to Control Infectious Disease
Immunization, Screening, and Treatment
This chapter and the next examine the most ancient and enduring threats to health in the population — infectious diseases. The effects of epidemics in society are as destructive as those of war (Garrett 2000; Levy and Sidel 1997). For example, the estimated 45 million deaths from AIDS in the world exceed the combatants killed in World War I, World War II, Korea, and Vietnam combined (Gellman 2000a). Not surprisingly, the United States classified HIV/AIDS as a national security threat in 2000, reasoning that it would result in destabilization of strategic regions such as Africa and Asia (Gellman 2000b).
For most of history, society's only response to epidemics has been crude separation of persons with disease. But in more recent history, science has developed the biological means to help prevent, detect, and intervene in epidemics. (For a review of the major trends in dealing with infectious diseases during the twentieth century, see CDC [1999a], posted on the Reader web site.) The three major biological approaches are vaccination to prevent outbreaks, screening to identify persons who are infectious, and treatment to alleviate symptoms and reduce infectiousness. The readings in this chapter discuss these biological approaches; the readings in chapter 13 discuss deprivations of liberty as a method of disease control — civil confinement (isolation and quarantine) and criminal punishment.
The value of biological approaches to infectious diseases cannot be exaggerated. Vaccination programs, for example, have eradicated (e.g., smallpox) or significantly reduced the incidence of diseases (e.g., polio)