Preparing for the Next Pandemic: Expert Opinions
This year we had a hantavirus scare on a cruise ship and ebola flaring again in the Democratic Republic of the Congo. It remains a possibility that avian flu acquires the mutations it needs to spread between people. Each one is a drill we keep half-passing.
In June I moderated a session at Aspen Ideas Health called Preparing for the Next Pandemic, stepping in for my colleague Dr. Céline Gounder, who could not join due to a family emergency. I had the privilege of facilitating a conversation between three people who each saw a different part of the COVID-19 response up close: Ashish Jha, who served as White House COVID-19 Response Coordinator; Jessica Malaty Rivera, infectious disease epidemiologist and science communicator who helped lead the COVID Tracking Project; and John Nkengasong, virologist, founding director of the Africa CDC, and a leader of the U.S. global HIV response. These are three people whom I deeply respect.
Five years out from COVID, the harder question is not whether the next threat is coming. It is whether the structures we would rely on to meet it are stronger or weaker than they were in 2020. WHO members are negotiating the first legally binding pandemic agreement in history. At the same time, public health budgets, data systems, and global institutions are being cut back. We are building and dismantling at once.
The next pandemic may be engineered, not natural
Ashish opened with a historical framing. Around 120 years ago, scientists learned to engineer chemistry, and a decade later the world saw chemical weapons in World War I. In the 1930s we learned to engineer physics, and a decade later came nuclear weapons. About a decade ago, scientists learned to engineer biology, and this time the new capability is arriving together with artificial intelligence. His claim, and it is his to defend: it would be a historical anomaly if we did not see an engineered biological threat used within the next five or so years.
Whether or not you accept the timeline, the premise deserves attention, because nearly everything we would need to meet an engineered threat is the same infrastructure we need for a natural one: diagnostics, data, vaccines, and public trust.
Detection is easy to call for and hard to pay for
Everyone on stage agreed that early detection matters. As a health economist, I kept pulling the conversation toward the question underneath: who should pay to find biological threats to US national security, and what keeps the system funded in year seven when nothing has happened in years one through six?
Surveillance is a classic public good. Everyone benefits, and no one wants the bill. Twenty years ago I worked on a project using open-source signals to identify early signs of emerging threats. Those systems ended up siloed, not because the science failed but because the financing did. Until we connect the communicators with the epidemiologists, and the epidemiologists with the data scientists, we will keep missing the whole picture.
During COVID I built infection surveillance and testing programs for employers, manufacturers, professional sports leagues, and live theater, and I learned something that surprised me: the private sector often has a stronger financial incentive to detect and contain outbreaks than the government does. An outbreak stops production, closes venues, and empties offices, and those losses hit a balance sheet immediately. A durable preparedness system will be financed not just by federal appropriations but by the employers whose productivity depends on healthy people.
An outbreak anywhere is a threat everywhere
John pushed back on the most American question in public health: is it going to come here? We learned from COVID that it takes less than 30 days for a virus to emerge anywhere in the world and affect everywhere in the world. Supporting the Ebola response in the DRC is not charity. It is self-protection, and it is far cheaper than waiting.
He also offered the most hopeful data point of the hour. The current Ebola outbreak is being led by the DRC’s own ministry and health workers, who sequenced the virus and deployed community teams themselves. That capacity is the return on decades of global health investment, the very investment now being dismantled. His prescription: a security architecture that works at three levels, global, regional, and national, and a WHO narrowed to the things only a WHO can do.
We do not have one outbreak, we have fifty
Jessica made the case that information resilience belongs on the preparedness list right next to labs, vaccines, and stockpiles. Federalism means the United States never has one outbreak; it has fifty, unevenly resourced and inconsistently reported. That is why an 800-person volunteer effort, the COVID Tracking Project, had to exist to make sense of the country’s own pandemic data.
I can vouch for that one personally. When I was called to the White House in March 2020 to model ventilator capacity, the highest quality, most current data available did not come from the CDC. It came from Jessica’s volunteers.
Her line that stayed with the whole room: a vaccine doesn’t save a life, a vaccination does, and the difference between those two is a message. If we spend billions on research and development and nothing on the communication that turns tools into trust, we are doing the work in vain.
What to watch over the next year
I closed with a lightning round: name one indicator that will tell you whether we are getting more ready or less. Their answers make a useful scorecard.
- Regional production of medical countermeasures (John)
- Whether public health departments create and fund dedicated science communication roles (Jessica)
- Whether detection of biological threats, natural or engineered, becomes a funded priority rather than a talking point (Ashish)
My honest takeaway from the hour is that we still don’t all agree. Local vs global response? Private vs Public? Choice vs mandate? The economics of preparedness are unforgiving in one direction. Detection, data infrastructure, incentives for innovation, and trusted communication are cheap relative to what we lose when they are missing. We priced that lesson once already.
Thank you to the Aspen Institute and Aspen Ideas Health for hosting this conversation, and to Ashish, Jessica, and John for bringing candor to a hard topic. Thank you also to Céline Gounder for preparing the thoughtful discussion guide that shaped this conversation. The full session is above, and it is worth the hour.
I used Claude Fable 5 as an assistant while drafting this post and used the YouTube transcript from the recorded session.
