Protecting America from MERS and other Biological Threats

Posted with permission of the authors William J Parker III, PhD and Maryellen Meymarian, JD

The Centers for Disease Control and Prevention (CDC) issued statements of concern and posted warnings at 22 different airports urging travelers to be mindful about washing hands and being in contact with sick people, especially while traveling overseas following separate Middle East Respiratory Syndrome (MERS) cases being confirmed in the United States in the past few weeks. It is critical that the CDC and the World Health Organization (WHO) continue to learn more about the MERS virus, particularly its origination point and transmission mechanisms.  But in the absence of stronger regulations governing who can enter the United States, the U.S. government will continue to merely be playing catch-up.

Protecting America from communicable diseases requires proactive federal action for both potential immigrants and citizens traveling abroad. The U.S. must promote minimum health and vaccination requirements for individuals who travel to and from the country.  Currently only a small number of individuals are required to provide proof of medical examinations and vaccinations prior to entry into the United States. Immigration regulations should mandate that all frequent and long term non-immigrants provide proof of medical examinations and vaccinations prior to visa issuance.  The classes of individuals specifically targeted should include individuals who receive Border Crossing cards, work visas, student visas, and 10 year multi-entry tourist or business visas.  These individuals are frequent travelers or durational residences and as such should demonstrate that they are admissible pursuant to the health requirements currently set forth in the law.  Additionally, and in addition to the medical exams that they are already required to have prior to entry, all new refugees and K visa applicants should be required to complete the vaccine process prior to entering the U.S..    The individuals targeted for these new rules are noncitizens who will be living in the U.S. for numerous years or frequently traveling to the U.S. Visa requirements for these individuals already involve a significant time and financial investment to obtain. 

The U.S. should also recognize that its own citizens who travel are potential carriers of disease not only domestically, but also when they travel to and from this country.  Promoting healthy living and traveling will also have a positive domestic impact. The public plays a significant role in preventing the transmission of disease.  Sick individuals must be educated on the importance of staying home, seeking treatment when necessary and avoiding contact with others especially in enclosed public transportation and work venues.  Public awareness campaigns can be very effective and at the same time can be very simple.  For example, DHS’ nationwide public awareness security campaign “If You See Something, Say Something,” encourages the average person to report suspicious activities to law enforcement.  A similar healthy travel slogan should be developed and be mandated to be printed on all travel materials including: airline, train and bus tickets; passport and visa applications, and on posters though travel venues.    Something as simplistic as “Travel happy and healthy: if you are sick and must travel, consult a medical professional first.”  Travel insurance should also be encouraged, as the economic cost of rescheduling most travel plans is costly.  The national goal should be to make healthy travel a priority.

In addition to domestic awareness, U.S. citizens who wish to travel internationally should be properly vaccinated against preventable diseases.  Citizens need to actively participate in the prevention of disease.  Obtaining and updating vaccines is already recommended by the World Health Organization and the CDC for all international travelers.  These recommendations should be a required element for initial and renewal of a U.S. passport.  In certain countries and areas of the world, proof of vaccination is already required prior to entry.  Therefore, individuals seeking to obtain a new or renewal U.S. passport should be required to provide vaccination documentation similar to individuals seeking admission as immigrants. U.S. law already provides numerous reasons for why a passport can be denied, including for failure to pay child support and mental illness. Failure to provide adequate vaccination documentation can simply be one additional category. Individuals seeking a passport from the Department of State already pay a processing fee.  If requiring proof of vaccination requires additional resources, then the fee can be adjusted to account for the added cost in processing the applications.

The CDC and State Department also have travel advisories for certain areas around the world.  Travelers, both citizens and noncitizens, who seek entry or reentry after traveling to a high risk part of the world, should also be required to provide proof that they were vaccinated against the disease threat prior to having entry into those high risk regions.  Non-immigrants who seek to enter without the required vaccines can be denied entry.  Non-citizens and citizens who were not properly vaccinated prior to admittance in the threat area should be fined and followed by local health officials.  The fine should compensate relevant local health officials for required follow up monitoring.  The cost of fine can vary depending on the required nature of the follow up; and should encourage individuals to seek vaccination prior to departure and if not, the fee can serve to permit follow up by local officials.  With the major changes that have occurred as a result of new health care laws, preventative care is generally free and includes the immunization, shots, screening and tests for preventative care.  Therefore there is little or no cost to obtaining the recommended vaccines. 

Requiring health preventative measures to obtain a U.S. passport or admission to the United States sends a strong message that disease prevention needs to start with the individual. More importantly, there is no additional, direct, upfront cost to the U.S. government for requiring travelers to comply with these requirements. Although there may be additional costs associated with checking medical examination and vaccination records during passport and visa processing, these costs may be recovered by charging additional fees to international travelers.

 Mandating health prevention standards for those seeking entry to the U.S.–whether citizens or noncitizens–would help to close a critical gap in America’s homeland security.  In our globalized world, infectious diseases can spread faster than at any point in human history, and yet despite many great efforts by the government over the past decade, our disease prevention protocols are currently rooted firmly in the past. It’s time to provide a new standard of protection that’s in line with current science on communicable threats and update our regulations for the 21st century.


Dr. Parker holds a PhD in biological defense and is a fellow at the Council on Foreign Relations.

Ms. Meymarian is an attorney specializing in immigration and naturalization law.