Someday a Big Plague Will Come

Previous articleNext article FreeSomeday a Big Plague Will Come: Laurie Garrett’s The Coming Plague: Newly Emerging Diseases in a World out of BalanceVassiliki Betty SmocovitisVassiliki Betty SmocovitisUniversity of Florida, Gainesville Search for more articles by this author PDFPDF PLUSFull Text Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinked InRedditEmailQR Code SectionsMorePlagues are as certain as death and taxes.—Richard KrauseThe problem is serious, and it is getting worse.—Joshua LederbergLaurie Garrett’s The Coming Plague: Newly Emerging Diseases in a World out of Balance isn’t a standard work of history.1 There is little in the way of engagement with secondary sources or deep archival research, and it does not display the kind of subtle or nuanced thinking we are accustomed to in exacting historical scholarship. A quick glance at the book is enough to tell you that it is not even a standard academic work: from the sensationalist title, to the jacket design, to the lurid description and reader blurbs on the back—featuring words like “shocking,” “scary,” and “frightening”—it appears to be designed to attract attention, mostly from a general audience. Yet this is hardly your typical popular book. At 750 pages in length, it makes for difficult reading on an airplane or on holiday at the beach, and the topic—emerging infectious disease in a world undergoing ecological upheaval—is not exactly escapist fare. On closer inspection, the book has substance, features a well-developed argument, and draws heavily on the historical record over about fifty years, starting in 1950 or so, and occasionally on earlier historical examples. It is thick with descriptions of pathogens and disease progression, at times going into a staggering amount of scientific detail as well as history. We learn about people who expressed concerns about new microbial pathogens, like Joshua Lederberg, a well-known figure in the history of biology, and William H. McNeill, a historian and the author of the pathbreaking classic Plagues and Peoples, and about “disease cowboys,” scientists and doctors who seek to corral microbial pathogens.2 We learn about the history of antibiotic use, vaccines, and other developments that led people to think that the era of infectious disease was over by the late 1960s, as all the while bacteria responsible for age-old diseases like tuberculosis were evolving to resist antibiotics and viruses like HIV were about to emerge as global killers. Garrett’s list of diseases is a veritable bestiary of pathogens, and it grows longer and more alarming with each chapter. The combination of ecological conditions and the interplay of the constantly shifting dynamic of social practices also becomes more apparent, as we come to appreciate the importance of travel, urbanization, biodiversity loss, increasing global population, and the health-related consequences of changes in the Earth’s climate. The book is in fact well researched, and the endnotes appear to go on forever, with extensive citations to scientific publications, government documents, and medical reports. Though she does not spare us the doomsaying, Garrett does offer solutions—not so much to prevent plagues, which are sure to happen, but to mitigate outcomes: to monitor, surveil, treat, and plan with optimal effectiveness so as to minimize the damage on a global scale. The book’s success is due not just to the many examples she compiles; Garrett also leaves us with a sense of empowerment and optimism, as limited as it may be. Relentless in style and argument, the book draws the reader in, literally from page 1, as it begins to build a case—a very convincing case—that in a world that is clearly out of balance emerging pathogens will increasingly pose existential threats.In short, The Coming Plague is a popular work, written by a journalist, but it occupies a niche recognizable to historians of biology or disease who are familiar with Paul de Kruif’s classic Microbe Hunters or John Postgate’s popular Microbes and Man.3 The book is especially relevant as we contemplate the COVID-19 predicament, as historians of science, disease, and the environment, and most particularly for those of us interested in the history of biology with a focus on ecology and evolutionary biology. It matters. Briefly put, Garrett’s argument is this: We learn from the historical record that emerging pathogens result from the combination