THE ERRORS WE’VE SEEN SO FAR HAVE INVOLVED SOME degree of subtlety. With the DEMONIZER, subtlety is chucked out the window. This rhetorical maneuver simply takes advantage of a difficult and usually scary scientific concept—often, the spread of dangerous diseases—and links it to an unrelated issue to advance a political agenda. Politicians most often deploy this tactic in efforts to criticize and curtail immigration.
For example, in early 2015 a disease straight out of the past made national news when a measles outbreak began at Disneyland. The outbreak was a direct result of the profoundly unscientific anti-vaccination movement,1 but that didn’t stop some politicians from pinning the blame on that eternal bogeyman, the foreigner. Here’s an extended, grammatically challenged rant from Alabama congressman Mo Brooks, speaking on Matt Murphy’s radio show:
I don’t think there is any health care professional who has examined the facts who could honestly say that Americans have not died because the diseases brought into America by illegal aliens who are not properly health care screened, as lawful immigrants are. It might be the enterovirus that has a heavy presence in Central and South America that has caused deaths of American children over the past six to nine months, it might be this measles outbreak—there are any number of things. . . . unfortunately our kids just aren’t prepared for a lot of the diseases that come in and are borne by illegal aliens. You have to have sympathy for the plight of the illegal aliens, I think we all understand that. But they have not been blessed with—in their home countries—with the kind of health care, the kind of immunizations that we demand of our children in the United States.2
This is an impressive example of fearmongering and contains a litany of scientific errors. Diseases are frightening things, especially those that sound unfamiliar to us—like the enterovirus Brooks mentioned (and was wrong about, as we’ll see), or measles, which used to be common in the United States but was declared eliminated by the Centers for Disease Control and Prevention in 20003 (with sharp declines in prevalence decades before that). Brooks took advantage of that fear to connect the diseases to another issue that may be unpopular with his particular constituency: illegal immigration. In doing so, he spread decisively false scientific and medical information.
First, Brooks mentioned enterovirus. He was correct that this disease had caused the deaths of children in the United States, but he was wrong about its origins. The specific strain that caused problems in the United States in 2014 was enterovirus D68, which causes “mild to severe respiratory illness,” according to the CDC.4 Various other enteroviruses circulate in the United States every year, but the 2014 outbreak was a particularly severe strain. During that outbreak, assorted media personalities tried to pin the blame on a recent flow of undocumented immigrant children from Honduras, Guatemala, and El Salvador. Brooks was parroting that claim, and he spoke as though the connection had been firmly established. It had not.
In fact, no one knows exactly why there was a spike in D68 cases in 2014, or exactly where the virus came from. However, the CDC has said that “children arriving at U.S. borders pose little risk of spreading infectious diseases to the general public.”5 In the case of the enterovirus, certain studies also indicate that the flow of immigrants was unlikely to be the cause. One such study examined people across Latin America with flu-like symptoms and found that only 3 percent of them carried any enterovirus strain. Of that 3 percent, only 10 percent (meaning, 0.3 percent of the total, or three in one thousand individuals) carried the D68 variety.6 In other words, the flow of children crossing the border almost certainly was not the source of the D68 outbreak in the United States.
Brooks, and the others who made the claim before him, had no evidence whatsoever that undocumented immigrant children were bringing this disease into the country with them. But criticizing undocumented immigrants in certain circles is a no-lose proposition, and Brooks took advantage.
Since his comments pertained to measles, it turns out Brooks was even more wrong. He suggested that all these children coming in from Central America don’t have the levels of protection against disease that the United States has—that we are better at vaccinating against measles than the developing countries south of our border. That sounds logical; after all, the United States is among the most advanced nations in the world. Wouldn’t it have better rates of measles vaccination than El Salvador?
