Microbiologist Joanna Verran set up a book club to encourage discussion about infectious disease using fiction, never anticipating the impact that it would have on her own learning

As a microbiology academic, and a university professor with a lifelong career in teaching and research, I was somewhat taken aback when it occurred to me that reading fiction about infectious disease had supplemented my understanding of the science. 

Fictional stories of infection lingered long after I’d read them, as I thought about the characters and analysed the science and its role in plot development. These thoughts ran deeper than those arising from reading textbooks, scientific papers, or articles online. Perhaps this is because fiction intends to entangle with our emotions, capture our attention, and ensnare the reader, while scientific writing is deliberately objective. In medical writing, case studies that focus on the individual are impartial descriptors of symptoms. How much more memorable are those symptoms when the case is constructed as a story? 

This got me thinking about how a fictional narrative and its emotional engagement can encourage learning about and engagement with science. Can fiction be useful as a vehicle for scientists to practise science communication through conversation with non-scientists, by supplementing facts with discussions about human fallibility, relationships, and imagination? Can it facilitate the discussion of infectious disease epidemiology with non-scientists? I decided to put these musings into practice.

I set up the Bad Bugs Book Club in 2009 as a way to encourage discussion about infectious disease using fiction. I did not anticipate back then the impact that the activity would have on my own learning or attitudes. Typically for our book club, eight members meet six times a year, usually in a pub, to discuss a book selected at the previous meeting. Members comprise scientists and non-scientists, and discussions encompass both literary and scientific aspects of the narrative. Meeting reports and reading guides for more than 60 books have been posted on the website, and are available for download.

From a literary standpoint, the focus on infectious disease as the common denominator has enabled us to read from every genre. As readers, we have together discovered new authors, and as curious scientists we have encountered a wide range of microorganisms and epidemiologies. We have discussed vaccines, virulence, transmission, diagnosis and treatment, and changes in disease epidemiology over time.

For me, added value emerged when themes began to materialise through reading several novels about the same disease or condition. The properties of the microorganisms shape how the plot progresses. For example, there are few novels about antimicrobial resistance (AMR). I wonder if this is because AMR tends to affect individuals, and is not necessarily infectious, so the scope of the story is restricted and there is less opportunity for character development or heroic journeys? Of course, there are nosocomial and community outbreaks, and in the fiction that does feature AMR, to create drama, a common trope is for hospital patients to be deliberately infected with a multi-resistant strain of bacteria by some villain or other (the novels are often therefore thrillers or murder mysteries). At the moment, AMR spreads across human (rather than bacterial) populations relatively slowly, in comparison to respiratory viruses, for example. For a story that’s on a more epic scale, an infection must be contagious—preferably highly contagious—before it fits as a plot device in an apocalyptic novel. 

Zombie fiction provides an excellent apocalyptic experience, but with 100% transmissibility and 100% of victims infected (or consumed), there is little opportunity for character exploration other than as a survival narrative. More recently, there has been a tendency for the zombies to acquire some human characteristics or a change in behaviour, which provides some plot development and moves the genre forward. 

Real pathogens bring all their history and terrifying virulence with them into fictional worlds. In recent years, influenza has been a popular choice for pandemic fiction, with several recent novels using the virus to explore human behaviour alongside disease progression. As a model for post-apocalyptic narratives whose trajectory is dictated by the infection and mortality rates of the pathogen, influenza stories can be about survival (high virulence), about disease management (lower virulence), and about the best and worst sides of human nature. These virulence determinants, coupled with airborne transmission, make influenza easier to use to shape and drive plots than, for example, plague or Ebola, where mode of transmission and incubation period might slow the pace of a novel.

Curiously, most fiction about influenza is set in the present or near future, rather than at the beginning of the 20th century, when the devastating 1918 pandemic took place. Several more recent publications have been set during the 1918 pandemic (perhaps a result of renewed interest during the centenary?) and the 1918 virus strain itself is often used in contemporary settings as the resurrected aetiological agent. Yet the paucity of fiction about influenza written in the 1920s or 1930s stands out, apart from Katherine Porter’s Pale Horse, Pale Rider. I wonder if this is because the collective trauma experienced by the world’s population at the time precluded significant creative outputs. Will there be a similar silence around covid-19 in upcoming novels, or is a lot of coronavirus fiction incubating out there?

It is likely that in the current climate, more members of the public are becoming familiar with the language and epidemiology of infectious disease. Sources of information are plentiful, but their accuracy can vary, and the language and concepts can be difficult to grasp. Fiction is written for a more general readership, and our club has found that relevant narratives can be used to enable discussion about infectious disease between interested individuals with varying experiences and expertise, whether scientists or non-scientists. 

For myself, reading and discussing fiction with others has provided a profound insight into human behaviour and the impact of infectious disease on humanity. Although a microorganism might be underpinning or driving the plot, the stories themselves are about people, bringing themes of resilience, creativity, and kindness to the fore. They remind me that surviving and enduring an infectious disease experience is as much about our humanity as  “the science,” and I have some faith that our current pandemic experiences will reveal the same. 

Joanna Verran is an emeritus professor of microbiology at Manchester Metropolitan University. In addition to her laboratory based research career, she is an award winning educator and science communicator. In 2019 she obtained an MA in creative writing. Twitter @JoVerran

Competing interests: None declared.