Are We Ready for the Next Pandemic?

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100 years ago, a flu virus devastated the world, killing off as much as 5% of humankind.

There have been a number of medical advances in the intervening years, but the viruses have advanced as well.

Would the world effectively unite against another global pandemic?

Or would it rip us apart?

This is Radio Atlantic.

Hi, I'm Matt Thompson, Executive Editor of The Atlantic.

Here with me in the studio are two Atlantic staff writers, both science writers, Sarah Zhang.

Hello, Sarah.

Hello.

And Ed Young.

Hello, Ed.

Hello, hello.

You last heard Ed's sonorous tones, perhaps, reading E.M.

Forster's The Machine Stops.

As your rent of Britain.

Yes.

So great.

With a quick quick programming note,

Jeff and Alex are both off gallivanting this week, but they will be back soon.

So,

Sarah, we have talked about a lot of different threats on Radio Atlantic.

Threats to liberal democracy, nuclear threats, concerns about terrorism and technology and more.

However, There's one giant global threat that always seems to get underweight next to the tremendous risk that it poses us, pandemics.

As we speak in the year 2018, it's a century since a horrific flu virus swept across the world's population in 1918, killing as many as 100 million people.

It's unimaginable.

5% of the world's population died in that 1918 flu.

Ed, you recently traveled around the world looking into the

band of scientists protecting us from such a catastrophe today.

So I just wanted to ask as a wide open question,

how much safer are we from the pandemics than we were in 1918?

Well,

okay,

let's do the good news first.

Obviously, in a century of progress and advancement, we have a lot of advantages that the good people of 1918 did not.

We have better ways of treating people.

We have the infrastructure for for creating flu vaccines.

We have surveillance systems that allow us to monitor what is going on with influenza viruses around the world in people and in animals.

So in many ways we are better prepared and much safer than we were 100 years ago.

That being said,

there are a lot of causes for concern too.

For example, the world is changed.

Back then there were, what, 2 billion people, probably just over that.

Now there are more than 7 billion people around the world and

those people are now living mostly in urban centers where humans are very densely packed and where diseases can more easily spread.

We live in a world of intense air travel, of globalization, where it's very, very easy for people from any part of the world to get to any other part of the world within a day or so.

That wasn't true back in 1918.

So the ability of diseases to spread now is much greater.

And unfortunately, the number of diseases that we have to worry about is, if anything, increasing.

So there are all kinds of new contagions that we have only recently learned about.

Things like Ebola, like Nipper, Hendra, MERS, SARS, and flu, that age-old adversary, is still very much around

in lots of new and constantly shifting guises.

Flu is a constantly evolving adversary

and since 1918 it has triggered several pandemics, none of which were quite as bad, but that shouldn't lure us into a false sense of security.

A flu pandemic

caused by a strain that was as lethal as the one in 1918

could cause immense devastation even today.

And you know, we only have to look to 2009, less than a decade ago, to understand how we might be taken off guard.

So the 2009 flu pandemic happened despite the fact that flu was the disease we were arguably best prepared for.

Our surveillance networks, our ability to spot new strains of flu were concentrated in East Asia at H5N1 bird flu that was seen as the biggest threat then.

It missed the rise of new strains of H1N1 swine flu in Mexico.

So those strains were only detected after they'd been circulating for months and after they started sickening some people in California.

So right in our backyard we we failed to realize that these new strains of potentially pandemic flu were developing.

When they circulated around the US, hospitals were stretched very thin.

They weren't overwhelmed, but pediatric units were stretched thin, intensive care units were stretched thin, a lot of equipment that put people on life support

were in short supply.

And this was for a pandemic that many saw as sort of a dress rehearsal for something bigger, you know, a training wheels pandemic that really wasn't actually that powerful.

And finally,

our infrastructure for making vaccines wasn't able to rise to the occasion.

We do have flu vaccines, that is something we don't have for the vast majority of new diseases that could potentially threaten us.

And yet,

those vaccines need to change on a regular basis because flu is such a constantly shifting adversary.

And back in 2009, our ability to make vaccines against the pandemic strain was too slow.

By the time the first doses rolled out,

the peak of the pandemic had already passed.

So we were effectively vaccinating survivors, which is not really what you want to do.

You know, this year, the seasonal flu, which wasn't even a pandemic strain, managed to stretch the healthcare system

to a concerning point.

And I think this just goes to show that even for something like flu, which we know well, which we understand well, and which we are arguably readier for than anything else, that can still cause us problems.