To understand the answer to that question, a bit of background is useful. In 1998, a group of researchers led by UK physician Andrew Wakefield published a paper in the prestigious journal the Lancet with this impenetrable title: “Ileal-Lymphoid-Nodular Hyperplasia, Non-specific Colitis, and Pervasive Developmental Disorder in Children.”7 The paper argued, essentially, that the MMR vaccine—measles, mumps, and rubella—could cause autism in young children.
To be extremely, urgently clear: that conclusion was false. Vaccines. Do. Not. Cause. Autism.
Numerous studies have since looked for a connection between the MMR vaccine and autism, and have found nothing. It took a while, but eventually the Lancet retracted the paper entirely (in 2010) after finding severe flaws, while an investigation by the British Medical Journal turned up evidence of outright fraud.8 Wakefield’s medical license was stripped. Even before that, though, the Wakefield paper’s influence was a bit bizarre, since the results it reported came not from a large cohort study of the sort that would ordinarily be required to find such a potential hazard with the MMR vaccine, but from only a small, observational study of a handful of children.
In general, the study and the still-resounding furor about vaccines and autism is perhaps the best-ever example of that golden rule: correlation does not equal causation. Autism spectrum disorders are generally diagnosed at an age range when children have recently received various vaccines, including the MMR; it is understandable that confused and worried parents look for something to blame, and the vaccine may have been the most recent connection to the medical world for that child. But in no way does that mean the vaccine caused the disorder.
Unfortunately, the long delay in retracting the study enabled the anti-vaccination movement to grow and metastasize, with the Internet furthering the cause by helping spread an entire genre of totally false and misleading vaccine information.9 This movement led many parents to refuse vaccines for their children entirely, or at least to delay them, both of which increase the risk of disease not only for the unvaccinated children, but also for those around them. That trend, to withhold lifesaving vaccinations from children, has, against all odds, dropped the United States behind the developing countries that Brooks mentioned when it comes to protection against measles.
Some of the countries in Latin America that immigration hawks are so concerned about have similar or even better measles vaccination rates than the United States. According to the World Health Organization, the American rate of coverage among one-year-olds has ranged between 91 and 93 percent over the last couple of decades,10 and certain small pockets of the country have seen those rates drop dramatically. Some places, such as Orange County, California, home of Disneyland and the origin of the 2015 measles outbreak, have seen huge drops in vaccination rates even as the national rate has stayed relatively high.11 Across all of California, in 2000 only 0.77 percent of children started kindergarten with a “personal belief exemption” from vaccinations;12 in 2013, that rate was four times as high, though it dropped a bit in 2015. And that statewide average masks the clumps of unvaccinated kids: some counties had exemption rates above 10 percent, and overall vaccination rates can drop into the low 80 percent or high 70 percent range.13
Those percentages are important because of a result of vaccination known as “herd immunity.” Some children cannot receive vaccines for medical reasons; they may have a compromised immune system, say, thanks to leukemia or other diseases that require immunosuppressing therapies. Herd immunity is what protects those children from diseases like measles; it basically means that, with a high enough immunization rate, the disease can’t take hold in a community and won’t be able to infect vulnerable people. At the low levels of immunization seen in some California counties, herd immunity is severely compromised. Some parents argue that vaccinating their kids should be up to them alone, but the decision has actual, demonstrable effects on other people; even if you homeschool your unvaccinated children, are you going to keep them out of every other public space where they may interact with other children? Like, say, Disneyland?
The anti-vaccination trend, which we’ll explore again in a later chapter, is, in large part, an American creation. Still, certain countries from which undocumented immigrants arrive do, in fact, have lower vaccination rates than the United States. For example, Guatemala’s rate dropped to 85 percent in 2013, followed by a sharp dip to 67 percent in 2014. For a decade prior to that, though, the country had rates similar to those of the United States—at or above 90 percent (and the children who crossed the US border would likely have been of vaccination age during the period of higher vaccination rates).
