Risky Trade: Infectious Disease in the Era of Global Trade (review)

Risky Trade offers a thorough, if somewhat fragmented, analysis of the interplay between globalization, trade and travel, and infectious diseases. In addition to the now common observation that the increasingly globalized trade of commodities and travel of people leads to the spread of diseases, the book also describes the indirect ways by which economic globalization leads to ill health. Particularly, Kimball identifies pressures of international competition and dependence on imported commodities as major factors in recent local and international outbreaks.

The book is divided into two parts. In Chapters 1–5, Kimball identifies the various links between globalization and ill health. In Chapters 6–9, she describes and evaluates three possible levels of prevention: primary (preventing a disease from emerging), secondary (preventing a local outbreak), and tertiary (preventing international transmission).

Kimball begins her analysis of the link between globalization and health with a description, in Chapter 2, of how global trade in food contributes to the spread of diseases. The chapter not only discusses the relatively straightforward observation that international trade allows contaminated food to widely spread across the globe, but, more interestingly, the chapter also suggests that competitive pressures of the global market lead to business practices that intensify food safety problems which, in turn, may lead to future epidemics. One such example is farmers’ increased use of antibiotics, including growth enhancers, which may produce drug-resistant strains of microbes. In Chapter 3, Kimball shifts her discussion from trade to the relationship between travel and emerging diseases. The first part of the chapter is devoted to a general discussion of transmission on cruise ships and airplanes, while the second part focuses on two recent examples in which travel has played a major role: SARS and avian flu. Chapter 4, in turn, is devoted to HIV/AIDS. Here, Kimball offers a fresh look, if somewhat limited in its scope, at the disease’s journey across the globe by focusing on transmission through the global blood trade. The second part of the chapter is devoted to BSE (“mad cow disease”). As in previous chapters, Kimball sees global trade pressures as responsible for the emergence and dissemination of both HIV/AIDS and of BSE. In Chapter 5, Kimball shifts, somewhat unexpectedly, to the issue of intentional harm, and discusses bioterrorism (the use of infectious microorganisms to attack humans) and agroterrorism (spoiling crops or livestock, or contaminating food products).

In the second part of the book, each chapter corresponds to one of three possible levels of prevention. In Chapter 6, Kimball deals with the primary level, defined as preventing a disease from emerging, and concludes that there is no way to prevent the emergence of new microbes. We are, therefore, left with the need to prevent local outbreaks and, short of that, the need to prevent international transmission. Here, again, Kimball’s outlook on the odds of success is far from optimistic. Kimball devotes Chapter 7 to the current technology available for identifying outbreaks and their sources, but also identifies gaps in those capacities. The gaps include disparities in different nations’ abilities to detect and respond to outbreaks, and the lack of communication across borders. Finally, in Chapter 8, the author is similarly pessimistic in her discussion of attempts by international organizations — particularly the World Health Organization and the World Trade Organization — to prevent an outbreak from becoming an international pandemic. Here, for the first time in the book, economic considerations meet political domination, with harmful health outcomes.

Risky Trade interestingly locates various intersections between globalization and diseases, and one of the book’s main contributions is the identification of links that are rarely investigated in other accounts. The political-economic analysis, however, is not completely satisfying. Kimball finds increased international competition to be the singular source for any economic, scientific, or organizational change that occurred in the last few decades, and neglects alternative explanatory factors. Domestic political struggles and geopolitical considerations, in particular, are rarely discussed. The book’s strength is the biomedical...