Michael Osterholm, University of Minnesota Center for Infectious Disease Research and Policy director, was driving to the airport the morning of Dec. 30, 2019, when his cellphone rang.
A colleague was on the line. Reports were trickling in about an unusual pneumonia spreading in Wuhan, China.
The moment felt eerily familiar.
Osterholm likens it to a seismologist watching the first needle tremors before an earthquake, unsure whether it will pass quietly or destroy everything in its path.
“Is there something to this, or is it just background noise?” he recalls in his new book, cowritten with journalist Mark Olshaker, “The Big One: How We Must Prepare for Future Deadly Pandemics” (Little, Brown Spark).
“Is this something to alert the public to, or will it just cause needless worry and social disruption?”
Osterholm argues that humanity spends billions preparing for wars but only scraps defending against microbes.
The 1918 influenza pandemic “killed as many as 100 million people worldwide, far more than the blood-soaked world war that had recently ended,” he notes.
COVID-19 was a “microbial 9/11” that killed millions, warped global politics and reordered daily life.
It brought society to its knees “in a matter of weeks,” he writes — a feat terrorists could never achieve.
But compared with what could come, it was just the dress rehearsal.
The looming nightmare is what Osterholm calls the Big One — “the disaster, the catastrophe, the cataclysm, that haunts the midnight of every responsible epidemiologist’s soul.”
A virus that manages to be as contagious as COVID and as lethal as SARS.
In this contest, he adds bluntly, “Mother Nature still has the upper hand.”
Osterholm makes his case not with charts but with a hypothetical that reads like a disaster movie. He imagines a dusty Somali village where a farmer named Warsame Osman develops a fever and hacking cough. Soon his son is sick too. His wife turns to Jamilah Shamshi, a community-health worker who’s seen plenty of cholera and measles but can offer little more than fluids and comfort.
On the road to the Hagadera refugee camp, Zahi and Axlam Yussef carry their toddler daughter, Hani, as she coughs and gasps for breath. Within days, Shamshi is overwhelmed by “several more patients with the same symptoms.” The contagion is spreading, and no one knows what it is yet.
The virus, novel and aggressive, doesn’t stop at Hagadera. An aid worker boards a flight to Paris. A businessman departs for Jakarta. A student volunteer returns home to Atlanta. Within days, three continents are seeded. The disease doesn’t move at the pace of caravans or ships; it moves at the pace of modern life.
The fictional scenario ends with the verdict of scientists who’ve sequenced the pathogen, declaring it a new coronavirus. One researcher delivers the diagnosis with grim understatement: “We may be looking at a world about to change.”
This is no mere storytelling trick. Osterholm uses it to drive home the nightmare is not far-fetched. “The battle lines are clear,” he writes. “Microbes’ genetic simplicity and evolutionary flexibility against our intellect, creativity, collective social cooperation, and political will.”
It’s not an abstract idea. History is littered with reminders. The 1918 influenza virus, unusually, targeted the young and healthy, decimating soldiers and parents in their prime. Decades later, HIV emerged slowly but lethally, killing 42 million worldwide since 1981. Even supposedly minor viruses can spring lethal surprises: Zika, once dismissed as a mild mosquito-borne illness, suddenly began leaving babies with microcephaly in Brazil.
“Microbes were here long before us,” Osterholm reminds, “and probably will be here long after us.” A virus we think we know can mutate, recombine or simply surprise us, turning what was manageable yesterday into a catastrophe today.
And they’re more mobile than ever. “In today’s crowded, interconnected world, infectious disease outbreaks that might once have burned themselves out in remote or isolated locations now have the potential to spread widely and rapidly,” Osterholm warns. Humanity has become “an extraordinarily efficient biological mixing bowl as well as a highly productive viral mutation factory.”
These diseases spread with a weapon humans can’t match: speed. A virus like SARS-CoV-2 can complete a new generation “in about ten hours.” That gives microbes, in Osterholm’s math, a 220,000-to-1 advantage over us.
