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

Nonfiction | Book | Adult | Published in 1994

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Summary

Background

Chapter Summaries & Analyses

Introduction-Chapter 3

Chapters 4-8

Chapters 9-12

Chapters 13-17

Key Figures

Themes

Index of Terms

Important Quotes

Essay Topics

Themes

Ecological Perspectives on Microbial Infection

Garrett’s broad picture of humanity’s interactions with bacteria, viruses, and parasites is one of ecological relationship. Human societies in the past considered diseases as something from the outside that occasionally broke in and afflicted populations at various times or places. Garrett, however, portrays diseases as a feature of the balance inherent in our intimate, tightly woven relationship with microbial life. They affect us not as something from outside our experience but as part of our environment on every side (including within our bodies): “The lesson of macroecology was that […] all life forms and chemical systems on earth were intertwined in complex, often invisible ways” (557). In those macroecological environments, we humans are just another organism, like microbes themselves are. In some cases, we exist symbiotically with microbes, while in other cases, they are the predators, and we are the prey.

Existing in an ecological web with microbes, any major change humans enact on the environment or their own behavior will affect the balance of the ecology, forcing other organisms to adapt. This can occur, for instance, when humans take over new habitats by expanding into previously untouched environments like rainforests and marshlands. In doing so, we expose ourselves to microbial life that might be disrupted from its former balance in that habitat. Waterborne parasites will find new hosts in the invading human population, and zoonotic (animal-borne) microbes can spill over from their reservoir species into humans.

Sometimes changes that at first appear relegated to human social patterns alone also carry significant consequences for microbial ecology. To give a few of Garrett’s examples, the rise in frequency of multiple-partner sexual relationships in many societies around the world, habits of reusing syringes for injectable drugs, and increasing rates of global migration in human populations all opened expansive avenues of transmission for microbes. Other human interventions directly affect the ecological balance with microbes, as in the case of antibiotic treatments, which force bacteria to adapt and evolve resistance to the drugs to survive. In that case, human interventions intentionally disrupt the ecology in ways that offer short-term benefits but which also carry long-term consequences since the bacteria will react to the change, adapt, and become harder to deal with in future interactions. Garrett quotes author Mark Lappé as saying, “We have changed the whole face of the earth by the use of antibiotics” (437).

The Effects of Social Factors on Disease Outbreaks

There is a temptation to view disease outbreaks as purely medical events, in which the causes and effects of an outbreak are considered in a reductionistic way, relating only to the biological interactions between the human body and the microbial organism. Garrett, by contrast, examines the complex relationships between human societies and epidemics, considering both the ways in which social arrangements amplify outbreaks and how social responses might help or hinder the scientific efforts to research and treat the new disease.

The Coming Plague examines social features in the mid-to-late 20th century that allow for outbreaks. Primary among these factors are the cycles of poverty that grip many communities in the developing world. As people migrate to cities surrounded by urban slums, populations become denser and often have less access to clean water and waste disposal systems, all of which are factors in spreading disease. The growth in regional conflicts in the 1980s and 1990s also spurred social collapses and mass migrations, which offered new avenues of transmission for microbial infections. These factors, however, were not limited to the developing world. Garrett identifies trends of “thirdworldization” as having affected industrialized countries in the former Soviet sphere, many of which suffered severe economic collapses in the late 1980s and early 1990s, leading to undersupplied and understaffed medical systems. The US, too, experiences cycles of systemic poverty in many urban areas, which mirror the disease-spreading conditions in the urban slums of the global south. Garrett quotes Jim Weill, a speaker at the 1990 World Summit on Children, as saying, “Let’s face it, when it comes to America’s children we live in the third world” (512).

Not only do social factors contribute to the conditions that allow for outbreaks, but they also amplify the outbreak once it has begun. Many people tend to react with panic to the outbreak of a new disease, a response that hinders the disease investigators at every turn, from pilots who refuse them transportation to governments who would rather deny the extent of the problem, thus cutting the researchers off from needed funding and support. Garrett also identifies the discrimination and marginalization of populations affected by disease outbreaks as yet another social factor in their continued spread, as these reactions tend to remove even more access to proper support from the victims and group them together with other vulnerable people. In speaking of the spread of HIV/AIDS, Garret notes that this sort of reactionary, alienating impulse on the part of the wider public formed “a social bridge across which HIV traveled into one society after another” (475).

The Movement from Optimism to Realism

One of the main narrative arcs Garret draws through the stories of the outbreaks is the changing mood among public health officials from the post-World War II era to the end of the 20th century. At the beginning of that period, an attitude of optimism prevailed:

Medicine was viewed as a huge chart depicting disease incidences over time: by the twenty-first century every infectious disease on the chart would have hit zero. Few scientists or physicians of the day doubted that humanity would continue on its linear course of triumphs over the microbes (30).

This sensibility was reinforced when the vaccination campaign against smallpox proved wildly successful, completely eradicating one of humanity’s longtime microbial nemeses. As the decades wore on, however, the victory over smallpox came into focus more as the exception than the rule. Other diseases, like malaria, proved nearly impossible to suppress without causing its resurgence in even more virulent forms, and bacterial infections slowly but steadily gained resistance against every class of antibiotic drugs to which they were exposed.

The same pattern of attitude shifts arose in the burgeoning field of genetic science, which exploded with new knowledge after the discovery of DNA’s structure: “Once again,” Garrett writes, “optimism pervaded biological research. Once again, scientists predicted bold discoveries over everything from cancer to malaria” (222). It was thought that understanding how DNA and RNA work in bacteria and viruses would provide ways for us to find new susceptibilities in their defenses by attacking them in ways that their genomes could not account for. However, researchers discovered that microbes used DNA and RNA in ways that made them a strength, not a weakness. Bacteria, for example, were masters of gathering, manipulating, and switching strands of DNA as part of their defense, using new genetic information when external pressures forced them to adapt. The dizzying complexity of their abilities in this regard left them in a position of advantage relative to humanity’s attempts to attack them. Humans might win short-term gains with the discovery of a new class of antibiotics, but it wouldn’t be long before the bacteria had identified and plugged in new genetic material needed to tip the scales back in their favor. Viruses showed similar capacities, and new viral outbreaks like AIDS showed an impressive array of retroviral genetic techniques hiding from, tricking, and attacking the human immune system.

By the mid-1990s, when The Coming Plague was written, the scientific community had descended from the heights of optimism and was coming to grips with the complex realities facing humanity’s struggle against microbes. Advances in knowledge and new treatment options would not be enough; what would be required is a broader understanding of humanity’s place in the microbial ecology and a keener sense of how not to disturb that ecological balance.