January 2022 Letter on Vaccination at the Southern Border
Hon. Xavier Becerra
Department of Health and Human Services
200 Independence Avenue, SW
Washington, DC 20201
Hon. Alejandro Mayorkas
U.S. Department of Homeland Security
3801 Nebraska Ave NW
Washington, DC 20016
Dr. Rochelle Walensky
Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30329
January 28, 2022
Dear Secretary Beccerra, Director Walensky, and Secretary Mayorkas:
Since the beginning of the pandemic, our coalition of public health experts, epidemiologists, and physicians has repeatedly written to the Centers for Disease Control and Prevention (CDC), the Department of Homeland Security (DHS), and the Department of Health and Human Services (HHS) to express our grave concerns about the lack of public health rationale for the March 2020 Title 42 order, which has since been renewed and adapted multiple times. Two years into this pandemic, it is clear that the Title 42 order is nothing more than a politically expedient measure that exploits the COVID-19 pandemic to expel or block from the country people seeking asylum.
In light of recent reports that the White House may be considering COVID-19 vaccination as a requirement imposed upon those seeking asylum at the border, we write to express our strong support for the provision of vaccines, including boosters, but also our concern that vaccination not be used as a tool to further delay, restrict, or block asylum seekers from exercising their right to seek asylum in the United States. While vaccines should be provided and be made available, public health concerns do not require or justify the imposition of vaccination as a condition for seeking asylum. As a group of public health experts, we acknowledge that vaccination, alongside other public health measures, serves as an important instrument in protecting individuals – both citizens and migrants – from COVID-19 and its potential harms. The use of vaccination as part of an integrated and layered public health approach to protecting asylum seekers and host communities is welcome and should be strongly encouraged; however, it must be guided by the advancement of individual and public health and be grounded in the evidence and in good public health practice to be effective. On no account should vaccination be used as a tool of immigration control or enforcement. With that in mind, the implementation of safe and effective vaccination of asylum seekers requires that:
Vaccines should be offered to asylum seekers and migrants without discrimination, safely, and in a timely manner after their arrival or entry to the United States. The inability of the United States government to vaccinate asylum seekers – be it due to vaccine shortages, lack of appropriate personnel or logistical support, or any other reason – cannot be used as a justification to deny, filter, or “meter” access to refugee protections.
Under national and international law, asylum seekers and refugees should under no circumstances be required to be vaccinated as a condition for entering the United States. Moreover, an individual who feels unsafe in their country of origin or transit due to persecution by the government or government inaction cannot be expected to have access to government resources such as vaccination.
Asylum seekers should not be detained, or have their detention prolonged, on the basis of their vaccination status. Although vaccination should be offered to asylum seekers and other immigrants who are otherwise detained, opportunities for vaccination are widely available throughout the United States. Those who do not receive a vaccination during processing, as well as individuals who need a second dose or booster, should be provided with informational resources and encouraged to seek this out at the appropriate time after they arrive at their family’s homes or other community destinations.
Recognizing the power imbalance, high rates of distrust, and potential for coercion of new arrivals by Customs and Border Patrol (CBP) and U.S. Immigration and Customs Enforcement (ICE), vaccination should be provided by trusted interlocutors outside of DHS such as independent medical providers, public health authorities, or civil society organizations. Vaccine hesitancy remains a significant challenge globally, and asylum seekers, who are in a vulnerable position, may experience vaccine hesitancy as well. Fortunately, guidance regarding addressing misinformation and vaccine hesitancy is amply available and includes approaches that allow for provision of culturally and linguistically appropriate information from reliable, community-based sources and ample time for questions.
Vaccination is one element of a layered and integrated approach to safeguarding public health. Non-pharmaceutical public health measures – such as timely testing; accessible, high-quality (KN95 or N95) masks; adequate ventilation; and social distancing – remain necessary components to stopping the spread of COVID-19. The Omicron variant, and the likelihood of future variants of concern that may diminish vaccine efficacy, serve to remind us of the importance of a multilayered health response and the need for CBP to follow evidence-based public health measures.
In conclusion, we urge the provision of vaccination to new arrivals and encourage the use of evidence-based approaches to health communication and public health practice delineated above. We reiterate that vaccination status must not be used to deny individuals their right to seek asylum, itself a life-saving measure that is protected under U.S. and international law.
Megan Coffee, MD, PhD, Infectious Disease Specialist and Assistant Professor, Columbia University’s Mailman School of Public Health
Michele Heisler, MD, MPA, Medical Director, Physicians for Human Rights
Professor of Internal Medicine and Public Health, University of Michigan
Rachel Moresky, MD, MPH, Director of the Columbia Global Emergency Medicine Fellowship and Associate Professor at Columbia University’s Mailman School of Public Health
Paul B. Spiegel, MD, MPH, Professor of the Practice, Health Systems, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Director of the Johns Hopkins Center for Humanitarian Health
Ronald Waldman, MD, MPH, Professor Emeritus of Global Health, Milken Institute School of Public Health, The George Washington University and President and Chair of the Board of Directors, Doctors of the World - USA
Monette Zard, MA, Allan Rosenfield Associate Professor of Forced Migration and Health, Director of the Forced Migration and Health Program, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health