Trump's Executive Order May Have Serious Global Health Implications

President Donald Trump’s executive order banning immigrants/refugees from 7 predominantly Muslim countries, which was signed on January 27th, has generated significant mainstream media coverage as well as large public protests in cities and international airports across the country.

However, while attorneys for the Justice Department battle it out with state attorney generals and human rights organizations—the American Civil Liberties Union (ACLU), among others—over lawsuits challenging the legality and/or constitutionality of the ban (with some components of the order being relaxed as a result), public health and infectious disease experts remain concerned about the global health implications of the “not my problem” philosophy underlying it, to use one expert’s words. Several experts based at Johns Hopkins University Bloomberg School of Public Health gathered on January 31st for an online symposium entitled “The Executive Order on Refugees: An Emerging Public Health Crisis” to discuss these issues and others associated with the ban.

Indeed, the key theme of the event centered on the fact that, for some immigrants from the affected countries—Iran, Iraq, Libya, Somalia, Sudan, Syria, and Yemen—travel and admittance into the United States is “a matter of life and death,” noted 1 of the 9 speakers at the event, Nancy Kass, ScD, Phoebe R. Berman professor of Bioethics and Public Health, Department of Health Policy and Management at the school. “And the sacrifice to us, in the long run, is minimal. In such cases, ethics says we should act. This is a context, if there ever was one, where health and human rights are obviously, inextricably joined.”

Meanwhile, Gilbert Burnham, MD, professor of International Health at Johns Hopkins Center for Global Health, emphasized that the need to act is substantial. He noted that, currently, in Iraq, approximately 10% of the population is displaced, and that a recent survey of 44 refugee camps in the country identified serious health and sanitation problems. At present, he added, access to healthcare is low, due to a shortage of clinicians.

For displaced Syrians, the “health needs are vast,” noted Shannon Doocy, PhD, associate professor at the Center for Humanitarian Health, with most being hosted, at least for now, in Turkey, Lebanon, and Jordan. “It’s a huge population living in limbo, and it will take decades for the health system to recover,” she said. “I think everyone here would agree we have an ethical obligation to continue supporting protection.”

In addition, Leonard S. Rubenstein, JD, senior scientist at Johns Hopkins Center for Public Health and Human Rights, said that the security concerns behind the ban are perhaps moot, at best. “Of the 800,000 refugees admitted to the United States in the last 15 or 20 years, three or four have been accused or alleged to have been involved in some activity involving terrorism,” he said. “Three or four out of 800,000. You don't have to take biostats to know that that's a pretty low percentage. The risk is beyond low—it’s practically nonexistent.”

The speakers advised public health and infectious disease specialists to respond to the ban by getting involved in efforts to stabilize the healthcare systems in the affected countries so that they can better respond to epidemics and other crises; they also encouraged the specialists to establish surveillance programs to track the health of migrants “caught in the pipeline” in order to better identify needs and design programs to help them.

At present, it is difficult to accurately assess the infectious disease-related needs of the populations in the 7 countries listed in President Trump’s executive order, as well as others, given that accessing the at-risk populations can be challenging for clinicians and media alike. However, a study of the prevalence of multidrug-resistant organisms among refugee patients at a hospital in Germany, which has taken in tens of thousands of refugees since 2011, found that more than half (52.1%) tested positive for at least one such organism. The study was published in January by the journal BMC Infectious Diseases.

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.