Are Eradicated Diseases Making a Comeback Because of Immigrants and Refugees?

In April 2019, the Facebook page “Donald Plants” shared the following meme (archived here), which claimed that six “eradicated diseases” are in the process of “making a comeback” thanks to the presence of refugees and undocumented immigrants in the United States.

In the meme, six “eradicated diseases” were named: tuberculosis, measles, whooping cough, mumps, scarlet fever, and bubonic plague. Predictably, no supporting information for either claim (whether these diseases were on the rebound or if immigrants had anything to do with it)  appeared alongside it.

The claim is multilayered. One aspect of it is that six diseases were eradicated in the United States, but have recently returned. The second seemed more amorphous, blaming the purported return of the six diseases on refugees and undocumented immigrants. (No mechanism for disease favoring undocumented immigrants over their documented counterparts was included, either.)

Of note is that only two diseases worldwide are considered to be fully eradicated, neither of which (smallpox and rinderpest) appear on the list. Moreover, only two of the diseases mentioned on the list are considered potentially eradicable — measles and mumps. No vaccine exists for scarlet fever, and plague and tuberculosis vaccines are typically not recommended to Americans. Measles was declared “eliminated” in 2000, which is not the same as eradicated.

However, it is also worth noting that according to the Centers for Disease Control, there isn’t actually any information in 2019 to suggest that the six diseases included in this particular meme — tuberculosis, measles, whooping cough, mumps, scarlet fever, and bubonic plague — are necessarily “making a comeback.” Of the six illnesses in the meme, only one was mentioned on the CDC’s “Current Outbreaks” page as of May 2019 — measles. Consequently, five of the six diseases were not returning, nor had they been eradicated in the first place.

Up-to-date information from the CDC attributed two factors for the 2019 spread of measles — travelers (not immigrants, whose journeys are not typically as short as visitors), and vaccine refusal:

The U.S. experienced 17 outbreaks in 2018. Three outbreaks in New York State, New York City, and New Jersey, respectively, contributed to most of the cases. Cases in those states occurred primarily among unvaccinated people in Orthodox Jewish communities. These outbreaks were associated with travelers who brought measles back from Israel, where a large outbreak is occurring. Eighty-two people brought measles to the U.S. from other countries in 2018. This is the greatest number of imported cases since measles was eliminated from the U.S. in 2000.

To recap, none of the six described diseases had been eradicated as of 2019, and five of the six (except measles) have not made any sort of “comeback.” In the case of measles, a mixture of travel to other countries and pockets of homegrown vaccine refusal fueled the outbreaks in 2018 and 2019. As in earlier outbreaks, populations known not to vaccinate are particularly at risk. But are immigrants or refugees the ones spreading those diseases?

Of note is the fact that refugees are subject to screenings before entering the United States to rule out or quarantine cases of infectious disease. In 2015, PolitiFact contacted experts in infectious disease to enquire about the plausibility of long-circulating claims that immigrants and refugees spread disease. Those experts noted that no substantiation of those claims seemed to exist:

The experts we contacted agreed that there is no evidence of a massive influx of infections across the border.

“There is no evidence whatsoever that this is so,” said Arthur Caplan, director of the division of medical ethics at New York University’s Langone Medical Center. “No study or survey shows this. There is no outbreak or bump in disease attributable to immigrants.”

Thomas Fekete, the section chief for infectious diseases at the Temple University School of Medicine, agreed.

“When it comes to the health of immigrants, it is possible that undocumented folks have more health conditions that warrant concern, but I do not know of a scientific or quantitative assessment,” Fekete said. “Workers are probably in decent health as the work itself is arduous. But there are some illnesses that occur more commonly in poor countries, such as tuberculosis, and some that occur more commonly because of farming or lifestyle issues, such as cysticercosis. But the notion that the Mexican government is orchestrating the movement of sick Mexicans to the U.S. is wacky.”