You traveled all across the world, basically reporting this story, looking at what would happen.

if a plague were to hit.

What did you find on the other side of the world?

What did you find in the Congo?

Yeah, so I went to this city called Kikkwit in the Democratic Republic of Congo, which experienced a devastating outbreak of Ebola back in 1995.

And it was that outbreak that was one of the reasons that Ebola became the infamous menace that it is today.

I think it was the second

or third, depending on how you count it, outbreak that the Congo had experienced, and certainly the first one that

was captured by journalists and news crews and then it showed what an Ebola outbreak truly would be like and I wanted to see how the country had moved on from that you know almost almost two decades on so I saw the hospital where that acted as one of the epicenters of the outbreak I went to the site of the mass graves where people were buried I talked to people who had survived the outbreak and found out what their lives have been like since.

And what I found

was,

in many ways, similar to what I learned talking to people in the US.

Many of the themes on this issue of preparedness were the same in the two countries, despite the fact that there is a vast gulf in their wealth and the amount of resources they have.

People in the Congo were talking about

how subject preparedness is to political attention and to this cycle of panic and neglect, how after the Kiquit outbreak,

surveillance systems were put in, protective equipment was widely distributed, and then as time passed,

all of that preparedness dwindled.

People started to forget, resources started disappearing, they were taken away for other purposes and they weren't replaced.

So to this date, people in the Congo are very, very

savvy when it comes to Ebola and a lot of other diseases that vex them locally.

They know what to do, they know what symptoms to look for, but they don't have the resources to actually protect themselves, to investigate potential new outbreaks very well.

You know, they are very good at controlling the diseases in their borders, but I think they are still subject to the psychological problems that befuddle preparedness against diseases across the entire world.

And by that I mean things like forgetfulness and short-sightedness.

And people in the States who I talked to said exactly the same things to me, starting from a very, very different base point,

but very similar in kind, that

we go through these crises where things like

Ebola happens, we respond to the West African outbreak, we worry about Ebola reaching our shores, investments rise and then they fall.

Zika appears

within America's borders.

And again, investments rise, attention peaks, but then slowly they dwindle.

And this seems to be the underlying problem that stops us from becoming truly prepared to deal with the disease threats of the future, that

these risks operate across time spans that go longer than than political cycles.

Yeah.

Sarah, do you think that there's any way that we could break out of that sort of cyclicality, given your attention to the vagaries of science and the public response to it?

Yeah, that's such a good question, right?

So I think one of the themes that Eds really hits on in his story is that leadership matters and who we have at the top matters.

But maybe what we really need to be resilient is to build a system where it doesn't matter who it is at the top, a type of system that, you know, it could be anonymous, you know,

rather anonymous epidemiologists.

And they go about their work regardless of who is at the top directing their attention to it.

Like, you know, it's just kind of an automatic reflex that's in the system.

Yeah.

That illustrates one point that was implicit in your story, Ed.

Anonymous epidemiologists are

legion.

Probably not legion enough, but there are

toiling in the laboratories of the world.

there are all of these individuals who will be called upon to step up in the event of some sort of out-of-control virus.

Who are some of the memorable individuals that you encountered on your journey into our public health supply chain?

Oh my god,

there are so many of them,

and

a lot of them weren't even in the piece.

I feel like public health folks are the unsung heroes here.

Yeah,

the work they do is often

not sexy or glamorous, but it's the work that keeps us all alive.

You know, I went to

a public health lab in Wisconsin that acts as a big center for flu surveillance in the country.

And, you know, back in the 2009 pandemic, they were really working 24-hour days.

They were doing the diagnostic tests that actually told people whether they had flu or not.

And these are the same people who are also doing doing like screening for newborns and who are checking out like food contamination or water contamination.

You know, they are,

when a pandemic hits, it's not like you can suddenly parachute in this like emergency team whose job is to take take care of things like you do, like you see in, you know, movies like Contagion.

It's the same people who are, you know, doing this hard work day in, day out, who have to rise to the occasion.

You mean that like Rafe Fienes isn't going to show up?

That's right, yeah, that's right, right, right.

Or like, you know, Kate Winslet leading like a

who drop team.

Yeah, that's that's sadly not going to happen.

This is making the flu seem even worse.

Right.

And those people are chronically underfunded,

you know, and

they are understaffed.

If you look at budgets that have gone into public health preparedness over the last decade and perhaps longer, or that go into training epidemiologists, to funding public health labs, to getting hospitals ready for future diseases.

There's just been a downward trajectory.

