SAN YSIDRO, CALIFORNIA -- Chanting "We won't leave this gate until you let us vaccinate," about 50 physicians and other healthcare providers stood before the iron gates of the U.S. Customs and Border Protection detention center here pleading to immunize detainees against the flu.
"Let them out. Let us in. Let them out!" "No more flu deaths."
Just 2.5 miles from the Tijuana border, they sang and called out for more than four hours to officials in buildings they could barely see. But they received scant response.
Bonnie Arzuaga, MD, a neonatologist at Boston Children's Hospital and one of the organizers of the event, said the group's multiple requests were ignored.
Federal policy has precluded these immigration detainees from being vaccinated, despite recommendations from the CDC that the policy could cause many preventable deaths and hospitalizations.
The doctors, some of whom flew to the San Diego border town from as far as North Carolina, Seattle and New York, said they wanted media attention to pressure federal officials to do the right thing, not just for the immigrants, but for the nation as a whole. They plan to continue their protest at the CBP gates Tuesday and Wednesday, in hope that officials will relent.
"This is a public health issue," said Peter Bretan, MD, president of the California Medical Association and a transplant surgeon and urologist who came from Santa Cruz to support the event. "When detainees are not vaccinated, they pose a risk for the whole United States. Vaccinating them will prevent disease transmission which can be deadly."
'Passive Genocide'
Mario Mendoza, MD, an anesthesiologist from Queens, New York, had harsher words. He called the failure to vaccinate detainees, especially children, "passive genocide," especially since three detention center deaths among children to the flu during the last influenza season.
Further, he said the "dehumanizing" tactics being used for long periods of time -- lights on 24 hours a day, cold floors, a rule prohibiting siblings hugging each other -- can traumatize children and adults with acute stress and leave them mentally or psychologically scarred for life, as well as even more vulnerable to infection.
He knows, he said, because he and his brother left El Salvador when he was seven, and "ran for 12 hours" to get across the border in 1981 after his mother was threatened by the Salvadoran government that they would kill her and her two sons. "We experienced post migration trauma, and I still bear mental health scars from that," he said. "We had no choice."
Candace Ireton, MD, who helped open a federally qualified health center and now practices in a free clinic in rural Henderson, North Carolina, also flew in for what she considers a noble cause. "Working with the Latino community has enriched my life, and I see this as a chance to give back. And my husband's family, several of them, were killed in the camps in Nazi Germany, so the similarities are really striking to me. I want to be able to say that when it happened (in my lifetime), I did something."
'You Can't Build a Wall Against a Virus'
Many of the doctors noted the irony of President Donald Trump's comments that migrants bring disease into the U.S. because the current CBP policy seems to make that more likely. Infections transmitted in crowded detention centers with poor conditions can facilitate exposure to the influenza virus throughout the U.S. and worsen what many physicians believe will be a heavier than usual flu season this winter, a costlier and more difficult burden for doctors and hospitals and one that usually takes its toll on the most vulnerable.
La Jolla cardiovascular surgeon Julie Swain, MD, came with her twin sister, cardiologist Judith Swain, MD. "Who could be against giving medical care to children and adults? These current policies are totally unacceptable, unethical and inhumane," said Julie Swain. She added that the detainees are not only endangering others' lives by not getting vaccinated, but they are endangering the lives of detention facility workers, many of whom she said are not vaccinated.
"Then (those workers) expose their family members, their infants and grandparents," who are at higher risk for more serious influenza illnesses.
"You can't build a wall against a virus," said Karl Steinberg, MD, medical director of a hospice in Solana Beach, California, who took time off from work to join the rally.
120 Doses Ready to Go
The organizers of the protest, Arzuaga, Danielle Deines, DO, of Roanoke, Virginia, and Marie DeLuca, MD, an emergency room physician in New York City, received enough donations to purchase 120 doses of influenza vaccine. They were ready to administer them if CBP officials would let them in.
"What we've proposed is a pilot program," Arzuaga said. "We want to show them that this is feasible, and we have dozens of volunteer physicians and nurses here with us who have volunteered their time, taken time off from work to do this. ... All they have to do is open the gates."
She added, "We are not going to take no for an answer. There's no logical reason why they need to decline."
One CBP argument for not vaccinating detainees, reportedly, is that the migrants are only there for 72 hours. But Arzuaga said humanitarian groups that have assisted the detainees after their release into the U.S. know that "children have been kept in this facility for days, if not weeks at a time. ... That's more than enough time for somebody to contract the flu."
After they had waited nearly two hours Monday, the child of one of the doctors at the event rang the CBP call bell at the gate. Someone inside the detention center eventually answered and asked, what do you want?
"They said that we wanted to come in and vaccinate," recalled DeLuca, but "CBP said 'no' and hung up."
Later Monday afternoon, two of the physicians reportedly were able to drive to the nearby CBP headquarters and speak with officials there, but no minds or policies were changed, DeLuca said late Monday.
In an interview last week, Arzuaga said that physicians in area emergency rooms have reported that detainees are being brought into local hospitals with possible flu. "That puts people in danger; we don't know how long people have been sick before that. It puts everybody they've come into contact with at risk of being infected as well."