need medical care.

Avoid sharing body fluids

Diseases can be spread through body fluids, such as saliva, blood, vomit, and semen.

Protect yourself:

• Use latex condoms correctly.
• Do not inject drugs.
• Limit alcohol consumption. People take more risks when intoxicated.
• Do not share needles or any devices that can break the skin. That includes needles for tattoos, piercings, and acupuncture.
• If you receive medical or dental care, make sure the equipment is disinfected or sanitized.

Know how to get medical care while traveling

Plan for how you will get health care during your trip, should the need arise:

• Carry a list of local doctors and hospitals at your destination.
• Review your health insurance plan to determine what medical services it would cover during your trip. Consider purchasing travel health and medical evacuation insurance.
• Carry a card that identifies, in the local language, your blood type, chronic conditions or serious allergies, and the generic names of any medications you take.
• Some prescription drugs may be illegal in other countries. Call Bonaire’s embassy to verify that all of your prescription(s) are legal to bring with you.
• Bring all the medicines (including over-the-counter medicines) you think you might need during your trip, including extra in case of travel delays. Ask your doctor to help you get prescriptions filled early if you need to.

Many foreign hospitals and clinics are accredited by the Joint Commission International. A list of accredited facilities is available at their website ( www.jointcommissioninternational.org ).

In some countries, medicine (prescription and over-the-counter) may be substandard or counterfeit. Bring the medicines you will need from the United States to avoid having to buy them at your destination.

Select safe transportation

Motor vehicle crashes are the #1 killer of healthy US citizens in foreign countries.

In many places cars, buses, large trucks, rickshaws, bikes, people on foot, and even animals share the same lanes of traffic, increasing the risk for crashes.

Be smart when you are traveling on foot.

• Use sidewalks and marked crosswalks.
• Pay attention to the traffic around you, especially in crowded areas.
• Remember, people on foot do not always have the right of way in other countries.

Riding/Driving

Choose a safe vehicle.

• Choose official taxis or public transportation, such as trains and buses.
• Ride only in cars that have seatbelts.
• Avoid overcrowded, overloaded, top-heavy buses and minivans.
• Avoid riding on motorcycles or motorbikes, especially motorbike taxis. (Many crashes are caused by inexperienced motorbike drivers.)
• Choose newer vehicles—they may have more safety features, such as airbags, and be more reliable.
• Choose larger vehicles, which may provide more protection in crashes.

Think about the driver.

• Do not drive after drinking alcohol or ride with someone who has been drinking.
• Consider hiring a licensed, trained driver familiar with the area.
• Arrange payment before departing.

Follow basic safety tips.

• Wear a seatbelt at all times.
• Sit in the back seat of cars and taxis.
• When on motorbikes or bicycles, always wear a helmet. (Bring a helmet from home, if needed.)
• Avoid driving at night; street lighting in certain parts of Bonaire may be poor.
• Do not use a cell phone or text while driving (illegal in many countries).
• Travel during daylight hours only, especially in rural areas.
• If you choose to drive a vehicle in Bonaire, learn the local traffic laws and have the proper paperwork.
• Get any driving permits and insurance you may need. Get an International Driving Permit (IDP). Carry the IDP and a US-issued driver's license at all times.
• Check with your auto insurance policy's international coverage, and get more coverage if needed. Make sure you have liability insurance.
• Avoid using local, unscheduled aircraft.
• If possible, fly on larger planes (more than 30 seats); larger airplanes are more likely to have regular safety inspections.
• Try to schedule flights during daylight hours and in good weather.

Medical Evacuation Insurance

If you are seriously injured, emergency care may not be available or may not meet US standards. Trauma care centers are uncommon outside urban areas. Having medical evacuation insurance can be helpful for these reasons.

Helpful Resources

Road Safety Overseas (Information from the US Department of State): Includes tips on driving in other countries, International Driving Permits, auto insurance, and other resources.

The Association for International Road Travel has country-specific Road Travel Reports available for most countries for a minimal fee.

Maintain personal security

Use the same common sense traveling overseas that you would at home, and always stay alert and aware of your surroundings.

Before you leave

• Research your destination(s), including local laws, customs, and culture.
• Monitor travel advisories and alerts and read travel tips from the US Department of State.
• Enroll in the Smart Traveler Enrollment Program (STEP) .
• Leave a copy of your itinerary, contact information, credit cards, and passport with someone at home.
• Pack as light as possible, and leave at home any item you could not replace.

While at your destination(s)

• Carry contact information for the nearest US embassy or consulate .
• Carry a photocopy of your passport and entry stamp; leave the actual passport securely in your hotel.
• Follow all local laws and social customs.
• Do not wear expensive clothing or jewelry.
• Always keep hotel doors locked, and store valuables in secure areas.
• If possible, choose hotel rooms between the 2nd and 6th floors.

Healthy Travel Packing List

Use the Healthy Travel Packing List for Bonaire for a list of health-related items to consider packing for your trip. Talk to your doctor about which items are most important for you.

Why does CDC recommend packing these health-related items?

It’s best to be prepared to prevent and treat common illnesses and injuries. Some supplies and medicines may be difficult to find at your destination, may have different names, or may have different ingredients than what you normally use.

If you are not feeling well after your trip, you may need to see a doctor. If you need help finding a travel medicine specialist, see Find a Clinic . Be sure to tell your doctor about your travel, including where you went and what you did on your trip. Also tell your doctor if you were bitten or scratched by an animal while traveling.

For more information on what to do if you are sick after your trip, see Getting Sick after Travel .

Map Disclaimer - The boundaries and names shown and the designations used on maps do not imply the expression of any opinion whatsoever on the part of the Centers for Disease Control and Prevention concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Approximate border lines for which there may not yet be full agreement are generally marked.

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Bonaire, Sint Eustatius, and Saba

Travel Advisory July 17, 2023

Bonaire - level 1: exercise normal precautions.

Reissued with obsolete COVID-19 page links removed.

Exercise normal precautions in Bonaire. 

Read the country information page for additional information on travel to Bonaire. 

If you decide to travel to Bonaire:

• Enroll in the Smart Traveler Enrollment Program (STEP) to receive Alerts and make it easier to locate you in an emergency.
• Follow the Department of State on Facebook and Twitter .
• Review the Country Security Report for Bonaire.
• Prepare a contingency plan for emergency situations. Review the Traveler’s Checklist .
• Visit the CDC page for the latest Travel Health Information related to your travel.

Travel Advisory October 16, 2023

Sint eustatius - level 1: exercise normal precautions.

Reissued after periodic review without changes.

Exercise normal precautions in Sint Eustatius. 

Read the country information page for additional information on travel to Sint Eustatius.  

If you decide to travel to Sint Eustatius: 

• Read the Department of State’s COVID-19 page before planning any international travel, and read the Consulate's COVID-19 page for country-specific information on COVID-19 information.  
• Enroll in the Smart Traveler Enrollment Program (STEP) to receive Alerts and make it easier to locate you in an emergency. 
• Follow the Department of State on Facebook and Twitter . 
• Review the Country Security Report for Sint Eustatius. 
• Prepare a contingency plan for emergency situations. Review the Traveler’s Checklist . 

Saba - Level 1: Exercise Normal Precautions

Exercise normal precautions in Saba.

Read the country information page for additional information on travel to Saba.

If you decide to travel to Saba:

• Read the Department of State’s COVID-19 page before planning any international travel, and read the Consulate's COVID-19 page for country-specific COVID-19 information.
• Review the Country Security Report for Saba.

Embassy Messages

View Alerts and Messages Archive

Quick Facts

Must be valid for period of stay.

One page required for entry stamp

None required for visits up to 180 days

Yellow fever if arriving from select countries .

$10,000 (or equivalent) must be declared

Embassies and Consulates

U.s. consulate general curacao.

J.B. Gorsiraweg 1, Willemstad, Curaçao Telephone : +(599) (9) 461-3066 Emergency After-Hours Telephone: +(599) (9)843-3066 (from Curaçao); +1-(503)-420-3115 (from the United States) Email:   [email protected]

Destination Description

See the Department of State’s  Fact Sheet on the Netherlands  for information on U.S. - Netherlands relations.

Entry, Exit and Visa Requirements

All U.S. citizens must have a U.S. passport for all air travel to and from the BES Islands. All sea travelers must have a U.S. passport or passport card. Review further information on Bonaire travel here .

Upon arrival in the BES Islands, you must have:

• proof of onward or return ticket;
• proof of sufficient funds; and
• proof of lodging accommodations for your stay.

For the most current visa information please visit the website of the Caribbean Netherlands Immigration and Naturalisation Service . For further information, travelers may contact the  Royal Netherlands Embassy  or its consulates in the United States. For more information on visas or extending your visit, please call the Immigration Office of Bonaire at +599-715-8330. HIV/AIDS Restrictions:  The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of the BES Islands. Find information on  dual nationality ,  prevention of international child abduction , and  customs information  on our websites. 

Safety and Security

Crime:  Bonaire, Saba, and Sint Eustatius are all assessed as low-crime areas as their small populations provide a high level of social control and their police forces are professional and responsive. Thoe crimes that do occur are generally non-violent, financially-motivated, and opportunistic in nature such as pickpocketing, thefts of unattended bags, and smash and grabs of empty vehicles. Do not leave valuables unattended in public areas or in unsecured hotel rooms and rental homes. Keep a copy of your valid U.S. passport in a secure location in case it is stolen. Car theft, especially of rental vehicles, can occur. Vehicle leases or rentals may not be fully covered by local insurance when a vehicle is stolen or damaged. Be sure you are sufficiently insured when renting vehicles and jet skis.

The legal drinking age of 18 is not always rigorously enforced on the BES islands, so extra parental supervision may be appropriate. Travel in pairs or groups and be responsible with alcohol consumption. For information on scams, visit the  Department of State  and  FBI  pages on scams and safety.

Victims of Crime:  Dial 911 for police assistance in the BES Islands. Contact the U.S. Consulate at (+599)(9)-461-3066 after you have contacted local police. Remember that local authorities are responsible for investigating and prosecuting the crime.

Do not rely on hotels, restaurants, or tour companies to make the police report for you. 

For more information, see our webpage on  help for U.S. victims of crime overseas .

• help you find appropriate medical care
• assist you in reporting a crime to the police
• contact relatives or friends with your written consent
• Provide general information regarding the victim’s role during the local investigation   and following its conclusion
• provide a list of local attorneys
• provide our information on  victim’s compensation programs in the U.S .
• provide an emergency loan for repatriation to the United States and/or limited medical support in cases of destitution
• help you find accommodation and arrange flights home
• replace a stolen or lost passport

Domestic Violence : U.S. citizen victims of domestic violence are encouraged to contact the Consulate for assistance.

Tourism:  The tourism industry is unevenly regulated, and safety inspections for equipment and facilities do not commonly occur. Hazardous areas/activities are not always identified with appropriate signage, and staff may not be trained or certified either by the host government or by recognized authorities in the field. In the event of an injury, appropriate medical treatment is typically available only in/near major cities. First responders are generally unable to access areas outside of major cities and to provide urgent medical treatment. U.S. citizens are encouraged to purchase medical evacuation insurance . 

Local Laws & Special Circumstances

Criminal Penalties:  You are subject to local laws.  If you violate local laws, even unknowingly, you may be expelled, arrested, or imprisoned.  Individuals establishing a business or practicing a profession that requires additional permits or licensing should seek information from the competent local authorities, prior to practicing or operating a business.

Furthermore, some laws are also prosecutable in the United States, regardless of local law. For examples, see our website on  crimes against minors abroad  and the  Department of Justice  website.

Arrest Notification:  If you are arrested or detained, ask police or prison officials to notify the U.S. Consulate immediately. See our  webpage  for further information.

Dutch law allows for suspects to be held by order of a judge without a hearing during an investigation .

Counterfeit and Pirated Goods:  Although counterfeit and pirated goods are prevalent in many countries, they may still be illegal according to local laws. You may also pay fines or have to give them up if you bring them back to the United States. See the  U.S. Department of Justice website  for more information.

Faith-Based Travelers:   See the following webpages for details:

• Faith-Based Travel Information
• International Religious Freedom Report – see country reports
• Human Rights Report – see country reports
• Hajj Fact Sheet for Travelers
• Best Practices for Volunteering Abroad

LGBTQI+ Travelers:   There are no legal restrictions on same-sex sexual relations or the organization of LGBTQI+ events in the BES Islands.

See   our  LGBTQI+ Travel Information   page and section 6 of our  Human Rights report  for further details.

Travelers with Disabilities:  The law in the Dutch Caribbean prohibits discrimination against persons with physical, sensory, intellectual or mental disabilities, and the law is enforced. Social acceptance of persons with disabilities in public is as prevalent as in the United States. The most common types of accessibility may include accessible facilities, information, and communication/access to services/ease of movement or access.  However, accessibility may be limited in some lodgings and general infrastructure.

• Please visit the  InfoBonaire Website for Handicapped and Disabled Services  for more information.

Students:  See our  Students Abroad  page and  FBI travel tips .

Women Travelers:  See our travel tips for  Women Travelers .

Access to quality medical care is limited on the BES Islands, and facilities do not offer the health and service standards typically expected in the United States .

For emergency services in the BES Islands, dial 911 .

Ambulance services are widely available.

A  list of medical facilities  in the BES Islands is available on our Consulate website. We do not endorse or recommend any specific medical provider or clinic.

We do not pay medical bills.  Be aware that U.S. Medicare/Medicaid does not apply overseas. Most hospitals and doctors overseas do not accept U.S. health insurance.

Medical Insurance:  Make sure your health insurance plan provides coverage overseas.  Most care providers overseas only accept cash payments.  See our webpage for more information on overseas insurance coverage.  Visit the U.S. Centers for Disease Control and Prevention for more information on type of insurance you should consider before you travel overseas.

We strongly recommend supplemental insurance to cover medical evacuation.

Medicines: Always carry your prescription medication in original packaging, along with your doctor’s prescription. If traveling with prescription medication, check with the government of the Netherlands   to ensure the medication is legal in the BES islands. Always carry your prescription medication in original packaging with your doctor’s prescription. 

Drug stores or “boticas” provide prescription and over-the-counter medicine. Visitors need a local prescription, and may not be able to find medications normally available in the U.S. Emergency services are usually quick to respond.

Vaccinations:   Be up-to-date on all vaccinations recommended by the U.S. Centers for Disease Control and Prevention.

Use the U.S. Centers for Disease Control and Prevention recommended mosquito repellents and sleep under insecticide-impregnated mosquito nets.  Chemoprophylaxis is recommended for all travelers even for short stays.

Visit the U.S. Centers for Disease Control and Prevention website for more information about  Resources for Travelers  regarding specific issues in the BES Islands. 

Further health information:

• World Health Organization
• U.S. Centers for Disease Control and Prevention (CDC)

Air Quality: Visit AirNow Department of State for information on air quality at U.S. Embassies and Consulates.

Travel and Transportation

Road Conditions and Safety: Nonexistent, hidden, and poorly maintained street signs are a major road hazard on the BES islands. Proceed through intersections with caution. Roads can be extremely slippery during rainfall.  Night driving is reasonably safe if you are familiar with the route and road conditions. Many streets are poorly lit or not lit at all. In Bonaire and St. Eustatius, be vigilant for wild donkeys or other animals crossing the road. Use caution when driving in Saba as roads tend to be steep and have many sharp turns.

The emergency service telephone number is 911. Police and ambulances tend to respond quickly to emergency situations.

Traffic Laws:   Driving on the BES islands is on the right hand side. Right turns on red are prohibited and traffic conditions require somewhat defensive driving. Local laws require drivers and passengers to wear seat belts and motorcyclists to wear helmets. Children under 4 years of age must be in child safety seats, and children under 12 must ride in the back seat.

Public Transportation: Taxis are an easy form of transportation on the islands. Verify the price before entering the taxi, as there are no meters. Fares are quoted in U.S. dollars. In Bonaire, public minibuses are inexpensive and run nonstop during the day with no fixed schedule. Each minibus has a specific route displayed on the windshield. Buses, which run on the hour, have limited routes. The road conditions on the main thoroughfares are good to fair. There is no public transportation in Saba or St. Eustatius.

See our Road Safety page for more information.

Aviation Safety Oversight: The U.S. Federal Aviation Administration (FAA) has assessed the government of the BES Islands’ Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of BES Islands’ air carrier operations. Further information may be found on the FAA’s safety assessment page .

Maritime Travel: Mariners planning travel to the BES Islands should also check for U.S. maritime advisories and alerts . Information may also be posted to the  U.S. Coast Guard homeport website , and the NGA broadcast warnings .

For additional travel information

• Enroll in the  Smart Traveler Enrollment Program (STEP)  to receive security messages and make it easier to locate you in an emergency.
• Call us in Washington, D.C. at 1-888-407-4747 (toll-free in the United States and Canada) or 1-202-501-4444 (from all other countries) from 8:00 a.m. to 8:00 p.m., Eastern Standard Time, Monday through Friday (except U.S. federal holidays).
• See the  State Department’s travel website  for the  Worldwide Caution  and  Travel Advisories .
• Follow us on  Twitter  and  Facebook .
• See  traveling safely abroad  for useful travel tips.

Review information about International Parental Child Abduction in  Bonaire, St. Eustatius, and Saba (BES) .  For additional IPCA-related information, please see the  International Child Abduction Prevention and Return Act ( ICAPRA )  report.

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Philippines

Republic of North Macedonia

Republic of the Congo

Saint Kitts and Nevis

Saint Lucia

Saint Vincent and the Grenadines

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Saudi Arabia

Sierra Leone

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South Korea

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Turkmenistan

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United Arab Emirates

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Every Caribbean Island's COVID-19 Travel Policies — and What You Need to Know to Plan Your Trip

Almost every Caribbean destination is open to travelers regardless of vaccination status.

When COVID-19 struck the United States in late winter 2020 relaxing on a warm beach with a subtle island breeze was all anyone could want. Now, almost two years since, most Caribbean islands have fully reopened to travelers.

Below is an island-by-island guide for U.S. travelers with everything you need to know before planning a trip to the Caribbean.

