This piece was originally published by The Bulwark on January 13, 2020.

It’s flu season again, but most Americans are fortunate to have ample access to flu shots (it’s still not too late!) at a relatively low price. Without the immunization, the flu can kill even a healthy adult, but the disease disproportionately claims the lives of children and the elderly. While the flu is generally considered a manageable epidemic disease, it can still cause astonishing harm in places where vaccines are limited and people are crowded together – places like immigrant detention camps at the southern border, where an epidemic crisis now looms.

Recent advances in immunization techniques have significantly enhanced the vaccine’s efficacy, reduced adverse effects, and made administering it possible in nearly any conditions. But the flu virus is still a dangerous disease. In the winter of 2017-18, the flu and its complications killed 80,000 Americans (646,000 people worldwide), leading to almost frantic calls for annual immunization.

According to the Centers for Disease Control (CDC), children should be vaccinated every flu season. Children under 9 who have never had a flu vaccine require two doses, given four weeks apart, to ensure they are adequately protected against the flu during peak months between October and February.

Despite fervent warnings from the CDC about the need to immunize children seeking asylum at the border against the flu, border authorities will not allow flu immunizations. Even more irresponsibly, offers by private individuals to do so at no cost to the government have been spurned for no discernible reason.

Many children waiting with their parents to make an asylum claim in the U.S. come from countries in Latin America that do not have adequate access to an effective influenza immunization, often because available vaccines are a mismatch to the circulating strains of the flu that vary annually or because of misconceptions and poor awareness among the public about the effectiveness of the immunization. Providing the vaccine is critical to the populations arriving at our southern border from these parts of the world, as well as greatly beneficial to herd immunity in the United States.

Generally speaking, medical examinations are mandatory for all refugees coming into the country and all applicants outside the U.S. applying for an immigrant visa, in accordance with our immigration laws. Section 212(a)(1)(A) of the Immigration and Nationality Act states that the U.S. may not admit individuals that have a communicable disease of public significance, who fail to present documentation of having received vaccination against vaccine-preventable diseases (like the flu), who either have or have had a physical or mental disorder with associated harmful behavior, or who are drug abusers or addicts. If a vaccine is not available, a civil surgeon or panel physician refers the applicant to a place where the vaccine is provided, or grants a waiver to provide the vaccine in the U.S.

Both Immigration and Customs Enforcement (ICE) and the Office of Refugee Resettlement (ORR) provide flu vaccinesto children (and adults) in their custody. CBP has never provided immunizations for detained migrants due to the short-term nature of CBP holding.

Now, however, susceptibility to the flu has been magnified by conditions at the border resulting from the Migration Protection Protocols (MPP) and the resulting unofficial border camps – and crowded CBP facilities. The sheer number of children living in tents along the border and held for extended periods in CBP facilities increases the spread of the flu virus and complicates treatment.

At least three children – aged 2, 6, and 16 – have died in CBP custody since December 2018 of flu-related illness. In a letter to Congress, doctors cite poor conditions at CBP facilities for amplifying the spread of influenza and other infectious diseases. Health care professionals also suspect that DHS and the Department of Health and Human Services (HHS) may not be following the best practices with respect to screening, treatment, isolation, and prevention of influenza, and asked Congress to investigate.

As a result, parents in MPP are forced to send a child who falls ill back to border officials as an unaccompanied minor – who are never placed in the queue to wait in Mexico – in order to ensure that the child will be given medical care by ORR.

To make matters worse, when a child reaches the border, CBP officials are often the only government officials who interact with children of asylum-seeking families prior to their return back to Mexico to wait for admission under MPP. The MPP guidelines give CBP officers full discretion to assess the physical and mental health of an individual for the purpose of deciding whether they are fit to wait in Mexico – a task for which they are manifestly unqualified.

Essentially, CBP officers are charged with eyeballing children and determining how healthy they are, without the aid of any health care background or knowledgeable assessment. Children placed in MPP are likely to never get any care until they get desperately ill – and even then, probably not. Prophylactic vaccination could help resolve the problem.

In an early April press call last year, Border Patrol Chief of Operations Brian Hastings said that the agency then sent an average of 63 people per day to get additional medical treatment – the highest number it has seen since it began tracking.

In defense of the agency’s rejection to provide flu vaccinations, CBP spokeswoman Kelly Cahalan said:

CBP has significantly expanded medical support efforts, and now has more than 250 medical personnel engaged along the Southwest border. To try and layer a comprehensive vaccinations system on to that would be logistically very challenging for a number of reasons. The system and process for implementing vaccines — for supply chains, for quality control, for documentation, for informed consent, for adverse reactions — is complex, and those programs are already in place at other steps in the immigration process as appropriate.

But many argue these reasons are pretextual. According to one physician  , it would take less than half an hour to administer the vaccine to more than 100 children via a free mobile flu clinic. Groups of physicians and health care providers continue to protest the government’s refusal to allow them to administer flu shots to the willing. If CBP were to administer immunizations itself, the cost would be minimal; about $1.40. per immunization, and would likely prevent costly hospitalizations that result from complications of preventable disease.

Vaccinating children against the flu common across agencies in DHS and HHS, and is a practice (seemingly) easily translated to CBP facilities. Allowing physician volunteers access to the populations in the interim to administer immunizations at such low or no cost, with such obvious positive consequences, is a no-brainer.