When the zombie apocalypse hits, who’s left to do the math?
In HBO’s The Last of Us, the public health infrastructure has collapsed, but the science hasn’t disappeared. Somewhere, someone is still modeling infection timelines, developing diagnostics, and creating triage protocols. That “someone” may not be a government employee. In the real world, especially during crises, epidemiologists in the private sector are increasingly stepping up to fill critical evidence gaps.
Having worked in both public and private settings, I’ve seen firsthand how much faster, more adaptive, and often more impactful private sector epidemiology can be when lives and systems are at stake.
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.
Experience From the Front Lines
In 2020, I served as an epidemiologist advising President Trump in the White House during the COVID-19 pandemic. I was brought in not as a government official, but because of the experience I gained in the private sector. I was ready to listen for decision dilemmas, identify uncertainties, move quickly, analyze complex data, and deliver evidence that leaders could use immediately.
Working across biotech, data analytics, and global business environments gave me the skills needed to navigate urgent, high-stakes scenarios. That experience 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.
Infection Timelines Built from Messy Data
In Episode 2, the show introduces a chart from the Federal Disaster Response Agency (FEDRA) that outlines how long it takes someone to turn after being bitten, depending on the body region:
- Neck/head: 5 to 15 minutes
- Torso: 2 to 8 hours
- Leg/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. 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.
Despite these limitations, we 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. The green light means uninfected. The red light means danger. Beneath this scene is a real scientific concern: test validation.
How accurate is the test? What is its 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. See how my team at Infectious Economics moved rapidly to assess COVID test performance in workplaces here. 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. I’m doing this now at Flatiron Health building the infrastructure for EHR-derived real world datasets in the UK, Germany, and Japan, described here.
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 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, but we are designing tools, building evidence, and shaping response strategies that can make a difference when the next real threat appears.
The Future of Outbreak Science Is Collaborative
Fans of The Last of Us are drawn in by its intense storytelling and dystopian world. But beneath the drama is a deeper message: science is survival. And in the real world, survival will depend on partnerships that extend beyond government systems.
Sometimes the most important insights come from a biotech company refining detection algorithms. Sometimes they come from an epidemiologist working with real-world data to identify disease patterns. Sometimes they come from professionals like me, who learned to move fast and think strategically because the system couldn’t afford to wait.
The last epidemiologists might not be on government payrolls. They might be in industry, consulting, or nonprofits. But they are doing the work that matters most—wherever they are needed.
In the end, it’s not about who employs them. It’s about who’s ready.