A. Pieter Kappetein, MD, PhD, was looking forward to a busy week of meetings and activities at the annual meeting of the American Association for Thoracic Surgeons (AATS) in late April. Dr. Kappetein, a cardiothoracic surgeon at Erasmus MC in Rotterdam, the Netherlands, and secretary general for the European Association for Cardio-Thoracic Surgery, was giving two presentations at the meeting and had a full schedule of committee meetings, board meetings, and the like.

But on his way to the United States, Dr. Kappetein was pulled aside by U.S. immigration officials in Dublin and questioned about his travel background. After a long interrogation, he was informed he could not enter the United States and had to return home. The reason? His passport showed he had traveled to Iran 2 years earlier.

“They asked, ‘What did you do in Iran?’ I said. ‘I’ve been there because of lecturing, and I’m a surgeon,’ ” Dr. Kappetein recalled in an interview. “I had to go to another room, same questions, all my fingerprints were taken, my photo was taken. They said I was not allowed to travel to the U.S. I had to go apply for a visa.”

He was forced to give up his ticket to Boston, buy a new ticket home, and miss the work he was scheduled to do.

“I was angry,” Dr. Kappetein said. “They had to go get my luggage off the plane. I lost my ticket to Boston. It [was] a lot of money. I was very busy in Boston. I had meetings from early in the morning until late in the evening, and I had to give lectures as well. There were a lot of obligations that I could not fulfill.”

Restrictions hamper streamlined process

Dr. Kappetein’s ruined travel plans result from recent changes to the Visa Waiver Program ( VWP ). The program enables most citizens and nationals of participating countries to travel to the United States for tourism or business for 90 days or less without a visa; U.S. citizens and nationals get reciprocal travel access.

But changes to the program starting in 2015 mandated that most people who had traveled to or had been present in Iran, Iraq, Libya, Somalia, Sudan, Syria, or Yemen on March 1, 2011, or later, were no longer eligible to travel to under the VWP. The changes were part of the Visa Waiver Program Improvement and Terrorist Travel Prevention Act of 2015, signed by President Obama, which aimed to prevent travelers with ties to countries that pose terrorist threats from entering the country.

These new restrictions to the VWP have been enforced since January 2016, Jennifer Gabris, a spokesperson for U.S. Customs and Border Protection, said in an interview. She stressed that the eligibility requirements do not bar travel to the United States; rather, travelers who do not meet the requirements must obtain a visa.

Dr. Kappetein, however, said he has traveled to the United States from the Netherlands at least 10 times since his visit to Iran 2 years ago and encountered no problems until this year. He was under the assumption that travelers coming to the United States for business were exempt from the restrictions.

“I never had any issue at the border,” he said. “So the immigration officers, either they hadn’t seen [the passport stamp], or they had ignored it, or they didn’t care about it. I even got this prescreening [approval], so when I was in the States, I didn’t have to go in the line where you have to take off your shoes or your jacket.”

A Department of State spokeswoman referred questions about airport enforcement to the Department of Homeland Security, which declined to comment for this article.

Rolling out such restrictions generally takes time, and it’s possible that travelers are only recently seeing the effects of the VWP limitations, said Adam Cohen , a Memphis-based immigration attorney. Mr. Cohen said that he has not heard from many physician clients who have been affected by the VWP restrictions.

“It takes time to implement, even after it’s signed,” Mr. Cohen said. “I don’t know to what degree it was being enforced, but the limited application means it probably just didn’t raise much attention.”

He noted there was little publicity surrounding the VWP restrictions until President Donald Trump called out the changes to justify his controversial travel ban, Mr. Cohen added. In his revised executive order released in March, the president noted that the countries named in his ban had already been “identified as presenting heightened concerns about terrorism and travel to the United States” through their exclusion from the VWP.

Harm to collaboration?

The VWP restrictions are among a number of increased security measures for foreigners and immigrants entering the country. President Trump’s March 6 Executive Order on immigration expanded uniform screening procedures for all visa classes and nationalities, while another provision suspended the Visa Interview Waiver Program. The interview program suspension means that certain applicants seeking to renew a visa must be interviewed in person by a consular officer. While a number of courts, including the 4th U.S. Circuit Court of Appeals, have blocked much of the Executive Order, the decisions did not halt the additional screening requirements or temporarily suspend the Visa Interview Waiver Program rollback. Both provisions remain in effect.

On May 4, the State Department proposed another regulation that would require more personal information from a subset of visa applicants, including 15 years of biographical information, employment history, addresses, prior passport numbers, information about family members including current and former spouses as well as travel histories and how trips were funded. Visa applicants would be required to provide phone numbers and email addresses used over the previous 5 years, according to the proposed rule. The subset of visa applicants would be determined by Department of State consular officers when resolving an applicant’s identity or when vetting for national security–related visa ineligibilities.

In a May 18 letter to the State Department, the American Association for the Advancement of Science and 17 other associations cautioned that the rule, if approved, would blunt scientific and academic collaborations, discourage foreign students from seeking to study and participate in research projects in the United States, and damage U.S. competitiveness.

“The notice, as proposed, is likely to have a chilling effect not only on those required to submit additional information, but indirectly on all international travelers to the United States,” the letter stated . “The uncertainties and confusion regarding supplemental questions will have a negative impact particularly on U.S. higher education and scientific collaborations.”

Since Dr. Kappetein’s travel mishap, he has obtained the required visa so that he may again travel to the United States. But he noted that entering this country will take at least 2 hours longer because of the visa entry protocols and additional airport screenings. The added restrictions and increased scrutiny of foreign travelers is unfortunate for U.S.-based medical conferences, he said.

“The interchange of information is really happening at those meetings,” he said. “[This] will block the exchange of information and it will block innovation. That’s a pity for [foreign physicians], but also for Americans.”


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