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Open Letter on COVID-19 Boosters in U.S. Immigration and Customs Enforcement’s Detention Facilities

January 27, 2022

Dear Secretary Mayorkas and Acting Director Johnson,

As concerned medical school faculty, we write to express serious concerns about U.S. Immigration and Customs Enforcement’s (ICE) failure to provide COVID-19 vaccine booster doses to eligible immigrants held in ICE detention facilities nationwide.

The COVID-19 pandemic and the recent emergence of the Omicron variant pose a grave danger to the health and safety of more than 21,000 people held in ICE custody each day. The congregate nature of detention and the inability of detained people to maintain social distance from others have led to elevated rates of COVID-19 in ICE facilities. Over the course of the pandemic, COVID-19 infections in immigration detention have reached rates 20 times higher than in the general public.

In recent weeks, the Omicron variant has spread quickly in ICE detention. The number of COVID-19 infections in immigration detention rose by 520 percent in the first two weeks of January 2022 alone. As of January 27, 2022, 3,129 people in ICE custody have tested positive for COVID-19, comprising over 14 percent of the 21,602 people currently detained nationwide. It is now clear that booster doses of mRNA vaccines provide the most critical protection against serious illness and death from COVID-19. Data published by the Centers for Disease Control and Prevention (CDC) have demonstrated that Pfizer-BioNTech and Moderna booster shots are 90 percent effective against hospitalization with the Omicron variant; by comparison, without boosters, the Pfizer-BioNTech and Moderna vaccines are only 57 percent effective against hospitalization. The risk of hospitalization for unvaccinated people is 14 times higher than for fully vaccinated people with booster doses, and four times higher than for vaccinated people without a booster dose. The risk of death for unvaccinated people is 53 times higher than for fully vaccinated people with booster doses, and 2.8 times higher than for vaccinated people without a booster dose.

The CDC has recognized the importance of this additional protection, and most recently recommended COVID-19 booster shots to all people who received the Johnson & Johnson COVID-19 vaccine two or more months ago, and to all people ages 18 or older who received either the Pfizer or Moderna COVID-19 vaccine five or more months ago.

In spite of the urgent and active threat that COVID-19 poses to people in detention, ICE has, to this date, failed to issue any policy or protocol regarding COVID-19 booster shots for its 200+ immigration detention facilities in the United States. This policy failure and lack of oversight has left thousands of detained people without access to this important protective tool against COVID-19. According to the most recent data available, as of January 5, only 671 immigrants – or just over 3 percent – in ICE detention had received COVID-19 booster vaccines nationwide. As medical professionals, we urge ICE to immediately identify people in their custody who are eligible for boosters, provide education about the importance of boosters, and, most importantly, provide booster shots to eligible detainees.

Moreover, we emphasize the need for ICE detention facilities to offer mRNA vaccine and booster doses, instead of viral vector vaccines (Johnson & Johnson), to people in their custody.

Following a unanimous recommendation of the Advisory Committee on Immunization Practices, the CDC has emphasized that in light of data on vaccine effectiveness, vaccine safety, and rare adverse events, there is “a clinical preference that individuals receive an mRNA COVID-19 vaccine over Johnson & Johnson’s COVID-19 vaccine.” For these reasons, mRNA vaccines and booster shots have emerged as the consensus, professional standard of care for patients. Offering only a viral vector vaccine booster such as Johnson & Johnson to the exclusion of an mRNA vaccine booster to a patient would fall below this standard of care. Although the CDC has allowed the use of Johnson & Johnson vaccines in limited circumstances, including situations where patients would otherwise remain unvaccinated due to limited access to mRNA vaccines,12 the CDC has also noted that “the U.S. supply of mRNA vaccines is abundant – with nearly 100 million doses in the field for immediate use.” It is our belief that, as a federal agency, ICE can and should act quickly to secure mRNA vaccine doses to provide to all people in their custody.

Although the safest place for people during the COVID-19 pandemic is outside of detention, for those ICE insists on detaining, we urge ICE to act quickly to ensure robust protection of those in their care against COVID-19.


Vidya Kumar Ramanathan, MD, MPH, FAAP, University of Michigan Medical School

Deborah Ottenheimer, MD, CUNY School of Medicine, Weill Cornell Medical College, Icahn School of Medicine at Mount Sinai

Richard Kovar, MD, Clinical Professor of Family Medicine, University of Washington Amy Zeidan, MD, Emory School of Medicine & Georgia Human Rights Clinic

Holly G. Atkinson, MD, Affiliate Medical Professor, CUNY School of Medicine Katherine R. Peeler, MD, MA, Harvard Medical School

Adam K. Richards, MD PhD MPH, School of Medicine and Health Sciences and Milken Institute School of Public Health, The George Washington University

Todd Schneberk, MD, MS, MA, Assistant Professor at University of Southern California Keck School of Medicine

Sural Shah, MD MPH, Assistant Clinical Professor Medicine, David Geffen School of Medicine at UCLA

Eleanor Emery, MD, Instructor of Medicine at Harvard Medical School, Center for Health Equity Education & Advocacy, Cambridge Health Alliance

Parveen Parmar, MD, MPH, Associate Professor, Clinical Emergency Medicine, Keck School of Medicine, University of Southern California

J. Wesley Boyd, MD, PhD, Baylor College of Medicine and Harvard Medical School

Michael J. Devlin, MD, Columbia University Vagelos College of Physicians and Surgeons Susan Levine, MD MPH, UConn School of Medicine

Taylor Burkholder, MD, MPH, University of Southern California

Arthur C Grant, MD, PhD, SUNY Downstate Health Sciences University Rohini Haar, MD MPH, University of California, Berkeley

Joseph Shin, MD, MSc., Weill Cornell Medicine

Elizabeth Burner, MD, University of Southern California Keck School of Medicine Katherine McKenzie, MD, Yale School of Medicine

Lorenzo R. Sewanan, MD, PhD, Columbia University Medical Center Barbara Robles-Ramamurthy, MD, UT Health Science Center at San Antonio Kim Griswold, MD, MPH, SUNY at Buffalo

Anna Bershteyn, PhD, NYU Grossman School of Medicine Arthur Caplan, PhD, NYU Grossman School of Medicine

Nancy Neveloff Dubler, LLB, Affiliated Professor, Department of Population Health, NYU Grossman School of Medicine

Gunisha Kaur, MD, MA, Weill Cornell Medicine

Dr. Diana Sepehri-Harvey, DO, MPH, clinical faculty in Family Medicine and Preventive Medicine at Loma Linda University

Altaf Saadi, MD, MSc, Harvard Medical School, Massachusetts General Hospital, Massachusetts General Hospital Asylum Clinic

C. Nicholas Cuneo, MD, MPH, Johns Hopkins University School of Medicine, Johns Hopkins Bloomberg School of Public Health

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