Book Review

Virus Hunter: Thirty years of battling hot viruses around the world

N Engl J Med 1997; 337:577-578August 21, 1997

Article

Virus Hunter: Thirty years of battling hot viruses around the world
By C.J. Peters, with Mark Olshaker. 323 pp., illustrated. New York, Anchor Books, 1997. $23.95. ISBN: 0-385-48557-3

In his celebrated Microbe Hunters, published in 1926 (New York: Harcourt, Brace), bacteriologist-turned-novelist Paul de Kruif defined scientists who risk their lives by stalking deadly infectious agents as heroes. Colonel C.J. Peters would turn down the label of hero. Although “made more for sport shirts, blue jeans and sandals” than for a military uniform, he would simply describe himself as a good soldier telling the galvanizing but balanced account of his lifetime commitment to science, without indulging in romanticism or self-celebration. Virus Hunter is not merely the exhilarating tale of three decades of scientific research. It is also an outspoken, comprehensive analysis of the political and human issues that front-line scientists fighting outbreaks of hemorrhagic fever deal with daily. From the Sin Nombre hantavirus responsible for the Four Corners epidemics, to the Machupo virus hitting the Bolivian highlands, all the way down to the Ebola strain that recently devastated Kikwit, Zaire, the impact of hemorrhagic fevers goes far beyond the dramatic clinical picture.

Researchers in the field, as compared with those at the bench, begin their quest like homicide detectives. They inspect the body, conduct interviews, and trace the steps of previous victims, asking themselves, “What if the hoofbeats we are hearing are not from the proverbial horses after all?” In most cases, the few puzzling clues do not fit the medical dogma: the Cochabamba syndrome was slightly different from the one in Machupo, and so was the pattern of Rift Valley fever and the filovirus outbreak in Reston. The field investigator must be able to abandon any hypothesis, no matter how intellectually attractive. The overall feeling is a mixture of fear and exhilaration “typical of those moments in our life when something big is about to happen.”

Without reticence, the author describes the effects of these epidemics on the local population. More than the raw fear of the unknown, it is the often absurd denial of a few people worried about their petty economic interests, the religious taboos, or the political divisions that impede the need to accumulate scientific evidence before it is too late. Above all, it is the deep understanding of different cultures and the respect for local beliefs and customs that keep the investigator's motivation up and frustration at bay.

Then there is the money. Research often means turf wars for shoestring budgets and limited medical resources. Coping with local issues may be difficult if one does not know the culture or the political dynamics, but it is sometimes easier to get the chief of a rural village to understand the value of battling a virus than to persuade the bureaucrats responsible for budgets. Regrettably, a self-limiting outbreak clustered somewhere in the tropical forest may not be a convincing enough argument. To quote Peters's own words in another book, Emerging Viruses, edited by Stephen S. Morse (New York: Oxford University Press, 1993), what money would have been allocated “if a lentivirus had been isolated from a handful of immunosuppressed people in Zaire in the mid-1970's”? Yet there are many examples of modern scourges looming in our own backyard, as exemplified by the Reston epidemics, luckily contained, or the Venezuelan equine encephalopathy, which had to spread from Central America to Texas before being checked. It is disturbing that to obtain proper funding we need to refer to the threats of terrorist organizations and diehard dictators to use infectious agents as weapons.

Peters emphasizes that spending his childhood on a dairy farm helped him shape his “attitude about the roles of animals and human beings in each other's life.” We can trace our manipulation of the Earth's ecosystems back to Genghis Khan, who helped spread the plague to urban areas while laying siege to Feodosiya in the 13th century. The Columbian colonization paved the way for the spread of Aëdes aegypti, vector of the yellow fever virus. Modern traders unwittingly helped the tiger mosquito colonize new areas with a not-so-surprising capability of adaptation. And chaotic urbanization in the absence of sanitary infrastructures is the perfect pabulum for an outbreak. Peters underscores the fact that the largest issue in public health is the deprivation in overcrowded megacities, and that “bugs come second.” Ironically, he chose to study infectious diseases at a time, the early 1960s, when they seemed destined to end because of the large-scale use of antibiotics and mass vaccinations. Nevertheless, the surveillance of emerging viruses remains important. None of the diseases they cause are curable, but they are largely preventable, and serious health problems require serious research.

Francesco Negro, M.D.
University of Geneva Medical School, 1211 Geneva, Switzerland