Why Pandemics Matter to the History of U.S. State Development

When a new strain of influenza circled the globe in the fall and winter of 1918, it swept through the United States at terrifying speed, infecting at least 25 million Americans—roughly one-quarter of the population—over the next two years. Based on any metric, the pandemic was the country's largest mass-mortality episode of the twentieth century, killing approximately 675,000 Americans and surpassing the death toll of World War I. Even as the virus struck the United States with unprecedented ferocity, however, the federal government left most public health decisions to the states, producing a disjointed and hyper-localized approach to a crisis that was national and global in scope. In the absence of a strong federal role, state governments carved out their own policy paths, adopting widely divergent strategies to stem the spread of the disease. This preventive playing field was wildly uneven. Some states were well-equipped with robust public health infrastructures; others lacked the tools to manage the disease's rampant spread.