Review by Choice Review
Globalization no longer applies only to interconnected economies. Prior to the 19th century, outbreaks of new diseases were largely confined to remote regions of the world, as the extent of spread was severely limited by slow modes of travel. Shah, a science journalist, describes in detail how the evolution of transportation--from the development of railroads to steamships (replacing sailing ships) and ultimately routine air travel--resulted in a revolutionary change. Antibiotic-resistant bacteria originating in the slums of India can now be transported within days, or even hours, worldwide. Human encroachment on heretofore remote areas of the world has not only disrupted the ecosystem but also resulted in exposure to zoonoses that were once rare to encounter. Many of these organisms developed the capability to "jump" over other species and begin to infect humans. Using cholera as a prototype, Shah delves into the origin and spread of numerous emerging or recurring diseases, which now number in the hundreds. Each chapter addresses a common basis of the problem of spreading diseases--with examples ranging from locomotion and filth to crowds. It is very easy to assign culpability, yet realistic approaches to solutions are lacking in otherwise fascinating accounts. Summing Up: Recommended. All readers. --Richard Adler, University of Michigan, Dearborn
Copyright American Library Association, used with permission.
Review by New York Times Review
OVER CHRISTMAS, HEADLINES across Britain screamed that Victorian-era diseases had returned. The past five years had apparently witnessed a 136 percent increase in scarlet fever cases, a remarkable 300 percent rise in the confirmed cases of cholera along with reported occurrences of other once-vanquished diseases like tuberculosis, measles and whooping cough. The 300 percent jump in cholera cases is especially troubling - that deadly microbe devastated England nearly as much as the plague, claiming thousands of lives, especially in London. And the disease happens to be making its mark all over the world today, from ISIS-controlled territories in Syria and Iraq to Cuban prisons. Having appeared only in Bengal, cholera made its first pandemic leap in 1817, during British rule in India. Two centuries later, it is in its seventh pandemic. The microbe's most horrible 21st-century toll continues to unfold today in Haiti, where Vibrio cholera was unwittingly introduced by Nepali United Nations peacekeepers bivouacked alongside a river tributary after the 2010 earthquake. Water systems across the nation were soon contaminated with the bacteria passed in human waste, leading to a breathtaking cumulative 745,558 diagnosed cases of the disease by July 2015, causing 8,972 deaths. Though the cause of cholera is known and its treatment is well understood and inexpensive, efforts to contain it are often stymied by politics, poor planning or poor infrastructure. From the moment cholera appeared in Haiti in 2010, its control became fodder for intractable public health disputes, allowing the microbe to spread unchecked. The outbreak that threatens millions of refugees and people living in disputed territories in Syria and Iraq and in neighboring nations is fueled by man-made disasters like war coupled with El Niño ocean-warming events, which may spread the bacteria and be especially intense in 2016 thanks to climate change. Given these developments, I eagerly anticipated Sonia Shah's "Pandemic." Cholera is the spine that runs through her tour of global contagions, and I hoped Shah would deliver the historical, biological, political and social perspectives on the disease that she brilliantly exhibited in her book on malaria, "The Fever." Like John M. Barry's spectacular "The Great Influenza," Shah's previous book took readers on a long, research-rich journey through the historic struggles between mankind and one of its great scourges. Sadly, "Pandemic" has no clear focus, and it is not the much-needed definitive analysis of cholera I hoped it would be. It tries instead to cover every single major outbreak of recent history, from the 2003 SARS epidemic to Shah's own battle with MRSA (methicillin-resistant Staphylococcus aureus), adding little to the large canon of outbreak and emerging-diseases literature that stretches from Paul de Kruif's masterpiece "Microbe Hunters" (1926) to my "The Coming Plague" (1994), Jaap Goudsmit's "Viral Fitness" (2004), David Quammen's "Spillover" (2012) and The New York Times's Pulitzer Prize-winning reports from the 2014 Ebola epidemic in Africa. This canon combined with the deep trove of scientific publications on the topic prompts the question, Why another book? Shah struggles with the question herself. Should she dive into the history of a pathogen, she asks herself at the start of her investigation, or profile a nascent one? She finally finds a solution in a speech given by the microbiologist Rita Colwell. Colwell refers to the "Cholera Paradigm," which states that all of the factors inherent in disease emergence and spread can be explained by studying just one microbe, Vibrio cholerae. Shah structures her book accordingly, weaving back and forth from cholera to other newer viruses and bacteria, visiting cities in China, India and Haiti that were once the sites of outbreaks. "Today, as we stand on the cusp of the next pandemic, the multistage journey from harmless microbe to pandemic-causing pathogen is no longer invisible," she writes. "Each stage can be laid bare to see." Much of the literature on contagions appeared at a time when the war on infectious diseases was far from won and the idea that human behavior could promote the emergence of previously unknown pathogens was deeply controversial. That is no longer the case anywhere in the world. Doctors and public health specialists in countries as wealthy as Japan and as poor as Papua New Guinea now share strong concerns about the waning efficacy of antibiotics amid rising drug resistance. Outbreaks now emerge with such gravity and frequency that SARS, Ebola, swine flu, H5N1 influenza, XDR-TB, NDM-1 plasmids, E. coli 0157:H7, Zika and dozens of other frightening microbes are regarded as national security threats. The multibillion-dollar Global Fund to Fight AIDS, Tuberculosis and Malaria was established after the 2000 G8 Summit in Japan, and in almost every G8 (now G7) summit since, disease treatment, surveillance and control have regularly been on the agenda. Last year Chancellor Angela Merkel of Germany and President Obama called for a multibillion-dollar health-security initiative aimed at bringing all of the nations of the world up