When René Najera emigrated to the United States from Mexico at age 10, he had to prove he was fully up to date on all of his vaccines. He got every single childhood vaccine again, since his original records were lost. Last week, Najera watched U.S. vaccine advisers blame immigrants for disease outbreaks at their high-profile meeting to discuss the childhood vaccination schedule. It was frustrating for more than one reason: Najera is now a historian of vaccines and a professor of public health. He knows immigrants to the United States are, on the whole, a highly vaccinated population—and he knows how often they are used as scapegoats anyway.
At the meeting of the Advisory Committee on Immunization Practices, or ACIP, on Thursday and Friday, presenters blamed Asian immigrants for hepatitis B cases and advisers asked whether measles outbreaks were seeded by foreign visitors. This narrative has long been promoted by people opposing childhood vaccination in the United States. Now this antivax trope is openly broached at the highest levels of U.S. vaccine policymaking, highlighting how the Make America Healthy Again movement, spearheaded by Health and Human Services Secretary Robert F. Kennedy Jr., and the Make America Great Again movement, spearheaded by President Trump, join seamlessly to blame immigrants for America’s ills.
There are other scapegoats too. Anti-vaxxers claim hepatitis B, for instance, is a disease of drug users, queer people, and sex workers, even though most people don’t know how they acquire the virus. The message is increasingly clear: In Donald Trump’s and RFK Jr.’s America, illness comes from—and is experienced by—other, lesser people.
Having high-level officials endorse this misinformation endangers people of color, as we saw when anti–Asian American hate crimes rose following rumors about Covid as a Chinese bioweapon or hoax. It endangers everyone else too, if it causes health officials to implement the wrong policies—for example, if they were to institute travel bans rather than a vaccination campaign for a disease already circulating domestically. “Scapegoating basically puts blinders on our ability to actually identify how to solve the problem,” Richard Pan, a pediatrician and senior lecturer in public health at U.C. Davis, told me. “You’re not actually getting to exactly what’s causing the problem—and then how do we solve it?” And this misinformation endangers people another way: Blaming immigrants leads nonimmigrants to believe they’re not at risk, which makes them less likely to protect themselves or to seek out testing when they become sick—harming themselves while infecting others.
Scapegoating outsiders for disease outbreaks goes back centuries. And it’s not just a narrative, but a worldview. “It’s a very long-standing trope, whether it’s immigrants or other groups, that disease comes from outside,” Pan pointed out. “If you see someone who’s sick, you run from them or expel them from your community because they might make other people sick.” Frequently, this comes with moral and religious implications. “Being sick often means that you did something wrong, or you’ve been cursed, or you’ve committed sin, and that’s why God is punishing you,” Pan said. There’s an idea that sick people “did something wrong, or they’re the wrong people, or they’re dirty people, or they ate or did the wrong things; they weren’t healthy.” By extension, in this worldview, health is a barometer of goodness; people who get sick are inherently lesser, weaker, deserving their illness in some way, while people who have the good luck (and financial resources) to stay healthy are simply built different. After all, RFK Jr. doesn’t believe in germ theory; he believes diseases are caused by poor hygiene and sanitation. If you keep yourself clean and pure, the logic goes, you have nothing to worry about.
Kennedy isn’t the only Trump health official to take this “personal responsibility” theory of disease prevention to unscientific and insulting extremes. Centers for Medicare and Medicaid Services administrator Mehmet Oz said over the summer that impoverished and elderly Americans need to do their part to stay healthy and eat better. He reiterated the message in a recent email to employees: “You don’t have to try every cookie on the holiday table.” National Institutes of Health director Jay Bhattacharya outlined a brief plan last month to prepare for the next pandemic: “Whether simply by stopping smoking, controlling hypertension or diabetes, or getting up and walking more, anything that makes the population healthier will prepare us better for the next pandemic,” he wrote. Sure, it’s always better to be healthy, but it’s hard to see how walking more could have significantly disrupted a virus that sickened, disabled, and killed millions.
When tragedy strikes, people try to make sense of it through the stories they tell themselves. But with something senseless like a disease outbreak, often there is no narrative; we learn how an outbreak began months or years after the fact, if we ever find out at all. “People look for reasons, and often we in public health are unable to provide them the full reason why,” Najera, director of public health at the College of Physicians of Philadelphia, told me. In the absence of answers, people create their own, he said. “They want a scapegoat.”
Blaming other people, especially groups that have already been marginalized and mocked, “makes it easier to say that ‘I don’t need to do anything about disease. If we only got rid of those other people, the disease would go away,’” Pan said. People also feel a false sense of safety when they believe that other, more culpable people are to blame, instead of acknowledging the randomness of tragedy. “It makes people feel safe if they don’t belong to the minoritized group,” Najera said. For instance, with misinformation about hepatitis B vaccines, people tell themselves, “If I’m not Asian, and if I’m not a traveler, then I should be safe. And why should I get vaccinated?”
Immigration came up again and again at the ACIP meeting, with presenters and advisers blaming, with glaringly incomplete data, both authorized and unauthorized immigrants for surges in hepatitis B and even potentially measles.
