Credit: UNOHCR.

By Jamile Tellez Lieberman and Joe Amon
PHILADELPHIA, US, Oct 7 2021 (IPS)

Last month, asylum-seeking families at the U.S.-Mexico border appeared to have won a victory, however temporary, in their last-ditch bid for safety in the United States. It was also a victory for evidence-based public health policy.

The 1,954-mile-long southern border has always been a magnet for debate, with deep political divides. Bolstered by Donald Trump during his presidency, long-simmering anti-immigrant rhetoric and xenophobia surrounding migration and immigration increased dramatically.

Starting in 2016, under the previous administration, thousands of migrant families who made it to the southern border were told by immigration officials that they must remain in Mexico to await their asylum decisions, rather than in the United States.

The CDC was once heralded for its apolitical, evidence-based public health policy. Sadly, this is no longer the case. The first step in restoring the CDC’s tarnished reputation is to repeal the CDC’s Title 42 order

With long waits for the processing of their asylum cases, families caught in this legal limbo were forced to make do in temporary settlements in Mexican border towns, many of which are controlled by cartels. Life in these settlements is violent, unstable and impoverished.

In March 2020, then Vice President Mike Pence directed the Centers for Disease Control and Prevention (CDC) to use its emergency powers to effectively seal the southern border, overruling the agency’s scientists. The CDC invoked Title 42 of the Public Health Service Act which gives federal health officials the ability to take extraordinary measures to limit transmission of an infectious disease.

In practice, the “extraordinary measures,” however, did not apply equally to all travelers entering the United States, including travelers who may have been infected with the SARS-CoV-2 virus. Nor were these measures calibrated to where COVID-19 cases were most prevalent.

These scattershot measures have no meaningful impact on the pandemic in this country. Instead, they victimize migrants attempting to cross into the U.S. from Mexico, including asylum seekers.

Despite promising that his administration would respect science, the CDC’s Title 42 order has been renewed under the Biden administration. Public health leaders, human rights advocates, and former CDC officials and academics have repeatedly called on the CDC to end the use of Title 42 in favor of evidence-based approaches that can protect migrants and the American public from COVID-19 transmission. United Nations officials have also raised concerns that the expulsions may violate the United States’ obligations under the 1951 Refugee Convention.

Even Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, weighed in on Title 42 and the recent COVID-19 surge on October 3, saying that migrants are “not the driving force of this, let’s face reality here.”

No matter the CDC’s reasoning, one thing is clear: this policy enables profound and irreparable harm to migrant families and single adults. If forced back to Mexico, they would be once again at the mercy of the violent Mexican cartels they were so desperate to escape.

Hope has come from the judiciary if not from the CDC. On September 16, 2021, a federal district court judge in the District of Columbia granted the motion to reject Title 42 and issued an order that prohibits the expulsion of migrant families, saying, “in view of the wide availability of testing, vaccines and other minimization measures, the Court is not convinced that the transmission of COVID-19 during border processing cannot be significantly mitigated.”

The CDC was once heralded for its apolitical, evidence-based public health policy. Sadly, this is no longer the case. The first step in restoring the CDC’s tarnished reputation is to repeal the CDC’s Title 42 order. This will jumpstart the overdue process of returning the CDC to its role as an exemplar in public health policy-making instead of providing cover for xenophobic immigration policies.

Beyond Title 42, the CDC must work to restore its reputation with the American public and regain our trust. This is urgent during the current public health emergency, as well as future crises. It will be a lengthy, painstaking process, but without it, the consequences to public health would be immeasurable.

The order to reject Title 42 was set to take effect on September 30, but an appeals court suspended the judge’s order on October 1, permitting border officials to expel migrants. Amidst this legal back and forth, the question we are left wondering is: Who are these measures meant to protect? The COVID pandemic in the U.S will advance and retreat regardless of immigration policy.

The CDC is turning its back on migrants, as well as science. More broadly, the Biden administration is not listening to scientists, despite his pledge to return to science-based, humanitarian, decision-making. It’s not too late to rebuild trust in science, migrants and their contribution to America, and the American people they hope to become part of.

Jamile Tellez Lieberman is a Doctor of Public Health candidate at the Drexel University Dornsife School of Public Health and a Global Alliance for Training in Health Equity (GATHER) Fellow.

Joe Amon is the director of global health at Drexel University’s Dornsife School of Public Health and former director of health programs at Human Rights Watch.

A healthcare worker at a testing facility collects samples for the coronavirus at Mimar Sinan State Hospital, Buyukcekmece district in Istanbul, Turkey. Credit: UNDP Turkey/Levent Kulu

By Joe Amon and Christina Wille
PHILADELPHIA, US, Mar 3 2021 (IPS)

In the first months of the COVID-19 pandemic, at a certain hour of the evening, people in cities around the world opened their windows or stood on their rooftops and banged pots and rang bells. As the coronavirus spread and the number of deaths mounted, it was a moment for people distancing themselves from others to show solidarity and appreciation for the heroic work of health workers. But even as health workers were being celebrated by some, others attacked them.

