Book review: ‘Pathogensis’ by Jonathan Kennedy

Kennedy, a sociologist, catapults the reader around the world, through 60,000 years of history, in fewer than 250 pages. The book’s obvious predecessor is William H. McNeill’s 1976 work, “Plagues and Peoples,” to which Kennedy appropriately nods. Kennedy, for his part, wrangles an astonishing breadth of material into easily accessible, plain prose. He challenges us to think big and long about the enduring impacts of infectious-disease outbreaks — “an invisible but devastating weapon of mass destruction” — all in the service of his argument that “plagues that occurred thousands of years ago played a crucial role in shaping the world we now inhabit.”

“Pathogenesis” is organized chronologically, with each chapter representing a different historical period and illuminating how key events of the era were manipulated by microbes. He explains how Neolithic European farmers probably fell to Black Death from Yersinia pestis, allowing the Steppe Herders to move in, bringing wheel, wagon and language with them. Malaria and yellow fever, he writes, “created a defensive force field that made military conquest all but impossible” for Europeans trying to colonize much of sub-Saharan Africa. Gen. Charles Cornwallis’s troops were no match for deadly malaria, and Yorktown was lost — and soon the Revolutionary War for the British. And so on.

Immunity may be exploited, though. “West African labor suddenly became a much more appealing proposition for plantation owners,” Kennedy writes of North American colonies in the late 1600s, because of some Africans’ partial immunity to malaria. According to Kennedy, this led to the emergence of slavery in the South: “In fact, malaria had the biggest impact on the expansion of slavery in counties where labor-intensive crops were grown.”

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Kennedy, who teaches global public health at Queen Mary University of London, writes through a historical lens rather than a biological one. Surprisingly, though, for a book on plagues, he doesn’t dwell on the pathology of individual diseases, sometimes glossing over their symptoms. No deep scientific dissections are needed, but he might have drawn more from the rich bounty of poetry and literature that many of these pathogens have inspired. In the 17th century, for example, John Dryden memorably described the disfiguring marks that gave smallpox its name: “Blisters with pride swell’d, which through’s flesh did sprout / Like rose-buds, stuck i’ th’ lily-skin about.”

Maybe it’s the professor in Kennedy who’s practiced in leading classrooms that motivates him to start many sections with popular cultural references: “The Seventh Seal,” Monty Python, “Game of Thrones.” The resonance of these references will vary from reader to reader. Kennedy’s personal anecdotes can feel still more misplaced — his account of coming across rubberneckers at Stonehenge on his drive to visit his parents isn’t the most compelling way to introduce the famous landmark — but, fortunately, he doesn’t slip into first-person stories often. That said, when he seems to be uncovering the material along with us, we are carried along by his own passionate ride of discovery. The book gathers fiery momentum as it goes, especially from colonial plagues on.

Even readers familiar with the material will find fascinating how Kennedy arrived at some of these revelations. When construction workers were building a new subway stop for the Olympics in Athens in the late 1990s, they unearthed a mass grave of those who rapidly succumbed to a plague, probably typhus or smallpox. Kennedy describes how the upper layers of corpses were strewn much more chaotically, telltale signs of escalating panic as the plague spread, probably affecting the outcome of the Peloponnesian War.

Some of the anecdotes feel especially poignant, as we are all now readers who have lived and lost through a pandemic. A Parliament-appointed committee ignored John Snow, the British doctor who first warned that cholera was waterborne; when he died, his obituary in a leading medical journal made no mention of his research. Kennedy also effectively deploys statistics, which land with aplomb: He notes that the average European would have survived only four months in West Africa in the early 19th century and that “malaria killed eight times more British troops than American guns” during the Revolutionary War.

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Occasionally, the book overreaches, especially when trying to push back against previous works, such as Jared Diamond’s “Guns, Germs, and Steel.” Kennedy writes that Diamond didn’t emphasize germs as much because he wrote the book before the U.S.-led invasion of Afghanistan, which failed despite the Americans’ wealth of resources. But his argument doesn’t quite hold when its expected corollary — the Americans retreated because of a plague — isn’t true.

The last chapter, which takes us almost to the present day, could already use a refresh. Kennedy refers to White, middle-aged, less-educated men falling to drugs, alcohol and suicide — “deaths of despair,” a term coined by the Princeton economists Angus Deaton and Anne Case. Newer research from the same husband-and-wife team suggests that deaths of despair are also rising for Blacks and Hispanics without four-year college degrees, in large part because of fentanyl. It’s also unfortunate for the chapter that China has since lifted its “zero covid” strategy, throwing its health-care system into chaos, which casts Kennedy’s praise of the country’s previous disease control into relief. Still, these lapses are few.

Despite Kennedy’s seemingly demoralizing thesis, his narrative tilts toward hope and empowerment, ending on a call to action to work collaboratively on improving everyone’s basic health care, as we prepare for the (inevitable) next pandemic. Kennedy will leave readers galvanized by the time they flip to the last page, having assured us that we could win the narrative back from germs — if we’re able to muster the political will to do so. “Pathogenesis” puts us in our rightful tiny place in the universe as this great, big — and terrifying, at times — world spins. But, Kennedy reminds us, we are not helpless.

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