“The elephant in the room that I’ll mention is immigration,” said Evelyn Griffin, an ACIP adviser and “functional medicine” obstetrician and gynecologist. “We have had years of illegal immigration, undocumented people coming from higher-endemicity countries.” Griffin herself is an immigrant; her parents moved from Poland to Canada, and then she moved to the United States. She decried the lack of testing for hepatitis B without mentioning that vaccination is a requirement for immigration or that many unauthorized people first enter the country with paperwork. Undocumented people also tend to come from countries with very high vaccine acceptance. “Especially in Latin America, they’re very adamant about vaccinating children,” Najera said. “They have vaccination campaigns at every corner. You see the nurses with the coolers, giving the vaccines. You see the people going home to home, checking for vaccination records.”
The risk hepatitis B presents to American children has been overstated, argued Cynthia Nevison, a climate researcher who has sought to link vaccines to autism and is now a contractor with the Centers for Disease Control and Prevention. At the meeting, she presented a paper, from a quarter-century ago, showing that half of cases in the 1980s where parents transmitted hepatitis B to children occurred among Asian immigrant populations. Nevison concluded that horizontal transmission—from people of the same generation, rather than from parent to child—“can occur among certain high-risk immigrant communities.”
The presentation ignored the context of immigration following the Vietnam War, the Korean War, and World War Two, Najera said—when “a lot of immigration happened from that part of the world, and hepatitis B was very prevalent in those places.” Those were trends from nearly 50 years ago, before the vaccine was offered to every child at birth in the U.S.—a policy that meant recorded cases among children dropped from 20,000 to about 20 a year.
Anti-vaxxers see hepatitis B as a disease of vice, only occurring among drug users and the sexually promiscuous, but some 50 to 70 percent of the two million people living with hepatitis B in the U.S. have no idea where they got it. Unlike HIV, which is only transmitted by close contact with certain bodily fluids, hepatitis B is infectious for up to a week on surfaces. That means you might get sick from nail clippers shared with a family member, or sports equipment. There are major issues with detecting it through testing, as well. The hepatitis B test has a high false-negative rate, which means about one in 20 people who have hep B may test negative. The test is usually given in the first trimester of pregnancy, but people can acquire hep B later in pregnancy, and half a million pregnant people in the U.S. aren’t tested for hep B at all.
Even so, Robert Malone, vice chair of ACIP and a major source of vaccine misinformation, used “economically disadvantaged Asian immigrant populations” as an example of “high-risk communities.” At one point, he mistook a physician’s question about grandparents visiting infants to mean immigrants were causing higher rates of infection among older Americans. He also made a confusing reference to the possible role of travel in the current U.S. measles outbreak. “I have some information about the history of the original West Texas outbreak, but that’s anecdotal and secondhand,” Malone said, without offering further details. Cody Meissner, an adviser and professor of pediatrics at the Geisel School of Medicine at Dartmouth College, asked a presenter how much of the rise in measles cases could be attributed to immigrants bringing the virus with them.
“That one is personal to me,” Najera said, pointing to evidence that the U.S. outbreak spread to Mexico, not the other way around. A current outbreak now in Chihuahua, Mexico, is thought to have been caused by an unvaccinated school-age child who traveled to Seminole, Texas—the heart of the ballooning U.S. crisis earlier this year, where two unvaccinated children died—and then to Mexico. Since then, 15 children in Chihuahua have died from measles. “They went to the state that I’m originally from, Chihuahua,” Najera said. “A lot of children there in the native Mexican, Native American community, they’ve been hit very, very hard.”
“When people talk about, ‘Well, it’s immigrants’—no, it’s actually Americans who aren’t taking precautions,” Pan said. Most reported cases of measles in the U.S. happen when an unvaccinated American travels to places where measles is more common and brings the disease back—and, if they belong to unvaccinated or under-vaccinated communities, it sparks an outbreak. The same is true of the occasional polio case detected in the United States.
Contrary to the moralistic view of disease, we don’t always know who is going to get sick, or who is sick already and doesn’t know it yet. “That’s why we recommend everybody get vaccinated,” Najera said. “Once we eliminate and then eventually eradicate the disease, then we can stop vaccinating, but not until then.” Believing that you’re not at risk because you’re living your life the right way offers a false sense of security, Najera said, and “you’re hurting children who are going to be under-protected when those diseases do arrive—and they will arrive.” Children who survive whooping cough at a young age have a higher risk of lung disease later on. One in 1,000 children who survive measles will later develop an encephalitis, or brain swelling, that is 100 percent fatal.
Americans are primed to believe in rugged individualism. “We tend to frame health decisions as individualistic—you’re healthy because of choices you made, not because of your environment. But we know the research all shows the opposite,” Pan said. We all drink the same water and breathe the same air. “We’re all exposed to the same stuff, and we’re all in it together.”
We’re all in it together—but the decisions some of us make can have ripple effects for everyone, and not everyone is able to protect themselves equally. Adults make these choices, Najera said. But “in the end, it is the children who suffer the consequences.”
