Dr. Michael Osterholm: “The Pandemic Clock Is Ticking”

Today's guest is one of the world's most trusted voices on pandemics, Dr. Michael Auststerhomem. This is real. We can tell you right now the pandemic clock is ticking. We don't know what time it is. Do not do lockdown. If we got to 90 95% capacity, then please for the next two weeks, slow down and then get it back down again so you can ride out the next wave. We spent millions and millions and millions of dollars on things like plexiglass that made no difference whatsoever. Science is not truth. Science is the pursuit of truth. He has advised every US administration since Ronald Reagan and led world responses to SARS and MS.

He's authored a new book, The Big One: How We Must Prepare for Future Deadly Pandemics. The vaccine saved millions of lives around the world and likely at least 1.2 to 1.8 million lives in the United States. We just cancelled our investment as a country in mRNA technology for flu vaccines. There is not a scientific trained person in the upper echelon of CDC today. There is no one whose job it is in the White House to be overseeing bio preparedness. None. This is not a conversation about politics. It's about facts, lessons learned, and how we actually get ready for what's coming next. Technology could be an incredible uh opportunity to take some of these real challenges off the table.

There is so much good in this world. The difference between those two scenarios is millions and millions and millions of deaths. Okay. So, what did we just do? The Nick Styley Show. Yeah, it's an honor to be with you today. Hey, it's a the honor is mine, sir. I I actually listen to your show, so I uh I I I like the way that in fact when you when you were very kind to offer an opportunity here. I I really appreciate it because I like the way you get into conversations. You do very good job at it. As somebody who does podcasts, you do a very good job of conversations. I appreciate that immensely.

And as I'm uh going to mention in the in the intro here, you're someone I respect very much. So that that does mean a lot uh to hear that coming from you. Yeah. Yeah. Well, you're good at it. I mean, you you can tell that. I mean, when you get into it, you don't even realize you're doing it. You can tell it. I mean, you just do it, you know. Yeah. That's that's it's like it's like a great wide receiver, you know, when they when they're catching the ball, it's like nothing big for them. Even though they're going to get the hell blast out of them one second later, they're just good at it. Well, gosh, thank you so much.

I all I know is that it's um I am just having so much fun doing it and having run businesses most of my life. This is really I'd say the first time where I just look at this and go, "Wow, I would do this for free. It's just fun and interesting and stimulating and and I just really enjoy it." And so that's why you like being a wide receiver and not making uh hamburgers at McDonald's. See, that's the difference. Yeah. Yeah. Yeah. Dr. Auststerhomem, on a personal note, I just wanted to make sure to say during lockdowns, you were a voice of clarity during a very uncertain time for me and for so many other people.

I know numerous ER doctors who are on the front lines of COVID. And man, when they found your show, they all texted me the same thing. some version of this guy gets it and I was uh just really impressed by your work on the podcast. Some of it was the accuracy of your predictions. Um but more than anything it was the honesty about what was known, what wasn't, what work was going on to figure out the things that weren't known and the willingness to say I don't know when that was the truth. because there were a lot of people giving oversimplified answers that might have brought moments of short fleeting comfort, but they led to they swed the seeds of long-term confusion.

And I just really appreciated the consistent messaging and especially about coming together and supporting each other. And that kind of leadership mattered then, it matters now. And I'm honored to have you here today. Well, thank you, Nick. It's my honor to be here with you. And as uh I've shared, I uh very much appreciate the manner in which you do your podcast. So, somebody who does podcasts, we're in that kind of group of individuals that admire or don't admire our colleagues and uh you are one of those ones that I actually spend my time listening to and so I want to tell you I appreciate very much the chance to be with you.

Thank you so much. Um the the book is the big one which is out now uh how we must prepare for future deadly pandemics. And uh I was I was really relieved when I read the book to find out that uh CO was a once in a-lifetime event and we never have to worry about something like that happening again. Did I did I get that right? Well uh a great provocative question. Well delivered. uh you know let me just start out for the listeners uh that may not be familiar with our work or my work. You know I have been in this business now 50 years. Um I have had a role in every presidential administration since Ronald Reagan including in Trump one I was a science envoy for the state department.

Um was on the Biden Harris transition team COVID work. Um I was at the state health department for 25 of those 50 years as well as at the university at the same time. I worked for two Republican governors, two Democratic governors, and as we affectionately say in Minnesota, one independent wrestler, Jesse Ventura. And no one would know my partisan politics. I was a private in the public health army. It's my job to basically do good public health. And I today I I would say that my real goal is just to call balls and strikes. You know, I'm not here as a political uh issue with anyone. I'll say what I believe was the ball and strike count uh and why it was that.

And so I think as we go through this today, I'm going to probably sound like somehow I Oh, wait a minute. It's confusing me. Is he on this side of the aisle or is he on that side of the aisle? And I'm not on any side of the aisle. I'm just try to call balls and strikes. I think we need more of that in our general discourse about an array of issues. But let's jump into your area of expertise which are infectious diseases and pandemics. Um you in the in the book you use this really clever story mechanism which is you tell you and your co-author tell the story of what it would be like if a new SARS virus came into the world that was more deadly than COVID.

And we get in the first chapter a little glimpse of it's it's starting to percolate across the globe. And then you follow that up with facts and data and research on why that would happen. And then in chapter two, it's the same thing. We get a continuation of the story. Then you dive into the research behind it and and so on and so forth through the rest of the book. And I was curious why you and your co-author decided to tell uh a story like that and why that mechanism was important to communicate things that charts and graphs might not capture. Well uh first of all I want to acknowledge my co-author Mark Olshaker.

This is a second book that we did together and uh it was a blessing to work with him. Um when we wanted to put this together uh I was of somewhat ambivalence about wait a minute we really need a 911 report like report to be done where you know I I had the good fortune uh to serve in the uh Bush administration again splitting my time between Minnesota and HHS after 911 and uh you I was there more from the bioteterrorism perspective and I got to watch the early days of the 911 commission come together and what I saw was an amazing effort to be nonpartisan. Uh the two chairs were incredible and they uncovered a lot of mistakes, a lot of things that we needed to correct, but there was never fingerpointing.

