Expanding the Quarantine System at the Nation's Borders

Since 1921, the federal government has had responsibility for preventing the introduction, transmission, and spread of infectious disease from foreign countries into the United States. The U.S. quarantine program reached its zenith in the latter half of the 20th century during the global smallpox-eradication campaign. By the 1970s, as the eradication of smallpox became a reality and the threat that infectious diseases in general posed for the human population was perceived to be significantly lower than in the past, the number of quarantine stations standing sentry at the nation’s borders had declined sharply to a mere seven. The Centers for Disease Control and Prevention (CDC) added an eighth station in Atlanta just before the start of the Olympic Games in 1996.

Further expansion of public health assets at the ports of entry into the United States was prompted both by the threat posed by bioterrorism and by the global spread of severe acute respiratory syndrome (SARS). The first station added as part of this recent expansion was in the greater Washington, D.C., area, where CDC opened a station at Dulles International Airport at the beginning of fiscal year 2005. Among the more important priorities assigned to the station were to create effective working partnerships within its jurisdiction and to develop a communicable-disease response plan for Dulles itself.

The experiences at Dulles can be used in almost any situation in which disparate agencies must work closely with one another to achieve a common goal.

The support provided by state and local health departments, U.S. Customs and Border Protection, the Metropolitan Washington Airports Authority, and other agencies and jurisdictions led to the successful achievement of these goals. The Dulles communicable-disease response plan – the first modern plan to include an option for the large-scale on-site quarantine of a large number of people – has been used as a template by other CDC stations as well as by several other U.S. airports that lack the benefit of an on-site CDC presence. The Three Keys to Operational Success The success of any such endeavor is dependent primarily, of course, on the willingness of those involved in the process to support public health efforts. In addition, several working principles gained from the experiences at Dulles can be used in almost any situation in which disparate parties and agencies must work closely with one another to achieve a common goal. Among the most important of those principles are the following:

  • Authority: The possession of regulatory authority by any one agency does not immediately translate into the willingness of other agencies to comply with the regulations postulated. It is, rather, a collaborative approach to developing effective working relationships with the regulated partners that fosters compliance.
  • Communications: There is no such thing as “too much” communication. In this area, the regulatory authority usually must build redundant protocols, in fact, to ensure that all parties and/or agencies involved possess the situational awareness required, independently of who or what agency receives the initial report of an incident.
  • Expertise: Success is dependent on collaboration. Here, the regulatory authority must take advantage of the expertise provided by many others, individuals as well as organizations, specifically including those who are working in seemingly unrelated fields. In many situations, a different perspective may be the key needed to unlock the door to the success of any cooperative effort.

These three considerations, all of which were critical to the early successes of the Washington Quarantine Station, may be overlooked by programs faced with short deadlines and high expectations. It still must be remembered, though, that the goal of preventing the introduction, transmission, and spread of infectious disease from foreign countries into the United States is and probably always will be a joint effort. Achievement of this multifaceted goal relies primarily, therefore, on the contributions of numerous federal agencies as well as state and local governments, private industry, and both nonprofit and nongovernmental organizations. These and other collaborations have significantly strengthened the overall U.S. quarantine system, making the 20 current CDC stations an interdependent web of coordinating points for the protection of public health at the nation’s ports of entry.

Mathew Thomas

Lieutenant Commander Jason Thomas is the officer in charge of the Washington [D.C.] Quarantine Station of the Centers for Disease Control and Prevention (CDC), which protects the health of the public by preventing the introduction, transmission, and spread of communicable diseases from foreign countries into the United States. His station’s jurisdiction includes U.S. ports in the District of Columbia, Maryland, Virginia, and West Virginia. Thomas also serves as regional officer-in-charge of the CDC quarantine stations throughout the Northeast region of the United States. A graduate of the Colorado State University’s College of Veterinary and Biomedical Sciences, Thomas originally was commissioned into the U.S. Navy’s Medical Service Corps and, among other assignments, served as the Preventive Medicine Division Officer at Naval Hospital Newport. He transferred to the U.S. Public Health Service after completing graduate training at Columbia University’s Mailman School of Public Health, and served as the deputy director of public health for the National Park Service before being assigned to the CDC’s Division of Global Migration and Quarantine.

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