Storytelling about Public Health, Immigration and Power

Here is a headline for you to consider:

CDC Recommended that Migrants Receive Flu Vaccine, but CBP Rejected the Idea

With a different headline and presented in a different order, the same facts and even the same text would tell a different story.

This is how the story in the Washington Post by Robert Moore starts out:

As influenza spread through migrant detention facilities last winter, the Centers for Disease Control and Prevention recommended that U.S. Customs and Border Protection vaccinate detained migrants against the virus, a push that CBP rejected, according to a newly released letter to Congress.

In Washington, I guess that's what this story is about: a battle between agencies, political conflict, and, with any luck, a cover-up and a scandal.  It's about power.  And who will be blamed when the outbreak inevitably occurs.

I noticed a couple of other stories embedded in this same article; it made me wonder about the editorial choice to put the political story first.  First of all there is the story of the individual immigrants and their families who suffer.  Terrible:

An 8-year-old Guatemalan boy died of the flu while being detained near El Paso in December, a month before the CDC’s vaccination recommendation. In the months after CBP rejected the recommendation, at least two children — one in El Paso and one in Weslaco, Tex. — died after being diagnosed with the flu in Border Patrol custody, autopsy reports showed. 

So now Moore has established a frame for the reason we cannot immunize immigrants at the border.  We should immunize them because it's "unconscionable" not to.  It is a moral argument:  two deaths are two too many and it doesn't matter that they are not citizens.  And then, against that moral argument, we get the pushback:

“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,” she said.

In a super-partisan climate polarized by immigration, public services, taxes and ethnic nationalism, this is a losing battle.  It seems to be a zero-sum game, costing American citizens millions to provide high-cost services for a few unwanted immigrants.  But that's not the end of the story.  In fact, there's a completely different narrative built into the same article.  It's just not easy to spot because it doesn't make sense in that initial frame.

“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.”

In other words, it may be possible to reuse a lot of infrastructure that is already there to dramatically reduce the cost.  We're not really told anything about the scale of these systems and the relative costs.  If you read it carefully, it undermines the political story Moore starts with.  But many readers will miss it entirely because it does't fit in the narrative.

But we're missing an even larger story here:  the benefits to American citizens of the proposed vaccination program.  This is the last paragraph in the story:

A new report from the Brookings Institution warns that risk factors such as lackluster sanitation, overcrowding and poor nutrition are creating a “perfect storm” of conditions in CBP detention facilities that could lead to severe outbreaks of the flu and other communicable diseases. The report recommends vaccinating detained migrants as a way of limiting outbreaks.

Unexplored is the connection between outbreaks in these detention facilities and one that threatens every American.  Perhaps it is in our interests to vaccinate immigrants at the border.

With a different headline and presented in a different order, the same facts and even the same text would tell a different story.  Here is a different headline for the story that would begin with that paragraph instead of ending with it:

Threat of Influenza Outbreak from Inadequate Healthcare and Crowded Conditions at Border

Compare that to the original:

CDC Recommended that Migrants Receive Flu Vaccine, but CBP Rejected the Idea

Interesting, no?  

If we were to name that bias, what would we call it?  A liberal bias?  I think not.  We have an attention problem.  It's easy to tell a compelling story about the suffering of individuals, an unenlightened Administration and conflict between powerful interests.  It's a lot harder to connect the dots and show how costs can be managed and, even more importantly, how EVERYONE would benefit from improvements to the vaccination program at the border we already apparently have.