This review is from my second reading of The Great Wheel, the rating is the same both times: I gave it 5 stars back in 2013, and I'm happy to be able to leave that unchanged on a second reading following the turn of the year into 2021.
Set in a future where hinted nuclear war and other calamities have rendered much of Africa and other parts of the world uninhabitable, the main character is Father John, an English priest who works in the Endless City - a sprawl along the North African coast packed with refugees from further south. Europeans live with a special implant which prevents illness, but the African 'Borderers' have no such technology and still suffer from sicknesses. Europeans have to wear gloves and avoid contact so as not to spread illnesses to them.
While the story follows Father John as he attempts to discover the source of so much myeloid leukemia in the Borderers who use his church run clinic, that isn't really what the story is about. To my mind at least, it's about John's faith, in people or life itself. He doesn't truly believe in God anymore, and the world often seems apathetic or even hostile to his attempts to improve things. His life in the Endless City contrasts with his memories of childhood in an idyllic England with an older brother he idolized.
I don't want to go into more details on the story, but I found the atmosphere and descriptions of the book really pulled me in and didn't let go. The places and institutions are brilliantly realized. The people stick less in my head - in part because so much happens that we don't get to spend too much time with any given characters, and I think also in part because I'm personally less interested in people than the world they inhabit, so your mileage may vary on that. I'm certainly not trying to say the characters are flat or uninteresting.
The book has a melancholy mood to it in my opinion, which appeals to something deep in me. Father John's attitude is melancholy, but he has determination to keep going and I guess an underlying belief that things can be better. As life goes on in the Endless City despite privation and well-meaning disregard from Europe, so life goes on everywhere. Particularly with the world and Covid as it is, I find that - and the book overall - comforting. Comforting in a way that encourages you to think that things are possible, rather than the numbing comfort of being told not to worry yourself or hiding away from the negative things of life. I hope I'll read it again in less than seven years time.