BOOK REVIEW

Preventing the Next Pandemic, by Peter J. Hotez

By Alec Pruchnicki, MD

The last time I reviewed a book by Peter Hotez it was for a publication done in 2023 just after the Covid pandemic abated (The Rise of Deadly Anti-Science, Village View, Sept. 2025). This present review is for one released in 2021 when we were still in the middle of the pandemic. But the predictions he made were prescient and are still relevant today.

Dr. Hotez’s main expertise is in tropical diseases and vaccination treatments for them but this book includes a wider range of options for disease control and prevention. He starts by describing himself as engaging in vaccine diplomacy. This involves going to numerous countries, most of them economically undeveloped, and building alliances with local governments, health agencies, institutions, and individual leaders in public health policies. Before his own work there was cooperation between the United States and the Soviet Union during the 1950s to develop a polio vaccine, even though it was during the height of the Cold War between those countries.

This example of cooperation didn’t start the international approach to disease prevention and control. He describes the history of smallpox prevention starting with Edward Jenner in the 1700s that spread around the world (including the Continental Army under George Washington), the international cooperation under the guidance of the United Nation and the World Health Organization, and the official eradication of smallpox from the face of the earth by 1980. He describes international cooperation of this type as essential in dealing with diseases that are internation and jump border lines easily.

He enumerates many of the common and rare diseases that medicine combats. Some of these are spread by person to person contact like measles, tuberculosis, and Covid. Others are spread by insect vectors like malaria from mosquito bites. Many parasitic diseases, especially in warm climates, are spread by unclean water and food. Some of these diseases can be combatted with vaccines, and some with public health measures like water treatments and food inspection standards. Results are variable but in almost all cases these approaches improve health, if not completely eliminate the underlying illness.

But along with the range of diseases that nature produces, there are complications in both the prevalence and treatment of disease brought about by human activity. This had been described as Anthropocene complications and some historians of science believe the present times should be described as the Anthropocene epoch. He focuses on five of these trends; war, global warming, poverty, urbanization, and nationalism.

Outright wars, or political instability resulting in widespread violence and destruction, have several effects above the killing of populations. Medical institutions and health care distribution systems are often damaged or destroyed both intentionally and inadvertently. Food production can be harmed with resulting public health deterioration. Refugees from fighting or occupation can easily cause local outbreaks of infectious diseases to be spread more widely, sometimes to combatants, sometimes to civilians. He gives detailed accounts of wars in Africa and the Middle East, along with political instability in South America, and how they destabilized the provision of health care and the prevention of disease.

Global warming, sometimes euphemistically described as climate change, can make disease caused by vectors to increase. Some of these are insect born diseases and some are water born diseases if water treatment is inadequate. He predicted that warming would increase insect distribution even to developed countries that were free from tropical illnesses and these insects would bring their diseases, such as malaria and dengue fever, to larger areas of the United States, among other nations.

Throughout history, plagues have often been worse in cities where populations are dense and person to person spread is easy. Over the last century urbanization has increased steadily and this trend is continuing. This problem is worsened when the economy of the country is poor and normal health care systems, including sanitation and water purification, cannot expand as rapidly as the urban population does.

Poverty and disease are closely linked for many reasons. Besides lack of access to health care services, there are additional problems with lack of proper nutrition, water contamination, housing, and just overall population density. These problems aren’t just for underdeveloped nations but also for developed countries which have pockets of poverty within them.

Sometimes international cooperation to fight disease is complicated by nationalism. The belief that your own nation is somehow exceptional can lead to the belief that it needs no help when dealing with a health care problem, even if the health care problem can easily jump over national boundaries. He cites the first Trump administration’s withdraw from the World Health Organization (temporarily blocked by Biden but recently repeated) and the Brexit withdraw of Great Britain from the European Union. The lack of cooperation in policies and planning is worsened by the fact that health care professionals are often foreign born and not easily replaced by the home-grown supply.

One topic he touches on briefly in this book, and in more detail in the other book cited above, is the anti-vax and sometimes anti-science beliefs of some segments of the population in developed countries where resources for health care are available but rejected for political, philosophical, or religious reasons. He predicted that the outbreak of measles in a religious community in Brooklyn could be repeated in other insular areas, and that is what happened in the measles outbreak in West Texas last year.

To address all these problems, he has a variety of solutions. One goal is to increase international cooperation like what he described in a variety of examples throughout the world in which he was personally involved. He gives examples of new international consortiums that have developed recently and can expand in the future. He advocates for more education of the public in health literacy but also more advocacy by normally apolitical scientists and health care providers. He uses his own experience in public speaking, media involvement, and book writing, like this one, directed to the general population.

Will this work? One thing he doesn’t do much of is to predict the severity of the “next pandemic.” It is reasonable to predict that more local epidemics and global pandemics will occur at some undefined time in the future, but it is more difficult to predict their severity.

Throughout history there have been pandemics much worse than Covid and there is no reason they can’t recur. That is the topic for another article. A very scary article.