As of Oct. 1, there are no entry requirements to Anguilla, according to the U.S. Embassy

Antigua and Barbuda

Antigua and Barbuda have removed all preexisting COVID-19 entry requirements, according to the government. However, any passenger displaying symptoms may be isolated by the government.

Aruba has waived all preexisting COVID-19 entry level requirements, however, travel insurance is highly recommended, according to the country's tourism site.

Non-U.S. citizens must show proof of vaccination, and there are no entry requirements for U.S. citizens according to the U.S. Embassy in the Bahamas.

Barbados has discontinued all COVID-19 entry requirements the tourism board announced in September.

Barbados is also welcoming visitors to move to the island for a year for the ultimate remote work experience.

Fully vaccinated travelers by air or by cruise to Bermuda will be required to show proof of vaccination, and must upload proof prior to travel. Unvaccinated travelers must upload proof of valid travel insurance to enter, according to the government.

All travelers aged 2 and up must have Travel Authorization and will be required to pay $40 for the application.

Bonaire, Sint Eustatius and Saba

There are no COVID-19 entry requirements for the Caribbean Netherlands according to the UK Government.

The British Virgin Islands

The British Virgin Islands have discontinued all COVID-19 entry requirements, according to the BVI government.

Cayman Islands

The Cayman Islands have removed all COVID-19 entry restrictions, according to Cayman Islands tourism board.

There are no COVID-19 entry restrictions to visit, according to the Curaçao tourism board .

Dominica has removed all pre-arrival testing along with testing on arrival for symptomatic passengers, according to the tourism board.

Dominican Republic

The Dominical Republic has removed all COVID-19 entry requirements, however, when required random testing may occur and passengers may present proof of vaccination to be exempt, according to GoDominicanRepublic.com

There are no covid entry requirements for tourists visiting Grenada, according to PureGrenada.com

The Guadeloupe Islands have dropped all COVID-19 entry requirements for visitors, t he archipelago announced in August.

All passengers 12 and older are required to present proof of vaccination or a negative PCR taken at most 72 hours before departure. Passengers aged 5-11 are required to present a negative PCR test, and passengers under 5 are exempt, according to the Department of Foreign Affairs.

For additional precautions, please see  the U.S. State Department's Advisory .

Jamaica has ended all COVID-19 entry requirements, according to the U.S. Embassy.

Martinique has lifted all COVID-19 entry requirements as of August, according to the tourism board.

Since October the government of Montserrat has ended all COVID-19 requirements for entry.

Puerto Rico

All travelers will be able to enter Puerto Rico without any proof of covid vaccination or any other requirement, according to Discover Puerto Rico .

All COVID-19 entry restrictions have been lifted, according to the U.S. Embassy.

St. Kitts and Nevis

All visitors regardless of vaccination are permitted to enter St. Kitts and Nevis, according to the Tourism Authority.

Sint Maarten

Travelers to Sint Maarten are no longer required to provide travel insurance or test upon arrival if unvaccinated, the electronic health authorization requirement has also been removed.

St. Martin has removed all preexisting COVID-19 travel requirements for U.S. Citizens, according to the U.S. Embassy.

All COVID-19 restrictions have been removed, according to the St. Lucia tourism authority.

St. Vincent and the Grenadines

All COVID-19 restrictions have been lifted, according to the Ministry of Health, Wellness, and Environment.

Trinidad and Tobago

According to the U.S. Embassy there are no COVID-19 entry requirements for Trinidad and Tobago.

Turks and Caicos Islands

There are no COVID-19 entry requirements for Turks and Caicos, according to the government.

United States Virgin Islands

The U.S. Virgin Islands have removed all preexisting COVID-19 entry requirements, according to the government . The territory removed all restrictions for American travelers in May.

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Bonaire/St Eustatius/Saba

Warnings and insurance.

The Foreign, Commonwealth & Development Office ( FCDO ) provides advice about risks of travel to help British nationals make informed decisions. Find out more about FCDO travel advice .

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COVID-19 travel advice

A coronavirus disease 2019 (COVID-19) vaccine can prevent you from getting COVID-19 or from becoming seriously ill due to COVID-19. But even if you're vaccinated, it's still a good idea to take precautions to protect yourself and others while traveling during the COVID-19 pandemic.

If you've had all recommended COVID-19 vaccine doses, including boosters, you're less likely to become seriously ill or spread COVID-19. You can then travel more safely within the U.S. and internationally. But international travel can still increase your risk of getting new COVID-19 variants.

The Centers for Disease Control and Prevention (CDC) recommends that you should avoid travel until you've had all recommended COVID-19 vaccine and booster doses.

Before you travel

As you think about making travel plans, consider these questions:

• Have you been vaccinated against COVID-19? If you haven't, get vaccinated. If the vaccine requires two doses, wait two weeks after getting your second vaccine dose to travel. If the vaccine requires one dose, wait two weeks after getting the vaccine to travel. It takes time for your body to build protection after any vaccination.
• Have you had any booster doses? Having all recommended COVID-19 vaccine doses, including boosters, increases your protection from serious illness.
• Are you at increased risk for severe illness? Anyone can get COVID-19. But older adults and people of any age with certain medical conditions are at increased risk for severe illness from COVID-19.
• Do you live with someone who's at increased risk for severe illness? If you get infected while traveling, you can spread the COVID-19 virus to the people you live with when you return, even if you don't have symptoms.
• Does your home or destination have requirements or restrictions for travelers? Even if you've had all recommended vaccine doses, you must follow local, state and federal testing and travel rules.

Check local requirements, restrictions and situations

Some state, local and territorial governments have requirements, such as requiring people to wear masks, get tested, be vaccinated or stay isolated for a period of time after arrival. Before you go, check for requirements at your destination and anywhere you might stop along the way.

Keep in mind these can change often and quickly depending on local conditions. It's also important to understand that the COVID-19 situation, such as the level of spread and presence of variants, varies in each country. Check back for updates as your trip gets closer.

Travel and testing

For vaccinated people.

If you have been fully vaccinated, the CDC states that you don't need to get tested before or after your trip within the U.S. or stay home (quarantine) after you return.

If you're planning to travel internationally outside the U.S., the CDC states you don't need to get tested before your trip unless it's required at your destination. Before arriving to the U.S., you need a negative test within the last day before your arrival or a record of recovery from COVID-19 in the last three months.

After you arrive in the U.S., the CDC recommends getting tested with a viral test 3 to 5 days after your trip. If you're traveling to the U.S. and you aren't a citizen, you need to be fully vaccinated and have proof of vaccination.

You don't need to quarantine when you arrive in the U.S. But check for any symptoms. Stay at home if you develop symptoms.

For unvaccinated people

Testing before and after travel can lower the risk of spreading the virus that causes COVID-19. If you haven't been vaccinated, the CDC recommends getting a viral test within three days before your trip. Delay travel if you're waiting for test results. Keep a copy of your results with you when you travel.

Repeat the test 3 to 5 days after your trip. Stay home for five days after travel.

If at any point you test positive for the virus that causes COVID-19, stay home. Stay at home and away from others if you develop symptoms. Follow public health recommendations.

Stay safe when you travel

In the U.S., you must wear a face mask on planes, buses, trains and other forms of public transportation. The mask must fit snugly and cover both your mouth and nose.

Follow these steps to protect yourself and others when you travel:

• Get vaccinated.
• Keep distance between yourself and others (within about 6 feet, or 2 meters) when you're in indoor public spaces if you're not fully vaccinated. This is especially important if you have a higher risk of serious illness.
• Avoid contact with anyone who is sick or has symptoms.
• Avoid crowds and indoor places that have poor air flow (ventilation).
• Don't touch frequently touched surfaces, such as handrails, elevator buttons and kiosks. If you must touch these surfaces, use hand sanitizer or wash your hands afterward.
• Wear a face mask in indoor public spaces. The CDC recommends wearing the most protective mask possible that you'll wear regularly and that fits. If you are in an area with a high number of new COVID-19 cases, wear a mask in indoor public places and outdoors in crowded areas or when you're in close contact with people who aren't vaccinated.
• Avoid touching your eyes, nose and mouth.
• Cover coughs and sneezes.
• Wash your hands often with soap and water for at least 20 seconds.
• If soap and water aren't available, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands and rub your hands together until they feel dry.
• Don't eat or drink on public transportation. That way you can keep your mask on the whole time.

Because of the high air flow and air filter efficiency on airplanes, most viruses such as the COVID-19 virus don't spread easily on flights. Wearing masks on planes has likely helped lower the risk of getting the COVID-19 virus on flights too.

However, air travel involves spending time in security lines and airport terminals, which can bring you in close contact with other people. Getting vaccinated and wearing a mask when traveling can help protect you from COVID-19 while traveling.

The Transportation Security Administration (TSA) has increased cleaning and disinfecting of surfaces and equipment, including bins, at screening checkpoints. TSA has also made changes to the screening process:

• Travelers must wear masks during screening. However, TSA employees may ask travelers to adjust masks for identification purposes.
• Travelers should keep a distance of 6 feet apart from other travelers when possible.
• Instead of handing boarding passes to TSA officers, travelers should place passes (paper or electronic) directly on the scanner and then hold them up for inspection.
• Each traveler may have one container of hand sanitizer up to 12 ounces (about 350 milliliters) in a carry-on bag. These containers will need to be taken out for screening.
• Personal items such as keys, wallets and phones should be placed in carry-on bags instead of bins. This reduces the handling of these items during screening.
• Food items should be carried in a plastic bag and placed in a bin for screening. Separating food from carry-on bags lessens the likelihood that screeners will need to open bags for inspection.

Be sure to wash your hands with soap and water for at least 20 seconds directly before and after going through screening.

Public transportation

If you travel by bus or train and you aren't vaccinated, be aware that sitting or standing within 6 feet (2 meters) of others for a long period can put you at higher risk of getting or spreading COVID-19. Follow the precautions described above for protecting yourself during travel.

Even if you fly, you may need transportation once you arrive at your destination. You can search car rental options and their cleaning policies on the internet. If you plan to stay at a hotel, check into shuttle service availability.

If you'll be using public transportation and you aren't vaccinated, continue physical distancing and wearing a mask after reaching your destination.

Hotels and other lodging

The hotel industry knows that travelers are concerned about COVID-19 and safety. Check any major hotel's website for information about how it's protecting guests and staff. Some best practices include:

• Enhanced cleaning procedures
• Physical distancing recommendations indoors for people who aren't vaccinated
• Mask-wearing and regular hand-washing by staff
• Mask-wearing indoors for guests in public places in areas that have high cases of COVID-19
• Vaccine recommendations for staff
• Isolation and testing guidelines for staff who've been exposed to COVID-19
• Contactless payment
• Set of rules in case a guest becomes ill, such as closing the room for cleaning and disinfecting
• Indoor air quality measures, such as regular system and air filter maintenance, and suggestions to add air cleaners that can filter viruses and bacteria from the air

Vacation rentals, too, are enhancing their cleaning procedures. They're committed to following public health guidelines, such as using masks and gloves when cleaning, and building in a waiting period between guests.

Make a packing list

When it's time to pack for your trip, grab any medications you may need on your trip and these essential safe-travel supplies:

• Alcohol-based hand sanitizer (at least 60% alcohol)
• Disinfectant wipes (at least 70% alcohol)
• Thermometer

Considerations for people at increased risk

Anyone can get very ill from the virus that causes COVID-19. But older adults and people of any age with certain medical conditions are at increased risk for severe illness. This may include people with cancer, serious heart problems and a weakened immune system. Getting the recommended COVID-19 vaccine and booster doses can help lower your risk of being severely ill from COVID-19.

Travel increases your chance of getting and spreading COVID-19. If you're unvaccinated, staying home is the best way to protect yourself and others from COVID-19. If you must travel and aren't vaccinated, talk with your health care provider and ask about any additional precautions you may need to take.

Remember safety first

Even the most detailed and organized plans may need to be set aside when someone gets ill. Stay home if you or any of your travel companions:

• Have signs or symptoms, are sick or think you have COVID-19
• Are waiting for results of a COVID-19 test
• Have been diagnosed with COVID-19
• Have had close contact with someone with COVID-19 in the past five days and you're not up to date with your COVID-19 vaccines

If you've had close contact with someone with COVID-19, get tested after at least five days. Wait to travel until you have a negative test. Wear a mask if you travel up to 10 days after you've had close contact with someone with COVID-19.

©2024 Mayo Foundation for Medical Education and Research (MRMER). All rights reserved.

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If You Test Positive for Covid, Can You Still Travel?

With coronavirus cases on the rise, summer travelers are once again facing difficult questions. Here’s the latest travel guidance from health experts.

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By Shannon Sims

As new coronavirus variants gain traction across the United States, summer travelers are facing a familiar and tiresome question: How will the ever-mutating virus affect travel plans?

In light of updated guidelines from the Centers for Disease Control and Prevention , the answers may be slightly different from those in previous years.

Here’s what to know about traveling this summer if you’re worried about — or think you might have — Covid-19.

What’s going on with Covid?

Recent C.D.C. data show that Covid infections are rising or most likely rising in more than 40 states. Hospitalization rates and deaths, while low compared with the peaks seen in previous years, are also on the rise.

The uptick is tied to a handful of variants — named KP.2, KP.3 and LB.1 — that now account for a majority of new cases .

At the same time, record numbers of people are traveling by car and plane.

I’d planned to travel, but I’m sick with Covid. What should I do?

In short: You should probably delay or cancel your trip.

If you tested positive or are experiencing Covid symptoms, which include fever, chills, fatigue, a cough, a runny nose, body aches and a headache, the C.D.C. recommends that you stay home and keep away from others.

According to its latest guidelines, the agency advises waiting until at least 24 hours after you are fever-free and your overall symptoms are improving before going back to normal activities, including travel.

What are the isolation rules?

New C.D.C. guidelines issued in March made significant changes to the recommended isolation period for people with Covid.

The agency now says that you can resume daily activities if you meet two requirements : You have been fever-free for at least 24 hours (without the use of fever-reducing medications) and your symptoms are improving overall. Previously, the agency recommended isolating for at least five days, plus a period of post-isolation precautions.

Even after your isolation period, you may still be able to spread the virus to others, which is why the C.D.C. encourages you to continue to take precautions for the next five days: Use masks, wash your hands frequently, practice physical distancing, clean your air by opening windows or purifying it, and continue testing yourself before gathering around others.

Are there any lingering testing or vaccine requirements?

Travelers no longer need to show proof of being vaccinated against Covid or take a Covid test to enter the U.S. (This applies to both U.S. citizens and noncitizens.)

The same is true in Europe and most other countries.

How can I prepare before traveling?

First, make sure you stay up-to-date with Covid vaccines .

Next, plan to bring any items that would be helpful should you become sick while traveling.

“Make sure to take a good first aid or medication kit with you,” said Vicki Sowards, the director of nursing resources for Passport Health , which provides travel medical services. Ms. Sowards recommended that your kit include medications that you usually take when you are ill, as well as Covid tests.

You may want to consider packing medications that can help alleviate the symptoms of Covid, like painkillers, cold and flu medicines, and fever reducers. Bringing along some electrolyte tablets (or powdered Gatorade) can also help if you get sick.

Ms. Sowards also suggested speaking with your physician before traveling, particularly if you’re in a vulnerable or high-risk group. Some doctors might prescribe the antiviral Paxlovid as a precautionary measure, she said, to be taken in the event of a Covid infection.

How can I stay safe while traveling?

Wearing a mask on a plane or in crowded areas is still a good idea, said Ms. Sowards. Covid is spread through airborne particles and droplets, “so protecting yourself is paramount, especially if you are immunocompromised or have chronic health conditions.”

If you do get sick, start wearing a mask and using over-the-counter medications such as ibuprofen or acetaminophen for fever or joint aches, Ms. Sowards advised.

Follow New York Times Travel on Instagram and sign up for our weekly Travel Dispatch newsletter to get expert tips on traveling smarter and inspiration for your next vacation. Dreaming up a future getaway or just armchair traveling? Check out our 52 Places to Go in 2024 .

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CDC Recommends Updated 2024-2025 COVID-19 and Flu Vaccines for Fall/Winter Virus Season

For Immediate Release: June 27, 2024 Contact: Media Relations (404) 639-3286

Today, CDC recommended the updated 2024-2025 COVID-19 vaccines and the updated 2024-2025 flu vaccines to protect against severe COVID-19 and flu this fall and winter.

It is safe to receive COVID-19 and flu vaccines at the same visit. Data continue to show the importance of vaccination to protect against severe outcomes of COVID-19 and flu, including hospitalization and death. In 2023, more than 916,300 people were hospitalized due to COVID-19 and more than 75,500 people died from COVID-19. During the 2023-2024 flu season, more than 44,900 people are estimated to have died from flu complications.

Updated 2024-2025 COVID-19 Vaccine Recommendation

CDC recommends everyone ages 6 months and older receive an updated 2024-2025 COVID-19 vaccine to protect against the potentially serious outcomes of COVID-19 this fall and winter whether or not they have ever previously been vaccinated with a COVID-19 vaccine. Updated COVID-19 vaccines will be available from Moderna, Novavax, and Pfizer later this year. This recommendation will take effect as soon as the new vaccines are available.

The virus that causes COVID-19, SARS-CoV-2, is always changing and protection from COVID-19 vaccines declines over time. Receiving an updated 2024-2025 COVID-19 vaccine can restore and enhance protection against the virus variants currently responsible for most infections and hospitalizations in the United States. COVID-19 vaccination also reduces the chance of suffering the effects of Long COVID, which can develop during or following acute infection and last for an extended duration.

Last season, people who received a 2023-2024 COVID-19 vaccine saw greater protection against illness and hospitalization than those who did not receive a 2023-2024 vaccine. To date, hundreds of millions of people have safely received a COVID-19 vaccine under the most intense vaccine safety monitoring in United States history.

Updated 2024-2025 Flu Vaccine Recommendation

CDC recommends everyone 6 months of age and older, with rare exceptions, receive an updated 2024-2025 flu vaccine to reduce the risk of influenza and its potentially serious complications this fall and winter. CDC encourages providers to begin their influenza vaccination planning efforts now and to vaccinate patients as indicated once 2024-2025 influenza vaccines become available .

