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Flight plan: TB or not TB
Question of the Day
One of the great combat generals of World War II, Manton Eddy, had a favorite saying when battle reports came in: “Things are never half as good or half as bad as they look at first.” Gen. Eddy believed in waiting for enough information to make a good decision. This also applies to homeland security.
Before people start assigning blame, spending money and proposing fixes, they ought to have enough facts to make a respectable guess at the right thing to do. Yet where homeland security is concerned, thinking before speaking seems to be the exception rather than the norm.
It’s happening now in the wake of the story about the international travels of Andrew Speaker, the Georgia resident who is infected with a rare form of tuberculosis. His sojourn and his ability to slip past border officials have spawned thousands of newspaper articles and hours of TV coverage as well as accusations that the Departments of Homeland Security and Health and Human Services were at fault.
The only thing we don’t have yet are the facts needed to make any really useful assessments about what this story might portend and how to fix the problem.
The first thing necessary to understand is what Mr. Speaker knew about his illness and what various health officials told him to do. So far, the record is contradictory and confusing. But it makes a big difference. In dealing with an infectious disease, the most important instrument of control is the voluntary behavior of individuals. Getting people to do the right thing — what is in their own best interest and that of the community — is paramount.
This is an important teaching moment for all Americans. They need to understand the importance of their role in public and the magnitude of their responsibility. Public health officials, must learn how to communicate to citizens so their messages are credible and understandable.
Next, we need a complete timeline of the actions taken by all officials — not just in the U.S., but in all the countries involved. No one has all the facts yet, and we can’t properly evaluate government response without them. For example, news stories have focused on Mr. Speaker’s entry into the U.S. across the Canadian border. But how did he get into Canada? If a truly communicable disease crosses the ocean, and the onset of symptoms isn’t visibly apparent in a few hours, then likelier than not it will reach the United States, carried by innocents infected in Canada or Mexico who have no idea they are infected.
Finally, the problem needs to be put in perspective. The U.S. already has a communicable disease problem — big time. And the individuals entering the U.S. legally through legitimate points of entry are the least part of it.
Tuberculosis, including strains increasingly drug resistant, is one of the world’s fastest-growing diseases. This is partly due to the spread of HIV/AIDS, which reduces the human immune system, leaving individuals more susceptible to TB.
The World Health Organization says more than 8 million people a year get TB, and about 98 percent live in the developing world. Most illegal migration comes from the developing world to Europe and the U.S. Many of these persons never pass through a point of entry, which is the most likely source of a human-carried pandemic. That’s where the real problem is. In fact, today when the Department of Homeland Security detains an individual for removal from the United States, virtually the first step taken is to test him for TB.
That said, as the Senate considers a bill to immediately grant legal status, including the right to pass back and forth across the U.S. border, to about 12 million individuals living unlawfully in the United States — with no health check required — the advice to think before acting should hold special significance.
Knee-jerk responses to one individual case make for bad public policy. In evaluating homeland security, sizing up public health policies, and passing immigration laws, we ought to proceed a little more thoughtfully.
James Jay Carafano is a senior research fellow for homeland security at the Heritage Foundation (heritage.org).
By Matt Kibbe
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