Epidemics, national security, and US immigration policy

What are relationships between epidemics, national security, and US immigration policy? This question is important because it sheds light on transnational or nontraditional security areas, American immigration policy, and a pressing issue for US leaders who have recently faced epidemics such as the West Africa Ebola outbreak that began in 2013. This article answers it and lays ground in the area by reviewing epidemics in world history, using International Relations and Security Studies works to specify dangers of contagions for states, and identifying three general immigration measures that American leaders have utilized from the seventeenth century to the present day to protect against contagions, which are (1) policies restricting entrance of foreigners thought to carry specified diseases, (2) the isolation or quarantining of immigrants with contagious disease, and (3) delegating the President with authority to stop immigration in the event of an epidemic abroad. This study has implications for research and contemporary US immigration policy.


Introduction
President Barack Obama and other high-ranking American leaders declared epidemics "a national security priority for the United States" on 26 September 2014 in front of officials from more than 40 countries at a Global Health Security Agenda summit. 1 Obama described contagions as formidable foes and explained that the Ebola epidemic "underscoresvividly and tragicallywhat was already known: that in an interconnected world, outbreaks anywhere, even in the most remote villages and the remote corners of the world, have the potential to impact everybody, every nation." And the threat, the President warned, is pervasive: "nobody is that isolated anymore," he clarified. "Oceans don't protect you. Walls don't protect you." Within such a world, Obama admonished, We have to change our mindsets and start thinking about biological threats as the security threats that they arein addition to being humanitarian threats and economic threats. We have to bring the same level of commitment and focus to these challenges as we do when meeting around more traditional security issues. 2 He could have framed Ebola as solely a humanitarian concern, but he also declared it an urgent national security issue.
immigration constitute potential non-military dangers to nation-states within the global community. 12 Finally, it will contribute to debates on the pragmatism and risks of constituting areas such as immigration and epidemics as "security" issues by exploring dangers to states from contagions and US policy responses to them. 13 This article will unfold in four parts. First, it will survey several epidemics through world history to identify threats they pose to civilizations and nation-states. Second, it will draw from IR and Security Studies literatures to specify security risks posed by epidemics for nationstates. Third, it will present three broad types of immigration measures US leaders have used since the seventeenth century to protect against contagions, which are (1) policies restricting entrance of foreigners thought to carry specified diseases; (2) the isolation or quarantining of immigrants with contagious disease; and (3) giving the president authority to stop immigration in the event of an epidemic abroad. 14 Fourth, the article will conclude with research and policy suggestions.

Epidemics and security in historical perspective
Many examples exist through history of epidemics destroying societies and abruptly altering the fate of civilizations. Thucydides recorded perhaps the first account of a contagion by detailing the horror of the "plague of Athens," which was brought to Greece by sailors from Northern Africa and reduced the Athenian population by over one-third, weakened their army, and contributed to their defeat in the Peloponnesian War. 15 The bubonic plague (the Black Death) arrived in Europe during the fourteenth century via the Silk Road from Central Asia and reduced the population of the continent by an estimated 30-45% and the discord in its wake likely contributed to the collapse of the feudal system. 16 European explorers introduced diseases in the New World that between Christopher Columbus's arrival in 1492 and the eighteenth century killed as many as 95% of the American Indians and contributed to the relative ease with which their lands were taken by imperial states. 17 The resolve of German soldiers was broken by the 1918 influenza (Spanish Flu) outbreak during World War I and disease killed more soldiers during World War II than combat in many battle areas. 18 The USA has also struggled with epidemics over its history. Deadly outbreaks of the ague, bacillary dysentery, cholera, diphtheria, influenza, lobar pneumonia, malaria, tuberculosis, typhus, typhoid, scarlet fever, smallpox, and yellow fever repeatedly broke out across the America from the seventeenth through the early twentieth centuries. 19 As just a few examples: Philadelphia lost as much as an eighth of its population to yellow fever in 1793; New Orleans had a higher death than birth rate for most of the nineteenth century in part because of cholera and yellow fever; and large parts of America were stricken with cholera outbreaks in 1832, 1849, and 1866 that are estimated to have taken over 200,000 lives. 20 Contagions continued to claim large numbers of Americans during the first quarter of the twentieth century, exemplified by typhoid killing an estimated one million lives from 1880 to 1920, and the Spanish Influenza, the deadliest disease in history as measured by the absolute number of lives it claimed worldwide, struck near the end of World War I to kill an estimated 500,000 Americans in a few short years. 21 By the mid-twentieth century, US death tolls from communicable diseases plummeted with improvements in sanitation methods and the discovery of cures and vaccines for many infectious diseases. Even so, approximately 170,000 Americans die each year from contagions and epidemics remain a security threat. 22 For example, a US National Intelligence Council report on infectious disease estimates that since 1973 at least 20 known diseases, such as cholera and tuberculosis, have reappeared or spread to new locations around the globe. Furthermore, scientists have discovered approximately 30 previously unknown diseases such as Ebola and hepatitis C, many of which do not have available cures. The report also emphasizes the susceptibility of modern states to biological attacks by rogue groups and individuals, citing the 2001 mail-based anthrax attacks throughout the USA as an example of bioterrorism. 23 These risks, coupled with recent outbreaks in developed nations (e.g. the 2003 Severe Acute Respiratory Syndrome (SARS) virus, the 2009 Swine Flu, and the continuing West Africa Ebola outbreak) indicate that the USA remains susceptible to epidemics.
Security threat of epidemics to the USA As the previous examples illustrate, epidemics pose security threats to states in a number of ways, primarily through their detrimental effect on economic and military power, foreign relations, and domestic or internal security. This section draws from IR and Security Studies works to elucidate security threats to states from epidemics to emphasize why US leaders have a strong incentive to devise migration policies to protect against contagions. 24

