Cover image of "Pandemic," a book about the history of contagious disease

To judge from the over the top rhetoric on display among the Republican candidates in the 2016 Presidential primary campaign, many millions of Americans live in abject fear of immigration, terrorism, and having their guns taken away. It’s true there are genuine reasons to fear that our lives, our livelihoods, and our lifestyles might be disrupted in the near future. But they have nothing to do with immigration, terrorism, or hunting rifles.

Any logical, clear headed look at the world around us reveals that the true threats on the horizon include climate change, nuclear holocaust, pandemics, and, at a higher level of logical abstraction, rampant consumerism. However, the most immediate of these threats to our civilization is clearly contagious disease, as the COVID-19 pandemic of 2019-21 has made abundantly clear. But in Pandemic, published before the outbreak, Sonia Shah ranges far afield, surveying the past, present, and future of infectious disease. Just so it’s clear: she’s not writing about simple colds and mild flus, but about illnesses that might kill tens or hundreds of millions of people with little warning and with unpredictable consequences for the cohesion of society. The heart of the problem, as she explains, is that “epidemics grow exponentially while our ability to respond proceeds linearly, at best.”

Pandemic: Tracking Contagions from Cholera to Ebola and Beyond by Sonia Shah (2016) 290 pages ★★★★★

A balanced view of contagious disease

Thanks to alarmist reporting, Americans are terrified that hemorrhagic diseases such as Ebola will “break out” and kill us by the millions. Shah patiently explains that much more common diseases are far more likely to pose threats to us, influenza and cholera in particular. A series of unfortunate mutations in either one could fashion a disease that is not just virulent (contagious) but also highly lethal.

Today, for example, flu kills only a small proportion of its victims. We tend to regard it more as a nuisance for most of us, a threat only to those who are most vulnerable. However, the “Spanish flu” (the H1N1 virus) that broke out in the final days of World War I infected up to 500 million people (between a fifth and a third of the world’s population) and killed between 50 and 100 million. Epidemiologists live in fear that H1N1 or one of the countless other varieties of flu incubating in Southern China could put on a repeat performance — or worse. Cholera poses a similar threat.

Sanitation, Hippocratic medicine, and Christianity

One of the most fascinating passages in Pandemic is Shah’s account of the role of Christianity in fostering infectious disease for more than a thousand years.

History shows us that two thousand years ago the Romans piped clean drinking water to their cities through an elaborate system of aqueducts and made public baths available to one and all. Cleanliness was a virtue to them. That all began to change with the advent of Christianity a few centuries into the Common Era. Unlike the Jews and (later) the Muslims,  Christian clergy disdained personal hygiene, associating it with Roman polytheism and viewing cleanliness as superstitious. It was common for Catholic priests and the Protestant pastors who succeeded them in some parts to discourage their flocks from bathing. For many centuries, the vast majority of people in Christian lands lived side-by-side with their animals atop pits filled with excrement and cooked with smelly water drawn from contaminated streams or wells.

Medicine only started becoming a science in the 19th century

When disease struck, as it did with increasing frequency as population grew and gravitated toward the cities, the physicians who purported to combat it were in the thrall of the Hippocratic school of medicine, which attributed all disease to an imbalance in the four “humors” within the body and in external factors that exacerbated it. For example, cholera, which sickened hundreds of millions through the centuries and killed half of them, was blamed on the inhalation of what the ancient physician Galen termed “miasmas” (offensive smells). The nineteenth-century physicians who practiced medical “science” based on these beliefs “increased [cholera’s] death toll from 50 to 70 percent.” Though the germ theory of disease was first proposed in the sixteenth century, it wasn’t until three centuries later, on the cusp of the twentieth century, that practicing physicians began to accept the role of microorganisms in causing disease.

Meanwhile, progress toward improved sanitation and the availability of clean drinking water was even slower. As Shah explains in chilling detail, the construction of London’s sewer system was not prompted because public health officials understood that water used for drinking and washing was dangerously contaminated. The reason they proposed the effort was that they thought it was essential to pipe all the smelly sewage into the Thames, the source of the city’s drinking water! Only in the twentieth century did it become common for municipalities to regard drinkable water as a necessity of life.

Why is contagious disease more of a threat today than ever before?

In Pandemic, Shah describes the role of contemporary trends in making the threat of epidemic disease greater than ever. Five stand out: climate change, continuing urbanization, ever more accessible global transportation, resistance to vaccines, and the encroachment of development on previously virgin lands, especially in sub-Saharan Africa, South and Southeast Asia, and the Amazon. The result is that an increasing number of unknown and unpredictable new tropical diseases is emerging and making their way into more and more crowded cities further and further north on the globe. All the while, diseases previously thought conquered, such as polio and measles, rise up in communities around the globe.

About the author

The daughter of Indian immigrants, Sonia Shah is an American investigative journalist who has reported from around the world, principally on corporate power and gender inequality. Pandemic is her sixth book. Though her parents are both physicians and she lives with a molecular biologist, it appears that the impetus for writing this book came from a painful personal experience with MRSA (methicillin-resistant Staphylococcus aureus), which she contracted from her son. Shah describes her eye-opening experience at length in Pandemic.

For more great reading

I’ve reviewed three other books about epidemiology:

And you can find a list of books on related topics at Books about epidemic disease and the COVID-19 pandemic.

This is one of the books I’ve included in my post, Gaining a global perspective on the world around us. It’s also one of 20 good nonfiction books about the future.

You might also enjoy Science explained in 10 excellent popular books.

And you can always find my most popular reviews, and the most recent ones, on the Home Page.