It wasn't blame. It was okay, this is the hot wash we need to have. What can we learn from this? What can we make us better prepared so this one doesn't happen again? But if it does happen again, how can we respond in a more effective way? And so I was always hoping for a 9/11 like commission and I had promoted that for several years. Now, in the meantime, we surely did look at this book and we said, well, if there's not going to be this, this has got to be my best shot to get that out there. And as as as ridiculous as this may sound, I would actually call this book a love story because it's really about my what I'm leaving my kids and grandkids.

And if we can't be better prepared for the next pandemic and I can't help with that, then what have I done for them? And so what we did is we wanted to tell a story. You know, I come from smalltown Iowa, you know, and if you can't sell something at the 10:00 coffee club at the SND Cafe on Main Street, you know, forget it. You can't sell it. Okay. So, you got to be able to help the individuals reading this understand what's going on. And so, one of the ways we thought about that was well, tell the story of what would be really a a much more severe pandemic, not even the real necessarily big one, but then tie that back, as you said, to the issues around mandates or communication, vaccines, etc.

And so that people could see why would it unfold like it did and then what did that mean? And I think that was a device that we hoped would help people better understand what we're talking about. And let me just for the sake of understanding what the likelihood of this is that we're going to see the big one. We can tell you right now the pandemic clock is ticking. We don't know what time it is. We could have another major one tomorrow. And for this particular virus that we used in the scenario is a corona virus much like we saw with COVID and what happened there. But I also had the good fortune or unfortune uh to work on the original SARS outbreak that occurred in 2003.

I was still at HHS part-time and I watched this this virus emerge for the first time as a corona virus really causing serious illness and deaths. And fortunately this virus which emerged in China obviously a spillover from animals and uh it was one that killed up to 15 to 20% of the people that got it but it wasn't that infectious. There were a few people that were super spreaders but once we could basically surround them and keep them from spreading more we we we ended it. Well, then in 2012, we had another episode with another corona virus called MS, Middle Eastern respiratory syndrome. And that happened in 2012, and I actually was advising the royal family of the United Arab Emirick.

So, I was actually on the Arabian Peninsula working on this issue, watching what happened with camels, transmitting it to the to the human population, and that one killed up to 35% of the people. And then when it spilled over one more time from somebody who was a resident of South Korea who had been to the Middle East had come back with MS, no one recognized what it was at the time and started a large outbreak in Seoul. Again, the same thing happened. I I went and helped in the hospital outbreak in Seoul at Samsung Medical Center and it was one where there was a couple of super spreaders but generally we could contain it.

But that one again remember killed 30 to 35% of the people. So now along comes 2020 and what we see now is a virus that is highly infectious. You know widespread transmission but fortunately it only kills about 1 to one and a half% of the people and you can say well that's you know not much. Well it's a lot if you get the infect the whole world. But what we now have and we've identified these viruses viruses in bats that basically have the ability to be transmitted like SARS Kovv2 or the the co virus highly infectious but it also has on board the genetic makeup to kill at the rate of 20 to 35%.

Now imagine instead of 1 and a.5% this pandemic was 20 or 25%. case fatality rate. You can see the difference. And so when we talk about this one, actually this one is only about seven times more lethal than was COVID. This wasn't 20 or 25 times. And so I think that's where we have to help people understand these viruses already exist. They're in nature and they're going to spill over. This isn't about something, you know, A plus B plus horror movie equals, you know, interesting outcome. This is real. Yeah. What scares you the most as you put this book together and you're looking towards the future?

Well, interesting enough, I'm actually an optimist by nature, and I actually believe that with the right dedication, we could in fact develop the vaccines that could be made that would stop these viruses dead in their tracks and could be made in advance in a way that such as we could administer them quickly around the world. And if we could do that, it would fundamentally change what a pandemic could do. It would still start. it would still have its initial hit, but we could do so much to change that. Now, the problem with that is is that when you look at our priorities for defense, and I put that in quotes, is the fact that we have killed many, many more people in this world and in our country from microbes in the last century than we have from all the wars.

And yet, as much as we invest in in the defense side of the house, which I I'm not an expert in, so I can't say it's too much or too little, whatever. Okay? We've almost put nothing into defenses against our microbes. If we had the kind of resources that one aircraft carrier would provide, I am convinced in the next 5 to seven years, we could actually develop vaccines that would be highly effective and they could be made in advance on in the freezer ready to go. And we're not doing that. We're just not doing that. So, so and and right now what I'm watching is of course the destruction of even our immediate public health response.

What's happening right now is is the darkest days I believe in the last 100 years of public health. And so if you can't be prepared for the immediate time, how are you going to be prepared for something down the road like this? But I think in the end, I'm going to keep fighting for what I believe is the kind of research and development that we could do. And our center, by the way, happens to be the repository internationally for what we call vaccine roadmaps for corona viruses and for influenza. And we're mapping out every day, keeping them updated where's the research at, what what are we finding, what needs yet to be done, what's the next step to get over this particular hurdle.

And and that's what gives me optimism. This is not just wishful thinking. I think we could get there. So, I'm optimistic about that. But we've got to have a major change in mindset and realize these microbes are as deadly, if not more deadly, than someone's armaments. Yeah. Two things struck me there. One, it sounds like there are people trying to do the work, and it wouldn't take that much more funding to put us in a place where we were much better prepared to deal with what is likely coming down the the pipeline here. Yeah. And then, can I give you an example of that real quickly? I think that'll help you.

This is the kind of choice that we've just made right now. If we had a major influenza pandemic, of which a 1918- like pandemic could happen tomorrow, we in the first 12 to 15 months based on the technology we currently have, meaning basically we grow influenza virus and chicken eggs and cell culture to make vaccine. We could make enough vaccine in the first 12 to 15 months to cover about a quarter of the world's population. That's it. It would take year two and three before we'd have more. In the meantime, millions of people would die. The mRNA technology vaccines, the one which of course was so important in COVID, actually has tremendous possibility of also being a good influenza vaccine.

Not great, meaning that we still get infected. You could still potentially get sick, but you would surely diminish greatly serious illness, hospitalizations, and deaths. Okay? If we could use mRNA technology, we could probably have enough vaccine in the first 9 to 12 months to vaccinate the world. The difference between those two scenarios is millions and millions and millions of deaths. Okay? So, what did we just do? We just cancelled our investment as a country in mRNA technology for flu vaccines. We had $500 million that we were working to make that a reality and and Mr. Kennedy just summarily ended it.

