"We have effectively destroyed our entire capacity to respond to a pandemic," says leading epidemiologist Michael Osterholm.

Two nurses at Martin Luther King Jr. Hospital in Los Angeles, California, treat a patient who tests positive for COVID-19 amid the coronavirus pandemic. A new book warns that the next pandemic could be even worse. (Photo: Francine Orr, Getty Images)

According to the World Health Organization, COVID-19 has killed more than 7 million people worldwide, including more than 1 million in the United States. Beyond this staggering death toll, the disease has unleashed a wave of chronic illnesses and, at the peak of the pandemic, caused widespread disruptions to supply chains and health care, ultimately putting lives at risk or causing death.

The novel coronavirus SARS-CoV-2 has had a huge impact on society since its emergence in 2019. But the next pandemic could be even worse.

That’s the message in a new book by Michael Osterholm, founding director of the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota, and award-winning author Mark Olshaker. It’s not just a cautionary tale. As its title suggests—“The Big One: How We Must Prepare for Future Deadly Pandemics” (Little Brown Spark, 2025)—it lays out lessons learned from past pandemics and points to steps we can take to mitigate damage and save lives when the next infectious disease outbreak sweeps the globe.

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It is noteworthy that the text was finalized before the start of President Donald Trump's second term.

Since then, “we’ve essentially destroyed our entire pandemic response capacity,” Osterholm told Live Science. “The office that would normally do this work at the White House has been completely dismantled.”

Live Science spoke with Osterholm about the new book, what we should expect from the next pandemic, and how we can prepare for it — both in ideal circumstances and in the current realities facing the U.S.

Nicoletta Lanez: Given the title of the book, Big, I thought we might start by defining what you mean by that phrase.

Michael Osterholm: Working as I do with coronaviruses, I've found two very important characteristics: first, how infectious are they? How transmissible are they? And second, how deadly are they? How severe are the illnesses they cause, and how many people die?

I worked with SARS and MERS before COVID. [SARS and MERS are severe coronavirus infections that preceded COVID-19.] These were two viruses that essentially had the ability to kill 15% to 35% of those they infected, but they were nowhere near as infectious because they didn't have ACE receptors. [In comparison, SARS-CoV-2 attaches to the ACE2 receptor on human cells.]

But then along came COVID, which essentially has this high transmissibility, but fortunately the fatality rate and the severity of the disease were much lower than MERS and SARS. In just the last six months, new coronaviruses have been isolated in China from bats that are now both highly transmissible and highly fatal. They have the ACE receptors, and they have the piece of the virus that caused such severe disease.

Imagine the next pandemic that is as infectious as COVID, but instead of killing 1-2% of those infected, it kills 15-35% of people. This is what we are talking about when we talk about the “Great Pandemic.”

Same thing with flu. You know, we haven't seen a really serious flu pandemic since 1918, compared to what it could be. And obviously flu pandemics are out there, in a sense, waiting to happen. In the future, someday, it could very well be similar or even worse than what we saw with the 1918 flu.

So we're trying to make people understand that there's no denying the seriousness of COVID and its impact. It was devastating. But it was devastating in a small “D” rather than a capital “D” compared to what could happen.

Michael Osterholm, author of “The Big One: How We Must Prepare for Future Deadly Pandemics,” warns that America is not prepared for the next pandemic.

NL: You mentioned both coronaviruses and influenza. Do you think the pathogen that causes the next pandemic will belong to one of these groups?

MO: In our book, we call them “viruses with wings” — to really qualify as a pandemic, you need a “virus with wings.” I don't think there's a bacterium out there right now that meets that criteria; it's actually in the virus family.

The most likely would be influenza [virus] or coronavirus. Of course, an unexpected infection could occur, but it would have to have characteristics similar to influenza and coronavirus in terms of transmission through the respiratory tract.

NL: Could you clarify what you mean by “a virus with wings”? What gives a virus its pandemic potential?

