Sam Harris speaks with Michael Osterholm about his new book, The Big One: How We Must Prepare for Future Deadly Pandemics. They discuss the lessons learned from the COVID-19 pandemic, the major mistakes made in the public health response—including lockdowns, school closures, and border policies—the science of airborne versus droplet transmission, the promise and controversy of mRNA vaccines, the reality of vaccine adverse events, the politicization of vaccine hesitancy, and the erosion of scientific institutions like the CDC and HHS under the Trump administration. Looking forward, they explore the characteristics of a future, more deadly pandemic—what Osterholm calls “The Big One”—and what we should be doing to prepare for it. If the Making Sense podcast logo in your player is BLACK, you can SUBSCRIBE to gain access to all full-length episodes at samharris.org/subscribe.
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I am here with Michael Osterholm.
Michael, thanks for joining me.
Thank you for having me.
So you have written a um an alarming book titled The Big One, How We Must Prepare for Future Deadly Pandemics.
Uh you co-wrote that with uh Mark Olshaker.
And um we're gonna get into that.
I mean, obviously we're we you we're um I think as a presage to uh your book.
I mean, you're actually book your book accomplishes uh much of this as well.
I think we should do a bit of a post-mortem on the COVID pandemic and and what we've learned or failed to learn from that experience.
That was as bad as that was, that was a kind of dress rehearsal for the thing you're imagining, which would be quite a bit worse.
Before we jump in, what what is your scientific background and and what what are your responsibilities as a um an epidemiologist at this point?
Well, I actually was fortunate enough to know when I was in seventh grade I wanted to become a medical detective.
It turned out that uh someone in my small Iowa farm town actually subscribed to the New Yorker.
And at that time there were a series of uh articles in there by Burton Roger, which were medical who doneits, basically kind of uh the CDC versions of these outbreaks.
And when I read that, I said, this is what I want to do.
So when I graduated from undergraduate, I immediately went to graduate school at the University of Minnesota uh in uh infectious disease epidemiology, and uh at the same time was employed by the Minnesota Department of Health.
And so I've now been in the business 50 years, of which 25 of those years were split between uh the university and the State Health Department, and 25 I've just been at the university.
Throughout that time, I also have had a number of other appointments.
And I think for the context of our comments today, I've had a role in every presidential administration since Ronald Reagan, having been involved with HIVAIDS back in the 1980s.
And during Trump won, I was a science envoy for the State Department going around the world trying to help get us better prepared for a pandemic that was in 2017-18.
Not sure we did so well that way.
Uh, and then of course I was on the Biden Harris transition team.
So I'm an epidemiologist by training.
Our group has been involved with many, many uh outbreaks of international importance.
And then at the university, I started uh the Center for Infectious Research and Policy in 2001, the same week as 9-11.
And uh we had already been very involved in the area of bioterrorism.
In fact, I wrote a book that was published uh on September 1st of 2000 that was called Living Terrors, what our country needs to know was five of the coming bioterrors catastrophe.
And right after uh, of course, 9-11, my book, which I think I had bought 14 of the 18 copies that were sold in the year between its publication and 9-11, then became a New York Times bestseller.
Uh, I ended up splitting my time between Minnesota and and the Department of Health Human Services in Washington as an advisor to the Secretary Tommy Thompson.
So I was very involved in those international activities and uh have have really had a variety of experiences, but I've published a lot even early on on the issue of the potential for pandemics.
2017, I published the book, Deadliest Enemies, Our War Against Killer Germs, and I laid out in three chapters what a a serious pandemic would look like, uh, which uh I had suggested it was an influenza virus.
It was a obviously a coronavirus, but if you read the three chapters, you would think it was exactly what had happened throughout the course.
So I continue to be obviously uh very engrossed in the issue of pandemic preparedness, uh, but it comes from a lifetime of experience with infectious diseases.
Well, as you know, management has changed over at the HHS.
Since you were there, I think we'll probably get a chance to comment on that.
But let's talk about your experience during COVID.
