How We’re (Not) Preparing For the Next Pandemic

of mine. And if we're all breathing a tentative side of relief, virologists and public policy officials are already starting to look ahead to the next pandemic and making sure we don't get caught so flat footed when, not if, it happens again. So how do we prepare to fight off a possible threat we know nothing about when we're still struggling to keep on top of the one that's right in front of us. Here to answer that question

is Dr Angela Rasmussen. She's a virologist at the University of Saskatchewan's Vaccine and Infectious Disease Organization, and she has spent years studying the emergence of Avian flu ebola and of course COVID nineteen. Dr Esmuson, thanks so much for being here, Thanks so much for having me, Wes, and she has someone who thinks about pandemics a lot. I'm going to ask you, maybe an unfair question just to start. We're not done with this one yet, but where do

you think the next one comes from? Well, I mean I think the next one probably comes from someplace similar to where this one came from, and that is, are increasing interactions, increasing encroachment on animals on wild spaces, in places where people either haven't been before, or in places where we're using the land potentially in different ways, interacting

with nature in different ways. Now, this pandemic started likely due to zoonotic spill over at a market in Wuhan, China, where live animals were being sold, but this can happen in many, many different scenarios, so where people are in contact with animals um whether that be through animal sales, raising animals, farming those types of activities, or just clearing land, disrupting ecosystems, driving animals from where they live into new

places and coming into contact with people. I really do think that that is where the next pandemic is going to come from, and that's really where all of the pandemics that we've been experiencing are coming from. So we are seeing viruses increasingly emerging. You use this expression zoonotic transmission, Can you explain exactly what that is? Zoonotic transmission or zoonotic spillover refers to a virus or any kind of infectious disease being transmitted from an animal host into a

human host. Now that's probably how this pandemic got started. Myself and other colleagues have been involved in research that really that's the only explanation that fits the evidence that we have. But zoonotic spillover really refers to that virus which was not previously in humans, coming from its animal host and getting into the human population and spreading from there. You know, we think about pandemics as being these fairly

rare things. Pandemics are actually fairly common. Certainly in virus emergence and epidemics are very very common, and it's you know, not always novel viruses that is sort of infrequents compared to other viruses that we know about. But for example, in two thousand nine, we had an H one N one influenza pandemic. We have influenza pandemics roughly every ten to thirty years, so they have been a lot more

frequently than people realize. They can be less disruptive than this particular pandemic has been really globally an epidemic can be. It might not spread around the world, but it can still be incredibly disruptive regionally, um and it actually can cause global disruption. So stars coronavirus one when it emerged was for the most part restricted to East Asia, and then it did come over here to Canada, but nonetheless caused huge disruptions and things like global travel cost a

lot of money, harms the global economy. So certainly something doesn't even have to be technically a pandemic to cause problems around the world and to really impact the global community. So you've described how the next pandemic is likely to emerge. Do you anticipate that it could be a deadlier pandemic, a deadlier virus than the one that we've you know,

just lived through. I mean, that's certainly possible. And you know, I think that this pandemic has shown us that a virus doesn't actually have to have a catastrophically high case fatality rate to still kill millions and millions of people and to cause tremendous harm globally to people, to communities, to economies. It doesn't have to be something that is like ebola, where you know, you see a majority of people who get sick die from it. And actually viruses

like that they can cause big epidemics for sure. But you know, there's not a lot of viruses that are transmitted by the respiratory route, which is one of the reasons why the COVID pandemic has been so destructive and it has impacted so many people. It's a lot easier to control viruses that aren't being transmitted in the air that you breathe. There's also viruses that are not coronaviruses that don't necessarily even cause primarily respiratory disease, like NIPA virus.

It's in another family of viruses, but it can have as much as mortality rate. Can you see more about that one, because I think people aren't as familiar with that. Yeah, So NIPA virus is actually transmitted from bats and from pigs. Pigs get it from the bats and they can transmit

it to people. It also can be spread person to person, but fortunately it's not as efficiently transmitted, and NIPA is spread by the respiratory route, but it is primarily deadly when it causes encephalitis, so it actually causes a brain disease.

