The U.S. Has Tried to Wall Off Disease Since 1878. It Has Never Worked.
From shotgun quarantines in 1905 to airport screening that found 9 cases in 766,044 travelers, the U.S. keeps learning the same lesson and forgetting it.
The U.S. is running an old experiment again.
Public health isolationism is the belief that you can protect a country from infectious disease mainly by controlling its borders instead of detecting outbreaks where they start, cooperating with other countries, or building domestic readiness. The United States is running the most aggressive version of this experiment in its modern history. But the experiment is not new.
Yellow fever, plague, and influenza all got through.
In 1878, yellow fever killed an estimated 20,000 people in the Mississippi Valley. Congress responded with the National Quarantine Act, the first law giving the federal government direct quarantine enforcement power. It was the start of a pattern the country has repeated for nearly 150 years: a deadly outbreak, a rush to seal the borders, and a slow discovery that it doesn’t work.
In 1900, San Francisco quarantined Chinatown after plague cases appeared, drawing the boundaries to exclude white-owned businesses while locking Chinese residents inside. A federal court struck it down as racial discrimination. The quarantine didn’t stop plague.
It drove cases underground. In 1905, Mississippi sent its state militia to the Louisiana border during a yellow fever outbreak — men with shotguns turning back trains and travelers at gunpoint. Public health officials called them “shotgun quarantines.” Yellow fever spread anyway. The mosquitoes that carried it didn’t stop at state lines.
At Ellis Island, inspectors ran “six-second physicals“ on arriving immigrants — flipping eyelids with a buttonhook to check for trachoma, chalk-marking coats for further review. Immigrants warned each other about “the buttonhook men.” The system filtered individuals. It could not filter viruses.
In 1918, U.S. port quarantines failed to keep influenza out. The virus killed 675,000 Americans. None of it worked. The disease got through every time.
From cholera ships to Cold War smallpox: how cooperation replaced isolation.
In 1851, France convened the first International Sanitary Conference in Paris. Twelve nations sent delegates. They couldn’t agree on anything. For the next four decades, conference after conference failed to produce a binding treaty. It took until 1892, another cholera pandemic, for them to sign the first one.
The breakthrough was political, not medical. Countries accepted that going it alone didn’t work. That insight drove every major institution that followed: the International Sanitary Bureau in 1902, the WHO in 1948, the International Health Regulations in 1969.
In 1958, the Soviet Union proposed a global smallpox eradication campaign to the World Health Assembly. By 1966, the U.S. had committed major resources to the effort. Two superpowers that agreed on almost nothing agreed that a virus didn’t respect borders. By 1980, smallpox was gone, the only human disease ever eradicated.
A rock star walked into Jesse Helms’s office.
A rock star walked into Jesse Helms’s office. In 2002, Bono and Senator Bill Frist, the only physician in the Senate, sat across from Jesse Helms in his Senate office. Helms was the most conservative member of the chamber and had long dismissed HIV/AIDS as a moral failing. Bono told him the disease had orphaned 10 million children in Africa. Frist told him a single dose of a new medicine could stop mother-to-child transmission. Helms listened.
Months later, Helms wrote in The Washington Post that he was ashamed he hadn’t acted sooner. He announced he and Frist would seek $500 million for mother-to-child prevention. Bono, meanwhile, spent eight days barnstorming through Nebraska, Iowa, Illinois, Indiana, Ohio, and Kentucky on his “Heart of America Tour,” building grassroots support in red states.
On January 28, 2003, President George W. Bush proposed the Emergency Plan for AIDS Relief in his State of the Union address — $15 billion over five years. Frist and Democratic Senator John Kerry shepherded the legislation through Congress. Bush signed it on May 27, 2003, 23 years ago today.
PEPFAR became the largest commitment by any country to fight a single disease: more than $110 billion over two decades, credited with saving 26 million lives. But its value went beyond HIV. PEPFAR funded more than 70,000 clinics and trained over 300,000 health workers across Africa. It built the labs, the tracking systems, and the workforce that countries later used to spot and fight Ebola, H1N1, and COVID.
The Global Health Security Agenda, launched in 2014, extended the same logic to more than 40 nations. Its origin — a Republican president, a conservative icon who changed his mind, a Democratic co-author, and a rock star — crossed every political line in American life.
170 years of institutions. 12 months of cuts.
The U.S. left the WHO in January 2026.
By mid-2025, 71% of PEPFAR implementing partners reported at least one category of work cancelled.
U.S. disease researchers were limited to listen-only mode in WHO outbreak meetings.
The Trump administration’s position: the WHO is bloated and political, global agreements limit American sovereignty, and bilateral deals give the U.S. more control.
The latest Ebola outbreak is testing this strategy.
Border measures buy days. They don't stop epidemics.
The track record is consistent. Border controls buy small amounts of time. They do not stop epidemics.
During COVID, the U.S. screened 766,044 travelers at airports from January to September 2020 and found nine positive cases. The CDC itself said the results showed the need for a “fundamental change” in border health strategy.
Cochrane reviews of COVID-era travel bans found low-certainty evidence overall. The clearest finding: border measures without domestic action don’t stop spread.
Countries that beat COVID paired border controls with mass testing, tracing, and masks. The border was one layer in a system, not a replacement for one.
Political scientists found that nationalist governments closed borders faster but were slower to act at home. They called it “security theatre.”