A review by archytas
Preventable: The Politics of Pandemics and How to Stop the Next One by Devi Sridhar

informative reflective medium-paced

4.5

I've strongly recommended this book to three people in the week since I have finished it - that's really high for any book, and especially so for a dense non-fiction read I'm well aware won't appeal to most people. It's also high for a book with a very big problem: which is that it was finished in August/September, before Omicron hit, but published well after. This has been addressed in a rather sad Afterward, but it does rather loom over the rest of the narrative. Despite all this, I think this is a book anyone who wants to understand what the hell happened to the world in the last two years should start with.

Refreshingly, Sridhar doesn't make this a polemical book. She has views about what measures would have been best implemented at different times, but one of her main points is that we failed in allowing a reasoned discussion of difference. She details the cost of both the spread of the virus and of lockdowns themselves. This is most upsetting around school attendance - Sridhar covers the huge impact on girls' education globally, for example, with the estimate of 11 million girls who left education altogether and have not returned.

The chapters are organised by geographically and chronologically. The early content focuses on China, then Europe and East Asia, then the global spread. Sridhar takes a deep dive into particular exemplars (Czechoslovakia, Senegal, Kerala are among the most interesting, but also NZ) to show how different responses had different results. At each point she details different points of view, conclusions and where evidence is debated.

The narrative is clinical, but emotions occasionally peak through. Sridhar is angry at Downing Street, covering meticulously how disastrous their early assumptions were. She is deeply worried by China's government, whose early responses could have led to a very different global picture as she shows it. She is disappointed in the absence of global cooperation - which could not only have mediated the impact on the most vulnerable, but was also our main chance of actual eradication of the disease. Much of the narrative is driven by the dynamics of a race - with our health services and governments trying to manage while medical researchers raced to perfect vaccines faster than the virus could mutate to bypass them. She admits in the afterward that ultimately, Omicron - a milder strain but one infectious enough to run rampant in a vaccination population - arrived before the world was vaccinated, ultimately ensuring we will be living with Covid for some time. It is a defeated end - mediated yes, by the fact that our vaccinations have drastically lowered deaths, long term complications and health system impacts - but still one looking at terrible economic, social and health losses, and immense numbers of deaths. She also warns that this will happen again - that our global society, and the destruction of natural habitats for animals, means repeated new infections.

A friend, hearing a radio segment about the book which debated whether the title was true or whether "we are all ultimately virus food" asked me if I was pessimistic. I realised I didn't know which is the pessimistic viewpoint - that this pandemic was preventable but our systems, structures and biases meant we couldn't prevent such a bad outcome, or the "virus food" one. I think in the end, the latter is more comforting and the former more true. 

Ultimately, Sridhar however is focused and concrete. She suggests, for example, that we can't trust our nation-states to act outside of their own domestic political situations. So she advocates strongly for building vaccine and research facilities in Africa and other regions currently without them. Rather than a failed shared vaccine solution, she argues the capacity to produce and vaccinate their own populations must be stood up.  Modelling - which she regards as a major failure during the pandemic - must acknowledge that race and poverty are major indicators of health risk - not just health conditions (and that health workers are largely drawn from highly vulnerable populations). We need diversity in our leadership, and governments can't rely on mathematical models without advisory panels which embody that diversity. And finally, that the impacts of any measures are vastly different between elites and the rest. If we don't face our problems square on, then we will indeed, be virus food.