Uh, the the uh many of us uh I think first discovered you on uh Joe Rogan's podcast.
You appeared fairly early in the pandemic, and I must say we're to uh found yourself talking to a very Different Joe Rogan than the Joe Rogan that we uh have him with us now uh on these topics.
What was your experience of trying to message into the uh a very fragmented and and and fragmenting information landscape during the the first months and maybe perhaps first year of COVID.
Yeah.
Well, first of all, we picked up on this uh situation in Wuhan actually on December 30th of uh 2019.
So we were well aware of what was going on at that time, and of course, we didn't have an infectious agent at the point.
But then soon uh after uh we realized it wasn't influenza virus, and I thought, well, this is great.
We can probably control this because I'd been very involved with both SARS and MERS to other coronavirus infections that had occurred uh in 2003, SARS, this severe acute respiratory syndrome disease that came out of China was one that because I was still at the Department of Health Human Services, I helped respond at a national level.
And what we found was a virus that was not that infectious uh except for a few super spreaders, but enough so that we could really control it.
But it killed anywhere up to 15% of the people.
And then in 2012, uh we had another coronavirus emerge on the Arabian Peninsula, MERS, Middle Eastern Respiratory Syndrome, a virus that uh originated from camels.
And very much the same picture as we saw with SARS in the sense that it wasn't that infectious, we could really control it.
But the difference was 35% of the people who developed uh MERS died from it.
And so that was surely a warning.
And in my book in 2017, when I laid out the three chapters that talked about pandemics, one of the chapters after that was on coronavirus as a harbinger of things to come.
And so I I kind of sensed that we could see a very different world.
Well, along comes uh MERS and following SARS, giving us a sense of what could be really bad.
But then, of course, we saw COVID arrive and it was highly, highly infectious, unlike the other two, but it was not killing nearly as many, one and a half percent of the people, which still is a very real and large number.
And so at that point, when early in the pandemic, I thought if this was a a coronavirus, this is good news.
We're gonna be able to control it, like we did SARS and MERS.
Well, that went out the window quickly when we recognized that there was clearly a lot of airborne aerosol-based transmission occurring, people not even knowing they were infectious, infecting people at long distances away from them.
And uh on January 20th of 2020, I actually wrote a piece on our website and said, this is the next pandemic, get on with it.
And uh that was not well received by many.
Uh, they didn't want to believe that such a thing was going to happen.
And you noted that about the issue with Joe Rogan, actually on March 10th of 2020, I was on Rogan, and uh at that time I made a prediction that I thought we could easily see 800,000 deaths in the next 18 months in this country.
And I might as well said bad things about everybody's mother uh because that too was not well received.
And of course, you know what happened.
Uh in fact, uh 18 months later, we were at 790,000 deaths.
Yeah.
And so I think that was the hard part was getting people early on to recognize we really were in the face of this.
And it wasn't until middle March before the WHO actually declared it a pandemic.
Well, what was the resistance to acknowledging the uh airborne contagiousness of COVID?
It seemed there's something you you talk about in your book a bit.
It seemed that we were very slow to admit this, and uh, even as we were starting to admit it, there was this emphasis on droplet spread as opposed to aerosol spread, which you know you perhaps you can take a moment to describe the difference, but it's a very important difference from a an epidemiological point of view.
Well, you know, I hate to admit this, but we still have a challenge today.
There's still a core group of people that don't believe that it's airborne.
What we mean by airborne and droplet-related transmission is how does the virus leave your body such that it would expose others to the virus?
And in the case of a respiratory infection in your lungs, in your nasal passages, that then you breathe out.
Basically, when I talk or you talk, uh, and when we cough, we have these large droplets that actually come out of our mouth, our nose, that if you're in the front two rows of a concert or a play, you can see the actor or singer, and you see these drops constantly coming out.
Well, they fall to the ground, usually within six to eight feet.
And so you could be in the same room as someone twenty feet away and never really be exposed if it's a droplet.
And there are some diseases that are primarily droplet transmitted.