Well, and in terms of cost, it seems the cost of having to of society shutting down to one degree or another for 2 to 3 years versus a much shorter time. the the cost to develop these things would be a drop in the bucket versus what it would cost were we to have a pandemic break out and we're unprepared. The best insurance policy our country could buy in terms of protecting the masses. And not only that, but of course, as we learned from the pandemic, what happens here happens around the world and global economies crash as global economies, not just one country at a time. Uh and so you're absolutely right.

I mean, the the payback on this and remember this is not arbitrary. This is going to happen. It'd be like if you and I are on here now arguing, are we ever going to see another hurricane? You'd say, "What are you arguing about?" You know, we're going to see more hurricanes. We just don't know when, where, and how bad. We're going to see more pandemics. We just don't know when, where, and how bad. But I'm telling you, they're going to happen. They're going to happen for the world, and they're going to be bad. And why not take them off the table? Yeah. Well, as we look back on things we learned or didn't learn, I thought the the book does a a wonderful job of being like a 9/11 report as you described on trying to just examine what what worked, what didn't, what can we learn for the future.

Let's start with some of the touch point topics here regarding COVID. Um were lockdowns the right approach? Were they employed in the right ways? Thoughts on that? Uh, I'll start out with just the conclusion. No. Um, I wrote a piece in the Washington Post with Mark um in in March, early March of 2020. And I said, "Do not do lockdowns." That was the title of the piece in in the Washington Post. And the reason was is because I had this, you know, sense of what was going to happen. This was not going to be like a hurricane where it was going to blow through for a short period of time due to great destruction and then we go into recovery.

I had the vision that this was going to last for years. And so whatever you did, you had to make it last for years. Okay? Well, if you talk about lockdowns as 41 states did all starting in late March, every one of them was completely u ended ended by June, first part of June except for one state. and they never were going to work because in fact the virus was still going to be here out there. And so even if we shut down a a large part of our society, we're going to have to open up at some time. You can't stay locked down for 3 years. And so sure enough, if if in fact that were a question, China was an example of what I was talking about because two years in they had areas of China that had been in total lockdown.

I mean people had food brought to their homes and they did not vaccinate these populations after so much political pressure. They relaxed what their requirements for a lockdown and suddenly millions of Chinese died because the virus was still there. It just postponed it until they encountered it. And and so what we proposed was what is the most important thing in the earliest days of the pandemic that we could do to so people didn't die. Have good medical care. And if your hospitals are overrun and you're 140% capacity, you're not going to get any kind of good care at all. So what I we had proposed was a snow day approach saying don't do lockdowns because they're not going to work.

And by the way, in many cases there really weren't true lockdowns. Minnesota as an example. When our governor put in place an executive order for stay at home, they made it so that essential employees could still go to work. 82% of our workforce in Minnesota declared essential. Okay. So, I mean, was that really a lockdown? Okay. But the point of it was if you had snow days, what you would do is every hospital in the country, your hospital, every morning, you would know exactly what the census number is. And if we got to 90 95% capacity, then please for the next two weeks, slow down. You know, try to avoid large public gatherings.

Schools may be closed during that time. Okay? Not extensively, but at that time. And then get it back down again so you can ride out the next wave. And so the chances of surviving are going to be much higher if in fact you get that good medical care. And that's what we had proposed should be done. and my snow days didn't go very far. I guess that's a Midwesterner kind of thing. You know, they nobody thought that that was a great idea. But I still hold by that. Next time, don't do lockdowns. Manage it. If you don't have a vaccine, what's the most important next thing you have? You got medical care.

Don't let it collapse because you overrun it at these waves. That seems like such a common sense approach that even I can understand without any sort of public health background. Why why didn't that gain any traction as a I you know I don't know. I I mean I was you know I think it's hard for me sometimes to to say why. Uh and and early on, you know, I was kind of a thorn in the side of a lot of my colleagues. You know, I um I went on Joe Rogan, which by the way, talk about podcast, I have to come clean, okay? Early in the pandemic, th those first months. Um I got a request from Joe Rogan to come to his podcast, okay?

And I said to myself, who the hell's Joe Rogan? and and my younger staff people, you know, the my graduate students, they all looked at me like loser, are you a loser? You know, what's a biggest podcast in the world. Yeah. Loser. And I did. So I I went and did Joe Rogan, which was really a you know, I I thought it was a positive experience. I had a wonderful discourse with him. But I said at that time in early March, I said, "We're probably going to lose up to 800,000 people in the next uh 18 months." And you would have thought that among my colleagues and among a lot of people in the community, I was just the scariest, you know, horrible guy in the world.

Well, actually 18 months later, we were at 780,000 deaths. Yeah. So, you know, so it wasn't bad. But at the time, no one could actualize this. You know, it just seems so hard to imagine. And so one of the things we have to help people understand when you have a pandemic like this, it's going to be, you know, whether you die the first 6 months, the second six months, the third six months, the fourth six months, you're still dead. And so what we need to do is figure out how to get through several years of it. And and I think hopefully in the next pandemic, we'll think that way. Another example that fits very much with your question was closing borders.

You cannot stop a virus with wings with like these respiratory transmitted viruses. You can't. They're going to happen. And so when we fortified our west coast with all the ports, you know, everybody had to be tested coming in, etc. Because China was west of us, we didn't understand that the virus had just moved quickly to Italy and other countries in Europe because of transportation. and they brought it into New York and suddenly we're having this huge outbreak in New York and we're all sitting there trying to fight the West Coast battle. And so border closings don't work. Don't do them. And in fact, what they do is they're a disincentive for countries to report early on so that we get an early warning because they don't want to get, you know, basically labeled as the country where it came from.

And so I think there's another practical example we talk about in the book. You know, next time this happens, don't even think about border closings. You're not being irresponsible. You're not dropping the ball. You're just dealing with viral reality. This episode is brought to you by Manta Sleep. As you have astutely observed, I've got one of their sleep masks on my face right now. I'm staring up at thousands of watts of studio lights, and yet all I see is pure black. It's as though I've been dropped into the middle of a cave in Kentucky. [Music] This sleep mask helps me sleep like a baby. Waking up refreshed, ready to take on the day.

