In the past few decades there has been increased integration of communicable disease policies in Europe. The historical roots of this process date back to the mid-nineteenth century, when national authorities realized that the cross-boundary spread of diseases cannot be only a matter of national governance but requires common agreements and regulations. In the early 1950s the structuring of the World Health Organization in regional offices further contributed to the definition of Europe as a unit for risk assessments and international health cooperation. More recently the consolidation of the European Union has provided new institutional bases for shaping communicable disease policies at the supranational level. This article reviews these different attempts to protect the European space from diseases. It is argued that changing modes of communicable disease control not only have reflected shifts in public health priorities and institutional contexts but have also been important loci where different understandings of Europe and European political identity emerged and were negotiated. Against this background the article then examines past achievements and future challenges of the current European framework and discusses implications for the wider process of European integration.