President Biden is correct to cite the success of vaccines in reducing the impact of COVID-19 on individuals and communities. In a White House speech last month he said, “The truth is that deaths and hospitalizations are drastically down in places where people are getting vaccinated. But unfortunately, cases and hospitalizations are not going down in many places in the lower vaccination rate states.”
One of those places with low vaccination rates is under the executive branch’s complete control: immigration detention. As of Aug. 1, there have been 22,518 cases of COVID-19 in ICE detention, resulting in at least nine deaths, though these numbers likely are severe underestimations. COVID-19 cannot be contained behind the walls: Spread to surrounding communities is an expected consequence of detention outbreaks.
It is the responsibility of the federal government to protect the health of individuals it detains. Since immigration detention facilities are congregant settings associated with rapid spread of a potentially life-threatening disease, universal vaccination is a reasonable minimum standard of care. Given the high risk of disease transmission within detention to detainees, workers and surrounding communities, this is both a moral and public health imperative.
As of mid-July, the Federal Bureau of Prisons has administered more than 202,205 vaccine doses to inmates in custody. But in immigration detention, vaccination efforts were delegated to local health authorities, complicating logistics. This approach largely has been a failure. In his May 13 written testimony before Congress, Acting Immigration and Customs Enforcement (ICE) Director Tae Johnson reported that only 1,229 detainees had been fully vaccinated.
The recent reported delivery of 10,000 vaccine doses to ICE (over 9,500 of which have been distributed) is an improvement, but still not nearly enough to protect those currently in ICE custody. Nor does it account for the high turnover of detainees or ongoing transfers between facilities that continue with frequency, contrary to Centers for Disease Control and Prevention (CDC) guidelines. Encouragingly, however, the same report claimed a 70 percent vaccination acceptance rate by detainees. This is far better than the vaccination rates of Irwin and Stewart counties in Georgia (27 percent and 26 percent, respectively), the location of two ICE detention facilities known for their high COVID-19 contagion rates, and even higher than the U.S average.
The same recommendations we made to the Trump administration about the need to reduce populations in detention, limit transfers, provide personal protective equipment (PPE), and conduct testing and screening — along with vaccinating — apply just as strongly to the current administration. Indeed, we have escalated these concerns to the new leadership of Department of Homeland Security’s Office for Civil Rights and Civil Liberties where we continue to serve as consulting medical experts, to the Biden administration’s White House Coronavirus Response Team and COVID-19 Health Equity Task Force, and most recently, to Congress.
The number of people in ICE custody has increased by 50 percent since the end of the Trump administration. Increased populations make social distancing and quarantining in indoor, congregate settings far more difficult, if not impossible, heightening the need for the vaccination of workers and migrants.
As COVID-19 continues to spread with new variants, the full public health response to containing the spread must include addressing conditions in ICE detention. And that includes vaccinating all detainees and staff at these facilities. Although the number of detained persons is increasing, the average number of immigrants in ICE custody is still fewer than 28,000 detainees, a number that could be provided easily with widely available vaccines.
At least one federal judge agrees with the urgent need to vaccinate immigrant detainees. Judge Jesus Bernal in the Fraihat v. ICE case recently ordered that ICE “[m]ake vaccinations available to all subclass members within 30 days of today.” While that is a step in the right direction, the subclass covered by the litigation includes only migrants with high risk of severe illness from COVID-19 across the ICE detention complex — a far cry from the full population in detention, and hardly enough to create adequate protections for everyone in and around an ICE facility.
It should not require litigation to protect public health and safety. What’s needed is policy.
The Biden administration and ICE have a legal obligation to protect the health of those detained — the stakes could not be higher for the immigrants whose lives are in the hands of detention center staff and medical providers. ICE also has a legal duty to protect the health and safety of workers at its detention facilities, and an ethical duty to protect the nearby communities.
The president is right to promote COVID-19 vaccines as one of the most effective measures to fight the virus. The lives of immigrants and workers inside ICE detention facilities, and the lives of those outside as well, depend on it.
Dr. Scott A. Allen, MD, is professor of medicine emeritus at the University of California, Riverside. Dr. Josiah Rich, MD, MPH, is professor of medicine and epidemiology at Brown University. They are co-founders of the Center for Health and Justice Transformation at Miriam Hospital, and both serve as medical subject matter experts in detention health for the Office for Civil Rights and Civil Liberties in the Department of Homeland Security. The opinions expressed here are theirs alone.