Economic and military power
Epidemics can reduce the ability of a state to project economic and military power in the international system. Infectious disease does this primarily through its affect on human health and productivity, with possible results of an epidemic including a high mortality rate; sick citizens unable to return to work; and laborers performing suboptimallyall outcomes that can tax social and healthcare systems and stagnate economic and military production of a state. Disease also has a psychological toll on citizens and can generate anxiety and fear among members of a polity, which in turn can curb social and technological innovation, disrupt trade, limit capital investment, and encourage firms and entrepreneurs to abandon long-term economic plans. 25

Domestic or internal security
The psychological impact of disease on people within a society is frequently severe, with the uncertainty and devastation wrought by epidemics capable of prompting erratic and violent behavior among members of a polity. "Emotions and perceptual distortions" emerging as a result of a disease outbreak, noted Andrew T. Price-Smith, "may … generate the construction of images of the 'other', resulting in stigmatization, persecution of minorities and, even, diffuse inter-ethnic or inter-class violence." 26 As they attempt to cope with the horrors of an epidemic, citizens may blame one another for the outbreak and violence may erupt. Disease can also limit the ability of a state to control its constituents, which can force it to impose strict measures on citizens; and disease may reduce the services a state can provide to its populace, which can limit its legitimacy. Citizens dissatisfied with the state may protest, with possible outcomes including rioting, civil-police violence, and even civil war. 27

Foreign relations
Epidemics affect relations among states in a number of ways. The economic and societal disorder from a contagious disease may affect trade and social interactions among states, perhaps limiting their ability to cooperate and find solutions to disagreements and collective action problems. States may similarly take punitive action against one another if they blame the outbreak of a disease on the ineptitude or irresponsibility of governments other than their own. Epidemics may also be a direct cause of conflict among states if they are perceived as originating from a biological attack carried out by a state or a rogue group within a state. They may indirectly cause conflict among states by weakening the economies and militaries of some states more so than those economies and militaries of other states in the international system. In which event, they can alter the balance of power in the global community and may even lead to war. 28 Leaders thus have security incentives to create measures to protect the US from disease carried by immigrants.
Epidemics and US immigration policies US leaders since the colonial era have devised at least three broad immigration measures to protect against epidemics, which are: policies restricting entrance of foreigners suspected of carrying contagions; the isolation or quarantining of arriving immigrants thought to host dangerous disease; and delegating to the President the authority to stop all immigration in the event of an epidemic abroad. 29 This part focuses disproportionally on the two former methods, since they have constituted primary ways that leaders have sought to protect against contagions, whereas the third measure is presented because it may be reconsidered if the USA faces an epidemic. This part also consults government documents, legal statutes, and public and private statements as well as secondary sources by historians and scholars in other fields to ascertain how American officials have identified epidemics and migration as being security issues.
Conditioning/restricting entrance to foreigners carrying disease US officials from the colonial era through to the present day have devised laws that condition or disallow foreigners carrying diseases perceived as being dangerous entrance to the country.

