The novel coronavirus is not the first infectious disease to prompt government action in the Hawaiian Islands. Public health interventions under the Kingdom of Hawaiʻi included everything from vessel screenings to travel bans to quarantine laws.
The first wave of imported diseases that swept through Hawaiʻi came with Captain James Cook in 1778. His sailors brought gonorrhea, syphilis and tuberculosis. But the first foreign disease that brought a local intervention was cholera or maʻi ʻōkuʻu in 1804.
“The maʻi ʻōkuʻu starts the initial portion of the population collapse,” says Kealoha Fox, a public health scholar.
She says this cholera epidemic wiped out a number of King Kamehameha the Greatʻs soldiers who were about to wage war on Kauaʻi.
“This becomes so serious an epidemic that there is no actual battle that takes place,” says Fox. “(Kamehameha) calls together the highest ranking kahuna who are still practicing at this time and he opens what is functionally a medical college in the lower Nuʻuanu area.”
Kamehameha retrained his native Hawaiian healers on how to diagnose and cure ailments and illnesses plaguing his people.
Dr. Ben Young is the former dean of students at the UH medical school and was the physician on board Hōkūleʻaʻs maiden voyage in 1976.
“He [Kamehameha] also gathered the doctors whose ships were in the harbor. So that he could train his kahuna, experts as healers in how to handle this disease,” Dr. Young said, referring to the cholera epidemic.
Hawaiʻiʻs vulnerability to disease and geographic isolation prompted the kingdomʻs first known public health measure. In 1836, Kuhina Nui Kīnaʻu ordered all ships entering Hawaiian waters to be boarded and inspected for smallpox -- "because they observed whenever ships came into Honolulu Harbor, diseases escalated,” says Dr. Young.
“And the orders were that if anyone was on board who was sick, that ship was to be placed under quarantine. A yellow flag was to be raised. No one was allowed to disembark. This was probably the most effective way of dealing with epidemics.”
Similar orders would follow to help contain the spread of disease, including laws to quarantine the sick and orders banning interisland travel. By the 1850s, the kingdom began collecting vital statistic data, mandating vaccination for certain diseases, and instituted the first Board of Health, long before anything comparable is established in the United States.
But the population continued to dwindle. Hawaiian history scholar and writer Ron Williams, Jr., says the Kingdom of Hawaiʻi dealt with a neverending string of infectious disease for more than 50 years, including cholera, smallpox, measels and whooping cough.
“The story of disease and death from disease is fairly well-known about Hawai’i but maybe not the scope,” says Williams. “Thereʻs different estimates of what the population was when Captain Cook arrived in 1778, but they average about 700,000 to 800,000. By 1890, the native population was down to about 40,000. So youʻre really talking about a 90 percent reduction of the population. It was a devastation.”
Williams has poured over historical records, letters, and diaries from this era of the Kingdom of Hawai’i. He says despite those deep losses, public health care remained a priority in the Kingdom of Hawaii.
“Without romanticizing it, if you do the research and you go into the record, you really get an understanding of the fact that these moʻi kings and queens and monarchs and so forth – they were working off this understanding that they were responsible for the people. They really were,” says Williams.
From the earliest days of the kingdom, health care was a part of the kuleana of the leadership of the country. Not only their kuleana, but also their legacy.