of the biological properties of microbes and changes in human social behavior. In what we might call an evolutionary arms race, microbes adapt rapidly to take advantage of us, our actions, and the changes that we inadvertently make in the world. Fundamentally, this is an evolutionary argument, one that has dominated evolutionary science since AIDS drew special attention to emerging pathogens. And let us recall that AIDS wasn’t the sole killer that surprised the generation that had become complacent about infectious disease: we also had Legionnaire’s disease, Lyme disease, and Toxic Shock Syndrome, which was especially alarming to women of my generation, raised with a false sense of security thanks to heavy antibiotic use and effective vaccination campaigns. Nor was Garrett alone in adopting such evolutionary arguments: in the early 1990s, a body of important literature was appearing that stressed the adaptable properties of microbial systems and what this meant in terms of emerging pathogens. Indeed, the whole notion of “emerging pathogen” or “emerging disease” began to gain currency right at this time, when it became common in scientific circles. Some of the books exploring such phenomena, like Paul Ewald’s The Evolution of Infectious Disease, were weighty, pathbreaking scientific treatises, while others, like Richard Preston’s The Hot Zone: The Terrifying True Story of the Origins of Ebola Virus, were popular fare drawing the attention of millions, who read it like a real-world version of Michael Crichton’s fictionalized viral thriller from the late 1960s, The Andromeda Strain.4 Others included emerging pathogens within a bigger movement for a new synthesis of evolution and medicine, traveling under the banner of evolutionary medicine, while still others were books about evolutionary biology that increasingly began to draw on examples of antibiotic resistance not just to raise concerns about their overuse and their lingering presence in the environment but also to demonstrate evolution, normally a slow, gradual process, difficult to observe, “in action.”5 With a reproductive rate on a scale of as little as twenty minutes, bacteria are not just able to double in population size quickly but can rapidly evolve novel antibiotic-resistant strains.My own interest in the topic of emerging pathogens arose as I was thinking through the next areas to be integrated into the “evolutionary synthesis.”6 It became apparent, at least to me, that emerging pathogens, the evolution of microbial systems, and even microbiology—a truly heterogeneous science defined merely by the minute size of the organisms it studies—were finally being actively integrated with wider evolutionary theory. Microbiology, with its many organisms, had not been part of the “evolutionary synthesis” of the 1930s and 1940s, despite the energetic efforts of virologists like Frank Macfarlane Burnet.7 Reading other contributions to the historical literature—some of which are now classics in the field of disease history, especially work by Hans Zinsser, William H. McNeill, Alfred Crosby, Jr., and others—it seemed to me that part of this wider turn to emerging pathogens or infectious diseases was an outcome of a recognition that evolutionary and ecological processes were important to human history.8 Wider historical circles were discovering the value of this kind of biological inquiry, the importance of nonhuman agents, and what came to be called environmental history, broadly construed; but this approach gained a new kind of urgency when seen as an outcome of a human-mediated reshaping of the natural world in the mid-1990s, as outbreaks were happening. I could see that human social behavior, human–animal encounters, and the stunning alteration of the land by humans over a very long period of history were being accompanied by historically devastating outbreaks. Pathogens were often opportunistic, exploiting particular circumstances that might well be contingent; they were constantly adapting to changing social practices, such as travel, or to agriculture, colonization, industrialization, and urbanization. Like others who were gaining an appreciation of biodiversity as a concept, or an idea, in the late 1980s or so, I grew increasingly alarmed at rainforest destruction, habitat loss, and the extinction of species on an unprecedented scale, made worse by the growing realization that climate change was becoming very real. With other historians