A framework for public health crises: How America has used public health to justify exclusionary immigration laws (and where we go from here)

Abstract

Background Over 1.6 million non-citizens have been expelled from America’s land borders between March 2020 and January 2022 under Title 42. For 22 years between 1988-2010, HIV-positive immigrants were deemed ineligible and had their applications for immigration denied after their immigrant medical exam. In the face of public health challenges, America has historically decided to enact strict immigration laws and used the protection of public health as the justification of such exclusionary practices. These laws, however, are often enforced without serving a true public health need. Further, they remain stagnant as they fail to be amended with new research or medical advancement. Methods Using 1963-2020 immigration applicant denial data from the Immigrant Visa Control and Reporting Division of the United States Department of State, we analyzed trends in immigration ineligibility. We also used data from the Department of Homeland Security to study Title 42 expulsion from 2020 to 2022. These trends were then investigated through lenses of significant policies and Presidential administration. Results Policies and presidential administrations have an impact on the immigration denials and approvals. Looking at communicable diseases, required vaccination, and Title 42 we can see how trends over lay with policy and administration. Discussion We developed a framework based on prevention, transmissibility, and severity characteristics of future communicable disease crises. The framework and policy recommendations will help create a more ethical and public health informed immigration response to crises, allowing for law and policy to change as new developments are made in science and medicine. Conclusion In times of public health crises driven by communicable and infectious diseases, immigration policies are frequently enforced as a means of controlling the spread of disease, as we showed with HIV and COVID-19. Acknowledging this history and the impact of health justified immigration policy will make America more prepared to tackle the next public health crisis.