In December 2018, The Lancet examined global claims about migration and disease due in part to anti-immigrant rhetoric in countries including Poland, the UK (in relation to Brexit), and the United States. Researchers found that “there is no systematic association between migration and importation of infectious diseases,” a theme which continues to pop up in debunkings of the infinite variations and iterations of the claim:

There is also a specific disease surveillance infrastructure between the U.S. and Mexico border, called the Binational Border Infectious Disease Surveillance Program. Agents screen people for HIV, measles, pertussis, rubella, rabies, hepatitis A, influenza, tuberculosis, shigellosis, syphilis, Mycobacterium bovid infection, brucellosis and food-borne diseases, according to Politifact. The only disease outbreak found among undocumented minors from Central America during a 2104 immigration surge was scabies, the story said.

In fact, cases of disease outbreaks caused by people crossing U.S. borders have more often been caused by Americans harboring pathogens acquired overseas. For example, one of the worst most recent outbreaks of measles was caused in 2014 by an American missionary who brought the disease back from the Philippines to an Ohio Amish community. The U.S. had virtually eliminated measles in the U.S. by 2000, but the disease has come back as pockets of people have declined to vaccinate their children. Measles is caused by a virus. Symptoms include rash, fever and cough and the virus can cause blindness, pneumonia, encephalitis and complications in pregnancy.

There are many reasons the claim that immigrants and refugees are spreading six once-eradicated diseases is, and has been, completely untrue. One is that of the six diseases, only one was considered eliminated (not eradicated) in 2000 — measles. The other five were not. Measles cases have seen an uptick in recent years, but that has largely been attributed to vaccine refusal, sometimes combined with travel and return to cloistered communities such as those of Orthodox Jews or Amish people. Finally, infectious disease experts have never identified any such epidemiological trends — and if they existed, quarantines would ensure that they did not affect the population.

Finally, the “immigrants carry disease” trope is far from new. It has been part of every anti-immigrant movement in the United States going back centuries, according to University of Minnesota immigration history professor Erika Lee:

It’s absolutely been a driving factor throughout the centuries. We know that whatever “immigrant menace” was the focus of xenophobes in the past — whether it be Irish Catholics in the 19th century, then later Chinese and other Asians, of course, Italians and Jews and other southern and eastern Europeans and Mexicans — the claim has always been that these groups were not only racially inferior, but that they brought particularly dangerous and contagious diseases that would end up harming the U.S. native population.

A historical study published by University of Michigan researchers in 2002 goes a step farther than that, noting that fears of immigrant-borne illness never occur in an ideological vacuum nor do they often have any basis in hard fact. In fact, the researchers concluded, such xenophobia might be making Americans (and the world) much more vulnerable to pandemics:

In order to protect the public health of Americans today, the all too common tendency to conflate disease with foreigners and/or specific ethnic, racial, or sexual minorities must be held in check by discovering where the risk factors for public health threats actually lie. At many points over the past century, some people have wanted to exclude persons perceived as foreign, inassimilable, and dangerous to the country’s social, political, or economic fabric. Metaphors of germs and contagion have never lurked far beneath the surface of such rationales.

As we have shown,  more often than not these arguments have been motivated by, and closely intertwined with, ideologies of racialism, nativism, and national security rather than substantiated epidemiological or medical observations. Not surprisingly, these attitudes have deterred rather than encouraged many immigrants from seeking medical care. As the 20th century came to a close, the associations between immigration and disease remained powerful and prevalent.

The world we inhabit today is essentially a global village. Ideas, goods, and people can now travel long distances in a matter of hours. More compelling, microbes are not required to carry passports and can easily escape the best-laid plans to block their entry. Safeguarding America’s health means safeguarding the world’s health. If any concept in this brief history of immigration and public health is antiquated, it is the idea that infectious diseases can be controlled by targeting certain populations based on apparent ethnic or national background.

The Ellis Island model of medical inspection is not appropriate to our current era, and it is fitting that this symbol of American immigration history is now a museum. Moreover, economists and experts in global public health have demonstrated that the most humane, effective, and fiscally sound approaches are those in which wealthy nations, organizations, and corporations come to the assistance of poorer nations in order to protect all the world’s citizens.