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Nick. That's mantasleep.com and the code is nicke. Join the pronap movement. Try the mantle sleep mask. Good night. When you mentioned the virus with wings and the let's see there was a tweet from the world health organization. uh it's quoted in the book fact COVID 19 is not airborne. Why were those various health organizations so slow to acknowledge that it was airborne? I mean, I can remember people in the community, they're still disinfecting their Amazon packages with with cleaning fluid uh 2 years into the pandemic because there was so much confusion around this issue and yeah, how did that happen?

Well, first of all, let me just reinforce what you just said. We spent millions and millions and millions of dollars on things like plexiglass that made no difference whatsoever. Um, and frankly, we still have people today that don't believe this is an airborne transmitted disease. Let me explain what airborne means. And and there's different definitions, but when you and I are breathing, we constantly in particular when we're speaking, we put out these droplets. If you ever been in the front row of a concert or a play, you know, you can see these droplets coming down on you. They usually fall within 6 to 8 feet of the your mouth in your nose.

Okay? And there are some diseases for which droplets are very important. But at the same time you're creating those, you're also creating aerosols. Aerosols are those very very fine little particles that you don't see unless for example you see sunlight coming through the window in your house and you see all this dust that appears to be floating there. Those are aerosols. Smoke is an aerosol. So that if in fact I'm walking down the street and I suddenly smell a cigarette smoke situation and I look at the that person's 30 feet ahead of me, that's an aerosol. Okay, I'm in a department store and I smell perfume four aisles before I get to the perfume department.

That's an aerosol. That's what most of what transmission for CO was all about. It was the aerosols and it was spreading through a large distance. And let me give you a classic example of just how dynamic aerosol transmission can be. I worked up an outbreak here in Minnesota uh in the 1990s at uh was a special Olympics global uh event here and opening night session they had all the teams from around the world march in by alphabet. A's came in first. They came into the Hubert Humphrey Metrodome from a like a big garage door in the right field. Walked down to home plate went up to third base left field and came back and finally the A's stopped on home plate.

Well, it turned out we had not had measles in our state for the previous five years. And that night, a young boy from Argentina was incubating and just breaking with measles on home plate. Well, there was an outbreak that occurred in the players, the coaches, the people who were on the day-to-day basis with this event. But there was 60,000 people in the stands, many of them who never attended another event for this event, for this thing. Well, we had a group of cases of measles that night, people who developed measles who'd only been to the opening night session. And when we actually located them by seats, they were all sitting in one section of about 200 seats in the far far far upper right side bleachers where Mark Magguire couldn't hit a home run at the time on steroids.

Okay, it was 420 ft up. What happened was when we looked at the air flow that came out from behind home plate, it came across home plate. And Barky Anderson, the coach of the Detroit Tigers, was probably right when you turn the fans on and off because then that smoke literally took off and it dumped all the way at the big ex exit air vent up at that section. That virus nailed everybody in that section who had not previously had measles vaccine or had measles. That's 420t away. Yeah. And and so that's what an aerosol can do. So, you know, when we're in public spaces in particular buildings, etc., you you have no idea how much of that aerosol activity is there.

And and that's what people didn't understand was that's how dynamic this transmission was, right? and in an enclosed space. I remember Denny's in the ' 80s when I was a kid growing up. They had a smoking section and a non-smoking section, but the entire restaurant smelled like smoke. It was Yeah, I seem to always get stuck behind the smoking section on an airplane. I was the next row of seat. It didn't matter. But you know this is an important point because you know there was a lot of uh accusations made that public health was basically treating different groups in different ways and most notably was the issue with the George Floyd riots in the Twin Cities and it was misinterpreted that we said there was no problem with the riots.

Okay. And in other words saying it's okay to have them. Uh whereas in the meantime, the Republican convention which resulted in cases of COVID occurring from this indoor exposure killed several notable people was was bad. Well, no. What happened was is that the Minnesota Department of Health did a very extensive surveillance effort in the two weeks after George Floyd happened and we saw no increase in CO here, right? These were all outdoor events and they so and they are but that changed because as we got into the omccron variant which was much more infectious we actually started to see outbreaks in outdoor groups that got together that were closed together.

We had a a concert for example was outdoor concert where people stood next to each other for 3 hours didn't know each other and we could show pockets of co that occurred that night. So, so even that changed and that's where as you pointed out earlier, this is where we needed the humility to say, well, originally outdoor air seemed pretty good, but this virus is so infectious now. If you're standing in large populations of people outside, you could still transmit the virus. But at the time, and I still hear this all the time, oh, you public health people were, you know, so pro- George Floyd riots in terms of COVID, but you complained to us about the Republican convention.

It's just what happened. It was a matter of indoor versus outdoor initially, but then the virus got Yeah. indoor outdoor initially, but then the virus got so infectious even outdoor posed a challenge. What about school closures? Let's turn to that for a second. Were looking back what pros and cons was was it worth it? Was it the right we missed that one again? So the first year of the pandemic, 199 kids in this country died from COVID. And if you look at the rate, it was quite low, but it was real. And there were a lot of studies done that showed that you didn't need to close schools. You could keep them open.

Uh you know, didn't worry about transmission that much. Well, then what happened was as the variance changed and we got into the to the delta variant into omocrron, it took a very different tact on kids. Ultimately, just in the next two years, we had year 1, year two, and year three, we had over almost 1,600 kids die of COVID. 87% of the COVID deaths in kids was in year two and three, not in year one. But we kept handling it was year one. And so again, when we had outbreaks in schools, which we had many in the year two and three, we kept referring back schools are safe, everything. Snow days would have worked very well there.

We had outbreaks in schools that we could have said, you know, for the next two weeks. We're not trying to keep schools closed. We're just saying you got to let this tone down. There was an outstanding study done by a group in Boston looking at COVID transmission in households. That's the with the Delta and and Omocron variants and over 80% of the cases that we documented in households originated from kids bringing it home from school year two and three not in year one and yet we operated and it's still if you go to the medical literature it's still year one data seems to be the prevalent conclusion.

