CRAWFORD KILIAN
BOOK REVIEW
An American science journalist Sonia Shah has published earlier books on malaria and the testing of pharmaceuticals in poor countries. She must have understood the challenge of her new book, Pandemic: Tracking Contagions, From Cholera to Ebola and Beyond, and what it would take to organise a vast body of research—not only that, but to make that research understandable to a lay audience.
She has succeeded brilliantly. On page one, she describes her flight from Haiti to Florida, delayed because another passenger had come down with cholera just as he took his seat on the plane. By page two, I knew I was in good hands and I was not disappointed by the time I reached the extensive documentation. This is the best single book I have yet read about the disease threats we all face in the 21st century.
Shah builds her book around the backstory of a single disease: cholera. But in explaining it, she takes us on a superbly guided tour of many other diseases. Each may have its own symptoms but all, she argues, rely on humans to spread them.
Vibrio cholera was an unassuming marine bacterium, minding its own business in warm coastal waters, until the British East India Company occupied and developed the coast of what is now Bangladesh in the late 18th century. By turning the wetlands into farmlands, the British disturbed the local ecosystem and brought humans into much closer contact with Vibrio cholera.
Once cholera got into human beings, it quickly learned how to destroy other bacteria in the human gut by producing a toxin that would flush everything else out. Typically humans would dehydrate and die in hours, but their excrement would spread cholera to their caregivers and the local water supply.
India's first cholera outbreak was in 1817. Newfangled steamboats carried it to Europe within a few years, and then to the Americas. People died in millions.
We are now a quarter-century into the seventh cholera pandemic, which began in South America in the 1990s and climaxed in the imported catastrophe of cholera in Haiti, which has killed 10,000 people since 2010.
Similarly, other diseases have emerged as we pushed the interface between wilderness and ourselves, and as our very success crowded more of us together.
HIV/Aids emerged from the exploitation of central Africa's forests and spread worldwide by air travel. And many of South China's millions make their living off pigs, poultry, and occasional wild animals; those in turn have given us countless strains of bird flu as well as SARS.
Human prosperity is part of the problem. As China opened up to international trade, millions with money in their pockets began to demand more meat—pork, fowl, and wild animals. Chinese farms produced more livestock to meet the demand, and wild animals were hunted for the menus of ''wild taste'' restaurants. The result was the eruption of new bird flus, starting with H5N1 in Hong Kong in 1997. Then SARS emerged from ''wild taste'' restaurants.
Just as steamships carried cholera from Europe to the Americas, affordable air travel has spread these new diseases. SARS hopped from a Hong Kong hotel to Vancouver and Toronto in a matter of hours. British schoolgirls on holiday in Mexico in 2009 brought H1N1 pandemic flu home as a souvenir. A young Alberta nurse, returning from a holiday in Beijing in Dec. 2013, died of H5N1 in her own Red Deer hospital a few days later.
Medical tourism compounds the problem: Many people travel to countries like India for cut-rate surgery and come home with more problems. Since 2008, Shah points out, such tourists in New Delhi have been picking up NDM-1, a fragment of DNA that can move between bacteria and endow them with superpowers of resistance to antibiotics. Western hospitals are already struggling to suppress bugs like ''methicillin-resistant Staphylococcus aureus'' (MRSA) and E. coli. If NDM-1 really spreads, we will find ourselves back in the pre-antibiotic 19th century.
Shah notes the cooperation of governments in spreading diseases. Italy suppressed news of a cholera outbreak in 1911, just before the 50th anniversary celebrations of the country's unification. Spanish influenza got its name because only Spain, a neutral country, reported cases of the new flu. The combatants censored all reports; the Americans rushed more troops to Europe in crowded conditions that ensured still more cases.
More recent governments have done the same thing: Indonesia refused to report human H5N1 cases for a long time, China was silent on SARS for months, and Saudi Arabia has released almost no data on Middle East respiratory syndrome, which tends to spread in Saudi hospitals. Even the World Health Organization was reluctant to mention Ebola at first, fearing the economic impact on West Africa's economies.
Shah makes it clear that pandemics are largely our own damn fault. We clear-cut forests, use our rivers as sewers, insist on flying cheaply wherever we please, underfund our healthcare systems, and misuse medical advances such as antibiotics. We even have to be reminded to wash our hands.
Worse yet, we seem unable to think outside our own culture. West Africans encouraged the spread of Ebola by the custom of bathing and kissing their dead before burial. That showed love and respect. Our own culture expects sanitation as a matter of course, but then tolerates undrinkable water in Canada's First Nations and actually imposes lead poisoning on the people of Flint, Michigan, as a cost-saving measure.
Sonia Shah's Pandemic shows that it is indeed possible to step out of our culture and see how it may be our own worst enemy. If we ignore her warning, we'll have only ourselves to blame for the consequences.
(Originally published in The Tyee online newspaper)