Microbe is also a book designed to disrupt our sense of complacency about the public health system in the U.S. It challenges our assumption that the public health system works well, even in the face of widespread disease and even epidemics. The reader encounters example after example of past system failures under even modest stress. A long litany of probable future outbreaks and bioterror events is presented, in a factual and straightforward manner. Having made the case for the need for systematic improvements, the authors propose some practical ways to make those improvements.

Much of the book is dedicated to demonstrating the science and epidemiology of past outbreaks, including chapters on the West Nile virus, SARS, Hantavirus, Creutzfeld–Jakob disease, cholera, cryptosporidiosis, and others. In addition to the science and history of outbreaks for each organism, the successes and failures of the public health early warning systems are described. In most cases, new outbreaks are only slowly recognized, often by single outspoken individuals fighting a disbelieving system. In some cases governmental efforts to avoid panic sidetrack efforts to fight and contain outbreaks, as was the case with China during the recent SARS outbreak. These outbreak reports highlight the serious risks of outbreaks and the still present weaknesses in early detection warning systems.

The reality of bioterrorism attacks with biological agents is also well explored. The use of toxins, pathogenic bacteria, and pathogenic viruses are all described, as is the limited progress in building early detection systems since September 11, 2001. Having read through this material, the reader can only believe such events are probable in the near term future and that our preparedness is still weak.

Microbe is authored by a risk analysis expert and a physician. Both flavors are present in the book, nicely melded into a flowing story. The emphasis is on the science of the biohazards we face in the coming years and the role and realities of the public health system as the prime responder to bioterrorism or natural epidemics.

One limitation of the book is its broad focus. With a different infectious agent in each chapter, the stories can only include a limited amount of detail on each one. To get a deeper appreciation of the impact of a broad epidemic in modern society, this reviewer would encourage readers to also explore a single event in detail. A number of very nice book-length explorations of the 1918 influenza epidemic that killed 20–40 million people have been published recently, and similar works exist for yellow fever, polio, plague, and smallpox outbreaks.

If you want to read a comforting story of the benefits of modern science and medicine, this book isn’t for you. If you want a serious overview of the broad dangers we face from natural and man-made pathogenic organisms, you’ll get your money’s worth from this book. You’ll also find a sobering, real-life evaluation of the current status of the U.S. public health system.