Author Donald G. McNeil Jr.
Donald G. McNeil Jr. was a New York Times science and health reporter for twenty-five years. In that time, McNeil became an expert on pandemics, and he shares his insights in this book. The treatise is divided into four parts: Initial Reflections on Pandemics; The Tangled Roots of Pandemics; The Human Factors That Spread Pandemics; and Some Ways to Head Off Future Pandemics.
🧬 Initial Reflections on Pandemics
Since it's so recent, the Covid pandemic is well-known around the globe. Many plagues have come and gone, however, most of which are not in the world's collective consciousness. McNeil is more conversant with global contagions than most, his first 'up close' experience being in Johannesburg, South Africa in 1998, at an orphanage full of HIV-positive children doomed to die.
South African AIDS Orphanage
Triple-therapy antiretroviral cocktails for HIV were available, but they were expensive, and South Africa couldn't afford them. There were negotiations and patent wars and so on, and in time, pharmaceutical companies were (essentially) pressured into selling the drugs to poor countries for reduced prices. McNeil observes, "The world was changing its attitude toward the dying poor." This is important for many reasons, one being that - in our interconnected world - ANY reservoir for contagious diseases is a potential threat to everyone.
🧬 The Tangled Roots of Pandemics
McNeil believes the United States badly mishandled the Covid pandemic. To assess how we dealt with the virus, McNeil compares America to two countries that match us in culture, per capita income, public health expertise, and risk factors. The two countries are Canada and Germany.
By 2023, as the pandemic wound down, the United States had suffered almost twice the per capita death rate of Germany and almost three times that of Canada. McNeil attributes this to poor leadership. He notes that "German chancellor Angela Merkel and Canadian prime minister Justin Trudeau took the threat seriously from day one and worked hard to get their populations to accept social distancing, business closures, and masks." However, in the United States, "We had denialism, finger-pointing, and polarization, much of it coming from the top."
Angela Merkel
Justin Trudeau
Another recent pandemic, less well known, is the monkeypox (Mpox) outbreak that lasted from spring 2022 to spring 2023. The illness affects gay men, and though it's not usually lethal, Mpox can result in intense pain, secondary infections, and scars.
McNeil observes, "One would imagine that, having just survived [the Covid] pandemic....we would have reacted judiciously to the new one.....since we already had two vaccines that could stop [Mpox]." Instead our response was disappointingly slow - this time because Mpox was a 'gay disease.'
Patient with Mpox
McNeil writes, "[The CDC's] chief concern seemed to be to damp down alarm and to avoid stigmatizing gay men by avoiding any mention of the fact that almost all the new victims were male and gay." In short, the authorities feared they'd be accused of gay bashing. McNeil feels it's imperative that public health leaders "get over their squeamishness and fears of criticism; they must directly address whoever is at highest risk and counsel them on how to protect themselves."
At one time, the major factors affecting life on Earth were phenomena like asteroid strikes, volcanic eruptions, atmospheric heating, glaciation, plate tectonics, etc. In prehistoric times, these types of events caused five major extinctions. Now that humans have come to dominate the planet, disease is shaping our destiny. McNeil states, "Pandemics have had more impact than any earthquake or eruption, any new weapon or infantry tactic, any new religion or political system."
Pandemics began with the establishment of human settlements, when people started living in close proximity, farming, and domesticating animals.
Early human settlement
The author notes, "We stored our new abundance of food in granaries, attracting rats, mice, and other disease-spreading rodents. We dug cisterns for fresh water, pits for sewage, and dumps for our food waste. That helped mosquitoes, flies and other disease-spreading insects adopt us as new hosts....We sneezed in each other's faces, defecated in each other's drinking water, and slept with each other's spouses. We opened pathways for animal bacteria, viruses, worms, parasites, and fungi to spread among us."
Most pandemics originate when animals pass their microbes to us; these illnesses are called zoonotic diseases. Zoonotic diseases happen more and more as we invade animals' territories - or get close to them - because of human population growth, deforestation, bushmeat hunting, factory farming, live animal markets (wet markets), and so on.
Unfortunately, new disease threats are evolving all the time; no pandemic will be our last; and what will matter is how intelligently and fast we respond.
🧬 The Human Factors That Spread Pandemics
Once a new disease appears, many factors affect its dissemination and the number of people infected. A major stumbling block for pandemic control is the fact that most pathogens first appear in a small network of similar people. The ideal time to stop the pandemic would be now, at the very beginning, before it spreads.
