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Dr. Michael Osterholm
“Are we going to base what we do for the health of our population on science, or are we going to go with magic smoke and mirrors?” says Dr. Osterholm
COVID-19 is looming again, after reshaping the world in 2020. Many thought we had lived through the defining health crisis of our lifetimes. But Dr. Michael Osterholm, one of the world’s foremost epidemiologists, insists that the coronavirus was not "the big one."
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That dreaded event, a pandemic with mortality rates far beyond COVID-19’s reach, is still looming, and, he warns, the world is less prepared than ever to face it.
In his new book, The Big One: How We Must Prepare for Future Deadly Pandemics, coauthored with Mark Olshaker, Osterholm dissects the lessons of past outbreaks, chronicles both triumphs and failures, and imagines the devastating reality of what could come next.
Yet in speaking with him, it is the current unraveling of the U.S. public health system that most animates him.
“This is all about one simple decision,” Osterholm said during a long interview with The Advocate. “Are we going to base what we do for the health of our population on science, or are we going to go with magic smoke and mirrors? And this would be OK if it was just an academic debate. But the fact of the matter is, this is life and death.”
He points to recent state and federal efforts to weaken vaccination requirements and dismantle the Centers for Disease Control and Prevention as signs of a country courting disaster. “Do you realize what’s happening right in front of you? And if you don’t end up speaking up, speaking out, and getting our elected officials to deal with this, this is what’s going to happen,” he warned.
"Imagine a category six hurricane just blew through your town. You know how long is going to take to rebuild that? A long time,” Osterholm explained about the damage done to CDC. “But you can rebuild it. You can, and I am optimistic. But we have to get this turned around soon, and if we don’t, maybe there will be a point of no return. But right now. we can still bring it back, but it is not going to be easy to do."
Osterholm, who has advised presidents and served as a State Department science envoy, does not mince words about the Trump administration and Health and Human Services Secretary Robert F. Kennedy, Jr. “You know, when you have a Trump-Kennedy combination, those are leaders of that side of the house, you might say, that continue to be very powerful,” he said. “Where are our leaders? Who are they? What do we need to do to help the population understand what’s really going on?”
Asked if the damage Kennedy has inflicted on the CDC is irreversible, Osterholm paused. “Until basically, the postmortem says you’re dead, I think we have reasons to believe we can do it. If Mr. Kennedy is no longer secretary, and you bring in somebody reasonable who can start to help rebuild it,”
That sense of urgency carries into his defense of mRNA technology, which Kennedy has targeted for elimination. Osterholm described the administration’s withdrawal from mRNA as catastrophic. “Right now, if we don’t have mRNA technology available in the first year [of a flu pandemic], we can maybe vaccinate up to a quarter of the world. Otherwise, it’s going to be three years before we can vaccinate the world.”
“With mRNA, we can likely vaccinate the whole world in the first year. That’s millions of lives saved. And so to me, it’s just a challenge to understand, how could you withdraw?”
He added bluntly, “It makes zero sense. Absolutely, completely. It makes zero sense.”
For Osterholm, the consequences of political decisions are personal. “My daughter gave me an electronic picture frame for Christmas, and it sits on my desk at home. Every 30 seconds, a new picture of one or more of my grandchildren shows up. Every time in a meeting, I just keep looking at this frame, and I know exactly what I’m doing. My job. It’s about them. What are we leaving them right now? We’re watching the destruction of the public health system as never before.”
The Florida move to end school vaccine requirements struck him especially hard. “This reckless decision will needlessly endanger the health of children in Florida. It flies in the face of a mountain of evidence that clearly shows the benefits of vaccinating kids before they enter school, and it makes the entire state less safe to visit or live in. Every parent of a child who dies or is hospitalized with a vaccine-preventable disease will know exactly why.”
And the problem will not stop at Florida’s borders. “What happens is Florida is a magnet for people to come down there, Disney World, Universal Studios, the beaches. And so what’s going to happen is they’ll have their problems in Florida, but visitors as well as state residents will then continue to transport those viruses back to all the other 49 states. This is a huge issue.”
Meanwhile, COVID-19 is resurging, flu has already killed hundreds of children this past year, and measles outbreaks are on the rise. “It’s the lack of rationality,” Osterholm said, exasperated. “I mean, I don’t know how to describe it, but it’s just that crazy.”
Despite his warnings, Osterholm resists despair. “The pandemic clock is ticking. We just don’t know what time. But one of the things I have to say our country did really well was after 9/11. That commission went through and identified all the lapses without finger pointing, without partisanship. We need that desperately right now, and that is to learn the lessons of this pandemic and apply them for the future.”
Global preparedness, he added, is slipping as well. “Preparedness has always been in our bailiwick. People tend to follow us. And now I worry. For example, the [European Union] is cutting back on infectious disease and global health because they’ve upped their GDP allocation to defense. It’s a real challenge.”
Still, Osterholm insists there is time to act, if leaders ultimately choose science over ideology. “We know the next big one will come. It’s just a matter of time. The question is whether we will be ready, or whether we will stumble into it with our public health system dismantled and our tools abandoned. That’s what this book is about. That’s what I’m fighting for.”
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