The Wisdom of Plagues

1. Early Warnings and Decisive Leadership Are Critical

If we had taken the threat seriously from the outset, and had reacted more intelligently, how many lives might have been saved?

Delayed response. The initial U.S. response to COVID-19 was marked by disbelief and a lack of urgency, contrasting sharply with the swift, aggressive actions taken by many Asian countries and even some European peers. While the author saw early signs of a major pandemic, his warnings were often met with skepticism, even within his own newsroom. This delay in acknowledging the severity of the threat proved catastrophic, costing hundreds of thousands of American lives.

Global comparisons. Comparing the U.S. outcome to countries like Germany and Canada, which share similar per capita income and public health expertise, reveals a stark difference in leadership.

• Germany and Canada took the threat seriously from day one, implementing restrictive but effective lockdowns, social distancing, and mask mandates.
• The U.S. suffered almost twice the per capita death rate of Germany and nearly three times that of Canada.
• East Asian countries, drawing lessons from SARS and bird flu, had battle plans ready, rapidly produced tests, and enforced strict quarantines and mask-wearing, resulting in significantly lower death rates.

Leadership vacuum. The fragmented and often contradictory messaging from the U.S. leadership, coupled with political polarization, undermined public trust and compliance. Strong, unified leadership, as seen in countries that fared better, was crucial for mobilizing a coherent national response and convincing populations to adopt necessary public health measures.

2. Pandemics Are Inevitable and Accelerating Due to Human Activity

Thanks to our lust for meat, we exited the Ice Age and entered the Pandemic Age.

Zoonotic origins. Most pandemics originate from zoonotic spillover, where pathogens jump from animals to humans. This phenomenon has intensified dramatically since humans began domesticating animals and living in close proximity to them, creating ideal conditions for viruses and bacteria to adapt to new hosts. The bushmeat trade, factory farming, and live animal markets further exacerbate this risk.

Increasing frequency. The rate at which new diseases capable of infecting humans are emerging is accelerating. Studies estimate that new pandemic threats emerge an average of three to five times a year, with a significant increase in zoonotic disease outbreaks in Africa over the last decade. This proliferation is attributed to:

• Population growth and encroachment on wild habitats
• Deforestation and loss of biodiversity
• Intensive factory farming practices
• Global travel, allowing rapid spread
• Antibiotic overuse and climate change

Unpredictable threats. It is impossible to predict the exact nature of the next pandemic, as pathogens constantly evolve and find new ways to spread. The world was largely focused on influenza as the "Big One," yet COVID-19, a coronavirus, proved to be the most lethal pandemic in a century, highlighting the need for broad preparedness against diverse viral families.

3. Human Nature and Societal Flaws Fuel Disease Spread

When a new disease erupts, it is usually greeted not with alarm but with inertia. People have a hard time accepting that the danger is real.

Denialism and fatalism. A pervasive "not me" denialism often characterizes the early stages of an outbreak, where individuals and even leaders refuse to believe the threat is real until it directly impacts them or someone they know. This is compounded by fatalism, particularly in religious communities, where belief in divine will can lead to the rejection of life-saving interventions like vaccines.

Bigotry and blame. Epidemics almost inevitably trigger blame, with the initial affected networks—often marginalized or ethnic groups—being scapegoated. From the "French pox" (syphilis) to accusations against Jewish communities during the Black Death and cholera outbreaks, this tendency is deeply rooted in history.

• Monkeypox messaging initially avoided mentioning gay men to prevent stigmatization, but this evasiveness hindered effective communication to the highest-risk group.
• The 2019 measles outbreak in New York's ultra-Orthodox Jewish community, fueled by anti-vaccine campaigns, illustrates how specific networks can become vulnerable.

Cultural misunderstandings. Western public health efforts often fail when they clash with local cultural norms and power dynamics. Attempts to protect African women from HIV, for instance, repeatedly failed because interventions like condoms or gels were rejected due to:

• Stigma associated with promiscuity or HIV infection
• Fear of male partners' reactions or violence
• Lack of basic science education leading to unfounded fears (e.g., condoms getting lost inside the body)

4. Trust in Institutions is Fragile and Essential for Public Health

If the first casualty of war is truth, then the first casualty of pandemics is trust.

Erosion of trust. Trust in political leaders, doctors, and science is paramount for an effective pandemic response, yet it is easily shattered by ineptitude, inconsistency, and a history of untrustworthy behavior. The U.S. has a long history of medical abuses, such as the Tuskegee syphilis study, which continues to fuel distrust, particularly among Black Americans, impacting vaccine acceptance.

Hygiene theater and shifting advice. Early pandemic responses often involve "hygiene theater"—visible but ineffective measures like widespread street fogging or sanitizing groceries—which, when later debunked, erode public confidence in scientific advice. Constantly shifting guidance on masks, for example, confused and irritated the public, making them more susceptible to skepticism.

