Health Nativism

Health Nativism

Borders are not going to help us fight this virus.

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As COVID-19 sweeps across the United States, Donald Trump has sought to convert his immigration policies into a public health response. “We need the Wall now more than ever!” the president wrote on Twitter last week in reply to a tweet from conservative activist Charlie Kirk that said “With China Virus spreading across the globe, the US stands a chance if we can [get] control of our borders.” Trump has repeatedly referred to the coronavirus as the “Chinese virus“ or “foreign virus,” at once fueling trade wars with China and seeking to deflect blame from his administration’s fumbled response to the deadly pandemic.

Trump’s call for a border wall flies in the face of advice from public health officials, who say that the virus is likely now beyond containment. In his pronouncements, he displays the illogic of health nativism—an attempt to keep out that which is already inside, put borders around a problem that is borderless, and shore up an illusion of safety by projecting the origin of the problem as always somewhere else.

At its least worrisome, health nativism is a political performance designed to capitalize on a public health crisis. It is Donald Trump Jr. advising people to buy guns and support Second Amendment rights on Twitter. At its worst, which is what we are currently seeing in the United States, health nativism is the focus of an entire governmental strategy.

The government has quietly put the president’s messaging into practice. On February 26, Health and Human Services Secretary Alex Azar appeared before a House subcommittee to testify on behalf of a budget that included coronavirus response funding. When the committee asked him how much of the funding would be earmarked for international efforts to fight the virus, Azar answered that “we’re not going to help the Chinese stop this in China—China will do that or not be able to do that.”

The U.S. refusal to help other countries fight the pandemic is an unfolding disaster. The testing delays, for example, which make the outbreak of the coronavirus in the United States difficult to track, occurred because the Centers for Disease Control and Prevention (CDC) insisted on making a coronavirus test from scratch, even though a viable diagnostic test had already been developed by German researchers and approved by the World Health Organization. This failure to work together with researchers across the globe undoubtedly worsened the American outbreak.

Health nativism is nothing new. The spread of disease has long provided fodder for anti-immigrant policies and enhanced border security. The early American colonies, for example, routinely inspected docked ships to ensure the good health of passengers, and at Ellis Island a key task of border agents was to perform medical inspections on immigrants.

The 1882 American Immigration Act, which excluded entry to all “persons suffering from a loathsome or a dangerous contagious disease,” scapegoated Irish, Italian, and Chinese immigrants for decades as infectants to the nation (at a time when their labor was seen to take jobs away from natural-born citizens). The migrant crisis of the past decade has also served as fuel for claims of pestilence and disease being brought into countries.

The coronavirus brings its own share of nativist fearmongering in the name of public health safety. In addition to Trump’s rhetoric about the “Chinese virus,” anti-Asian racism has spread around the world, with stories of small businesses refusing service to Chinese customers and petitions by citizens calling for the quarantine of Chinese nationals.

But despite its overt racism and xenophobia, health nativism can often be difficult to separate from sensible public health procedures like quarantine and social distancing, which are also isolating tactics. These policies—all vital components of the current response—are oriented toward individuals who have been, or may be, exposed to the virus. Quarantine, from the Italian word for forty (quaranta)—the number of days once believed necessary for a virus to incubate—has since the fourteenth century served to isolate communities from each other during outbreaks of plague, smallpox, and influenza.

Quarantining and social distancing are approaches informed by the scientific idea that infections are impossible to transmit if they cannot find a new host. Small-scale quarantines are very effective for disease and virus control. Initially, for example, Canada recommended that anyone arriving from any international location to “self-isolate and stay at home” for fourteen days and contact public health authorities within twenty-four hours of arrival; in the last few days, however, Canada has followed the lead of the United States, banning the entry of all foreigners with the exception of U.S. citizens. Social distancing is also an effective measure to delay the spread of a virus. By limiting large gatherings, closing schools and public places, the likelihood of virus transmission is decreased.

Health nativism, on the contrary, turns to border restrictions to exclude persons and goods from large swaths of the globe without reasonable belief. On February 28, a group of Republican House lawmakers sent a letter to White House officials requesting increased border security in the wake of the coronavirus. “Given the porous nature of our border,” said the lawmakers, “it is foreseeable, indeed predictable, that any outbreak in Central America or Mexico could cause a rush to our border.” At a time when they should be looking inward at the state of the U.S. healthcare system, many Republican lawmakers are playing a border-wall politics that endangers millions of lives.

Unlike quarantines, border bans make people considerably less safe. Travel restrictions are supposed to decrease the number of newcomers into a community, but in practice they do the opposite, encouraging a rush of people to return immediately to their home countries. U.S. passport and green-card holders who attempt to return home after a restriction is imposed are a public health risk, especially when, upon return, they receive no mandatory or recommended quarantine guidance. So are foreigners in the United States who seek to return home to their countries in the wake of a travel ban. An airport crowded with people from outbreak zones all over the world is not a coherent strategy for fighting a pandemic. It is a public health nightmare. At any rate, by the time Trump blocked European entry into the United States on March 11, the virus had already been spreading across the country for weeks. Its merits as a public health measure were nonexistent, but it continued to shore up the idea that the coronavirus is a foreign problem.

Travel restrictions also prevent doctors and aid from arriving where they are needed. It is difficult to get health supplies into a region that has suspended air travel. And border bans do nothing to stop a virus from spreading to countries with less resilient health systems, such as those in Sub-Saharan Africa, where the majority of deaths from 2009’s H1N1 outbreak occurred.

Borders are not going to help us fight this virus. Instead, we need global cooperation and coordination on a variety of levels—and we need it quickly.

For starters, we need to ensure that researchers around the world coordinate their programs to learn as soon as possible about the disease, which drugs may be useful, and how to generate a vaccine that is safe and effective. One country cannot solve this independently. Instead, the CDC needs to work with researchers across the world. This is especially important as clinical trials for a vaccine are undertaken in many countries.

To help the CDC do its job, the government needs to restore and increase its infectious disease defense infrastructure, which has been woefully inadequate since 2018 when the global health security team was fired amid a reorganization of the National Security Council and the CDC was forced to cut 80 percent of its budget to fight global disease.

Funds for infectious diseases must be global in scope, including relief efforts to help other countries—and to receive aid from others. The Chinese billionaire Jack Ma, founder of Alibaba, just donated over 500,000 coronavirus test kits and a million face masks to the United States (he has committed even more to countries in Africa). “Now it is as if we were all living in the same forest on fire,” Ma said. He is right.

The United States must swallow its pride, let go of its trade antagonism, and accept these supplies—though ideally supplies wouldn’t have to come from a billionaire’s philanthropy but would instead be part of the Chinese government’s global disease defense strategy. 

It is also essential, in the years after the crisis fades, to take the lesson that a global health response requires ongoing domestic preparation at all times. Beyond research funding and disaster preparation teams, the United States needs to ensure that public health is not only a right for insured individuals. When people delay getting medical help for any reason—because they are undocumented, uninsured, or a tourist in a foreign country—the virus has more opportunity to spread. Individuals with access to affordable healthcare are not only more likely to survive the virus, they are less likely to pass it along to others. This outbreak has clarified the urgent need for truly universal programs, both domestically and globally.

Health nativism should be seen for the oxymoron that it is. The health of others reflects the health of all. There is no “us” against “them” in a pandemic.

Stephanie DeGooyer is co-author of The Right to Have Rights (Verso Books) and is completing Acts of Naturalization for Johns Hopkins University Press. She is visiting assistant professor of English at Harvard University.

Srinivas Murthy is Associate Professor of Infectious Diseases and Critical Care at the University of British Columbia.