When Ebola exploded in West Africa in 2014 — the largest outbreak in history, with more than 28,000 infections and at least 11,300 deaths — Osterholm boarded a plane straight into the chaos. There, he led a group of 20 senior experts in Ebola virology and epidemiology, assembling a report that became infamous in his field.
Their conclusion, published in the infectious-disease journal mBio, was blunt enough to rattle colleagues: “Ebola viruses have the potential to be respiratory pathogens with primary respiratory spread.” The pushback was fierce, but Osterholm has never softened the warning.
“Nothing has changed my scientific opinion,” he writes, “that respiratory transmission might very well occur in a future outbreak.” The difference between a regional epidemic and a civilization-shaking catastrophe could come down to one microscopic genetic roll of the dice.
COVID-19, when it finally arrived, played out like a grim validation of Osterholm’s warnings. He recounts how the public-health messaging unraveled almost immediately. On March 2, 2020, the US surgeon general tweeted, “Seriously people- STOP BUYING MASKS,” only for the Centers for Disease Control and Prevention to reverse itself weeks later and recommend cloth face coverings. The whiplash did lasting damage. “The only currency public health has is trust,” Osterholm writes, “and we have seen how far that has been eroded during COVID-19.”
Behind the scenes, supply chains collapsed like dominoes. Hospitals rationed gowns and gloves. Testing kits arrived late or not at all. Even the richest nation in the world discovered it had no surge capacity. And as scientists scrambled to learn more, politicians rushed to fill the vacuum with half-truths and snake oil. Leaders promoted “unproven or discredited treatments,” Osterholm writes, further corroding credibility at the very moment the country needed it most.
Yes, science delivered astonishing breakthroughs in record time — vaccines, antivirals, diagnostic tools — but Osterholm insists technology alone can’t save us: “Regardless of how much vaccine and medical counter-measure progress has been made when the Big One hits, a robust and effective response will only be possible if public health officials and government leaders work together for a common goal, admitting what we don’t know.”
Trust, in other words, is not optional; it’s the infrastructure. The best vaccine in the world is useless if people won’t roll up their sleeves.
His biggest criticism over how the last pandemic was handled isn’t about the science but the culture wars that ended up defining it. “The success of the containment and mitigation efforts rely substantially on the actions and compliance of ordinary citizens,” Osterholm writes. “We find it unreasonable that so many assert personal choice and freedom in resisting actions like wearing N95 respirators and accepting vaccination.”
Osterholm insists the tools exist, but the will is missing. He argues that rapidly spreading respiratory-virus pandemics are “as much a fact of life as war and crime. All we can do is our best to mitigate their effects and shorten their duration and spread.” COVID’s lesson isn’t about a single virus; it’s about the permanent vulnerability baked into our global systems.
The warning is stark. COVID killed millions, but “as bad and life-altering as that pandemic has been, it could have been worse.” Severe acute respiratory syndrome (SARS) had a 15% fatality rate; Middle East respiratory syndrome (MERS) killed more than a third of those it infected. A virus with COVID’s transmissibility and MERS’ lethality would be civilization-rattling.
Yet the last pandemic’s failures were obvious. There were “mistakes of judgment, denial of scientific evidence, overpromising and underperforming leadership, misleading or confusing communications, reliance on ‘experts’ who actually weren’t, inadequate drugs and supplies, insufficient healthcare facilities and personnel, intensified economic inequality, and institutions floundering to meet their stated missions,” Osterholm writes.
That’s the stage on which the Big One will arrive. Not in the slow crawl of caravans and ships but in the “extraordinarily efficient biological mixing bowl” of modern life, where pathogens travel as fast as jets and mutate as readily as algorithms. And if the next outbreak is met with the same delay, confusion and politics that marked COVID, the damage will multiply long before science has a chance to catch up.
COVID, for all its horrors, wasn’t the Big One. But the actual Big One could be just on the horizon. And we aren’t ready.
