1. Nature is out to kill us. Don’t be fooled by rainbows and sunsets. Beneath all the beauty is a brutal evolutionary struggle between humans and microbial pathogens. We adapt to new diseases over time; the problem is that pathogens evolve much faster. E. coli, for example, reproduces so quickly that it can pack as many mutations into a day as humans do in a millennium. A new pathogen emerges, on average, every four to five years. Covid-19 has been bad enough, but the larger danger comes from a novel influenza that has a high fatality rate and is highly transmissible before the development of symptoms. Modeling indicates a 3 percent probability each year of a flu pandemic with a fatality rate similar to the 2009 swine flu pandemic (which took from 150,000 to 575,000 lives worldwide in its first year, compared with approximately 2 million deaths after one year of covid-19). There is a 1 percent yearly probability of an influenza pandemic that causes 6 million deaths or more.
2. We are making the problem worse. About 75 percent of new emerging diseases are zoonotic (originating in animals). And humans amplify that threat in a variety of ways. The demand for protein has led to vast increases in the number and concentration of domesticated animals such as pigs, which are grunting petri dishes of disease. At the same time, deforestation is bringing humans into more frequent contact with wildlife such as bats, which effectively spread infection through their waste. Nature offers a poisonous smorgasbord of dangerous pathogens. Scientists in the Predict program have discovered 1,200 animal-borne diseases over the past several years and estimate there may be 700,000 more we don’t know about.
3. Isolation from these threats is a myth. Nearly everywhere on Earth is a day’s plane ride to London or Atlanta. And as we have seen, the spread of disease outside our borders in places such as Brazil, South Africa or Britain can lead to genetic variants that evade immunity or become more deadly. We are far less effective in fighting diseases here if they are not effectively fought elsewhere.
4. Decentralization is good political theory and bad health policy. The U.S. response to covid-19 is divided among more than 3,000 state, local and tribal health departments and agencies — and you can tell. The federal government initially failed to provide adequate support for testing and contact tracing, failed to effectively distribute medical supplies and equipment, failed to standardize epidemic data, and failed to set and enforce rational triggers for stay-at-home orders and school closings. The result has been a patchwork response in which large portions of the country essentially surrendered to the spread of the pathogen.
5. Altruism is not an effective motivator of behavior change. Why have so many Americans failed to take relatively minor preventive steps such as mask-wearing and social distancing? Part of this was because of a president who consistently played down and politicized a public health crisis, for which he has blood on his hands. But the problem runs deeper than red-state resistance. As the disease surged late last year, more than 70 percent of its onward spread came from people ages 20 to 49. But more than 80 percent of the people who have died because of covid-19 (as of early February) are 65 or older. Consciously or not, this is a massive act of intergenerational betrayal. Consider it another way: If you are 65 or older and get the disease, you have a 5.6 percent chance of dying. If you are 20 to 49 and get the disease, you have a .0092 percent chance of dying. It is impossible to avoid the question: How would U.S. behavior have been different if irresponsible actions had been more closely aligned with the risk of death? When those actions and risks are misaligned, only effective government action can make up for the lack of better motives.
6. Though we are better prepared for the next one, we are not prepared for the big one. If our response were calibrated to the urgency of the danger, we would slow deforestation and better police the wildlife trade. We would better regulate or even reconsider factory farming. We would engage in a much broader, ongoing effort to monitor for pathogens that spread from animals to humans. We would speed up the creation of a genetic catalogue of zoonotic diseases that might help us identify and test for new threats. We would invest more to strengthen health systems in the developing world, so they can snuff out the early sparks of infectious disease. We would adequately fund pandemic preparedness in the United States and increase the ability of the federal government to set policy and direct resources during a health crisis.
The possible consequences of our inattention are horrible and entirely foreseeable.