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Reviews and Notes: Infectious Diseases: The Coming Plague: Newly Emerging Diseases in a World Out of Balance

The Coming Plague: Newly Emerging Diseases in a World Out of Balance L Garrett. 750 pages. New York: Farrar, Straus & Giroux; 1994. $25.00. ISBN 0-374-12646-1. Order phone 800-788-6262. A bracing review of the sex life of mosquitoes and all of its consequences awaits the reader of this lengthy but well-written collection of short stories. More accurately, this collection chronicles the personal heroism of physicians and epidemiologists involved in solving the puzzle of mysterious outbreaks of new and old diseases in human populations the world over. One might describe it as a longer and more cynical version of Berton Rouche's Eleven Blue Men, a collection of stories about physician-epidemiologist-investigators whose earnest efforts and ingenuity have inspired many a young person to decide to join the Center For Disease Control and Prevention's Epidemiologic Intelligence Branch. Garrett's book is much longer, however, and in reviewing failed World Health Organization efforts to eradicate malaria and yellow fever, pointedly repeats that humans are themselves to blame for the political and cultural differences that obstruct the greater good of disease eradication. At times, the book reviews ancient history, including the extinction of dinosaurs (an example of a thoughtless race that did not protect itself from natural ecology), but it focuses primarily on 20th century discoveries, such as Lassa fever; the Ebola, Marburg, and Hantaan viruses; and the acquired immunodeficiency syndrome (AIDS). The second half of the book focuses on the origins of AIDS research and the enormous political battles that have surrounded the recognition and subsequent funding of this research. This part of the book is particularly strong: Garrett provides a minimally biased and extremely well-researched account of what occurred around the world from day to day as epidemiologists, patients, physicians, molecular biologists, and oncologists struggled to gain public validation and political funding for their efforts throughout the 1980s. Garrett does not specifically review problems in public health education, but I was a World Health Organization physician myself in the late 1980s, and we had excellent handouts and videos made by superb groups in the United States for the education of young people. These collected dust in our Geneva archive, having been rated as pornographic for mentioning anal sex (in the context of explaining that this practice might reduce pregnancy but does not reduce the spread of sexually transmitted disease). The United States fired one surgeon general for advocating liberal sex education and stands poised to renounce another. Garrett's point is well taken: We need to stop haggling over small points while the huge epidemic (not only of viruses but of ignorance and thoughtless self-interest) overwhelms us. Nonetheless, there are reasons for cautious optimism; one recent example is the slower spread of multidrug-resistant tuberculosis outside of the New York area. Grim projections had it devastating the West Coast by now, but a combination of thoughtful cooperation, funding, and good luck seems to be working. Disease control efforts are not a lost cause.