The New Plagues: Pandemics and Poverty in a Globalized World

September 3, 2009

Stefan Kaufmann is both lucky and unlucky. His luck is to be a senior scientist at the Max Planck Institute for Infection Biology in Berlin, situated close to the Luisenstrasse, where in 1880 Robert Koch established a bacteriology laboratory in the Imperial Health Office.

Over the next two years, Koch made significant advancements in medical microbiology, inventing the plate culture method for growing bacteria, establishing the scientific principles underpinning heat sterilisation, discovering the tubercle bacillus, and travelling to Egypt and India in 1883 to discover Vibrio cholerae.

More recent history is relevant, too: in the Max Planck Institute in 1955, Werner Schafer first showed that bird influenza (then called fowl plague) and human influenza were caused by essentially the same virus. He founded the influential German influenza school that has made fundamental discoveries about the evolution of pandemic influenza strains, most presciently, emphasising the importance of pigs as "mixing vessels" in which human, bird and pig influenzas swap genes. Tuberculosis, cholera and influenza, along with HIV and malaria, loom large in Kaufmann's book.

But it is his bad luck that the first influenza pandemic of the 21st century was caused by a virus from pigs, not birds. His account of H5N1 - starting with the high-mortality outbreak in Hong Kong in 1997 - is good. What he says about its pandemic potential is still true, and his treatment of "pandemic panics" is measured, appropriate and timely.

His account echoes that of the official pandemic plans produced in the past few years, in that the notion that a virus from swine (rather than birds) originating in Mexico (rather than South East Asia) and striking at its onset with a mortality rate close to that of seasonal flu (rather than one that is outrageously high) may mean that the next pandemic does not even merit a footnote. So Kaufmann is in good company.

In his favour, this provides striking support for the theme that runs through his book; namely, that new disease-causing microbes appear from time to time. My criticisms are that his account underemphasises the degree to which these novelties continue to take us by surprise, and that it hardly mentions the mechanism by which they usually arise: evolution.

The title of the book accurately reflects its content. It is an authoritative but friendly account for the general reader. Its German orientation makes a refreshing change from the multitude of similar books written for US readers, even if those in the UK will look in vain for accounts of E. coli 0157 and Salmonella enteritidis. I particularly enjoyed the free-standing vignettes printed on pink, not only as a relief from the sometimes rather sombre text, but as good stories describing cases such as TB in lions in South Africa's Kruger National Park.

Accounts describing the rehabilitation of DDT and offering a fair account of Bjorn Lomborg's recent work will court controversy, but in my opinion are spot on. Kaufmann's book is a call to arms. It explains why even enormous sums from the Bill and Melinda Gates Foundation are insufficient to deliver freedom from preventable infections. Pessimism outweighs optimism, perhaps a little more than it should in a production by someone working a stone's throw from Robert-Koch-Platz, but it is a timely and necessary book, nevertheless.

The New Plagues: Pandemics and Poverty in a Globalized World

By Stefan Kaufmann

Haus Publishing

0pp, £9.99

ISBN 9781906598136

Published 1 May 2009

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