Specialists suggest that influenza viruses and coronaviruses present the greatest possibility of starting “The Big One,” a pandemic with considerably more severe repercussions compared to COVID-19.(Image credit: SOPA Images via Getty Images)
The COVID-19 health crisis transformed existence as we recognized it and took the lives of millions, but the coming pandemic could be even more catastrophic. A fresh publication, titled “The Big One: How We Must Prepare for Future Deadly Pandemics” (Little Brown Spark, 2025), details a hypothetical, yet realistic, situation where a novel and more lethal coronavirus surfaces and rapidly expands throughout the globe, regardless of public health officials’ most diligent attempts to halt it.
Within the pages, Michael Osterholm, the originating director of the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota, together with award-winning author Mark Olshaker, deliberate on understandings we should glean from prior outbreaks to reduce the destruction that a “SARS-3” might inflict upon the world’s populace. Here is an excerpt extracted from the book.
Assuming you are fortunate enough to avoid contracting the respiratory illness, it’s highly probable that someone you have affection for will. Even extending beyond that, a pandemic would substantially distress the global supply chain to such a degree that both everyday and long-lasting items, victuals, prescriptions, and fundamental necessities would be limited or simply unobtainable. Acute deficits would emerge across all nations for a broad assortment of supplies; not only edibles, but also sanitizers, stationery, illumination, and fuel, not to mention components for conveyances, aircraft, railroads, military instruments, urban water systems, and power stations. Even interment containers would be in limited quantity. With Covid, we witnessed the interconnectedness of global financial structures.
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The central idea: Regarding combating pathogens, prioritizing one nation has limited influence. Within America, the bulk of our crucial, and frequently life-saving, common medications are sourced from China and India, both of which would be leading focal points for pathogen propagation, triggering operational halts in production sites. We’ve been advocating for this particular style of pharmacological manufacturing to be reestablished within America and other dependable countries for years as a matter of homeland security. However, that would certainly entail some level of governmental assistance, because the earnings on the majority of unbranded medicines are extremely meager, with corporations even pulling out of the marketplace overseas. This implies that as centralizing in China and India has transpired, a broad weakness for the United States and the West has been carved out.
Dissimilar to a multitude of sectors currently, ethics persists as an indispensable and intrinsic part of medicine and public health, thus providing a strong argument to regard the remainder of the planet with matching concern and compassion that we extend to our own society.
“The Big One,” 2025
The axiom that individual safety is incomplete until collective safety is achieved is a reality due to its fundamental truth. To paraphrase the words of the late Nobel laureate Dr. Joshua Lederberg, previously cited in the beginning of Chapter One, “Bacteria and viruses are oblivious to geopolitical boundaries… No matter how selfish our objectives might be, we can no longer remain unconcerned regarding others’ adversity. A germ that debilitated a child on a faraway landmass yesterday could reach your offspring today and trigger a global outbreak tomorrow.”
Alternately, as expressed by poet John Donne, “Never question for whom the signal tolls; it tolls for thee.”
In sequence, as we strategize for the Big One, we must evade a repetition of what unfolded with Covid, where high-income economies accumulated substantial vaccine supplies — commonly exceeding their consumption capacities — whilst lower- and middle-income nations possessed minimal quantities, regardless of COVAX’s [a worldwide initiative to guarantee equal admittance to COVID-19 vaccines] honorable goals. Our responsibilities are not only to create innovative and potent immunizations; but also, by means of pact and collaboration on a global scale, to formulate an approach to intensify production volumes to gratify worldwide requirements, accompanied by an efficient infrastructure for conveyance and allocation, irrespective of cold storage conditions. A globalized method of public funding will be essential to subsidize the extra manufacturing competencies necessitated throughout a crisis.
Dissimilar to a multitude of sectors currently, ethics persists as an indispensable and intrinsic part of medicine and public health, thus providing a strong argument to regard the remainder of the planet with matching concern and compassion that we extend to our own society. However, realistically, there is nothing particularly unselfish regarding allocating inoculations with lower- and middle-income nations in adequate quantities to insulate their populations. It essentially serves our best interests. With the present capability to circumnavigate the world in fewer than 48 hours, geographic distance offers inadequate fortification from communicable afflictions. Should someone in a secluded village inside the Western Pacific region or sub-Saharan Africa be suffering from a unique airborne pulmonary virus, humans on the opposing side of the world might be facing imminent peril, which is a fundamental reality in our contemporary epoch.
We understand the improbability of accomplishing this degree of international collaboration in actuality, considering the standing of international affairs and the intrinsic inclination of each individual country to reserve vital treatments and vaccinations for its own inhabitants. Nonetheless, this likelihood does not detract from its significance. Manufacturing nations must sustain the proficiency and scope to generate inoculation reserves for the rest of the world, and there must be collaborative discussions and arrangements relating to the mechanisms by which the distribution of inoculation stocks would be executed.
Even within the United States, there will be insufficient antiviral agents to sufficiently satisfy demands for at least several months’ time. Supposing potent antivirals are even discovered that can address the virus that sparks the pandemic, we’ll have to ascertain the order of priority among individuals enduring critical health conditions. Health professionals and emergency responders? Politicians and top executives? Senior citizens and those with suppressed immune function? Critical workforce and operators? Every category will retain its proponents. It is considerably more judicious to wrestle with the moral considerations implicated in defining these priorities at present, in an open setting, rather than postponing the discussion until the crisis is upon us.
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A further consideration arises, since SARS-CoV-2 [the virus instigating COVID-19] predominantly impacted the elderly and immunocompromised with severe conditions, yet the subsequent pandemic may not follow the same pattern. Bear in mind that during the 1918 influenza [pandemic], greater than half of the deaths were observed in persons from 18 to 40 years of age that were generally in good health. The causes of these fatalities were potentially attributed to a virus-prompted response within the victim’s immune composition — a cytokine burst, as we described in Chapter Four — which led to acute respiratory distress syndrome (ARDS). To put it simply, through the process of opposing the disease, the strong defenses of these healthful individuals reacted excessively, severely impairing the lungs and resulting in their death. At present, the worldwide medical community remains marginally better prepared to oversee tens of millions of cases of ARDS than they were exceeding a century ago.
Additionally, although the SARS coronavirus, as an illustration, only affected about 8,000 persons in 2003 prior to its containment, approximately 10% succumbed, validating that our conceptualization of SARS-3 is not outrageous.
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The Big One: How We Must Prepare for Future Deadly Pandemics
“The Big One” scrutinizes prior pandemics, accentuating the approaches that societies both capitalized on and failed in as they addressed them; tracks the COVID-19 health crisis and examines its management; furthermore, projects into the days ahead, envisioning potential presentations of the next pandemics and mandatory procedures to alleviate them. It signifies a compelling, exhaustive, and exigent caution. Given that COVID-19 signified merely a glimpse of events to come — our preparedness is vital to survive the upcoming major pandemic.
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Dr. Michael OsterholmEpidemiologist, author and CIDRAP director
Dr. Michael Osterholm functions as Regents Professor, McKnight Presidential Endowed Chair within Public Health, additionally, the originating director of the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota. Being a globally distinguished epidemiologist, he has stood at the vanguard of communal health readiness, has steered multiple outbreak studies carrying worldwide consequence, and counsels world leaders pertaining to the consistently expanding inventory of microbial threats. He is the author of the New York Times bestseller Living Terrors. His podcast series, “Osterholm Update: COVID-19,” has been accessed by surpassing 8 million listeners.
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