The CDC's Title 42 order fuels racism and undermines public health

The CDC's Title 42 order fuels racism and undermines public health
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America’s top physician, Dr. Anthony FauciAnthony FauciFauci to appear on Fox Business Friday for rare interview on the network Hawaii reports its first omicron case Glenn Greenwald discusses criticism of Fauci overseeing 'medically unjustifiable' experiments on dogs MORE, had a message for Republican officials who scapegoat immigrants for coronavirus spread:

“Let’s face reality here." 

“The problem is within our own country,” Fauci explained in a recent interview on CNN. “Focusing on immigrants, expelling them... is not the solution to an outbreak.”

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Dr. FauciAnthony FauciFauci to appear on Fox Business Friday for rare interview on the network Hawaii reports its first omicron case Glenn Greenwald discusses criticism of Fauci overseeing 'medically unjustifiable' experiments on dogs MORE is not alone. Many public health experts like ourselves are alarmed that the tools of our trade are being weaponized against the most vulnerable among us. 

To this day, the Centers for Disease Control and Prevention (CDC) continues to back a pseudoscientific and discriminatory policy that the Biden administration uses to carry out mass expulsions of asylum seekers, such as the appalling recent scenes from Del Rio, Texas.

Earlier this week, the Biden administration announced it intends to continue this policy despite the announcement that vaccinated tourists, shoppers, and visitors will now be able to cross our borders, in addition to truck drivers and a long list of other persons dubbed “essential” who were permitted to cross throughout the pandemic. This week’s announcement conspicuously left out one group yet again: Asylum seekers. 

From its inception under the Trump administration, the misuse of “Title 42” to block and expel asylum seekers — despite the objections of senior CDC experts and other public health professionals — was based on political, rather than scientific, considerations, rooted in racist tropes and populistic untruths. 

Now the Biden administration similarly invokes “public health” to justify the expulsion of thousands of people to danger, in violation of both domestic and international laws of asylum.  By continuing to stand by this policy, the CDC is sanctioning the ongoing politicization of the institution, weakening its authority, and decreasing public trust in the agency.  

In its most recent Title 42 order, the CDC notes the emergence of the more infectious delta variant as a key reason for the continued expulsion of asylum-seekers. However, the CDC acknowledges in that same order that mitigation measures, such as masking and social distancing, work to prevent the spread of disease; it even lauds the ongoing program for unaccompanied minors as an example of the protection that mitigation measures provide.

The CDC’s claims that U.S. Customs and Border Protection (CBP) lacks the capacity to implement such measures beyond minors are not tenable. The agency has an annual budget of $18 billion. Moreover, more than 20 months into the pandemic, we have a track record of successfully implementing such mitigation measures by agencies in other U.S. settings. The U.S. asks Pakistan — a country with a fraction of our resources — to keep their borders open to Afghan refugees. We certainly have the capacity to do the same.  

The CDC also justifies the Title 42 order by citing the enhanced risks of COVID-19 transmission in congregate settings. This mistakenly assumes that asylum seekers must be detained, a practice long denounced as unnecessary, inhumane and detrimental to the health of migrants and surrounding communities.

Public health experts have repeatedly recommended other approaches to safely process asylum cases. Community-based initiatives such as the Family Case Management Program, provide high compliance at a fraction of the cost of individual detention. Yet these approaches have been disregarded, as have public health measures that can mitigate disease transmission risks in instances where congregate settings for brief periods cannot be avoided.

The U.S. has a long history of stoking fears of disease to galvanize support for anti-immigration policies. Border Patrol agents on horseback, terrorizing Haitian asylum-seekers, fits this tradition of xenophobia and racism. Sen. Ted CruzRafael (Ted) Edward CruzCongress averts shutdown after vaccine mandate fight On The Money — Congress races to keep the lights on House sets up Senate shutdown showdown MORE (R) of Texas and Florida Gov. Ron DeSantisRon DeSantisHaley hits the stump in South Carolina Democratic frustration growing over stagnating voting rights bills A sad reality: In a season of giving, most will ignore America's poor MORE (R) have blamed migrants for the increased rates of COVID-19 in their states — false narratives that epidemiologists and public health experts have debunked.

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The Title 42 order helps to fuel this rhetoric. As part of its public health mandate, the CDC should dismantle tropes that present migrants as vectors of disease rather than promote them. 

When public health policy is subverted to serve political agendas, or to exclude, control, or discriminate against certain groups, we are all at risk. War, persecution and torture do not pause for pandemics, and the right to seek asylum is enshrined in both domestic and international law

Twenty months into this pandemic, we have an arsenal of proven public health tools, including testing, vaccines and other common sense public health measures that would allow the United States to process asylum-seekers effectively. It is time to definitively end Title 42.

Monette Zard, MA, is the Allan Rosenfield associate professor of Forced Migration and Health, director of the Forced Migration and Health Program in the Heilbrunn Department of Population and Family Health at Columbia University’s Mailman School of Public Health. Michele Heisler, MD, MPA, is medical director, Physicians for Human Rights, and professor of Internal Medicine and Public Health at the University of Michigan. Paul B. Spiegel, MD, MPH, is professor of the Practice, Health Systems, in the Department of International Health at Johns Hopkins Bloomberg School of Public Health and director of the Johns Hopkins Center for Humanitarian Health. Ronald Waldman, MD, MPH, is professor emeritus of Global Health at the Milken Institute School of Public Health at The George Washington University and president and chair of the Board of Directors, Doctors of the World - USA.