THE EFFECTIVENESS OF COVID-19 CONTROL ACTIONS AT THE U.S.-MEXICO BORDER

BY SAMUEL STRATTON

The U.S.-Mexico border is crossed by more people than any other border in the world.  At 3,145 kilometers (1,054 miles) in length, the U.S.-Mexico border is also the longest contiguous land border in the world. As the COVID-19 virus spread throughout the globe during 2020, the often crossed southern U.S. border seemed to receive little media or official government attention. Interesting to note is that the first COVID-19 confirmed infections in northern Mexico were tracked to infection spread by individuals who had crossed the border from the United States.

In March 2020, the border, which has an average of 986,000 legal crossings daily, was closed for all but essential traffic by both the U.S. and Mexican federal governments. Concurrently, borders throughout the globe were closed at this time. For the order community, this effort to control the spread of COVID-19 was logical. The community's experience during the 2009 Influenza H1N1 outbreak in Mexico with closure of the state borders around Veracruz and Mexico City as well as the international order with the United States helped limit the global spread of the virus. In addition, during the outbreak the use of facial covering to limit the spread of H1N1 became accepted in areas of Mexico affected by the virus.

Also in March 2020, it was little recognized that along with the closing of the order, state and local health departments along the order shared infection rate data in an effort to locate potential local “hot spots” and limit COVID-19 spread. 

Today (May 2021), the efforts and actions taken along the order by both the United States and Mexico are rarely reported locally while tragic infection and mortality spikes in India and other nations separated geographically from the United States receive the focus of both popular media and the world political leaders. It would seem that the world’s longest, most crossed border would be an area for attention and ongoing concern for spread of COVID-19 (Figure 1).

Figure 1: Map of the U.S.-Mexico border region illustrating major areas for human movement into both countries. (figure complements of the U.S. Centers for Disease Control and Prevention)

Why has the border been rarely addressed politically and by the media? Simply put, the globe’s border region at highest risk for person-to-person transmission of COVID-19 has been an example of successes in limiting spread of the virus. The lack of public interest in COVID-19 issues at the U.S.-Mexico border supports a saying among public health providers: “success is expected; only failures receive public attention and news exposure.”

Not all efforts at the border were immediate successes. In October 2020, El Paso, Texas, became a COVID-19 hot spot as the infection spiked to the degree that hospitals in El Paso were overwhelmed and could handle no further cases. Both federal and state emergency resources were deployed to the area with deployment and opening of large fully equipped medical tent hospitals. During this time, the El Paso County morgue was filled with three times the usual daily number of deceased that required coroner resources.

El Paso is a major medical referral center with specialized hospitals that serve a surrounding 150-mile radius area. El Paso is directly on the border with Mexico and Ciudad Juárez is on the border directly south of El Paso. This sister-city area is called the Borderplex and there is a total population of 2.7 million. The Borderplex region contains six border crossing sites with daily crossing traffic (when the border is not closed) of 2,600 commercial trucks and roughly 110,000 persons. The Borderplex region is the major manufacturing and commercial area of central northern Mexico and the southwestern United States.

With El Paso a hot spot for infection and the border essentially porous to human crossing, it would have been expected that spread of COVID-19 both south and north would be rapid. Fortunately, the El Paso spike in infection remained localized without increased transmission rates detected into Mexico or along commercial transportation routes into the United States. This success was attributed to public health and political actions to control local community infection transmission and isolate the city area of El Paso.

The usual social distancing, closure of all but essential business, and cancelation of large public gatherings were implemented. But the action that seems to have had the most impact was the community-wide acceptance for the importance of use of face covering when in public. Remarkable is that facial covering in the Borderplex area was by a population that is a diverse bilingual population, is multicultural, and is diverse in ages. While standard infection control actions were taken, general acceptance of facial covering was the factor that was different from many other populated global regions and is now associated with limiting initial spread of COVID-19.

In mid-March 2021, the El Paso Sector Border region was opened to usual traffic by both the United States and Mexico. While acceptance of facial covering and the usual mitigation efforts by a diverse population contributed to control of spread of COVID-19, another factor has come into play. As COVID-19 immunization has now become available, access to vaccination was directed to the entire border community and not just those residing on one side or the other of the border. Certainly, the tiered access to vaccination was adhered to on the U.S. side of the border where vaccine first became available. But local health departments and vaccination sites did not limit access to only those who proved legal U.S. residence.

Continued aggressive production and distribution by the United States of vaccines throughout the Western Hemisphere is the next logical public health action.

While “politically incorrect” to have recorded data for the number of Mexican residents who were able to cross the border and obtain immunization, it is reported in Mexico that significant numbers of persons who worked on the U.S. side of the border, but resided in Mexico, were able to obtain vaccination north of the border. In the current (Spring 2021) vaccine-available era of the COVID-19 pandemic, the health philosophy of inclusiveness for an integrated border community has helped in developing infection resilience for the Borderplex region.

The acceptance by a diverse, multicultural, and bilingual community of basic social measures to limit spread of COVID-19 and the public health approach of considering the border community as a single population as opposed to two populations has proven effective for control of COVID-19 spread. The border experience serves as an example of success in public health and politics that must be emphasized as the world faces future novel viral outbreaks that can rapidly develop into pandemics.

Finally, an interesting point regarding the United States and Mexico should be made. Vaccine diplomacy or the donation of large amounts of vaccines by vaccine-owning nations for political gain to other countries that are unable to manufacture COVID-19 vaccines is of general global political concern. With respect to the United States and Mexico, as well as the rest of the Western Hemisphere, the sharing of vaccine supplies by the United States is extremely important from a pandemic control perspective.  Political goodwill may or may not be a benefit of vaccine sharing, but public health professionals agree that the United States has an ethical obligation to share vaccine supplies within the Hemisphere.

Reports from Mexico regarding the first doses of AstraZeneca vaccines delivered from the United States have been extremely positive and helped develop intercommunication among health providers on both sides of the border. Politics aside, as the United States catches up with internal vaccination goals, continued aggressive production and distribution by the United States of vaccines throughout the Western Hemisphere is the next logical public health action for protection of all in the Western Hemisphere and the overall global population. 

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Samuel J. Stratton, MD, MPH, is an Adjunct Professor in the Department of Community Health Sciences at the UCLA Fielding School of Public Health. He is also a Deputy Health Officer and the Medical Director for Health Disaster Management/ Emergency Medical Services at the Orange County California Health Care Agency.

The views and opinions expressed here are those of the author and do not necessarily reflect the official policy or position of the Pacific Council.