Following reports that the incoming Trump administration may once again invoke Title 42 public health authority to turn away asylum seekers and migrants at the border, leading epidemiologists, former CDC officials, and other public health experts reiterate their strong objection to any misuse of public health authority. While the first Trump administration directed the Centers for Disease Control (CDC) to cite the COVID-19 pandemic as justification for invocation of Title 42 to turn people away at the border despite refugee and immigration law protections, reports indicate that incoming officials are searching for diseases to try to justify their plan or may rely on a broad assertion that migrants may carry diseases.
In 2020, the Trump administration invoked Title 42, a provision of U.S. public health law, during the COVID-19 pandemic to block and expel asylum seekers and migrants under the pretense of public health. Epidemiologists and public health professionals overwhelmingly condemned the policy, stating that it was not necessary to protect public health, perpetuated racist tropes, weaponized public health against asylum seekers, and undermined the credibility of the CDC.
Over 80 epidemiologists, former CDC officials, physicians and other public health experts, from leading public health schools, medical schools, hospitals, and other U.S. institutions, detailed their concerns in letters to the Trump administration and Biden administration. For example, in May 2020 they explained that the Title 42 policy was based on “specious justification” and used “the imprimatur of the Centers for Disease Control and Prevention (CDC) to circumvent laws and treaty protections designed to save lives,” and warned that the “nation’s public health laws should not be used as a pretext for overriding humanitarian laws and treaties that provide life-saving protections.” Public health experts noted in a July 2021 letter that the Title 42 expulsion policy had been “based on political, rather than public health, considerations,” “implemented despite the objections of senior CDC experts and public health experts,” and served to sanction the ongoing politicization of the CDC. In August 2021 they detailed how the policy perpetuated racially-based tropes presenting migrants as vectors of disease and exacted a terrible toll on the lives and well-being of people seeking asylum, many of whom were blocked in or expelled to Mexico where they suffered kidnappings, torture, and other harms.
As public health experts repeatedly explained in the context of the COVID-19 pandemic, there are rational, evidence-based public health measures that can instead be employed to safeguard both the health of the public and the lives of adults, families, and unaccompanied children seeking asylum and other protection.
Public health experts urge U.S. officials to reject and not resurrect policies and approaches that misuse Title 42 public health authority:
Joe Amon, PhD, MSPH, Distinguished Professor, Johns Hopkins Bloomberg School of Public Health, and former CDC epidemiologist, said: “At a moment of widespread misinformation and distrust in public health, and persistent and troubling health disparities among the American people, it is crucial that U.S. public health policies are based on evidence and necessity and not on rank political calculations. Reimplementing Title 42 is not an evidence-based response to the public health threats facing this country. It will only undermine trust in state and federal public health institutions and impede our efforts to address the real challenges we face to “make America healthy again”.”
Michele Heisler, MD, MPA, medical director at Physicians for Human Rights and professor of internal medicine and of public health at the University of Michigan, said: “Whether it is COVID-19 or any other infectious disease, the scientific consensus remains clear: there is no epidemiological evidence justifying the selective exclusion of asylum seekers while allowing other travellers to enter the United States. The previous implementation of Title 42 from March 2020 onward demonstrated the severe human costs of such policies. Research shows how the policy harmed the health and human rights of children, families, and single adults, exposing them to violence, separating families, and inflicting serious medical and psychological impacts on asylum-seeking children and adults, including high rates of post-traumatic stress disorder, anxiety, and depression.”
“Public health measures should not be used as a pretext to deny the fundamental right to seek asylum, which is protected under both U.S. and international law. We urge policymakers to reject approaches that could weaponize public health justifications to advance policies that circumvent established asylum protections.”
S. Patrick Kachur, MD, MPH, FACPM, FASTMH, Professor at the Columbia University Irving Medical Center, Vice Chair for Education, Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, and a former (retired) CDC scientist and USPHS Commissioned Officer, stated: “U.S. public health laws should not be misused as a pretext to override humanitarian laws and treaties that provide life-saving protections to refugees seeking asylum in the United States.”
Kathleen Page, MD, Professor at the Johns Hopkins School of Medicine and Infectious Diseases Specialist, said: “There is no scientific basis for singling out asylum seekers or migrants to address public health threats, particularly when they account for only a small fraction of those entering the country every day. Public health measures should be evidence-based and universally applied, yet Title 42 selectively targets asylum seekers while millions of others cross the border unrestricted. This policy weaponizes public health authority to enforce immigration control, violating international protections against returning people to danger.”
Katherine Peeler MD, MA, FAAP, Physicians for Human Rights medical advisor and assistant professor of pediatrics at Harvard Medical School, said: “Any reimplementation of Title 42 would lack scientific justification, as epidemiological data does not support singling out asylum seekers as uniquely able to transmit disease. The evidence shows that this demographic presents no greater public health risk than other groups who maintain unrestricted entry to the United States. Selectively applying health-based restrictions to asylum seekers and migrants contradicts established principles of evidence-based public health policy.”
Dr. Ron Waldman, an epidemiologist at the CDC for more than 20 years who is now Professor Emeritus at the Milken Institute School of Public Health, George Washington University said: “Public health authority should never again be misused and weaponized against people seeking refuge at our borders. The Title 42 policy was a cynical manipulation of public health arguments that inflicted untold damage to people seeking asylum, bolstered the xenophobic trope that migrants are vectors of disease, and contributed to the erosion of trust in our public health institutions.”
Monette Zard, former director of the Program on Forced Migration and Health at Columbia University’s Mailman School of Public Health, said: “Applying a public health policy to justify the expulsion of vulnerable people into harm’s way runs counter to the public health tenets of preventing disease, prolonging life, and promoting health. It undermines the credibility of our public health institutions, and in the process, makes us all less safe.”
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Physicians for Human Rights (PHR) is a New York-based advocacy organization that uses science and medicine to prevent mass atrocities and severe human rights violations. Learn more here.