keen on the environment, disease, and biology, I could see that such changes were going to have devastating consequences in terms of spillover events, precipitating new and destructive zoonotic epidemics on a planetary scale.By the mid-1990s and afterward, furthermore, infectious disease began both to capture the popular imagination and enter classrooms like mine.9 The 1993 film Philadelphia made Hollywood history by shaping public opinion on AIDS, as did a number of other films, theatrical productions, and novels drawing on the theme of contagion.10 Especially notable was the 1995 thriller Outbreak.11 It happened to be inaccurate, and it was pretty bad. Beyond the fact that it showed colossal insensitivity in its colonialist depiction of a lethal hemorrhagic fever coming “out of Africa,” it featured a cute and photogenic nonhuman actor as a smuggled vector, a white-faced capuchin monkey named Betsy, an animal known to be native not to Africa but to Central America (and these are just some of the problems that crop up in the first fifteen minutes or so). Despite the stereotypes and silliness, this film and others did, and do, serve as a reminder in the popular imagination that outbreaks can and do happen.12 Fictional films like this were countered, eventually, by excellent documentary films made available to classrooms, such as the PBS series NOVA’s Ebola: The Plague Fighters.13 Based on the 1995 outbreak in Kikwit, Zaire (now the Democratic Republic of Congo), this 1997 documentary focused not just on victims’ suffering and on confusion in the monitoring and treatment of the disease, but also on the inadequacies of health-care systems, as well as the complex matters of medical ethics that surfaced with the differing treatment philosophies of French physician-researchers keen on data collection and clinicians on the ground who were more concerned with patient care. The idea that a big plague was coming was therefore “in the air” as Laurie Garrett was writing her book and shortly thereafter, though she unquestionably produced the most comprehensive, engaging, and compelling account.No need to convince us of any of this now, of course. The COVID-19 pandemic has made this book, published over twenty-five years ago, even more relevant. It was a blockbuster when it first appeared in 1994 and made Garrett a celebrity in the journalistic world. She has emerged once again as the “Cassandra” of the twenty-first century.14 Though much has happened since the book appeared (think of emerging diseases like SARS, H5NI influenza, MERS, and Zika and the importance of Asian wet markets, factory farming, and cruise ships as incubators of disease), it remains a compelling read; and, indeed, everything that has happened since its publication confirms Garrett’s initial warnings. What can we do in response, as historians of science? Minimally, we can continue to do what we’ve been doing by generating multidisciplinary scholarship and engaging in teaching that draws on the historical record, inclusive of biological inquiry, and that explores the sociopolitical outcomes of disease and the disparities that can fuel them, along with providing constructive criticism of policies. But we can—and should—also take a stronger, activist stance in doing what Garrett and others have been urging us to do: we should prepare ourselves for the next coming plague, because it is almost certainly on its way.NotesVassiliki Betty Smocovitis is Professor of the History of Science at the University of Florida. Her interests include the history of ecology and evolutionary biology and, especially, the historical event termed the “evolutionary synthesis.” She teaches “The History and Evolution of Infectious Disease” in the Department of Biology and the Department of History. Department of Biology and Department of History, University of Florida, Gainesville, Florida 32611, USA; [email protected].1 Laurie Garrett, The Coming Plague: Newly Emerging Diseases in a World out of Balance (New York: Farrar, Straus & Giroux, 1994); the epigraphs are from p. 5. My title is a wordplay on the classic line in Martin Scorsese’s Taxi Driver (1976) presaging the end of the world.2 William H. McNeill, Plagues and Peoples (New York: Anchor, 1976).3 Laurie Garrett is best described as a science writer, with a specialty in the health sciences. Formally trained in immunology, she turned to trenchant reporting on AIDS in the 1980s. For a brief biography see