I first read “The Coming Plague: Newly Emerging Diseases in a World Out of Balance” by Laurie Garrett nearly eight years ago. I have a penchant for “disease books,” and as Garrett’s book covers hemorrhagic fevers (Ebola, Marburg, Lassa, hantavirus, and Ebola), yellow fever, meningitis, swine flu, AIDS, toxic shock syndrome, Legionnaire’s, and cholera, it provided me both with ample disease tidbits and fodder for small anxieties for many months to come. It is absolutely comprehensive in terms of emerging diseases.
I recently picked up the book again, following the World Health Organization's upgrade of the H1N1 "swine flu" virus to pandemic status, for a refresher in all the nasty things out there that can — and may well — kill us. Garrett will also be a guest on "The Colbert Report" tonight: the show will be online tomorrow.
What stands out about her book, even so many years later, is how large a role human behavior plays in the spread of disease. Some of the connections are obvious, such as sexual habits in the case of STDs (such as AIDS) and the well-documented overuse of antibiotics (in both people and animals). Others are less so: genetic recombination of viruses found in human and animal waste (such as cholera) swapping genetic materials as they multiply in bodies of water around the world. Ample time is also given to bumbling bureaucracies, the difficulties people have maintaining appropriate hygiene when in poverty, and religious figures and institutions who put their own idea of morality ahead of the well-being of the individuals at risk. (Think here of Pope Benedict stating that condoms actually contribute to the spread of AIDS to get an idea of what Garrett's discussing here.)
However, what "The Coming Plague" doesn't discuss as such, is the transfer of diseases between humans and animals, and how our industrial food system facilitates this transaction. The book was written in 1995, before avian flu had made an appearance on the world stage, so perhaps such an omission is understandable. Perhaps Garrett will discuss recent developments with Stephen Colbert tonight.
I would love to see a revised edition come out that addresses many of the emerging diseases we’re seeing today, from SARS and avian flu to the new H1N1. We've learned so much in the past 15 years, especially with regards to CAFOs serving as breeding grounds for new, nastier, and more drug-resistant bugs (see our Q&A on MRSA, and this New Scientist piece on H1N1). Although it may well be true that there is no causal relationship between Granjas Carroll de Mexico and the H1N1 outbreak in Mexico, that doesn't mean such an outbreak isn't likely in the future.
While Garrett’s subject matter is grim, she does end with recommendations for reacting to or preventing future outbreaks. Increased international monitoring of emerging diseases, increased public health spending, and increased access to basic necessities such as sanitation systems and clean drinking water are all common-sense steps that too often fall victim to budget cutting or myopic self-interest.
The global monitoring system is getting a workout these days with the emergence of the H1N1 virus. Let’s hope that public health officials worldwide are as aware of Garrett of the coming plague, whatever it might be.