If anybody's familiar with the movie Contagion, that fictional virus was based on a more transmissible version of NIPA virus out NIPA virus keeps me up at night as well as as its cousin Hendra, because they do have such a high mortality rate and they can potentially be transmitted by the respiratory route. A more transmissible mers coronavirus Nipa hendra H five N one highly pathogenic avian influenza, which also is not very efficiently transmitted from person to person,

could be potentially catastrophic. And I'm not exaggerating by saying that a virus like that that spread light covid around the world could potentially have civilization ending consequences. I mean, can you imagine what would have happened if of the people who got stars coronavirus two died from it? If we were having problems with at the highest two to three percent case fatality rate, our hospitals are overwhelmed. Even now with vaccines and the mortality rate is even lower.

We're still seeing so much transmission that we're still seeing huge burden on our health care system. Imagine what that would be like if we were talking about a virus that was as transmissible but killed up to half the people that get it. That would be absolutely catastrophic and potentially an existential threat to our civilization. So you're not speaking metaphorically when you say it keeps you up at night. As a virologist, it actually keeps you up at night. Yeah,

I don't think about it sometimes if I want to sleep. Well, that, I guess raises a question. If this is a concern to you, as a scientist and other scientists looking at what could come down the road, how do we prepare

for that, how do we protect against it should it arise? Well, this is why I'm glad to be a virologist, actually, because even though I know about all of these really scary viruses that are out there, we also do this work so that we can develop countermeasures, and that means developing new anti viral drugs, developing new ways to treat these emerging viruses. And one thing I think that is going to be very impactful is we know what a

lot of these virus families are. So like I said Nip ben Hender, the Hannup of viruses, and there's many, many other viruses. There's twenty five families of viruses I think that can cause disease and humans. You know, some of them have known pathogens, but any of them could potentially produce a virus that would infect people, be capable of human to human transmission and cause a pandemic. The problem is trying to figure out which of those viruses

are the threat. Here at my own research institution and many other virologists around the world are working on this too. There's a push to make vaccines that can recognize viruses based on which family they're in, rather than working on

individual viruses. So, for example, people are developing pan influenza vaccines that would cover any influenza that you would get exposed to, and not just the three strains that are in this year's flu shot, or pan coronavirus vaccine that could protect against Stars one and stars too, as well as maybe mirrors and any other novel coronaviruses that might emerge.

And I think that this is one really powerful way to approach countermeasures, because if you can vaccinate people who are at risk of being exposed to these viruses, you have a stockpile of these vaccines ready to distribute should an outbreak happen. You could contain that very early before it became a pandemic, and you could potentially contain viruses that we don't even actually know about yet. What is the timeline do you think for something like that to

be developed, produced, and stockpiled. Certainly not overnight. Many of these vaccines are currently still in development. There are some clinical trials however, going on. And one of the challenges I think that people don't always appreciate is that it's not just developing the vaccine and then testing it. You have to get it all the way to the point where it has regulatory approval, and you have to be able to fund manufacturing so that you can actually make

the vaccine in large enough numbers. So it's really important that we not only develop these things as scientists, but that we actually also follow through to make sure that we're doing the right kind of testing. We're doing safety testing, and we have processes in place that can allow us to actually manufacture vaccines that could be used in an

emergency immediately. And when you make the case for this with policy makers, politicians are in charge of spending the money on this, do you find that there's urgency to do it in the absence of an emergency. So this is one of the great challenges to doing any type

of pandemic prevention or preparedness work. If you're actually successful at preventing a pandemic, it looks like you're not doing anything because nothing happens, that pandemic doesn't happen, and it's very difficult to maintain, you know, from one Congress to the next, from one president to the next, it's very difficult to justify spending lots and lots of taxpayer money on something that seems like it's not doing anything. And things are probably worse than they've ever been right now

because it has been so politicized. Public health itself, pandemic prevention, and virology research have all been sort of uniquely politicized and in many cases demonized, and that also makes it very difficult to make the case that we need continued funding. We need continued support for this type of work, and we actually need a lot more of it than less.