to high technical standards for disease detection and response. Either Shah is not aware of the international drama unfolding at this level or she chooses to ignore it. She doesn't investigate why all but 48 nations of the world refuse to abide by the epidemic surveillance principles of the World Health Organization's International Health Regulations. Nor does she delve into why both the G7 and G20 efforts have largely failed to concretely address global vulnerabilities to old diseases like cholera, or new ones such as SARS. She makes no mention of the enormously important 2015 Gesundheitsministertreffen G7 pact to fight anti-biotic resistance, control microbial disease and reform the W.H.O. post-Ebola. Instead, Shah offers a sort of TED talk list of technological quick fixes for identifying outbreaks in their early stages. But no technological tool kit or team of disease detectives can protect humanity from the rising tide of new microbial diseases, or newly evolved and drug-resistant older scourges. As Shah demonstrated in "The Fever," the tools of malaria prevention, such as curative drugs and bed nets, are useless unless a global political and financial will is in place to facilitate their distribution in poor countries and the recipients put the devices to proper and consistent use. She doesn't ask why the W.H.O. maintains a stockpile of only one million doses of the cholera vaccine (although it's expected to double this year) or how it decides which populations should receive precious supplies. And in an otherwise detailed section on the cholera outbreak in Haiti, she doesn't dissect the disagreement between medical advocates, like Dr. Paul Farmer at Harvard, and environmental activists over how best to tackle the epidemic. Farmer, who worked closely with former President Bill Clinton on the Haitian earthquake response, focused on a medical approach to cholera control: vaccination and treatment. In contrast, French public health experts working in Haiti tracing the Vibrio's spread said the microbe had exploited a water system that was already known to be a major source of child illness and death. Fixing the water and sewers never garnered the technical and financial resources necessary, and cholera is now a permanent feature in impoverished Haiti. More seriously, Shah doesn't examine the failures to implement disease surveillance and epidemic control. Five high-level assessments have been completed regarding the performance of the W.H.O. and other global institutions in the recent Ebola outbreak in Liberia, Sierra Leone and Guinea. Each concluded that a litany of errors allowed the disease to spread for months before the W.H.O. declared a state of global emergency and any significant assistance from the rest of the world arrived in the West African nations. Between 2013 and 2015, there were 28,637 reported cases of Ebola, and 11,315 people died. Thousands more were sickened before American and British soldiers and humanitarian aides arrived, bringing more than a billion dollars' worth of supplies and equipment. Shah's discussion of solutions too often reads like a boilerplate list of technocratic fixes that have been much discussed or, worse, debunked. She writes of a "global immune system" of technology and surveillance that "could detect pandemic-worthy pathogens before they hop on flights and get swept up in population movements, pinpointing the next H.I.V., the next cholera and the next Ebola before they start to spread" and could be funded by a 1 percent tax on air travel. The Ebola experience demonstrates that she is wildly wrong: In March 2014, the Pasteur Institute in Lyon, France, correctly identified Ebola as the cause of the then-small African outbreak. A standard tool kit of case detection and high-tech lab tools was applied to hunting down cases. By the end of April 2014 the W.H.O. and its advising experts from all over the world were convinced that Ebola was vanquished, but they were horribly mistaken. SAVING HUMANITY FROM microbial threats will require far more than the social-media searches, satellite sweeps, "hot spot" surveillance teams and similar solutions Shah proffers. Nothing short of an international commitment to full implementation of the International Health Regulations, coupled with provision of basic health care to all and an all-out scientific R&D effort to develop rapid point-of-care diagnostics, treatments and vaccines will be sufficient. Such a scale cannot be funded by an airplane tax - a system that is, by the way, already in place in the form of Unitaid, funding some H.I.V., tuberculosis and malaria care in poor countries. When Shah focuses on a single epidemic - as she does with cholera in the chapter titled "The Cure" - her skills as a historical investigator shine, and we are left hungering for more. She brings fresh insights to the century-long battle inside the European medical community over the cause and the treatment of the disease, which swept periodically through London, Paris and countless other European and North American cities. In pages as riveting as any thriller, Shah describes pitched battles between the dominant "miasmatists," who believed the smell of human waste caused the illness, versus the British anesthetist John Snow, who was convinced that cholera was caused by contaminated waters - and perhaps traceable to one water pump. Snow died while trying in vain to defend his theory to the British Parliament, and miasmatists so dominated thinking throughout the 19th century that Londoners deliberately filled the Thames with human waste during cholera outbreaks to distance themselves from the fumes they believed caused the disease. By the 1860s, the German chemist Max von Pettenkofer led medical perspectives on the disease, refuting John Snow's contaminated-water hypothesis in favor of "poisonous clouds." Even when the German microbiologist Robert Koch announced in 1884 that he had discovered the pathogen responsible for the disease, Pettenkofer and the miasmatists clung to their "smelly air" views and held sway over politicians and governments. It was only when cholera returned to Germany in 1897, killing residents who drank from the deliberately contaminated river while sparing those who drank filtered water, that the miasmatists backed off. Now, this is storytelling - a narrative that evokes both the power of the disease and the power of human folly. Had Shah devoted herself to telling us more about the are of human understanding and battle with cholera, rather than superficially rehashing the existing literature, "Pandemic" would have been riveting to read and an invaluable contribution to public health.
