PIH Leaders Call on CDC, President Biden to Stop Blocking Asylum Seekers 

Dear President Joseph Biden: Stop using public health as a pretext to block asylum seekers at the United States borders. 

That’s the message from a new Perspective piece in The New England Journal of Medicine, written by Partners In Health leaders and collaborators. 

At issue is a March 2020 order by the Trump Administration overriding national and international legal protections for asylum seekers at the U.S. border and using the COVID-19 pandemic as the rationale to do so. 

The “Title 42” order, which has been extended by the Biden administration, “suspended the right of these migrants to have their claims heard and singled them out for immediate expulsion,” write the authors, Dr. Anne G. Beckett, assistant professor of medicine and pediatrics at Boston University School of Medicine; Loune Viaud, Partners In Health’s chief gender and social equity officer; Dr. Michele Heisler, medical director of Physicians for Human Rights and professor of internal medicine and public health at the University of Michigan; and Dr. Joia Mukherjee, PIH’s chief medical officer.  

The order, issued by the Centers for Disease Control and Prevention, draws on a previously obscure public health law enacted in 1944 to single out asylum seekers “by reason of the existence of any communicable disease in a foreign country,” essentially arguing that the migrants pose a serious threat of bringing more COVID-19 cases into the U.S. and increasing its spread. At the same time, other travelers, such as students and drivers, were allowed to enter the U.S. without COVID-19 testing, demonstrating a blatant double-standard, which the authors call out: “There is no evidence that noncitizens who lack documentation are more likely to transmit Covid than are residents, citizens, or tourists entering the country.” 

The bottom line, they write, is this: 

“There was — and remains — no public health evidence that singling out asylum seekers or other migrants for exclusion is effective in stemming the spread of Covid-19.”  

Or, as first author Beckett puts it, “The Title 42 order is a racist policy that targets Black and Brown migrants and causes unthinkable harm. President Biden campaigned on a pledge to restore the U.S.'s commitment to asylum-seekers, and instead his administration has increased the use of Title 42. The hypocrisy is staggering: under the false guise of protecting public health, the order has had a devastating impact on the physical and mental health of vulnerable and marginalized migrants who are denied access to a safe asylum process and expelled to dangerous conditions.” 

Moreover, the authors add, by expelling asylum seekers, the Title 42 order violates this country’s obligations to not send migrants back to dangerous regions. Since the order went into effect, the authors say, more than 1.6 million people entering the U.S. from Mexico or Canada have been expelled to countries where they could face persecution or torture, with no chance for asylum. Still, "asylum seekers represent a small fraction of the travelers who cross the border; in the same period in which 1 million asylum seekers were expelled, nearly 100 million other travelers were admitted at U.S. land borders," the authors write.

The health implications are severe: people who “already had experienced much trauma from persecution in their home countries have been even further traumatized, with profound mental and physical health consequences,” the authors write. 

People from Haiti seeking asylum in the U.S. have been particularly mistreated, says Mukherjee. “The Title 42 order has been disproportionately enforced along racial lines, particularly against Haitian asylum seekers,” she says. “This policy has no public health evidence behind it. U.S. citizens, not Haitian nationals, had a far higher rate of COVID-19.” She notes that Haiti is in the midst of a political crisis, and to deport asylum seekers into such insecurity and violence against the backdrop of a pandemic is “immoral and even lethal.” 

The piece also takes on several myths surrounding the order. For instance, one justification rests on the assumption that migrants must be held in “congregate settings,” typically crowded quarters that can drive infections. But there are alternatives, the authors write, for instance, “programs that allow migrants to shelter, under parole arrangements, within the community have been demonstrated to be effective alternatives to facility-based detention;” indeed, such programs are associated with “improved health outcomes...excellent compliance with immigration court requirements, at a fraction of the cost of detention.” 

Medical and public health practitioners must advocate for the end of the misuse of the Title 42 order, the authors conclude. They must do this “through the use of evidence-based Covid-mitigation measures at the border, including avoidance of inhumane and unnecessary immigration detention, rapid expansion of vaccine access, and implementation of data systems with public reporting to ensure the protection of the health and rights of asylum seekers. As the CDC considers extending the order yet again, health professionals should join in calls to the agency and to Biden to end the misuse of Title 42.” 

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