Infectious Diseases Making the Border Crisis Worse

By Andrew R. Arthur on March 13, 2019

The so-called "anti-vaccination" movement has been in the news of late. For example, the New York Times ran an opinion piece captioned "Measles Is Making a Comeback. Here's How to Stop It" in which its editorial board took on what it termed "anti-vaccine propaganda and vaccine misinformation". In the midst of this campaign, however, there has been scant attention paid to the dangers of our current border crisis as they relate to the outbreak of serious contagious diseases in the United States.

Interestingly, a recent article from Reuters ("Mumps, other outbreaks force U.S. detention centers to quarantine over 2,000 migrants") failed to make the connection, although it spoke in explicit detail about detained aliens who were quarantined because of exposure to vaccine-preventable diseases. The key paragraph in that article (from my perspective) states:

ICE health officials have been notified of 236 confirmed or probable cases of mumps among detainees in 51 facilities in the past 12 months, compared to no cases detected between January 2016 and February 2018. Last year, 423 detainees were determined to have influenza and 461 to have chicken pox. All three diseases are largely preventable by vaccine.

Interestingly, that column does not focus on whether most or any of those detainees had mumps, influenza, or chicken pox at the time that they were taken into custody, although that would appear to be a very salient point. Instead, it focuses on the response of U.S. Immigration and Customs enforcement (ICE) to those potentially exposed to those diseases and the effect of quarantines on the ability of those detainees to appear in court.

These are important points and, as an immigration judge, I regularly had to continue cases involving respondents who were in so-called "negative airflow" detention (that is, quarantine) because they had one communicable ailment or another or had been potentially exposed to someone who did. As the name "negative airflow" suggests, disease is not contracted in a vacuum. It has to come from someplace.

I briefly alluded to the dangers of foreign nationals crossing the border with one of these illnesses in a February 2019 post about the increasing costs to the Border Patrol of providing humanitarian aid:

In FY 2018, the [Yuma] sector [of the Border Patrol] incurred more than $700,000 in medical care costs to cover 1,700 aliens who were apprehended and who had to be transported to the hospital. ... Other aliens show up sick, particularly children, some of whom are suffering from illnesses not generally seen in modern American society, including mumps, measles, and tuberculosis, as well as others with influenza, scabies, and other skin diseases. Plainly, the Border Patrol is not able to turn these individuals away without treatment.

It is important to note that the possibility of aliens crossing the border with communicable diseases is not a recent subject. In fact, concern about diseases crossing borders is not unique to the United States or even modern times. The Centers for Disease Control (CDC) notes that:

The practice of quarantine, as we know it, began during the 14th century in an effort to protect coastal cities from plague epidemics. Ships arriving in Venice from infected ports were required to sit at anchor for 40 days before landing. This practice, called quarantine, was derived from the Italian words quaranta giorni which mean[s] 40 days.

CDC then goes on to discuss government efforts to prevent diseases from crossing the border into the United States from the foundation of this country to the present.

Reflecting those concerns, the first ground of inadmissibility in section 212 of the Immigration and Nationality Act (INA) relates to "health-related grounds", including a requirement that immigrants prove that they have been vaccinated for mumps before they can be admitted. A part of any adjustment hearing is when the immigration judge opens the sealed envelope from the examining physician relating to the applicant's health to ensure that said applicant is not inadmissible under this ground.

The changing demographic of aliens who are entering the United States illegally (unaccompanied alien children (UAC) and family units from Guatemala, Honduras, and El Salvador, as I described in great detail in recent testimony before the House Appropriations Committee's Labor-HHS subcommittee) heightens the danger that such diseases will make their way to this country.

With respect to youths, for example, the World Health Organization (WHO) states: "Mumps is an acute disease of children and young adults." And notably, in September 2018, GardaWorld reported:

The Honduran Ministry of Health announced a medical state of emergency on Wednesday, September 19, for northern Cortés department amid an ongoing mumps epidemic that has infected at least 5500 people since January. Cortés department is among the areas most affected by the outbreak with 3788 cases reported — 855 of which have been reported in the region's capital, San Pedro Sula. Health authorities estimate that 3.2 million adults are susceptible to the disease due to low vaccination rates and have expanded a nationwide measles, mumps, and rubella (MMR) vaccination program to stop the spread of the disease. [Emphasis added.]

As the Center has previously noted, a migrant caravan left the city identified, San Pedro Sula, the next month.

None of this should be understood as a stigmatization of children or of migrants from Central America. Regular immigration, in which a foreign national obtains a visa from a U.S. consulate abroad and travels to this country through a port of entry, however, provides for the screening of foreign nationals before they arrive in this country and interact with the public, including other foreign nationals lawfully present.

Irregular migration, on the other hand, by which a foreign national enters the United States illegally between the ports of entry, does not provide any of those safeguards. Once they are here, they are here, regardless of whether they are apprehended and detained, or make their way to their final destinations without apprehension.

These points echo ones previously made by Peter Edelstein, M.D., in Psychology Today in January 2017, shortly after Donald Trump's inauguration:

In the end, it is hard to completely ignore the health risks posed by those whose entry into the country avoids medical examination and treatment. Whether you sit on the "build a wall" end of the spectrum or the "they're just seeking a better life" end, accepting that treatable major health risks are freely entering into our general population is an unwise strategy, regardless of your political leaning (assuming those risks are meaningful, a debate we can have). [Emphasis in original.]

Despite this more than two-year-old medical advice, this is an issue that few have considered. The danger posed by communicable diseases, however, is yet another reason to discourage a wave of aliens who are only apprehended after they have entered the United States, as we have seen in recent months. Especially from places that have recently been under "medical state[s] of emergency" for contagious diseases.