BOOKS OF THE TIMES; A Frightening Portrait of a Threat to the Species - The New York Times
BOOKS OF THE TIMES; A Frightening Portrait of a Threat to the Species
By Michiko Kakutani
Nov. 9, 1994
THE COMING PLAGUE Newly Emerging Diseases in a World Out of Balance By Laurie Garrett Illustrated. 750 pages. Farrar, Straus & Giroux. $25.
"Everybody knows that pestilences have a way of recurring in the world," Albert Camus wrote in his 1948 novel "The Plague," "yet somehow we find it hard to believe in ones that crash down on our heads from a blue sky."
In "The Coming Plague," her prodigiously researched new book, Laurie Garrett, a writer for Newsday, draws a frightening portrait of the myriad infectious diseases threatening humankind: both familiar ones like malaria, tuberculosis, cholera, bubonic plague, yellow fever, syphilis and AIDS, and the newly emerging viruses and bacterial infections that scientists are only just beginning to identify and fight. Included in her survey are discussions of Legionnaires' disease, swine flu, the rodent-borne hantaviruses, toxic shock syndrome, E. coli contaminations, Lassa fever and the deadly Marburg and Ebola viruses, both devastating and excruciating.
Ms. Garrett's overall assessment is gloomy: "That humanity had grossly underestimated the microbes was no longer, as the world approached the 21st century, a matter of doubt," she writes. "The microbes were winning. The debate centered not on whether Homo sapiens was increasingly challenged by microscopic competitors for domination of the planet; rather, arguments among scientists focused on the whys, hows and whens of an acknowledged threat."
Compared with Richard Preston's best seller "The Hot Zone," which focused on a handful of virus hunters and biohazard specialists and their efforts to track down and contain the lethal Ebola virus, "The Coming Plague" initially seems unwieldy, disorganized and dry. Ms. Garrett does not have Mr. Preston's breezy storytelling skills, and her ambitious agenda -- to create a comprehensive anatomy of contemporary microbial diseases -- precludes the sort of narrative suspense Mr. Preston exploited to such effect in his book.
What "The Coming Plague" may lack in superficial drama, however, is more than made up for by Ms. Garrett's energetic reporting and her gutsy determination to situate her subject in the larger landscape of recent social, political and ecological developments. The result is a sober, scary book that not only limns the dangers posed by emerging diseases but also raises serious questions about two centuries worth of Enlightenment beliefs in science and technology and progress.
Indeed, Ms. Garrett contends that many recent scientific and social developments have actually worked to amplify the range and virulence of dangerous microbes. The widespread use of antibiotics and other drugs (the very agents that once seemed to promise a disease-free future) has led to a host of mutant strains of microbes, resistant to all or most treatment, including penicillin-resistant staphylococcus, antibiotic-resistant pneumococcus, chloroquine-resistant malaria, acyclovir-resistant herpes, AZT-resistant H.I.V. and multiply drug-resistant tuberculosis.
The use of DDT sprays to control malaria-carrying mosquitoes has similarly backfired, Ms. Garrett says, leading to declining diversity in the insect world and the eventual resurgence and spread of disease-bearing mosquitoes. Other man-made alterations to the environment, she adds, have also had unforeseen consequences. The building of huge dams in Egypt, the Sudan and Ghana seems to have led to rising numbers of the schistosome parasite and a concurrent rise in related diseases, just as deforestation in North and South America has led to changes in the region's flora and fauna, which in turn have led to significant shifts in the microbe population. One such shift, Ms. Garrett says, has contributed to the recent spread of Lyme disease, an ailment carried by the I. dammini tick, which has proliferated in denuded forest areas in conjunction with a rapidly expanding deer and rodent population freed from such natural predators as cougars and wolves.
Social developments, too, Ms. Garrett says, have unwittingly aided the microbial assault on humans. The growing urbanization of third-world countries has created dense population centers where poverty, poor sanitation and overextended health care systems combine to create the perfect conditions for an epidemic. At the same time, cheap and accessible air travel has helped create a global village in which microbes can migrate from one remote ecosphere to another within days, even hours.
The social factor in the spread of disease, Ms. Garrett suggests, has been especially pronounced in the case of AIDS. During the 70's, loosening sexual mores and intravenous drug use contributed to its swift spread in North America, while civil war, tribal conflicts and mass refugee migrations (accompanied by famine, malnutrition and increased prostitution) helped accelerate its march through sub-Saharan Africa. The unwillingness of governments to grapple quickly and directly with the epidemic further contributed to its rapid spread.
As Ms. Garrett sees it, the AIDS crisis may be only the tip of the microbial iceberg. "As the Homo sapiens population swells, surging past the six billion mark at the millennium, the opportunities for pathogenic microbes multiply," she writes. "If, as some have predicted, 100 million of those people might then be infected with H.I.V., the microbes will have an enormous pool of walking immune-deficient petri dishes in which to thrive, swap genes and undergo endless evolutionary experiments."
It's a frightening vision of the future and a deeply unsettling one, especially in light of the optimism that burned so brightly only a few decades ago with the prospect of mankind's conquest of polio and smallpox.
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A version of this article appears in print on Nov. 9, 1994, Section C, Page 15 of the National edition with the headline: BOOKS OF THE TIMES; A Frightening Portrait of a Threat to the Species.