https://www.lauriegarrett.com/about. See also the best-selling classics by Paul de Kruif, Microbe Hunters (New York: Harcourt, Brace, 1926); and John Postgate, Microbes and Man (London: Penguin, 1969).4 Paul Ewald, The Evolution of Infectious Disease (Oxford: Oxford Univ. Press, 1993); Richard Preston, The Hot Zone: The Terrifying True Story of the Origins of Ebola Virus (New York: Anchor, 1994); and Michael Crichton, The Andromeda Strain (New York: Knopf, 1969). See also Stephen S. Morse, ed., Emerging Viruses (Oxford: Oxford Univ. Press, 1993); and Morse, The Evolutionary Biology of Viruses (New York: Raven, 1994).5 Randolph Nesse and George C. Williams, Why We Get Sick: The New Science of Darwinian Medicine (New York: Times Books/Random House, 1994); and Marc Lappé, Evolutionary Medicine: Rethinking the Origins of Disease (San Francisco: Sierra Club, 1994). See also Jonathan Weiner, “The Resistance Movement,” in The Beak of the Finch: A Story of Evolution in Our Time (New York: Knopf, 1994), Ch. 18.6 Vassiliki Betty Smocovitis, “Reproblematizing the Evolutionary Synthesis,” in Unifying Biology: The Evolutionary Synthesis and Evolutionary Biology (Princeton, N.J.: Princeton Univ. Press, 1996), Ch. 6.7 Frank Macfarlane Burnet, Virus as Organism: Evolutionary and Ecological Aspects of Some Human Virus Diseases (Cambridge, Mass.: Harvard Univ. Press, 1945). For more on Burnet and the origins of disease ecology see Warwick Anderson, “Natural Histories of Infectious Disease: Ecological Vision in Twentieth-Century Biomedical Science,” in Landscapes of Exposure: Knowledge and Illness in Modern Environments, ed. Gregg Mitman, Michelle Murphy, and Christopher Sellers, Osiris, 2004, N.S., 19:39–61. For one account of the history of microbial evolution see also Jan Sapp, The New Foundations of Evolution: On the Tree of Life (Oxford: Oxford Univ. Press, 2009).8 See Hans Zinsser, Rats, Lice, and History (New York: Little, Brown, 1935); McNeill, Plagues and Peoples (cit. n. 2); Alfred Crosby, Jr., The Columbian Exchange: Biological Consequences of 1492 (Westport, Conn.: Greenwood, 1972); and Crosby, America’s Forgotten Pandemic: The Influenza of 1918 (Cambridge: Cambridge Univ. Press, 1989). See also Crosby, Ecological Imperialism: The Biological Expansion of Europe, 900–1000 (Cambridge: Cambridge Univ. Press, 1987). For examples from science studies see Bruno Latour, The Pasteurization of France (Cambridge, Mass.: Harvard Univ. Press, 1993).9 For a description of HIS 3495/ZOO 4926, “The History and Evolution of Infectious Disease,” and reflections on its origins and evolution since 1996–1997 see Vassiliki Betty Smocovitis, “When Biology Meets History: Reflections on the ‘History and Evolution of Infectious Disease,’” Pts. I–V the Teach311.org+COVID-19 collective+History of Science ON CALL Teaching Moments project, https://www.teach311.org/category/on-call/. See also Smocovitis, “Real-Life Lessons for an Infectious Disease Class,” Gainesville Sun, 3 Apr. 2020.10 For a detailed analysis of AIDS, infectious disease, and the popular imagination see Priscilla Wald, Contagious: Cultures, Carriers, and the Outbreak Narrative (Durham, N.C.: Duke Univ. Press, 2008). Wald also includes a discussion of Garrett’s Coming Plague and its influence.11 Outbreak (1995), film directed by Wolfgang Petersen, Punch Productions, Inc., Warner Brothers.12 See also the 1995 film Restoration, directed by Michael Hoffman, Miramax Studios, for a better depiction of the plague of 1665 and its impact.13 Ebola: The Plague Fighters, NOVA, 1997, https://www.pbs.org/wgbh/nova/education/programs/2304_ebola.html.14 Frank Bruni, “She Predicted the Coronavirus: What Does She Foresee Next?” New York Times, 3 May 2020; and David Ewing Duncan, “Prepare, Prepare, Prepare: Why Didn’t the World Listen to the Coronavirus Cassandras?” Vanity Fair, 27 Mar. 2020. Previous articleNext article DetailsFiguresReferencesCited by Isis Volume 111, Number 4December 2020 Publication of the History of Science Society Article DOIhttps://doi.org/10.1086/712360 Views: 1726 © 2020 by The History of Science Society. All rights reserved.PDF download Crossref reports no articles citing this article

Ancient history · Balance (ability · Plague (disease · Political science · Diverse Historical and Scientific Studies · Historical Studies and Socio-cultural Analysis · History · History of Science and Medicine · Medicine

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