“The truism that no one is completely safe until everyone is safe is a truism because it happens to be true.”
So caution Michael Osterholm, epidemiologist, professor at the University of Minnesota School of Public Health, and director of CIDRAP (the Center for Infectious Disease Research and Policy at the U-MN) and collaborating writer Mark Olshaker in their new book, The Big One. (In this post, for the sake of brevity, I’ll refer to the two authors as “O&O”).
Simply put, the tagline tells us what we are about to read: a playbook for, “how we must prepare for future deadly pandemics,” and why.
For context, I’ll share that I had the privilege of interviewing Dr. Osterholm for the South-by-Southwest festival in 2021 when the conference was all-virtual. Please listen to our conversation here to get a sense of the déjà vu moment we’re in now…..with Dr. Osterholm’s message so consistent over the four years since we met at a distance to brainstorm COVID-19: The New Reality.
In between their sage advice in this detailed playbook, we have the opportunity to absorb the exhaustive history before, during, and since the Covid-19 pandemic. Starting with Dr. Osterholm’s personal coronavirus origin story dated from December 2019, we go back decades to the Great Flu Epidemic of 1918 (the Spanish Flu), get details on the Black Death from the Middle Ages, and more contemporarily appreciate the expanding list of public health threats including HIV/AIDS (which for many people working in public health was another déjà vu experience that felt a lot like early Covid times), malaria, TB, cholera, dengue, Zika, MERS, Ebola, and Mpox/monkeypox.
One of the authors’ most useful and humbling approaches to crises comes from a quote from General Dwight D. Eisenhower; Ike advised,
“In preparing for battle, I have always found that plans are useless, but planning is indispensable.”
When it comes to planning in advance for “The Big One,” we should be humbled by the thought that, “the pain and suffering from the Covid pandemic (will) seem like a mere warning shot across the bow.”
And that planning should begin “now,” they urge.
I’ll share some of my own takeaways that speak to me right now:
– From SARS, we learned about the “inter-connectedness of daily life, as well as the impact of worldwide air travel and its necessity for business,” and how these “could enhance the transmissibility of any microbe.”
– Take a page out of the realtor’s handbook: from “location, location, location,” think, “transmission, transmission, transmission” in trying to solve for the spread of a virus — whether airborne, fecal/oral, close bodily fluid contact, breaks in the skin, or via blood transfusion. The most challenging to deal with, O&O assert, is the airborne-respiratory route; the others are easier to control.
– A huge challenge is `how to impose preventive measures on something you haven’t yet detected or identified. To deal with this conundrum, we should adopt Dr, Thomas’s Precautionary Principle: “Until you have evidence to the contrary, act as though every new infectious agent is easily spread through the air. It could save your life.”
– The chapter on mandates — which covers all sorts of issues from masking to school closings, vaccinations, and border closings — clearly states that any mandate must be based on the best evidence available. “Like all hygiene theater [remember that phrase], actions that will not affect infection, transmission, and health outcomes will be disruptive and harmful to long-term public cooperation.”
– The corollary to evidence-based mandates: remember that, “The juice must be worth the squeeze.”
– Part of planning is to be prepared ahead of time: “We don’t wait for a war to develop and then build tanks,” the authors advise.
– Effective communication is a key pillar in dealing with The Big One for both planning and meeting the moment. “Pandemic communication isn’t a one-lane road, or even a two-way street. It’s a multilane superhighway interchange, with traffic zooming past in every possible direction.” At the core, O&O explain, “we are talking about effective risk communication.” And in the current omni-channel world, this requires that, “reliable public health messaging should be present on all popular platforms….written and produced in a way that will reach the divergent audiences on each one,” whether via TikTok videos or traditional news outlets. In executing this, we are strongly urged to balance authority with humility.
What’s at stake: the obvious top-line is lives lost which could have been prevented. “It is estimated that by the end of 2023, more than 200,000 Americans had died needlessly” because they didn’t trust (and, thus, receive or opt into getting) the Covid vaccine, O&O quantify. Furthermore, they add that beyond the coronavirus, “This skepticism has even more problematic downstream effects, such as when the anti-vaccine trend moves into vaccines we’ve trusted for years, such as those for polio, measles, tetanus, diphtheria, and other diseases,”
O&O quote Dr. Peter Hotez, who wrote in his 2023 book The Deadly Rise of Anti Science: A Scientist’s Warning, “Partisan leanings were strongly associated with the likelihood both to be unvaccinated and to lose one’s life to COVID-19. The ’redder’ the county in terms of the percentage of Republicans, the higher the loss of life,” Dr. Hotez wrote. That’s not a political statement, O&O say, but an objective epidemiological finding.
Going forward: the U.S. health care system as a largely fee-for-service model is ill-equipped to deal with and scale services for the challenges of a pandemic and effectively deliver public health. O&O say a value-based/population-based care model would be better positioned to deal with The Big One.
As I introduced this post, I’ll repeat my favorite sentence in this 300+ page book of wisdom, facts, and actionable advice: “The truism that no one is completely safe until everyone is safe is a truism because it happens to be true.”
Health Populi’s Hot Points: “The only currency public health has is trust….Hope is not a strategy, and fear is not an excuse,” O&O conclude in the closing paragraphs of the book’s calls-to-action.
With that in mind, I recommend that you check out this recent column from Tom Lee, MD, Chief Medical Officer with Press Ganey. The title, “Meeting me where I am — quickly, please,” communicates the urgency that O&O inspire in me when it comes to moving at the speed of trust — that is, quickly in my case where I trust the heaps of evidence they serve up in The Big One.
I press “publish” on this book review on Monday September 15th kicking off a week where the Centers for Disease control, vaccinations, and other public health challenges are center-stage in health politics.
On Wednesday this week, the Senate HELP Committee will meet with Susan Monarez, ex-head of the CDC, to testify along with Debra Houry, former Chief Medical Officer of the Center, both of whom were ousted from their CDC leadership positions. (Note: HELP is the Committee on Health, Education, Labor and Pensions).
On Thursday and Friday this week, the vaccine advisors chosen by Robert F. Kennedy, Jr., will meet to talk about and perhaps vote on recommendations for vaccinations covering Covid, Hep B, MMRV (measles, mumps, rubella, and varicella), and RSV. This reconstituted panel includes some with a history of vaccine skepticism.
Keep the O&O book in mind, ongoing…..I think my copy is going to get well-worn in the coming months.
