Refugee Polio Scare Can Be Costly

Yesterday, I noted the potential cost savings from immunizing refugees before they enter the United States. It focused on the actual cost of giving those shot. In fact, there are additional, less obvious costs associated with the immunizing-later strategy. And one of them is spelled out by researchers from a host of federal and local groups in a second report in the same issue of Morbidity and Mortality Weekly Report. They focused the impacts of turning up two cases in October 2006 of paralytic polio among children at a refugee camp in Kenya. These were the “first virologically confirmed cases” of polio in Kenya in more than two decades.

Some 950 refugees were heading for resettlement in the United States from Kenyan camps. However, once word of the polio cases spread, a massive containment effort went into effect. In some cases, refugees were offered a dose of polio vaccine before getting on a plane for the States. In instances where people were already en route, the doses started only after the refugees landed. And a massive stool-screening program was launched to scout for signs of additional polio cases.

In all, some 5,000 hours of work were logged by the personnel working on the project, 3,271 doses of polio vaccine were dispensed and 1,050 miles of road were traveled to manage the containment program. No additional cases of polio turned up. Ensuring that this was the case cost U.S. taxpayers and domestic relief agencies some $310,000.

The need for such emergency containment programs would be dramatically reduced, the authors of this report note, if routine immunization of refugees slated for resettlement in the United States was standard policy. Indeed, imagine if one of those refugees infected someone. Containment costs would likely have escalated logarithmically.

Such an episode might also go a long way to stigmatize later refugees and relief programs. And that, in the end, would likely prove the most tragic cost of all.