BRev The Coming Plague: Newly emerging diseases in a world out of balance By Laurie Garrett. 750 pp. New York, Farrar, Straus and Giroux, 1994.

(PDF) Book Review The Coming Plague: Newly emerging diseases in a world out of balance By Laurie Garrett. 750 pp. New York, Farrar, Straus and Giroux, 1994. $25. 0-374-12646-1

BOOK REVIEWS
THE COMING PLAGUE: NEWLY EMERGING DISEASES
IN A WORLD OUT OF BALANCE
By Laurie Garrett. 750 pp. New York, Farrar, Straus and Gi-
roux, 1994. $25. ISBN 0-374-12646-1.


During the past decade, members of the infectious-disease
and public health communities began to express concern
about the appearance of new infectious diseases and the re-
surgence of previously recognized ones. The advent of the ac-
quired immunodeficiency syndrome (AIDS) and the discovery
of its cause, a new virus, were the most dramatic in a series
of developments involving new, emerging, or reemerging in-
fectious diseases. Toward the end of the decade, scientific
meetings were organized to discuss emerging infectious dis-
eases, and in 1992 the Institute of Medicine released a water-
shed report entitled Emerging Infections: Microbial Threats to
Health in the United States (edited by Joshua Lederberg, Robert
E. Shope, and Stanley C. Oaks, Jr., Washington, D.C.: Nation-
al Academy Press). It highlighted the complacency that had
developed regarding infectious diseases in the United States,
emphasized the need for enhanced surveillance of infectious
diseases, documented the deterioration of the U.S. capacity to
address new and emerging infectious diseases, and made 15
recommendations to address the problem. The report of the
Institute of Medicine was of great interest to the scientific and
public health communities but went largely unnoticed by the
lay public.


In The Coming Plague, Laurie Garrett, a health and science
reporter with Newsday, building on the foundation laid in the
Institute of Medicine report, has created a comprehensive, al-
most encyclopedic work on infectious diseases that have
emerged or reemerged during the past three decades. 


She
leads the reader through a series of interesting and thorough
chapters, arranged for the most part in chronologic order,
dealing first with the discovery of viral hemorrhagic fevers,
then with legionnaires’ disease, toxic shock syndrome, and
others, including the outbreak of hantavirus pulmonary syn-
drome, which was recognized in the spring of 1993. Tales of
the Machupo, Lassa, Ebola, and Marburg viruses are told in
a compelling fashion. Through extensive interviews, Garrett
introduces the reader to the “disease cowboys,” who played
leading roles in the discovery, isolation, and description of
these deadly viruses. With colorful examples and hard statis-
tics, she describes the resources needed to address future mi-
crobial challenges and exposes gaps in existing capacities at
the national and international level. Garrett’s work is exten-
sively documented, with over 100 pages of footnotes contain-
ing references and extensive statistics, and also includes a de-
tailed index. Figures effectively highlight specific points; for
example, a map on page 249 shows the locations of the largest
urban areas with projected populations of more than 10 mil-
lion by the year 2000 and the per capita earnings for each
country. The author warns about the explosive potential of
such urban “megacities” to amplify the transmission of infec-
tious agents.


In her treatment of the human immunodeficiency virus
(HIV) and AIDS, Garrett offers an exceptional perspective,
not only of the scientific adventure associated with the dis-
covery of new diseases but also of the social and political in-
terplay that can accompany scientific discovery. 

The book’s centerpiece is the emergence of HIV and AIDS in North America, Europe, Africa, and Asia, but the chapter on “third-worldization” of public health in the United States is particu-larly interesting. 

Examples abound of daily battles against budget cuts, homelessness, illicit drug use, and new and resur-gent pathogens in major cities in the United States and
around the world.


The Coming Plague is a must for public health policy makers,
but anyone intrigued by the biologic sciences will find it of
considerable interest. Some of the material could easily be
adapted for science courses at the secondary-school or college
levels.


The breadth of coverage and unique perspectives of The
Coming Plague will entertain, educate, and challenge the read-
er. Experts will recognize minor technical errors and omis-
sions, but they will undoubtedly agree with the central themes
that new infectious diseases will continue to emerge and that
we must be ready to respond. Garrett has effectively made
her point: the world, at least when it comes to dealing with
emerging infectious diseases, is out of balance. Yet she con-
veys the message that these challenges can be effectively ad-
dressed if we have the will to ensure the professional and
technological capacity to detect such threats and respond to
them in a timely manner.


JAMES M. HUGHES, M.D.
Centers for Disease Control
Atlanta, GA 30333 and Prevention