However, an aerosol is that fine, fine material that's coming out of my mouth as I speak right now.
And if you could test this room, you'd find my aerosol has actually infiltrated much of the room.
And you'd have no idea that it's there.
To give you an idea of what an aerosol is like, think of walking outside and suddenly you smell cigarette smoke and 30 feet upwind from you is somebody smoking.
That's an aerosol.
That's what floats.
If you're in your house and a light light comes shining through the window and you see all those particles floating in the air, that's an aerosol.
They sit there.
And that's what is so challenging because they can move great distances.
And in fact, one of the classic outbreaks in an airborne related mode was ha happened right here in Minneapolis, uh, not far from where I am right now at the Hubert Humphrey Metrodome back when we had the Special Olympics here for the world.
And uh on the opening night ceremony, all of the uh participants, coaches, players, et cetera, marched in from the right field kind of garage or we call it, filled the infield and outfield.
Well, meanwhile, there were 64,000 people in the stands.
We had not had measles in this state for five almost five years.
Well, after that night, when a young boy from Argentina who stood almost on home plate was breaking with measles, there was an outbreak that has subsequently occurred over the next 10 weeks, 10 days to two weeks with the players, coaches, et cetera.
But in that opening night session, there was also an outbreak of people who had never had any other association with the Special Olympics except being at the opening night session.
And we had not, as I said, had indigenous measles in the state.
So we figured that this had to be uh involved.
When we actually placed where these people sat that night, they all sat in the very small same section of the stadium at 400 and uh almost 90 feet away from the home plate and where they're near an outtake fan was located in the stadium.
And it turned out that the air was coming out behind home plate, passing this young boy, and then literally traveled through the air to that otake fan uh at the time where Mark McGuire on steroids couldn't hit a home run.
And it basically infected everybody in that section who hadn't previously had measles or who had not been vaccinated.
And so it just shows you how dynamic this virus can be and its movement.
And that's measles, but measles and COVID viruses are very similar in how they're transmitted.
So you make the point that if the barrier you have put up or the precautions you have made would not prevent you smelling someone smoking a cigarette on the other side of those barriers or precautions, it's not going to prevent the transmission of an aerosol-based respiratory uh virus.
You know, we engaged in so much hygiene theater uh where people wanted to feel safe.
They wanted to say if you stay six feet away from me, it'll be okay.
We spent millions and millions of dollars on plexiglass shields that were supposed to protect people.
They provided no protection whatsoever.
And I think that's a lesson that really needs to be brought forward for future pandemics.
We need much better respiratory protection.
We need better air quality.
You know, when you and I drink water out of a tap, uh, or eat in most cases our food, we assume it's pretty much safe, but we never think about the air.
And in fact, that's one of the real challenges right now is for the future, how do we help protect people trying to stay, you know, in line with their everyday life, but at the same time keeping them from getting infected.
And one way to do that would be to have a much more effective type of respirator protection mask.
Uh, the one we have now is called an N95.
Basically, it's one where if you think about where does a mask leak, it never leaks in the material as such, just like a swim goggles, don't leak in the lens, they leak in the seal.
N95s are meant to be really tight to the face.
The problem with that is if you have something that's too occlusive, meaning it's blocking air, you suffocate.
So, what is unique about these N95 respirators is it's a material that's made to have enough porous space for air to move readily through it, but they have an electrostatic charge built into it.
So it traps all the virus if I'm breathing it out or if I'm inhaling it in.
And unfortunately, those type of respirators, as we call them, are really uh somewhat uncomfortable to wear for long periods of time.
We need we should have been investing after during and after the pandemic and come out with much better respiratory protection to deal with uh this airborne transmission issue.
Yes, we're going to talk about what we would want to uh prepare ourselves for the next pandemic uh again, what that could be quite a bit worse from COVID.
I mean, what one of the one of the things we're dealing with here, I think, is a kind of a background of fundamental skepticism about this topic because it it's been widely perceived that in some ways we overreacted to COVID, right?
