For immediate release:
Tuesday, January 24, 2006
12:01 a.m. EDT


Christopher Fleming

Americans Favor Quarantines To Combat Diseases, But Are Skeptical Of Tough Enforcement And Monitoring  

Researchers Say Americans Also Less Receptive Than Others To Requiring Masks, Screenings; More Distrustful Of Government

Bethesda, MD — Most Americans favor the use of quarantine as a weapon against contagious diseases like SARS and avian flu, but that support dries up quickly when the talk turns to strictly enforcing and monitoring the quarantines.

This message is contained in a new study, “Attitudes toward the Use of Quarantine in a Public Health Emergency in Four Countries,” that will be published 24 January on the Health Affairs Web site. While 76 percent of Americans surveyed said they favor quarantining those potentially exposed to serious contagious diseases, only 42 percent supported a compulsory quarantine under which those who refused to comply could be arrested.

Among residents of Hong Kong, Singapore, and Taiwan, the threat of arrest also reduced support for quarantine, according to Robert Blendon of the Harvard School of Public Health and his coauthors, John Benson and Catherine DesRoches of Harvard and Martin Cetron, Theodore Meinhardt, and William Pollard of the U.S. Centers for Disease Control and Prevention (CDC). However, in these Asian nations, which recently experienced quarantines and other public health measures in connection with the SARS epidemic, the use of quarantine retained majority support even when the arrest sanction was included.

In the U.S., the threat of arrest reduced support for quarantine especially among African Americans. In phone interviews conducted between 18 November and 16 December 2004, 90 percent of blacks said that they supported the use of quarantine, compared with 76 percent of whites. But when told that quarantine violators could be arrested, only 33 percent of blacks stood by the use of quarantine, versus 46 percent of whites.

Blendon and colleagues’ survey found that, in general, Americans were also less supportive of intrusive methods of monitoring quarantine compliance, such as guards, electronic ankle, bracelets and periodic video surveillance, than residents of the three Asian nations. Other weapons against contagious disease found tougher going among U.S. respondents as well: A bare majority of 53 percent of Americans said that in the event of disease outbreak, they would favor requiring everyone to wear masks in public, and only 44 percent of Americans said that they would favor requiring people to be screened for illness by having their temperature taken before entering public places. In Hong Kong, Singapore, and Taiwan, those measures enjoyed support ranging from 64 percent to 99 percent.

Many respondents in all four countries expressed concern about obtaining needed health care and prescription drugs while quarantined; they also worried about whether they would be paid for time lost from work, and whether they might lose their jobs or businesses. Significantly more than other respondents, Americans preferred quarantine at home for themselves and family members. However, Americans, who lack much experience with quarantines, might not realize the difficulty of adhering to safeguards required by home quarantine, such as the use of masks to avoid infecting healthy family members, the researchers point out. “If institution-based quarantine is required, findings from Taiwan and Singapore suggest that there will be a high level of worry about overcrowding, becoming infected while in quarantine, and being unable to communicate with family members,” they write.

President Bush recently included pandemic influenza in the U.S. list of quarantinable diseases. However, Blendon’s team warns that much work would be required to make quarantine viable in this country: “Findings from other sources suggest that regions with quarantine experience still had problems with compliance, as evidenced by increasing fines and arrest penalties. It seems reasonable to conclude, therefore, that the United States would have an even higher rate of noncompliance.”

To increase compliance, the researchers say, public health authorities must prepare “trusted spokespeople to explain to the public the steps that need to be taken to halt the spread of disease.” Unfortunately, however, over time Americans — and particularly African Americans — have become “less respectful of and confident in those who serve in both elective and appointive government roles,” a trend seemingly exacerbated by the government’s response to Hurricane Katrina. While between half and three quarters of respondents in the three Asian nations said that they would trust the government “a lot” as a source of information on disease outbreaks, only 40 percent of Americans expressed similar trust in their government.

To combat public distrust, public health authorities must “provide evidence of managerial competence,” Blendon and his coauthors write. They add that officials might also seek endorsements for their efforts from “independent professional groups, scientists, and opinion leaders.”

The study can be read at It was funded by the CDC.



Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at


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