Members of the American Medical Association (AMA) weighed the risks and benefits of the U.S. implementing a vaccine mandate for immigrants and examined policy recommendations around short-term medical trips during the House of Delegates annual meeting.
Sarah Mae Smith, an alternate delegate from California who spoke on behalf of AMA’s Medical Students Section, said that requiring vaccination to immigrate to the U.S. would be “unconscionable.”
Michael Greene, MD, a delegate from Georgia, disagreed, and suggested that vaccines, in particular COVID vaccines, should be offered and required at entry for any immigrant. He put forward an amended policy resolution to that effect.
“If you’re not willing to be vaccinated, you don’t come in,” he said flatly.
As for U.S. citizens re-entering the country, Greene wasn’t certain what the protocol should be. “[T]hat’s something that has to be investigated,” he noted.
Corliss Varnum, MD, a delegate from New York speaking on his own behalf, said that while he didn’t want to deny entry to the U.S. to anyone, the thought of allowing someone who is sick to enter into the U.S. worried him.
“If we watch what India went through, and what Brazil went through … Anything gets through that border, and we lowered … our defenses … we’re only setting ourselves up for another major catastrophe,” he added.
Varnum suggested that the House refer the proposed policy recommendation to the Board of Trustees to help determine a “logical, meaningful” solution.
Douglas Myers, MD, speaking on behalf of the American Academy of Otolaryngology-Head and Neck Surgery, also supported referral in order to examine the cost of such a policy and how it would be paid, as well as whether different protocols should be implemented for immigrants versus repatriating citizens.
“There’s a lot of issues here that I think we’re just skimming over,” he said.
Laura Faye Gephart, MD, a delegate for the American College of Obstetricians and Gynecologists and an obstetrician working at the U.S.’s southern border, speaking on her own behalf, argued against the “abhorrent” amendment mandating vaccination for immigrants, saying that it “grossly misrepresents” people coming across the southern border who, for the most part, have better vaccination rates than most U.S. residents — excepting Honduras.
However, she called for vaccination to be offered to immigrants entering the country, and urged her colleagues to adopt the original policy recommendation.
“[W]ouldn’t it be nice if we could have a median line that says that we support people?” she asked.
Smith, likewise, asked the House not to refer the decision, given the timeliness of the issue — structures around vaccine credentials and mandates are being developed now, she said.
An amendment recommending that vaccine credentials not be used to prevent immigration and that vaccine mandates be implemented uniformly “regardless of citizenship,” part of a broader report on vaccine credentials, was ultimately referred to the Board of Trustees for a decision by the House in a vote of 245-202.
Scrutinizing Short-Term Medical Trips
A policy report focused on short-term medical trips was referred back to the Council on Ethical and Judicial Affairs, after several delegates pointed out its shortcomings.
Samantha Rosman, MD, who spoke on behalf of the American Academy of Pediatrics, called for the policy to be referred because she said the report lacks any mention of promoting “true bi-directional relationships” and doesn’t address the U.S.’s history of colonialism and its influence on global health work.
The report also fails to mention the importance of appropriate supervision for program participants.
Rosman, who has experience working in Rwanda and Lesotho, recalled how a medical student in Lesotho was permitted to see patients on his own. “[L]ocal staff said, ‘great, someone from the U.S. is here,’ and they left,” she said.
“The harm that that does to patients and families, and communities in general, is really unbelievable,” she added.
Anna Yap, MD, a delegate for the American Association of Public Health Physicians, speaking on behalf of the Pacific West Conference, stressed the importance of considering the “power imbalances” that exist in relationships with global health partners and the need to address the scope of practice issues, “so we aren’t practicing on people of color in other countries, things we wouldn’t do to our own children or to our own patients.”
What Yap referred to as “voluntourism” normalizes power differentials between volunteers and partners in developing countries and “further increases the idea that, unfortunately, outsiders are somehow more crucial to helping non-white people who … cannot help themselves.”
The House referred the policy report back to the Board of Trustees for study, with 66% of delegates supporting referral.