Fetishization of science. On the flip side, some individuals fetishize science, mastering arcane details and becoming zealots who bully others for non-compliance. This "mask police" phenomenon, while driven by a desire to follow science, can alienate the public and contribute to polarization, turning public health measures into political badges rather than practical tools.

5. Media's Influence Can Amplify or Undermine Pandemic Response

There’s a pernicious synergy between the media and public health agencies, especially in the early days of a pandemic.

Self-reinforcing cycles. The media and public health agencies often operate in a self-reinforcing cycle: journalists hesitate to sound alarms until agencies make it official, but agencies often don't act until media attention, particularly from influential outlets, prods politicians and bureaucrats. This dynamic can lead to delays or overreactions.

Mismatched imperatives. Media coverage can be skewed by various pressures, including the need for sensational headlines, financial struggles (limiting investigative travel), and political agendas. The author recounts how a leaked, outdated report predicting 90,000 H1N1 deaths was sensationalized by other outlets, while his more cautious, accurate reporting was buried.

• The H1N1 "swine flu" pandemic (2009) was initially met with alarm, then complacency, then renewed alarm after a high-profile death, illustrating how media focus can shift.
• The author's own experience with the "lab leak" theory for COVID-19 highlights how even respected scientists can mislead journalists, and how internal editorial debates can shape narrative.

Disinformation's impact. The rise of 24-hour news, the internet, and social media has made rumor mills more frantic and insistent. News, once filtered by editors, is now easily bypassed, allowing conspiracy theories to proliferate. This breakdown in public discourse, coupled with low science literacy, creates fertile ground for misinformation that directly impacts public health decisions.

6. Profiteering and Misinformation Are Deadly Epidemic Complications

Every epidemic is exploited by profiteers.

Exploiting fear. Crises bring out those who seek to profit from fear and desperation, often by promoting unproven "miracle cures" or supplements. These range from vitamins and minerals to industrial solvents or repurposed drugs, often touted with anecdotal evidence or small, unscientific studies.

• The "Virodene scandal" in South Africa (AIDS) and the promotion of Kemron in Kenya were costly, government-backed scams that delayed effective treatment.
• During COVID-19, hydroxychloroquine and ivermectin were aggressively pushed by some politicians and media, leading to dangerous self-medication and undermining clinical trials.

Anti-vaccine industry. The modern anti-vaccine movement, often masquerading as concerned parents or charities, is a well-funded industry that profits from selling alternative treatments and soliciting donations. Its lies have devastating consequences, leading to outbreaks of preventable diseases like measles and polio.

• The "Disinformation Dozen" are identified as key spreaders of vaccine misinformation on social media.
• The CIA's use of a fake vaccination campaign to hunt Osama bin Laden severely damaged trust in polio eradication efforts in Pakistan and Afghanistan, leading to violence against vaccinators.

Industry downplaying threats. Beyond outright fraud, some industries downplay disease threats that could impact their profits. Owners of bathhouses during the AIDS epidemic resisted closure, prioritizing business over public health. Similarly, in 1918, some cities resisted closing public venues during the Spanish flu, leading to higher mortality.

7. Mandates, Though Unpopular, Are Necessary to Save Lives

Nothing in our Constitution enshrines my inalienable right to give you a fatal disease.

Prioritizing life. The author argues strongly for mandates, asserting that in a pandemic, the government has a duty to protect its citizens from existential threats, even if it means curtailing individual liberties. People are often poor at protecting their own health and terrible at protecting others, falling prey to denialism, fatalism, and misinformation.

Historical precedent. Mandates have a long history of saving lives, from George Washington ordering his troops inoculated against smallpox to modern laws requiring seatbelts and motorcycle helmets.

• Vietnam's success in fighting tuberculosis, a highly regimented disease, was attributed to its communist government's ability to enforce strict treatment protocols.
• California, New York, and Maine successfully eliminated religious and philosophical vaccine exemptions, leading to increased vaccination rates and reduced disease outbreaks.

Cost of inaction. The U.S. failure to mandate vaccines more broadly during COVID-19, despite having highly effective mRNA vaccines, led to hundreds of thousands of preventable deaths. The Biden administration's hesitation to implement vaccine passports or stricter mandates, fearing political backlash, prolonged the pandemic's impact.

8. Global Poverty is a Breeding Ground for New Pathogens

Almost every outbreak of disease starts in poor countries, or the parts of countries where the poor are concentrated.

Animal-human interface. Poverty forces millions to live at the animal-human interface, increasing their exposure to novel pathogens. This includes hunting wild game, digging guano in bat caves, and living in close quarters with domestic animals that may carry viruses from their wild relatives.