Most people need only one dose of the flu vaccine each season. While CDC recommends flu vaccination as long as influenza viruses are circulating, September and October remain the best times for most people to get vaccinated. Flu vaccination in July and August is not recommended for most people, but there are several considerations regarding vaccination during those months for specific groups:

• Pregnant people who are in their third trimester can get a flu vaccine in July or August to protect their babies from flu after birth, when they are too young to get vaccinated.
• Children who need two doses of the flu vaccine should get their first dose of vaccine as soon as it becomes available. The second dose should be given at least four weeks after the first.
• Vaccination in July or August can be considered for children who have health care visits during those months if there might not be another opportunity to vaccinate them.
• For adults (especially those 65 years old and older) and pregnant people in the first and second trimester, vaccination in July and August should be avoided unless it won’t be possible to vaccinate in September or October.

Updated 2024-2025 flu vaccines will all be trivalent and will protect against an H1N1, H3N2 and a B/Victoria lineage virus. The composition of this season’s vaccine compared to last has been updated with a new influenza A(H3N2) virus .

For more information on updated COVID-19 vaccines visit:  Coronavirus Disease 2019 (COVID-19) | CDC . For more information on updated flu vaccines visit: Seasonal Flu Vaccines | CDC .

The following statement is attributable to CDC Director Dr. Mandy Cohen:

“Our top recommendation for protecting yourself and your loved ones from respiratory illness is to get vaccinated,” said Mandy Cohen, M.D., M.P.H. “Make a plan now for you and your family to get both updated flu and COVID vaccines this fall, ahead of the respiratory virus season.”

### U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Whether diseases start at home or abroad, are curable or preventable, chronic or acute, or from human activity or deliberate attack, CDC’s world-leading experts protect lives and livelihoods, national security and the U.S. economy by providing timely, commonsense information, and rapidly identifying and responding to diseases, including outbreaks and illnesses. CDC drives science, public health research, and data innovation in communities across the country by investing in local initiatives to protect everyone’s health.

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Exit Notification / Disclaimer Policy

• The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website.
• Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.
• You will be subject to the destination website's privacy policy when you follow the link.
• CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website.

Public support for air travel restrictions to address COVID-19 or climate change

Affiliation.

• 1 CICERO Center for International Climate Research, P.O. Box 1129 Blindern, 0318 Oslo, Norway.
• PMID: 36568359
• PMCID: PMC9760087
• DOI: 10.1016/j.trd.2021.102767

An improved understanding of public support is essential to design effective and feasible climate policies for aviation. Our motivation is the contrast between high support for air travel restrictions responding to the COVID-19 pandemic and low support for restrictions to combat climate change. Can the same factors explain individuals' support for restrictive measures across two different problems? Using a survey, we find that largely the same factors explain support. Support increases with expected effectiveness, perceived threat and imminence of the problem, shorter expected duration of the measure, knowledge, and trust, while support decreases with expected negative consequences for self and the poor. When controlling for all perceptions, there is no significant residual difference in support depending on whether the measures address climate change or COVID-19. The level of support differs because COVID-19 is perceived as a more imminent threat, and because measures are expected to be shorter-lasting and more effective.

Keywords: Air travel; COVID-19; Climate change; Public support; Restrictive measures.

© 2021 Elsevier Ltd. All rights reserved.

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COVID-19: travel health notice for all travellers

Bonaire travel advice

Latest updates: The Health section was updated - travel health information (Public Health Agency of Canada)

Last updated: July 2, 2024 09:25 ET

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Safety and security, entry and exit requirements, laws and culture, natural disasters and climate, bonaire - take normal security precautions.

Take normal security precautions in Bonaire.

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Petty crime, such as pickpocketing and purse snatching, occurs in Bonaire.

Residential break-ins and theft from vehicles, hotel rooms and rental units also take place.

• Ensure that your belongings, including your passport and other travel documents, are secure at all times
• Never leave valuables such as jewellery, cell phones, electronics, wallets or bags unattended on the beach or in your vehicle
• Avoid unpopulated areas and unpatrolled beaches after dark
• Check with local authorities to determine which beaches are safe

Women's safety

Women travelling alone may be subject to some forms of harassment and verbal abuse.

Advice for women travellers

Water activities

Coastal waters can be dangerous. Rescue services may not be consistent with Canadian standards.

Follow the instructions and warnings of local authorities.

If you are planning to take part in water sports such as scuba diving, jet skiing or parasailing:

• ensure that equipment is safe and in good condition
• ensure helmets and life jackets are available
• avoid participating in any water activities when you are under the influence of alcohol or other substances
• check that your travel insurance covers accidents related to recreational activities

Water safety abroad

Wildlife viewing

Wild animals can be dangerous, particularly if you are on foot or at close range.

• Always maintain a safe distance when observing wildlife
• Only exit a vehicle when a professional guide or warden says it’s safe to do so
• Only use reputable and professional guides or tour operators
• Closely follow park regulations and wardens’ advice

Road safety

Major roads are in good condition, but many drivers don’t respect traffic laws.

Animals on the road pose a hazard.

Road signs are different from Canada. Familiarize yourself with the signs before driving.

Public transportation

Public transportation in Bonaire is fairly limited. There is no public bus system operating. Taxis are the only form of public transportation on the island.

Taxis in Bonaire must be registered and have license plates marked with “TX”.

Taxis are not metered and operate on a flat rate by destination set by the government. Despite the regulated price, agree on a fare prior to departure.

We do not make assessments on the compliance of foreign domestic airlines with international safety standards.

Information about foreign domestic airlines

Every country or territory decides who can enter or exit through its borders. The Government of Canada cannot intervene on your behalf if you do not meet your destination’s entry or exit requirements.

We have obtained the information on this page from Dutch authorities. It can, however, change at any time.

Verify this information with the  Foreign Representatives in Canada .

Entry requirements vary depending on the type of passport you use for travel.

Before you travel, check with your transportation company about passport requirements. Its rules on passport validity may be more stringent than the country’s entry rules.

Regular Canadian passport

Your passport must be valid for the duration of your stay in Bonaire.

Passport for official travel

Different entry rules may apply.

Official travel

Passport with “X” gender identifier

While the Government of Canada issues passports with an “X” gender identifier, it cannot guarantee your entry or transit through other countries. You might face entry restrictions in countries that do not recognize the “X” gender identifier. Before you leave, check with the closest foreign representative for your destination.

Other travel documents

Different entry rules may apply when travelling with a temporary passport or an emergency travel document. Before you leave, check with the closest foreign representative for your destination.

Useful links

• Foreign Representatives in Canada
• Canadian passports

Tourist visa: not required for stays of up to 90 days in a 180-day period Business visa: not required for stays of up to 90 days in a 180-day period Work permit: required Student visa: required

Visitor entry tax

You must pay a $75 USD visitor entry tax to visit Bonaire. The tax can be paid online using the official government site.

Visitor entry tax – Government of Bonaire

Other entry requirements

Customs officials may ask you to show them:

• a return or onward ticket
• proof of the purpose of your stay
• proof of sufficient funds to cover your stay
• proof of valid health insurance
• proof of accommodation for your stay

Other entry requirements may apply.

• Bonaire Immigration and Entry Requirements – Info Bonaire
• Requirements for travelling without a visa – Government of the Netherlands
• Children and travel

Learn more about travelling with children .

Yellow fever

Learn about potential entry requirements related to yellow fever (vaccines section).

Relevant Travel Health Notices

• Global Measles Notice - 13 March, 2024
• COVID-19 and International Travel - 13 March, 2024
• Zika virus: Advice for travellers - 31 August, 2023
• Dengue: Advice for travellers - 2 July, 2024

This section contains information on possible health risks and restrictions regularly found or ongoing in the destination. Follow this advice to lower your risk of becoming ill while travelling. Not all risks are listed below.

Consult a health care professional or visit a travel health clinic preferably 6 weeks before you travel to get personalized health advice and recommendations.

Routine vaccines

Be sure that your  routine vaccinations , as per your province or territory , are up-to-date before travelling, regardless of your destination.

Some of these vaccinations include measles-mumps-rubella (MMR), diphtheria, tetanus, pertussis, polio, varicella (chickenpox), influenza and others.

Pre-travel vaccines and medications

You may be at risk for preventable diseases while travelling in this destination. Talk to a travel health professional about which medications or vaccines may be right for you, based on your destination and itinerary. 

Yellow fever   is a disease caused by a flavivirus from the bite of an infected mosquito.

Travellers get vaccinated either because it is required to enter a country or because it is recommended for their protection.

• There is no risk of yellow fever in this country.

Country Entry Requirement*

• Proof of vaccination is required if you are coming from or have transited through an airport of a country   where yellow fever occurs.

Recommendation

• Vaccination is not recommended.
• Discuss travel plans, activities, and destinations with a health care professional.
• Contact a designated  Yellow Fever Vaccination Centre  well in advance of your trip to arrange for vaccination.

About Yellow Fever

Yellow Fever Vaccination Centres in Canada * It is important to note that  country entry requirements  may not reflect your risk of yellow fever at your destination. It is recommended that you contact the nearest  diplomatic or consular office  of the destination(s) you will be visiting to verify any additional entry requirements.

There is a risk of hepatitis A in this destination. It is a disease of the liver. People can get hepatitis A if they ingest contaminated food or water, eat foods prepared by an infectious person, or if they have close physical contact (such as oral-anal sex) with an infectious person, although casual contact among people does not spread the virus.

Practise  safe food and water precautions and wash your hands often. Vaccination is recommended for all travellers to areas where hepatitis A is present.

  Hepatitis B is a risk in every destination. It is a viral liver disease that is easily transmitted from one person to another through exposure to blood and body fluids containing the hepatitis B virus.  Travellers who may be exposed to blood or other bodily fluids (e.g., through sexual contact, medical treatment, sharing needles, tattooing, acupuncture or occupational exposure) are at higher risk of getting hepatitis B.

Hepatitis B vaccination is recommended for all travellers. Prevent hepatitis B infection by practicing safe sex, only using new and sterile drug equipment, and only getting tattoos and piercings in settings that follow public health regulations and standards.

Measles is a highly contagious viral disease. It can spread quickly from person to person by direct contact and through droplets in the air.

Anyone who is not protected against measles is at risk of being infected with it when travelling internationally.

Regardless of where you are going, talk to a health care professional before travelling to make sure you are fully protected against measles.

Coronavirus disease (COVID-19) is an infectious viral disease. It can spread from person to person by direct contact and through droplets in the air.

It is recommended that all eligible travellers complete a COVID-19 vaccine series along with any additional recommended doses in Canada before travelling. Evidence shows that vaccines are very effective at preventing severe illness, hospitalization and death from COVID-19. While vaccination provides better protection against serious illness, you may still be at risk of infection from the virus that causes COVID-19. Anyone who has not completed a vaccine series is at increased risk of being infected with the virus that causes COVID-19 and is at greater risk for severe disease when travelling internationally.

Before travelling, verify your destination’s COVID-19 vaccination entry/exit requirements. Regardless of where you are going, talk to a health care professional before travelling to make sure you are adequately protected against COVID-19.

 The best way to protect yourself from seasonal influenza (flu) is to get vaccinated every year. Get the flu shot at least 2 weeks before travelling.  

 The flu occurs worldwide. 

•  In the Northern Hemisphere, the flu season usually runs from November to   April.
•  In the Southern Hemisphere, the flu season usually runs between April and   October.
•  In the tropics, there is flu activity year round. 

The flu vaccine available in one hemisphere may only offer partial protection against the flu in the other hemisphere.

The flu virus spreads from person to person when they cough or sneeze or by touching objects and surfaces that have been contaminated with the virus. Clean your hands often and wear a mask if you have a fever or respiratory symptoms.

In this destination, rabies  may be present in some wildlife species, including bats. Rabies is a deadly disease that spreads to humans primarily through bites or scratches from an infected animal. 

If you are bitten or scratched by an animal while travelling, immediately wash the wound with soap and clean water and see a health care professional. 

Before travel, discuss rabies vaccination with a health care professional. It may be recommended for travellers who will be working directly with wildlife. 

Safe food and water precautions

Many illnesses can be caused by eating food or drinking beverages contaminated by bacteria, parasites, toxins, or viruses, or by swimming or bathing in contaminated water.

• Learn more about food and water precautions to take to avoid getting sick by visiting our eat and drink safely abroad page. Remember: Boil it, cook it, peel it, or leave it!
• Avoid getting water into your eyes, mouth or nose when swimming or participating in activities in freshwater (streams, canals, lakes), particularly after flooding or heavy rain. Water may look clean but could still be polluted or contaminated.
• Avoid inhaling or swallowing water while bathing, showering, or swimming in pools or hot tubs. 

Typhoid   is a bacterial infection spread by contaminated food or water. Risk is higher among children, travellers going to rural areas, travellers visiting friends and relatives or those travelling for a long period of time.

Travellers visiting regions with a risk of typhoid, especially those exposed to places with poor sanitation, should speak to a health care professional about vaccination.  

Insect bite prevention

Many diseases are spread by the bites of infected insects such as mosquitoes, ticks, fleas or flies. When travelling to areas where infected insects may be present:

• Use insect repellent (bug spray) on exposed skin
• Cover up with light-coloured, loose clothes made of tightly woven materials such as nylon or polyester
• Minimize exposure to insects
• Use mosquito netting when sleeping outdoors or in buildings that are not fully enclosed

To learn more about how you can reduce your risk of infection and disease caused by bites, both at home and abroad, visit our insect bite prevention page.

Find out what types of insects are present where you’re travelling, when they’re most active, and the symptoms of the diseases they spread.

There is a risk of chikungunya in this country.  The risk may vary between regions of a country.  Chikungunya is a virus spread through the bite of an infected mosquito. Chikungunya can cause a viral disease that typically causes fever and pain in the joints. In some cases, the joint pain can be severe and last for months or years.

Protect yourself from mosquito bites at all times. There is no vaccine available for chikungunya.

Zika virus is a risk in this country. 

Zika virus is primarily spread through the bite of an infected mosquito. It can also be sexually transmitted. Zika virus can cause serious birth defects.

During your trip:

• Prevent mosquito bites at all times.
• Use condoms correctly or avoid sexual contact, particularly if you are pregnant.

If you are pregnant or planning a pregnancy, you should discuss the potential risks of travelling to this destination with your health care provider. You may choose to avoid or postpone travel. 

For more information, see Zika virus: Pregnant or planning a pregnancy.

• In this country,   dengue  is a risk to travellers. It is a viral disease spread to humans by mosquito bites.
• Dengue can cause flu-like symptoms. In some cases, it can lead to severe dengue, which can be fatal.
• The level of risk of dengue changes seasonally, and varies from year to year. The level of risk also varies between regions in a country and can depend on the elevation in the region.
• Mosquitoes carrying dengue typically bite during the daytime, particularly around sunrise and sunset.
• Protect yourself from mosquito bites . There is no vaccine or medication that protects against dengue.

Animal precautions

Some infections, such as rabies and influenza, can be shared between humans and animals. Certain types of activities may increase your chance of contact with animals, such as travelling in rural or forested areas, camping, hiking, and visiting wet markets (places where live animals are slaughtered and sold) or caves.

Travellers are cautioned to avoid contact with animals, including dogs, livestock (pigs, cows), monkeys, snakes, rodents, birds, and bats, and to avoid eating undercooked wild game.

Closely supervise children, as they are more likely to come in contact with animals.

Person-to-person infections

Stay home if you’re sick and practise proper cough and sneeze etiquette , which includes coughing or sneezing into a tissue or the bend of your arm, not your hand. Reduce your risk of colds, the flu and other illnesses by:

•   washing your hands often
• avoiding or limiting the amount of time spent in closed spaces, crowded places, or at large-scale events (concerts, sporting events, rallies)
• avoiding close physical contact with people who may be showing symptoms of illness 

Sexually transmitted infections (STIs) , HIV , and mpox are spread through blood and bodily fluids; use condoms, practise safe sex, and limit your number of sexual partners. Check with your local public health authority pre-travel to determine your eligibility for mpox vaccine.  

HIV (Human Immunodeficiency Virus)   is a virus that attacks and impairs the immune system, resulting in a chronic, progressive illness known as AIDS (Acquired Immunodeficiency Syndrome). 

High risk activities include anything which puts you in contact with blood or body fluids, such as unprotected sex and exposure to unsterilized needles for medications or other substances (for example, steroids and drugs), tattooing, body-piercing or acupuncture.

Medical services and facilities

Medical care is generally good but may be limited in availability.

Medical evacuation can be very expensive and you may need it in case of serious illness or injury.

Medical facilities may require immediate cash payment for medical treatment.

Make sure you get travel insurance that includes coverage for medical evacuation and hospital stays.

Travel health and safety

Keep in Mind...

The decision to travel is the sole responsibility of the traveller. The traveller is also responsible for his or her own personal safety.

Be prepared. Do not expect medical services to be the same as in Canada. Pack a   travel health kit , especially if you will be travelling away from major city centres.

You must abide by local laws.

Learn about what you should do and how we can help if you are arrested or detained abroad .

Transfer to a Canadian prison

Canada and the Netherlands are signatories to the Convention on the Transfer of Sentenced Persons. This enables a Canadian imprisoned in Bonaire to request a transfer to a Canadian prison to complete a sentence. The transfer requires the agreement of both Canadian and Bonaire authorities.

This process can take a long time, and there is no guarantee that the transfer will be approved by either or both sides.

Penalties for possession, use or trafficking of illegal drugs are severe. Convicted offenders can expect heavy fines and jail time. 

The island is used as a drug trafficking hub between South America and North America. Only carry your personal belongings and don’t leave them unattended. Don’t agree to carry packages that are not your own.

Drugs, alcohol and travel

Dual citizenship

Dual citizenship is not legally recognized in the Netherlands, with some exceptions.

If local authorities consider you a citizen of the Netherlands, they may refuse to grant you access to Canadian consular services. This will prevent us from providing you with those services.

