‘The Last of Us’ Epidemiologists: How to Survive Zombies

When a zombie apocalypse hits, who’s left to calculate how to survive?

In HBO’s The Last of Us, society crumbles under the weight of a fungal pandemic, and scientists try to answer key questions. Even with the government gone, someone is still thinking about how infections spread, where safe zones should be, and how to triage limited resources. That someone isn’t always a public official. These are the last of us epidemiologists.

Watching the show, I couldn’t help but see the story through the eyes of an epidemiologist (one who doesn’t work for the government) who steps up when systems fail. That’s not just fiction. In America, private-sector epidemiologists are becoming more essential, especially in moments of crisis when the usual institutions break down. I’ve lived this shift firsthand, and it’s reshaping how we respond to health emergencies.

This article explores how the epidemiologists in The Last of Us used their expertise to help humanity survive a deadly fungal outbreak and why those same skills are essential in tackling real-world crises today.

Outbreak Science, Before the Outbreak

The show opens with a 1968 interview in which Dr. Neuman, an epidemiologist, warns about the possibility of a fungal pandemic. He explains that while fungi currently cannot infect humans due to body temperature, a rise in global temperatures could force them to adapt. This speculative scenario is a compelling introduction to what epidemiologists are trained to do: identify emerging threats, analyze cross-domain risks, and anticipate what others may miss.

Today, that kind of foresight often comes from cross-sector partnerships. Life science companies, surveillance data firms, and insurers now employ epidemiologists to forecast infectious threats not just for public health but for business continuity, healthcare delivery, and supply chain stability. These predictions influence real-world strategies and prepare organizations for health-related disruptions.

How to Survive a Zombie Attack

In The Last of Us, people avoid becoming zombies (also known as the “infected”) by taking strict precautions to avoid exposure to the Cordyceps brain infection, a mutated fungal pathogen that turns humans into aggressive, mindless hosts. Here are the main ways characters try to avoid infection:

1. Avoiding bites and scratches
2. Avoiding inhalation of spores
3. Immediate amputation (rare and risky)
4. Quarantine zones

Search for the cure

I’ve had a theory, since middle school, that if in the future there really was a zombie apocalypse, that that a realistic solution would probably be discovering antibodies to stop infection turning you after a bite. Survivors could get infusions of antibodies to keep themselves protected. This is why immune individuals like the series protagonist, Ellie, are so special. Ellie was bitten but never turns. Scientists (and characters like Joel and Marlene) hope her immunity could lead to a vaccine or cure.

If you lived in a post-apocalypse community, would you want to recommend or mandate the other survivors receive doses of zombie antibodies? How would you balance the risks and rewards?

Antibodies are still in development to stop HIV infection. My team at Infectious Economics evaluated the economics of antibodies for HIV prevention to figure out if there was a commercial business case. It’s an interesting marketplace now with new competition/complements in long-acting lenacapavir from Gilead available as treatment and soon pre-exposure prophylaxis (PrEP).

If only Coryceps fungal infection became treatable with a long-acting injection, how would you propose delivering it to the zombies?

Rational Rationing

I suspect that industrial pharmaceutical manufacturing capabilities will be severely limited in a post-apocalypic world. This means we would need to ration the supply of vaccines or treatments discovered. During the MPOX outbreak, we had to calculate the tradeoffs of rationing and splitting doses of vaccine to cover more people when there was a shortage that could not meet demand (Dimitrov 2023). My assessment tool for establishing local pharmaceutical manufacturing in low- and middle-income countries could be helpful if zombies destroy facilities or turn all the workers in high-income countries (Zimmermann 2018).

If there was a limited supply of medicine that could stop a bite from turning the victim into a zombie, who among the survivors should be prioritized to use it? What allocation policy would give humans the best chance at surviving longer-term?

Those are questions that I’ve been considering since middle school.

My Experience in The White House

In 2020, I served as an epidemiologist/economist in The White House directly advising the President of the United States (see press briefing in the Oval Office for President Trump’s remarks on my contributions). I was brought in not as a government official, but because of the skills and experience I gained in the private sector. I was ready to listen for decision dilemmas, identify uncertainties, move quickly, code in many languages, analyze complex data, and deliver evidence that leaders could use immediately to inform policy. If you want to learn more, read action-packed stories of my time there included in books ranging from Breaking History by Jared Kushner, Preventable by Andy Slavitt, and Memoir of a Pandemic by Brett Giroir. 

We need more scientists with experience working across biotech, data science, and global business environments and the skills needed to navigate urgent, high-stakes scenarios. Those experiences made me ready not only to understand a fast-moving crisis, but also to help shape a national response. It was a clear example of how private sector training can prepare professionals for essential roles in public service during emergencies. The Last of Us confirms we need special skills to survive zombies attacks.

Infection Timelines Built from Messy Data

In Episode 2, we see hanging on the wall in the background of a scene is a chart from the Federal Disaster Response Agency (FEDRA) that outlines how long it takes someone to ‘turn’ after being bitten by a fungal zombie, depending on the body region:

• Neck or head: 5 to 15 minutes
• Torso: 2 to 8 hours
• Leg or foot: 12 to 24 hours

Although the chart appears only briefly, it reflects a sophisticated type of analysis using field data that was probably messy and unstructured. I was very impressed! This is the kind of work that private sector epidemiologists routinely do. Whether using electronic health records, wearable device data, or informal safety reporting systems, we often work in environments where controlled trials are not possible or timely.

