From its inception in the 14th century until the end of the 19th century,
quarantine policy lacked uniformity both within and between nation states.
It was often devised and implemented by local authorities in response to local
crises. Variability in the use of quarantine as a public health measure often
stemmed from disagreement about the factors that precipitated epidemics of
infectious disease. By the mid-19th century, repeated European cholera pandemics
highlighted the lack of international uniformity in quarantine practices.
In response, France proposed a meeting in 1834 at which the international
standardization of quarantine could be discussed. The meeting did not eventuate
and it was only in 1851 that the first International Sanitary Conference was
convened in Paris.
This and subsequent conferences held in the following decades were concerned
with developing international consensus on the control of cholera, plague,
and yellow fever.1 Ten conferences were
assembled between 1851 and the end of the century, but it was not until 1893
that a compromise was reached concerning notification of disease and minimum
and maximum periods of detention.1,2 Agreement
was limited, and negotiations continued into the 20th century.
International cooperation was difficult to achieve because quarantine
policies are almost always a reflection of issues other than a state's desire
to protect itself from the importation of infectious disease. It can represent
the levels to which a state chooses to intervene in the activities of its
citizens, and it plays an important role in the types of regulations that
govern the movement of foreign persons or goods across its borders.3 Quarantine has been closely connected with the
development of restrictive immigration policy and the protection and control
of trade. It has been used as an effective tool in international relations
and as a means to define the sovereignty of a state.3 One
of the key reasons, therefore, why it took so long to reach any agreement
on a standardized quarantine was because for each of the states who attended
the International Sanitary Conferences, quarantine fulfilled various political
and economic needs, as well as providing protection against disease.
The 1885 conference in Rome provides a clear example of how political
and economic agendas prohibited open negotiation about quarantine and why
consensus remained elusive for such a long time. A proposal was offered relating
to the inspection and quarantine of vessels from India intending to traverse
the Suez Canal. Britain objected that the free movement of its trading vessels
was paramount and that such precautions would be extremely costly. France,
at the same time, was angered by Britain's unilateral assumption of power
over Egypt and wanted to limit growing British dominance in the canal. Thus,
the French insisted on an independent international inspection of vessels
entering Suez, knowing that British ships constituted the greatest proportion
of the canal's traffic.3 A quarantine station
at Port Said (Egypt) would provide a buffer for Europe against disease from
"the East" and create an obstacle to British trade.
In a similar vein, the 1881 Washington conference was summoned to meet
political expedients. This time, an international disease control convention
was sought in order for the United States to achieve the aims of the National
Board of Health Act, which was passed in 1879 to protect against "the introduction
of contagious or infectious diseases into the United States."4 The
act required that "all merchant ships and vessels sailing from a foreign port
where contagious or infectious disease exists, for any port in the United
States, must obtain from the consul . . . at the port of departure . . . a
Bill of Health."5 This required US consular
officials as well as the port officials of the country of departure to inspect
the ship before it set sail for America. "It is hardly surprising," Howard-Jones1 points out, "that difficulties arose in the enforcement
of such a law, and it was evidently the realization on the part of Congress
that the Act must necessarily remain a dead letter unless other nations could
be persuaded to agree to it that led to the idea of an international conference."
These 2 examples, among a long list of other such instances, show how
economic and political agendas impeded negotiations that should have been
focused on reaching international consensus on disease control. A ratified
convention was achieved in 1893, however, at the end of what was the final
European cholera pandemic in 1892. It was a further half-century and many
conventions more until the formation of the World Health Organization heralded
a unified and universally agreed set of international laws relating to infectious
disease.2 International conventions were
only achieved once some consensus was reached regarding the manner in which
diseases are transmitted. This provided a clearer focus for the reasonable
application of internationally endorsed quarantine regulations. From this
point forward, the international community was able to more effectively combat
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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