How the Trump administration’s anti-immigrant stance threatens human rights, public health, and the lives of people living with TB
By Erica Lessem and Suraj Madoori
Perhaps the most recognizable symbol of the current presidential administration and the campaign that led Donald Trump to the White House is the wall. In 2015, then-candidate Trump first announced his intention to build a wall between the United States and Mexico. Now his administration is implementing its even broader anti-immigrant agenda, with grave consequences for human rights and public health.
After activists’ hard-fought victories to remove a pernicious travel ban against people with HIV and to stop the quarantining of Ebola response workers, the United States is once again on a dangerous path of implementing stigmatizing immigration and migration policies that threaten to undermine public health and well-being. In particular, those affected by tuberculosis (TB) are at major risk of poor health outcomes and discrimination because TB is an airborne infectious disease and because existing policies and attitudes relating to immigration and TB are already heavily biased against people with TB.
The notoriously alt-right Breitbart Media, formerly helmed by White House chief strategist Stephen Bannon, is already positioning TB as a public health and economic threat to fuel nationalist anti-immigrant rhetoric. Bannon’s closeness to the White House and his association with the controversial travel bans is of critical concern to the TB advocacy community. Despite TB being a relatively rare disease in the United States that receives little attention in the mainstream media, Breitbart has propagated stigmatizing and sensational coverage of TB among foreign-born individuals in the United States, with more than 25 of those stories posted in the six-month period spanning the final months of the election cycle and the presidential transition.
In years past, these stories could have been dismissed simply as the baseless rhetoric of nationalist fringe groups. But with Bannon’s newfound influence on policy as chief strategist to the President, the impact of these stories riding the wave of “alternative facts” must be taken as serious threats to the health and safety of immigrants. Such prejudiced attitudes severely compromise our ability to engage vulnerable populations in prevention work.
TB is preventable and curable;
TB is rapidly rendered noninfectious upon the start of appropriate therapy;
Numerous personal and environmental controls (ventilation, UV light or sunlight, the wearing of respirators) are highly effective at preventing TB transmission;
Recent transmissions of TB in the United States are mostly connected with U.S.-born, rather than foreign-born, individuals;
Refugees make up just 4.3% of the total number of people diagnosed with TB and only 6.4% of the foreign-born people diagnosed with TB;
Foreign-born individuals are most likely to be diagnosed with TB over 10 years after their arrival in the United States.
“TB should never be used as a pretext to stigmatize migrants or justify discriminatory policies,” clarifies Peter Davidson, president of the National Tuberculosis Controllers Association (NTCA). “People migrating to the U.S., including and especially refugees, are not arriving to the U.S. sick or infectious and do not pose a risk to the communities in which they settle. TB is a major threat in the U.S., but one that can be best addressed through a robust public health response, not through immigration controls.”
However, people migrating to the United States have long been subject to cumbersome and often archaic TB screening and control policies (see table). TB is still a quarantinable disease according to U.S. law, a fact that can easily be exploited to deny people affected by TB to stay in the United States.
Indeed, the evidence indicates that the most effective and economical path toward eliminating TB as a public health threat in the United States would be an aggressive, two-pronged approach that mobilizes public health resources and deploys the latest scientific advances. First, we must empower TB controllers with more resources to focus on TB prevention—identifying those individuals most at risk for developing active TB among the millions in the United States with latent TB infection and providing them with safe, effective, and easy treatment. The Division of Tuberculosis Elimination (DTBE) of the U.S. Centers for Disease Control and Prevention and the NTCA have created a robust prevention plan, but though the plan costs only an estimated $40 million per year, which would be rapidly offset by projected savings from cases averted, the sorely underfunded DTBE does not currently have resources to support this work. Second, increased U.S. leadership on and investment in global health security for TB would help reduce the global burden of disease and the resulting impact of TB on the United States. Modeling by Schwartzman and colleagues showed that investing in other countries’ infrastructure to respond to TB would ultimately save costs in the United States.
The implications of anti-immigrant policies on both science and health care are frightening. Over half the biomedical researchers in the United States are foreign born; travel bans and other policies that deter migration to the United States will be a huge blow to science. On the delivery side, stigmatizing noncitizens, isolating them through fear, and removing access to social services not only violates individual rights but also creates a breeding ground for public health threats that could actually cost taxpayers much more than providing services up front would. The continued unchecked proliferation of anti-immigrant messaging could allow for the use of discriminatory immigration policy as a “public health” strategy, justifying the shirking of U.S. commitments to support global TB elimination and other diseases.
One of the paradoxes of TB is that the body walls off the bacteria to sequester the infection, but this creates conditions in which TB can multiply, damage tissues, and spread. Now consider the political and social conditions: the Trump administration’s isolationist immigration and foreign policies also foster the conditions for TB to flourish, transmission rates to worsen, and stigma to thrive. We must not mimic the body’s perverse attempt at disease control by creating political or actual walls that will cut people off from needed services. Leading with science and strengthening public health defeated nonsensical travel bans for people with HIV and halted the knee-jerk policy response to the Ebola crisis; these will be the same strategies needed to protect the rights and fight the stigmatization of communities vulnerable to TB.