Infectious Diseases among Immigrants and Refugees – What Trump says

The United States of America bears the highest immigrant and refugee population in the world, at about 47 million foreign-born people. A majority of these immigrants come from developing countries with poor living and health conditions. As a result, a significant part of the immigrant and refugee population is exposed to a diverse range of infectious disease such as tuberculosis, hepatitis B, AIDS and Ebola. However, immigrants also provide several benefits such as labour, and diversity to the US. US history has always shown inclusion of immigrants as part of its underlying philosophy. Therefore, complete restriction of immigrants cannot be a solution to the problem of infectious diseases in immigrants. Since new immigrants and refugees are transporters of infectious diseases into American soil, are more frequently affected by infectious diseases than the old immigration population, and the US screening processes require improvements, restricting the number of entries into the country can be effective in improving reducing the number of infectious diseases within the US in the short-run.

Immigrants and refugees carry with them a number of unique, infectious diseases which could be a threat to the US population. Certain infectious diseases seem to be more prominent in immigrant populations rather than the domestic US population. A survey conducted in Atlanta indicated that, in a sample of 462 African-born refugees, 44% were infected with schistosomiasis and 46% were diagnosed with the strongyloidiasis infection (Venters, & Gany, 2009, p. 336). These infections are prominent in the African immigrant population and pose imminent health hazards to the US population. Even though immunizations and disease prevention in the US has improved over the years – with the advent of policies such as Medicare and Medicaid – there are diseases among immigrants and refugees whose vaccinations have not been invented yet and can easily transmit to the US population, as immigrants continue to enter the country. Studies indicate an estimate of 238,091 people, excluding an added 109,000 cases of undocumented immigrants, are infected with T.cruzi (Chagas) – a deadly parasite, usually visible among Latin American immigrants which implants itself into the human blood stream and multiplies (Manne-Goehler, Umeh, Montgomery, & Wirtz 2016, p. 1). Chagas antibodies are alien to the US population, and no solid cures have been identified to fight the disease which makes it all the more, a bigger threat to the domestic population.

Long-settled immigrants in America are less exposed to communicable diseases than new immigrants which means that restricting new immigrants can reduce the rate of infectious diseases in the US. For example, if we examine the case of tuberculosis between old and new immigrants, we can find clear distinctions in the rates at which they are affected. The tuberculosis rate for new immigrants from Micronesia is 157 per 100,000 people, whereas tuberculosis rates for Micronesian people living in America is 62 per 100,000 people (MacNaughton, 2013, p. 308). These disparities exist because old immigrants pay taxes and contribute to the economy, therefore the healthcare system does its part for them. Since many immigrants and refugees settled in the US have access to better health facilities than their native countries, a majority of infectious diseases are more evident among recent entrants. Between 2007 and 2011, there was an overall decline of 1456 cases (-19.3%) of tuberculosis among immigrants due to a reduction in the number of immigrants in the US, especially new immigrants (Baker, Winston, Liu, France, & Cain, 2016, p. 7). The results of this study is a direct reflection of the efficacy of restricting new immigrants to the US.

The existing screening process in the US require procedural improvements as several of these screened immigrants and refugees still enter the United States with undetected diseases increasing exposure to epidemic in the US population. Asylees are not expected to report an arrival date while they seek asylum in the US. A study estimated that asylees were screened a year later than refugees due to unpredictable arrival dates, resulting in added risk of disease transmission to the US population (Chai, Cole & Cookson, 2012, p. 656). As the leading choice of country for refugees from around the world, systematic weaknesses to the screening process leaves the US vulnerable to infectious diseases. Several refugees arrive in the US without any previous immunization records, which complicates the issue of screening. If some refugees have recommended vaccinations pending, they need to be kept in appropriate settings, away from the general population, which can be an expensive affair. Some challenges of screening includes implementing cost-effective screening processes, increasing immunization to prevent vaccine-preventable diseases, and accommodating the health needs of all refugee and immigrant groups with communicable diseases (Barnett, 2014, p. 840). Until these issues of screening are solved, restricting immigrants might be the best option both financially and to prevent diseases from entering the US population.

Opponents of immigration restrictions indicate that statistics regarding new immigrants are often skewed and do not paint the complete picture, which means that restricting these new immigrants would not spur the reduction of communicable diseases in America. They claim that it is a myth that immigrants are a burden to the US healthcare system. In 2014, immigrants paid a total of 88.7 billion dollars in premiums to insurance companies and in turn these companies only spent $64 billion for immigrants’ care (Zallman, Woolhandler, Touw, Himmelstein, & Finnegan, 2018, p.1666). This means that the net contribution of immigrants to the healthcare system was positive, showing that it is not actually cost-inefficient to allow immigrants into the country and provide them with healthcare. They claim that even though restricting immigrants may be an effective short term fix for preventing diseases, the opportunity cost of their restriction to the US economy is greater.

One factor that the counterargument fails to encapsulate is that the US has a high rate of illegal immigrants and refugees who are a burden to the healthcare system. Many of these illegal immigrants cannot afford insurance and treatment for infectious diseases as they come from poor backgrounds. Federal taxpayers subsidized around $11.2 billion dollars in health care to undocumented immigrants (Conover, 2018, p.2). Illegal immigration is an undesired consequence of expansionary immigrant policies and therefore immigration and illegal immigrants must be considered in unison to reach an informed judgement of the burden of immigration on the US healthcare system.

The availability and access to vaccinations to US-born people and residents in the US has resulted in the low rates of infectious diseases among the US population. However, immigrants who enter the US from developing countries are responsible for the income of certain viruses responsible for infectious diseases that never existed in US soil before. The screening process is  expensive and the burden of funding this and public health facilities falls on the American taxpayers. Hence, restricting immigrants may be the best way to reduce the influx of diseases into the US. However the US philosophy throughout its history has been to accommodate immigrants and refugees. While restricting immigrants may be a great short term fix to the infectious disease problem, it is also important to improve the screening process and introduce cost-efficient public health facilities in the long run. This can be achieved in the long-run through technological advances in the fields of biology and healthcare.

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