It's not a problem. No, it was so dependent on the variant. That's again why when you raise it why humility is so important. You know if I if I could just share one truth with the audience here science is not truth. Science is the pursuit of truth. And every day we're going to learn new things. Every day we got to come back and re-evaluate. Well that's what we knew yesterday. And I can't tell you Nick how many times I said to myself I'd go to sleep and I'd say boy I wish I knew today what the hell I'm going to know six weeks from now. I wish I do it today, you know, and we needed to have more of that sense of that.

Well, and I certainly seems to me that had there been more communication from top health officials that had a little bit more I don't know what I don't know yet and I don't know how things are going to change or how the variance may change, how the circumstances on the ground may change as this thing develops. If that had happened early on, the lines of communication would have been much stronger with the public because when there's a sense of certainty from public health officials who are describing this and what to do and then things change, well, suddenly we look back and we go, "Oh, well, he was he or she was wrong before.

Why would they be right now?" And it sews the seeds of distrust. And I think a that little bit of humility at the beginning, more messaging that acknowledged the lack of certainty would have gone so far into helping people along the ways along the way of the uh the broader experience of of the two to three years. I think you're absolutely right and I would hope that that's a lesson we learn for the future and that we do understand that. Let let me give you a case in point. Another one that I got stuck on when we had the first results out of Operation Warp Speed within a year. They were simply remarkable.

94 96% protection against getting ill, okay, with the vaccine. But it was only for two months, but it still was very significant. But anyone who had worked with corona viruses knew that they were notorious for waning immunity. So if you get infected today, you know, two years from now, you may have very little protection left in your body. And I had actually in several meetings really urged that we just don't put those results out, but we continue to follow these cohorts of people who are part of these studies and say what happens in month three or five or 10 or 12 and we'll find out if we have way immunity because if we do, we may need to tell people to get a booster.

Yeah. Yeah, if we had said that right up front and then every month we gave them the number and said, "Ah, 94 uh 87, 82, now we're down to 60% protection. We're going to probably need a booster." People could have understood that. I think that they would have accepted that. But so what happened was in the summer of 2021 started on the Cape, you know, basically saw these huge outbreaks of people who had previously been vaccinated and all of a sudden was wait a minute, you didn't tell us the truth. And people were truthful. They just hadn't thought through what could be the next level of information we need to act on.

And so boosters should never have been a surprise. and and people understand why is not a surprise and why that was important. And I think those are the kind of lessons that for future pandemics they should be marked right now and and put into place. Yeah. And I think it's not necessarily the line of thinking that I went down myself, but I can empathize with a line of thinking where if you didn't know about say the existence of the Sidrap podcast, which is where I was getting the majority of my information uh during that time, you might be looking at media figures and and public health figures on TV and when the booster comes as as a surprise and there have been several things that were stated as certainties and then facts on the ground change the the disease changes the approaches to it change.

Suddenly they seem like those were somebody was not telling them the truth at the beginning and then you easily come to the conclusion that the boosters are a profit grab by the pharmaceutical companies or other you know various uh that there are intentions going on behind the scenes that we're not aware that the public is not aware of and a lot of it comes down to the nuance of communication. So it's not so much are we lying, are we telling the truth, but understanding the nuances of communication and that seems critical to your understanding of public health, but maybe not these public health institutes in general.

Is that fair to say? No, I think I think you got it very well. I think I'd add one maybe additional piece to that is you got to anticipate the future. So part of your communication is about saying, you know, I don't know for sure how this vaccine is going to hold up at 6 months or 12 months. Just anticipate that and say, but we're going to tell you, you know, you can never overcommunicate in a public health crisis. You can never overcommunicate. And we should have been reinforcing all along that, you know, look at how well they're working right now, but we're going to keep on top of it. And it's issues like that.

There's issues in for example on the lockdowns we should have anticipated can you really lock down for three years no so what is it well it's medical care and I think each one of these were those kinds of issues that basically were I think really important to consider so that the public wasn't just surprised by them and you know it may turn out that it it didn't happen the vaccine worked perfectly well for three years at 95% protection but at least then I knew that I I think to me we got to stop thinking for the next day. Okay, it's it's to follow up with the great Wayne Greskby quote. Don't skate to where the puck is, skate to where it's going to be.

Okay, and that's what we should be doing a lot more of. When on vaccines, since we're talking about them, looking back now, what do you see in the possible risks from the vaccines? Was it what was done well? What wasn't? I mean there was a lot of debate and emotional conversations about vaccines at the time. It still is an emotional topic when it when people discuss it to this day and we actually can look back now and say okay what did the what does the data tell us? So what what does the evidence show now? Absolutely unequivocal. The vaccine saved millions of lives around the world and likely at least 1.2 to 1.8 8 million lives in the United States.

It was absolutely incredible. And it was a tragic finding that if you looked at the red states versus the blue states as the pandemic went on, the deaths continue to accelerate in the red states and not in the blue states, you know, which was in a sense a choice and that was really hard to watch. But I think that one of the things we got into and and I go into great detail in the book about the idea of mandating vaccines and actually in the summer of 2021 I actually wrote a piece that was published in our local newspaper here. Do not mandate COVID vaccines for our students at the University of Minnesota etc.

And the reason for that was again how do we get the most people vaccinated? Well, you can say a mandate would do that, but in this case, you could opt out if you had a religious objection. Okay? Well, of course, anybody who didn't want to take it was going to opt out. Well, once you opt out, you're done. You're not going to get them back. Okay? I would rather have encouraged everyone to get it, sell it the best I could. And for those that wouldn't get it, I just wouldn't give up on them. I'd keep saying, you know, why, why, why, and let them make their own choice. And I think that that whole issue of mandates for that kind of a vaccine where it didn't o stop transmission.

It didn't stop illness, but by God, it was incredibly powerful in stopping you from getting seriously ill and dying. And that to me is why I got mine and I keep getting mine. But we needed to sell that. We needed to make it so I'm not telling you exactly what you have to do. I'm trying to appeal to your better senses why you want to get it. And I think in the end you get more people vaccinated that way. Um then you know because in the end people can still opt out you know and most cases that only increased over time with people opting out and like I said once that happened you're never going to get them back.

