by Craig Klugman, Ph.D.
In the 2019 BBC/HBO fictional near-future mini-series Years and Years, people deemed by a totalitarian U.K. government as undesirable—including immigrants and political dissidents—are placed into concentration camps. As Vivienne Rook, populist and fascist Prime Minister, says in response to overcrowding in the camps, “They simply let nature take its course. The camps were crowded, pestilent, and rife with disease. On the one hand that was regrettable. On the other hand, fitting. Because a natural selection process took place, and the population of the camps controlled itself. You might call it neglect, you might call it efficient”. In other words, when people are in enforced crowded situations, infectious disease gains a foothold and tends to kill a large number of people.
In a chilling acting out of fiction, the U.S. Customs and Border Protection agency has stated that it will not be vaccinating migrants in their charge against the flu. CBP stated in an email to Congressional representatives, “Due to the short-term nature of CBP holding and the complexities of operating vaccination programs, neither CBP nor its medical contractors administer vaccinations to those in our custody.”
FLU BASICS
Since August 1, at least three children in CBP custody have died from the flu. In the 2017-2018 flu season, the Centers for Disease Control and Prevention estimate over 79,000 deaths, 959,000 hospitalizations, and 48.8 million ill people. Among minors, the CDC estimates 186 deaths from the flu, mostly in unvaccinated children.
The flu is a highly contagious virus. According to the CDC,
People with flu can spread it to others up to about 6 feet away. Most experts think that flu viruses spread mainly by droplets made when people with flu cough, sneeze or talk.These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. Less often, a person might get flu by touching a surface or object that has flu virus on it and then touching their own mouth, nose, or possibly.
The CDC offers several recommendations to prevent the spread of the flu: avoid close contact, stay at home (and away from others), clean your hands often, clean often-touched surfaces, and get plenty of exercise, rest, and nutritious food. The agency also recommends that everyone over age 6 months should receive an annual flu vaccination.
AN EPIDEMIC IN THE MAKING
The U.S. concentration camps (for more on why I am using this term, click here) are reportedly overcrowded. Often there is not enough space for people to lay down. Reports earlier this summer told of the facilities lacking soap and clean clothes and linens. An Office of the Inspector General report from July 2019 found overcrowding and a lack of sanitation, health care, and nutritious food. Given CDC reports on how the flu spreads and how to prevent spreading, it is clear that conditions in the camps are ripe for a flu outbreak. This should not be surprising considering there have already been outbreaks of mumps and chickenpox in 39 concentration camps. Ten percent of adults in ICE custody (5,200 of 52,000) are currently under quarantine for these two diseases. Other communicable diseases have also infested the camps including scabies, shingles, and lice. It is not a question of will there be a flu outbreak but when and how many will be hurt.
On top of this announcement, the Trump administration has issued a change to immigration policy that anyone who receives public assistance can be denied permanent residency simply for using services, which may include medical vaccination (the “may” is because the rules are extensive and unclear). Since this announcement, fewer immigrant families have been seeking vaccines for their children. The result is a larger pool of unvaccinated hosts for 2019-2020 flu viruses. Some people cannot be vaccinated due to allergies in components of the vaccines and while normally protected by herd immunity, they may be at greater risk this year. These policies are a threat to the entire nation’s public health since we are all more likely to be exposed this year. Another result may be further stigmatization of immigrant communities because they may be blamed for a bad flu season. This would only fuel further anti-immigrant sentiment and xenophobia.
VIOLATING PUBLIC HEALTH ETHICS
In public health ethics, protecting the public from health harms is a paramount virtue (solidarity). In this principle, governments have an obligation to prevent the spread of disease to reduce morbidity and mortality in a population. A second virtue is efficacy, that a public health policy should be based on sound scientific evidence and be culturally/politically/socially feasible. The science on the effectiveness and safety of vaccines is solid. Vaccines, especially flu vaccine, save lives and prevents illness. Preventing access to vaccines when people can benefit from them violates public health ethics. Not protecting the general public from a preventable disease violates public health ethics.
So why is the government taking this approach? There is no reliable evidence supporting a reason but there are several possible explanations from the mundane to the conspiratorial.
Is the government trying to save money? A dose of flu vaccine ranges from $13 to $19. The cost of treating flu spans from $300 (at home) to over $4000 (hospitalization). Thus, cost savings cannot be a reason for this shift in policy. Is the executive branch trying to court anti-vaccine proponents to its support base? Possibly. Or is the government secretly adopting a Years and Yearspolicy of passive killing migrants and refugees through infection? Intriguing, but there is no evidence.
From a bioethics principles approach, there are problems in this policy as well. Many of these parents (if not most) might choose to vaccinate themselves and their children. They have the autonomy to make this choice, but, the U.S. government is preventing them from making that choice. According to Section 25 of the U.N. Declaration of Human Rights, everyone has a right to adequate medical care, especially children. That the U.S. is flouting and ignoring international conventions is not surprising, but still remains morally deplorable. These policies not only endanger others (violate justice) but they also remove choice (violate autonomy) and place people’s health at risk (violate nonmaleficence and beneficence).
CALL YOUR REPS
The U.S. needs to change these harmful rules that threaten the health, well-being, and safety of immigrants, refugees, minority communities, and the public-at-large. We can call our Congressional representatives and demand they pass laws to countermand these inhumane policies. We can demand that our senators and representatives investigate the reasons for these changes. The science of epidemics has been known for thousands of years. We ignore it at our own peril. Protecting health and providing medical care cannot become subject to political expediency (even though they always are). Years and Years is fictional; we do not have to take it as a blueprint for draconian cruelty.