Pandemics start with a small group of people infected
However, public health officials are in a difficult position because these 'patient zero' networks are often composed of one ethnic or marginalized group - like gay men, the homeless, ultra-Orthodox Jews, or Amish farmers. Thus health officials trumpeting the threat are liable to be accused of bigotry.
McNeil observes that the 'blame' issue comes up in almost every outbreak. The most famous example is syphilis, which first appeared in the army of Charles VIII of France in 1495. The author writes that the French called it the Neapolitan curse; the English, Italians, and Germans called it the French Pox; the Russians called it the Polish disease; the Turks called it the Christian disease; the Japanese called it the Chinese pox; and so on.
Any group can end up being blamed for spreading disease, and in modern times, condemnation has fallen on Jews (measles, polio); Chinese people (bubonic plague); Mexicans (swine flu); homeless people and drug abusers (tuberculosis); college students and Alpine skiers (Covid); and more.
By definition, pandemics don't remain local, and 'superspreader events disperse contagions far and wide. For instance, smallpox has spread during the Hajj (Islamic pilgrimage to Mecca); Covid spread during India's Hindu festival of the Kumbh Mela; and flu spread during World Youth Day (a gathering for young Roman Catholics).
Smallpox spread during the Hajj
Covid spread during India's festival of the Kumbh Mela
The flu spread during World Youth Day
The best way to contain a disease is to identify an outbreak as soon as it starts, and internet 'disease-alert services' report new contagions all the time. McNeil, who's a subscriber, observes, "I see new outbreaks reported from somewhere in the world almost every day.....[though] most are not terribly threatening."
Many outbreaks begin with a pattern of unexplained deaths in remote areas that fly under the radar until the illness reaches a city. For instance, between 1976 and 2012, there were 17 Ebola outbreaks in Africa, none of which killed more than 300 people. In 2014, the virus reached the capitals of Liberia, Sierra Leone, and Guinea, and killed 11,000 victims.
There are a number of disease alert services, such as the Global Outbreak Alert and Response Network; FluTrackers; ProMed and others. Some services are better then others, and all would be more useful if medical personnel and public health officials consulted them regularly.
Another problem with disease control is the (attempted) cover-up. For instance, in 2003 Beijing lied about a SARS (Severe Acute Respiratory Syndrome) outbreak in Guangdong, which eventually infected about 8,000 people in 29 countries; and in 2012, Saudi Arabia covered up a MERS (Middle East Respiratory Syndrome) outbreak, which spread to more than a dozen countries.
SARS outbreak in China
MERS outbreak in Saudi Arabia
McNeil goes on to write about disease spread fueled by denialism - people who think the threat's not real or that it won't happen to them; and fatalism - the refusal to save oneself by getting vaccinated. Fatalism is sometimes connected with religious beliefs. For instance, some Muslims denied the polio vaccine, leaving their fate in Allah's hands; and in India, devout Hindus refused smallpox vaccine because they feared angering the smallpox goddess Shitala Mara.
The smallpox goddess Shitala Mara
Worse yet, antivaxxers sometimes mount campaigns purely for profit. McNeil opines, "The modern anti-vaccine lobby....portrays itself as a movement of concerned parents but is really an industry underwritten by unscrupulous entrepreneurs." Some antivaxxers profit by selling immune enhancing vitamins; some promote homeopathy, chelation, hyperbaric chambers, etc.; and some sell books and quack cures. Sadly, the antivaxxers cost many lives during the Covid pandemic.
Antivaxxer Larry Cook
🧬 Some Ways to Head Off Future Pandemics
McNeil observes that America's most lethal pandemic in a century, namely Covid, was so bad because no one was in charge. All manner of people weighed in, including the president, directors of various health agencies, the U.S. surgeon general, FDA commissioners, cabinet members, medical professionals, and more. But there was no one 'at the top.'
To defuse future pandemics, the author advocates a clear chain of command; a 'health pentagon'; tougher public health laws; and a better prepared society. McNeil also emphasizes the need to fight global poverty; derail the anti-vaccine lobby; deny religious exemptions for vaccination; and improve surveillance.
The author also supports working with 'witch doctors', who are respected and influential in their cultures; and curtailing civil liberties when they impede disease control. This would include things like mandating masks, enforcing social distancing, shutting businesses, closing borders, curtailing large gatherings, and so on.
Witch doctors are respected and influential in their cultures
Pandemic control might include curtailing people's civil liberties
McNeil has done an immense amount of research and cites myriad examples for his observations and opinions. The narrative is a little repetitive, but anyone interested in epidemics, pandemics, and the fight to stop them would find valuable information in this book.
Rating: 4.5 stars