Other neighboring countries do even better. Nicaragua’s measles immunization rate rose to 96 percent in 2005 and has held steady at an impressive 99 percent ever since. El Salvador’s hasn’t been quite as steady or as high, but in 2013 and 2014 it held at 94 percent. Mexico’s rate in 2014 was 97 percent. The implication from Brooks was that these backward, disease-ridden countries were dumping their illnesses on rich, healthy Americans, but in fact the opposite is true. Coming to the United States from El Salvador might increase one’s risk of disease, thanks to the lower vaccination rates here than back home.
The troubling vaccination trends in the United States, and the impressive public health immunization efforts in Latin America, didn’t seem to matter to Brooks and others. Here’s Ben Carson in 2015, at the time gearing up for his presidential bid, making a similar point:
We have to account for the fact that we now have people coming into the country, sometimes undocumented people, who perhaps have diseases that we had under control. So now we need to be doubly vigilant about making sure that we immunize our people to keep them from getting diseases that once were under control.14
That’s Doctor Ben Carson, by the way. Just as with Congressman Brooks, Dr. Carson seizes on the assumption that the United States is more medically advanced than the developing world. He was less obvious in his demonization of the “other,” the diseased foreigner, but the implication is the same: we need to immunize “our people” because the other people might bring diseases with them.
It is not hard to draw a straight line from this type of scientific misstep to the anti-immigration policies espoused by many GOP politicians. Donald Trump’s idea to build a (wholly impractical and prohibitively expensive15) border wall is in some ways a direct reaction to the idea of the diseased foreigner (obviously, economic fears and other factors play in as well). And of course, those types of fears are manifested in how the public votes. In other words, this misrepresentation of science and medicine can help produce actual policy that is unsupported by the scientific concepts behind it.
MANY OF THE OTHER ERRORS described in this book are relatively recent phenomena. The DEMONIZER, though, is perhaps the most persistent misuse of science that politicians have engaged in across US history. The fear of immigrants has been a common theme since the early days of Ellis Island—and even before—and there are examples of misstatements about disease and immigration from various points since.
Moving backward through history, we can see that politicians have repeated, time and again, the idea that immigrants are bringing over every disease that happens to be in the news. Here’s former presidential adviser, 1992 and 1996 presidential candidate, and noted racist Pat Buchanan going for the DEMONIZER grab bag:
High among these is the appearance among us of diseases that never before afflicted us and the sudden reappearance of contagious diseases that researchers and doctors eradicated long ago. Malaria, polio, hepatitis, tuberculosis, and such rarities of the Third World as dengue fever, Chagas disease, and leprosy are surfacing here.16
Leprosy! This is an incredible list of misinformation, so let’s debunk it disease by disease. First of all, malaria: between one and two thousand cases of malaria are reported in the United States every year, almost all in residents who have traveled abroad to endemic areas. It is very unlikely to then pass from person to person; a mosquito in the United States would have to bite the infected person and then bite other people, transmitting the parasite that causes malaria. Such outbreaks do occur—it happened sixty-three times between 1957 and 2014, according to the CDC—but this has nothing to do with immigration, but rather with travelers failing to take basic precautions.17
Next up, polio. No cases of polio have originated inside the United States since 1979, and the last time a traveler brought it in was 1993.18 That’ll do.
It almost isn’t worth addressing “hepatitis,” as that refers to five different diseases with differing modes of transmission. Some evidence does suggest that prevalence of hepatitis B, which is transmitted via bodily fluids, is higher among foreign-born individuals living in the United States,19 so we’ll let him have that one. Tuberculosis also may be brought across borders by those arriving both legally and illegally, though this isn’t considered a large concern.
