Borders, Budgets, and the Rising Risk of Disease

July 6th, 2011

Is there a perfect storm brewing along our nation’s southern border? Let’s take a look at the numbers in El Paso, Texas where I recently visited:

• There are 27 million crossings per year alone at the El Paso Point of Entry (POE) and a border population of 25 million;
• Cuts to federal funding including a 50% reduction in the Early Warning Infectious Disease Program as well as 12.5% cuts to critical preparedness and response funding;
• Texas is second in the nation for number of tuberculosis cases, the majority of which are found near the border and many of the cases involve tuberculosis strains that are drug resistant
• The bordering country, Mexico, was the source of the last global influenza pandemic

So is this a bad situation getting worse or ticking bomb?

An Invisible Public Health Structure

Earlier this month I visited the El Paso POE and came away thoroughly impressed by the professionalism of the Customs and Border Protection. I met many of those “boots on the ground” local public health folks who work on the Texas/Mexico border and who shared with me how the border has been neglected with minimal resources for years. Staff have been forced to live by that old credo “do more with less” to safeguard not only the communities living along the border, but the nation itself.

During my trip I also had the distinct honor to meet and chat with a lawmaker who really understood the importance of border health—U.S. Rep. Silvestre Reyes, D-Texas who notes, “A border crosser with an infectious disease can be anywhere in the United States within 36 hours.” Congressman Reyes knows that the border is a challenging environment with many barriers including different priorities for the two countries who share the border, different public health systems, travel restrictions, language, and politics. Additionally, our public health teams must contend with new and emerging infectious diseases, an economic crisis where budget cuts have decimated public health programs that man the border, and gaps in preparedness.

Disease Threats

While in El Paso, I also met with Dr. David Lakey, Commissioner of Texas Department of State Health Services who discussed his concerns about tuberculosis and other infectious diseases around the border. Lakey pointed out that Texas is second only to California with tuberculosis cases and that these cases are higher near the border than other parts of the state. Lakey said that in the poor communities along the border, people are less likely to get early treatment and often times they travel back and forth across the border and are not able to complete their treatment routine which leads to drug-resistant tuberculosis. Clearly the border is a challenge for those seeking to control infectious diseases.

Valley Fever

In addition to tuberculosis, an emerging disease called coccidiodomycosis or “Valley Fever” seems to be on the rise in this border region. Valley Fever is caused by inhalation of fungal spores that live in the desert soil; the spores can be dispersed by high winds. We see between 10,000 and 15,000 new cases diagnosed in Arizona each year, but very few cases are diagnosed across the Arizona-Mexico border, even though we know that pathogens don’t stop at borders. What is more likely than the pathogen stopping at the border is that health-care providers and laboratories are not trained to recognize and diagnose Valley Fever, allowing it to spread further.

Hard Questions and the Way ahead

How do we conduct surveillance and create sustainable bi-national systems for early warning infectious disease surveillance recognizing that there are 250-400 million northbound legal border crossings a year and that 25% of the US population and 35% of the Mexican population resides in the ten combined Border States? Is doing more with less really the answer? If so, then what can we no longer afford to do? Moving forward we must work to implement guidelines or a process for both countries to coordinate on epidemiological events. We require a bi-national border system for case reporting and communication and outbreak investigations and responses. And finally we must do a better job linking and integrating existing bi-national border efforts.

To learn more about CDC’s Division of Global Migration and Quarantine, which works to prevent the introduction, transmission, and interstate spread of communicable diseases into the United States and its territories, visit: http://www.cdc.gov/ncezid/dgmq/

Tell Us What You Think

Do you live in a border state? Had you ever thought about the importance of public health at our borders? How do you think the nation needs to address the issue of budget cuts and possible disease threats?