Ali S. Khan has written a fascinating book that offers unique insight into how the world's public health community has responded to outbreaks of the most dangerous infectious diseases over the past 25 years. Charting his experiences throughout the world—from conflict zones in Zaire, federal buildings under quarantine in Washington DC and luxury hotels in Singapore—his largely autobiographical book paints a vivid picture of the people, places and politics that have shaped some of the most important public health events through his career. Mixing his masterfully told first-hand accounts with expert descriptions of disease characteristics, Khan lays bare the complexities that frame how epidemiologists track down unfolding contagions. At a time when the threat of infectious diseases remains high on the political agenda, Khan takes an original look at how the nature of tackling disease outbreaks has evolved throughout history and what the main challenges facing the prevention of future health emergencies are.
One of the major strengths of this book is Khan's ability to demonstrate that the threat of an infectious disease anywhere is a threat of an infectious disease everywhere. From the very first chapter, his clear argument that ‘no country can afford to isolate its public health system’ (p. 25) rings true. For instance, Khan describes how a strain of swine flu that resulted in the deaths of more than 2,000 people in India was also the cause of cases seen in multiple states across the United States and Canada. Likewise, the author explains how ‘the right mosquito, and the right bird … combining to create the right enzoonotic cycle’ (p. 149) gave rise to the outbreak of West Nile virus in the Middle East, North America and Africa. While the book contains repeated warnings of the insufficient protection that international borders and geography provide against the spread of infectious diseases, Khan's assertion that a planet-wide approach to ‘protect everybody from many of these emerging diseases’ (p. 164) gives useful insight into how the threat of infectious diseases can be tackled pragmatically and effectively.
Against the backdrop of the recent Ebola outbreak in west Africa and the spread of Zika and Middle East respiratory syndrome-related coronavirus (MERS), much has been written about the potential for certain diseases to give rise to pandemics. However, few have been able to chart how the challenges that epidemiologists faced in responding to outbreaks during the twentieth century have persisted many decades later. This is where Khan has succeeded. The difficulties that he and his colleagues at the US Centers for Disease Control and Prevention have faced—including the payment of bribes to corrupt officials in war zones, the reluctance of national governments to accurately report cases of infectious diseases and managing opposition to recommended travel restrictions—are all areas of contention in today's efforts to contain infectious disease outbreaks. This book puts forward many recommendations for how these challenges can be overcome, but it is the author's arguments for investing in disease preparedness and prevention—and the evidence of the chaos that ensues without it—that strike the loudest tone. For example, Khan's call for the establishment of a United Nations under-secretary for health security and ‘a global fund to help improve health security preparedness internationally’ (p. 257) create a sense that, if heeded, these recommendations (and the others described in the book) will help mitigate the impact that infectious diseases continue to have on societies across the world.
This remarkable book is at times thrilling, at other times informative, all the while giving readers a unique look into the life's work of a visionary epidemiologist and it offers them a clear understanding of the issues underpinning the threat of diseases with pandemic potential.