• More about dual citizenship – Government of the Netherlands
• General information for travellers with dual citizenship

International Child Abduction

The Hague Convention on the Civil Aspects of International Child Abduction is an international treaty. It can help parents with the return of children who have been removed to or retained in certain countries in violation of custody rights. The convention applies between Canada and the Netherlands.

If your child was wrongfully taken to, or is being held in Bonaire, and if the applicable conditions are met, you may apply for the return of your child to the Bonaire court.

If you are in this situation:

• act as quickly as you can
• contact the Central Authority for your province or territory of residence for information on starting an application under The Hague Convention
• consult a lawyer in Canada and in Bonaire to explore all the legal options for the return of your child
• report the situation to the nearest Canadian government office abroad or to the Vulnerable Children's Consular Unit at Global Affairs Canada by calling the Emergency Watch and Response Centre

If your child was removed from a country other than Canada, consult a lawyer to determine if The Hague Convention applies.

Be aware that Canadian consular officials cannot interfere in private legal matters or in another country's judicial affairs.

• List of Canadian Central Authorities for the Hague Convention
• International Child Abductions: A guide for affected parents
• The Hague Convention – Hague Conference on Private International Law
• Canadian embassies and consulates by destination
• Request emergency assistance

Identification

Bonaire is a special municipality of the Kingdom of the Netherlands.

By Dutch law, you must always carry valid identification. You should have a copy of your passport with you at all times.

There are no traffic lights on the island, but international road signs are common.

Consult local regulations before driving in Bonaire.

Canadian driver’s licenses are accepted. 

You should carry an international driving permit.

• Traffic on Bonaire – Info Bonaire
• International Driving Permit

It is strictly prohibited to remove or attempt to leave the island with seashells, corals or beach sand.

Investments

If you plan on buying property or making other investments, seek professional legal advice in Canada and in Bonaire before making commitments. Related disputes could take time and be costly to resolve.

Buy insurance when renting motorboats, jet skis and vehicles. Ensure that you obtain detailed information, in writing, regarding personal liability.

The currency of Bonaire is the U.S. dollar (USD).

Climate change

Climate change is affecting Bonaire. Extreme and unusual weather events are becoming more frequent and may affect your travel plans. Monitor local media for the latest information.

Hurricane season

Hurricanes usually occur from mid-May to the end of November. During this period, even small tropical storms can quickly develop into major hurricanes.

These severe storms can put you at risk and hamper the provision of essential services. You could face serious safety risks during a hurricane.

If you decide to travel to a coastal area during the hurricane season:

• be prepared to change your travel plans on short notice, including cutting short or cancelling your trip
• stay informed of the latest regional weather forecasts
• carry emergency contact information for your airline or tour operator
• follow the advice and instructions of local authorities
• Tornadoes, cyclones, hurricanes, typhoons and monsoons
• Large-scale emergencies abroad
• Active storm tracking and hurricane watches and warnings – U.S. National Hurricane Center

Seismic activity

Bonaire is located in an active seismic zone. Earthquakes can occur.

Earthquakes – What to Do?

Local services

In case of emergency, dial:

• police: 911
• ambulance: 911
• firefighters: 911
• coastguard: 913

Consular assistance

There is no resident Canadian government office in Bonaire. You can obtain consular assistance and further consular information from the Consulate of Canada to  Curaçao, in Willemstad .

Aruba, Bonaire, Curaçao, Venezuela

Aruba, Bonaire and Curaçao

For emergency consular assistance, call the Embassy of Canada to Colombia, in Bogotá, and follow the instructions. At any time, you may also contact the Emergency Watch and Response Centre in Ottawa.

The decision to travel is your choice and you are responsible for your personal safety abroad. We take the safety and security of Canadians abroad very seriously and provide credible and timely information in our Travel Advice to enable you to make well-informed decisions regarding your travel abroad.

The content on this page is provided for information only. While we make every effort to give you correct information, it is provided on an "as is" basis without warranty of any kind, expressed or implied. The Government of Canada does not assume responsibility and will not be liable for any damages in connection to the information provided.

If you need consular assistance while abroad, we will make every effort to help you. However, there may be constraints that will limit the ability of the Government of Canada to provide services.

Learn more about consular services .

Risk Levels

  take normal security precautions.

Take similar precautions to those you would take in Canada.

  Exercise a high degree of caution

There are certain safety and security concerns or the situation could change quickly. Be very cautious at all times, monitor local media and follow the instructions of local authorities.

IMPORTANT: The two levels below are official Government of Canada Travel Advisories and are issued when the safety and security of Canadians travelling or living in the country or region may be at risk.

  Avoid non-essential travel

Your safety and security could be at risk. You should think about your need to travel to this country, territory or region based on family or business requirements, knowledge of or familiarity with the region, and other factors. If you are already there, think about whether you really need to be there. If you do not need to be there, you should think about leaving.

  Avoid all travel

You should not travel to this country, territory or region. Your personal safety and security are at great risk. If you are already there, you should think about leaving if it is safe to do so.

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• Open access
• Published: 05 July 2024

Assessing the reactions of tourist markets to reinstated travel restrictions in the destination during the post-COVID-19 phase

• Xuankai Ma 1 , 2 , 4 , 5 ,
• Rongxi Ma 2 , 4 ,
• Zijing Ma 5 ,
• Jingzhe Wang 6 ,
• Zhaoping Yang 3 , 4 ,
• Cuirong Wang 2 , 4 &
• Fang Han 2 , 4  

Scientific Reports volume  14 , Article number:  15495 ( 2024 ) Cite this article

136 Accesses

Metrics details

• Socioeconomic scenarios
• Sustainability

This study, leveraging search engine data, investigates the dynamics of China's domestic tourism markets in response to the August 2022 epidemic outbreak in Xinjiang. It focuses on understanding the reaction mechanisms of tourist-origin markets during destination crises in the post-pandemic phase. Notably, the research identifies a continuous rise in the potential tourism demand from tourist origin cities, despite the challenges posed by the epidemic. Further analysis uncovers a regional disparity in the growth of tourism demand, primarily influenced by the economic stratification of origin markets. Additionally, the study examines key tourism attractions such as Duku Road, highlighting its resilient competitive system, which consists of distinctive tourism experiences, economically robust tourist origins, diverse tourist markets, and spatial pattern stability driven by economic factors in source cities, illustrating an adaptive response to external challenges such as crises. The findings provide new insights into the dynamics of tourism demand, offering a foundation for developing strategies to bolster destination resilience and competitiveness in times of health crises.

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Introduction.

The COVID-19 pandemic has had an enormous and long-lasting social and economic impact on the tourism industry 1 . International tourist arrivals (overnight visitors) plummeted by 73% in 2020 due to a global embargo, widespread travel restrictions, and a massive drop in demand. Compared to 2019, there were approximately 1 billion fewer international visitors that year 2 . The year 2021 is considered by scholars as the Year of Recovery for tourism, with tourism indicators signaling recovery 3 , 4 . The climate crisis and the European return to war are expected to restrict international travel 5 , and the domestic market will be an appropriate approach to drive tourism recovery 6 . The expansion of domestic tourism is propelled by a considerable accumulation of suppressed demand, a rising preference for domestic locales, and stringent border entry and exit controls.

Nevertheless, the mutation of the Omicron virus resulting in greater contagiousness will lead to localized areas being re-closed to counter the diffusion of the Virus 7 . It is an additional shock to the recovering tourist destinations. The investigation of the response of origin markets to the reclosure of destinations during the tourism recovery period is of significant relevance for regional authorities to assess the impact of the outbreak and the maintenance of tourist origins.

This paper aims to investigate what changes occur in origin market demand for destinations affected by reclosure during the tourism recovery period, what spatial differences such changes show, and how the differences in response exhibited by origin markets arise. The response in tourism demand is quantified through the analysis of annual growth rates in the domestic market during periods of reclosure. Based on tourism demand theory, demographic, economic, and environmental conditions, COVID-19 epidemic status, healthcare conditions, Internet access coverage, and traffic activation will be potential influential factors to account for the variation in origins market response. We add new insights to the COVID-19 study of short-term effects and spatial differences in tourism demand by examining the pattern of origins market response in the face of destination reclosure from the tourist origins' perspective (cities).

Literature review

The covid-19 and the tourism industry.

The dramatic impact of COVID-19 on the tourism industry has intensified the involvement of scholars in studies on the issue. In the initial phase of the pandemic (2020), UNWTO reported international tourist arrivals to decline by 70–75% for 2020. Academics have addressed the effects of the pandemic on national tourism markets 8 , 9 , the response of the tourism industry to the crisis 10 , 11 , and the framework for sustainable development 12 , 13 , 14 . Greece, with its developed tourism industry, the loss of tourism revenue due to the pandemic has directly contributed to the overall economic decline of the country 15 . The pandemic has declined tourist arrivals and affected employment and productivity in the Balearic Islands, revealing the region’s decline 1 . Hotel revenues in Italy fell by 66% relative to Turkey due to the embargo policies 16 . The U.S. hotel industry lost about $30 billion in revenue in the spring of 2020 17 , while the restaurant industry also faced a notable crackdown 18 . The multidimensional assessments of the influence of the pandemic on tourism demand were performed by comparing this crisis with the normal state of affairs before the crisis, which pointed to a significant negative consequence of tourism with its sibling sectors along the entire tourism industrial chain 19 . Restoring tourist arrivals to pre-crisis standards will probably confront prolonged pain 20 .

Some improvement in the epidemic accompanies the crisis response and recovery period (after 2021). Regardless, the pace of recovery continues to be sluggish and uneven in all regions of the world due to varying degrees of mobility restrictions, vaccination rates, and traveler confidence. Dynamic adjustment of travel restrictions within the country during the post-pandemic period could stimulate a recovery to a limited extent and allow domestic tourism to dominate 21 , 22 . Empirical studies show that regions with monoculture industries have no buffers to adapt to the crisis in the face of shocks that significantly reduce tourism demand 23 , 24 . In contrast, regions with prosperous industries and strong tourism specialization will be highly resilient to disruptions in the context of less restrictive movement of people, presenting a competitive advantage with a slight decline in demand 25 , 26 . Scholars believe this is the best time to promote equitable and sustainable tourism development, and the disconnect between tourist demand and destination development (growth expansion) needs to be repaired 27 , 28 . The construction of tourism sustainability will focus more on the changing needs of tourists themselves and their demand preferences. In the future, regulating the balanced development of regional tourism by changing tourists’ needs is the focus of tourism sustainability in the post-epidemic era 29 , 30 .

Measures of tourism recovery

In the tourism literature, scholars have proposed and implemented the concept of tourism resilience to quantify post-crisis tourism outcomes, particularly the ability and magnitude of regional tourism to recover from the COVID-19 disruptions 31 . Metrics such as employment rates, tourist arrival rates, and tourism revenues are measures to assess regions’ tourism resilience within geographically large areas 32 , 33 , 34 . It is noteworthy that the recoverability of tourism in different regions varies by geographic area and thus shows distinct patterns of recovery. Thus, the spatial heterogeneity of tourism recovery must be considered 35 . Scholars have argued that location quotients 36 , the share of an industry in the local total divided by the share of the industry in the national total, can better account for the speed of tourism recovery from that region’s crisis 37 .

Tourism demand change observation

In the era of Big Data, the utilization of search engines by tourists to acquire travel-related information ahead of their trips has become the initial step in travel planning 38 . The significance of search engine data in characterizing and predicting tourism demand has been gradually acknowledged by tourism researchers since 2010 and has been incorporated into various models for analytical work 39 , 40 , 41 , 42 . Due to the search behavior of tourists based on their destinations of interest, these electronic behavior records are normalized into search engine indexes to indicate tourism demand, preferences, travel intentions, and the location of the tourists’ origin 43 . Researchers have conducted studies on tourism demand response to pandemics and tourism recovery rates with search engine data, confirming the significant advantages of search engine data in fitting economic indicators during the COVID-19 pandemic 22 , 44 , 45 . Therefore, we attempted to characterize the rate of change in tourism demand in the origins market by investigating search engine data for a specific period (destination reclosure) as search engine data gives high-frequency information on the travel intentions of Internet users in different regions for a defined destination.

Overview summary

In the post-epidemic era of tourism recovery, a sub-black swan event of local reclosure is inevitable. We are interested in how origin markets will respond to destination reclosure, the characteristics of the spatial response patterns, and the reasons for this heterogeneity that need to be urgently explored. While the literature has usefully explored the recovery of tourism with mature domestic markets, it is crucial to focus on the changes in tourism demand for destinations at the national level, where the origin markets are the roots of tourism demand. To address the limitations of previous research, this paper contributes to the tourism literature by using a search engine to quantify short-term tourism changes during tourism crises and constructing models of tourism demand changes in different regions to explore the drivers of different response patterns.

Materials and methodologies

Tourism demand data.

Search engine data is identified as an efficacious data source for measuring high-frequency tourism demand. Google Trends has extensive applications worldwide, whereas Baidu has a more indicative role in China. The Baidu search engine has two data products: Keyword Search Index and Brand Index ( https://index.baidu.com ). The Keyword Search Index contains data from 2011 till now, and the Brand Index is a more professional industry-based index that will be available from August 2021. This paper utilizes daily keyword indices from 2011 to 2022 to investigate the background of tourism demand for the Duku Road and brand indexes from August 10 to October 31 in 2021 and 2022 to measure changes in tourism demand for the Duku Road from different origins regions during the destination closure period under the impact of the pandemic.

where i is a tourist origin city; j is a date from August 10 to October 31; BBI is the Baidu Brand Index of a city search for Duku Road on a date. s is a spatial series of origin cities or an individual city; t is a temporal series of dates; T.D. is the sum of demand from s during t .

The Chinese domestic tourism market was chosen as the study case due to the robust intervention policies adopted by China during the first pandemic, dramatically impacting international and domestic tourism in China. In the post-epidemic era, a multitude of countries have eased international travel restrictions. The massive mobility of individuals within China and the mutation of the Virus made travel policies contingent on the consequences of the containment of the pandemic. In this context, domestic tourism demand has emerged a robust recovery. This phenomenon is also prevalent in other countries, and scholars are confident that domestic tourism will be the recovery engine in the short term. It is a matter of significant concern that tourist arrivals may abruptly decline to zero in instances where destinations are compelled to shut down anew amidst a pandemic resurgence. Notwithstanding, it is pertinent to note that latent tourism demand persists. In response, this study meticulously tracks variations in demand at these destinations and corresponding responses from origin markets, employing high-frequency search engine data as a quantitative metric of demand. Distinct from conventional statistical methods, the monitoring of such rapid changes necessitates the utilization of big data analytics.

Xinjiang was one of the most popular destinations for domestic tourism in 2022, with millions of tourists entering Xinjiang by self-drive, high-speed rail, and air. The Duku Road (high-rank landscape driveway) is the most attractive destination for tourists, with 28.35% of tourism demand in Xinjiang. It serves as a tourist hub, radiating tourists to other attractions 46 . Tourism prosperity has made Xinjiang an unignorable destination during domestic tourism recovery. Nevertheless, the massive tourist flows have planted the potential for the spread of the epidemic. The entire territory of Xinjiang entered a region-wide silent management to control the epidemic on August 10 and will remain in effect through the winter. During this period, all travel activities had to be ceased, and the government organized the transfer of healthy travelers back to their origins. This unexpected outbreak has had a fatal impact on Xinjiang’s thriving tourism industry. The study case has typical implications. This paper investigates the origins market’s response to the destination’s reclosure, considering the Duku Road as the destination and cities outside Xinjiang as the domestic origin markets.

Three hundred and seven cities of China’s domestic tourism market were adopted as the tourist origins for the case study. The Duku Road, located in Xinjiang, served as the destination (Fig.  1 a). The Duku Road is a mysterious and fascinating landscaped driveway that stretches through the north and south of the Tianshan Mountains, a World Natural Heritage Site, which is also known as the Tianshan Road. The Duku Road runs with a unique topography, with numerous sharp curves and steep slopes, more than 280 km of road sections above 2000 m above sea level, 1/3 of the whole course is a cliff, 1/5 of the lot is in the high mountain permafrost, crossing nearly ten major rivers in the Tianshan Mountains, and over four ice-pass of mountains that accumulate snow all year round (Fig.  1 b). Driving on Duku Road, travelers experience the seasonal transformations in a single day, which shows the magnificent scenery of “four seasons in one day, ten miles in different skies” to off-road enthusiasts and self-driving tourists.

The study case. ( a ) The domestic tourist markets of Duku Road. ( b ) The location of Duku Road, Xinjiang, China. Notes: The map in ( a ) was produced using ESRI ArcMap 10.2, and the standard map service was provided by the Ministry of Natural Resources of China, accessible at http://bzdt.ch.mnr.gov.cn/ with Grant No. GS (2021) 5448. The photographs in ( b ) were taken by the first author for tourism resources investigation in September 2021.

Dependent variables

The literature has proposed numerous valid measures of change in tourism demand, and scholars have characterized tourism resilience based on micro-level expenditure elasticities and annual percentage changes between the pre-and post-pandemic periods 6 , 25 . This paper pays attention to measuring the instantaneous response of origin markets to the public health crisis in a destination that caused the closure period (August 10–October 31), where typically, growth rates are employed to capture the difference in performance relative to a benchmark 26 , 47 . Thus, tourism demand in 2021 is considered the initial period of the post-pandemic recovery period, and the growth rate for the corresponding period in 2022 versus the benchmark period is adopted as a measure of Tourism Demand Growth Rates (TDGR). The demand ratio is chosen indicator of short-term resilience 48 , and we generate the Tourism Demand Ratio (TDR) as the alternative dependent variable to test the robustness of conclusions. To illustrate the distribution of these dependent variables, Fig.  2 presents a histogram, kernel function density estimation plot, and maximum likelihood Gaussian distribution fit, providing a comprehensive view of the underlying data structure and the variability in Tourism Demand Growth Rates (TDGR) and Tourism Demand Ratio (TDR).

where i is a tourist origin city; t' is the current year (2022), and t is the control year (2021); TDGR i is the tourism demand variation of the city i; \({TD}_{i}^{t}\) is the sum of demand from city i in year t .

