One of the key contributions of economics is understanding how societies can correct externalities: when individuals impose costs or benefits on third parties, they do not fully internalize the costs. A classic example comes from a contagious disease. While people may take precautions to avoid falling ill, they may not consider how their behavior affects the probability that bystanders contract the disease. As a result, preventative measures such as vaccinations will, in general, be below the social optimum.
The standard economic solution to these market failures typically takes the form of government intervention, including Pigouvian taxes and subsidies, mandates, the establishment of property rights, or voucher systems. While this dichotomy between public and private actors has led to many useful insights, it often overlooks the complex nuance of institutions that straddle the private and public spheres.
Sheilagh Ogilvie’s Controlling Contagion: Epidemics and Institutions from the Black Death to COVID-19 confronts this nuance head-on. The book considers six institutions—markets, the state, local community, religion, medical guilds and associations, and the family. By doing so, Ogilvie provides a more comprehensive account of how societies have responded to epidemics than a public/private division would allow.
The book is organized thematically by institution, rather than chronologically by epidemic. A typical chapter investigates how the incentives of a given institution either slowed or accelerated the spread of contagion. For example, the chapter on religion discusses how holy wars contributed to the spread of disease, drawing on examples as varied as the First Crusade to the Thirty Years’ War. This organizational choice allows Ogilvie to show that certain mechanisms recur across different geographies and times. It also supports her broader thesis that institutions matter not just incidentally, but systematically, across space and time. One consequence of such a choice is that the book may resonate more with readers interested in institutions than those seeking a history of epidemics. For example, the book offers detailed discussions of the Black Death and smallpox, particularly during the period leading up to Jenner’s development of the smallpox vaccine. Other diseases, including yellow fever and polio, receive only passing mentions. However, even for those readers, this book makes an excellent case for why one should care about institutions.
A recurring theme is that no institution is all good or bad. Each has acted to either mitigate or exacerbate contagion, depending on context and incentives. Traders sometimes circumvented quarantines in pursuit of profit, governments used pandemics to expand their authority, and religious gatherings functioned as vectors of disease. Local communities provided care for the poor but also attacked outsiders. Markets supplied both vaccinations and dubious cures. Religious organizations offered charity while rejecting germ theory and promoting harmful beliefs. In many respects, the book is as much about institutional incentives during crises as it is about epidemics. The institutional responses Ogilvie documents likely extend to other crises, such as famine or war.
While there is much discussion about how institutions attempted to control disease, there is little about how disease affected institutions in the long run. The most notable omission from the economics literature is that the book does not engage with the work of recent Nobel Prize winners Daron Acemoglu, Simon Johnson, and James Robinson (AJR). AJR have argued that institutions themselves were endogenous, with European colonizers establishing institutions more conducive to economic growth in colonies with lower rates of malaria and yellow fever, and hence lower European settler mortality (Acemoglu, Johnson, and Robinson Reference Acemoglu, Johnson and Robinson2001, Reference Acemoglu, Johnson and Robinson2002). With more economic growth come vaccines, sanitation, and better nutrition, and in turn, fewer epidemics. Of course, the AJR interpretation of the data is not without debate (see Glaeser et al. Reference Glaeser, Porta, Lopez-de-Silanes and Shleifer2004; Albouy Reference Albouy2012), and it would have been interesting for this book to engage in that debate.
Overall, Controlling Contagion provides a nuanced and detailed history of the role six institutions played in the dispersion of contagious disease and will be of interest to scholars studying the economic history of both institutions and epidemics.