You know, their funds have started at high points and then have gone down.

And that's a problem that

has transcended administration, sadly.

It was very prevalent during the last one.

It is still a problem in this one.

So when I was reporting on the Ebola outbreak in 2014, I remember learning and realizing that there are three top biocontainment units in the country: one of them near the CDC, one of them near the National Institutes of Health, and the last one in Nebraska.

One of these maybe just feels like it doesn't quite belong.

So, you actually go to Nebraska.

How did Nebraska end up being one of the most prepared places in the country for an outbreak?

Yeah, so Nebraska has this biocontainment unit, which is this kind of special ward that is specifically designed to deal with things like Ebola, like SARS, bioterror attacks, the deadliest of the deadliest infectious diseases.

I think it's instructive how they became prepared.

So after SARS in 2003

and after an outbreak in the Midwest of monkeypox of all things,

one of the heads of the University of Nebraska Medical Center, a man named Phil Smith, decided the hospital really needed to get its act together to create a place that could handle people with these conditions and it created the unit then and then nothing happened.

You know there wasn't another SARS, there wasn't another Ebola.

This unit sat dormant and a woman named Shelly Schwedhelm helped to keep it afloat.

She and her team helped to make the case for why this unit was important and why its existence was paramount.

And

because of that vision,

the unit was ready in 2014

when Ebola actually arrived in Nebraska,

when Americans who had been dealing with the outbreak in West Africa had to be medivaced over to the US

to be treated with Ebola.

I think it just goes to show that preparedness often becomes this matter of individual will.

It becomes the result of specific people who understand the need for it and who can make the case for it even if there's no immediate danger banging on their doors.

And you sort of need that.

You need people to put aside resources and money and physical spaces.

in the event of something that will happen in the future, even if that event may not happen for years or maybe even decades.

And

that's a tough investment to

justify in the face of all these other health crises that are so

in our faces right now.

One of the just a striking fact came from a conversation with Bill Gates,

who said that a simulation that he'd seen showed that a severe flu pandemic could kill, quote, more than 33 million people worldwide in just 250 days.

How would you compare the the scale of the public health apparatus that you were able to observe to the scale of potential calamity that's at risk here?

Yeah,

I think it's fair to say that those two things feel out of proportion to each other.

You know, public health is something that, as I said, I think is underfunded and underappreciated.

And yet it is our bulwark against

what seems to be be one of the greatest threats that we might have to face in the future.

You know, the problem of infectious diseases isn't going away.

If anything, it's getting worse as the world changes and the number of new diseases rises.

And yet

we just seem psychologically and societally ill-equipped to make the stable, sustainable investments we need to properly defend ourselves against against it.

Aaron Powell, yeah, it's kind of a political problem, right?

Like,

you don't get credit for preventing a terrorist attack because people don't understand the depth of the devastation that would have happened.

You don't get credit for preventing a pandemic because people, it was hypothetical.

They didn't realize what could have happened.

Aaron Powell, but one of the implicit themes there that

you've written about a fair amount has been the nature of the public response to science and the politics around science.

And what do you think would happen if a politician politician were to demagogue the flu?

If we were to talk about the flu the way that sometimes the Trump administration talks about, say,

the tiny strand of people that are in MS-13?

Well, we have seen politicians demagogue Ebola, right?

I think

what would be interesting with the flu is that

there's so much that intersects with public health and short-term political interest, and they do not always align, and in fact, may often not align.

So if you see a case where a flu is coming from another country, and you know, we we call the 1980 flu the Spanish flu, it probably did not actually come from Spain, but you could very easily see how a shorthand like that could become like this is a foreign thing, a foreign pestilence that's coming to invade us.

And I think that could be really problematic.

Yeah, but would there be chances of a politician using this power for good?

I mean,

could you imagine someone campaigning on a, I want to eradicate the killer that might fell tens of thousands of Americans

but I I think it's I think the problem with all of this is that

diseases by their very nature are sort of invisible.

You know,

it's hard to picture in your mind what the threat looks like.

It doesn't have a face.

And

it therefore, I think, makes it hard to

really appreciate

the nature of the threat.

I think Sarah is right that the more likely direction is that these threats are used

to

stoke fear.

of the other,

of people coming in from other parts of the world and bringing diseases with them.

We saw this play out during the Ebola outbreak that hit West Africa.

So, you know, A magazine published a cover about how people were going to bring Ebola into the States because they were

taking bushmeat with them.

All kinds of paranoid thinking emerged and were fanned online by the man who is now in the Oval Office.