Yeah. And I have always felt that even even if mandating it if if you were of the opinion hey if we mandate this for everyone that is the best for the common good. You also have to say, "Hey, this is at least in in the United States, we don't have a history of forcing people to do stuff." So, there are going to be a lot of people that are going to react poorly to a mandate. And the American way to approach that in my opinion is to retain that agency and that freedom of choice, but to explain to people in an ongoing conversation, not a one-time statement or declaration, but an ongoing conversation on why it is in their best interest and the broader best interest on how this thing can help and what the risks and benefits are.

Yeah. And you know, and and this is where someone may say I'm inconsistent and oh, I would never listen to him again. But you know, I very strongly support mandating the childhood vaccines for schools and school children because one, they're highly highly effective. They stop you from getting infected. They stop you from transmitting the virus. Okay? So they don't they do what what flu vaccines and co vaccines don't do. And in that regard, I can make the case that that is in fact a public good because if I can stop people from transmitting the virus, you know, it's like put another rod in the reactor, it keeps the reactor from blowing up.

And so there it's one where you're appealing to them because of the fact of the characteristics of the vaccine. And I try to go into that in great detail in the book why I could be not for mandating co vaccines but could be mandated or supporting mandation for uh measles vaccines. And I think that's that's also some of the nuances we haven't explained or why we need to make that those data very clear. I also think those are vaccines that have been around for a long time and this was something brand new and it wasn't crazy to have concerns about this brand new thing that was just put together. It's another reason why I would like to see that MN MNR am I saying that right?

Um research Yeah. Yeah. There we go. I'd like to see that research continue so that things can be developed and tested ahead of time and it's not just a oh the storm hit one it's going to take a really long time to get a new vaccine for whatever comes down the down the pipeline uh get that in place and we're back to that same spot where this thing is brand new. We haven't had time to test it amply. My response to that is amen. Yeah, I agree 100%. Yeah. Uh, let's turn real quick to another hot point, a a real dividing one for people and and I know I've I've heard you talk about this a little bit uh recently on the the lab leak versus did it come from a bat?

There's been a lot of time spent arguing over it. It seems like both are possibilities and for the future we need to just prepare for both options. But I I don't want to put words in your mouth, so I I just I'm going to let you run with that. You know, again, let me just add context to this. Um I actually served on the National Science Advisory Board for Bio Security from 2005 to 2012. This is the group that was first established to make sure that research done in the US was done safely and you know federal funders etc. And you know, I've raised concerns about the issue of lab leaks and challenges.

And in fact, in 2012, I was very outspoken, you might say, about some flu work that was being done that I was very concerned could leak out and could start the next pandemic. So, I'm hardly agnostic on the issue. Okay? But when it comes to what happened in Wuhan, there is absolutely no doubt in my mind, we will never know. We will never know. I don't care how many times you argue about it, how many angels can dance in the head of a pin, we're never going to know. And it's exactly as you laid out. That gives me all the reason to say we need to make sure we're doing everything we can to prepare for a lab leak potential or for a spillover in the future.

And quit wasting our time debating something that's not ever going to be decided. I don't know what it is. You know, if you had to ask me, I think the data tend to favor a bit more a real spillover, but I I can't say. And so, but I can say you are going to deal with this again. And so, what are we doing about it? What and and and we're not doing anything right now. We're basically uh whether it be lab leak or, you know, spillover. Look at the vaccine things have all shut down. Everything we're working on, you know, the whole issue. So to me, that's that's another one of the just practical things.

You know, this is what you learned back in smalltown Iowa. You know, that horse just doesn't run here, you know. Right. Right. If you could take a moment to explain what gain of function research is and what the concerns around that are. And then is the research that is gained like what we learn from gain of function research is that worth the potential risk? Yeah. Um really good question. First of all, gain of function in a very simplistic way is are we doing anything to a microbe that would enhance its ability to be transmitted or to cause serious illness or death? Okay, so we're enhancing it.

We're making it worse. Um, and the reason you'd even consider doing that one is you're a bad guy and you have a bioteterrorism or bioattack program you want to do and want to launch it. Okay, that's the kind of thing we'd surely not like to have happen. But the second piece of it is uh and and I happen to actually so I'm not talking out of both sides of my mouth. I I I do believe that dual use research of concern etc. is important for some reasons. And I'll give you an example. Um, if you think back on what's one of the most famous books in all of infectious diseases, The Hot Zone by Richard Preston.

That was a book about an outbreak of an Ebola virus in Rustin, Virginia with the monkeys that were there part of a large program uh for that. And and it spread quickly through the entire facility and killed all these monkeys. obviously was respiratory transmitted. Okay. Well, historically Ebola viruses have always been thought of being a body fluid contact. You know, you got to have contact with the blood, you got to touch something, you know, etc. But we've had a series of outbreaks in laboratories where lab animals, monkeys, basically have been infected when the nearest animal to them were, you know, 34 30 to 40 feet away.

And again, we just talked about aerosols. We talked about that no contact. And I raised this issue in 2015 16 during the Ebola outbreak in West a in West Africa. And we actually I led a a group of 16 people that published a paper who were really senior senior Ebola people who said, "Yeah, I think that sometimes respiratory transmitted Ebola occurs." M well what would happen if today we suddenly had a huge outbreak of a respiratory transmitted Ebola virus okay I mean this would be the nightmare and you know I don't want to suggest it's going to happen but there's enough data there to be concerned about it okay so today in the lab if we had a BSL4 the most highest containment that had multiple barriers for this virus ever getting out I would really welcome the opportunity to know in our research.

Can we show that these viruses can be made to be aerosol transmitted and if they can man that ought to accelerate a whole new area of research about the vaccines about how to control it etc. So do I want that done anything short of a high high containment situation? No. You know it would be absolutely I think criminal to put that into a lower level of protection. So, I can be for this, but at the same time, I would only do it under the conditions where it was really certain it's not going to leak out. And and it has to be for a real reason. The Ebola one is not a curiosity. The Ebola one is really trying to get prepared if that should ever happen again.

And again, you can't deny the fact we have enough evidence that there has been respiratory transmitted Ebola viruses that have occurred. So that's an example I think of dual use research of concern or you know that type of issue that that I worry about. So it sounds like so many things gain of function research or um the whatever term uh we're using for that is it's not a binary thing where it is good it is bad. The devil is in the details. It's not a a social media type I like it I don't like it. Exactly. You nailed it. You nailed it. Yeah. And that's what we but that's what's hard to get across to the public sometimes.

