Disease, Borders, and Blame: A Seven-Century Pattern
From the Black Death to Ebola, disease control has been used to sort people by race and nationality. The pattern is centuries old, and it is happening again.
An Air France flight was diverted this week. The history behind it is 700 years old.
HIV, SARS, Ebola, COVID — each outbreak found its scapegoat.
Stigma is not a side effect of outbreak response. It is a failure of outbreak response.
An Air France flight was diverted this week. The history behind it is 700 years old.
An Air France flight from Paris to Detroit was diverted to Montreal this week. The reason: a passenger from the Democratic Republic of Congo was on board, and U.S. authorities said the plane could not land because of new Ebola entry restrictions.
The other passengers were not exposed. Ebola spreads only through direct contact with the blood or body fluids of someone who is actively sick. There is no indication this passenger had symptoms. The diversion was a border enforcement action, not a medical emergency.
But the story traveled fast, and the framing was familiar. A foreign passenger. A frightening disease. A plane full of people wondering if they were safe.
That framing has a long history. And it has done real damage.
Plague, pogroms, and the birth of quarantine.
During the Black Death in the 1300s, Jews were accused of poisoning wells. Pogroms followed across Europe, even as Pope Clement VI issued formal statements rejecting the charge. The 1377 quarantine decree in Ragusa — one of the earliest formal quarantine measures on record — was designed to keep trade moving while managing risk. But the panic around plague also fed conspiracy and violence directed at outsiders.
That double inheritance — bureaucratic disease management alongside social scapegoating — has shown up in every major outbreak since.
In 1793, yellow fever tore through Philadelphia. Refugees from Saint-Domingue were blamed. Free Black residents, including Absalom Jones and Richard Allen, organized care for the sick, and were later accused of profiteering by Mathew Carey, a white publisher who had fled the city. Jones and Allen published a rebuttal pamphlet. The pattern was already locked in: the people doing the most dangerous work were blamed for the disease they were fighting.
The fusion of disease screening and border control.
Federal quarantine law in the United States began in 1878, driven by yellow fever and cholera. The Immigration Act of 1891 excluded anyone with “a loathsome or a dangerous contagious disease.” These provisions fused disease screening with border control, and that fusion never operated neutrally.
The Chinese Exclusion Act of 1882 was not written as a public health measure. But anti-Chinese disease rhetoric made it politically easier to pass. Cartoons in California depicted Chinatown as a source of smallpox, leprosy, and plague. In 1900, San Francisco officials quarantined an entire district of more than 15,000 Chinese residents during a plague scare. Federal courts struck it down. In Jew Ho v. Williamson, the judge found that officials had acted with "an evil eye and an unequal hand."
🎧 Listen: Past Is Prologue — Epidemics & Anti-Asian Xenophobia The San Francisco plague outbreak is one of the most revealing episodes in American public health history. In this episode of EPIDEMIC, I spoke with historian David Randall and public health scholar Merlin Chowkwanyun about how a federal quarantine officer used disease as a weapon against Chinatown, and what happened when he was replaced by someone who chose trust over force. The parallels to today are hard to miss. Listen on Apple Podcasts → or on Spotify →
At the same time, at Ellis Island, first- and second-class passengers were examined in their cabins. Steerage passengers, the poorest immigrants, were lined up for public inspection. At Angel Island, Asian immigrants underwent invasive exams and were detained for days or weeks. The rejection rate at Angel Island was as high as 33%. At Ellis Island, it was 6%.
Along the U.S.-Mexico border in 1917, Mexican workers were stripped, showered with kerosene, and inspected for lice. Women protested in what became known as the Bath Riots. The disinfection regime continued long after the typhus threat had passed.
HIV, SARS, Ebola, COVID — each outbreak found its scapegoat.
The 1918 influenza pandemic became “Spanish flu,” even though it did not originate in Spain. The name stuck because Spain, neutral in World War I, was the only country reporting cases openly. The label attached a global pandemic to a single nationality.
HIV produced one of the sharpest examples. In 1987, the U.S. added HIV to its list of excludable diseases and banned all HIV-positive non-citizens from entering the country. The ban lasted 22 years. During that time, HIV was spreading domestically among U.S. citizens. No comparable restriction was placed on citizens’ movement. UNAIDS declared in 2004 that the ban had no public health justification. It was repealed in 2010.
Haitian asylum seekers got it worse. In the early 1990s, more than 260 Haitians fleeing a military dictatorship tested HIV-positive after being intercepted at sea. They were detained at Guantanamo Bay in a camp surrounded by barbed wire. A federal judge called it an “HIV prison camp.” The government acknowledged they were legitimate refugees, but refused to process their cases.
SARS in 2003 hit Chinese and Asian-diaspora communities hard, not just medically but socially. CDC documented stigma and discrimination. Chinatown neighborhoods in New York and other cities saw sharp drops in business, even where there were few or no cases. Research described a neighborhood “infected with fear.”
During the 2014 Ebola outbreak, WHO explicitly advised against travel bans. Modeling showed flight restrictions would delay international spread only modestly, and could make things worse by disrupting aid and supply lines. Many countries imposed bans anyway. In the U.S., some states quarantined asymptomatic healthcare workers returning from West Africa. Kaci Hickox, a nurse who had treated Ebola patients with Doctors Without Borders, was held in a tent on hospital grounds in New Jersey. Two Ebola tests came back negative. A Maine judge ruled the quarantine unjustified.
COVID brought the full pattern back. The framing of the virus as “Chinese” or “Wuhan,” including by senior U.S. officials, fueled a sharp rise in anti-Asian harassment and violence. A randomized controlled trial found that using the term “Chinese virus” increased negative attitudes toward Asian Americans compared to neutral scientific naming. Stop AAPI Hate documented more than 9,000 incidents in the first year of the pandemic.
Title 42, a public health authority, was used to expel more than 2.5 million migrants and asylum seekers at the southern border. CDC’s own experts objected. Experts called it “misusing public health as a pretext to end asylum.”
Stigma is not a side effect of outbreak response. It is a failure of outbreak response.
When a disease gets attached to an ethnicity or nationality, three things happen. Communities are punished economically beyond the zone of actual risk. People become less willing to report symptoms, disclose travel, or seek care. And public health authorities lose the cooperation they need to contain the outbreak.
CDC recognized this explicitly during SARS. The same dynamic played out during Ebola, when fear and stigma drove people to hide cases and avoid treatment centers. It happened again during COVID, when anti-Asian rhetoric changed behavior around testing and disclosure.
The Ebola outbreak now spreading in eastern Congo is caused by Bundibugyo ebolavirus. The WHO has declared it a Public Health Emergency of International Concern. An American doctor has tested positive and was evacuated to Berlin for treatment. The U.S. has responded with a Title 42 order barring non-citizens who have been in the DRC, Uganda, or South Sudan within the past 21 days. Citizens are exempt.
Seven centuries of evidence point to the same conclusion: when disease control is used to sort people by nationality or race, it does not make anyone safer. It makes outbreaks harder to fight.