ASTMH Leadership Advises Against Closing US Doors to Immigrants

Updated: 3/15/2017 at 5:45 PM

The anti-immigration rhetoric expressed throughout the 2016 presidential election certainly offended a number of minority groups—and recent arrivals—to the United States.

However, a team of experts in infectious diseases, public health, epidemiology, and biosecurity fear such “closed-door” as restricting immigration and/or reducing and/or eliminating foreign aid for the management of infectious diseases may ultimately do more than ruffle feathers. They could, in fact, put the United States and the entire world at greater risk for epidemics and pandemics.

Indeed, this point of view has been supported by numerous studies, including an analysis published in 2005 in The New England Journal of Medicine, which found that US-funded expansion of directly observed treatment, short course (DOTS) strategy in managing tuberculosis (TB) in Mexico—to the tune of an estimated $34.9 million—would have resulted in 2,591 fewer cases of the disease in the United States, as well as 349 fewer deaths. Furthermore, providing support for additional tuberculin skin testing in addition to radiographic screening of legal immigrants from Mexico would have resulted in 401 fewer cases of TB in the US.

In a commentary published on January 13, 2017, by The American Journal of Tropical Medicine and Hygiene (AJTMH), the current leadership of the American Society of Travel Medicine and Hygiene (ASTMH) argue that it is “essential to maintain established US policy toward human migration and global health that is evidence-based and upholds the value of compassion, as well as key principles in international human rights law… [because] experience informs us that limiting migration and the flow of refugees will, by itself, have little impact on the control of infectious diseases.”

While the authors acknowledge that travel restrictions “may be warranted under extreme circumstances of epidemics and pandemics,” based on World Health Organization (WHO) guidelines, they note that research evidence suggests that such restrictions have limited effect, and send a negative message to the rest of the world. Their commentary effectively represents a position statement for the ASTMH, with the leaders/authors pledging to continue working with political leaders and “global health stakeholders in support of evidence-based policies and programs” designed to ensure public health in the United States and abroad.

“We are concerned that the disease and/or public health implications of refugees and immigrants to the United States have been overblown,” commentary co-author Philip J. Rosenthal, MD, AJTMH editor-in-chief and a professor at the University of California San Francisco School of Medicine told Contagion^TM. “The numbers of other types of travelers far outnumber refugees and immigrants, and refugees and/or immigrants undergo careful medical checks, limiting their risk of spreading disease.”

More importantly, though, Dr. Rosenthal and his co-authors—a veritable “who’s who” of public health opinion leaders that includes Daniel G. Bausch, MD, of the WHO Epidemic Clinical Management Unit, Pandemic and Epidemic Diseases, and a professor in the Department of Tropical Medicine at Tulane School of Public Health and Tropical Medicine; Stephen Higgs, PhD, director of the Biosecurity Research Institute at Kansas State University; N. Regina Rabinovich, MD, MPH, of Harvard T.H. Chan School of Public Health; David R. Hill, MD, professor of infectious diseases at Quinnipiac University’s Frank H. Netter, MD, School of Medicine; Christopher V. Plowe, MD, MPH, of the University of Maryland School of Medicine’s Institute for Global Health; Karen A. Goraleski, ASTMH executive director; and Patricia F. Walker, MD, of the University of Minnesota and HealthPartners Travel and Tropical Medicine Center—emphasize that the United States “must continue to engage and invest in programs that improve the health of vulnerable populations worldwide,” stating that this should be viewed as a “fundamental and perhaps defining American principle.” They note that such global research outreach has not only benefitted those in “vulnerable populations” in the developing world, but has also helped protect US citizens from infectious disease threats and by serving a supporting role in diplomatic efforts.

“It is in the best interest of the US to maintain our infectious disease control and research efforts around the world,” Dr. Rosenthal said. “Decreasing our efforts to control and understand infections in the developing world will put the United States at risk of increasing problems with a range of infections.”

The key to this, Dr. Rosenthal and his colleagues write, will be continued funding for federal agencies that “support global health research and service,” such as the National Institutes of Health, the Centers for Disease Control and Prevention, and the US Agency for International Development, among others.

ASTMH released an updated statement on March 9, 2017, stating, "This Order will continue to impede solutions to global issues that require scientists, students and health professions to further their knowledge, conduct research and participate in scientific conferences in the search for solutions to tropical infectious diseases. Academic exchange in tropical medicine and global health is by its very nature based on bilateral exchange; travel is critical to progress. Furthermore, any restrictions on movement of refugees should follow key principles of international human rights law and be done in consultation with national and international medical experts in refugee health. The American Society of Tropical Medicine and Hygiene will continue to support evidence-based policies and programs that protect the health of people inside and outside the United States. This will require national and international collaboration.​"

Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous healthcare-related publications. He is the former editor of Infectious Disease Special Edition.