Last week, the leaders of four organizations representing infectious diseases and HIV as well as global and domestic public joined me in This time, U.S. officials acknowledged that they will not administer vaccines against seasonal influenza to immigrants in detention.
Their rationale, that vaccination programs are too "complex" to be offered to people in federal detention, and that those being held at the border are being held for "short" periods of time, flies in the face of facts and of the most basic public health tenets and practice. In fact, vaccines are routinely administered to people being held in facilities for the protection of their own health as well as community health. When release is imminent into a community where access to services is uncertain, this only increases the importance of vaccination on both levels.
Current detention conditions include limited access to soap and water, poor sanitation, overcrowding, and the stress of separation from family members -- conditions the Infectious Diseases Society of America, the organization I represent, and other health and human rights organizations, already have spoken out repeatedly against. These conditions heighten the urgency and need for vaccinations as influenza spreads easily when people are crowded together. Vaccination is indispensable to limit infection spread and potential serious illnesses and even death.
The denial of routine healthcare to people because they are in federal custody is a stark violation of law, ethics, and public trust, and a frightening violation of public healthcare principles.
It is all the more astonishing that this could happen here, at a time when leaders in the administration and Congress have demonstrated they understand the importance of the federal government's role in supporting the provision of evidence-based effective and essential medical services -- both as a measure of our values, and in the interests of our common good.
The administration has made that clear as exemplified by the goals of its , which aims to reduce transmissions of the virus by 90% in the next 10 years through expanded outreach, prevention, and treatment efforts with a focus on reaching those who have faced the greatest obstacles to those services.
Congress, in turn, has recognized that undetected, unprevented, and untreated diseases anywhere pose threats everywhere, with increased allocations for the coming fiscal year in domestic and global tuberculosis responses, including the Global Fund to Stop AIDS, Tuberculosis and Malaria, and with continued investments in health systems domestically and abroad such as .
Yet, at least in part due to gaps in federally supervised care, as reports have noted, following a decade during which no child died while in U.S. immigration custody, at least three children have died in recent months after detention in facilities overseen by U.S. Customs and Border Patrol (CBP). The separation of children from their families also continues to challenge the first step in the most basic health services of collecting medical histories, including of immunizations. While Department of Health and Human Services and CDC policies provide immunizations and basic health exams for unaccompanied minors, immigrants, and refugees, the most recent reports open yet more room for doubt on whether any of these policies are being followed. The CBP's current practice of allowing immigrant families to be separated because a parent is living with HIV also runs counter to both federal policy and public health principles.
We can't say we don't know the stakes. According to the CDC, seasonal influenza alone was associated with over 57,000 deaths -- 129 in children -- during the recent 2018-2019 season. During the same season, this country saw the numbers of measles cases exceed those of more than 2 decades due to insufficient vaccine coverage.
Having given lip service to the value of public health for public good, the administration can't hope to evade responsibility for the consequences if it does not reverse the current policy on vaccinations. If it does not, it will be up to Congress to act.
Cynthia Sears, MD, is president of the Infectious Diseases Society of America, professor of medicine at the Johns Hopkins University School of Medicine, and a member of the Johns Hopkins Kimmel Cancer Center and the Bloomberg-Kimmel Institute for Cancer Immunotherapy.