What is The Coming Plague about?

The Coming Plague, published in 1994, is Laurie Garrett's argument that the era of conquest over infectious disease declared in the 1960s was a dangerous illusion, and that the conditions for catastrophic new pandemics were already in place. The book is enormous — nearly 750 pages — and covers an extraordinary range of outbreaks, pathogens, and public health failures across decades and continents. Garrett was a science journalist and had reported on many of the events she describes; the book reads like sustained investigative journalism with an epidemiological framework underneath.

The central argument is ecological and systemic. Garrett traces how deforestation, urbanization, antibiotic overuse, disrupted ecosystems, collapsing public health infrastructure in developing countries, and the HIV epidemic together created the conditions for new and dangerous pathogens to emerge and spread. She is not predicting a single specific event; she is describing a category of risk that follows from the intersection of these trends. The book was published the same year as The Hot Zone, and together they shaped a decade of public conversation about infectious disease risk.

Garrett devotes extensive attention to specific outbreaks: Ebola in Zaire, Lassa fever in Nigeria and Sierra Leone, Hantavirus pulmonary syndrome in the American Southwest, the resurgence of cholera in Latin America, and drug-resistant tuberculosis. Each chapter is dense with epidemiological detail, including the kind of fieldwork specifics — what the health workers were wearing, what the hospital conditions were, what the political pressures on public health officials looked like — that give the book its texture. She is consistently attentive to the institutional and political obstacles to effective response.

The most prophetic sections concern antibiotic resistance. Garrett argues at length that the combination of agricultural antibiotic use, overprescription in human medicine, and the economic disincentives to develop new antibiotics had created a trajectory toward untreatable bacterial infections. Three decades later, antimicrobial resistance is a recognized global health crisis and Garrett's analysis looks more accurate than prescient. The Coming Plague is long and dense enough that many readers will use it as a reference rather than reading cover to cover, but it rewards serious engagement.