Statistical distribution analysis of TD, TDGR, and TDR variables. Notes: TD. is the Baidu brand index during the closure period, metric tourism demand, and the number in parentheses is the year; TDGR is the growth rates of tourism demand, and TDR is 2022 vs. 2021 ratio of tourism demand. The values of the above variables are processed by f = ln(x).

Determinants and proxy variables

The willingness of tourists to explore a destination depends on the determinants of the origin’s financial capacity, physical constraints, and psychological tendencies, in addition to the destination’s attractiveness. Furthermore, challenged by pandemic restrictions on mobility, we considered the origin markets’ epidemic circumstances and medical availability. We have selected the population, economics, environmental conditions, COVID-19, medical healthcare, Internet accessibility, and traffic activeness of the origin cities as potential determinants of tourism demand to analyze their impact on tourism demand changes, as detailed in Table 1 43 , 49 , 50 , 51 , 52 , 53 .

China has a substantial tourism market with spatially non-stationary development levels of cities in each region, and origins cities have significant spatial stratification heterogeneity. Accordingly, following large administrative geographical regions, we disaggregate the origin markets into East China, South China, Southwest China, North China, Northeast China, and Northwest China. The statistical data of each city are obtained from the National Bureau of Statistics ( http://www.stats.gov.cn/ ), and the epidemic data sources of COVID-19 are informed by the National Health and Health Commission and the provincial health and health commissions ( https://2019ncov.chinacdc.cn/2019-nCoV/ ). The advantages of this paper’s dataset are that it measures the seven explanatory variables mentioned above through twenty-five proxy variables, which captures the diversity of factors driving the tourism demand changes. Additionally, all the proxy variables will be standardized within large administrative geographical regions (Fig.  3 ), which helps to reveal significant differences in the explanatory variables performing distinct roles in different local regions.

Proxy variable box plots group by regions. Notes: The labels of the X-axis, East China, South China, Southwest China, North China, Central China, Northeast China, and Northwest China are abbreviated as N.C., NEC, E.C., CC, SC, and NWC, respectively. The Y-axis labels are abbreviations for the proxy variables in Table 1 .

Research framework

The research framework, as illustrated in Fig.  4 , consists of three stages: temporal and spatial change analysis of tourism demand, exploratory regression analysis, and model evaluation.

The research framework. Notes: TD-Tourism Demand; TDGR-Tourism Demand Growth Rates; LISA- Local Indicators of Spatial Association; EC, SC, NC, CC, SWC are the models in different regions (East China, South China, North China, Central China, and Southwest China) respectively.

The first stage involves depicting the spatial pattern of the Duku Road tourist origin markets and its changing process in the temporal dimension. The Global Spatial Autocorrelation method is applied to assess the spatial patterns of the origin markets, the Getis-Ord Gi* Hotspot Analysis method 54 detects the dominant origin market clusters, and the Local Spatial Autocorrelation Analysis method 55 is assigned to reveal clusters and outliers areas of tourism demand variation. The spatial distribution characteristics will map out the origin markets and pinpoint the dominant origin regions.

In the second stage, this paper uses an exploratory knowledge discovery strategy, i.e., finding the most significant drivers of each region among the many proxy variables that may impact tourism demand changes. Candidate proxies that are significantly correlated are initially filtered out from the Correlation Analysis between the proxies and explanatory variables. Then the candidate proxies are imported into a multi-round Linear Regression Analysis for iterative modeling and comparisons, thereby investigating the factors influencing the tourism demand variation in each region. Since the proxy variables in this paper are not entirely customarily distributed, Spearman’s Correlation Analysis 56 has the advantage of handling mixed data. The proxy variables with correlation coefficients greater than 0.3 and a significance over 95% will be considered candidate proxy variables. The Stepwise Regression Analysis 57 can perform multiple turns of regression analysis on candidate proxy variables and automatically remove the insignificant variables, resulting in the exploration of the model with the optimal performance with significance.

The third stage is the diagnostic evaluation and robustness testing of the model. Multiple linear regression, autocorrelation, normality of residuals, and eteroscedasticity are used to diagnose the model’s performances 57 . We compare the conclusions obtained from Stepwise Regression Analysis with the results obtained by substituting the dependent variable to evaluate the validity of the conclusions. The above experiments will be replicated with the ratio of tourism demand during the destination closure in 2022 to the corresponding period in 2021 as the dependent variable, and the conclusions will be considered dependable and robust in case of substantial consistency.

Spatial and temporal changes in origin markets demand

The paper utilizes the Baidu search engine to garner search records of the Duku Road in China over the past decade (Fig.  5 a). Results indicate a rapid surge in the attraction of the Duku Road since 2015, peaking in 2019. Despite the impact of COVID-19 in 2020, the demand for tourism quickly rebounded, hitting a new high in 2022. It is imperative to note that due to safety risks associated with the Duku Road, it is only accessible to tourists from May to October every year. During this period, the tourism demand for Duku Road exhibits a primary and secondary peak, with a critical point at the main peak, dividing this phase into a rising and a declining period. Specifically, the rising period commences in early May, peaking towards the end of July, followed by a continual decline. However, a second surge forms during the National Day Golden Tourism Week, which subsequently dwindles gradually.

Variation of Baidu index for Duku Road (2011–2022). ( a ) The daily Baidu Index trend for Duku Road (2011–2022). ( b ) The Baidu Index during the years of unrestricted access for The Duku Road (2011–2022).

Considering a sudden outbreak of COVID-19 across Xinjiang, local authorities initiated a silent management policy, imposing traffic restrictions from August 10 to October 31. According to historical time series characteristics of the Duku Road, this time point coincides closely with the critical date when the tourism demand transitions from a peak to a decline. A comparison of the keyword index during the rising and declining periods of each year reveals that the tourism demand maintained a high level before the travel restrictions, while the destination closure significantly impacted the tourism demand, causing a sharp decline (Fig.  5 b).

Although post August 10, 2022, marked the declining phase of tourism demand for the Duku Road, the Baidu index for the keyword “Duku Road” remained high (only a 5% decrease compared to the same period in 2021) before August 10, 2022. This suggests a stable tourism demand for the Duku Road prior to the pandemic closure. However, post August 10, the Baidu index plummeted by 43% compared to the same period in 2021, inferring a direct impact on the tourism demand for the Duku Road due to the outbreak of COVID-19 in Xinjiang and the traffic control measures. Noteworthy is that despite the inability to conduct any tourism activities in Xinjiang post August 10, the source market maintained a robust potential tourism demand for the Duku Road from August 10 to October 31. During the COVID-19 outbreak and lockdown in Xinjiang, the tourism demand from seven administrative regions in China for the Duku Road grew by an average of 31.49% compared to 2021, indicating a strong resilience in the tourism demand for the Duku Road. This reflects that despite the restrictions imposed by the pandemic and traffic control policies, the restrained tourism demand will gradually be released once the situation is under control, highlighting a significant potential for recovery.

Based on the spatial autocorrelation analysis results (Table 2 ), the tourism demand from the source market demonstrates a significant spatial clustering pattern, with the spatial pattern of the Duku Road’s source market transitioning from a low level to a moderate level of spatial clustering. The spatial distribution of tourism demand from source cities to the Duku Road has been impacted by the pandemic crisis, exhibiting a trend of contraction and clustering towards core source cities.

Viewed from the perspective of source cities, this section utilizes the Jenks Natural Breaks method to categorize source cities into five groups based on the intensity of tourism demand towards Duku Road and constructs a spatial distribution map of tourism demand from the source market. The map employs a color gradient from blue to red to represent the intensity of tourism demand from source cities to the Duku Road, where red and orange cities signify core and secondary source cities, respectively. The domestic source market is primarily distributed in the developed cities in eastern China. In Fig.  6 a,b, cities like Beijing and Shanghai are identified as core source cities, while Chengdu, Chongqing, Hangzhou, and Guangzhou are recognized as secondary source cities. A comparison between Fig.  6 a,b reveals that cities like Lanzhou, Xi’an, and Nanjing no longer serve as secondary source locations, indicating that some secondary source cities are more sensitive to the tourism demand for Duku Road under Xinjiang pandemic crisis than others, which exhibiting a variability within the secondary source market.

The spatial patterns of tourism demand and its' variation. Notes: Hu Huanyong Line in ( e ) is a comparison divider proposed by Chinese geographer Hu Huanyong (1901–1998) in 1935 to delineate the population density of China, which has significant heterogeneity in the population, society, and economy between the east and west of the line.

Upon further hotspot analysis of the source market, the results exhibit significant statistical clustering in the spatial domain for the Duku Road’s source market. As depicted in Fig.  6 c,d, the red zones represent the hotspots of tourism demand, encompassing the Jing-Jin-Ji region, Yangtze River Delta, and the Pearl River Delta, which emerge as the most crucial source markets with lesser impact from the pandemic crisis on Duku Road. On the other side, the blue zones signify the cold spots of tourism demand, where cities within these regions exhibit an exceedingly low tourism demand towards the Duku Road. A comparative inspection of Fig.  6 c,d unveils a shift in some cold spot areas (for instance, the disappearance of the cold spot on the Qinghai-Tibet Plateau, and the emergence of a new cold spot area north of the Hexi Corridor), while the stability of cold spot regions in Northeast China remains high (such as Hulunbuir and Daxing’anling area).

This section analyzes the growth rate of tourism demand, designating cities with growth rates below zero with a gradient of cool colors (blue), and those with growth rates above zero with a gradient of warm colors (red), with intervals of (±) 20%. As shown in Fig.  6 e, cities with a growth rate exceeding 100% are rendered in deep red. There is a significant positive correlation in the spatial distribution of tourism demand growth rates, indicating neighboring cities share a consistent response pattern to the pandemic. A distinct contrast is formed on either side of the Hu Huanyong Line; source markets to the east primarily exhibit positive growth rates, while those in the western regions display negative growth rates. Analysis of local clustering and outliers reveals the formation of three distinct local clusters in the spatial distribution of tourism demand growth rates (Fig.  6 f). Cities near the Qinghai-Tibet Plateau and Hexi Corridor in Northwestern China respond strongly to the pandemic crisis, with rapid declines in tourism demand towards Duku Road in this area (L–L). A sporadic distribution of outlier cities (H–L) emerges on the eastern side of Northwestern China, exhibiting superior risk resilience and higher tourism demand compared to other local areas. In Southwest China, Yunnan province has higher demand growth, with Pu’er and Lijiang being typical tourist cities. The fluctuations in their demand are impacted by their respective tourism industries, exhibiting a phenomenon where they are encircled by proximate cities experiencing high demand growth rates (L–H).

By dividing the source market according to administrative regions, summing up the tourism demand from cities within each administrative region to Duku Road, and averaging the growth rate of tourism demand, regional differences are identified. As shown in Fig.  7 , a comparison of tourism demand scale and growth between 2021 and 2022 across administrative regions is made. Using the Jenks Natural Breaks method, they are categorized into high, medium, and low levels. This corresponds to East China being the primary source market for Duku Road, while North, Central, South, Southwest China are secondary source markets, and Northeast and Northwest China are potential source markets. Northeast and South China have the highest growth rates in tourism demand, followed by North, Central, and East China, with Southwest and Northwest China having the lowest. There is minimal variation in the scale of tourism demand from cities within each region to Duku Road, but a larger difference in the growth rates of tourism demand.

The maps with box plots of the tourism demand and growth rates.

Correlation analysis for TDGR

The correlation between explanatory variables and the growth rate of tourism demand significantly varies across different regions, suggesting that a more nuanced analysis could be obtained by partitioning the source market for modeling. In the South China region, 64% of the explanatory variables are negatively correlated with the growth rate of tourism demand, while in the Northwest region, no explanatory variables exhibit significant correlation. In the Northeast region, only two explanatory variables are negatively correlated with the tourism demand growth rate. In East China, Southwest, North China, and Central China, about one-third of the explanatory variables show a correlation with tourism demand growth rate at a significance level better than 0.05.

The correlation results indicate that under the “dynamic zeroing” policy control, new cases in source areas do not correlate with the potential tourism demand growth rate of residents. For instance, the numbers of newly confirmed and asymptomatic cases only show a negative correlation with the tourism demand growth rate in the South and Southwest regions of China. The relationship between the number of COVID-19 recovered patients and the tourism demand growth rate differs between the southern and northern regions, showing a weak positive correlation in the Southwest region and a weak negative correlation in the North China region. Notably, a significant moderate negative correlation exists between public medical resources of local source cities and the tourism demand growth rate. In the post-pandemic era, factors related to tourism demand growth rate are constantly changing, and the relationship between influential factors and tourism demand growth rate shows spatial non-stationarity across different regions.

Significant explanatory variables in the East China region include per capita disposable income, average wages, consumer price index, savings deposits, the number of people covered by basic medical insurance, and highway passenger traffic. In South China, the variables include the resident population, per capita GDP, per capita disposable income, per capita consumer spending, savings deposits, PM2.5 concentration, AQI index, newly confirmed cases, newly confirmed asymptomatic cases, the number of hospitals, hospital bed count, basic medical insurance coverage, mobile phone user count, broadband access user count, private car ownership, and civil aviation passenger traffic. In Southwest, the variables include per capita GDP, infection count, newly confirmed cases, newly confirmed asymptomatic cases, recoveries, private car ownership, highway passenger traffic, and spatial distance. In North China, significant variables include savings deposits, industrial solid waste utilization rate, recoveries, mobile phone user count, broadband access user count, and private car ownership. In Central China, the variables include per capita GDP, savings deposits, AQI index, hospital bed count, basic medical insurance coverage, mobile phone user count, broadband access user count, private car ownership, and spatial distance. In Northeast, the significant variables are average wages and savings deposits. In Northwest, no significant explanatory variables have statistically meaningful correlation with tourism demand growth rate.

Stepwise regressions

Diverging from studies that directly engage in regression analysis with correlation tests 6 , this chapter adopts a stepwise regression modeling approach. It sequentially incorporates significant explanatory variables from Table 3 (highlighted in bold) for each region into the model to explore influential factors under optimal fitting circumstances. However, the results of stepwise regression analysis reveal that in the Northeast and Northwest regions (Table 4 ), due to a limited number of significant explanatory variables and a lack of significant linear relationships between these variables and the dependent variable, no effective models are obtained. In other regions, there is a noticeable disparity between influential factors and model fit.

In East China, average wages are the sole factor affecting the growth rate of tourism demand, albeit with weak explanatory power (R 2  = 0.08). In South China, the AQI index exerts a negative impact on the tourism demand growth rate, contributing to 17.9% of the variance explanation. In North China, the growth rate of tourism demand is negatively affected by the industrial solid waste utilization rate, with an explanatory power of 17.8%. In Central China, per capita GDP is a significant factor negatively impacting the tourism demand growth rate. In the Southwest region, the tourism demand growth rate is influenced by multiple factors, where spatial distance has a positive impact, and per capita GDP has a significant negative impact. Combined, they account for 42% of the explanatory power concerning the growth rate of tourism demand.

In summation, the growth rate of tourism demand in source markets chiefly hinges on local economic, environmental, and transportation factors. Although there is a significant weak correlation between the local pandemic situation and the tourism demand growth rate in certain areas, it fails to exert a statistically significant impact on the local tourism demand towards the Duku Road.

The efficacy of the models has been corroborated by the diagnostic items and parameters delineated in Table 5 . The results indicate that the models passed the F-test (p < 0.05), implying that the independent variables in each model significantly affect the dependent variable TDGR, denoting the models are meaningful. With a limited number of dependent variables in the models, the VIF (Variance Inflation Factor) values are well below 5, suggesting that there is no multicollinearity issue, and the models are well-constructed.

In the autocorrelation test of the models, the D-W (Durbin-Watson) value of the model for the South China region deviates significantly from 2 (1.508 < 1.7), indicating that the significance testing and goodness of fit for this model would be unreliable; hence, this model failed the validation, while the other models are deemed credible. Moreover, this section re-models using TDR from Sect. 7.2.2 as an alternative dependent variable following the framework procedure. The results of the new model are consistent with the conclusions previously obtained, eventually leading to linear regression models for the tourism demand growth rate in four regions.

Factors affecting TDGR

The response to the changes in tourism demand for the Duku Road during the pandemic period is manifested through the tourism demand growth rate of the source cities. The results of the regional model construction discussed earlier (see section " Stepwise regressions ") indicate that the factors affecting the growth of tourism demand for the Duku Road vary significantly across different regions. As shown in Fig.  8 , on a national scale, the models for the North China, Central China, East China, and Southwest regions have all passed the significance test and robustness test. Each model corresponds to a subplot, with the title of the subplot being the model formula for the respective region, and the content of the subplot displaying the spatial distribution of the tourism demand growth rate and explanatory variables. All indicators are divided into five intervals using the Jenks Natural Breaks classification method, with colors from blue to red representing intervals from low to high.

The influential factors models of response heterogeneity of tourist origin markets to Duku Road.

Upon comparing the similarities and differences across regional models, it is found that during the pandemic period in Xinjiang, the primary factors influencing the response differences to destination lockdowns in the domestic source markets for the Duku Road include Per Capita GDP, average wages, industrial solid waste utilization rate, and spatial distance. Economic factors have a counteractive effect on the tourism demand growth of the source cities, an impact widely present in East China, Central China, and Southwest regions, exhibiting robust spatial consistency. Notably, environmental factors indicate that the growth of tourism demand is constrained by the industrial solid waste utilization rate, a significant relationship found only in North China. This section observes that in industrially prosperous areas within this region (Hebei-Tianjin), the growth of tourism demand is limited, or even decreased, whereas in remote areas with lower industrial levels (Inner Mongolia), the tourism demand is not high, but generally has a high rate of growth. The significant positive impact produced by the distance factor in the Southwest region can be attributed to the distinct differences between the Qinghai-Tibet Plateau and the Sichuan-Chongqing-Yunnan-Guizhou Plateau; the former has low levels of tourism demand and growth rate, while the latter has relatively higher tourism demand and growth rate, thereby leading to a higher tourism demand growth response in source cities farther from the Duku Road.

