A New Book Asks, Are We Prepared for the Next Contagion?

Lloyd I. Sederer, MD


November 05, 2021

The Contagion Next Time is a book whose very premise may have you wanting to skip ahead to the end. Written by Sandro Galea, MD, PhD, a physician, epidemiologist, and dean and Robert A. Knox Professor at the Boston University School of Public Health, the book offers a four-part treatise on what it will take to prevent the next global health catastrophe.

Galea begins by sharply detailing the complex and entrenched social, racial, economic, and political problems that have persistently produced this country's exorbitant, broken, and inequitable healthcare system. Of course, COVID-19 has served to even more clearly bring these complex problems to the surface, which have long obstructed our ability to achieve the "common good" of health.

In the first three sections, Galea's elegant and scholarly prose provides compelling evidence that more "contagion" — whether infectious or not — awaits our unprepared nation. That he's capable of compressing what would typically take a year-long seminar to cover into fewer than 200 pages is a great lesson for teachers everywhere. It also makes these sections rich sources of detail for the subjects that are germane to you, personally or professionally.

On initial read, the foundational "forces" that Galea identifies may not seem to be directly related to health. These include:

  • Multigenerational poverty, with its scarcity of stable housing, food insecurity, foreclosed educations, and absence of sanitation and clean water to drink;

  • Racial injustice, putting lives in peril while relying on criminal justice solutions for social and economic problems;

  • Economic inequities, deepening the divides between the rich and the poor

  • Partisan politics and political extremism; and

  • The primary pursuit of money (especially in healthcare, for the purposes of this book), frequently eclipsing the common good. 

Nonetheless, these sections clearly illustrate how these forces can destabilize and sometimes ruin our societal institutions, as well as any chance for preventing disease. If left unaddressed, Galea makes a compelling forecast that the "contagion next time" will set the stage for an even more massive disaster than COVID-19.

However, it's the book's fourth and final section, titled "A Science for a Better Health," that truly stands on its own. It wisely portrays methods for actual problem-solving, showing the how and the why. Galea deftly illustrates the give and take of human negotiations that lead to action, urges the need to think and work flexibly in environments rife with complexity and doubt, and offers a rather unexpected ending about the necessity of humility. To Galea, humility is not only a virtue; it is a state of mind. Humility allows for "(knowing) that we don't know what we don't know," as well as not knowing when we are done.

Every one of us (well, maybe not hermits) has been touched by the destructive hand of COVID-19 and the legion of societal problems it has amplified and released. The gravity of this pandemic continues to mount, with so many of us still in its crosshairs and no certain end in sight (I found this out myself when, despite being fully vaccinated and diligent about prevention, I became very ill and required hospitalization for a breakthrough COVID infection). That's the enemy at our gates.

Can you imagine an even more malevolent "contagion next time"? Galea can. But rather than shrink from the terror this concept might produce, he answers the challenge and provides a guide to what we must do to forestall yet another disaster.

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