Colonial legislation
These types of laws were first enacted during the colonial period when at times ships "arrived in port with half of their passengers sick," prompting cities such as Philadelphia to set up a "pest-house provided at public expense" to shield residents from an infectious disease. 30 Colonial governments sought to protect against the infirm by passing laws that: required the screening and reporting of arriving immigrants for disease; disallowed foreigners with diseases considered dangerous from entering territory; required boat masters or citizens to post bonds for the arriving sick for security against public relief expenses; and obligated ship captains to return sick passengers to their ports of departure. 31 The titles of several of these laws provide a sense of their purpose: a 1756 Massachusetts Colony Act was titled, "An Act to Prevent Charges Arising by Sick, Lame or Otherwise Infirm Persons, Not Belonging to This Province, Being Landed and Left Within the Same;" and a 1740 Delaware Colony Act was entitled, "An Act Imposing a Duty on Persons Convicted of Heinous Crimes and to Prevent Poor and Impotent Persons being Imported." 32 As these titles suggest, the Colonies enacted measures to protect citizens from disease, exemplified by a 1751 Massachusetts Law that was created because during travel immigrants often contract mortal and contagious distempers, and thereby occasion not only the death of great numbers of them in their passage, but also by such means on their arrival in this province, those who may survive, may be so infected as to spread the contagion, and be the cause of the death of many others. 33 Local and state legislation US local and state legislatures throughout the late eighteenth and nineteenth centuries devised the same types of measures as the colonial governments to safeguard Americans from contagions. 34 For example, a Massachusetts Law permitted officials to order anyone who arrived from a place infected with "smallpox or other malignant temper" to depart within two hours or "be removed;" a New York Law allowed leaders to remove travelers suspected of carrying disease from the state; and Connecticut, Delaware, and Pennsylvania Laws permitted officials to disallow trade with those carrying disease. 35 Leaders passed these laws in part to secure America, exemplified by a New York Immigration Commissioner declaring that his state's measures allow for the "protection of the whole country from pestilential scourges" and defend "the interest of the whole Union, by efficiently … preventing the spread of the diseases imported by [immigrants] over the country at large." 36

Federal legislation
Issues involving disease and immigration were primarily the domains of local and state governments during the first hundred years of the country, but after a series of epidemics in the late nineteenth century the federal government began to increasingly institute measures in the area. For example, federal leaders, after decades of jurisdictional debate with state officials over immigration regulation, included a stipulation in the Act of 3 March 1891 that for the first time disallowed entrance to foreigners "suffering from a loathsome or a dangerous contagious disease." 37 Events preceding its creation indicate that it was devised to protect against the security risk of contagions, with, for example, several notable epidemics after the Civil War contributing to agitation for federal action in the area such as the 1878 yellow fever outbreak, which killed more than 5000 people, disrupted commerce in the South, prompted armed men to stop passengers from getting off of trains to prevent disease spread, and led to residents dying of exposure and starvation as they hastily attempted to flee the contagion. By 1888, the yellow fever caused a half-million dollars of damage in just Jacksonville, Florida, alone, forced officials to ration food and set up refugee camps, and halted commerce. 38 The ability to protect against epidemics was likely on the minds of Justices when, in a 1893 Supreme Court decision, Nishimura Eiku v United States, they decided the federal government possessed the right to turn away immigrants for national security: "It is an accepted maxim of international law," as explained in the majority opinion, that every sovereign nation has the power, as inherent in sovereignty, and essential to self-preservation, to forbid the entrance of foreigners within its dominions, or to admit them only in such cases and upon such conditions as it may see fit to prescribe. 39 Leaders have subsequently factored similar provisions within major immigration laws, including the Immigration Act of 1917, the Immigration and Nationality Act of 1952, the Immigration and Nationality Act of 1965, and the Immigration and Nationality Act of 1990. 40 Under provisions within contemporary law, most immigrants are inspected abroad and at the port of entry. Foreigners found with specified diseases such as smallpox and tuberculosis are not permitted entrance into the USA. 41 It also prohibits the entrance of foreigners lacking vaccinations, such as those for diphtheria, hepatitis B, influenza type B, measles, the mumps, pertussis, polio, rubella, and tetanus. 42 The federal government, at first responding to the mayhem of nineteenth-century epidemics, has restricted entry ever since to those carrying contagious diseases for national "self-preservation."