Factors influencing tourism demand towards Duku road

Understanding the factors influencing the tourism demand from source cities to Duku Road is crucial for grasping the heterogeneity in tourism demand growth rates. This section employs a loop iteration approach to individually examine the linear fit between twenty-five explanatory variables of source cities within seven administrative regions, and the tourism demand scale of these cities towards Duku Road, to investigate the factors affecting the tourism demand scale of source cities to Duku Road. From a total of 175 linear models, eight models were identified as statistically significant and demonstrating a superior degree of fit ultimately. These models, with a significance level exceeding 0.01 and an R 2 value greater than 0.8, effectively explain the scale of tourism demand across more than four administrative regions.

As illustrated in Table 6 , different variables significantly positively impact the demand for tourism to the Duku Road across various regions. The rise in the number of broadband and mobile phone users suggests more individuals have mobile communication capabilities, enhancing the accessibility to information regarding Duku Road. This improved digital outreach fosters the online visibility and awareness of the destination, consequently boosting the local residents’ desire to travel there. Savings deposits reflect the economic capacity of individuals or families in the source cities, laying the foundation for affording travel to Duku Road. A higher per capita Gross Domestic Product indicates a relatively higher income level and consumer spending capacity, enabling more discretionary income for long-distance travel expenditures. The economic stature of the source cities implies a higher preference for tourism and a more open cultural backdrop, collectively fostering an increased interest and demand for traveling to Duku Road. An augmentation in the number of individuals covered by basic medical insurance and the quantity of hospital beds signifies enhanced medical security for more residents. Better medical services and emergency response capabilities help mitigate the impact of local epidemics on residents’ travel activities. Simultaneously, it alleviates tourists’ concerns about the travel risks and uncertainties associated with the epidemic situation in Xinjiang, bolstering their confidence in traveling to Duku Road. Higher air passenger traffic denotes more flight connections between the residents and the destination, supporting the accessibility for inland tourists to Duku Road. Elevated private car ownership in source cities inclines residents towards choosing self-driving tours to Duku Road, offering greater flexibility, freedom, comfort, and convenience. This mode of travel satisfies tourists’ desire to explore the scenic routes of Duku Road and indulge in personalized experiences.

In summary, determinants such as the extent of internet coverage, economic conditions, medical security, and transportation facilities in the source markets influence the residents’ demand for tourism to the Duku Road in various aspects. The extent of internet coverage lays the foundation for environmental awareness of the Duku Road among residents of the source cities; whereas economic conditions are essential for residents to travel to the Duku Road. Amid an ongoing pandemic, medical security in the source cities can mitigate the adverse effects of the local epidemic on residents’ travel behaviors; transportation conditions provide diversified accessibility for the residents of the source cities. In the source markets of the Duku Road, areas with a large scale of mobile phone users, high residents’ savings, comprehensive medical insurance coverage, and developed passenger aviation contribute the most to the tourism demand to the Duku Road. This conclusion aligns with the spatial pattern of tourism demand discussed in section " Spatial and temporal changes in origin markets demand ". As illustrated in Fig.  9 , box plots of the number of mobile phone users (IA1), savings deposits (E6), the number of individuals covered by basic medical insurance (H3), and the volume of civil aviation passengers (TA3) demonstrate that the Eastern China region ranks highest in these four indicators nationwide, and concurrently, it has the highest demand for tourism to the Duku Road. Furthermore, summarizing the determinants in Table 6 and arranging them in descending order based on the average R 2 reveals that the economic conditions > transportation accessibility > medical conditions > extent of internet coverage, indicating that economic conditions are the most crucial determinant affecting the scale and spatial pattern of tourism demand in the source markets.

Tourism origins market maps corresponding with boxplots of variables in regions.

The competitive resilience of core tourist attractions

The study unveils a nuanced understanding of tourism demand dynamics, particularly illuminating the interplay between spatial structures of source markets and economic factors amidst unprecedented health crises such as COVID-19. Even during the crisis, the potential demand from tourist origin markets for a leading tourist attraction continues to be remarkably high and will have considerable potential to counteract the crisis in the post-pandemic era 11 . By delving into the spatial patterns and demand determinants for Duku Road in Xinjiang during the epidemic silent management period, the study extrapolates the driving forces behind the resilience and demand sustenance of core tourism attractions.

Firstly, the notable positive spatial autocorrelation within Duku Road’s source markets elucidates a significant conceptual insight: geographically proximate source cities harbor similar tourism demands. The absence of a Matthew Effect, and the ensuing market dispersion and diversity, underscores Duku Road’s ability to allure visitors from a broad geographic spectrum, thereby diluting over-reliance on singular markets. This diversification not only embodies adaptive capacity to navigate tourism adversities but also buffers the blow from crises by enabling a continuum of demand from unaffected markets. The relative unscathed potential tourism demand during the epidemic crisis manifests the merits of such market diversification.

Secondly, the decisive role of economic factors extends beyond merely shaping the tourism demand from tourist markets towards Duku Road; it critically impacts the spatial configuration of its source markets 58 . The stratified heterogeneity in crisis response, with economically robust core source cities demonstrating stability versus the sensitivity of secondary source cities with moderate economic levels, unveils an inherent inertia in the spatial structure steered by economic dynamics. This is a salient contribution to understanding the spatial-economic nexus in tourism demand studies.

Lastly, the regional variance captured through sectional models divulges that core source cities with high economic indicators face a saturation effect in tourism demand scale for Duku Road, contrasting with potential source cities that possess a larger scope for escalating tourism demand growth rates. It also identifies regional differences in the factors influencing tourism demand variations 19 , 59 , 60 . This saturation effect, negatively impacting tourism demand growth rates, accentuates the regional disparities in factors influencing tourism demand variations. The knowledge will help to provide insights into the influential factors driving tourism demand variations in distinct regions 59 .

In synthesis, the resilience of core tourism attractions within a region is constructed on a quadrate foundation: the uniqueness of tourism experience, market dispersion, heterogeneity in crisis response, and spatial structural stability induced by economic factors in source cities. Post-crisis, core attractions sustain a substantial scale of potential tourism demand, with economic factors significantly steering the tourism demand scale, leading to a spatial structural inertia towards core cities. The marked discrepancies in response patterns among source cities, tied to the saturation effects on local economic factors, spotlight the imperative of diversifying source market risks to accrue potential tourism demand, thereby accelerating recovery and sustaining competitive edge post-crisis.

These insights are seminal for policymakers and industry stakeholders to craft efficacious strategies for mitigating crises impacts, fostering tourism recovery, and bolstering resilience. The discourse propels a deeper comprehension of the factors instigating regional variances in tourism demand, furnishing a robust theoretical scaffold for future empirical explorations in the realm of tourism demand studies amidst crises. This narrative, therefore, extends a substantial theoretical contribution towards understanding the ramifications of COVID-19 on tourism demand, while amplifying the criticality of domestic demand in substituting the downturn in international tourism, thereby laying a robust groundwork for successful post-crisis recovery and long-term resilience in regional tourism sectors.

Limitations and prospects

The limitation in dataset is that the dependent variable does not measure the actual visits, revenues, or employment in tourism in the destination area. Instead, it measures Internet searches for a particular attraction. As Internet interest is indeed correlated with actual trips, the possibility of inferring short-term variations in demand on the search alone is limited. Regarding our emphasis on core tourist attractions within a regional destination has inadvertently disregarded the vulnerabilities of a broader array of regional attractions. Forthcoming studies will encompass an evaluation of the comprehensive repercussions that tourism crises exert on the destination system, alongside an analysis of the source market’s reactions. Additionally, studies will classify tourist attractions by their level or type and will subsequently discuss the risk resilience and the mitigating strategies employed for each group of tourist attractions. An integrated and differentiated methodology such as this promises to yield a more systematic understanding, benefiting the strategic planning and operational decisions of tourism management entities.

In contemplating future research directions, several potential areas warrant further investigation. Initially, a novel comprehensive indicator should be generated for monitoring tourism demand by integrating search data, user-generated content on social media platforms, and statistical data. This integration would avoid the original error in sample coverage of the source market due to internet access disparities. Furthermore, expanding the research framework to encompass additional destinations and broader dimensional factors, and employing mixed-effect models to study the overall impact of these factors on tourism demand, would yield a more holistic understanding of tourism demand dynamics during crisis situations. Additionally, examining the economic downturn in the post-epidemic era, with a particular focus on the influence of decreased travel intentions following the lifting of travel restrictions and the subsequent general reopening, could offer crucial insights into the resilience of various destinations and origin markets. Lastly, an in-depth analysis of the long-term consequences of crisis events on tourism demand, as well as the recovery trajectories of destination and origin markets, would be instrumental in providing essential guidance for policymakers and industry planners aiming to mitigate the adverse effects of crises on the tourism sector.

Conclusions

This inquiry delved into the dynamics of potential tourism demand from China's domestic origin markets towards Duku Road in Xinjiang during the epidemic closure in August 2022. The exploration unfolded heterogeneous response patterns of tourism demand in the face of unexpected epidemic crises, particularly accentuating the post-epidemic era. The study homed in on the impact of demographic, economic, environmental, epidemic, medical, digital, and transportation facets on local tourism demand fluctuations within the origin markets, encompassing 308 cities. Utilizing spatial statistical and stepwise regression analyses, the investigation spotlighted spatial disparities in tourism demand variation rates across seven major regions.

A salient revelation is the altered response patterns of origin markets to epidemic crises at destinations, transcending the initial reactions during the 2019 onset of COVID-19. There is a notable uptick in tourism demand gravitating towards primary origins. While local epidemics and medical care in origins correlate with tourism demand variations, they do not forge a meaningful relationship. Economic determinants emerge as dominant negative influencers, with tangible regional disparities in factors affecting local tourism demand rates. Economically affluent regions surface as the core tourist origin markets, exhibiting resilience in tourism demand amidst destination tourism crises. Concurrently, core tourist-origin areas with high economic indicators appear to reach a saturation point, curtailing the growth rate of tourism demand. Conversely, potential tourist origin markets highlight significant variability with a pronounced growth potential, revealing a correlation with distance and an inverse relationship with industrial solid waste utilization rate.

Central to the findings above is the competitive resilience of core tourism attractions like Duku Road, demonstrated by its ability to maintain a stable tourism demand even amidst adversities such as the epidemic crisis. Firstly, the study demonstrates that core tourist attractions within destination systems can accumulate potential tourism demand during crises through their intrinsic appeal and diversified market structure. This accumulated demand provides substantial momentum for recovery, highlighting the importance of maintaining and enhancing the attractiveness of core tourism assets to sustain potential tourism demand. Secondly, core tourist attractions serve as both growth poles within destination systems and recovery nodes for tourism revival. The spatial differentiation and clustering of tourism demand driven predominantly by economic factors within origin markets contribute significantly to the risk resilience of core attractions. These factors suggest that economically robust regions can act as stable sources of tourism demand, reinforcing the importance of understanding and leveraging economic conditions in origin markets to enhance the resilience and competitive edge of core attractions.

The insights are pivotal for stakeholders aiming to design efficacious strategies to navigate through crises, promoting tourism recovery and resilience, thereby maintaining the competitive edge of core tourist attractions, and regional tourism sustainability by strategies as followed: (1) Destination management organizations should focus on diversifying their market structures to include a mix of economically strong and emerging markets to buffer against localized crises. (2) Continuous monitoring of economic indicators in origin markets can provide early warnings and strategic insights for tourism demand management, allowing for more resilient destination planning. (3) Policymakers should prioritize strategies that enhance the core attractiveness of key tourism assets while simultaneously fostering diversified and resilient origin markets to safeguard against potential crises.

Data availability

The raw datasets utilized in this study can be accessed through the Baidu search engine at https://index.baidu.com and the National Bureau of Statistics of China at http://www.stats.gov.cn/ . The processed datasets that were used and analyzed during this research are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors would like to thank the financial supports from the Xinjiang Major Science and Technology Projects (No. 2022A03002), the Xinjiang Social Science Foundation Projects (No. 2022VZJ028), Guangdong Basic and Applied Basic Research Foundation (2023A1515011273), Basic Research Program of Shenzhen (20220811173316001), and Specific Innovation Program of the department of Education of Guangdong Province (2023KTSCX315).

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Xuankai MA conceived and designed the study, conducted the data analysis and visualization, and wrote the manuscript. Rongxi MA and Zijing MA provided revisions. Jingzhe WANG gave guidance to improve the results in revision. Zhaoping YANG, Cuirong WANG, Fang HAN provided project administration, supervision, validation. All authors reviewed and commented on the manuscript.

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Ma, X., Ma, R., Ma, Z. et al. Assessing the reactions of tourist markets to reinstated travel restrictions in the destination during the post-COVID-19 phase. Sci Rep 14 , 15495 (2024). https://doi.org/10.1038/s41598-024-66459-2

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Bonaire Update–COVID-19 and Flight Restrictions

by Susan Davis | Oct 15, 2020 | Air Travel , COVID , Government , Local News

Bonaire update on the COVID-19 and flight restrictions by Lt. Governor Rijna.

This afternoon, Bonaire’s Lt. Governor Edison Rijna provided an update on the COVID-19 situation on Bonaire as well as providing additional information about the current flight restrictions in place.

Here is a transcript of his speech:

Today I will start with some less positive news. Yesterday the sad news reached us that Doctor Hermelijn died in the hospital in Curacao from the consequences of Covid 19. This is the third death on Bonaire as a result of Covid 19. Dr. Hermelijn’s passing is a great loss to the community. We offer his family and loved ones sincere condolences.

Today I am not able to announce further easing of the current measures, however much I would like to. We are cautiously positive about the data. It is good to see that we have had so few infections in the past week, but at the same time, we have also observed that fewer tests are being done. We need to continue testing to keep a clear picture of the status of the virus and whether it is still spreading or not. So again I appeal to you: if you have symptoms get tested!

Since current developments and the data show a favorable picture we have already started a number of new processes. These concern travel, gyms, and casinos. I would like to tell you something more about this matter.

If the number of infections remains low and stable, next Wednesday I hope to be able to inform you of an easing of measures applicable to air traffic and also when we may be able to implement them.

Currently, we are preparing to create more flexible conditions for inbound travel from the islands around us. Our priority in this matter is Curacao. However, this requires careful consideration. If circumstances permit more flexibility, we will be sure to put additional measures in place. You will hear more about this on Wednesday.

At the moment, Bonaire is still a code-orange destination for travelers coming from the European Netherlands. If the current decline in numbers continues, we will consider it justified to submit a request to return to code yellow. I hope to be able to do this next week. My request will be submitted to the Ministry of Foreign Affairs for assessment. As we are in direct contact with the Ministry, it is expected that Bonaire will be able to return to code yellow within one to two days after the application has been submitted. We are mindful of the safety of our island, especially now that the number of infections in the Netherlands is high. On Wednesday we will also communicate potential new requirements for entry from the Netherlands.

I do realize that it is important for the tourism sector to know when flights from the United States and other destinations will again be welcome on Bonaire. There is currently an airspace ban on flights from the United States. We are also investigating under which conditions this ban may be lifted.

In addition to the developments related to travelers, I can report the following about gyms and casinos. This week we have held talks with the representatives of these venues. They have all devised plans on how to open again in a safe manner. We hope that the gyms and casinos will be able to open again sometime next week.

I am pleased to be able to slowly but surely offer a more favorable outlook to our residents and entrepreneurs. Let’s work together to keep the numbers low. Together let’s be corona smart!

(Source:  OLB and RCN)

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• Open access
• Published: 05 July 2024

Primary health care utilisation and delivery in remote Australian clinics during the COVID-19 pandemic

• Supriya Mathew 1 ,
• Michelle S. Fitts 1 , 2 ,
• Zania Liddle 1 ,
• Lisa Bourke 3 ,
• Narelle Campbell 4 ,
• Lorna Murakami-Gold 5 ,
• Deborah J Russell 1 ,
• John S. Humphreys 6 ,
• Bronwyn Rossingh 7 ,
• Yuejen Zhao 8 ,
• Michael P. Jones 9 ,
• John Boffa 10 ,
• Mark Ramjan 11 ,
• Annie Tangey 12 ,
• Rosalie Schultz 12 ,
• Edward Mulholland 13 &
• John Wakerman 1  

BMC Primary Care volume  25 , Article number:  240 ( 2024 ) Cite this article

57 Accesses

Metrics details

Introduction

The COVID-19 pandemic period (2020 to 2022) challenged and overstretched the capacity of primary health care services to deliver health care globally. The sector faced a highly uncertain and dynamic period that encompassed anticipation of a new, unknown, lethal and highly transmissible infection, the introduction of various travel restrictions, health workforce shortages, new government funding announcements and various policies to restrict the spread of the COVID-19 virus, then vaccination and treatments. This qualitative study aims to document and explore how the pandemic affected primary health care utilisation and delivery in remote and regional Aboriginal and Torres Strait Islander communities.

Semi-structured interviews were conducted with staff working in 11 Aboriginal Community-Controlled Health Services (ACCHSs) in outer regional, remote and very remote Australia. Interviews were transcribed, inductively coded and thematically analysed.

248 staff working in outer regional, remote and very remote primary health care clinics were interviewed between February 2020 and June 2021. Participants reported a decline in numbers of primary health care presentations in most communities during the initial COVID-19 lock down period. The reasons for the decline were attributed to community members apprehension to go to the clinics, change in work priorities of primary health care staff (e.g. more emphasis on preventing the virus entering the communities and stopping the spread) and limited outreach programs. Staff forecasted a future spike in acute presentations of various chronic diseases leading to increased medical retrieval requirements from remote communities to hospital. Information dissemination during the pre-vaccine roll-out stage was perceived to be well received by community members, while vaccine roll-out stage information was challenged by misinformation circulated through social media.

Conclusions

The ability of ACCHSs to be able to adapt service delivery in response to the changing COVID-19 strategies and policies are highlighted in this study. The study signifies the need to adequately fund ACCHSs with staff, resources, space and appropriate information to enable them to connect with their communities and continue their work especially in an era where the additional challenges created by pandemics are likely to become more frequent. While the PHC seeking behaviour of community members during the COVID-19 period were aligned to the trends observed across the world, some of the reasons underlying the trends were unique to outer regional, remote and very remote populations. Policy makers will need to give due consideration to the potential effects of newly developed policies on ACCHSs operating in remote and regional contexts that already battle under resourcing issues and high numbers of chronically ill populations.