When you know, people are kind of over the pandemic, and people aren't dying in the same numbers that they were at the beginning of or during some of the subsequent ways before we had vaccination and there was a lot more population immunity, it's really hard to make the case that we should continue to be investing in this.

But what people, I think really need to know, what politicians need to know, is that this is an investment in our future, not only the future of our country and our public health, but also the future of our economy. And because we do live in a global world, this is really an investment in the future of the entire global population of the human race, and I think that people really need to be reminded of that as well as educated on what the benefits are of doing this

type of work. Dr Angela Erasmus, and thanks so much for talking to me today. Thanks for having me, Wes anytime when we come back. What the US government has learned from the COVID nineteen pandemic. I'm here with Bloomberg's bio Security reporter Riley Griffin and White House reporter Josh wind Grove. Riley and Josh, thanks much for being here, Thanks us, thanks for having us. We just heard from virologist Angie Rasmussen who talks about the increasing threat of

virus transmission from animals to humans. Riley, when you talk to scientists and policymakers, what do they say worries them most about how the next global pandemic might go? So I actually want to take you back to twenty nineteen when BARDA, which sits within the Assistant Secretary for Preparedness and Response which is now the Administration for Strategic Preparedness and Response, presented on biological threats. They called it the Wheel of Misfortune, and it was like the Wheel of fortune,

but instead of numbers, you had biological threats. And on it were things like anthrax, smallpox, plague, bautual is um, ebola, sudan ebolas, i hear Marburg virus, some things that you may have heard come up. The World Health Organization also releases its own list of priority pathogens, and you know on it are similar things Marbur Glass of fever, mers

and stars, those relatives of COVID nineteen zica. So I can name specific pathogens for us, but I think partly what scares me is the unknown pathogens, those that we don't have names for, or might be new iterations of viruses we may have seen before. And the way to deal with that is something we like to call in this world biosurveillance. Think of it as like a weather map. We're forecasting for infectious disease. And what we need to get to is really taking a pathogen agnostic approach to

pandemic preparedness. What does that mean? That means not preparing for one individual threat. One of the big shortfalls of our preparedness for COVID nineteen is that all these years we've been preparing for pandemic influenza. Think the eighteen flu also sometimes called the Spanish flu that killed up to a hundred million people. We've been preparing for that for years because that was really the last big epic pandemic.

All of our presidents, going back to Bill Clinton, he actually in the late ninety nineties he read a fictional book about a bio terrorism attack called the Cobra Event, and it spurred him to create the Strategic National Stockpile, which stockpiles all of our medicines and ppe and so forth, and so it's a protective gear that we all started wearing dandemic and every president since then has had their

own kind of plan. But many of these plans haven't been implemented, and a lot of them have been geared at pandemic influenza. So I think we need to think a little bit broader because these are all aimed at fighting the last pandemic instead of looking forward to the one we don't know about exactly. And the Biden administration they released their own plan. First it was the American Pandemic Preparedness Plan, and now it's transformed into the National

bio Defense Strategy. They lay out their own strategy for combating naturally occurring, accidental, and man made biological threats. So it's quite comprehensive, but what we're still seeing missing is real implementation and resources put to this. They've requested eighty eight billion in mandatory funding, but they're not necessarily likely to get it, and so what do you do with

all these documents but not a lot of action. What was made so clear early in the pandemic is that we did not really have a system for this or a plan for this, and I think those are two separate things. And the plan question is now hanging over is what can we do to prepare for the next one.

