Let me begin this review by indicating what Preventing the next pandemic: vaccine diplomacy in a time of anti-science, written by Peter Hotez, is not. It is not, despite its title, a strategic, epidemiological, or economic plan to prevent or ameliorate future epidemics and pandemics. Rather, it is in the genre of the 1936 National Book Award winner in nonfiction, An American Doctor's Odyssey: Adventures in 45 Countries, by Victor Heiser, a modern personal odyssey by an inspiring global health warrior. It takes the reader through the worlds of global health, diseases of the impoverished, and their diverse country contexts, into science diplomacy and a towards a vision for a healthier future. Hotez is Dean of the National School of Tropical Medicine and a Professor at Baylor College of Medicine, where he also co-directs of the Texas Children's Center for Vaccine Development. A physician-scientist, he is appreciated as the principal advocate for the 20 infectious diseases he originally designated as neglected tropical diseases (NTDs) and as major champion of vaccines. Recently Hotez has become a well-known avuncular bow-tied science sage and COVID-19 commentator appearing widely on American television.
The basic thesis of the book is that scientific diplomacy, more specifically vaccine diplomacy, is both valuable in preventing infectious diseases and as a bridge to peace between nations. His inspirations were particularly Jonas Salk and Albert Sabin, whose polio vaccine trials in the Soviet Union in the 1950's during the cold war led to some scientific thaw.
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The book begins with a review of the impact of childhood vaccines in saving lives and how many of the major infectious diseases of childhood have been largely controlled—eg, only 3 countries currently report poliomyelitis. By 2015 looked as if polio and measles, like smallpox, might be on the way to global eradication. But since then, outbreaks and epidemics of new and old infectious diseases, including those of NTDs, have increased. Hotez attributes the causes to social, political, and economic changes. The themes of civil wars and “unwars” in the Middle East and Africa that have produced political instability, together with migration and immigration, anti-science and nationalism, poverty and neglect of women, and climate change are framed in terms of their impact on health and specific diseases. Many previously rural diseases such as cholera, malaria, measles, Ebola, and NTDs have moved and adapted to cities, and global warming is moving the locus of many vector-borne diseases. This is a big picture view of the changing world of global infectious diseases.
President Obama's “New Beginning” speech at Cairo University, in Egypt, and his invitation for Hotez to become a science envoy to the Middle East between 2015 and 2016 presented an exciting new opportunity. Aware of the burden of schistosomiasis, leishmaniasis, and trachoma in that area, Hotez tried to build scientific collaborations, particularly addressing these diseases.
The book is an opportunity to describe what NTDs are, why they have re-emerged in many countries, and how they can be controlled. The list of NTDs is long, each is scientifically challenging, each has a particular national or geographic context, all of which are presented in clear non-technical terms in separate chapters on the Middle East, Venezuela and Latin America, and sub-Saharan Africa. One of the appealing, if sometimes disconcerting, leaps made throughout the book is Hotez's consistent linking NTDs in developing countries to their long neglected but significant prevalence within the rich nations of the world, including the USA. The question not addressed is why are they neglected. The likely answer is that while they inflict great suffering, they cause only 1·3% of global deaths.
While Hotez was engaged in vaccine diplomacy, terrorist attacks in Morocco and Tunisia and the proxy war between Saudi Arabia and Iran led, not to a transformational health initiative, but to increased incidence of leishmaniasis reaching 40 million people and the world's largest cholera epidemic in Yemen.
A powerful and very personal section of the book deals with the efforts of Hotez and his Center to create vaccines for hookworm, schistosomiasis, and SARS. His advocacy for these new vaccines and for childhood vaccination provided him with first hand experience of attacks and threats from the anti-vaccine movement. He reveals movingly writing his first book (Vaccines Did Not Cause Rachel's Autism) about the importance of vaccines while having a daughter with autism and the threats posed by the anti-vaxxers.
Hotez' vision for the future is, basically, more vaccine diplomacy. If only non-governmental organisations like CEPI, Gavi, and international collaborations like COVAX, could be mobilized and work together, it might be possible to put an end to many of the diseases that afflict the poorest people in all countries, prevent pandemics, and improve chances for world peace. Alas, the eradication of smallpox did not create world peace, polio vaccines did not end the cold war, and COVID-19 has spurred greater nationalism. But even if vaccine diplomacy is unlikely to lead to world peace, passionate scientists like Hotez will contribute to saving more lives and inspiring the next generation of young scientists and physicians to make similar commitments to global health and equity.