It seems as if you're you're kind of wishy-washy. I mean, somebody could say, "Wait a minute. Are you for it or against it?" Well, these are the conditions I would be absolutely against it. These are the conditions I would consider. These are the conditions I think that would actually be really helpful to us to learn that. Okay. Yeah. Because we can learn how to fight these diseases or how they might change through this research. But we also need to acknowledge the risk. Something could leak out and we could cause a problem that didn't previously exist if we don't have the right protocols in place.

The bioontainment has to be beyond reproach. It has to be absolute. You have to be certain of it. Okay? It's got to have multiple defense walls so that you wouldn't let it leak out. Then I think that's a different thing because if then if you came back and said, "Oh my god, we can make these viruses airborne." Then that should create an entire new initiative, a high priority to say, "Wow, we had no idea, right?" You know, and and we need to deal with that. This episode of the Nick Stanley Show is brought to you by Zapier. If you've ever felt buried in repetitive work, copying data, moving files, sending follow-ups, you know it's like death by a thousand mouse clicks.

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Exactly. Right. And this is one of the real challenges we have. Um and and I worry a lot about our capabilities today for bio preparedness. Do you know that for the first time in decades there is no one whose job it is in the White House to be overseeing bio preparedness? None. I did not know that. Oh, it's it's this administration has there's nobody in the security council, you know, and I'm not again balls and strikes in the Biden administration. There was an entire office led by Dr. Paul Friedri's outstanding individual. Um there was a a node in the security council. If you look back on all these e even in Trump one, there was a fair amount of work done to to really support this issue.

Okay. And and clearly uh Obama and Bush both had substantial activities here. We have none today. If there was a major bio event today, I don't have a clue who'd be in charge of it. Do you know that as I speak to you right now, there's not one person, not one person in the senior leadership at CDC that is a scientific professional, they're all political appointees. The entire This would be like running your aircraft carrier with 12 appointed political people, right? Think of that. That's where we're at today. So, so I do think right now our own country has to reflect on itself and say, "What are we doing to deal with this issue, spend less time debating Wuhan, spend more time preparing for tomorrow?" Why the shift?

Especially if the administration, because again, I I know you're not a politically motivated guy and you're saying, "Hey, with with Trump won, they did have they did they actually had a really good plan. They actually had a good plan." Yes. which is no longer in place. What's the result of that shift? I and maybe you don't know, but I I don't know. I mean, there's been a general, you know, bloodletting of of professionals in all areas of government. You know, CDC has lost 20ome% of its workforce since many of them are key people. You know, as I just pointed out, there is not a scientific trained person in the upper echelon of CDC today.

I mean, wow. You know that that would be like, you know, being a baseball manager in Major League Baseball today and never having seen a baseball before I ever played it. You know what? How many games you going to win? Right. Right. Oh, that's troubling to say the least. But that's what we're up against. And that's why, you know, you asked me earlier about, you know, why I do this and how I do this. You know, this is part of that love letter thing I mentioned for my grandkids. You know, I'm I I I couldn't walk away from this situation right now for the life of me because it's just too dangerous.

We got to do we we can and we can do more. This is not A plus B plus C plus miracle equals the answer. You know, there's things we could do. BOP preparedness right there. The microbes, remember, they've killed more humans in the last century than all the wars. And yet we we're we're not we're not even recognizing. Yeah. I mean, let's dive into that. So, for your grandkids, how how old are they? Let's let's just paint a little bit of a picture so we can like visualize it. And then what would you want? 15 to eight. 15 to eight. Okay. And and I've got kids in that range as well. And what would we want to have done so that their lives aren't at the very least disrupted the way many were during CO and in a much worse scenario that something tragic happens to them in the future?

I mean, what things should governments and our different institutions be doing? Well, first and foremost, don't lose the gains we've made. So the vaccines that we've used in this country to basically prevent you know in the last in in in the 9-year period from 1994 to 2023 we have very good data you know we have avoided over 500 million hospitalizations and serious illnesses with vaccines in this country. Okay. Um you know we we've avoided over 1.1 million deaths just with vaccines. Don't let those go away. And we're going to watch in the next few days here as more of the ACIP meeting unfolds and so forth.

It's going to be harder and harder and harder to get vaccines. So there's number one. Just keep that. We don't that that's not rocket science. That's not any new initiative. It's not more money. It's just applying what we have. But then the second thing is what we talked about with the vaccines for pandemics. You know, take that off the table. and and what would it take to take that off the table? It's not A plus B plus C plus miracle. Again, it's about a a well-defined research agenda with an outcome that we believe is really very doable and that we could make these vaccines in advance. And so, yeah, the first month might be a bit chaotic.

It might be really challenging, but within month or two, we we could stop that. I think the the third thing is just be aware of all these new infectious agents we're going to be dealing with. For example, this week there's been a lot on shagas disease. It's was a publication that came out uh about it about how it's spreading in the United States. CNN wrote a big piece Sanjay Gupta cover something. It's important he covered it and this is called basically kissing bugs. There's a type of of insect that is now spread through much of the southern part of the country and is moving north. And these are mosqu a type of bugs that actually bite you, but they look like they're they call them kissing and then they infect you with a parasite.

And it's really a it can be a a parasite that can leave you with serious heart disease and kill you. And that didn't exist 354 years ago. they got introduced into the country. With climate change in particular, we're seeing more and more of the northern movement of these insects that didn't used to survive like that. And you know, for our kids, again, we need to be looking at what are the new diseases that are coming, what can we do about them? And and so I think this is part of a a bigger agenda that is all about just, you know, trying to protect people the best you can. Yeah. Um if you could redesign our institutions, what changes would be made to make all of public health more effective, whether we're dealing with some major pandemic down the line or dealing with these kissing bugs or whatever new thing comes along.

You know, I I have I I have a bias here because I come from an undergraduate program where I had a a a dual major. I had one in biology and I had one in political science. And I never was sure for fact in my career which ones were more important. Okay. Um I think today we just need a population that is much more well-versed in what I guess I would call liberal arts. And I don't want that to be interpreted politically or negatively, but it's more understanding the world. You know, the best graduate students I've had don't come in with some deep deep deep deep understanding of the cellular wall of a microbe, but they see the big picture of life and what are the challenges and the issues are going to confront us in that.