But a lot of the things that really hobbled the response in the US, in particular, which namely a patchwork of fifty different systems, one for each state that isn't going away, and that will continue to hobble whatever we decide as a country to do about COVID, which right now is not a lot, and whatever the country decides to do for the next thing. Riley, you mentioned man made biological threats. What exactly are those and what is

the concern there? The concern there is that viruses, bacteria, other pathogens could be weaponized and used, either inappropriately or for nefarious intent, or that legitimate research done in academic and private sector laboratories and in government facilities might have accidental consequences. And so I actually just got back from Geneva from going to the Biological Weapons Convention, a review conference for this international treaty that bans a class of

weapons of mass destruction. This is an ever present threat and an increasing threat as biology and our understanding of it advances. And as a lot of these tools become cheaper and more accessible, and when scientists look at their best guesses about what to prepare for, you know, like every year there's the flu vaccine and they take the best guess of which strains might be the ones that hit us all, and we hope that we hit a year where they guessed right. When they don't, we got

a bad flu year. When they're preparing for the future, how do you guess you just named like fifteen different things that could kill us all, how do you know which is the one that we should be preparing for most in which one would be a little bit further down the list. Science, sometimes, I think is an art. You know, scientific stakeholders convene in the u N and

they sometimes have to resort to their best guests. If we had had this conversation in the middle of nineteen and we'd asked ourselves then what we needed or what was around the corner, I do think we now have clarity and more information and pathways than we did before. That is a silver lining of the few years that

we've been through. One is that we didn't really know how the early warning system would work right and with China really didn't work, and that will be the focus of congressionally hearings with Republicans holding the House in the next couple of years. But like it did work with Omicron, and so now there are systems in place where public health agencies can sound the alarm and it's taken seriously. When you say the early warning system, you mean they

saw it coming and were able to act in timely fashion. Right, Joe Biden started talking about OMICRON. I think it was like a Thanksgiving vacation in Nantucket a year ago, you know, like because South Africa and countries in Southern Africa had picked it up, and the sound of the alarm. Now that kind of stuff is critical and you know, is

a carry over the COVID experience. Another thing, for example, is like Kovacs and how they got vaccines that that was totally unprecedented and if we, god forbid ever have to go through that again, there is now a system because it is actually really annoying and legally thorny to shove vaccines out across international borders with dueling regulatory agencies, and what happened. So there are silver linings to having gone through this questions that we would have had in

this exact conversation. Pre COVID do have answers now, but so many others do not have answers now. And to Riley's point, it's like, have public health experts sort of shot their shot? Like have they sapped or worn thin the patients of the public, many of whom couldn't tell you, for instance, what the CDC recommendations are right now because

it's changed so much and they tuned out. So there is a silver lining on the one hand, But on the other hand, I wonder whether even though we have a playbook, that might not help as much if people are willing to listen to it. Riley and Josh tell us about the planning happening for the next pandemic when we return. Josh, you said that if we had the benefit of foresight in when this was coming down in December,

maybe things would have been different. Riley was talking about how every president had prepared or tried to prepare for this, so those preparations actually didn't work. How then, does the administration do all of the agencies involved in this sort of work figure out how to prevent what Riley is describing. Well, I think there's a lot of them who are doing

that work right now. The question I have is whether they'll have the money to do anything about it right like early on, just to go back west to those early days of COVID. You know, Trump really did take it seriously for a while. There was not enough ppe, there was not enough supplies, there are non enough ventilators. There were hospital ships outside in New York, remember this,

And like that was all under Trump. I think we sort of like forget you know that there was a dilection of this, uh, and then he stopped really caring to that extent for rajuries. And so now what we have is this question of like what's left over and where to go from it. As we stand here, the administration is begging for money from Congress that they are not getting for COVID response, and that is for stuff to deal with developing vaccines. You mentioned the flu shot

that we get yearly. That's what they want to do with COVID. The first version of that has had really abysmally low uptake, and there's not really money in the system right now to develop next year's annual COVID type flu shot because they just haven't allocated anything. They also have no money to buy more vaccines or you know, buy more packs of it, which we give to more severe cases when they get it to minimize your symptoms.