Isolation and quarantine
Isolation and quarantine are methods that have been used by world leaders to protect against contagions since ancient times. 43 American officials frequently employed them during the seventeenth through early twentieth centuries, but they have not been used in the country on a large scale in recent decades because modern medicine and sanitation methods have curbed the number of epidemics in developed countries, though their use has been increasingly reviewed in recent years with the rise in modern bioterrorism. Quarantine refers to the "compulsory physical separation, including restriction of movement, of populations or groups of healthy people who have been potentially exposed to a contagious disease, or to efforts to segregate these persons within specified geographic areas," whereas isolation signifies "the separation and confinement of individuals known or suspected (via signs, symptoms, or laboratory criteria) to be infected with contagious disease to prevent them from transmitting disease to others." 44 Colonial legislation Isolation and quarantine were the primary methods used by colonial and early American officials to protect against contagions carried by immigrants. 45 The Massachusetts Bay Colony, for example, instituted a quarantine measure in 1647 to stop passengers arriving from Barbados from infecting its populace with the plague. 46 The purpose of measures such as these was to safeguard residents from disease, as exemplified by the Pennsylvania Governor and Assembly members lamenting their state's quarantine procedures failed to "prevent the spreading of infectious Distempers among us, the Effects of which the City of Philadelphia has lately felt, altho' we think a due Execution of Laws [the isolation of sick passengers] might in part have prevented them." They called for additional measures to assist with "Guarding against the Dangers" of sick immigrants and "to prevent the future importation of Diseases into this City, which has more than once felt the fatal Effects of them." 47

Local and state legislation
Similar to the colonial legislatures, local and state governments from the country's founding through the early twentieth century also used isolation and quarantine to safeguard residents. For example, an 1808 Boston law, as summarized by one scholar, called for vessels from "tropical ports in the months of May through October (when threats of yellow fever were greatest) to be quarantined on arrival for three days or until twenty-five days had passed since departure." 48 Similarly, a New York Law gave the State's Governor and New York City Mayor authority in 1784 to quarantine immigrants based upon port doctor reports; and many US city and state laws during the nineteenth century mandated the erection of quarantine centers and inspectors at ports. 49 Leaders devised these measures to protect America from the "invasion" of disease, evidenced by a Justice asserting in a Supreme Court case in 1886 that American states required quarantines to protect against "the invasion of contagious and infectious diseases from abroad" because "for many years the cities of the Atlantic Coast, from Boston and New York to Charleston, were devastated by the yellow fever" and that Americans needed protection "from the ravages of these dreadful diseases." 50

Federal measures
Local and state bodies primarily regulated isolation and quarantine measures for the first hundred years of the country, but after a series of devastating epidemics during the late nineteenth century the federal government began to pass laws that gave it a larger role in the area. A system of shared power among local, state, and federal bodies regarding isolation and quarantine oversight arose during this period that remains in place today, with federal officials primarily having jurisdiction over epidemics across state lines and local and state governments possessing authority over epidemics within state lines.
Comments by leaders during the late nineteenth century indicate that the federal government assumed greater responsibility in this area for national security and public health reasons. For example, President Benjamin Harrison, with a worldwide cholera pandemic believed to be threatening the USA, signed an Executive Order in 1891 mandating a 20-day quarantine period over the New York port to protect against the disease because it posed a "direct menace to public health." 51 Similarly, Senator Charles Sumner, an influential Civil War and Reconstruction leader, called for more vigorous federal action against contagions "to secure the public health" and referring to cholera he asked his fellow Senators, Can we confess that a great Government of the world must fold its arms and see a foreign enemy, for such it is, crossing the sea and invading our shores and we [are] unable to go forth to meet it? I do not believe that this transcendent Republic is thus imbecile. 52 The USA has not used isolation or quarantine on a large scale for decades, but government agencies have carefully reviewed their use since the 9/11 terrorist attacks, the 2001 anthrax-mailings, the 2003 bioterrorist subway attacks in Japan, and the recent occurrence of contagious diseases such as SARS and Ebola in developed nations. 53 US leaders have done so because they fear the dangers posed by bioterrorism and epidemics, exemplified by a United States Commission on National Security warning that "attacks against American citizens on American soil, possibly causing heavy casualties, are likely over the next quarter century," cautioning that "we must plan ahead" for a "major attack involving contagious biological agents," and urging that steps need to be taken to protect the USA against bioterrorism and epidemics. 54 Special measurespresidential power to stop immigration to protect against a contagion The federal government passed a law in the late nineteenth century that remained in place for nearly 50 years that gave the President the power to suspend immigration if an epidemic abroad threatened US security. 55 It was created in response to the 1892 cholera pandemic, which devastated parts of Asia, Europe, Persia, and Russia, resulted in seven ships arriving in New York Harbor with passengers infected with cholera, and Americans in port states panicking. 56 During this period, Secretary of State John W. Foster declared that federal measures were needed "as a precautionary measure against the introduction of contagious disease which is epidemic, or threatening to become epidemic, in other parts of the world" and that regulation of immigration for this purpose constitutes "the exercise of the police power of the nation, or, as it is called by the publicists, the right of self-preservation.…" 57 Although legislation allowing for this provision was repealed in 1944, it is mentioned here because the USA may reinstate it if the country is faced with a destructive contagion.

