Plagues and the Paradox of Progress

Plagues and the Paradox of Progress

Why the World Is Getting Healthier in Worrisome Ways

By Thomas J. Bollyky

Why the news about the global decline of infectious diseases is not all good.





Why the news about the global decline of infectious diseases is not all good.

Plagues and parasites have played a central role in world affairs, shaping the evolution of the modern state, the growth of cities, and the disparate fortunes of national economies. This book tells that story, but it is not about the resurgence of pestilence. It is the story of its decline. For the first time in recorded history, virus, bacteria, and other infectious diseases are not the leading cause of death or disability in any region of the world. People are living longer, and fewer mothers are giving birth to many children in the hopes that some might survive. And yet, the news is not all good. Recent reductions in infectious disease have not been accompanied by the same improvements in income, job opportunities, and governance that occurred with these changes in wealthier countries decades ago. There have also been unintended consequences. In this book, Thomas Bollyky explores the paradox in our fight against infectious disease: the world is getting healthier in ways that should make us worry.

Bollyky interweaves a grand historical narrative about the rise and fall of plagues in human societies with contemporary case studies of the consequences. Bollyky visits Dhaka—one of the most densely populated places on the planet—to show how low-cost health tools helped enable the phenomenon of poor world megacities. He visits China and Kenya to illustrate how dramatic declines in plagues have affected national economies. Bollyky traces the role of infectious disease in the migrations from Ireland before the potato famine and to Europe from Africa and elsewhere today.

Historic health achievements are remaking a world that is both worrisome and full of opportunities. Whether the peril or promise of that progress prevails, Bollyky explains, depends on what we do next.

A Council on Foreign Relations Book


Out of Print ISBN: 9780262038454 280 pp. | 6 in x 9 in 52 b&w illus.


$19.95 T ISBN: 9780262537964 280 pp. | 6 in x 9 in 52 b&w illus.


  • A thought-provoking book that should be required reading for anyone working in public health or public policy arenas.

    Library Journal

  • A thoughtful reminder of the social, economic and political complexities inherent in sustainable public health.


  • A remarkable new book.

    Financial Times

  • A remarkable new book.

    Financial Times

  • [This book] brings to the task a remarkable command of history, science, technology, medicine, public health, and political science. Bollyky combines his scholarship with an unusually fluid, writing style that invites readers to read more. In mapping his many 'worries', Bollyky carefully treads a middle path between pessimism and optimism.

    The Lancet

  • "If you want to step back and think more broadly about Coronavirus, the Universe and Everything, you could do worse than start with 'Plagues and the Paradox of Progress' by Thomas J. Bollyky."


  • Plagues and the Paradox of Progress provides a smart warning about our future without discounting the successes of our past.

    Health Affairs

  • The book is beautifully written, packed with great one liners and historical anecdotes.



  • Noncommunicable diseases are an urgent global crisis that has been largely overlooked, with deadly consequences. By calling attention to it—and prescribing solutions—Bollyky's book can help to save many lives.

    Michael R. Bloomberg

    Founder of Bloomberg LP and Bloomberg Philanthropies, World Health Organization Global Ambassador for Noncommunicable Diseases, and three-term mayor of New York City

  • A remarkable piece of work, superbly researched, beautifully written, and sobering. It should be required reading not only for policymakers and philanthropists, but anyone seeking to understand the great progress that has been made in global health and the significant challenges that remain.

    Sania Nishtar

    Founder and President of Heartfile and former Federal Minister for Pakistan

  • This stimulating new book is a must-read for those who care about our collective future. A well-recognized leader in global health, Tom Bollyky is a powerful advocate at a critical time, but does not shy away from some unsettling truths. Interweaving history, science, economic/development policy and international affairs, he reveals the promise and peril of how health advances are reshaping our world, and he soundly argues that a safer, healthier world demands that we address this paradox of unintended consequences. We should take heed!

    Margaret A. Hamburg

    Foreign Secretary, National Academy of Medicine and Former Commissioner of the Food and Drug Administration

  • Plagues and the Paradox of Progress is a readable history of the rise and fall—and worrisome threat—of infectious diseases, as well as the new health threat to developing countries: chronic illnesses. Bollyky provides deep insight into how health challenges will impact the development of lower income countries. This is an excellent addition to the scholarship on global health.

    Ezekiel J. Emanuel

    Chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania and author of Prescription for the Future