Book Review

Contagious: Cultures, Carriers, and the Outbreak Narrative

N Engl J Med 2008; 358:1203-1204March 13, 2008

Article

Contagious: Cultures, Carriers, and the Outbreak Narrative
(A John Hope Franklin Center Book.) By Priscilla Wald. 373 pp., illustrated. Durham, NC, Duke University Press, 2008. $84.95 (cloth); $23.95 (paper). ISBN: 978-0-8223-4128-4 (cloth); 978-0-8223-4153-6 (paper).

Priscilla Wald, a professor of English at Duke University, was motivated to write Contagious by her “conviction that an analysis of how the conventions of the outbreak narrative shape attitudes toward disease emergence and social transformation can lead to more effective, just, and compassionate responses both to a changing world and to the problems of global health and human welfare.” Communicable diseases are indeed a function of social interaction. The outbreaks they cause can lead to fears, anxieties, and the alteration of behaviors and lifestyles. Wald rightly points out that narratives of outbreaks have consequences in an interconnected world, both to the individual person and to the society at large. As stories of outbreaks unfold, they affect routes of transmission and rates of survival. They also promote or mitigate stigmatization of infected persons, change behaviors, and affect economies. We do not have to look too far back in history to witness all these effects — they were evident during the outbreak of severe acute respiratory syndrome (SARS) in 2003.

Wald aptly illustrates how the description of a “superspreader” — someone who infects a large number of people — in images and storylines affects social interactions and practices, enabling societies and persons to reduce morbidity and mortality from communicable diseases. This is exemplified in the case of “Typhoid Mary,” which Wald considers a narrative legacy; in the case of “Patient Zero” in the AIDS pandemic, which she describes as an outbreak that was never contained; and more recently in the SARS outbreak. The public health story of “Typhoid Mary” indeed fashioned social and individual responsibilities from the lessons of bacteriology and evolved a culture of hygiene as a measure for the prevention of disease.

Wald describes how the circulation of ideas and attitudes about contagious diseases led people to form social groups and eventually social cultures. Her book is filled with an exceptionally thorough review of varied pieces of information from journalism and films, as well as from real-life scientific events, that will help readers glean perspectives of how disease and outbreak narratives can shape the way people think about their societies and how they relate to others in the face of danger and infection risks. She also shows how social contagion was interestingly shaped by Sir Arthur Conan Doyle's detective stories and by science fiction stories of brainwashing and body snatchers.

With the threat of avian influenza looming on the horizon, Wald writes that there are valuable lessons from the past that we can draw on. Although the importance of pandemic flu preparedness cannot be underestimated, there is also a need to warn of the danger of a panic. A pandemic will inevitably affect populations in different parts of the world inequitably. Wald concludes in her book that “emerging stories can exacerbate or begin to address the inequities.” Studies have shown that the level of education about a disease in a society can greatly affect the final size of the outbreak of that disease. It is therefore crucial that those who are involved in the production of outbreak narratives be exceptionally mindful about where, when, and how the stories are told — they will significantly affect the lives of those who hear them. In our interconnected and borderless world, outbreak narratives can endanger or save us.

Suok Kai Chew, M.B., B.S., M.Sc.
Ministry of Health, 169854 Singapore