Trump tweeted about how Obama was crazy and a psycho for not banning flights from the countries that were affected, even though no actual direct flights existed.

He mocked the President for

sending troops over.

He derided him for allowing Americans who had become

infected while trying to help control the outbreak, allowing them back into the country.

They should basically be left to die, is what he was saying, that they should suffer the consequences for their altruism.

And you could just imagine that

that might, how that might play out in a future epidemic.

When outbreaks like this happen, the things that we need are

a unifying spirit.

and calm, authoritative, reliable information.

None of these things were evident during the response to the West African Ebola outbreak from the people who now hold the reins of power.

And I think

I'm not super confident that those qualities will manifest in the future.

Aaron Powell, and to just add one more example,

there's a bacterial disease called leptospirosis

that is kind of common in deserts.

And when we were talking about Syrian refugees coming in, this was a thing on right-wing websites.

They were saying the refugees who bring in this bacterial disease into the U.S.

Aaron Trevor Barrett.

So it's all entangled.

Our thoughts about refugees also inflect the preparedness for a pandemic, perhaps.

So

we can go deeper into the dark times and the political challenges.

But I'm curious, what are the bright spots, Ed, as you've looked into the matter of public health preparedness?

What do you find that you're optimistic about?

So I think that

we've seen a few moves

over the last decade and certainly since that big Ebola outbreak in West Africa that are

reassuring, that provide some hope that the world is finally getting it.

So the US has an agency called BARDA,

which acts sort of like a venture capital firm within the government.

And that has funded the development of countermeasures against future threats.

It funded the creation of a vaccine-making plant in North Carolina that has the ability to churn out vaccines far more quickly than

previous techniques could do.

There is also an organization called CEPI, which is the

Coalition for Epidemic Preparedness Interventions.

My God, there are a lot of acronyms in this field.

But CEPI is an international alliance of governments and non-profits that is trying to prepare vaccines against deadly potential future infectious infectious threats.

For the moment, it's focusing on nipavirus, MERS, and lassifever, and trying to create vaccines for them and getting them to a point where they could be field-tested if outbreaks of these three diseases actually happen.

They're also investing in creating what are called platform technologies, which are like sort of like plug-and-play tools that will allow you to create vaccines against new unseen threats very, very quickly by kind of by taking

whatever is new and plugging it into a system that is old and tried and tested and already approved by regulators.

So the fact the existence of those agencies suggests to me that this is being taken seriously,

as is an agreement called the Global Health Security Agenda, which is trying to get nations all around the world to live up to an internationally agreed-upon framework for like what preparedness looks like.

It's trying to get everyone onto the same page of where everyone should be in terms of fighting infectious diseases and how different countries can get there.

So there are bright spots.

That is good to hear.

So stick with us.

In a moment, we will turn from bright spots to the politics of public health.

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We've talked a lot about the infrastructure and the response to pandemics here in the U.S.

Sarah, I'm curious what we can learn from other global players.

Yeah, so I think a good example of this is SARS back in 2002,

2003.

So SARS started in China.

And when this was happening, China, you know, obviously did not want to be known as the site of a new unknown virus outbreak.

So it really did not want to talk about it and for months was not telling the World Health Organization what was going on, was not letting people from the WHO come into the country to investigate.

And during this time, of course, the virus was spreading and we have airplanes.

It was, you know, getting all over the world.

And so it's, it's, you know, we talk about this globalized world

and we're also at a moment where the leader, the administration in the U.S.

is becoming increasingly isolationist and increasingly suspicious of the global community.

We've been talking about how that might affect us in the U.S., but when we do not want to participate in the global community, that is bad for the rest of the world as well.

Talk about some of the specific ways in which our instinct, perhaps, to shut down the borders in a crisis actually is counterproductive to protecting folks.

Yeah, well, I think

one of the things that comes up when you have an epidemic is that people are really scared of each other, right?

Because each person becomes a vector for the virus or for the disease.

So when

we shut down the borders, that is a drastic step.

This is saying like, this is, you know, if you think this is worth doing,

this must be really, really bad.

So when you stigmatize this illness so that people don't want to go to health officials, don't want anyone to know that they are sick, you're actually driving it underground.

You're making it harder to figure out what's going on.

You're making it harder to contain it.

And you're operating in the dark with much less information.

