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.
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.
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.
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?”
“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 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.
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.
“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.
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.”
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