In December 2017, then-ASTMH President Regina Rabinovich calmly read the tea leaves for the coming year. Her first observation—“There will be epidemics…”— became a tag-line for our 2018 meeting. In the meantime, Gina’s unblinking forecast made me wonder just a little harder about the next blight to strike. And the next. The exercise was both useful and disturbing, because it forced me to ponder not only microbes but modern life.
Reading Mark Honigsbaum’s latest book, one learns that looking back at epidemics can be equally useful and disturbing. In The Pandemic Century: One Hundred Years of Panic, Hysteria, and Hubris (W.W. Norton, 2019), the journalist and author-turned-infectious diseases historian not only revisits important global outbreaks but interrogates their social and cultural catalysts and scientific blind spots. The result is an important, riveting, and deeply-researched work that will likely be read for years to come.
Now for my disclosures. As a former history major, I believe that medical scientists in general and tropical medicine specialists in particular ignore history at their peril. Plus I am already Honigsbaum’s fan, having praised his first book—The Fever Trail: In Search of the Cure for Malaria (Farrar, Straus and Giroux, 2002)–in the Los Angeles Times and Scientific American. The Fever Trail chronicled the high-stakes, 19th century search for Cinchona ledgeriana, the elusive tree whose bark yields quinine. Criss-crossing South American jungles and cloud forest, three rivals led the race: Richard Spruce, a hypochondriacal moss collector; Charles Ledger, a cockney fortune-hunter; and Clements Markham, a high-minded geographer. Honigsbaum’s colorful narrative kept me glued to the page as I followed the men and the life-saving alkaloid eventually extracted after cinchona seedlings were transplanted to Dutch plantations on Java. Today, I would still commend The Fever Trail to anyone remotely involved with malaria.
The Pandemic Century, in contrast, is epic in scope, spanning Spanish flu, parrot fever, and plague to Legionnaires Disease and SARS to HIV/AIDS, Ebola, and Zika. Whereas The Fever Trail is a natural history thriller with noir-ish undernotes of commerce and greed, what distinguishes Honigsbaum’s new work is its dogged search for truths that some may find edgy. To what extent do past experiences and faith in technological tools du jour blind us to new ecologies, behaviors, and pathogens still waiting to burst on the stage? the author repeatedly asks, responding with a feast of information from earlier medical infernos. For serious students of the field, this is epidemiology at its richest.
Standing back, one could also liken Honigsbaum’s quest with current efforts to gauge how income, early childhood development, education, employment, housing, gender, and race impact 21st century health. At the same time conceding that “…’nature’ is the greatest bioterrorist of them all,”1 Honigsbaum shows how other byproducts of contemporary life—think roads and transportation; urbanization and crowding; healthcare facilities; religious and ethnic tensions; media; climate change, and the list goes on—have helped to fuel modern pandemics.
Of course, if we’re going to think big about social determinants of pandemics, why not think really big? One of the uber-morals of The Fever Trail is how people and organizations often seek selfish gain over collective good. Remember Charles Markham, the third man in pursuit of the life-giving tree with the cinnamon bark and crimson-lined leaves? His vision (shared by Florence Nightingale, no less) was to right the wrongs inflicted on Britain’s colonial subjects by providing them with better sanitation and low-cost malaria treatment. Sadly, years later, his dream was dashed. Although the worldwide price of quinine had indeed plummeted thanks to Java’s prolific groves of C. ledgeriana, malaria’s toll had not. In Honigsbaum’s words: “There was a limit to philanthropy and … the British had reached it. If any profits were to be made from the bark in the future, they would come from selling quinine to those who could afford it—in other words, ‘rich’ Europeans and Americans.”
The ecologies of human infectious diseases—both those that are stubbornly entrenched and those that go rogue—are multi-layered indeed.
Peiris JSM, Guan Y. Confronting SARS: a view from Hong Kong, Philosophical Transactions of the Royal Society of Biology, 2004.
Frank Honigsbaum, The Division in British Medicine : The Separation of General Practice from Hospital Care, 1911-1968 (London: Kogan Page, 1979) and Health, Happiness And Security: the creation of the National Health Service (London; New York: Routledge, 1989).