Peer Review reports

Primary Health Care (PHC) plays a crucial role in delivering health care, especially as geographic remoteness increases and population density decreases where there is high need to optimise the use of limited specialist services. Around 10% of the Australian population and over 34% of Aboriginal and Torres Strait Islander people (hereafter respectfully referred to as Indigenous people) live in outer regional, remote or very remote locations [ 1 ]. Indigenous people living in remote and very remote Australia experience a higher burden of injury and disease, shorter lives, and poorer access and use of health services compared to urban residents [ 2 ]. This highlights the importance of strong PHC delivery and effective utilisation of PHC services offered to community members [ 3 ]. The prevention and management of chronic conditions is a substantial challenge faced by the Australian health system [ 4 ]. Chronic conditions, the leading cause of illness, disability and death in Australia, consume a huge proportion of the Australian health budget (more than a third of the national health budget spent on Primary Health Care (PHC) [ 5 ]. About 80% of the mortality gap between Aboriginal and non-Indigenous people aged 35 to 74 years is due to chronic diseases [ 6 ].

Australian populations living inmost remote and very remote communities are serviced by government run and/or Aboriginal Community-Controlled Health Services (ACCHSs), while some remote and outer regional populations additionally have access to private practices. In remote and very remote clinics, staffing usually comprises of Remote Area Nurses (RANs), Aboriginal Health Practitioners (AHPs), administrative staff (e.g. receptionists, drivers and cleaners), and resident and visiting medical and allied health professionals (e.g. General Practitioners (GPs), medical specialists, allied health professionals) [ 7 ]. Many very remote clinics operate with 2 nurses in a clinic [ 8 ]), experience high staff turnover [ 9 ], which affects continuity of care. Community members prefer long term staff with established, trusting relationships who are culturally and clinically competent [ 10 ], though seldom do staff stay long enough in remote communities to foster development of such relationships.

During the initial stage of the COVID-19 period from 2020 to 2021, regional and remote PHC clinics and communities were severely affected by travel restrictions (e.g. lock downs, declared biosecurity zones including the need to stay in quarantine before entering specific communities), which effectively prevented the spread of the virus. This was combined with the additional stress created by the lack of capacity for health staff to take annual leave due to both workforce shortages and lockdowns [ 11 ]. Despite clear benefits, the implementation of various strategies by the Australian Government such as funding for Point of Care Testing (rapid laboratory diagnostic results conducted at the site of patient care [ 12 ]), additional social security payments, and funding to promote telehealth (see Fig.  1 ) [ 7 ] was an unintended source of increased burden on health services staff [ 13 ]. A national survey of Australian PHC nurses with around 30% of participants from rural or remote locations found that many nurses perceived an overall reduction in the quality of usual care delivered during the COVID-19 period due to lack of time, supervision and decreased administrative capability [ 14 ].

Access issues and high workforce turnover and staff shortages existed pre-COVID-19 in remote Australia [ 8 ], the pandemic however further exposed the exacerbation of these workforce challenges, particularly due to the pre-existing reliance on agency nurses and fly-in-fly-out staff. It is thus important to document learnings from how the pandemic directly or indirectly impacted PHC delivery and service utilisation in regional and remote communities during this time to inform future planning of pandemic responses. In this paper, we synthesise PHC staff observations on PHC service utilisation and delivery in outer regional, remote and very remote communities during the COVID-19 preparation period.

Data and methods

This paper sits within a broader study that explores the impact of short-term staffing on PHC delivery and clinic users [ 15 ]. COVID-19 occurred during the data collection of the broader study, providing opportunity to explore the effects of the pandemic on the PHC use and delivery. Semi-structured interviews were conducted with staff employed by 11 ACCHSs in the Northern Territory (NT) and Western Australia (WA). These ACCHSs deliver services in outer regional, remote and very remote communities, as defined by the Australian Bureau of Statistics Remoteness Areas classification [ 1 ]. The sizes of Aboriginal population serviced by the ACCHSs ranged from very remote communities with population under 100 to outer regional communities with a population of more than 10,000 people. The interview guide for the broader study is available as supplementary file 1 . Data were collected between February 2020 and June 2021 and aligned with: (i) the pre-COVID planning period (February 2020 – mid March 2020), (ii) the Australia wide lockdown period (March-June 2020), (iii) the subsequent period where several communities across the NT and WA were declared as biosecurity zones due to the emergence of COVID-19 cases (July 2020 – June 2021) and (iv) the commencement of the vaccination roll out period (February 2021-June 2021) (see Fig.  1 ).

Sources: [ 16 , 17 , 18 ]

Dynamic policy landscape between February 2020 (start of data collection) and June 2021 (last month of data collection) relevant for primary health care service delivery in outer regional, remote and very remote Australia. Time periods at which data was collected from each ACCHS have also been marked.

Research team members, including at least one Indigenous researcher visited each clinic and interviewed staff about the impact of short-term workforce on the service and the community. Interviews were recorded and the audio-recordings were transcribed verbatim. Interview transcripts were coded using NVivo v12 software (QSR International). One researcher read the interviews and coded the content inductively around common codes relating to PHC delivery and use during the COVID-19 period. Patterns in the codes and links between the codes were identified and organised into meaningful themes [ 19 ]. For each health service, three interviews were co-coded by two researchers (one Indigenous and one non-Indigenous researcher) and compared to validate the main themes. Any discrepancies were discussed with the wider research team until consensus was reached.

A steering committee that included representatives of the partnering health services and peak health bodies was established at the start of the project. Bimonthly written updates were sent to inform the committee about the progress of the project. The committee met every 6 months where members of the committee provided feedback on the findings that were presented by research team members. A detailed report of the findings was prepared for each health service. Feedback from each health service was collected which also informed the interpretation of the findings.

The study had ethics approval from the Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research (project number DR03171), Central Australian Human Research Ethics Committee (CA-19-3493) and Western Australian Aboriginal Health Ethics Committee (WAAHEC-938).

In total, 248 staff consented and participated in interviews, of whom 33% identified as Indigenous (also see Table  1 ). Diverse issues were discussed by staff across the themes of service utilisation (how remote clinics were used), PHC service delivery (how health services or clinics responded to community needs) and dissemination of information during the COVID-19 period (through what channels and with what impact).

Service utilisation

During the early phases of the pandemic, i.e. the lock down period and the biosecurity declaration periods, clinic staff observed changes in both how busy clinics were and the types of conditions that were presented.

Quieter clinics

Staff in most remote clinics reported that during the initial lockdown period the clinics were generally quieter than usual. Some staff suggested that there were also fewer acute respiratory presentations than what would otherwise be expected:

“[There were] a lot of people who didn’t come to the clinic, like it was very quiet here” (ACCHS 1, AHP 99, Indigenous) . “I would expect it [respiratory illness] would be a lot more than what we have been seeing because even when I’ve worked in small emergency departments, we see a lot more people with a cold than we have been here” ( ACCHS 11, RAN 52, non-Indigenous ).

Staff indicated that decreased use of the service could be for a range of reasons –

First, some staff suggested that COVID-19 awareness programs and education about hygiene practices might have had an effect: “… washing hands, keeping their distance, all that kind of stuff, I don’t know whether this has really contributed but there is a noticeable difference” (ACCHS 11, RAN 56, non-Indigenous).

Second, some staff indicated that patients might have been presenting earlier with mild symptoms and being treated before conditions became worse:

“It’s hard for me to attribute to one specific thing but I’m thinking maybe people are just a bit more alert now and they come to clinic much sooner because of, they think it might be Corona[virus], is it this, and then they present earlier to clinic and they don’t just present late at night with, complications and difficult to treat issue” (ACCHS 11, RAN 52, non-Indigenous).

Third, others felt people were not presenting to the clinic due to worries related to COVID testing or due to risk of transmission or fear that that they may be identified as the person identified as bringing COVID-19 to the community:

“Whether that’s because people don’t want to come up … they know they’ll be swabbed…” (ACCHS 11, RAN 52, non-Indigenous).

Fourth, border closures and travel restrictions into and out of remote communities were postulated to have reduced the usual high mobility of remote resident populations and thereby reduced the usual spread of respiratory infections:

“I did notice it has been a bit quieter, but that’s about it. And there has been a lot to do with border closures and borders reopening. Like we’ll get a huge influx when people are coming back into town and having health checks and things like that, and then people go back out” (ACCHS 1, RAN 87, non-Indigenous).

Finally, some staff speculated that COVID was associated with increased social cohesion which in turn may have led to decreased need for PHC:

“COVID has been a Godsend for the community … everyone was sort of here and then, then they started doing things together. People started coming out at night and there’d be fires and there’d be singing and there’d be groups of people everywhere” (ACCHS 9, RAN 320, non-Indigenous ).

Staff raised concerns that inappropriately low utilisation and limited PHC services being available in some communities (some clinics had to close due to staff shortages) could result in more severe chronic conditions into the future increasing demand on medical retrieval.

“There’s probably just groundswell of conditions and problems that are not being addressed. ….it’s just building up there, but we don’t know it, it’s going to hit us, people who would have been picked up as diabetics who are pre-diabetics won’t be identified. So, probably in another two or three months you might have … an acute presentation of somebody who’s sugar is way out of control” (ACCHS 4, Other health worker 13, non-Indigenous).

Busier clinics

In contrast, in some communities staff reported that there were more clients using the health service because there were more people in the community as a result of the ‘Return to Country’ [ 20 ] policy (policy and health promotions that encouraged Aboriginal people to return to their usual place of residence) coupled with the biosecurity restrictions which meant once people returned they could not then leave their communities to travel back to regional centres. This was introduced to try and limit the transmission of the virus and keep remote communities safe [ 7 ]. Staff commented on the resultant issue of increased overcrowding in houses, which not only added to the “ tensions of people living together in a small area ” (ACCHS 11, GP 53, non-Indigenous) , but exacerbated the transmission of other non-COVID communicable diseases (e.g., skin infections), which had an impact on clinic utilisation. Staff felt that certain skin related diseases commonly observed among children weren’t presented in a timely way due to the fear of being reported to the government for child neglect:

“They don’t present because they’ve got the fear that we’re going to report them to [to the government department that looks after child neglect] .you try living . with 15 people in your house. we had seen probably a 20% increase [in skin diseases] over the COVID [period] in [remote] populations” (ACCHS 11, RAN 51, non-Indigenous).

Staff reported that some community members were anxious about the virus and visited the clinic for reassurance: “… were coming in every single day, and they were anxious and worried about it [COVID]. They just wanted to talk about it” (ACCHS 9, Other health worker 315, non-Indigenous) . Staff reported that some community members were diligent and keen to take COVID tests if they had symptoms, especially because they were concerned about spreading the disease to the community or their family members.

“[A] lot of the community was worried. They’d come and say, “Can you swab me because I’ve got a sore throat”, … they were scared they were going to spread it to their family” (ACCHS 11, Administrative 57, non-Indigenous) .

Mental health related presentations increased, according to clinic staff in some communities, due to people losing jobs, the inability to move around freely, shop for essential items ( e.g. winter clothes, new born clothes for their growing children) or access the nearest town: “…the feeling that they couldn’t move, that they couldn’t go into town …release the valve, and I saw a lot more people with mental health presentations than I would normally” (ACCHS 11, GP 53, non-Indigenous). Staff remarked that there was “ an increase in mental health cases from people who … never really had any issues, barely accessed the clinic, who were having breakdowns ” (ACCHS 11, RAN 51, non-Indigenous).

Alcohol and domestic violence related presentations were also perceived to have increased in some communities. Staff speculated that increased alcohol related presentations may have been due to the availability of illicit alcohol and the ability to purchase it through the additional income that was available through various federal government policies (for many recipients the income doubled compared to the pre-pandemic period [ 21 ]), as well as limited presence of health promotion staff in the communities. Concerns were voiced that there was a shift from managing chronic disease to reacting to acute presentations.

“I think also because of the amount of money that’s been available with Centrelink payments and stuff, we’ve had issues around alcohol and violence and so that’s resulted in a lot of the care being more acute rather than chronic, looking at your chronic diseases and your program [alcohol and other drug program] stuff, and because program staff weren’t there, .a lot of the program work’s gone down as well” (ACCHS 4, Other health staff 116, Indigenous) .

PHC service delivery

Participants discussed that PHC service delivery had to adapt to the new circumstances brought about by the pandemic. Service delivery changed to account for people’s apprehension about COVID-19 (e.g. fears of contracting the virus or vaccine hesitancy), COVID-19 restrictions (e.g. lockdowns and declaration of biosecurity zones) and new PHC service delivery policies that were introduced (e.g. telehealth MBS items). Staff offered observations about how clinics and health services adapted in order to continue to effectively deliver PHC services in the communities.

Clinic resource availability during COVID-19

Staff talked about how COVID-19 preparedness brought about changes to regular clinic processes, and highlighted limitations of available clinic resources and infrastructure and a greater need for additional human resources for screening patients for COVID-19 related symptoms prior to appointments. Clinic staff interviewed in the early stages of data collection, i.e. soon after the Australia-wide lockdown raised concerns about insufficient availability of Personal Protective Equipment (PPE): “I don’t think we had enough PPE …it was only lucky we didn’t have any positive cases, otherwise we would have been in trouble.” (ACCHS 1, AHP 99, Indigenous) . Thereafter, most staff responses related to the resources required for patient screening for COVID-19 and how clinics worked to reduce transmission by isolating people presenting with COVID-19 symptoms from people presenting with other health issues. Participants described a range of measures put in place, including screening all patients for recent or current COVID-19 symptoms, regular cleaning of surfaces, installation of calling bells/desk call bells in clinics to alert staff about patient arrivals, chairs placed apart to ensure social distancing. Some clinics modified clinic infrastructure to separate patients with respiratory symptoms possibly related to COVID-19 from those without: “… an infectious side and a non-infectious side (of the building) and that we, we had to keep those patients that side, so we had to reform that, all our fencing and gating, and the way the patients flowed into the centre” (ACCHS 2, RAN 222, non-Indigenous). Staff commented that it was difficult to maintain social distancing given the lack of space in many small clinics, particularly during specialist visits. In some communities, men-only areas in the clinics were modified and utilised for patients who needed to be tested for COVID: “ Men’s section is not open as [the space was] needed for point of care testing” (ACCHS 2, GP 219, non-Indigenous) . Most staff talked about having either a nurse or receptionist at the front desk who was assigned the duty of screening patients using a screening questionnaire that included questions related to COVID-19 symptoms: “We had a nurse who was sitting at the front desk and she would be screening patients and stuff like that” (ACCHS 11, RAN 56, non-Indigenous).

Flexible PHC delivery to accommodate community’s varying needs and policy changes

In some communities, staff became aware that many patients with chronic diseases were not visiting the clinics regularly, so staff proactively took steps to ensure medications were delivered to people’s homes. For patients who were fearful of swab testing, an option to spit in a jar was offered as an alternative to nasal and throat swab tests: “ When you could spit in a jar and get sputum, you have the same thing and no-one’s terrified” (ACCHS 3, Physical 24, Indigenous) .

Telehealth, whereby clients were assessed by clinicians who were not physically present but in contact by phone or video link was introduced/enhanced in most clinics during the lockdown period. During this period, face-to-face General Practitioner (GP) consultations were less available but instead community members were able to consult with their regular GP using telephone or videoconferencing.

“[To overcome] our lack of GP coverage [in community] over COVID, we were able to implement our telehealth service a little bit better.” (ACCHS 5, Administrative 16, non-Indigenous) .

Many PHC allied health programs (e.g. podiatry, diabetes educators, cardiac educators ) and specialist visits (e.g. renal physicians, ophthalmologists) ceased during the initial COVID lockdown period. With the clinics becoming quieter, remote clinic staff commenced outreach activities to ensure usual PHC services, such as child immunisation, were delivered: “…like it was very quiet here, so then we just went outreach. So, one person would stay here, then another person would be on outreach, to go and see patients in the home” (ACCHS 1, AHP 99, Indigenous) . Another commented: “a lot of it was outreach. [Staff] would go out and get the kids …… for immunisation away from the clinic” (ACCHS 11, Administrative 57, non-Indigenous) .

Outreach activities were challenging as staff were instructed to wear masks and gloves which, along with the news about COVID related deaths, were creating panic among community members. One staff member recalled:

“I was scaring so many people out there, that I took them [protective gear] off, because they were terrified of that, and only gloves and mask too, that was all….And you know, coming through the news, there was all these thousands of people dying all over the world.” (ACCHS 9, RAN 322, non-Indigenous) .

After the Australia-wide lockdown period, staff observed that other services started going back to normal and they could return to focus on their usual portfolios:

“We have moved our focus back to getting adult checks done, and looking for underlying conditions and things like that. But previously it was a little bit of a what are you here for, let’s treat that and, and kind of minimising peoples’ time in the clinic. ….So you know podiatry, diabetes, cardiac educators, they’re only just starting to come back now that the borders [biosecurity zones lifted] have reopened” (ACCHS 11, RAN 54, non-Indigenous).

Dissemination of information and its impact

Remote health professionals also discussed the development of culturally appropriate educational resources and innovative ways by which information was disseminated to community members and the obstacles faced during various stages of COVID-19, including the vaccination period.

COVID related information resources

Some clinic staff were confident about the internal communications they were receiving about COVID-19, while others commented that policies were constantly changing, and the information they received was inadequate. Staff talked about the speed of ACCHSs’ responsiveness to the evolving pandemic, citing examples of employing staff in newly created COVID-19 specific positions, who: “made sure [staff] had access to all the key [COVID-19] training information, activities, ensure timely communication with staff and community members” (ACCHS 3, Other health worker 26, non-Indigenous).

In the initial COVID-19 preparatory phase (the period between Australia wide lockdown and before vaccinations became available), staff from ACCHSs and Indigenous health peak bodies were focussed on communicating social distancing rules, COVID-19 safe hygiene practices (how to cover your mouth when coughing or sneezing, proper wearing of masks, disposing of tissues etc.) and COVID-19 symptoms monitoring.