MO: For example, one of the factors that made SARS and MERS easier to contain was that many [infected people] only became highly infectious after they were already clinically ill. But with COVID, we clearly saw that a number of people were infecting others while they were asymptomatic or remained asymptomatic.

It [the “virus with wings”] must have the ability to be transmitted by airborne droplets, and that is the key factor here. … It must also be a virus that is new to the community, and it must not have pre-existing immunity.

NL: In your book, you argue that it is impossible to prevent the spread of a pandemic pathogen, but it is possible to mitigate its harm. Why?

MO: I think that’s why we present this scenario to the reader, because you can see the conditions on the ground in Somalia. [Editor’s note: Throughout “The Big One,” the authors return to the thought experiment in which a pandemic virus emerges in Somalia and then spreads around the world, despite the efforts of health authorities to contain it.]

Every city, every camp, every clinic, every public health event is real. But you can see very quickly how a virus that originated in animals — in this case, camels — got into humans and how quickly it spread around the world before anyone recognized it.

The mRNA technology gave us real hope that in the first year we could have enough [vaccine] for the entire world. And of course, you saw the White House just pull the plug on it.

Michael Osterholm, University of Minnesota

These viruses are by nature highly contagious, and in a highly mobile society, they will move around. It just goes to show that once the virus has gotten in, it's gone. It's impossible not to ring the bell. Whereas other diseases that may be much slower to develop and less likely to cause widespread spread, you might be able to get to them, but with a pandemic, it's not going to be easy. It's just gone. Wings, that's it.

NL: And when you talk about mitigating the impact of pandemics, you emphasize the need for governments to be involved, that industry cannot do it alone. Why?

MO: Let me just say: I wish we had another six months to do this book. So much has changed between even the last manuscript coming in at the end of last year and now, just because of what’s happened in the Trump administration. We’ve basically destroyed our entire pandemic response capacity. The office that used to do this work in the White House has been completely disbanded [the Office of Pandemic Preparedness and Response Policy]. And there are no experts there.

Today, if we had a serious flu pandemic and needed a vaccine, we would use chicken embryos, which is the only way we have to produce vaccine in large quantities. Novavax has a cell-based vaccine, but its volumes are very limited. Even with all the global capacity, we could only produce vaccine for a quarter of the world's population in the first 12 to 18 months. So three-quarters of the world's population will not get a vaccine at all in the first year of the pandemic, and it will take several more years to produce one.

Well, mRNA technology gave us real hope that we could, in the first year, supply the world with the drugs we needed. And of course, you saw the White House just pull the plug. HHS said, “Enough!” $500 million has already been allocated. The money has been allocated to Moderna to develop ready-to-use prototypes so that if we need them, we don’t have to go through the long, arduous process of getting them approved. We’re getting approval now that the strain switching issue [is left for when a pandemic virus emerges].

And suddenly it's like losing one of your wings at 30,000 feet [9,100 meters] – it's a devastating situation.

Osterholm said cutting government funding for mRNA vaccine technology is like “losing one wing at 30,000 feet.”

NL: Returning to the topic of mRNA: do you consider its main advantage to be the speed of vaccine production?

MO: The key to mRNA technology is speed, and you've managed to do that. Not just in terms of developing the vaccine, but also in terms of manufacturing it.

The second thing is how you can build specific antigens [proteins that seem foreign to the immune system] into these vaccines. You can take any fragment or multiple fragments, and there is work going on right now to build multiple antigens into an mRNA vaccine, and that would be even better.

So it's much simpler [than traditional vaccine production]. It's plug and play. We've never had anything like this before. And we've certainly demonstrated that the mRNA approach actually gets the human immune system to respond in the way that we want it to.

NL: You also spend a lot of time in your book on the topic of communications, namely how best to convey key messages as the pandemic unfolds. What do you think is the main takeaway for communicators?

MO: Science is not truth; science is the pursuit of truth. So be prepared that we will learn a lot over time. And I wish I could tell you today what I will know in three years, but I can’t. So the best I can do is keep you informed.

