Historical and Modern Responses to Plague Epidemics

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 Strategies for treating plague are generally outdated and of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.