PORT HEALTH IN MALTA

A Historical Review

Maritime quarantine began in the Mediterranean in the 14th century when plague erupted in Europe. Venice, then the chief port of entry into Europe from the East, experienced many epidemics of plague. Regulations were introduced requiring the isolation of forty days of people and goods arriving from countries reported to be infected, the period of time then thought necessary for goods to become non-infectious by exposure to air and sunlight. Subsequently, quarantine stations or lazarettos were established in many Mediterranean ports, in which travellers were housed during quarantine.

In Malta, measures to prevent the introduction of infection were recorded in the early 1500s when ships where isolated in Marsamxett Harbour. After the foundation of Valletta in 1566, a quarantine station was established on the Valletta wharf of the Grand Harbour at a site now known as "Il-Barriera", a name derived from the barrier which was built around the station.

Later, in 1643, the Knights of St John acquired the island in Marsamxett Harbour, then named Bishop Island, and built accommodation for the reception of patients and contacts. In the next century, Grand Master Manoel Vilhena built the fort on the island and a new lazaretto close to it in 1723, and thereafter the island became known as Manoel Island.

There were strict quarantine regulations formulated by the Knights of St John, which were enforced by a Commissioner of Health and his staff of twelve to eighteen Guardians of Health.

Following a Royal Commission in 1838, the Water Police and the Quarantine departments were amalgamated under the Superintendent of Quarantine, who became an important dignitary in Malta. A review of measures to prevent disease gave rise to a comprehensive set of regulations which were later consolidated in a special ordinance embodied in Maltese law.

The next major changes took place in 1885 and 1895, with the formation of the Public Health Department, which later became responsible for the quarantine services and the lazarettos.

The Department of Public Health remains today with many similar responsibilities. The need for quarantine of humans has decreased over the years and the Department of Public Health no longer manages dedicated stations reserved solely for this function. Methods for controlling the international spread of disease have changed with changes in disease ecology and advances in preventive measures.

The first international organisation for the control of infectious disease, the "International Office of Public Health", was established early in the present century. This remained until 1947, when it was absorbed into the World Health Organisation (WHO), together with the Health Organisation of the League of Nations. The International Sanitary Conventions were then replaced in 1952 by the WHO International Sanitary Regulations.

The speed and volume of international passenger traffic and the extent of air travel increased dramatically after the Second World War. Consequently, infected travellers could arrive from most parts of the world within the incubation period of the major infectious diseases. Furthermore, the enormous number of travellers made control measures at ports almost impossible.

In 1968, Dr Dorolle, the Deputy Director of the WHO commented:-

  " It seems evident that the system of protection based on the existing

    International Sanitary Regulations is no longer adequate."

Later, Dr Bruce-Chwatt, in an authoritative review of travel and disease came to the same conclusion:-

 "With the increase of world travel and trade it became obvious that the traditional system of protection of the national health, based on the former   International Sanitary Regulations was no longer practicable and a new approach was needed".

The new approach, developed by the WHO, recognised that disease control by quarantine measures was likely to be ineffective and might even give rise to a false sense of security. Instead, the more active approach of epidemiological surveillance was introduced, designed to detect communicable disease and infection as soon as possible so that control measures could be taken quickly.

The more permissive International Health Regulations (IHR) 1969 came into operation in 1971. They were amended in 1973 and 1981, and only plague, cholera, and yellow fever are subject to the Regulations. However, their effectiveness had been questioned, and it had been suggested that the cost of implementing them should be assessed against the world epidemiological situation of diseases subject to them and the risks they pose.

The control of imported communicable disease now depends primarily upon its early detection by epidemiological surveillance, swift control measures, and the communication of information worldwide.

Go to International Health Regulations 2005