The Coming Plague: Newly Emerging Diseases in a World Out of Balance

by Laurie Garrett
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The Coming Plague Analysis

  • The Coming Plague was published at a time when the public was particularly receptive to information about epidemics, given the recent proliferations of AIDS and Ebola.
  • Garrett employs literary techniques to render her historical account more evocative and compelling. These techniques include imagery, metaphor, and the inclusion of individual accounts. The latter technique allows readers to understand the impacts of epidemics at an individual level.
  • Although certain aspects of Garret's book are outdated, many of the trends and lessons she presents remain valid decades after its publication. Humans still have much to learn about how to prevent deadly outbreaks.

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Last Updated on April 24, 2020, by eNotes Editorial. Word Count: 787

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In The Coming Plague, Laurie Garrett argues from a public-health and journalistic perspective that humans are unprepared for the emergence of deadly new microbial infections. A quarter century after the book’s publication, some of Garrett’s predictions and medical data are outdated (such as communication methods in the pre-Internet age), but the book’s thesis remains relevant, and its historical examples of epidemic spread and response remain compelling.

The Coming Plague was published in 1994, on the cusp of the Internet age and a mere three years after the dissolution of the Soviet Union. The same year, Richard Preston’s The Hot Zone had become a bestselling account of deadly viral outbreaks. A film version of Preston’s book was released in 1995, coinciding with an epidemic of Ebola virus in Zaire (now the Democratic Republic of the Congo). While Ebola captured headlines temporarily, the emergence of HIV/AIDS had claimed more lives and required a national response in the United States. In 1987, Ronald Reagan formed the Presidential Commission on the HIV Epidemic. In 1996, Bill Clinton would develop a National AIDS Strategy.

In this receptive environment, Garrett’s work of popular science became a New York Times bestseller. With a background in both journalism and public health, she was able to translate complex scientific concepts for a general readership. Rather than merely presenting a dry account of statistics, she uses individual cases from first-person perspectives to draw in readers. The book’s first chapter, for example, begins in the viewpoint of the deathly-ill Karl Johnson, one of the physicians who eventually solved the mystery of the nature and transmission of Bolivia hemorrhagic fever. By placing readers in his viewpoint to witness first-hand the horrifying symptoms of illness, Garrett leads readers to understand the human impact of an epidemic—and what is at stake if it is not stopped. Other chapters begin similarly, bringing in human stories to deepen the topic at hand.

Garrett often uses rich figures of speech to engage readers. In describing the arrival of medical personnel in Bolivia, she writes, “like a tired old condor, the bomber circled La Paz slowly several times.” When a contingent of investigators reached Yambuku, an area of Zaire ravaged by Ebola, they “immediately felt the sad silence of the place.” She includes personal details on the medical personnel she calls “disease detectives,” including Karl Johnson’s adventurous and cantankerous personality and Uwe Brinkmann’s political fears and bohemian dress. Those who grow ill are also rendered as individual humans, such as early AIDS patient Greggory Howard, whose struggles and idiosyncrasies Garrett renders on the page.

These literary choices enrich Garrett’s central purpose: to tell an exhaustive history of epidemic disease outbreaks from the 1960s to the early 1990s. Garrett documents her sources in great detail, incorporating political and economic trends and cultural traditions relevant to the wider narrative. Without understanding the war between Tanzania and Uganda in 1979, one cannot understand how economic devastation, refugee movement, and famine contributed to the emergence of epidemic disease. Health inequity and disparity, too, is a major consideration. Diseases that emerge in poor countries are able to spread due to a lack of infrastructure for treatment. Alternatively, diseases that emerge in wealthier countries may develop resistance by the time they make their way to less-developed parts of the world. Health is a human right, as Garrett repeatedly asserts, and it is attained by some at the expense of others.

Interspersed in the accounts of outbreaks are asides that illuminate the dynamics of the diseases in question: processes of microbe mutation, the history of human urbanization, the development of gay culture in the United States, and rising rates of addiction to injectable drugs. Garrett presents the emergence of AIDS—first a mysterious new illness attacking only stigmatized groups, ultimately an epidemic with roots on three continents—as the inevitable result of trends presented in earlier chapters. A world that responds inconsistently and inequitably to disease outbreaks provides opportunities for new ones to emerge. “HIV, far from representing a public health aberration, may be a sign of things to come,” Garrett explains. “Humanity has learned little about preparedness and response to new microbes.”

As philosopher George Santayana observed, “those who cannot remember the past are condemned to repeat it.” Garrett provides plentiful examples of failed responses to epidemics in the latter half of the twentieth century, from the squandered opportunity of antibiotics (now increasingly ineffective against resistant bacteria) to the botched political response to Swine Flu that left American taxpayers, not vaccine producers, liable for ill effects. In a world still grappling with epidemics and even pandemics, it is clear that the lessons Garrett presents have yet to be fully learned a quarter century later.

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