And so the current question of what are we gonna do about the next pandemic I'm kind of worried about we're gonna do about the current pandemic we're still in. There is just simply no appetite in Congress as of now to fund anything for it, and that at some point you have to think is going to start being

a problem. Riley. It's kind of an important point. If we can't get enough money to pay for a pandemic that's still happening right now, where is the resolve to pay for something that we can't see, you don't know which it is, and don't know when it's going to come. I'm going to give an answer you might not expect. I think it's coming out of the Defense Department. I think you're seeing an increase in interest from other stakeholders beyond the obvious ones at the Department of Health and

Human Services take up this mandate. I think the intelligence community has an increased focus and appetite, partially at the direction of the Biden administration, and I think the Defense Department does as well. And what does that look like? How does when the Pentagon takes over the preservation of the human race, what does that look like? Well, I'll

give you one example. Recently, my colleague Madison Muller and I broke a story where the Department of Defense had cut a deal with Maderna for messenger RNA vaccines for EBOL viruses and other threats. This wasn't a function of congressional funding for pandemic preparedness. This was d O D saying this is something that affects troops, and we have the money to deploy, and we don't need to go through all those layers of bureau oocricy and approval to

get this done. They just did it. I think there's a lot more work like that happening. If you look to the intelligence community, they're developing tools for bio attribution, that is actually to look at a pathogen, to look at its genome, to sequence it, to look into the DNA and say can we see human signatures? Meaning can we look at the DNA of a virus and determine whether or not it was naturally occurring or that this

was a function of a human touch. These are quiet things that are happening outside of the Department of Health and Human Service enterprise that are in the name of bio defense biosecurity. And so I am watching this closely because I think a lot of that work. If it's going to get done, it's going to shift in that direction. Josh is a political matter, I suppose as a policy matter too. I don't know. It feels kind of weird to let the Department Defense and the Intelligence Committee lead

the way in this sort of thing. Is that how say the Biden administration wants this to play out, how any White House wants it to play out. Getting funding for d D is often a lot easier than getting funding for HHS, So d D can be the fig leaf for funding for this. The Biden administration will, I think, probably be okay with that. They could sleep at night and that's the case. But d D has been a

battleground on this already. I mean, we just saw a big throwdown fight over the NDAA, which is a defense funding bill, and one of the concessions made in that was eliminating the vaccine requirement for service members. I mean, this has been a partisan fight until now. And you know, what is the goal here? Right? I mean, this is a question that gets different answers these days around COVID, Like a lot of public health experts would like the

numbers to be a lot lower than they are now. Um. I mean, I'm sitting here, you know, a positive COVID case, working from home, talking to you guys with relatively mild symptoms, dedication to the cause. Josh, we wish you were here. Josh, I'm feeling thank you. I've dodged it for you know,

however many years and time they got me. But like cases like mine are probably in the eyes of like the Biden people kind of what they want if you're going to have a COVID case having and someone who has mild symptoms because they got vaccinated and they stay away from others and that's it. And so when it comes to the question of other pandemics and ending this one, there is disagreement on like what the victory line is,

where the goal line is. You know, it's hard to be optimistic when you're thinking about doomsday threats like this. And Josh and I have been in the trenches together covering COVID since the very beginning. Politics are at play, They've always been at play, But there are public health officials that have made this their life work and they have been at the CDC for decades. They were thinking about COVID well before COVID happened. Coronaviruses have been on

the radar. We've seen coronaviruses before. The CDC is undergoing a reorganization right now and overhaul, if you will, to become more of a responsive agency, and there will be workforce changes and structural changes that will potentially outlive the tenure of Director Wilenski, who currently runs the CDC. And you interview Dr Wilenski back in November of last year, Let's hear what she had to say about some of

those changes. So one of the things that we learned is that we need to be more nimble about how we develop and deliver our science. We have to communicate that not to necessarily only public health officials and to scientists, but we need to communicate it to the American public. We need easy to understand, easy to implement policies that are dedicated and science devoted and and based on science,

but that we can really convey in a simple policy message. Riley, you said there are structural changes happening at the CDC to minimize the threat of the next pandemic. What are they. I'll give you a really simple example. I don't know if a lot of people know this, but over at the CDC, the folks working on COVID had to volunteer to do so. They actually raised their hand right they

were working potentially on HIV or birth defects. People had to raise their hand to go over and work on COVID, and that cost a lot of issues in terms of the speed of the response. If you needed three epidemiologists work on something, you had to scan the agency and find them. One change that they're making is that you're going to deploy CDC staff like troops. They're going to give their availability months in advance, and if a crisis emerges,

