realistically able to prevent outbreaks of certain diseases . As Dallas , et al . ( 2018 ) observe , “ It is widely argued that undocumented immigration poses a serious threat to herd immunity because the clandestine presence of non-immunized individuals tips this balance — but without the knowledge of responsible authorities . If we have reports which assure us that the required 75 percent of the U . S . population is immunized for chickenpox , in reality , due to the high levels of non-immunized undocumented immigrants , the populations ’ sum immunity would likely to be much lower than the assumed threshold statistic . Such a circumstance places the U . S . in the dangerous position of being significantly at risk , yet unaware and therefore not responding appropriately to the actual real risk .”
Let ’ s examine the public health infrastructure related to immigration . The CDC ’ s Division of Global Migration and Quarantine ( DGMQ ) is tasked with assessing the health of individuals coming to live and work in the United States , including mandatory health screenings for all immigrants and refugees entering the U . S ., as well as overseas vaccination and parasitic treatment programs for refugees . These activities prevent the importation of infectious diseases , particularly tuberculosis , and provide relevant health information for healthcare providers continuing care after refugees arrive in the United States .
The DGMQ ’ s Immigrant , Refugee , and Migrant Health ( IRMH ) Branch works to protect the public health of the United States by safeguarding the health of US-bound immigrant and refugee populations by tracking and responding to disease outbreaks in refugee populations overseas and in the U . S . Domestically , IRMH collaborates with state and local health departments to improve the healthcare and monitoring of medical conditions in these populations after their arrival in the U . S .
Regarding tracking and responding to outbreaks , the IRMH is responsible for tracking disease outbreaks to improve understanding of the epidemiology of diseases of concern in immigrants and refugees , including tuberculosis and vaccine-preventable diseases ; developing guidelines to respond to disease outbreaks and other health events affecting U . S . -bound immigrants and refugees , and build capacity for healthcare partners and strengthen international partnerships .
Gushulak , et al . ( 2010 ) advocate for proactive , pre-event management of migrants “ through the identification of vulnerabilities within different migrant populations . Once identified , demographic and population-based risk analysis can reveal the extent to which mobility globalizes risks for national health systems .”
Modernizing strategies to manage the health challenges of migration is essential , experts say .
Gushulak , et al . ( 2010 ) explain that “… there is a paucity of systematic programs and policies to support the health of migrants . To improve global health management and preventive health practices , there is a need for coordinated international actions and partnerships between governments and organizations in nations of origin , transit , and destination . Studies have suggested that primary health prevention endeavors such as tuberculosis control in countries of migrant origin are more economical over the longer term than traditional immigration screening programs and policies . They address better universal access in support of equity and the right to health , and have secondary preventive benefits manifested through the improvement of health indicators in migrant source countries .”
The FAIR whitepaper ( 2017 ) emphasizes the importance of public health screening as a standard part of immigration processing and offers the following considerations :
• Provide ports of entry with the latest technology for the rapid discovery of infectious disease . Researchers have recently developed a breath analyzer that can detect 17 different diseases using a single breath sample . Other , similar technology is being rapidly developed and should be available for purchase soon .
• Expand the use of “ sniffer ” dogs at ports of entry . For years , specially trained canines have been used to sniff out bombs , illegal drugs and agricultural contraband at ports of entry . Medical researchers have recently trained disease-sniffing dogs . These working dogs could be used to rapidly and effectively screen for infected travelers .
• The U . S . Department of State ( DOS ) could require proof of certain vaccinations prior to issuing a visa to international travelers .
• DOS could also require travelers from regions with known public health issues to undergo preventative medical treatment ( prophylactic treatment with antibiotics or anti-retroviral drugs ) prior to traveling to the U . S .
• Many diseases of public health concern , like anthrax , are transmitted from animals to humans . Agriculture Specialists working for U . S . Customs and Border Protection ( CBP ) Animal and Plant Health Inspection Service could be trained to administer brief infectious disease questionnaires to travelers arriving at U . S . ports of entry .
• U . S . Customs and Border Protection Officers could be authorized to order secondary health screening for visibly ill travelers .
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