So is the answer to not be afraid

i i think the answer is to realize that um no single country can deal with this problem alone um

every this is a global issue that the world needs to work together on and things like travel bans um

border shutdowns they're just deeply unaffected ineffective and also um very counterproductive if if america had not sent people to West Africa during that big Ebola outbreak, the outbreak would have become even bigger than it actually was, which would then have increased the risk of people traveling to other parts of the world and for the thing to really start raging out of control.

And if you shut down travel and if you close your borders, you're also saying to people within your country, do not go and help people abroad because you won't be able to get back in.

And that also increases the risk that outbreaks elsewhere in the world will rage out of control.

I think the simple fact is that in this globalized world,

you just

can't stop diseases from spreading through things like walls

or travel bans or whatnot.

The best way to do it is through global cooperation, is by

rich nations helping poorer nations to shore up their own defenses, to increase their ability to

deal with and control their own outbreaks, to help them set up labs, train epidemiologists.

And this isn't even a case of

nations like the US sort of parachuting in to help out when problems are afoot.

It's about building local capacity.

And we've seen really good examples like this all over the world.

Thanks to investments from the US and other countries.

Uganda, for example, is now very good at doing surveillance for Ebola and other viral hemorrhagic fevers.

Their outbreaks used to spread to hundreds of people.

Now

there have been many, many outbreaks whose case numbers you can count on a single hand.

In Nigeria,

there were huge concerns that when a Liberian-American man arrived in Lagos,

the most popular city in Africa, that this was going to trigger a huge and devastating new phase of the Ebola outbreak.

But Nigeria already had this incredible health infrastructure for eradicating polio and all of those people and those resources could be diverted to dealing with the Ebola and so that outbreak never happened.

Ebola was brought to heal

in what many feared would be the nightmare scenario.

So there are so many examples where investments from the US and other rich nations have already paid off around the world.

And those are the investments that we need in order to make everyone safer.

This idea of America first

cannot translate to America alone.

When it comes to diseases,

even if you don't really buy into the moral imperative of helping other countries, from a purely selfish standpoint,

Still, the best thing to do is to help other people, like other nations.

Yeah.

Sarah,

how do we get better as a population about dealing with things like the flu?

You've written recently about the dynamics of recent flu outbreaks, and I'm curious,

how should individual people think about their own preparedness?

I think I heard this from my colleague Egg, that there's nothing they can really do as an individual.

I don't mean that in like, you know, we are all helpless, but that the things that we need are systemic.

You know, so one of the problems that happened with the flu this past year is

we ran out of IV bags, you know, very simple intravenous solution because they were being manufactured on Puerto Rico.

And when the hurricane hit, they stopped making them.

And you know, you literally had stories of people

learning things they had to doing things they hadn't do in 30 years, like slowly injecting fluid into someone's body because they had run out of this very, very simple thing, IV bags.

So

you have there are networks of people that need to be in place.

There are supply chains that need to be shored up.

These are all things that we can anticipate because we've been through them before, but there just seems to be the will to do them.

Yeah.

How, Ed, from your observation, traveling to

different spots, how good is the network of global coordination and collaboration around

the potential of a pandemic or around the viruses, outbreaks that we have seen?

I mean, I would say that

it varies

depending on the place.

There are lots of parts in the world that I think are working very well together to build up their own defenses.

You know,

I got to go to the Congo because

a team of researchers from the University of California, Los Angeles, led by Anne Ramoyne, an epidemiologist, had established a long-working relationship there.

They were friends with Congolese virologists and epidemiologists.

And the Congo, I would say, is a place that actually hasn't had that substantial an investment from

the US and other Western nations.

But I think this ethic of creating those connections

is vitally important because with those connections comes trust and that's crucial in an outbreak situation.

You need to know who you can rely on and if there are already established working relationships, those can really be brought to bear on a new crisis.

And I think that's one...

That's a thing that is imperiled at the moment.

A lot of those relationships have been very slowly built up over time.

Many of them are still quite new.

The CDC in the wake of the Ebola outbreak used large pots of money that were committed to fighting Ebola and towards the global health security agenda to increase their presence in a lot of countries around the world to build those relationships, to help shore up those local defenses.

But those investments are now drying up.

Trump's budget for 2019 would entail a 67% cut to the money that's been committed, that's been used so far for the global health security agenda.

And that lack of money translates into lack of jobs, lack of people on the ground.

The CDC and other agencies will have to pull back their presence in other parts of the world where these disease threats are very much alive.

And if they do that, what that means is that those relationships on the ground, that trust that's been built up will start to fray and break.

And that's a problem.

If anything, we need to double down.

We need to make those relationships even stronger than they have been before.