Real world outbreak example

The poster reminds me of when my team at Infectious Economics investigated the explosive COVID outbreaks in Broadway theaters in the fall of 2021. We identified the new omicron variant and rapidly re-assessed test accuracy to detect infectious cases before the virus spread around the orchestra pits and dressing rooms (Adamson 2022). We learned that omicron had a much shorter time from exposure to infectiousness than the previous variants, which is why the workplace safety policies became insufficient to prevent new outbreaks. When the NYC Health Department did not have time or capacity to help, I led the team that re-opened Broadway shows to bring life and tourism back into the city. Who would have ever guessed that epidemiology work would be so glamorous as to be featured in Vanity Fair and Rolling Stone?

Despite many limitations, private epidemiologists can generate evidence that supports clinical development, emergency planning, and commercial decision-making. When public systems cannot respond quickly due to bureaucracy or limited resources, the private sector can provide critical insights on a much faster timeline.

Validating Diagnostics Without Delay

In Episode 3, “Long, Long Time,” Bill uses a handheld scanner to determine whether Frank is infected with Cordyceps. Bill uses this tool before allowing Frank to climb out of a hole in the ground and enter his home. The green light means uninfected. The red light means danger. Beneath this scene is a real scientific concern: test validation.

How accurate is the scanner? What is the test sensitivity, meaning its ability to detect true infections? What is its specificity, or its ability to avoid false positives? These are the questions that epidemiologists must address to assess the real-world effectiveness of diagnostics to detect infectiousness that can spread. Epidemiologists in these environments helped shape clinical guidelines, optimize logistics, and deliver results that informed healthcare at scale.

Staging Disease When Time is Limited

Later in the series, viewers see a FEDRA stages-of-infection poster. It outlines the progression from exposure to complete fungal takeover. This type of framework is called the natural history of disease in epidemiology, and it helps clinicians and health systems understand how illness unfolds over time.

In today’s healthcare ecosystem, private sector epidemiologists are often the ones doing this type of work. From oncology to infectious disease to rare disorders, we identify key milestones in disease progression and use these insights to guide treatment strategies, clinical development, and regulatory submissions. Data privacy laws differ between countries, and I’m thrilled to have navigated a path for building global health data infrastructure with Flatiron Health to analyze complex electronic health record (EHR). Now I’m running studies to figure out which cancer treatments work best for patients in Japan, Germany, the UK, and US (Adamson 2025). 

In the context of an outbreak, this knowledge can also drive operational decisions, from triage planning to resource allocation and emergency use authorizations. What appears as a simple poster in a fictional bunker reflects a complex and critical part of public health science.

Fictional FEDRA and Real-World Evidence Gaps

FEDRA, the fictional agency in The Last of Us, is authoritarian and flawed. Yet it represents something that real-world public health lacks: centralized capacity for rapid outbreak response. In the United States, our system is decentralized, underfunded, and often politicized.

Private sector epidemiologists are already helping to fill these gaps. We support early warning systems, model supply and demand scenarios, advise governments and global health nonprofits, and respond in places where traditional infrastructure falls short. We may not wear official badges or uniforms, but we are designing tools, building evidence, and shaping response strategies that can make a difference when the next real threat appears.

Conclusion

The Last of Us gave us a haunting glimpse of a world where institutions fail, but science does not disappear. The post-apocalypse epidemiologists in that world must have operated under extreme pressure, surrounded by danger, relying on their training to guide decision-making through massive uncertainty. It’s true that we are often working behind the scenes, under pressure, trying to make sense of incomplete data in fast-moving situations where people’s lives are on the line.

In America today, a quiet shift is happening. More epidemiologists are working outside of government agencies, stepping into the private sector to fill in critical evidence gaps. This isn’t about a turf war between public and private. What matters is who is equipped to act quickly and responsibly when it counts. And that means epidemiologists must build a modern toolbox: analyzing complex EHR data, applying LLMs to derive insights, modeling the economic consequences of policy decisions, and interpreting trends in real time to inform action.

In the end, it’s not about who employs the epidemiolgists. It’s about who’s ready.

I appreciate HBO’s The Last of Us. This show takes infection seriously! I’m a fan, both of the storytelling and of the implied respect it gives to the role of epidemiology. If you’re a fan too, I’d love to hear your thoughts.

References

1. Adamson B, Sikka R, Wyllie A, Premsrirut P. Discordant SARS-CoV-2 PCR and Rapid Antigen Test Results When Infectious: A December 2021 Occupational Case Series. medRxiv 2022.01.04.22268770; https://doi.org/10.1101/2022.01.04.22268770
2. Adamson, B., Horne, E., Xu, C., Samani, A., Buhl, C., Mpofu, P., Pittell, H., Zhang, Q., Ng, D., Seidl-Rathkopf, K., Schinwald, N., Tajima, E., & Sujenthiran, A. (2025). Characterisation of oncology EHR-derived real-world data in the UK, Germany, and Japan. ESMO Real World Data and Digital Oncology, 7, 100113. https://www.esmorwd.org/article/S2949-8201(25)00002-5/fulltext
3. Dimitrov D, Adamson B, Matrajt L. Evaluation of mpox vaccine dose-sparing strategies. PNAS Nexus. 2023 Mar 28;2(5):pgad095. doi: 10.1093/pnasnexus/pgad095. PMID: 37152676; PMCID: PMC10154907.
4. Infectious Economics, LLC. The economics of antibodies for HIV prevention: a commercial assessment of profitability potential and market strategy in North America and Europe. September 2024. Available from: www.hvtn.org and here.
5. The White House Archives. Remarks by President Trump in Meeting with Governor Edwards of Louisiana. 29 April 2020. https://trumpwhitehouse.archives.gov/briefings-statements/remarks-president-trump-meeting-governor-edwards-louisiana/
6. Zimmermann, M., Adamson, B., Lam-Hine, T., Rennie, T., & Stergachis, A. (2018). Assessment tool for establishing local pharmaceutical manufacturing in low-and middle-income countries. International Journal of Pharmacy Practice, 26(4), 364-368.