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by Caitlin Burke

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Virus Hunter is the latest killer virus book and, like Frank Ryan's Virus X: Tracking the New Killer Plagues out of the Present and into the Future, it marks the shift in popular virus books from Ebola to the Four Corners-Meurto Canyon-Sin Nombre hantavirus, which broke out on the Navajo reservation in 1993. C.J. Peters had recently arrived in the Centers for Disease Control to take the chiefship of Special Pathogens when Sin Nombre broke out, and while Ebola's stories are retold in this volume, too, Virus Hunter has an agenda at once more personal and more institutional than other books in this area. Part memoir, part critique, C.J. Peters offers a highly readable and appealing book, tracing the career of a man who truly loves his work and wants it to succeed.

Readers of The Hot Zone, by Richard Preston, will remember Peters as the tough-talking Army colonel who took a crew of space-suited animal handlers into the Hazelton monkey facility to kill hundreds of "Ebola-infected" monkeys and then "nuke" the building. Readers of Virus Hunter may not even recognize the author as that same swaggering figure, although the Peters's diction and word choice is casual and sometimes even profane. What was an almost stereotypical military stance in Preston's book becomes down-to-earth talk about "pucker factor" and just how scary hemorrhagic fevers can be. Which spin is harder? Preston's lurid best-seller or the memoir of a physician who was a major participant in a colorful public health turf war? Peters's book, like Level 4: Virus Hunters of the CDC, sometimes reads like a rebuttal of The Hot Zone, but in a lower-profile way, retelling the story without the tabloid fodder of Preston's literary devices but also without the specific exception-taking of Level 4. And like McCormick and Fisher-Hoch, Peters is gracious about the musical chairs that brought him into McCormick's job so soon after Reston.

The vast majority of the drama of the Reston incident lay in the potential for a Yambuku in Washington DC, and Peters's account of it begs several questions. He notes that he and McCormick agreed that there should be no attempt at quarantine during the Reston crisis -- "It simply doesn't happen as in the movie Outbreak, which some mistakenly thought was based on the Reston drama." -- and yet when a crew member of his became ill, Peters wanted to quarantine him immediately. And in spite of the fact that Hazelton staff had been in the rooms with monkeys with "airborne Ebola" repeatedly over the substantial periods of time, it didn't seem to occur to anyone to test the facility workers for Ebola antibodies for over a year after the initial Reston incident. (Many were positive for antibodies, but no human has been known to become ill from the simian filovirus that killed the Hazelton animals.)

A huge proportion of macaques carry a simian herpesvirus that is extremely dangerous to humans, and so a high degree of human protection used in killing the monkeys at Hazelton was warranted, Ebola or no Ebola, but even the most circumspect description of Reston incident shows this was no sterling example of institutional cooperation. As Peters himself notes, "We'd spent years hunting this thing, and I'd be goddamned if I was going to turn the entire operation over to Joe or some folks in Atlanta, many of whom I'd never met, who'd have to start from scratch." One wonders if a higher degree of cooperation might have enabled an earlier determination that while Ebola Reston was bad for monkeys, it wasn't a human health disaster just waiting to happen.

C.J. Peters has had a long and rambling career in virology, moving from Johns Hopkins to Panama to San Diego to Maryland and finally to the CDC in Atlanta. The trigger for most of these moves has been money, and the vagaries of research funding is a major theme of Virus Hunter. Reduction in funding for areas of research or for specific programs creates concern for Peters on a larger level as well. Although full of praise for the excellent cooperation of agencies involved in the Sin Nombre epidemic, Peters notes that the U.S. Army had recently stopped funding research that might have been able to prevent the outbreak in the first place. Peters points briefly to "monoculture" as creating a vulnerability to disease, whether it's dense populations of humans or breeding-altered plants and animals (the argument is considered in more detail in Christopher Wills's Yellow Fever, Black Goddess: The Coevolution of People and Plagues). And Peters warns that just as the development of cities enabled the amplification of disease to new levels early in human history, the development of megacities may create opportunities for viruses to cause suffering on a scale unimagined since the flu pandemic of 1918 or even the Great Plague.

For Peters, the answer is more research, particularly in virology, and a willingness to use even speculative tests or procedures if they result in a very high level of clinical care as well as a contribution to knowledge. Which brings the funding theme full circle. Reduced funding in research is a problem, as is the low level of healthcare funding in developing countries, which desperately need better treatments for a vast array of infectious diseases -- and better preventive measures such as improved nutrition and clean water. These are weighty issues, and Peters can only refer to them in the most telegraphic fashion in the last few pages of his book, but he throws in a criticism of health maintenance organizations and managed care as well, basically making a reluctance to spend money the cause of certain doom. Preventive medicine is expensive, as many HMOs have demonstrated, but it would be nice to see a more substantive critique of the U.S. healthcare reimbursement "system" than just a few jabs at the whipping boy du jour; after all, traditional health insurance plans are covering less and less, too, and there is a growing socioeconomic class -- the working poor -- that can't even look forward to cost-conscious HMO care.

Overall, Virus Hunter: Thirty Years of Battling Hot Viruses Around the World is an appealing and engaging book, written in a highly accessible and personable voice. Stories from epidemiologists in the field are inherently interesting, and although the concluding chapter tries to do too much, Peters's perspective and particularly his philosophy are clear and consistent. He does a particularly nice job of describing dire circumstances in rational language. Beyond the bugs, Peters treats funding issues with respect for their serious ramifications for the extent and quality of medical care at home and abroad. Peters has undergone more than one major change in the focus and environment of his work as a result of funding issues alone, and by weaving those institutional pressures into his narrative, he nicely matches stories of some of the most exotic disorders recognized today with larger issues that affect the U.S. population more directly.

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