Title 42 must be upheld — for public health, not politics

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We applaud the Supreme Court’s decision Monday to halt the expiration of Title 42, and we hope the pressure Republican states are putting on the court with an emergency application keeps the statute upheld — for public-health reasons, not political ones.

Title 42 of the Public Health Service Act authorizes the director of the Centers for Disease Control and Prevention to suspend entry of individuals into the United States to protect public health. When I (Redfield) as CDC director invoked it in early 2020 because of the emerging COVID pandemic and influenza transmission at the border, I didn’t know it would block more than 2 million border crossings in the time since. What I did know was the border-detention structures, called by some reporters “cages,” put in place during the Obama years were designed for limited occupants — about 20 — at best, not the extensive overcrowding with people jammed in together witnessed by early 2020.

Seeing this, I made the decision myself. I did not have the backing of many at the CDC or bipartisan support throughout the federal government. But my pure motivation was to protect public health, the health of the migrants, the health of the government employees at the border and the citizens of our country, from contagious disease. I believe this move was successful and saved many thousands of lives.

Flash forward to now, after a DC federal appeals court rejected a bid by several Republican-led states to keep Title 42 in place and the Supreme Court intervened to keep it at least temporarily in effect. The problem remains one of public health and therefore national security.

Migrants line up at US border
With over 6,500 crossings a day now, the number could balloon if Title 42 expires.
James Keivom

Keep in mind that sending illegal migrants around the country to other cities is certainly not a fix for the Obama-era “cage” policy. Nor is simply hiring more Customs and Border Protection agents to add to the swamped and beleaguered group working now.

I first invoked Title 42 over health risks to the immigrants and guards because it was impossible for detention centers to comply with CDC-recommended social distancing and mitigation steps. And now the problem is far worse, with more than 2.3 million migrant crossings in 2022 so far, up from the historic 1.7 million in 2021. There are more than 6,500 crossings per day, and this number could easily double were Title 42 to expire.

Dr. James Hodges, internist working at the southern border, told us that “with cold weather, off-and-on rain, huge numbers coming in, we would expect worsening health conditions with poor sanitation and overwhelmed resources with the ending of Title 42. So if Title 42 was to end, we would expect a mess with all border towns overwhelmed.”

Migrants outside a church
The crush of migrants could overwhelm southern Texas hospitals.
James Keivom

Title 42 is a finger in the dike against the burgeoning health problems at the border, with high rates of flu, COVID, injuries while crossing, dehydration and diarrheal diseases from a lack of potable water — not to mention, once again, the terrible health and emotional risks to our hardworking CBP agents. 

The spread of fentanyl and other illegal opioids across our southern border isn’t covered under Title 42, but were it to expire, we would expect drug trafficking to increase along with the massive influx of more illegal immigrants.

Title 42 needs to be extended until the border problem is fully addressed — and not just because of a bad flu and respiratory syncytial virus (RSV) season or because the Biden administration still considers COVID a public-health emergency but for its humanitarian impact.

By the same token, COVID fatigue should not determine public-health policy. And busing migrants to Democrat-led cities is not a long-term solution either; many will add to our nation’s homeless at risk. We are far more concerned, though, about the onslaught of potentially ill migrants to southern Texas communities, where hospitals may be easily overwhelmed, as they were at the height of the pandemic.

Public health should not be about politics. It should be focused on improving the human condition. Title 42 traces its origins all the way back to the Public Health Service Act of 1944. It is an important part of our law and it is designed to protect us and limit the spread of infectious disease. It should be upheld and embraced.

Wanting to stop the spread of contagious and other diseases into the United States is in our national interest. This is why our ancestors were routinely screened for diseases, including tuberculosis, at Ellis Island and elsewhere more than a century ago when they applied for legal entry into America. Legal or illegal, the need for stringent public-health standards remains.

Robert Redfield, MD, was director of the Centers for Disease Control and Prevention from 2018 to 2021. Marc Siegel, MD, is a clinical professor of medicine and medical director of Doctor Radio at NYU Langone Health and a Fox News medical analyst.

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