PLAGUES IN THE NATION

A pointed study of how divisiveness and conflict undermine the nation’s response to disease.

Law professor and legal historian Price offers an authoritative history of America’s flawed responses to epidemics. “Not only does the United States have the most fragmented public health system in the world,” she writes, “but most states retain antiquated public health laws that do not serve us well.” Due to poorly constructed laws and underfunded health agencies, the U.S. responds to pandemics “not as one nation, but as fifty-five smaller nations—the states, territories, and commonwealths that politically subdivide the country.” Responsibility for tuberculosis control, for example, “is divided among 2,684 state, local, and tribal health departments.” Price recounts waves of epidemics in the nation’s early years, when there was no treatment except to isolate the ill. With the discovery of a vaccine for smallpox, local, state, and federal authorities mandated vaccination, although not without controversy. Often, citizens looked for groups to blame, including immigrants, Asians, Mexicans, or even people from other states. In response to yellow fever, “shotgun quarantines” were enforced by militias or deputized volunteers. In 1900, an outbreak of bubonic plague in San Francisco led to the quarantine of the city’s entire Chinatown—a strategy struck down by a federal judge. The rollout of vaccines for Covid-19 echoes what occurred with the vaccine for polio in the 1950s. “Not only was there no patent on the vaccine but there was no plan in place to oversee or coordinate its distribution,” writes Price. “America’s first nationwide vaccination effort was chaotic and politically divisive, as demand for the vaccine outpaced supply.” The author effectively shows how every epidemic has generated tensions about which level of government has the authority to make public health decisions. She recommends a stronger federal role in responding to pandemics, including coordination of the nation’s primary health agencies and nationally funded coverage of the costs of testing and treatment.

A vigorous argument for unified public health measures.