I think that our ability to prepare for these threats

is, as Sarah said,

a systemic thing.

It has to do with travel routes and supply chains.

But on top of that, it also boils down to these very individual relationships.

It's two people who know each other and who know how to get the job done.

But those two things feed into each other.

You know, our lack of political will, our lack of sustainable investments translates into a lack of relationships and trust on the ground.

And so I ask again,

why

is this not treated as a sort of big, let's get the world together?

There's this hypothetical that we've discussed on the show and we discuss,

you know, you'll hear this around like

dorm room conversations for kids in college.

If aliens were to invade the planet,

would that drive humankind apart?

Or would that bring humankind together?

And why, in the face of such an enormous potential, devastating population-level threat?

Why isn't that more of a galvanizing force to draw more

investment and focus?

I think you're right.

It should be a unifying force.

I sometimes, I often think of pandemic threats as like the squid monster from Watchmen.

Spoiler alert for anyone who's not read Watchmen.

You know, like

this unifying threat that affects everyone and it really ought to bring together like warring, polarized partisan factions.

But I think the problem is that

unlike say natural disasters, which are caused by these abstract, external,

you know, almost mythological forces like volcanoes and earthquakes,

which make it easier for people to sort of rally against, infectious diseases spread through people, through the microbes that we carry in our blood and our breath.

And so other people become vectors, they become sources of contagion.

And it's been said to me by several public health people that while disasters can bring communities together, diseases often tear them apart.

They turn people against their neighbors.

And they have this sort of inherent divisive quality to them.

And I think that's why it's so important to counteract that with a spirit of unification that needs to be...

portrayed by our leaders and that needs to be woven into the way we deal with the rest of the world.

You know,

in many ways,

this global zeitgeist of xenophobia and nationalism is exactly the opposite of what we need to deal with infectious disease threats.

A woman named Padi Sabeti,

who

works at Harvard and who has been involved in dealing with Ebola,

said to me that

viruses really are in many ways the one unifying threat.

They should be the thing that humanity takes a global stance against.

Whether we have the wisdom and the foresight to actually do that or not is an open question.

But I think you're right that they ought to unify us.

And

we can't stop them if we're not unified.

Sarah, one of the things that drives us apart, as we saw in the West African Ebola outbreak several years ago, is just pure blind panic, not knowing what to do and confronting something incredibly scary.

What is the role that panic plays in the spread of an outbreak?

And how do we, talking about the psychological approach to dealing well with the possibility of a pandemic, how do we prevent panics from breaking out?

Yeah, I think what's so scary about an outbreak isn't just that people get sick or die, is that it really tears apart the fabric of society, right?

Like

it changes how you interact with people.

There are photos of

the 1918 flu epidemic.

Like

court is being held outside because everyone is afraid of being indoors.

With the Ebola outbreak, you see that people, it was spreading because of their funeral practices.

And this is something that is very deeply felt in the community, but they had to stop it.

I think panic is useful if it can help us in the prevention.

I think once a virus is spreading, it taps so much into like our primal fears that it makes us suspicious of each other.

And I hope that

the maybe slight sense of panic we can get from meeting Ed's piece makes us slightly prepared to deal with that.

And misinformation flies around.

Yeah.

And I think it heightens some of our worst instincts, like racism, like xenophobia.

You know, when

Ebola fears were at their peak,

people were told to go home to take sick days.

Kids were sort of pulled out of school.

And often, like,

not with,

with

no reason.

You know, people were told to go home because they had just come back from different parts of Africa that had nothing to do with the outbreak.

You know, the

poor sense of geography, coupled with, you know, this sort of growing tendency to mistrust people from different backgrounds or different skin colours, I think is going to, is going, definitely has caused problems before during outbreaks past and will likely do so again in the future.

Trevor Burrus, Jr.: What do you think an effective political response is to that?

Like, what do you show me?

Tell me an example of a politician doing the right thing.

A woman named Mary Bassett,

who was New York City's health commissioner,

she

exemplified how to deal well with a crisis like like this.

So when

Ebola fears were at their height

and a doctor named Craig Spencer arrived in the US, having been involved in controlling the outbreak in West Africa and was diagnosed with Ebola, Bassett regularly appeared in the press as this,

I think she was described by the Times as a palpable force of calm.

She reassured people.

She spread the correct information because she had access to

her own scientific background and also strong evidence-based advice.

She went to places of business that Spencer had also visited to show that there was no risk of being infected just by being in those spaces.

I think she ate meatballs with New York's mayor to this restaurant.