Next, what about those “rarities of the Third World”? Most dengue fever cases are acquired outside the United States by travelers, though interestingly, experts are concerned that climate change could allow dengue’s spread northward by creating more habitat where the mosquitoes that transmit it can live. Fewer than forty cases of Chagas’ disease—caused by a parasite that is transmitted by the so-called kissing bug—have been reported in the United States since 1955.20
And finally, leprosy. Yes, this disease still exists. Also called Hansen’s disease, leprosy affected 2,323 people in the United States between 1994 and 2011, and Buchanan would be right if he noted it is more common among foreign-born individuals. But the idea that there is some explosion of this disease thanks to immigration is laughable; the rate of new diagnoses in that time period actually fell by 17 percent.21 And here’s another fun fact: some of the cases of leprosy in recent years have been transmitted not by people, but by armadillos.22
Perhaps it isn’t surprising that Pat Buchanan’s rhetoric on health and immigration isn’t exactly scientifically sound. Going back a bit further, here’s former Oklahoma senator Don Nickles during a 1993 Senate debate over trying to prevent HIV-positive foreigners from immigrating:
There are 700,000 immigrants that come into the United States every year. If we change this policy, it will almost be like an invitation for many people who carry this dreadful, deadly disease to come into the country because we do have quality health care in this country, better health care in the United States than any other country in [the world]. . . . I mention this amendment is not born out of hate. This amendment is not born out of fear. This amendment is not born out of homophobia. This amendment is raised to try and stop President Clinton’s administration from making a very serious mistake that will jeopardize the lives of countless Americans and will cost U.S. taxpayers millions of dollars.23
The policy in question—preventing immigration of HIV-positive individuals—had been in place since 1987 (created by Senator Jesse Helms). The “countless” Americans, though, were a figment of Nickles’s imagination; it was estimated that in 1989, for example, fewer than a thousand HIV-positive immigrants would even seek entry into the United States. Given HIV’s limited modes of transmission, this was far from a public health crisis. Importantly, though, the DEMONIZER really works: the policy Nickles spoke about remained in place all the way until 2009, when President Obama finally lifted the ban.24
We can continue to go back in time. In 1915, for example, a typhoid fever epidemic began in Mexico,25 spreading fear that it would penetrate the United States as well.26 Along with a growing nativist sentiment and concerns about immigrants from elsewhere in the world, this epidemic led to passage of the Immigration Act of 1917. That ignominious bit of legislation lumped in the presumably diseased “other” with a whole host of supposed undesirables rivaling the Blazing Saddles army of “mugs, pugs, thugs,” and so on:
The following classes of aliens shall be excluded from admission into the United States: All idiots, imbeciles, feeble-minded persons, epileptics, insane persons; persons who have had one or more attacks of insanity at any time previously; persons of constitutional psychopathic inferiority; persons with chronic alcoholism; paupers; professional beggars; vagrants; persons afflicted with tuberculosis in any form or with a loathsome or dangerous contagious disease.27
Of course, the fears that some politicians took advantage of at various points did at least have some basis in truth: there were occasional disease outbreaks in other countries less advanced than the United States, if one goes back far enough. But the language of the DEMONIZER persisted long after many parts of the world had begun to change. In a 2002 paper on the “persistent association” of foreignness and disease in the United States, University of Michigan researchers Howard Markel and Alexandra Minna Stern wrote about how much of the developing world modernized and left the American rhetoric behind:
After World War II, many countries built hospitals and rural clinics and spearheaded campaigns to combat endemic diseases, and many parts of the world benefited from reductions in childhood mortality and various infectious diseases as well as improved standards of nutrition as a result of hygiene and maternity programs. In addition, organizations like the United States Peace Corps and the United Nations World Health Organization brought modern sanitary techniques, public health administration, vaccines, and medical treatments to areas that had neither the financial or human resources to afford them.28
And yet, half a century and more later, politicians continue to connect foreigners with disease, even when those foreigners may have grown up with better health care than the politician did.
Again, the DEMONIZER is an easy tactic for politicians to use, since the diseases in question can be scary and most people won’t know that they are exceptionally rare in immigrants, or that vaccination rates are actually better in other parts of the world. Spotting this tactic is relatively easy, since it is generally limited to this particular scientific field: if a politician warns that allowing foreigners in will spread a certain disease, doubt the claim. Check the actual modes of transmission of the disease, or the actual prevalence of that disease. The devil isn’t the immigrant; it’s in the details.