Conclusions
"As I've said from the start of this outbreak," President Obama reminded reporters on 6 October 2014 soon after the first person on US soil was diagnosed with Ebola, "I consider this a top national security priority. This is not just a matter of charityalthough obviously the humanitarian toll in countries that are affected in West Africa is extraordinarily significant. This is an issue about our safety." The President continued, and so it is very important for us to make sure that we are treating this the same way that we would treat any other significant national security threat. And that's why we've got an all-hands-on-deck approachfrom DOD to public health to our development assistance, our science teamseverybody is putting in time and effort to make sure that we are addressing this as aggressively as possible. 58 Obama intently framed Ebola as a national security priority and called for immigration policies to confront the menace.
This article has shown that the President, though perhaps more resolutely than some of his predecessors, is acting in a similar way to many American leaders since the seventeenth century in labeling contagions as security threats necessitating immigration policies to contain them. After reviewing the devastation wrought by epidemics in world history, this article used IR, Security Studies, and secondary works in other fields as well as primary sources to identify dangers of epidemics for nation-states and three broad policies designed by American officials over the past several centuries to prevent immigrants from carrying contagions into the country, which are: (1) measures restricting the entrance of foreigners suspected of hosting dangerous germs; (2) the isolation or quarantining of arriving immigrants believed infected with contagious disease; and (3) delegating the President with authority to stop immigration in the event of an epidemic abroad. This article has laid ground on relationships between contagions, epidemics, and US immigration policy to serve as a base for future studies on this topic and to shed light on IR/Security Studies and migration studies topics, such as those on national security and US immigration policy, nontraditional/transnational security threats, and domestic-international political connections. 59 It has also provided policy-makers with a background to assist in the formation of measures to protect against contagions. Whereas other scholars have found that US leaders have at times overreacted and sensationalized the danger from epidemics to justify policies for ulterior or xenophobic motives, it is also important to underscore that contagions do pose potentially devastating dangers to countries that require migration policies to protect citizens and immigrants. With these two points in mind, US officials are challenged to form migration policies protecting humans from contagions; but at the same time they must remain wary of misusing epidemic fear to justify harmful migration policy. This article has shed insight into epidemics and immigration through a national security lens to bring transparency to the area and to help leaders with this task.

Disclosure statement
No potential conflict of interest was reported by the author. Notes 1. As described on its website, The Global Health Security agenda is an effort between the US government, other nations, international organizations and public and private stakeholders, to accelerate progress toward a world safe and secure from infectious disease threats and to promote global health security as an international security priority.
See http://www.globalhealth.gov/global-health-topics/global-health-security/ (accessed November 11, 2014). For the President's remarks, see Obama, Global Health Security Agenda Summit (Washington, DC, September 26, 2014), http://www.whitehouse.gov/the-press-office/2014/09/26/remarks-presid ent-global-health-security-agenda-summit (accessed November 11, 2014). 2. Ibid. Secretary of State John Kerry also warned that contagions It having been officially declared that cholera is prevailing in various portions of Russia, Germany, and France, and at certain ports in Great Britain, as well as in Asia, and it having been made to appear that immigrants in large numbers are coming into the United States from the infected districts aforesaid, and that they and their personal effects are liable to introduce cholera into the United States, and that vessels conveying them are thereby a direct menace to the public health, and it having been further shown that under the laws of the several States quarantine detentions may be imposed upon these vessels a sufficient length of time to insure against the introduction of contagious diseases, it is hereby ordered that no vessel from any foreign port carrying immigrants shall be admitted to enter at any port of the United States until said vessel shall have undergone a quarantine detention of twenty days (unless such