Books: Pandemics and plagues

Adam Jenney reviews two books that chart mankind's battle against disease, the times we have won and the times we have not.

Pandemics: What everyone needs to know
Peter Doherty, Oxford University Press (2013) RRP $23.99

The End of Plagues: The global battle against infectious diseases
John Rhodes, Palgrave Macmillan (2013) RRP $29.99

AUSTRALIAN Nobel laureate Peter Doherty wondered whether, being first and foremost a research scientist, he was the right person for the job when Oxford University Press approached him to write about pandemics for its eclectic series “What Everyone Needs To Know”. Would not a public health physician or epidemiologist have been better qualified? He is far too modest and we should be delighted that he took on the task. He has delivered a gem of a book that now sits on the shelf in the “need to know” series between Overfishing and Reproductive Politics.

Doherty tells us the process of writing Pandemics made him work very hard, as the question-and-answer format necessarily took him beyond his usual world of immunology into many adjoining fields. This led him to re-assess several assertions he had accepted over the years, an act of self-reflection that has brought a freshness to his prose as he brings the multi-faceted and shifting world of infectious diseases to a wide audience.

A “pandemic” officially occurs when two or more global regions (as designated by the World Health Organization) experience an outbreak of a disease at the same time and an international response is required. The book covers many of the topics that have made the news in the past couple of decades. Relevant biological, epidemiological and political concepts are explained, and scientific cant illuminated in Q and A diversions.

These include a most clear and pertinent précis of what immunity means, which is no mean feat. At the same time Doherty is not above asking (and then answering) earthier questions such as: “What is snot?”

Having worked on the immunity of influenza for several decades, the “swine flu” (H1N1 influenza) pandemic of 2009 is fertile ground for Doherty’s exploration. With probably 18,000 deaths from more than 50 million infections, this was undoubtedly a global pandemic, but not on the overwhelming scale of the post-World War I Spanish influenza pandemic, which killed more than 40 million. That could lull us into a false sense of complacency, however. It is hard not to be a little alarmed at the prospect of a high mortality respiratory virus, such as SARS or bird flu (H5N1), acquiring the infectivity of swine flu with potentially disastrous results. SARS, for example, caused 33 deaths from 258 known infections in Singapore and bird flu has a staggeringly high mortality rate of 60% but absolute numbers are low, with no human-to-human transmission confirmed as yet. Respiratory viruses are top of the list of infections most likely to graduate to pandemics, especially when, in the normal course of such an illness, a patient can be shedding the virus while flying around the planet.

Such stuff is grist to the mill of the tabloid headline writer, but there is no hysteria here, just facts calmly laid out and some measured advice on preparing for pandemics.Pandemics discusses much more besides: the author writes authoritatively on HIV/AIDS, mosquito-borne viruses (such as West Nile virus), prions that cause mad cow disease and the scourge of antimicrobial resistance (particularly regarding tuberculosis). Doherty, together with Rolf Zinkernagel, received the 1996 Nobel Prize for physiology or medicine for their discoveries on the immune system. In a couple of months a huge new medical research institute will open in Melbourne bearing his name. Fittingly, within it will be the new home for the WHO Regional Collaborating Centre for Influenza, a disease close to the author’s heart and fascinatingly discussed in this book.

The End of Plagues by John Rhodes is the historical tale of vaccination and the extraordinary achievements that have come from its implementation. This is a very clear and well-written description of the eradication of smallpox last century and the hopefully imminent demise of polio as a human pathogen.

Rhodes is an immunologist, but his interest here is in the human stories around the science. He draws us into the life of English country doctor Edward Jenner, a careful observer of life who wrote about cuckoos and hedgehogs as well as many human conditions. Jenner was also brave enough to build on the observation that milkmaids avoided the life-threatening effects of smallpox. He hypothesised that the agent of that protection was cowpox and then conducted an experiment to test this hypothesis.

The polio story pits two vaccines against one another. One of a living but weakened virus, the other dead. He also tells of many strong personalities who similarly clash in the process of developing and promoting these vaccines.

Rhodes delves into the rivalries and politics of it all but doesn’t miss the real point; that the once massive annual summer outbreaks of polio have become a thing of the past. There were fewer than 200 cases worldwide in 2012.

He discusses the difficulties of finishing the job that include finding the remaining vulnerable populations, overcoming the fringe and sometimes violent disapproval of vaccination and maintaining the enthusiasm of the teams of health care workers, often in war zones, charged with the task of eradicating polio.

This is a fascinating book, yet despite its hopeful title the story continues.

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