The autopsy reports showed that eight year-old Felipe, 16 year-old Carlos and two year-old Wilmer had the flu when they died in the custody of US immigration officials. If two plans announced by the Trump administration this week are ultimately enacted, there will almost certainly be more names to add to this list of dead children.

Two steps have lead to this potential public health catastrophe. The first of these, unsurprisingly, is imprisoning children. The Department of Homeland Security (DHS) and Health and Human Services (HHS) announced a new rule intended to free the federal government from complying with the Flores Settlement. Flores was designed to safeguard children in the custody of US immigration bureaucracies from abusive practices. Among other protections, it requires that children not be held in an unlicensed detention facility for more than 20 days. But under Trump’s new regulation, children could be held indefinitely while their immigration case is processed.

Second, denying those imprisoned children the flu vaccine. Customs and Border Protection (CBP) issued a statement to CNBC saying that "due to the short-term nature of CBP holding and the complexities of operating vaccination programs, neither CBP not its medical contractors administer vaccinations to those in our custody."

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On the very same day the Trump administration moved to hold children in custody indefinitely, CBP publicly claimed they won't provide flu vaccinations because they don't hold children long enough.

Why is this nonsensical position so dangerous? After all, influenza is relatively common – since 2010, the Centers for Disease Control (CDC) estimates that between 9.3 and 43 million people have gotten the flu each year.

But the danger was plainly laid out in a letter to Reps. Rosa DeLauro (D-CT) and Lucile Royal-Allard (D-CA) from public health experts affiliated with Johns Hopkins and Harvard. In the letter, which DeLauro and Royal-Allard, powerful House Appropriations subcommittee chairs, forwarded to DHS and HHS on 5 August, 2019, the experts explained that the flu is much more dangerous to children held in immigration detention.

At least 3 children (Felipe, Carlos, and Wilmer) have died from complications caused by flu, out of about 200,000 kids being detained. In the United States last flu season, there was one death due to flu per 600,000 kids. In other words, the children CBP is responsible for are nine times more likely to die due to influenza than kids in the rest of the United States.

In their letter, the public health scholars explain that "detention centers are at high risk for influenza outbreaks" and, complete with citations to the scientific literature, explain the epidemiological underpinnings of this heightened risk. They also note that CDC recommends every child over the age of 6 months be offered the flu vaccination if not medically contraindicated.

CBP knows about the recommendations that children over 6 months should be given the flu vaccine. It also knows flu outbreaks are more likely in detention centers and that detained children face a greater risk of death due to flu. Yet CBP still refuses to offer the flu vaccine. The cruelty, as is so often said in 2019, is the point.

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But giving children the flu vaccine isn't enough to solve the public health crisis. Children simply don't belong in jail.

Even if, to some lacking conscience, it isn't self-evidently morally wrong, imprisoning children is, in the language of public health research, an "Adverse Childhood Experience." Researchers have determined three categories of ACEs: abuse, neglect, and household dysfunction. Being imprisoned implicates all three categories of ACE. The more of these experiences that children are exposed to, the more likely they are to experience a severe, negative health outcome. These experiences are associated with increased risk of ischemic heart disease, stroke, suicide, depression, COPD, alcoholism, liver disease, cancer and more.

I know that the Trump administration is aware of the overwhelming scientific evidence around trauma. When the administration first announced it was moving to terminate the Flores Settlement, I helped organize clinicians through Kids Don't Belong in Jail to submit comments in response to the draft rules. Hundreds of highly qualified experts told the administration in excruciating detail the ways in which children would suffer life-long harm as a result of being imprisoned in immigration detention facilities. But this administration doesn't care about the overwhelming epidemiological evidence. We are harming, perhaps irreversibly, an entire generation of children who fled to us, begging for our protection.