• Poor sanitation, lack of clean water, and inadequate housing create environments where diseases thrive and spread easily.
• Malnutrition weakens immune systems, making populations more vulnerable to infection.

Economic development as prevention. Alleviating global poverty is a crucial, long-term strategy for pandemic prevention. Economic development leads to better living conditions, improved sanitation, access to healthcare, and reduced reliance on high-risk practices.

• Investments in infrastructure like paved roads, bridges, and airports facilitate economic growth and access to markets, reducing reliance on bushmeat.
• Supporting women's education, employment, and property rights consistently leads to healthier societies and better public health outcomes.

Sustainable aid and accountability. While international generosity has historically swelled and faded, sustainable efforts are needed. Programs like PEPFAR and the Global Fund have saved millions of lives, but reliance on charity is not a permanent solution. Aid must be coupled with strong accountability to combat corruption, which siphons resources and undermines trust.

9. A Centralized "Pentagon for Disease" is Urgently Needed

Throughout the worst pandemic of modern times, spanning two administrations, we had no clear sense of who was in command.

Fragmented leadership. The U.S. public health response to COVID-19 was characterized by a confusing array of advisors and overlapping missions, with no clear chain of command or accountability. This contrasts sharply with the military's highly organized structure, which trains for crises and holds commanders accountable for success or failure.

Underfunded and constrained agencies. Federal and state health budgets are often political footballs, leading to chronically underfunded agencies like the CDC. These agencies lack the authority, resources, and personnel to lead rapid, coordinated responses, often being limited to making suggestions rather than issuing commands.

• The CDC's "if it wasn't done here, it didn't happen" attitude and initial failures in test development proved costly.
• The reliance on private industry for vaccine development, while successful with Operation Warp Speed, highlighted the lack of a robust public sector capacity.

Reforms needed. A fundamental overhaul of the public health bureaucracy is required, including:

• Replacing the Department of Health and Human Services with an agency solely focused on disease.
• Reorganizing the CDC, FDA, and NIH for enhanced cooperation.
• Establishing a fixed term for the CDC director, independent of political changes.
• Creating a "West Point" for epidemic fighters and empowering the agency to commandeer resources and restrict travel during crises.

10. Religious Exemptions for Vaccines Are Dangerous and Unjustified

No major world religion objects to vaccination. They all endorse it. Vaccination exists for only one reason: to save lives.

False premise. The notion of "religious exemptions" for vaccination is a persistent absurdity, as no major world religion actually objects to life-saving medical procedures. These exemptions are often exploited by the anti-vaccine industry and individuals seeking to avoid mandates based on "philosophical" or "personal beliefs," which are not protected by the First Amendment.

Public health vs. individual choice. Vaccines protect not only the vaccinated individual but also the community by preventing transmission. Courts have long upheld the state's right to compel vaccination, recognizing its duty to prevent one citizen from harming others, even over religious objections.

• Historical outbreaks in Christian Science and Amish communities due to vaccine refusal demonstrate the deadly consequences of such exemptions.
• The return of polio transmission to the U.S. in 2022, linked to low vaccination rates in ultra-Orthodox Jewish communities, underscores this danger.

Religious authorities' stance. Major religious authorities, including top Jewish and Islamic scholars and the Vatican, have meticulously studied vaccines and ruled that they do not violate religious laws. They emphasize the sacred duty to preserve life, even if it involves trace ingredients like pork gelatin or cell lines derived from aborted fetuses, which are deemed permissible in medicine.

11. Robust Global Surveillance and Rapid Response Systems are Imperative

It is infinitely cheaper to head off a dozen pandemics than to suffer the consequences of even one.

Proactive surveillance. Investing in proactive surveillance programs, like USAID's former Predict program, which trained local experts to trap and sample wildlife for novel viruses, is far more cost-effective than reacting to full-blown pandemics. Such programs have identified thousands of new viruses and developed prevention strategies at the animal-human interface.

New technologies. Emerging technologies offer powerful tools for early detection and tracking:

• Wastewater surveillance: Can detect viruses like polio and COVID-19 variants in sewage, providing early warnings for specific communities or even international flights.
• Smart thermometers: Networks like Kinsa Health can track fever spikes in real-time, distinguishing new outbreaks from seasonal illnesses and identifying hotspots.
• Cell phone tracking: Can map population movements and predict where outbreaks will erupt after superspreader events.

Cautious gain-of-function research. While controversial, some gain-of-function research (manipulating dangerous viruses to be more transmissible or lethal) may be necessary to anticipate natural mutations and develop countermeasures. However, it requires far stricter oversight, remote facilities, and rigorous quarantine protocols for researchers to minimize the risk of lab leaks.