Selectively permeable national borders: An ethnographic study of a pre-entry TB screening centre
Abstract Background The securitisation of borders against the threat of invading microbes, carried by immigrant bodies, is not a new phenomenon. Tuberculosis (TB), transmitted through coughing, has been a core member of the infectious diseases deemed important to control for more than a century. Following evidence suggesting airport screening for TB using chest x-rays was ad hoc, ineffective and costly, the UK - following in the footsteps of other high-income, low TB-burden countries - moved to pre-entry screening of migrants for TB. Thus the 'biosecuritisation' of immigrant bodies was shifted off-shore. Since 2014, pre-entry screening for TB has been a mandatory part of the visa application system for those moving to the UK for a period of 6 months or longer from high-incidence countries. This ethnographic study explores how pre-entry screening is experienced by migrants. Methods Data was drawn from a project exploring migrants' experiences of accessing healthcare. This involved a focused ethnography, comprising 180 hours of field work over four weeks including interviews with clients and staff, in a pre-entry TB screening centre in India in 2017. During this time over 1000 individuals were screened for active pulmonary TB as part of their visa application. In addition, 14 in-depth interviews were conducted with migrants diagnosed with TB in the UK. Foucault's concept 'governmentality' and sociological theories of bordering were used alongside thematic analysis to analyse the data. Results This study reveals the previously undocumented harms experienced by individuals who are required to undergo pre-entry screening for TB. Through the 'biosecuritisation' of some, but not all, off-shore bodies; some, but not all, off-shore TB; some, but not all, infectious diseases; pre-entry screening becomes a border force, reinforcing global inequities and racialised hierarchies. In this context, I argue pre-entry screening makes UK citizens live while letting 'others' die. Key messages Pre-entry screening marks migrants as ‘other’ in a global, racialised, hierarchy of TB risk that ignores intra-country heterogeneity, obfuscating solutions that might reduce inter-country inequities. The global health security agenda must consider the experiences of those caught up in its policies and practices in order to ensure disease control does not do more harm than good.