Copyright (c) The New York Times Company [March 6, 2016]
Review by Booklist Review
*Starred Review* Investigative science journalist Shah (The Fever, 2011) is at it again, and if the words, and beyond, in her latest book's subtitle don't grab a reader's attention, they should. This time, she is calling on global leaders, public and corporate, to pay attention to an impending public health emergency. As she says, between 1940 and 2004, more than three hundred infectious diseases have either newly emerged or reemerged in places and in populations that had never seen them before, any one of which can unpredictably detonate a full-fledged global pandemic of potentially biblical proportions at any time. So much for humankind's so-called postinfection era. Yes, just the reemergence of cholera a disease previously believed thoroughly eradicated in Haiti and elsewhere should be enough to alarm us to the grim possibility of evolving/mutating microbes capable of bringing worldwide human suffering and death. Shah doesn't leave us wondering how this could happen in an age of proper sewage treatment and Purel. One-by-one she ticks off (no Lyme-disease pun intended) half a dozen conduits by which deadly microbes can spread faster than you can say Methicillin-resistant Staphylococcus aureus (MRSA) an infection, by the way, that affected her family. Yes, Shah is back and in rare form. And this time it's personal.--Chavez, Donna Copyright 2015 Booklist
From Booklist, Copyright (c) American Library Association. Used with permission.
Review by Publisher's Weekly Review
In this absorbing, complex, and ominous look at the dangers posed by pathogens in our daily lives, science journalist Shah (The Fever) cautions that there are no easy solutions. Of particular note is the challenge of tracking those pathogens that remain uncontained and which could overtake humans in a pandemic. As an example, Shah tracks the waterborne Vibrio cholerae bacterium from its home in the southwest Indian Ocean as it radiated from China and India to Paris in 1832, and then sailed to the U.S. with emigrants from cholera-plagued Europe heading to the eastern coast of North America-at the time there were 5,800 reported cases and nearly 3,000 deaths in New York City alone. Shah then meticulously dissects the conditions that made cholera's transmission so effective and new outbreaks inevitable, including filthy water, overcrowding, political corruption and inaction, scapegoating, and even the expedited expansion of the human population by the harnessing of fossil fuels. "For most of our history, we've been unaware of pathogens' role in our lives," Shah writes, adding that most of the challenges still lay ahead. Shah's warning is certainly troubling, and this important medical and social history is worthy of attention-and action. Agent: Charlotte Sheedy, Charlotte Sheedy Literary Agency. (Mar.) © Copyright PWxyz, LLC. All rights reserved.
(c) Copyright PWxyz, LLC. All rights reserved
Review by Kirkus Book Review
Vibrio cholerae was once a species of marine bacteria attached to some plankton in the coastal wetlands of the Bay of Bengal. In grim detail, science journalist Shah (The Fever: How Malaria Has Ruled Humankind for 500,000 Years, 2010, etc.) demonstrates how it became the global source of horrendous deaths and how the story of cholera is paradigmatic of how pandemics happen. Cholera emerged in the early 1800s after the East India Company began to fill in and settle the wetlands. Disease might occur if a fisherman swallowed some brackish water, a direct transmission from the vibrio to a human. But to make the jump to human-to-human transmission, the vibrio changed. It adapted ways to form colonies, making it harder to dislodge from the human gut, and it developed a toxin that flushes all the fluids from the body, causing death by dehydration. Still, cholera might have stayed local except for other 19th-century developments: steamships and newly dug canals and waterways moved goods and people rapidly across land and sea, creating new waves of infection while also swelling the populations of cities, which lacked clean drinking water and proper waste disposal. By the 1830s, cholera was devastating Paris, London, and New York, exacerbated by the arrogance of medical elites who swore by the miasma theory of disease. Then, add political corruption after the cause was known: city contractors asked to supply clean water but substituting foul; government officials who would deny the existence of disease, so as not to discourage business. The ingredients for pandemics remain potent in a jet age with deforested lands, ever- growing cities, the consumption of bush meat and other exotic wild cuisine (from illegal "wet markets"), antibiotic resistance, inadequate disease surveillance, and destructive cultural attitudes, ranging from abject fear to blame to indifference. Shah covers all of these aspects in vivid prose and through revealing eyewitness accounts. This is not fun reading, but it's necessaryone can only hope that it drives more effective surveillance and rapid response to tomorrow's plagues. Copyright Kirkus Reviews, used with permission.
Copyright (c) Kirkus Reviews, used with permission.
