Asylum seekers are no public health threat
Many issues with COVID-19 have led to a discomforting conflation of politics and science: the value of masks, when to forbid gatherings and whether vaccines will stop transmission. In some cases, we needed new evidence to make the policy decision. In others, there were tradeoffs with economic or liberty concerns. Yet, on one issue, the public health scientific community has been of one voice: There is virtually no logic to closing the border to asylum-seekers to prevent the public from contracting COVID-19.
In March 2020, the Centers for Disease Control and Prevention under the Trump administration issued a public health order, commonly known as Title 42, empowering border agents to immediately expel migrants attempting to cross the border, depriving them of the right to seek asylum. This has been widely criticized by medical experts as being divorced from public health principles. The CDC’s own scientists repudiated the policy at its inception when the Trump administration’s immigration officials overrode the agency’s health experts and instituted a deterrence policy that had been planned long before the arrival of COVID-19. As former CDC scientists, it is difficult to overstate what a very bad mistake this order has been in terms of damaging the institution’s scientific credibility, undermining staff morale and tarnishing the nation’s image abroad.
While SARS-CoV-2 is a novel virus, methods of disease prevention are not. The CDC and its predecessor agencies have a long history of recommending quarantine-type measures to prevent disease transmission. In decades past, immigrants and travelers were often tested for tuberculosis, for example, depending on their country of origin. During the 2014-16 Ebola outbreak, returnees from affected West African countries were required to check their temperatures and report into their local health department daily for three weeks. In these and other instances where the U.S. government placed restrictions on travelers in the name of public health, before COVID-19, they were based on one of two cornerstones of logic. Either the people targeted had been diagnosed with a contagious health condition, or their circumstances put them at dramatically higher chances of having the infection of concern than the average American. Neither of those cornerstones of quarantine logic apply with this CDC COVID-19 order, which expels migrants regardless of their COVID-19 status. We no longer deny entry on the basis of HIV, leprosy or tuberculosis. And as with those diseases today, we have tools to treat and contain COVID-19, yet we are actually expelling people seeking asylum rather than taking the basic mitigation measures we have used in the past, like testing and isolation where needed.
Indeed, there is virtually no disease-control rationale behind these Title 42 expulsions. First, there is no basis for singling out migrants given that all travelers in general may pose some COVID-19 risk. People seeking asylum, however, make up less than 1 percent of the inbound traffic arriving at the southern border each day. Truck drivers or U.S. citizens traveling for leisure now cross the southwest border without being tested or even screened for COVID-19, unlike incoming migrants.
Second, over virtually the entire outbreak, people in
Mexico or Central America have been less likely to be carrying the virus that causes COVID-19 compared to the U.S. general population, which has consistently led the hemisphere in COVID-19 cases and deaths. Evidence recently filed in federal court shows that only 1.14 percent of asylumseekers in Mexico tested positive for COVID-19, far lower than the positivity rates currently seen in the United States.
Third, unlike every quarantine example we know of, the main justification for the Title 42 order centers on the heightened risk of infection posed by keeping asylum-seekers in crowded facilities and for extended periods. However, these risks are created by the U.S. government’s own policies, which focus almost entirely on detaining or expelling migrants.
Evidence-based public health strategies such as offering vaccinations; deploying rapid COVID-19 tests during processing; shifting some processing to outdoor settings; and promoting masking, distancing, and improved ventilation can all reduce transmission risks but have instead been underemphasized. Most importantly, shortening detention and processing times reduces crowding. More than 90 percent of asylum-seekers have loved ones in the U.S. with whom they are attempting to reunite. During the Obama administration, allowing asylum-seekers to stay with such contacts was far more common; a pilot program in five cities that kept “asylumseeking kin together” resulted in 98 percent of applicants attending their assigned court hearings.
Finally, and most seriously, unlike the tens of thousands who cross the border daily without being detained, people seeking asylum are often fleeing for their lives. Many will eventually be killed or harmed after being expelled into the hands of gangs and cartels in Mexico.
Every public health intervention requires weighing costs and benefits. Yet, the Biden administration’s legal documents defending the renewed order completely ignore the harms induced. From an international perspective, this order, which seeks to justify a pre-existing Trump administration anti-immigrant policy, has become inextricably linked with the immigrant deterrence policy of separating children from their families — an act that occurred over 5,000 times during the Trump administration. Unsurprisingly, the U.N. High Commissioner for Refugees has called for an end to Title 42 and singled out the United States for enacting the most onerous border restrictions against the most vulnerable compared to many countries, including most of Europe, that have kept their doors open to asylum-seekers. A
recent Supreme Court ruling, imposing roadblocks to winding down an overlapping Trump-era policy, the Migrant Protection
Protocols (more commonly referred to as “Remain in Mexico”), compounds the harms imposed by Title 42 and elevates the urgency of bringing the order to an end.
This order is bad science. It is bad policy. And it induces an extremely negative international image. It needs to be rescinded. Kachur, MD, MPH, is a Columbia University public health professor and the former chief of the Malaria Branch at the the Centers for Disease Control and Prevention. Roberts, MSPH, PhD, is a public health professor at Columbia University and a former epidemic intelligence service officer and senior assistant scientist at the CDC.