The Coming Plague is a book about disease in the modern world. Not diseases that originated in the 20th century (though certainly this figures in the writing), but about how diseases in our world – specifically during the 1950s to the 1990s – spread, were identified, fought, and in some cases, ultimately conquered. It may sound like a dry subject, but Laurie Garrett’s prose, eye for the quirky detail and the topicality of the theme in a world made fearful by SARS, swine flu and H1N1, make it a riveting read.
The book is divided up into chapters that focus on a series of individual tiles that gradually make up a more compelling mosaic. Rather than solely concentrating on dry statistics and stultifying boring histories, it takes the point of view of the famous CDC disease cowboys of the era: men and women from the US Centers for Disease Control with scientific degrees and a quest for adventure who roamed the world trying to identify and quell outbreaks of diseases that heretofore were small and localized, but which in an increasingly integrated and mobile age threatened to bloom into something much more serious. Beginning in 1962, it explores the emergence of hemorrhagic fevers in South America and Africa, and gives us fascinating stories (I’m not trying to make light of the suffering of its victims, merely to say how well the narrative is presented) on the Bolivian hemorrhagic fever, Marburg virus, yellow fever, lassa fever, Ebola…and AIDS.
Interspersed with the major themes of increasingly virulent viral diseases are occasional side trips relevant to the whole, such as that of Legionaire’s disease, the resurgence of sexually transmitted diseases after the optimism of seeing penicillin-based drugs nearly eradicate them; feminine hygiene and the dangers of super-absorbent tampons. And then there are chapters on topics as important as recognizing the cities as centre points for the spread of diseases (particularly their poorest sections where drug use and needle sharing is rampant); the increase in drug-resistant super-bugs; and by far the most poignant series of chapters, on AIDS.
Several things occurred to me as I read this book in 1996, and again to write this review: Garrett correctly sounded the horn on how important it was to control disease by open communication between government, the people and the medical establishment (something that horribly failed in the case of AIDS); how superbugs were becoming more, not less common; how the optimism of eradicating smallpox was cruelly smashed by simple evolution and inconsistent global public health policy; and how correctly she noted that modern mass transit (national and international) coupled with crowded megalopolises and poor urban centers, created optimum conditions for efficient disease spread. It’s not the first time this had been posited: it’s the first time I had read it presented so well, though.
If I had a fault to find with the book it is that it presents, on some subjects, too little: malaria, for instance, could have been more comprehensively dealt with (especially how the banning of DDT promoted its resurgence) – and having had it many times myself I think it criminal how few resources are devoted to its suppression even now; the focus is on disease control from an overall American perspective, but there are fewer mentions about other nations’ efforts in the same areas. In other words, I wanted more, which is perhaps a bit shameless considering this thing is 750 pages as it is.
But I freely admit that modern history is catnip for me. I like knowing how things developed, how the world I live in was formed by the decisions (good or ill) of those who went before. I think that in our modern world of popular appeal, instant news and always-on hypermedia, we often lose sight of what’s really important, ignore more global themes and lose ourselves in a vacuous haze of noise. The Coming Plague was a dash of cold water on complacency — and to my mind the news of the last fifteen years regarding global pandemic scares could almost form the next chapters of this fascinating, informative and highly readable work of an often-neglected subject, by an author who knows how to make the case.