And she really importantly held town halls with the Liberian community to make sure that they weren't being stigmatized, that they weren't subject to xenophobia and hate as a result of misplaced paranoia.

I think that just shows that it's not impossible to maintain goodwill and togetherness during an outbreak.

It can be done, but

it does require having leaders with that unifying spirit.

Yeah.

I imagine one other dimension that plays into

the way that we underprepare for, underweight, the possibility of the pandemic is just that every year it seems like it's something else.

Also, I mean, we've gone through, it's Zika virus one year, Ebola virus the next year, bird flu, swine flu, mad cow disease.

How

first of all, why

does it seem like every year there's another big potential public health danger?

And how can we kind of be appropriately attuned?

What's the right way to think about the different seasonal new strains, new infections, new viruses that come out?

What's the right way to think about that without minimizing the potential dangers?

Oh, well, there are a lot of bad things out there that are trying to kill you.

That was not the calming part of the answer.

But I think, like, you know, as an individual, you don't need to be panicking about every single disease that crops up in some corner of the world most of them are unlikely to reach you um

i think there definitely is a panic and neglect cycle um you know as i said i i don't think it is your job as an individual to worry about this it is the the public health agency's job is the cdc's job to be on the front lines of all of this um i think as

as an individual, it's just a matter of

not hiding anything if you're worried about being sick, going to the doctor.

I think

public systems work when there's a spirit of trust and working together and generosity.

So I think if we could cultivate that kind of spirit where everyone is trying to do the right thing,

that is maybe the way to think about how to fight an epidemic.

Is there anything I should be listening for?

Like, is there something that is a tell that, oh no, this one really, really is worth paying attention to?

I mean, I feel like the

common thread to all these threats is that they are inherently unpredictable.

There are a lot of viruses and other infections out there.

There are thousands, perhaps millions that we don't know about that await discovery.

And

I think some people

feel that we might get to a point where we can reasonably predict which are most likely to jump into us.

Other virologists, and I think I would also argue that

such events are so stochastic, so unpredictable, that our chances of doing that reliably are very negligible.

All we can do is to spot new outbreaks when they happen and to do our best to control them.

But fortunately, I think

a lot of the solutions cut across diseases.

They are societal and political solutions.

They are a commitment to stable funding.

They are a commitment to vaccinology research,

regardless of the specific vaccine against the specific disease you're trying to make.

They are about training epidemiologists, ensuring that public health labs are adequately funded and resourced.

All of those defenses cut across diseases, whether you're talking about Zika or Ebola or flu or anything else.

If you get the infrastructure correct and if you get the political will in place

and the trust and relationship set up, then

that's our best defense against the things that we don't know about.

And assuredly, the things we don't know about are the things that are going to hit us in the future.

Well, Ed, thank you for traveling around the world to tell us about some of those things and people that we didn't previously know about.

You're welcome.

Sorry, I couldn't be the bringer of better news.

You know what?

You know what?

I'm happy to know how many people there are are all around the world,

underfunded or not,

fighting the fight against bad people.

There definitely are.

There definitely are.

I was going to say there's no shortage of them, but that's actually the opposite of what's really...

There are a lot of them.

And I think everyone, including them, would love there to be more.

So maybe the answer if you want to do something is become a public health official.

Right.

I mean, yeah.

Or maybe like hug your local public health official.

Figure out who your local public health official is and hug them.

Right.

But maybe, maybe not hug them.

That's

right.

With that, let us turn to our closing segment, Keepers, in which I ask, what have you read, heard, seen, watched, listened to, experienced recently that you do not want to forget?

I'm going to start with a keeper from one of our listeners, Julie.

My keeper is

a couple weeks ago, and I know it's not this week, but a couple weeks ago, my

aunt,

my 87-year-old favorite aunt, took myself, my wife, and my 13-year-old grandsons to dinner and told them stories and passed along memories to them that some I didn't know, some I did know.

And my keeper is, is at the end of it, when I took them back home to their parents' house, My grandsons were thrilled to tell their father about the story about the day when their nana was born.

And to me,

that was just amazing.

Because, you know, 13-year-old boys listening to an 87-year-old woman tell stories, not happening very often in this day and age.

So that's my keeper.

Wonderful.

I would definitely put in a plug for the family stories.

I record stories with my parents as often as I can.

And some of those stories are fantastic.

And I never would have known if I did not designate a time to sit down with them and ask them to tell me stories, particularly about the time before I came into the world.

Sarah, what is your keeper?

So I've been trying to read more fiction to unwind.