I mean, you're and and we we implemented things that were um, you know, just dogmatically asserted to be true, which uh in retrospect weren't.
We there was a lot of confusion around what we knew and when we knew it, you know, COVID was a moving target and the scientific messaging around that movement was often inept.
Half of our society seems to imagine that the COVID vaccines were more dangerous than COVID itself.
Uh, I believe we have uh someone running the HHS, uh, RFK Jr., who is a uh uh a fabulist and confabulator and liar and uh loon to a degree that I it's a little hard to exaggerate, who uh is one of these people, he I think he seems to believe that uh the vaccines were in fact more dangerous than the the illness.
And we'll we may talk about the implications of that.
But there's a lot of confusion here.
Uh so to be clear, I mean I I think we should say whatever we want to say about the lessons learned or not from COVID.
But in talking about what you call the big one, we are talking about something that is unambiguously awful, where the mortality rate is, you know, an order of magnitude or worse than the mortality rate of COVID.
And you and this will be something where the bodies will in fact be stacking up on the uh in the streets, and it'll be completely unambiguous as to whether this is a lethal pathogen that we need to worry about.
And so the first thing you have just put forward as uh something we really should have in hand and don't is a mask that is much easier to wear and much more comfortable to wear, perhaps one that's washable, perhaps one that will people will not hesitate to wear if they needed it, and that it's uh it's at least as good as an N95 that we have today.
And so who's building that, I don't know, but somebody should get to work on that, given what we're about to say.
You know, to add context to this, because I I appreciate very much how you just laid it out.
I think you were very accurate in what you had to say.
But you know, I have experienced throughout my entire career a kind of bad news mic momentum.
You know, I wrote the book on bioterrorism and what anthrax could do, it ended up doing it.
In 2017, when I wrote about what a pandemic could look like, that's what uh COVID actually became.
In each of those instances before the events happened, everybody just said you're just a scary guy.
Well, let me just be really clear about this idea of what could be the big one.
And in fact, I mentioned or earlier that the coronaviruses that we have identified causing serious illness in humans, SARS, MERS, and COVID.
Basically, what has fortunately kept those apart from their worst details are literally just something that's a temporary basis.
What I mean by that is that COVID could very well have been much more seriously causing illness, but it didn't.
It's one in one and a half percent deaths.
Well, it turns out that right now we've identified new coronaviruses in the wild in animals that have the infectiousness of what COVID was, but it has on board also the genetic packages that could kill like MERS and SARS.
So, you know, I I already said, you know, we've documented MERS killed 35% of the people that infected.
You know, so the idea of what I'm putting forward is even if it's seven or ten percent case fatality rate, the percent of people who get sick and die, is still a lot less than what MERS could present to us if it was in highly infectious.
So I think people cannot deny that this is in fact truly a possibility.
And the fact that we've actually identified this virus in nature is really important.
Remind me, is MERS more like 30% fatal?
30, 35 percent.
Yeah.
And again, I I I worked on that extensively.
I was a noted uh uh an advisor of the Royal Family, the United Air Emirates, and I was actually on the Arabian Peninsula working on that.
And then when a in 2015, when an individual uh who had been to the Middle East came back home to Seoul Korea, they came home with MERS, not realizing that they were hospitalized in Seoul and created several hospital-based outbreaks where they had been seen and again had that very high case fatality rate.
I was in Seoul helping with that outbreak investigation.
So I've seen SARS and MERS up close.
And I can tell you, under no conditions where I want to see either one of them develop the ability to be transmitted like COVID.
So it well, perhaps we should linger on the um controversy around the origins of COVID.
I as far as I know, the jury is still out and it would be rational to consider a a lab leak origin and a wet market origin as something on the order of a coin toss.
I mean, I I know people are biased in one direction or the other, but neither thesis is crazy.
Is that still the state of our understanding?
Yeah.
And let me add context to that.
You know, I was on the National Science Advisory Board for Biosecurity, the newly appointed committee in 2005 that was uh supposed to oversee national research at the federal government level and in other labs around the country for reasons of safety.
