The spreading Zika virus and the contamination of the Flint, Michigan water supply raise important questions about government’s responsibility in the face of a public health emergency. In Flint, where contaminated water has caused soaring levels of lead poisoning in city residents, and in Brazil, where the suspected connection between Zika infections in pregnant women and the rise in microcephaly among newborns was first detected, authorities fell short or failed outright in their response to emerging threats.   

This, unfortunately, is nothing new. From threat to threat, decade to decade, and even century to century, governments often make the same mistakes. In 1721, Boston experienced its worst smallpox epidemic in history. That epidemic sickened nearly half the town’s population, and killed more than eight hundred persons. Although it led to the first practice of inoculation in western medicine—a great medical triumph—the local government failed the people of Boston by not adequately anticipating or preparing for the epidemic, and by mismanaging the threat of public hysteria that surrounded the deadly outbreak. It is likely that the smallpox epidemic could have been averted or rendered less deadly had the government not fallen victim to mistakes, miscalculations, and misplaced priorities. Nearly 300 years later, governments still struggle with these same issues when managing public health crises, and would do well to remember the fever of 1721 and lessons we should have learned centuries ago. 

It’s not enough to have resources and a plan.

In the early 18th century, no one knew what caused smallpox or how it spread. But they understood that quarantine worked. In 1717 Massachusetts built a “pest house” on Spectacle Island in Boston Harbor and in 1718 it passed a law requiring ships carrying infectious diseases to anchor at the island until they were disease-free. However, those requirements were often flouted. Government officials had the foresight and infrastructure to stop smallpox from reaching Boston, but they lacked the resolve to make the quarantine hospital effective. 

Don’t dismiss the early warnings.

Usually there’s a warning before the danger arrives. On April 13, 1721, a Boston newspaper reported a smallpox outbreak in London.  Since ships carrying Londoners regularly arrived in Boston, officials ought to have increased scrutiny. Four days later another newspaper dispatch reported a “very Mortal” smallpox epidemic at Barbados. On that morning, ships returning from Barbados entered Boston Harbor. Had authorities heeded the warning and immediately ordered a close inspection of all returning ships, smallpox might never have reached Boston. But they failed to do so.

Don’t overlook an imminent threat for a potential one. 

Why, despite the quarantine station and the newspaper warnings, did the government fail to act? One reason is that officials were looking in the wrong direction. In the months leading up to the smallpox outbreak Boston had been receiving horrific accounts of an outbreak of bubonic plague in France. Government officials were so preoccupied with the expected arrival of the plague that they allowed smallpox to sneak in right under their noses. 

Don’t place economic concerns above public safety.

The other explanation for government’s inaction is that there was a strong economic incentive to ignore the threat and hope for the best. In 1721 Boston was the third busiest seaport in the British Empire. Oceangoing trade dominated the economy. Government officials and business leaders feared that any government acknowledgment of a smallpox threat might cause trading partners to ban Boston ships and keep their own ships away from the town. Officials were so concerned about the economic ramifications that they continued to deny and then downplay smallpox as it grew into an epidemic. This strategy backfired. As word of the massive death toll reached trading partners, Boston came under a total and prolonged embargo that ruined businesses, threatened Bostonians with starvation, and cost the government far more than it would have spent inspecting ships. That’s not to mention the hundreds of lives that were lost but might have been saved.

There was one additional factor in the government’s failure to stave off or contain the 1721 epidemic. Political gridlock. At the time smallpox broke out in Boston, the Massachusetts legislature and the royal governor were locked in an all-out battle for control of the colony. All the business of government—even protecting the people from a deadly threat—went begging while the two sides vied for dominance. Perhaps the most important lesson from 1721 is that the first symptom of a government too sick to prevent or manage a public health emergency is partisan paralysis.