In 400 incidents last year around the globe, health workers were attacked, clinics, hospitals and COVID-19 testing facilities were targeted, or public health officials were threatened.

Fear, misinformation and conspiracy theories flourished alongside frustration with the actions and inaction by governments to stem the pandemic and address the massive social and economic upheaval that accompanied it. At the same time, police and security forces arrested and assaulted health workers for protesting governments’ inadequate responses to the pandemic.

Health workers were assaulted by people who feared they were spreading the disease, and health facilities treating patients with COVID-19 were targeted

These incidents, and others, are documented in a newly released, interactive map  developed by Insecurity Insight and the Safeguarding Health in Conflict Coalition, with technical support from MapAction. Documenting these incidents and understanding their causes is important so that governments and health facilities can prepare for and prevent such atrocities.

Threats and attacks often arose from opposition to health measures to contain the spread of the virus, such as community-wide lockdowns. Health workers were assaulted by people who feared they were spreading the disease, and health facilities treating patients with COVID-19 were targeted.

For example, in Hong Kong, Molotov cocktails were thrown at four health centers after the government designated them  for COVID-19 treatment. Similarly, in Mexico, three health clinics under construction to fight the pandemic were threatened with or targeted in arson attacks.

Health workers were also threatened, or fired, by their employers, and in some cases arrested, for speaking out against the lack of protective equipment or government misinformation about the pandemic. Health workers were also targeted in settings of ongoing conflict.

For example, in Myanmar, a marked World Health Organization vehicle transporting COVID-19 testing samples came under gunfire, injuring a health care worker and killing the driver.

In Cameroon, a rebel militia destroyed a supply of hand sanitizers. In Libya, a plane reportedly carrying COVID-related equipment was shot down. And in Yemen, armed men in military vehicles stormed a health facility and confiscated COVID-19 disinfecting supplies.

Some of the attacks portray a desperation and despair in communities. In the Brazilian city of Belem, in April, dozens of people seeking medical treatment tore down the gate of a hospital that was reserved for COVID-19 patients and forced their way in.

In Dakar, Senegal, in May, people threw stones at Red Cross volunteers to prevent them from burying a person  who had died from COVID-19 in the local cemetery. In the Mexican state of Guanajuato, in August, a group of people attacked a nurse at a store owned by her family, accusing her of spreading the coronavirus.

The Safeguarding Health in Conflict Coalition, as its name suggests, has previously focused exclusively on attacks in conflict settings. But 2020 was an exceptional year. The organizations in the coalition, which include academic and independent researchers, international nongovernmental organizations, and human rights, public health and health care associations, collected information on threats and attacks related to COVID-19 globally, from news accounts as well as confidential contributions from aid agencies and professional organizations. 

These types of attacks are not unprecedented. In past outbreaks of SARS, Ebola, and H1N1, there were also attacks on health workers, facilities and ambulances. For example, in 2014, people attacked health workers and the hospital in Guinea’s second largest city, Nzerekore, shouting: “Ebola is a lie!” Violence against polio vaccination workers has halted progress toward elimination in Afghanistan, Pakistan, and Nigeria. 

Although most governments have detailed pandemic preparedness plans, few include measures to protect health workers and facilities. The 103-page “Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare Employers” published by the US government mentions violence against health workers in only one sentence. 

More needs to be done to prepare and prevent attacks. Clear and honest communication is key. New, deadly, and poorly understood disease threats understandably cause anxiety and government policies such as quarantines can amplify fear and misinformation.

But communication is not enough. Governments, and health care workers, also have to show that their response is not only based upon the best available evidence, but that it is grounded on human rights principles such as transparency, participation and equity. 

Engaging with the most affected communities early in a pandemic will open lines of communication and trust, as will transparency in demonstrating that supplies (such as PPE) and access to care is available, without discrimination, to those most affected. 

There will be another global pandemic. Hopefully, not soon. But we should learn the lessons from the COVID-19 pandemic that we have failed to learn with past outbreaks and anticipate and protect health workers and facilities from threats and attacks.

And governments should  act now to prepare for violence that  may occur around COVID-19 vaccine implementation and to end the COVID-19 related violence still occurring. Banging on pots to show appreciation of health workers is not enough. 

Joe Amon is clinical professor and director of global health at the Dornsife School of Public Health at Drexel University and a member of the Safeguarding Health in Conflict Coalition.

Christina Wille is director of Insecurity Insight. As a member of the Safeguarding Health in Conflict Coalition, Insecurity Insight collates data on violence against health care for the coalition.