And so, you know, I was very involved with that.
In 2012, I actually was one of several people on the NSAB that raised real concerns about how some of the flu research was being conducted.
So if anything, it many people would call me a hawk on lab safety and the challenges about transmission.
Having said that, I am completely on board with what you just said.
We're never going to know.
I it it's a it's it's a coin toss.
Was it uh, you know, a lab leak, was it a spillover from nature?
And my whole point is get over it and move on, because what we're not doing is getting prepared for the future, which could again be either one, a lab leak or a potential spillover.
And so I think, you know, as long as we keep fixated on that question, which will never provide, we'll never have an answer that will provide us any comfort as to knowing what happened, we need to prepare for the future.
So um in hindsight, what uh would you say we did wrong during COVID?
What were the most if if you could just take the top three mistakes and not make them, what would you change about our response to the pandemic?
Well, all three of the examples I'm going to give you really come back to humility and communication.
Okay.
Let me take the first one.
I wrote a piece in the Washington Post in early March of 2020 saying don't do lockdowns.
They'll never work.
Because of the fact we were talking about something that was likely to last up two to three years.
And could we really lock down for that long of a time period?
And the answer was absolutely no.
Well, what about slow the slow the curve?
That was where I'm going to come next.
Okay.
And so what I'd proposed is we use a concept of snow days.
And what was that was all about was the idea that at that early part of the pandemic we had no vaccines, we had limited drug availability.
But what was the one thing we could do to keep people from dying?
Is providing them good supportive medical care.
And if your hospital is at 140% census where people were in the hallways and beds and parking garages, you were getting bad care and a lot of people are going to die.
And so my whole per purpose here was to say, you know, what method would help us here reduce that?
Well, let people know what the hospital census is every day.
You know, make it your hospital has a public number, you can go look it up.
And if we got to 90, 95%, we would ask people to voluntarily back off of public events of maybe even schools, uh, et cetera.
And then when that number came back down, then you could begin to resume these activities, and again, we'd keep doing that day after day.
That would have given us both a public awareness of what was happening and the fact that our really most important job was to keep the hospitals from being overrun.
Michael, sorry to interrupt, but isn't this epiphany contingent upon understanding that it's an airborne illness?
And if we're if we there was a moment there where we were, you know, wiping down our packages because we were worried about foamites.
So at what point was it absolutely obvious that we were, at least to those who are willing to admit it, you know, that we're this was the worst case scenario with respect to infectiousness.
At what point was it obvious that this was airborne and aerosol and that you were not going to, you're not going to lock down so successfully so as to prevent its spread?
Yeah, there was a group of us early on that published information on this issue clearly demonstrating this was airborne.
So this was as early as February and March.
And we were very critical at that time of the WHO and to some degree parts of the CDC, because they were not on board with this, even though there was a very you know significant data supporting it.
So that did happen.
But I think again coming back to why people stayed apart, whether it was airborne or whether it was droplet particles, they still did.
And so one of the things I think there's a lot of revisionist uh revision of history going on right now with COVID.
And one of those was lockdowns.
And it turns out that in March of 2020, 41 states initiated some kind of what they called lockdowns.
Now you have to understand I don't know what a lockdown really is when you think about all the different things that were tried but take the state of Minnesota.
We technically went into a lockdown in March of 2020.
Our governor issued a directive order basically telling all non-essential workers basically to stay home.
The problem was 82% of our workforce was deemed as essential workers.
Now that wasn't a lockdown and even with that by early June all but one of the 41 states had eliminated those lockdowns.
So people keep talking about lockdowns that lasted for ye months and months up to several years.
That was not the case.
There were surely localized activities where people canceled events, schools were decided, but it wasn't based on a national federal level and I think the challenge we had was people just were fearful of being in public places.
And particularly as some of these waves of the virus continued to greatly see increased cases.
And so I I think the challenge we have was uh with lockdowns was they were mischaracterized what happened.
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