You know, I wrote an op-ed in the Washington Post early in the pandemic, before the lockdowns, and I urged people not to do them. “They won't work, don't do them. When are you going to lift the lockdown, because it's going to last for months, maybe even years?”

I proposed something like a snow day. The most important thing we could do to minimize severe illness and death was to make sure our health care system was functioning and able to provide the care we needed. Well, we couldn't do that because of the spikes. What if we had data on hospital capacity in every community, and we updated that data every day? And when we got to, you know, 95% of beds occupied, we said, “Please, like we do on snow days, next week, if you can reduce the number of patients, we can reduce that number.” We were in it for the long haul.

We should have done a much better job of communicating this to people, rather than just going into lockdowns, because when they end, what the hell are you going to do? We didn’t approach it as, “This is going to be a battle, maybe for three or four years.” We approached it too much like a hurricane. “It’s going to blow over, it’s going to be terrible, but in six to 12 hours we’ll be back in recovery mode.” That shouldn’t have happened.

In 50 years of business, I've learned that people want to know the truth. Don't sugarcoat it. At the same time, don't exaggerate: tell people how you got there.

NL: Given the complexity of our information ecosystem, I'm not sure if you had any idea where most people were getting their updates from? Or was the information very mixed?

MO: I think that's a very important point. And I would say that no one is talking about a unified opinion, because in finding solutions there will be disagreements, and they will change over time.

This is where we needed more humility. I keep coming back to this word humility – talking about what we know and what we don’t know, and how that might change. I think if we had done that, our public credibility would have been much higher. If you don’t know, say you don’t know.

NL: You close the book by noting that you are often asked what the average person is capable of. Is there anything?

MO: In fact, this has become especially noticeable now in connection with the vaccination issue.

For example, on our website, when I do the podcast, in the show notes we list organizations that are working in the community to vaccinate and help support vaccine availability, education, etc. Engage with them. We haven't deployed our public health army during the pandemic, although we could have. There have been some limited contacts, such as with religious leaders, pastors, etc., but I think we could have done a lot more. Information will not stop the pandemic, but it can minimize its terrible consequences.

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When I talk about citizen participation, they can't go out and make vaccines, but they can certainly reach out to their elected officials. They can ensure that [harmful] decisions aren't made by school boards, city councils, or state legislatures. There's a bill that's just been introduced in Minnesota that's starting to gain traction that would make developing mRNA technology a crime. Basically, if you get vaccinated, you could go to jail.

I think it's really important that citizens can monitor the situation, communicate and testify. … We need to do more and more to have citizen monitoring groups alerting people.

VIP [the Vaccine Integrity Project, an initiative to ensure the safety of vaccine use in the U.S.] is a good example. One of the speakers at our big meeting yesterday — a woman with three kids, who is a mom, a department head, all this stuff — I don’t know what 29-hour days she works, but she’s amazing. I said to her, “You know, you need to take a vacation.” And she said, “This is too important.”

That's what gives me hope, you know? That's what we have to turn to.

Disclaimer

This article is for informational purposes only and does not provide medical advice.

$25.74 on Amazon

Key takeaway: How we can prepare for future deadly pandemics

The Great Pandemic looks at past pandemics, highlighting societies’ successes and failures in dealing with them; examines the COVID-19 pandemic and assesses how it has been managed; and looks to the future, predicting what the next pandemic might be like and what needs to be done to mitigate it. It is a compelling, comprehensive, and urgent wake-up call. COVID-19 was just a harbinger of things to come, and if we are to survive the next great pandemic, we need to be prepared.

Nicoletta Lanese. Social Links Navigation. Editor of the Health Channel.

Nicoletta Lanez is the Health Editor at Live Science and previously served as the site’s news editor and staff writer. She holds a certificate in science communication from the University of California, Santa Cruz, and degrees in neuroscience and dance from the University of Florida. Her work has appeared in The Scientist, Science News, Mercury News, Mongabay, and Stanford Medicine Magazine, among other publications. Based in New York City, she is also an avid dancer and performs in productions by local choreographers.

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