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What Lessons Can Be Drawn from Case Studies in France, the United States and Madagascar?
Hugo Carnell

Despite its long history, plague has not been an internationally significant disease since the mid-twentieth century, and it has attracted minimal modern critical attention. Strategies for treating plague are generally outdated and of limited effectiveness. However, plague remains endemic to a few developing nations, most prominently Madagascar. The outbreak of a major plague epidemic across several Madagascan urban areas in 2017 has sparked a wider discourse about the necessity of improving global preparedness for a potential future plague pandemic. Beyond updating treatment modalities, a key aspect of improving preparedness for such a pandemic involves a process of sophisticated review of historical public health responses to plague epidemics. As part of this process, this article outlines and compares public health responses to three separate epidemics from the early modern era onwards: Marseille in 1720–22, San Francisco in 1900–04 and Madagascar in 2017. Based on this process, it identifies three key themes common to successful responses: (1) clear, effective and minimally bureaucratic public health protocols; (2) an emphasis on combating plague denialism by gaining the trust and cooperation of the affected population; and (3) the long-term suppression of plague through the minimisation of contact between humans and infected small mammals.

Journal of Humanitarian Affairs