Staff spoke about how ACCHSs and the peak bodies for ACCHSs developed their own COVID-19 posters, booklets, video clips and screening sheets for use in communities [ 22 ]. These resources included a lot of graphics and were used by staff to quickly convey targeted messages to clinic users with maximum effect, including during consultations.

“We had a booklet on COVID…. it’s something like “Communicating to Community Members with COVID.” So I actually printed it up and laminated it and put it into one of these things, so everybody that came in to my consulting room…could quickly go through the booklet” (ACCHS 9, Other health worker 315, non-Indigenous).

Some health service staff, however, suggested that COVID-19 preparation and processes to communicate to community members were slow to take effect.

“I think the response to set clinics up to be COVID-safe was a little bit harder, and actually have really good plans in place at the clinic, with signage and processes, I think that probably took a little bit longer” (ACCHS 4, Other health worker 116, non-Indigenous).

In addition to developing and distributing COVID-specific educational materials, remote clinic staff also identified a need to respond to the increased number of mental health related presentations. Mental health educational resources such as posters were developed for community members and were placed in public places (e.g. on public phones), where the messages, including who to contact for help, were readily accessible.

Many ways of channelling information

According to the staff interviewed, patients received information through a range of channels. In addition to the aforementioned locally developed printed materials, remote clinic staff also utilised local interpreters to talk in local languages to community members about COVID-19 and precautionary measures to be taken. Messages were broadcasted on local Indigenous radio such as the CAAMA radio and through each clinic’s televisions. Clinic users were encouraged to listen to the radio for information:

“Even though we had interpreters who talked to the community, it wasn’t enough, ‘cause I’ve said to people, “You might [want to] listen to CAAMA (local Indigenous radio)?” They reckon, “No,” but I instructed them. “You listen to CAAMA, ‘cause that’s where you’re going to hear what you need to know, and it’s going to be in language, so it’s easy for you to comprehend. (ACCHS 1, Other health worker 914, non-Indigenous)

Information was also disseminated in informal settings:

“In some areas where they couldn’t provide us with 1.5 metre distancing space inside, the clients were moved out and we did deliver education sessions under the tree outside” (ACCHS 2, Other health worker 27, non-Indigenous).

Pop up display stands detailing COVID safety guidelines, hand washing stands at public spaces and other creative strategies were used to ensure information dissemination without attracting crowds. Door-to-door campaigns were found to be an effective way to communicate the risks to community members, especially to elderly people.

“…door to door campaign really worked for us. The initial plan was actually to just do a public event in park, pop up stands. But then the [leadership team] said no it will attract crowds so we can’t do that, so after that we just went door to door to all the [name of community] and all the people really appreciated that” (ACCHS 2, RAN 217, non-Indigenous) .

Public events were planned initially, but cancelled due to concerns of attracting crowds and inadvertently spreading COVID-19. Staff instead pivoted to a more personalised and targeted approach to the public health activities, leveraging on existing relationships where possible to have the greatest impact: “ we had to make sure that the [door to door campaign] group had a mix of Indigenous, non-Indigenous staff and only certain staff was sent to the [site name], who’ve had relationship with somebody and knew those[site name], you know, so it had a better impact” (ACCHS 2, Other health worker 217, non-Indigenous).

Remote clinic staff ensured that they initiated ongoing conversations with community members about COVID-19 safe practices during ad-hoc visits to the clinic, thereby reinforcing earlier messaging:

“So just educating people constantly every time you see them in the clinic or wherever” (ACCHS 9, Other health worker 315, non-Indigenous) .

Another staff member noted the two-way nature of public health communications, with staff listening carefully to community concerns in order to be able to effectively address those concerns and health services providing information through respected community members using local languages:

“We had those really frank conversations with community and had great engagement and great feedback from community and there was lots of discussion that then came from community members and board directors in language with the community, about not sharing smokes and not sharing drinks and those sorts of things” (ACCHS 5, RAN 511, non-Indigenous).

One of the health services sought feedback from clinic users regarding their information dissemination strategy during the first stages of the COVID-19 period. Staff recognised that information sharing was becoming monotonous and frustrating for community members, given there weren’t any positive cases in communities. Staff kept revising the resources to ensure it wasn’t repetitive for community members:

“So the community members said, it’s just getting too much, we’re hearing too much about it, you know….we’re just getting bored with this all the information” (ACCHS 2, Other health worker 27, non-Indigenous).

All health services highlighted the importance of having culturally appropriate information dissemination materials. Staff worked within teams who were responsible to ensure any messaging was culturally appropriate.

“ You have got to be culturally appropriate in the way you deliver those messages…., our public health team did a lot of work around that, and that was working also with schools and places like that, so we’re all saying the same thing” ( ACCHS 4, Administrative staff 11, non-Indigenous).

Having local Indigenous staff leading the development of local educational resources was critical for cultural appropriateness:

“ Because we are [an]Aboriginal controlled organisation, so everything is culturally appropriate and specific for each community, the staff who were here that are recruited from the community usually take the lead in any resources that we make and then go through the process of cultural competency approval” (ACCHS 2, Other health staff 27, non-Indigenous).

Misinformation

Staff highlighted that community members were being misinformed about COVID-19 by what they saw on social media platforms and that this adversely affected the effectiveness of information they disseminated through the health services. This was especially evident during the vaccine roll out stage. “A lot of their education stuff comes from the internet or, Facebook” (ACCHS 7, Other health staff 315, non-Indigenous) . Staff discussed specific examples of misinformation accessed by community members through various media. One example was that Indigenous people would not be affected by COVID-19; “ COVID…was a white fella problem” ( ACCHS 4 , Administrative staff 62, non-Indigenous ); Australia is not affected by COVID-19; “if I stay in the community, I won’t get COVID” ( ACCHS 4 , Administrative staff 62, non-Indigenous ). There were also examples of vaccine misinformation, including a general lack of trust in the vaccines and that COVID-19 related deaths were not due to the virus, but vaccine related deaths. Many were confused and anxious about the relative risks of dying from COVID-19 versus dying from a blood clot caused by a vaccine, in the context of extensive media coverage given to a small number of highly publicised deaths following Astra Zeneca vaccination.

“I guess all of the deaths that people are hearing about on TV, that’s from the [ AstraZeneca ] vaccine and not from the virus. They’re worried about blood clots I suppose.” (ACCHS 5, RAN 37, non-Indigenous) .

As a result, staff felt it was important to educate community members well before the vaccinations were available in communities, so that misinformation and vaccine hesitancy could be addressed. Staff gave specific examples of how media hype had increased vaccine apprehension and anxiety in community. In one instance, a community member was vaccinated for COVID-19 and re-presented to the clinic feeling unwell and desperately asking for the vaccine to be taken out of her body as she was worried, she would die. In general, staff commented that “a lot of people were scared to come in [for vaccinations]” (ACCHS 6, Administrative staff 21, non-Indigenous). In the end, a major community engagement strategy that included “door to door” health education utilising local Aboriginal people and nurses was rolled out.

This study is an important synthesis of the perceptions of a large number of PHC staff regarding PHC service utilisation and delivery in outer regional, remote and very remote clinics during different phases of the COVID-19 pandemic. The perceived decline in PHC use observed across the different phases is consistent with PHC utilisation data published by the Australian Institute of Health and Welfare (AIHW) for the period January 2020 to December 2021 (see Figures S1 a-b, [ 23 ]) and several other studies [ 24 , 25 ]. While studies have associated the reasons for decline in PHC utilisation during the early COVID-19 planning phase to limited PHC services offered, patient fear of getting infected and higher public health related workloads of clinic staff, our study suggested additional possible contributors. These included - reduced availability of alcohol in some remote communities which may have reduced alcohol-related presentations; more stable populations within communities due to travel restrictions that may have reduced conflicts within communities; better income support through the Australian Government’s COVID-19 payment schemes reducing financial stressors and lessening the severity of poverty; and community members ability to spend more time in local cultural activities and less time travelling out of community which may have facilitated better social and emotional well-being as a result of greater connection to Country, culture and community [ 26 ]). The decreased PHC utilisation during the data collection period may not necessarily indicate better health outcomes for remote communities, as longer-term health implications could become evident later in the form of increased mortality and morbidity rates.

Increased income through the Australian Government’s COVID-19 supplementary payments predominantly improved people’s lives [ 21 ], there were perverse outcomes noted in a few communities, as in some instances community members were able to buy more alcohol from sly grog sellers, despite the enforcement of various alcohol restriction/management plans [ 27 ]. The Return to Country policy [ 20 ], initiated in the early phase of the pandemic, assisted many Indigenous people to return from larger towns to their remote communities. This, in conjunction with COVID-19 related travel restrictions which limited their subsequent mobility, exacerbated of overcrowding in remote communities and concomitant adverse impacts on spread of infectious diseases (e.g. increase in skin diseases) and development of mental health issues (e.g. anxiety and depression). Insufficient housing and inadequate housing infrastructure [ 28 ] has been recognised as key issues for Indigenous communities and is further highlighted in this study as it challenges the ability to adequately manage any infectious disease outbreaks in remote communities.

In terms of ensuring access to GP services, telehealth had an increased role in PHC delivery, as GP visits to communities ceased [ 13 ]. Despite the increased availability of telehealth, staff worried that limited utilisation of PHC services during the initial COVID-19 preparatory stages would result in more frequent or more acute clinic presentations at a later date, with concerns of increased need for retrievals and increased hospital admissions for potentially preventable primary health care conditions in the future. These concerns are consistent with the PHC utilisation trends reported by AIHW for outer regional, remote and very remote clinics, where the number of regular clients peaked after June 2021 [ 23 ] and with a recent report that two-thirds of remote NT Health clients with at least one chronic condition hadn’t had GP chronic disease management within a 12-month period [ 29 ]. This signifies the need to explore the acceptability of telehealth in remote community settings before further roll out.

Health services that deliver health care to remote communities are underfunded [ 30 ] and face workforce shortages [ 8 ]. Health service staff, who were already experiencing excessively heavy workloads, were required to adapt to fluctuations in the numbers and types of PHC presentations (e.g. increased screening for COVID-19), to the cessation of site visits from Allied Health and medical professionals, to the emergent imperative to conduct a range of public health activities such as developing contextually appropriate consumer resources, remodelling clinic infrastructure, educating and delivering vaccines, and to deliver services through outreach models when community members feared attending the clinic. The lack of adequate human and financial resourcing greatly impedes remote health service capacity to respond effectively and quickly when new threats such as the COVID-19 pandemic emerged. More investments are required to ensure remote clinics are adequately (human) resourced, and staffing models include some surplus capacity to support adequate responses to emerging health threats [ 31 ].

PHC delivery was affected by limited infrastructure to support best practice for screening and treating patients who presented with COVID-19 symptoms. Limited clinic space was an issue even before the pandemic. Some clinics utilised spaces that were previously dedicated for men’s health as COVID-19 screening spaces, which impacted on cultural acceptability for men seeking care. This can have longer-term adverse impacts on male health outcomes, and is highly undesirable as Indigenous men already have low health service utilisation rates [ 32 ]. There is a clear need for investing in fit-for-purpose and culturally suitable clinic infrastructure in remote communities.

Information dissemination related in initial phases to COVID-19 preparedness and in later phases to vaccinations was a significant focus of PHC delivery in remote clinics. Our study found that the planning and initial vaccination phases of the COVID-19 period impacted PHC utilisation in different ways in remote Australia. Indigenous leadership was considered by community member to be effective and receptive to their views when disseminating the information in the pre-vaccination stages [ 7 ]. The vaccination phase was reported by respondents to be challenging. Respondents perceived that social media was heavily influencing vaccine uptake/hesitancy; this was also found around the globe [ 33 ]. In particular, the news linked to AstraZeneca blood clots and subsequent misinformation was said to be a barrier to COVID-19 vaccination uptake amongst populations living in remote communities. This was also the case in other regions where AstraZeneca vaccine weren’t offered as Pfizer mRNA vaccines were readily available. During the vaccination phase, a door to door personal communication strategy proved to be successful. High vaccine coverage rates were achieved prior to opening of the NT borders at the end of 2021. By the time of the rapid spread of the Omicron variant in early 2022, the remote population was highly vaccinated [ 34 ]. This suggests that for the success of future vaccination campaigns, it is pertinent that all levels of government monitor varying public sentiments, including early identification of miscommunication through social media and respond quickly in ways that promote local understanding [ 33 ].

In summary, we found variability across communities in how they responded to COVID-19 and how various policies affected communities, and the impact on use of PHC services. Findings from this study, reveal the need to better align policies to the diversity of remote communities to mitigate future health crises; policy options based on local responses and knowledge are important considerations.

Future research directions

In terms of future research directions, a quantitative analysis of the PHC utilisation trends pre COVID-19, during and post COVID-19 period stratified by remoteness, clinic location, age, gender, cause and acuity of presentation could reveal specific utilisation trends and insightful information into the effects of specific policies on remote communities.

Strengths and limitations of the study

A key strength of the study is that it recorded perceptions of close to 250 staff in real time starting just before the lockdown till the start of the roll out of vaccines in remote communities. Interviews were conducted over a 17-month period and hence the focus of the responses varied depending on the COVID-19 phase at which the interview was conducted. This means staff who were interviewed in the initial stages weren’t able to provide their responses on issues emerging during later stages of the pandemic such as vaccine hesitancy. The research team included Indigenous researchers, but it is possible that cultural and language differences across the locations could have affected some of the staff interviews. The paper does not report the perceptions of community users, except when staff were also local community members.

The differential effects of the pandemic on remote and very remote communities highlights the diverse needs of the communities. It is important to ensure ACCHSs are funded adequately to be able to adapt clinic infrastructure and service delivery depending on future pandemic circumstances, building community resilience and independence, while reducing morbidity and mortality. The importance of tailoring staff, resources, clinic infrastructure and culturally appropriate information to enable ACCHs to connect with their communities and continue their work cannot be overstated. For future pandemics, policy makers need to connect more closely with the remote community context and be better informed about the potential effects of new policies on remote health service delivery and heath service demand, to enable ACCHSs to maintain adequate levels of PHC.

Data availability

Ethics approvals were obtained from Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research (project number DR03171), Central Australian Human Research Ethics Committee (CA-19-3493) and the Western Australian Aboriginal Health Ethics Committee (WAAHEC-938). All methods were carried out in accordance with the guidelines set by the three ethics committees. Informed consent was obtained from all participants of this study. Consent was obtained only to publish aggregated data and not for individual level identified data from the participants. The qualitative data collected was thus de-identified and aggregated before analysis. De-identified quotes have been included in the paper.

Abbreviations

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Aboriginal Community Controlled Health Services

Medicare Benefits Schedule

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Acknowledgements

The study was conducted during the COVID-19 period, when health services were facing staff shortages and additional work pressure. We acknowledge the time, flexibility and invaluable insights provided by staff, local health board members and executive staff from the participating ACCHSs. We thank the local Indigenous researchers who were recruited in each community to guide and assist the research team during data collection. We also acknowledge the guidance provided by Prof Terry Dunbar in the initial stages of the project.

The study received funding from the Australian Research Council’s Discovery funding scheme (project number DP190100328) and the Medical Research Future Fund through the NHMRC and Central Australian Academic Health Science Network. The information and opinions contained in the study do not necessarily reflect the views or policy of the Commonwealth of Australia (or the Department of Health).

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Authors and affiliations.

Menzies School of Health Research, Charles Darwin University, Alice Springs, Australia

Supriya Mathew, Michelle S. Fitts, Zania Liddle, Deborah J Russell & John Wakerman

Institute for Culture and Society, Western Sydney University, Parramatta, NSW, Australia

Michelle S. Fitts

Department of Rural Health, The University of Melbourne, Shepparton, VIC, Australia

Lisa Bourke

Flinders Rural and Remote Health Northern Territory, College of Medicine and Public Health, Flinders University, Darwin, NT, Australia

Narelle Campbell

Poche SA + NT, Flinders University, Alice Springs, Australia

Lorna Murakami-Gold

School of Rural Health, Monash University, Bendigo, VIC, Australia

John S. Humphreys

Miwatj Health Aboriginal Corporation, Nhulunbuy, NT, Australia

Bronwyn Rossingh

Northern Territory Department of Health, Darwin, NT, Australia

Yuejen Zhao

School of Psychological Sciences, Macquarie University, North Ryde, NSW, Australia

Michael P. Jones

Central Australian Aboriginal Congress, Alice Springs, Northern Territory, Australia

Top End Population and Primary Health Care, Northern Territory Government, Casuarina, NT, Australia

Mark Ramjan

Ngaanyatjarra Health Service, Alice Springs, Northern Territory, Australia

Annie Tangey & Rosalie Schultz

Independent researcher, Minyerri, NT, Australia

Edward Mulholland

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Contributions

SM analysed the data and drafted the paper. MF and ZL led the data collection and assisted with the data analysis. LB, LG, SM, DR and NC assisted with the data collection. JW, LB, LG, JSH and DR conceived the study, contributed to design, and reviewed different versions of this paper. All authors, including BR, YZ, MPJ, JB, MR, AT, RS and EM provided feedback on the manuscript and approved the final submitted manuscript.

Corresponding author

Correspondence to Supriya Mathew .

Ethics declarations

Ethics approval and consent to participate.

Ethics approvals were obtained from Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research (project number DR03171), Central Australian Human Research Ethics Committee (CA-19-3493) and the Western Australian Aboriginal Health Ethics Committee (WAAHEC-938). All methods were carried out in accordance with the guidelines set by all three ethics committees. Informed consent was obtained from all participants of this study.

Consent for publication

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Mathew, S., Fitts, M.S., Liddle, Z. et al. Primary health care utilisation and delivery in remote Australian clinics during the COVID-19 pandemic. BMC Prim. Care 25 , 240 (2024). https://doi.org/10.1186/s12875-024-02485-3

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Received : 26 December 2023

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Published : 05 July 2024

DOI : https://doi.org/10.1186/s12875-024-02485-3

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