Pandemics and Institutions: Lessons from Plague

May 8, 2020 | Blog
Home > Pandemics and Institutions: Lessons from Plague

by Guido Alfani (Bocconi University, Milan) & Tommy Murphy (Universidad de San Andrés, Buenos Aires)

This blog forms part E in the EHS series: The Long View on Epidemics, Disease and Public Health:Research from Economic History



The plague of Florence in 1348, as described in Boccaccio’s Decameron. Available at the Wellcome Library.

In a recent article[i] we reviewed research on preindustrial epidemics. We focused on large-scale, lethal events: those that have a deeper and more long-lasting impact on economy and society, thereby  producing the historical documentation that allows for systematic study. Almost all these lethal pandemics have been caused by plague: from the “Justinian’s plague” (540-41) and the Black Death (1347-52) to the last great European plagues of the seventeenth century (1623-32 and 1647-57). These epidemics were devastating. The Black Death, killed between 35 and 60 per cent of the population of Europe and the Mediterranean (approximately  50 million victims).

These epidemics also had large-scale and persistent consequences. The Black Death might have  positively influenced the development of Europe, even playing a role in the Great Divergence.[ii] Conversely,  it is arguable that seventeenth-century plagues in  Southern Europe (especially Italy), precipitated the Little Divergence.[iii]  Clearly, epidemics can have asymmetric economic effects. The Black Death, for example, had negative long-term consequences for relatively under-populated areas of Europe, such as Spain or Ireland.[iv] More generally, the effects of an epidemic depend upon the context in which it happens. Below we focus on how institutions shaped the spread and the consequences of plagues.


Preindustrial epidemics and institutions

In preindustrial times, as today, institutions played a crucial role in determining the final intensity of epidemics. When the Black Death appeared, European societies were unprepared for the threat. But, when it became apparent that plague was a recurrent scourge, institutional adaptation commenced — typical of  human reaction to a changing biological environment. From the late fourteenth century permanent health boards were established, able to take quicker action than the ad-hoc commissions created during the emergency of 1348. These boards monitored constantly the international situation, and provided the early warning necessary for implementing measures to contain epidemics[v]. From the late fourteenth century, quarantine procedures for suspected cases were developed, and in 1423 Venice built the first permanent lazzaretto (isolation hospital) on a lagoon island. By the early sixteenth century, at least in Italy, central and local government had implemented a broad range of anti-plague policies, including  health controls at river and sea harbours, mountain passes, and political boundaries. Within each Italian state, infected communities or territories were isolated, and human contact was limited by quarantines.[vi]  These, and other instruments developed against the plague, are the direct ancestors of those currently employed to contain Covid-19. However, such policies are not always successful:  In 1629, for example, plague entered Northern Italy as infected armies  from France and Germany arrived to fight in the War of the Mantuan Succession.  Nobody has ever been able to quarantine an enemy army.

It is no accident that these policies were first developed in Italian trading cities which, because of their commercial networks, had good reason to fear infection. Such policies were quickly imitated in Spain and France.[vii]  However, England in particular, “was unlike many other European countries in having no public precautions against plague at all before 1518”.[viii] Even in the seventeenth century, England was still trying to introduce institutions that had long-since been consolidated in Mediterranean Europe.

The development of institutions and procedures to fight plague has been extensively researched.  Nonetheless, other aspects of preindustrial epidemics are less well-known.  For example, how institutions tended to shift mortality towards  specific socio-economic groups, especially the poor.  Once doctors and health officials noticed that plague mortality was higher in the poorest parts of the city, they began to see the poor themselves as being responsible for the spread of the infection. As a result, during the early modern period their presence in cities was increasingly resented,[ix] and as a precautionary measure, vagrants and beggars were expelled. The death of many poor people was even regarded by some as one of the few positive consequences of plague. The friar, Antero Maria di San Bonaventura, wrote immediately after the 1656-57 plague in Genoa:

“What would the world be, if God did not sometimes touch it with the plague? How could he feed so many people? God would have to create new worlds, merely destined to provision this one […]. Genoa had grown so much that it no longer seemed a big city, but an anthill. You could neither take a walk without knocking into one another, nor was it possible to pray in church on account of the multitude of the poor […]. Thus it is necessary to confess that the contagion is the effect of divine providence, for the good governance of the universe”.[x]


While it seems certain that the marked socio-economic gradient of plague mortality was partly due to the action of health institutions, there is no clear evidence that officials were actively trying to kill the poor by infection.  Sometimes, the anti-poor behaviour of the elites might have backfired. Our initial research on the 1630 epidemic in the Italian city of Carmagnola suggests that while poor households were more prone to being all interned in the lazzaretto for isolation at the mere suspicion of plague, this might have reduced, not increased, their individual risk of death compared to richer strata. Possibly, this was the combined result of effective isolation of the diseased, assured provisioning of victuals, basic care, and forced within-household distancing[xi].

Different health treatment reserved to rich and poor and economic elites making wrong and self-harming decisions: it would be nice if, occasionally, we learned something from history!


[i] Alfani, G. and T. Murphy. “Plague and Lethal Epidemics in the Pre-Industrial World.” Journal of Economic History 77 (1), 2017, 314–343.

[ii] Clark, G. A Farewell to the Alms: A Brief Economic History of the World. Princeton: Princeton University Press, 2007; Broadberry, S. Accounting for the Great Divergence, LSE Economic History Working Papers No. 184, 2013.

[iii] Alfani, G. “Plague in Seventeenth Century Europe and the Decline of Italy: An Epidemiological Hypothesis.” European Review of Economic History 17 (3), 2013, 408–430; Alfani, G. and M. Percoco. “Plague and Long-Term Development: the Lasting Effects of the 1629-30 Epidemic on the Italian Cities.” Economic History Review 72 (4), 2019, 1175–1201.

[iv] For a recent synthesis of the asymmetric economic consequences of plague, Alfani, G. Pandemics and asymmetric shocks: Lessons from the history of plagues, VoxEu, 9 April 2020,

[v] Cipolla, C.M. Public Health and the Medical Profession in the Renaissance. Cambridge: CUP, 1976; Cohn, S.H. Cultures of Plague. Medical Thought at the End of the Renaissance. Oxford: OUP, 2009. Alfani, G. Calamities and the Economy in Renaissance Italy. The Grand Tour of the Horsemen of the Apocalypse. Basingstoke: Palgrave, 2013.

[vi] Alfani, G. Calamities and the Economy, cit.; Cipolla, C.M, Public Health and the Medical Profession, cit.; Henderson, J., Florence Under Siege: Surviving Plague in an Early Modern City, Yale University Press, 2019.

[vii] Cipolla, C.M, Public Health and the Medical Profession, cit..

[viii] Slack, Paul. The Impact of Plague in Tudor and Stuart England. London: Routledge, 1985, 201–26.

[ix] Pullan, B. “Plague and Perceptions of the Poor in Early Modern Italy.” In T. Ranger and P. Slack (eds.), Epidemics and Ideas. Essays on the Historical Perception of Pestilence. Cambridge: CUP, 1992, 101-23; Alfani, G., Calamities and the Economy.

[x] Alfani,  Calamities p.106.

[xi] Alfani, G., M. Bonetti and M. Fochesato, Pandemics and socio-economic status. Evidence from the plague of 1630 in northern Italy, Mimeo.


Guido Alfani –

Tommy Murphy –