Center for Scientific Studies

Review of "The Coming Plague"

by Elsie Y. Smith, Associate Professor of Biology

June 169, 2007 - The author, Laurie Garrett, is a writer noted for her incite and thoroughness in describing matters related to health and science. She writes in an intense, graphic manner that grips the reader from the first page to the last. Once a science correspondent for the National Public Radio, she has written articles for The Washington Post Magazine and the Los Angeles Times, as well as other publications. While a fellow at the Harvard School of Public Health, she engaged in research that led to the writing of The ComingPlague. Her interest and fervor have prompted her to investigate and write another book entitled The Betrayal of Trust: The Collapse of Global Public Health. In 1996, she won the Pulitzer Prize for reporting on the filovirus that causes Ebola hemorrhagic fever. Although The Coming Plague was published in 1995, the problems and fears presented are as real today as they were then.

Among the chapters in the book are vivid and captivating day by day descriptions of several outbreaks of infectious diseases such as Bolivia hemorrhagic fever, Lassa fever, Ebola hemorrhagic fever, swine flu, AIDS, and hantavirus pulmonary syndrome. The book places emphasis on the emergence of new pathogenic microorganisms and how they are destroying the once optimistic view of eradicating all infectious diseases. She then adds the layer of problems presented by existing pathogens that are becoming resistant to our entire battery of antimicrobial drugs.

Garrett believes the escalating problems relative to infectious disease to be the result of a world out of balance and she often unapologetically and sometime brutally places the blame on human behaviors such as drug abuse, uncontrolled sexual activity and environmental intervention/pollution. She also addresses the impact of increased urbanization which brings more people closer together, thus enhancing the opportunity for pathogens to spread from person to person. Her sharp comments chastise people in general and governments in particular for their ignorance and negligence regarding the effects of industrialization and technology on nature and its delicate ecological balance.

She views conditions of poverty such as crowded housing, poor sanitation and untreated water as continual and enlarging factors in the maintenance and distribution of pathogenic organisms. Little optimism is possible as she describes the worsening of conditions in third world countries resulting largely from a lack of interest or ability on the part of governments to offer solutions to the problems.

The entry and persistence of pathogenic microbes in the world’s food supply are also addressed as she alludes to the high percentage of foods imported by the United States from countries with few or no standards relative to agricultural practices and/or industrial processing of food products. The recent emergence of bacterial pathogens such as Campylobacter jejuni, Listeria monocytogenes and E. coil 0157-H7 is confirmation of her concerns as she cites failures on the part of agencies in the U.S. such as the FDA and the USDA.

Garrett is perceptive and accurate in details regarding outbreaks of infectious diseases and those on the front line in the fight against them. She argues for more funding for the CDC in order for it to expand the crucial services of controlling and preventing epidemics throughout the world. She believes it is essential that the United States take the lead in promoting efforts to monitor and disrupt the spread of pathogens from country to country. In a direct, chilling manner she predicts the inevitable outcome of the failure of our country to do so.

The book portrays an on-going, never ending battle between humans and pathogens in which both will experience brief periods of victory. Convinced that there are no quick or simple solutions, she urges more funding for research, development of detection and surveillance techniques and more rapid diagnosis of diseases caused by pathogens that kill quickly. She believes these accomplishments will be of value only if we have in place fast and adequate response plans in the event of an outbreak of disease.

Although one cannot read The Coming Plague without feeling uncomfortable to the point of being threatened, there is encouragement as Garrett describes an awakening among microbiologists and health professionals that could gain momentum and result in actions to avoid massive loss of human life via microbial attack. Such actions, she points out, will require education and cooperation throughout society because we are all soldiers fighting the same microbial enemies.