the CDC will readily deploy them. So that's a readiness change. There are other changes we can outline, but the point is there are these cultural and operational things that are just gonna be flipped if you will, to make it more of a responsive agency rather than the academic, bureaucratic, scientific kind of guidance entity that it's been for so long, Josh. One of the things we saw in the pandemic was how in the U S there's fifty different states, so

fifty different responses, some better than others. Another thing we saw was every country had its own response. Have governments learned from COVID that there's value to coordinating and cooperating from the beginning, or are we going to see something similar the next time sort of hell breaks loose. The optimistic answer is yes, some things worked better. KOVACS exists. KOVACS is the system that we set up to help get vaccines to low and lower middle income countries when

rich countries jammed to the front of the line. Like if you think Ticketmaster is bad, like the COVID vaccine process buying was insane and rich people got it and poor countries did not. And so we now have a system to at least get some vaccines to poor countries, but countries fundamentally responded in kind of everyone for themselves way. I don't know, No, I don't think it's a Kumbaya moment.

I think one of the real benefits of God willing not having a new pandemic to new something, a new pathogen, a new plague over the next couple of years will be to take the temperature down so that if and when we do face another one and we do hear these warning systems from the people whose job it is to tell us, and who have gone to school for years and years and years and years to be able to say no, this is the one that when they say that warning that the broad public, you know, is

willing to hear it. And at the international level. Two, I think there will be some basic learning lessons. Like travel bands, they're not very effective. Just because you're blocking flights from one country doesn't mean a virus is going to enter through another. So there have been some successes and some obvious failures throughout the pandemic. And you gotta think that those very equipped public officials that Josh is

describing are taking note of what didn't work. Riley, When you look down the road, which is your entire job, what are you watching for? What should people listening to this podcast be looking at for. I'll give you a present answer in a little bit down the road. I mean, I think we're still grappling with a lot, Josh said. He alluded to some of the issues with the lack of funding for current pandemic response. We've got COVID, we've got polio, we've got ebola, we've got RSP, we've got empox.

Our hands are full right now, and I think there might be some pandemic fatigue, but that doesn't mean that there aren't active threats that demand active response. So I'm thinking about that quite often. Down the road. I'm following this question of biosurveillance. What are the tools that are cropping up out of the public and private sector to better detect these threats right and there are a number of companies that are working on this. The technology is

fascinating and it's accelerating really quickly. Even if the government isn't investing in it, the private sector seems to see market opportunity here. This looks like wastewater surveillance. It looks like putting in detection in airports, which are these hubs of global travel where a lot of disease comes through. And so seeing what sticks and what continues to have investment beyond this cycle of panic and neglect, I think

will be a really telling portrait of the future. If we can continue to buy into these technologies, we will be better equipped those early warning signals are the most important thing. You can't catch it late, You've got to catch it early. And so where government, academia, and the private sector will rise to that opportunity and create a better weather map for infectious disease, That's what I'm looking for.

I don't want to leave us too sad. You know I'm a Debbie downer parently right now, you know, yeah, I know, you know, I'm trying to be up. Like the price of unfortunate threats and the distrust that has stewed up with medical professionals is that lives are saved. Right The recent study showed three million lives are saved

in the US because of the COVID vaccines. They got a vaccine to development production into pharmacies in incredible time, that stretched over two administrations that agreed on virtually nothing else. There is positive that comes from that, and you would hope that God forbid we deal with something else like this again, that all that would be true as well. So you know, as we deal with the fallout, like, it's those lives saved, it's those cases avoided, and as

a result, those long COVID cases avoided. That is the reason that these health professionals who are getting heckled and like bullied on social media, get up every day. Riley Griffin, Josh wynd Grove, thanks for taking the time to talk to me today. Thanks for having us. It's fun to be with you. Josh, Thank you, Wesh. Riley swimming in a wake as always, but West I try to bring some optimism. You can check out more of Riley and Josh's reporting about preparations for the next pandemic at Bloomberg

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