Okay. And what does that mean? and and and so I I actually welcome the fact that I see people who have these diverse interests. Sometimes people will say, well, you know, you probably am not interested in me as a graduate student because actually I did this or I did that. I said, man, that's exactly why I want you. Okay? Because you bring a whole new perspective, a new dimension to this kind of thing. And so to me that that is where our education system needs to go. I think more and more of that uh less less you know of the kind of really deep deep deep knowledge but only you know an inch wide when in fact somebody else is more like the Grand Canyon.

Yeah. And and be two miles wide and only a half mile deep. Yeah. I mean look at think about you and your show here. Think how many different topics you've covered and think how that's had to stretch you to better understand, you know, and that's that's what we need more of is the big picture things like that. That that so I mean and and and it's learning for the fact that you just don't learn because you have to, but because you want to and then how does that impact your life? Yeah, this this show among uh with with a few others. I mean, it was really a lot of prep work because I didn't want to sound I I I didn't want to have no clue what I was talking about.

So, as I'm reading the book, I'm looking up terms. It was like I was working with Chad GPT like, okay, what does this mean? Where' that come from? Yeah. Um, well, I think that that to me is is why programs like this are very helpful because they are broad and they do challenge people to think, you know, they challenge people to be uncomfortable sometimes. They challenge people to say, "What can I do?" And I think that's that's really healthy. Well, that's the goal rather than just to tell them how it is because I don't think any of us know how it is in in the big picture or across these topics.

Yeah. thinking critically is really the first step. And you know, I think the other thing also is is shows like this, and this this really plays to how I think we educate the public, they're not angry. They're they're they're factf finding. They're willing to discuss things. They're willing to challenge things, but they're not angry. And we need to tone down the anger. And we need to tone up the understanding more, you know, and and how that goes. And so I think that too is an important message today is how do we do that? One question I wanted to ask because we talk about AI a lot on this show because I do think it's an incredible technological de it'll be the biggest technological development of of our lifetimes.

How do you see that playing a role with public health? Now remember you're the guy that heard me talk about Joe Rogan today and how dumb I was. Okay. So maybe I'm the same way with AI. Well, I I don't fully appreciate yet, I think, just how dynamic AI will be, but what I know and how we've used it, it is exactly what you just said. And I think that one of the things that is going to be really important is understanding what are how do you learn AI? In other words, think how many people today are in their 70s or 80s who are very proficient at their laptop, but when they first got introduced 20 years ago, they weren't going to touch them.

You know, we had to bring people along. On the other hand, you know, if I want to get electronics fixed of some kind, I give it to my 15-year-old grandson, I get it fixed in no time. Okay? Don't give it to me. And so I think that one of the things with AI is just how do we bring people along to understand the power of it and how it gets used and what can it be good for versus what can it be harmful with. And I think that that's that's going to be really key. I I agree with you though. I think it's going to fundamentally change uh so much. I mean when I look back on think of you too cell phones, what the hell were they?

You know, I mean can you imagine our world before those? And now look at it. I mean, right, you know, it's it's an umbilical cord to life and I think AI will be even so much greater than that. Yeah. And being able to map how diseases develop over time, especially the zunotic ones that can jump from animals to humans that seem to cause us so many problems and could help us anticipate what is possibly down the line. Um, yeah, I think it can be super helpful. Um well I want to close out with this question. Um as you look towards the future you are an optimistic guy despite issues we're facing. And what gives you hope and makes you optimistic for the future?

Well one is is that I do believe technology can be our friend as much as it's our enemy sometimes. And I think in the world of infectious diseases, technology could be an incredible uh uh opportunity to take some of these real challenges off the table. Okay. Um and so I'm I'm optimistic about that. But you know, I think one of the things the pandemic showed me was that they surely are people who are angry, people who who are what I would consider unreasonable in how they look at life. But I also saw the other side of it. I saw so many good people, so many people who cared, so many people who wanted to do something to help.

And you know, I have to say I have been an incredible beneficiary of that with the podcast and creating what I call the podcast family. And it's it's reminded me that there is so much good in this world. There is a lot of good and we just have to sometimes emphasize it. And you know, just that extra hello or thank you or you know that that note of appreciation to someone. And when you think about that, it actually is is by itself an infectious agent. It's wonderful, you know. So, I'm optimistic about that. And the thing that makes me know that everything's okay is my 12-year-old grandson. A couple of weeks ago, after spending a day with him, we were doing a bunch of things.

As I was leaving that night from from my daughter's house, he looked up at me. He said, "You know, Grandpa, you're crazy." I knew I had arrived. I knew I had arrived. That makes me happy. That makes me happy. Yeah. Yeah. Yeah. I will also say when I spend time with young people, they do fill me with hope for the future. And I I hope they're going to tackle some of the issues we've talked about today. Um I hope you keep doing what you're doing. I hope you keep doing what you're doing. Do more of these. I'm not going to stop. I'm not going to stop. Good. I think that's important. Yeah. Let's let's get good information out there into the into the world.

And people the community is is coming together and they're um people are responding to a um to a a a more I don't want to say quiet, but a more a more nuanced approach. coach. I mean, I think the success of podcasts in general is an antidote to the 30se secondond dopamine overwhelming hits that people get on social media that are often filled with anger and made to trigger us. Um, and so I I could not agree with you more. I I I absolutely agree with that 100%. 100%. Yeah. And then and then finally Oh, yeah. Oh, absolutely. I was going to say thank you for having me. I'm I'm very honored. And yes, thank you for coming on.

I am honored as well. So, the feeling is mutual. And the the book is the big one. Um, how we must prepare for deadly pandemics. And then the last thing, just to make sure that we get it. If people want to follow your work online, I'll make sure to put it all in the show notes, but where where can they look um for some of your your work and to learn more? They just go to our website for our center w.idrapid.n.edu. edu. So, it's just sidrapn.edu and that's that's all there. Okay. Fantastic. All right. Well, thank you so much. Okay, everybody. Until next time, ask questions, don't accept the status quo, and be curious.

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