The COVID-19 pandemic has upended life as we know it, claiming millions of lives in the process, and the next one could be even worse. A new book called The Big One: How We Must Prepare for Future Deadly Pandemics (Little Brown Spark, 2025) describes a theoretical but plausible scenario in which a new, more deadly coronavirus emerges and rapidly spreads around the world, despite the best efforts of public health officials to stop it.
In this article, 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 discuss the lessons we must learn from past pandemics to reduce the damage that SARS-3 could inflict on the world’s population. Below is an excerpt from the book.
Even if you’re lucky enough not to get an airborne virus, there’s a very good chance that someone you know and care about will. But beyond that, the pandemic has had a severe impact on global supply chains, with both general and durable goods, food, medicine and everyday essentials likely to be in short supply or unavailable. In addition to food, all countries will experience significant shortages of a wide range of goods, including soap, paper, light bulbs, gasoline, cars, planes, trains, munitions, municipal water pumps, and parts for power plants. There will even be a shortage of coffins to bury the dead. COVID-19 has shown us just how interconnected the world’s economies are.
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The message here is that America First has its limits when it comes to fighting microbes. In the United States, most of our critical, and often life-saving, generic drugs are imported from China and India, both of which are prime targets for the spread of the virus and could lead to the closure of manufacturing plants. As a matter of national security, we have long advocated for the resumption of manufacturing of these drugs in the United States and other trusted countries. But most generic drugs have extremely low profit margins, and as companies are exiting the business even overseas, this will inevitably require some form of government subsidy. This means that consolidation in China and India has occurred, creating significant vulnerabilities for the United States and the Western world.
Unlike in many fields these days, ethics remains an integral and integral part of medicine and public health, so there are compelling reasons to consider the rest of the world with the same compassion and empathy that we feel for our own citizens.
“The Big One”, 2025
It is a truism that no one is completely safe until everyone is safe because it happens to be true. In the words of the late Nobel laureate Dr. Joshua Lederberg, quoted at the beginning of Chapter 1, “Bacteria and viruses know nothing about national sovereignty. . . No matter how selfish our motives may be, we can no longer remain indifferent to the suffering of others. The microbe that killed a child on a distant continent yesterday can reach you today and sow the seeds of a global pandemic tomorrow.”
Or, as the poet John Donne wrote, “Never let it be known for whom the bell tolls; it tolls for you.”
So, as we prepare for the Big One, we must not allow the same thing that happened with COVID-19 to happen. This means that high-income countries ended up with large quantities of vaccines (often more than they could use), while low- and middle-income countries had very few vaccines despite COVAX policies. [a global initiative aimed at ensuring equitable access to COVID-19 vaccines] Good intentions. We’re not just developing new and effective vaccines. International agreements and cooperation will also need to plan ways to scale up manufacturing to meet global needs and efficient systems for transporting and distributing them, even where cold chain requirements are involved. An international approach to public financing will be needed to cover the excess capacity needed during the pandemic.
Unlike in many fields these days, ethics remains an integral and integral part of medicine and public health, so there are compelling reasons to consider the rest of the world with the same compassion and empathy that we feel for our own citizens. But on a practical level, there is nothing particularly altruistic about sharing enough vaccines with low- and middle-income countries to protect their populations. That’s just self-interest. Although it is now possible to circumnavigate the globe within 48 hours, distance does not protect against infectious diseases. While someone in a remote village in the Western Pacific or sub-Saharan Africa may be infected with a new airborne respiratory virus, people on the other side of the world may also be in immediate danger, a fundamental fact of nature in the modern world.
We recognize how unlikely this level of global cooperation is in reality, given the state of international relations and the natural tendency of countries to retain critical medicines and vaccines for their own populations. However, this possibility does not make it any less important. Manufacturing countries must have the capacity and capacity to supply vaccine stocks for the rest of the world, and there needs to be international dialogue and planning on how to allocate vaccine stocks.
The United States also won’t have enough antiviral drugs to meet the need for at least several months. Whatever the pandemic virus turns out to be, and assuming effective antiviral drugs exist, we will need to understand who among the seriously ill will be prioritized. What about healthcare workers and first responders? Politicians and business leaders? Elderly and immunocompromised people? Essential workers and drivers? Each cohort has its own champions. It is far better to grapple publicly with the ethical issues involved in making such priorities now than to wait until a crisis occurs.
Another issue is that SARS-CoV-2 [the virus behind COVID-19] It mainly affects the elderly and critically ill immunocompromised patients, but this will not necessarily be the case in the next pandemic. In the 1918 influenza, [pandemic]more than half of those killed were between 18 and 40 years old, and most were in good health. These deaths were likely caused by the victim’s immune system response (cytokine storm, as discussed in Chapter 4) caused by the virus, resulting in acute respiratory distress syndrome (ARDS). In other words, in the process of fighting the disease, a healthy person’s powerful immune system overreacts, causing severe lung damage and death. Today, medical institutions around the world are less equipped to treat tens of millions of ARDS cases than they were more than a century ago.
And even though the SARS coronavirus, for example, infected only about 8,000 people before it died out in 2003, it killed about 10% of them. This shows that our thought experiment regarding SARS-3 is not far-fetched.
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