And over the past few months, I've read three books during World War II and one after the apocalypse.

So I'm going to talk about the book that's after the apocalypse.

It's called It's A Theory of Bastards by Audrey Shulman.

And it's about a bonobo researcher.

And she is studying bonobos in a facility in the Midwest and the modern world starts falling apart basically.

And it's such an interesting and compelling story about human nature and evolution and free will, but I also found it intensely frustrating of places as someone who writes about science.

So I am mentioning this because I really want to talk about it.

So please at me if you have read it.

Awesome.

Awesome.

Say it again.

Say the title of it again.

Theory of Bastards by Audrey Schulman.

Fantastic.

And what do you want to keep?

Oh man,

I recently wrote a story about these incredibly old, beautiful trees called baobams.

They're sometimes called the upside-down trees because they look as if someone has just like yoinked a tree out of the ground and turned it upside down and planted it back again.

Their branches look like a root system.

And sadly, a lot of these trees are dying.

Like some of the oldest and biggest ones

have died suddenly in the last few years, last decade or so.

And climate change seems to be the most likely explanation, which is very tragic.

But the story sticks in my head because I think about just how much these trees have experienced.

The oldest one was, I think, 2,500 years old.

You know, how many empires have risen and fallen in that time?

How much history has gone by while this thing was growing and before it eventually fell?

And I think that's

sort of a haunting and beautiful metaphor for the ways in which we are changing the world around us.

Absolutely.

Yeah, the Bayobog trees.

My earliest memory of the Bayobog trees came from the little prince.

Yeah,

too.

Yeah.

Yeah.

It's a sad thing to think that climate change is

threatening them.

They are majestic.

My keeper this week is

log rolling.

I want to shout out the 160 years of Atlantic Stories project that our team has put together over the past several months since the beginning of November of 2017 when the Atlantic celebrated its 160th birthday.

Our audience team has day by day been posting to the site

a story each weekday from a different year, a different successive year in the life of the Atlantic.

It's a compendium of stories,

some of which were incredibly prescient, some of which relate deeply to the world in which we now live, some of which

read very differently in light of history than they did when they were published at the time.

But nonetheless, it is quite a trove.

I'll mention a few pieces in particular that stood out just in reviewing this archive over the past few weeks.

There's a story from August 1965 by Mrs.

X called One Woman's Abortion

that is quite a stunning read now.

There are several pieces from the

early 70s and then again in the early 90s

about job discrimination against women and gender discrimination.

One piece by Wendy Kamener called Crashing the Locker Room,

which

was from 1992, right around the time of the Clarence Thomas trials and the testimony of Anita Hill.

Once again, it's one of those pieces that sort of reads

so interestingly now in light of what has happened in the years since.

We'll throw a link to this project in the show notes,

but it is just a tremendous record of journalism to sit with for a while.

So I highly recommend to all of our listeners to go and check it out.

Do you know what's not in that record?

What is not in that record?

The 1918 flu.

Aha.

We have no pieces in our archives about this incredible disaster that we started this show with.

And I think that's really interesting.

Yeah.

Especially given like the prominence that like infectious disease has in like the collective consciousness and the news today.

We totally did miss the boat on 1918.

However, I will shout out a piece by Justina Hill from the March 1944 issue, which is in the 160 Years of Atlantic stories

called How Bad is the Flu.

I'll note that one of the things about that story that's kind of remarkable is that they think that they are on the precipice of just solving this problem

in 1944.

Yeah, the story ends.

Not to spoiler alert.

The story ends with the sentence.

Influenza and pneumonia are sometimes killers.

We have learned much about them.

We are bound to learn more.

The possibility for their control seems brighter than it has ever been.

As Theobald Smith said, among other aims adopted for the post-war period might well be included freedom from respiratory disease.

So close.

So close.

So close.

So close.

Nearly there.

Just a few weeks more.

Oh, man.

May the optimism of the American spirit live eternal.

Indeed.

And with that, Ed, Sarah, thank you so much for joining us and not scaring us too much.

Thanks for nothing, guys.

And thank you for the tremendous reporting from you both.

I feel if I'm not unterrified, I at least am more knowledgeable, which is something.

That's all I ask.

That'll do it for this week's Radio Atlantic.

This episode was produced and edited by Kevin Townsend with production support from Kim Lau.

The executive producer for Atlantic Podcasts is Catherine Wells.

Our theme music, the battle hymn of the Republic, immortalized by the legendary John Batiste.

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What do you not want to forget?

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