As a leading expert on the viruses, bacteria, fungi, and parasites that make us sick, Michael Osterholm knows what happens when humans underestimate infectious diseases. Osterholm, who is director of the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota, was a leading voice during the COVID-19 pandemic.
Now, he’s watching the dismantling of the U.S.’s public-health infrastructure with a sense of informed alarm. Osterholm’s new book, The Big One, assesses the response to COVID-19 and highlights the urgent lessons we need to, but haven’t, learned to better handle the next inevitable pandemic.
[time-brightcove not-tgx=”true”]
He talks to TIME about why the world, and the U.S. in particular, may be even less prepared for a pandemic now than we were before COVID-19.
This interview has been condensed and edited for clarity.
You’ve written other books about the dangers of infectious diseases. Why did you feel the need to write this one about COVID-19?
We have never done a hotwash of any kind on what happened with COVID-19, and to me we’re missing an incredible opportunity to learn what went right and what went wrong, in a nonpartisan, no-finger-pointing way. What could we do better for the next pandemic?
Right now everything is about finger pointing. We’re hung up on the issue of what was the source of COVID-19—a lab leak or a spillover? We will never know the answer. We are never going to know that.
Read More: A Brief History of Donald Trump’s False and Questionable Claims About Health and Science
Since I’ve had the opportunity to be very involved in the COVID-19 response—I wasn’t just a distant bystander—I tried to summarize lessons we should have learned and haven’t.
What are some of the lessons we have not learned?
Given what is happening in the current Administration with vaccines, I think we are in free fall. We are in worse shape now than we were literally before the COVID pandemic. No one in the White House is in charge of leading the country through the potential next hit from an infectious agent, which could be more deadly than if somebody launched a physical war against us on our own shores.
You have some specific proposals for how we might avoid things like universal lockdowns, border closings, and mask mandates—which, in retrospect, turned out not to be very effective in controlling COVID-19. What are some of those strategies?
The No. 1 way to save lives if we don’t have a vaccine is to ensure that our health care system is not overrun. When hospitals are operating at 130% capacity, some people won’t get care, and those who do won’t get care that is sufficient to save their lives.
Read More: The Big Budget Bill Could Make Your ER a Mess
That’s where snow days come in. Imagine if we set up a system where every day, you knew the hospital census for the hospitals in your community. Once that capacity reached, let’s say, 85% or 95%, then the community could take action and say we need to shut down for a couple of days here and change what we’re doing to reduce the number of infections, and the number of people likely to need hospital care. This is all knowing that people will still get infected, but some will get infected in the first six months, others in the second six months, and others in the third six months. If the infections are spaced out enough, you can basically keep the health care system operational.
Communities would have to make a decision that their hospitals are overrun right now, so they need to back off. During such snow days, you don’t shut the entire system down, but some people may take a few extra days off work, or work from home, or schools may be canceled for a few days. These are all things that could beat down the virus and put the health care system in the best place to help people.
You also propose a more comprehensive monitoring system, including medical IDs, to keep track of infectious diseases.
It would take a federal effort. The idea of a medical ID is to help track your information so health officials can tell where and which populations are hard hit by an infectious disease. That would be helpful to know, so officials would know that they need to scale back on what people are doing every day to lessen the number of new infections and therefore give hospitals an opportunity to catch up.
There is a lot of opposition from people who automatically say they don’t want the government to have more information on them, but they don’t realize that the government already has a great deal of information on us, including through our Social Security, Medicare, and Medicaid numbers.
Government health agencies now have differing vaccine recommendations from some professional medical groups like the American Academy of Pediatrics (AAP). How should the public make sense of the conflicting advice?
I’ve been asked how to interpret the AAP not following the recommendations of the ACIP [the Advisory Committee on Immunization Practices, which makes recommendations to the U.S. Centers for Disease Control and Prevention (CDC)]. I say you are asking the wrong question. The question is, how did the ACIP get to the point where it is scientifically inconsistent with all the rest of the scientific world? The question should be, ‘What happened to the ACIP?’ Not ‘what happened to the AAP?’
Who can the public trust when it comes to health information now?
The bottom line is that we cannot trust the Department of Health and Human Services (HHS) and CDC right now. It’s a terribly hard thing for me to say. The CDC is such a very important voice. There are still very talented and highly trained professionals at the CDC, but what is happening to the leadership—specifically, Secretary Kennedy and his colleagues—has brought it to the point where it can’t be trusted.
What does that mean for the health of Americans?
I have never seen [so many] dangerous and potentially catastrophic decisions being made by HHS as I have in the last 10 weeks. We need mRNA technology for our influenza vaccines to have any hope of having enough vaccines available for the first year to year and half of the next possible flu pandemic. Now, we can make enough vaccine for a quarter of the world’s population during the first 15-18 months of a pandemic, with the chicken-egg culture we use today. That is an example of a very dangerous situation that we could basically take off the table if we have research and development invested in mRNA technology.
My point is that we can’t stop a pandemic. Once a virus takes off, nothing really can be done. When a spillover happens from animals to humans in any part of the world, when people travel, that virus can quickly spread. That’s why we have to prepare for that and minimize the impact of that spread with vaccines that we develop as quickly as possible to that specific virus. We need to make lots of it and to get it out, and mRNA is an important part of being able to do that.
During and after the pandemic, there was a lot of criticism of the World Health Organization (WHO) and how it responded. How can the response of organizations like WHO be improved?
The WHO is absolutely important, and it’s absolutely critical that we have a strong WHO for these kinds of events. The challenge is that during COVID-19, the WHO was one of the real obstacles to getting good recommendations to the public about respiratory protection. To me, that says that just because there are official government health bodies, it doesn’t mean they get it right.
To address that, we need to have discussions about the response. The WHO used to do a hotwash of its response. Why did it take almost two months to declare a pandemic? I put out a document through CIDRAP on Jan. 20 saying that this is a pandemic situation, and the world needs to deal with it. Why were they so slow off the block?
We all did good things, and we all did some challenging things. What’s important now is to ask, ‘What happened?’ and use that information to improve in the future.
What are some of the biggest lessons learned from COVID-19 and actions that shouldn’t be repeated in the next pandemic?
We need to come together and not finger-point. We don’t have to agree about what happened in Wuhan…but what we need to do is prevent something similar from happening in the future. If it does happen, how do we respond? In answering these questions, none of it should be partisan. It should all just be about what science tells us.
And we need to stop doing border closings. They are useless. We have no evidence that border closing materially affects any emerging pathogen that shows up, but it’s often politically what people think should be done. And to oppose them makes it look like we don’t care, which is not true at all.
What we have to do [a better job of] in public health is understand that we are not the only answer that will be on the table. There will also be social and political issues to consider.
Are we now in a better position to meet the next “big one”?
No. I would have to say that we are in worse shape. We don’t have the opportunity now to use tools like mRNA in a meaningful way. If a pandemic begins to emerge, we will divide up into camps to go at each other. We would right now have major challenges bringing people together, and if there were ever a time when we needed to bring people together against a common enemy—i.e. a virus—it’s during a pandemic.
We need to do that. But we have nothing at this point to support that. We should deal with all of this now, game the situation, and work out what we would do.