Historian Randall M. Packard’s Fevered Cities takes readers to dengue fever outbreaks in eight major cities across the Americas, the Caribbean and southern Asia over more than two centuries to make essentially the same case that the author has made in his three previous books, which offered histories of health and disease in South Africa, malaria and global health, respectively. That argument is that eliminating disease requires structural change, not only the flashier scientific advances that more often draw the attention of the press and global health organizations. The structure that Packard is concerned with in this latest text is that of the city and its built and social environments. He succeeds in rendering that space and the stories of how dengue-carrying mosquitoes have made it their home, as well as how a reliance on short-term public health interventions has failed to dislodge the insects and the disease, just as exciting as that of any biotechnological solution.

Stories of humans’ shifting understanding and experiences with the dengue virus and its six-legged vector propel Packard’s text as it leaps through time and space, from American Revolutionary War-era Philadelphia to twenty-first-century Manila, across an introduction, a conclusion and nine chapters divided into three parts. Except for one chapter that addresses Cuba’s two largest cities, each chapter is rooted in a single urban area. As Packard moves between cities, he proves the popular saying quoted in his conclusion that ‘If you have seen one dengue epidemic, you have seen one dengue epidemic’ (p. 280). Each chapter shows how a city’s urban growth patterns, social and cultural norms, and political and economic systems converge to shape distinct epidemic experiences and responses.

Part I traces the early history of dengue epidemics, with chapters on what contemporary physicians called bilious remitting fever, now believed by medical authorities to have been dengue, in Philadelphia in 1780; cases among American soldiers in Manila following the Spanish–American War of 1898; and waves of dengue that struck Bangkok in the 1950s and 1960s. The almost 200-year span allows Packard to show how medical understandings of dengue evolved from what physicians in colonial Philadelphia attributed to the influence of environmental factors on the bodily humours to today’s understanding of it as a complex virus with four overlapping subtypes, each with multiple genotypes.

Part II explores how dengue viruses and the Aedes aegypti mosquitoes that most often carry them spread into new territories with the economic and social changes of post-1970s globalization. This section includes chapters on dengue epidemics in Havana and Santiago de Cuba in the 1980s and 1990s, Delhi in the 1990s and 2000s, Rio de Janeiro throughout the twentieth and into the twenty-first century and Singapore in the mid-aughts. Packard writes that the end of World War II brought surges in economic growth, rural-to-urban migration and the number of people living in unplanned urban settlements in Southeast Asian nations, creating new mosquito habitats and increasing the population of people susceptible to dengue and living in close quarters with its vector. Those conditions allowed the virus and the mosquitoes to proliferate, and as the speed and frequency of global travel also increased during the period, they soon spread to new urban spaces. Packard shows how the global circulation of dengue variants challenged disease control and prevention efforts, as well as researchers. His chapter on Cuba is a particular delight, as he considers the island nation during two dengue epidemics, one during the Cold War and the other after, to show the influence of not only local but also global politics on how the epidemics unfolded and the governments of Cuba, as well as its enemies and allies, responded.

Finally, Part III highlights the novel biotechnologies that health authorities have prioritized in efforts to curb dengue. Packard shows that this approach has failed to eliminate the disease and argues convincingly that global health organizations treat such interventions as silver bullets at the peril of us all. The section’s two chapters return to Rio de Janeiro and Manila, featuring efforts to release male mosquitoes infected with Wolbachia bacteria, which reduces mosquito populations because eggs laid by female mosquitoes that have mated with infected males will not hatch, and efforts to develop a dengue vaccine, respectively. This section drives home Packard’s overarching argument that structural interventions are needed to make real progress toward controlling dengue. While the interventions described in the section are effective to some extent and have garnered the attention of health organizations and governments the world over, ultimately, the fact that governments tend to commit too few resources to dengue until an outbreak occurs and then wind down control and prevention efforts between outbreaks renders even the most cutting-edge biotechnological solutions insufficient and means that outbreaks are bound to recur.

Admittedly, at times, Packard’s decision to feature a series of urban spaces feels more like a clever (and effective, certainly) means of organizing the book than a reflection of the real focus of his research and argument. His treatment of the built environment is secondary to his analysis of the social, political and economic worlds of his chosen cities, and doctors, epidemiologists and public health experts are the protagonists of his chapters, not architects or planners. But even if it sometimes lacks more direct and thorough engagement with the built environment, urbanists will find much of value in this sweeping historical perspective on what Packard calls ‘the most widespread viral disease that most people in the northern hemisphere have never heard of’ (p. 4). Fevered Cities promises to deepen understanding of the proliferation of mosquito-borne diseases, make plain the grave risks inherent in the increasingly nationalist and isolationist approaches of world governments toward public health and challenge faith in new technologies as standalone solutions to problems that are global in scale and structural in nature.