Infectious disease and illegal immigration are a national security and public health threat

Since the 1890s disease screening and surveillance has been a basic component of public health policy associated with immigration into the United States. Public health inspections have a long history during the immigration process and for good reason. The spread of infectious disease throughout human existence is responsible for more deaths than all other phenomena combined in the history of the world. By far, disease has taken more lives than all the wars and battles fought since the beginning of time. We use these analogies only to highlight the potential destructive power disease holds over the morbidity and mortality of human susceptibility.

Most sovereign countries, including the United States, have a process for health screening of refugees and immigrants. The practice is well documented. The immigration of populations to the US in the 19th and 20th Centuries by Irish and European immigrants through Ellis Island was a common practice, fully supported, and accepted as a necessary safety screening process for all those entering the country. These same practices were conducted on the West coast through Angel Island Immigration Station located in San Francisco Bay. Opened in 1910, it was responsible for processing immigrants mainly from China, Japan, and India at the time. Although Ellis and Angel Islands were used as the primary ports of entry, there were many other locations used for detention and quarantine services as well.

In more recent times we have seen an influx of more than ten million illegal immigrants into the United States from over 150 countries, including Mexico, El Salvador, India, Guatemala, Honduras, Venezuela, Cuba, Nicaragua, Brazil, Canada, Haiti, China, Afghanistan, Colombia, the Dominican Republic, Philippines, Europe and the Middle East, including those engaged in or supporting terrorism.

Many of these illegal immigrants enter the United States with no identification and in many instances provide false names to immigration officials. This number does not include more than one million “got-a-ways,” who are totally unidentified or known to authorities. Without proper identification there is no way for immigration authorities to vet any of these illegal entrants, whether they have criminal backgrounds or serious medical conditions.

The distinct difference is that legal immigration allows for responsible health screening processes to be undertaken, whereas illegal migration often prevents the utilization of effective health surveillance.
Current law and guidelines from the Centers for Disease Control and Prevention (CDC), under the regulatory authority of the US Department of Health and Human Services (HHS) require all immigrants, refugees and status adjusters who enter the country to submit to a pre-immigration medical examination that is to be conducted outside the US. However, migrants entering the United States without inspection, including those who entered with and without proper documentation, designated under the category of “other,” are not subject to a medical examination. The purpose for these examinations is to identify applicants with inadmissible health-related conditions (communicable disease) and prevent them from entering into the country.

Our resilience to disease in modern society is somewhat tenuous. The recent increases in influenza strains, tuberculosis, dengue virus, hepatitis B, encephalitis, scarlet fever and others, are clear indication that the continued need for disease surveillance remains a critical public health and national security issue. At present, the number of diseases authorized for Federal isolation and quarantine include cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever, viral hemorrhagic fevers, severe acute respiratory syndromes, and influenza (pandemic strains). To place the health of the US population at risk over emotionally charged, politically motivated rhetoric is irresponsible, to say the least, and arguably demonstrates gross malfeasance. The allowance of individuals into the US without proper health screening is a practice that must be questioned and challenged, if for no other reason than this non-action disregards a fundamental responsibility of governance and places the nation’s population to needless risk. This non-action disregards a fundamental responsibility of governance –that of providing safety and protection to citizens.

However, what is not being addressed is the issue of immigrants entering the US illegally and bypassing all public health screening and quarantines. In the past, infectious diseases such as measles, polo, and Hansen’s disease (leprosy), were reduced or irradicated from the US. Currently, these and other diseases such as chickenpox, malaria, influenza strains, tuberculosis, dengue virus, hepatitis B, encephalitis, Scarlet Fever, plague and others, have seen a rise in cases in recent years. It is unknown if those entering the country illegally are vaccinated against these and other virulent diseases, bringing with them exposure problems affecting the entire US population.
Fiscal impact costs for illegal immigration to the US taxpayer in 2023 was estimated at $150.7 billion. This includes federal, state and local expenditures and receipts involving education, medical costs, justice enforcement, welfare costs, income tax and other taxes. Federal and state medical expenditures alone cost an estimated $41.6 billion. However, what is not captured in these figures is the fiscal requirements for potential treatment of infectious diseases and the direct and indirect costs to the general population, in additional medical care, lost wages, etc. as a result of increased exposure to infectious diseases. Calculation of these costs alone would most likely be considerable.

The time has come for rational and reasonable discussion of this credible threat be brought to the forefront of US policy consideration. We can no longer accept that our public health regulations go unenforced or neglected based on misplaced concerns about compassion and tolerance.
National public health policies must be based on sound medical and health science knowledge. The possibility of allowing a threatening disease to cross our borders without question is unacceptable. People must come to understand this is a public safety and national security issue, not a partisan issue. As a country, we must act responsibly.
As a nation of immigrants, we have built the most generous and accepting country in the world. A country that is built on common sense and a willingness to govern based on knowledgeable practices intended to serve our citizens in the best possible way. Public health surveillance of potential infectious diseases involving immigration and migration of individuals crossing our borders is an established practice. Its current and increasing use is critical to maintaining a safe and secure nation

Strong leadership is needed now to properly frame this issue and awaken the American people to the potential catastrophe that can result from this serious security and public health situation. Congress and every state must take decisive action now to halt the migration of illegal, unvetted and medically unscreened entrants into the United States.

John J. Walsh, Jr., Ph.D.
Adjunct Assistant Professor
Co-Director
Program in Disaster Research and Training
Vanderbilt University Medical Center
Vanderbilt University School of Medicine

Robert J. Bodisch, Sr.
Deputy Director/Chief of Staff (Retired)
Texas Dept. of Public Safety
Texas Homeland Security
Senior Fellow, Center for Security Policy

What we know about unauthorized immigrants living in the U.S., J. Passel and J. Krogstad, Pew Research Center, https://www.pewresearch.org/short-reads/2024/07/22/what-we-know-about-unauthorized-immigrants-living-in-the-us/ retrieved 8/2/24.
Centers for Disease Control and Prevention (CDC), https://www.cdc.gov/immigrant-refugee-health/laws-regulations/index.html, retrieved 8/24/24.
REFORM, F., 2024. The Fiscal Burden of Illegal Immigration On United States Taxpayers 2023, FEDERATION FOR AMERICAN IMMIGRATION REFORM. Retrieved from https://www.fairus.org/sites/default/files/2023-03/Fiscal%20Burden%20of%20Illegal%20Immigration%20on%20American%20Taxpayers%202023%20WEB_0.pdf, 8/15/24.