It’s winter in Australia and for the first time in three years, thousands of residents are flying to the Indonesian island of Bali for a July school holiday in the sun.
But Australian officials are growing concerned about what they will bring home and are considering advising travelers to leave their flip-flops – known in Australia as thongs – in Bali.
Foot-and-mouth disease (FMD) is spreading quickly through cattle in Indonesia, and on Tuesday the first cases were confirmed in Bali, a popular tourist destination with direct flights to seven Australian cities.
“Foot-and-mouth disease would be catastrophic if it reached Australia,” said Mark Schipp, the country’s chief veterinary officer, who advises the government on how to keep the virus out.
FMD is harmless to humans but causes painful blisters and lesions in cloven-hoofed animals such as cattle, sheep, pigs, goats and camels, preventing them from eating and in some cases causing severe lameness and death.
The disease is considered the top biosecurity threat to Australian livestock and an outbreak could lead to mass culling of infected animals and paralyze Australia’s lucrative beef export market for years to come.
“The impact on farmers if foot-and-mouth disease hits is too heartbreaking to even consider,” said Fiona Simson, President of the National Farmers’ Federation. “But it’s not just about farmers. Taking $80 billion off Australian GDP would be an economic catastrophe for everyone.”
Australia has begun tightening biosecurity checks at airports, screening luggage for meat and cheese products and warning tourists that dirt on their shoes could inadvertently cause Australia’s first FMD outbreak in 150 years.
But one control that has yet to be introduced are footbaths – containers of powerful chemicals that newcomers step into to kill traces of the disease they may be carrying on their shoes. The problem is that shoes typically worn in laid-back Bali are not compatible with standard biosecurity measures.
“A lot of people coming back from Bali don’t wear boots, they wear flip-flops or thongs or sandals, and you can’t really afford to get that chemical on your skin,” Schipp said.
He said officials are considering telling tourists to check their shoes.
“To wear no shoes at all or to leave the shoes behind,” said Schipp. “If you wear thongs in Bali, leave them in Bali.”
The advice has not yet become an official directive and is one of several options being considered, he added.
Foot-and-mouth disease is already spreading rapidly in Indonesia, where the first cases were detected in April. By May, Indonesian authorities had alerted Australia, which — along with New Zealand, Central and North America and continental western Europe — is FMD-free.
Indonesia tried to introduce a vaccination program, but as of June 27, only 58,275 of the country’s roughly 17 million herds had been vaccinated. said Agriculture Minister Syahrul Yasin Limpo in a tweet.
Schipp said the slow rollout reflects the logistical challenges in a decentralized country made up of thousands of islands.
“You can make the vaccine available at the national level, but it has to get to the provincial and district levels. And when it gets there, how are we going to get that into the animals? We don’t have yards. We can’t catch the cattle. We have no money for gas. We don’t have money for lunch money,” he said.
“Those are the logistical issues we’ve been trying to work with them.”
The timing of the outbreak was catastrophic in Indonesia, coming weeks before Idul Adha, the “Feast of Sacrifice” when animals are usually sold in bulk for slaughter, for three days beginning July 10. After the families have prayed and eaten together, they sacrifice cattle and distribute the meat to the poor.
Mike Tildesley, an expert in infectious disease modeling at the University of Warwick, told CNN it’s not the slaughter that dramatically increases the risk of infection, but the “considerable movement of animals leading up to festivals”.
“We see this in Turkey – there is a festival every year called Kurban (where FMD is endemic) which also involves the slaughter of significant numbers of cattle, preceded by large cattle movements across the country and an increase in reported FMD cases is typically seen when this happens,” he told CNN in an email.
“Transmission can also occur through contact with carcasses, particularly in the first few hours after slaughter, and therefore great care must be taken when disposing of potentially infected carcasses,” he said.
As of July 7, the outbreak in Indonesia had spread to more than 330,000 animals in 21 provinces, according to the Ministry of Agriculture. Thousands more doses of vaccine had arrived from France and more than 350,000 animals had been immunized.
When foot-and-mouth disease was discovered in sheep in the UK in 2001, the results were devastating. At the time, government contingency plans covered infection at 10 properties, according to a government report.
Instead, the disease spread to 57 locations before it was detected, and then a lack of coordination slowed the rollout of emergency vaccinations. More than 6 million animals have been killed in the seven months to eliminate the virus.
The UK was reinstated on the list of FMD-free countries the following year, but the impact went well beyond trade.
The report found that “tourism suffered the greatest financial impact of the outbreak, with UK and rural visitors being put off by initial blanket closures of footpaths by local authorities and media images of pyres”.
The entire episode cost the government and private sector a combined £8 billion ($9.5 billion).
Other countries have learned from the UK’s response and if an outbreak is detected a movement ban is usually imposed before animals are culled and sites decontaminated.
For Australia, vaccinating animals is only an option once the virus has entered the country because trading partners do not distinguish between a vaccinated animal and a sick animal.
“If we vaccinated preventively, we would lose our animal health status as a foot-and-mouth disease-free country and we would lose our trade and market access,” Schipp said.
Ross Ainsworth, a 40-year-old veterinarian who lives in Bali, says it’s too easy for tourists on the island to come into contact with cattle and bring the virus home.
“There’s cattle everywhere, and those cattle will get infected and they’ll shed virus,” he said. The virus can stay alive on the sole of a shoe for a few days, or a little longer when it’s colder, he said.
“So if you left your villa and stepped in infected saliva and got in a cab and flew home, you might have viable virus on your foot for another day and a half,” he said.
The National Farmers’ Federation has welcomed the increased biosecurity checks but says the government should “continuously review” security settings and potentially biosecurity inspection all incoming travelers from high-risk areas.
“Every person should at least be questioned by a biosecurity officer if not subject to an inspection,” said NFF President Simson. “We also need to continue to look at shoe disinfection stations as an option,” she said.
“Whatever it takes. We don’t want to look back and wish we had done more.”
Until potentially contaminated shoes are thrown away or foot baths become mandatory, Schipp says the best defense is reconnaissance. Promotional campaigns are being rolled out at airports and on social media – but Schipp said that doesn’t mean telling tourists to stay away from cows.
“Seeing cattle in Bali is part of the experience,” he said. “But it’s easy to wash your hands and make sure your boots are clean before you come home.”