Episode 64

What Will Variant Sigma Look Like?

with Michael T. Osterholm, Ph.D.

May 19, 2022


Michael T. Osterholm, Ph.D.
Regents Professor, Division of Environmental Health Science; Director, Center for Infectious Disease Research and Policy (CIDRAP) University of Minnesota

Dr. Osterholm is Regents Professor, McKnight Presidential Endowed Chair in Public Health, the director of the Center for Infectious Disease Research and Policy (CIDRAP), Distinguished Teaching Professor in the Division of Environmental Health Sciences, School of Public Health, a professor in the Technological Leadership Institute, College of Science and Engineering, and an adjunct professor in the Medical School, all at the University of Minnesota.

In November 2020, Dr. Osterholm was appointed to President-elect Joe Biden’s 13-member Transition COVID-19 Advisory Board. From June 2018 through May 2019, he served as a Science Envoy for Health Security on behalf of the US Department of State. He is also on the Board of Regents at Luther College in Decorah, Iowa.

He is the author of the New York Times best-selling 2017 book, Deadliest Enemy: Our War Against Killer Germs, in which he not only details the most pressing infectious disease threats of our day but lays out a nine-point strategy on how to address them, with preventing a global flu pandemic at the top of the list.

In addition, Dr. Osterholm is a member of the National Academy of Medicine (NAM) and the Council of Foreign Relations. In June 2005 Dr. Osterholm was appointed by Michael Leavitt, Secretary of the Department of Health and Human Services (HHS), to the newly established National Science Advisory Board on Biosecurity. In July 2008, he was named to the University of Minnesota Academic Health Center’s Academy of Excellence in Health Research. In October 2008, he was appointed to the World Economic Forum Working Group on Pandemics.

From 2001 through early 2005, Dr. Osterholm, in addition to his role at CIDRAP, served as a Special Advisor to then–HHS Secretary Tommy G. Thompson on issues related to bioterrorism and public health preparedness. He was also appointed to the Secretary’s Advisory Council on Public Health Preparedness. On April 1, 2002, Dr. Osterholm was appointed by Thompson to be his representative on the interim management team to lead the Centers for Disease Control and Prevention (CDC). With the appointment of Dr. Julie Gerberding as director of the CDC on July 3, 2002, Dr. Osterholm was asked by Thompson to assist Dr. Gerberding on his behalf during the transition period. He filled that role through January 2003.

Previously, Dr. Osterholm served for 24 years (1975-1999) in various roles at the Minnesota Department of Health, the last 15 as state epidemiologist. He has led numerous investigations of outbreaks of international importance, including foodborne diseases, the association of tampons and toxic shock syndrome, and hepatitis B and HIV in healthcare settings.

Dr. Osterholm was the principal investigator and director of the NIH-supported Minnesota Center of Excellence for Influenza Research and Surveillance (2007-2014) and chaired the Executive Committee of the Centers of Excellence Influenza Research and Surveillance network.

Dr. Osterholm has been an international leader on the critical concern regarding our preparedness for an influenza pandemic. His invited papers in the journals Foreign Affairs, the New England Journal of Medicine, and Nature detail the threat of an influenza pandemic before the recent pandemic and the steps we must take to better prepare for such events. Dr. Osterholm has also been an international leader on the growing concern regarding the use of biological agents as catastrophic weapons targeting civilian populations. In that role, he served as a personal advisor to the late King Hussein of Jordan. Dr. Osterholm provides a comprehensive and pointed review of America’s current state of preparedness for a bioterrorism attack in his New York Times best-selling book, Living Terrors: What America Needs to Know to Survive the Coming Bioterrorist Catastrophe.

The author of more than 315 papers and abstracts, including 21 book chapters, Dr. Osterholm is a frequently invited guest lecturer on the topic of epidemiology of infectious diseases. He serves on the editorial boards of nine journals, including Infection Control and Hospital Epidemiology and Microbial Drug Resistance: Mechanisms, Epidemiology and Disease, and he is a reviewer for 24 additional journals, including the New England Journal of Medicine, the Journal of the AmericanMedical Association, and Science. He is past president of the Council of State and Territorial Epidemiologists (CSTE) and has served on the CDC’s National Center for Infectious Diseases Board of Scientific Counselors from 1992 to 1997. Dr. Osterholm served on the IOM Forum on Microbial Threats from 1994 through 2011. He has served on the IOM Committee on Emerging Microbial Threats to Health in the 21st Century and the IOM Committee on Food Safety, Production to Consumption, and he was a reviewer for the IOM Report on Chemical and Biological Terrorism. As a member of the American Society for Microbiology (ASM), Dr. Osterholm has served on the Committee on Biomedical Research of the Public and Scientific Affairs Board, the Task Force on Biological Weapons, and the Task Force on Antibiotic Resistance. He is a frequent consultant to the World Health Organization (WHO), the National Institutes of Health (NIH), the Food and Drug Administration (FDA), the Department of Defense, and the CDC. He is a fellow of the American College of Epidemiology and the Infectious Diseases Society of America (IDSA).

Dr. Osterholm has received numerous honors for his work, including an honorary doctorate from Luther College; the Pump Handle Award, CSTE; the Charles C. Shepard Science Award, CDC; the Harvey W. Wiley Medal, FDA; the Squibb Award, IDSA; Distinguished University Teaching Professor, Environmental Health Sciences, School of Public Health, UMN; and the Wade Hampton Frost Leadership Award, American Public Health Association. He also has been the recipient of six major research awards from the NIH and the CDC.


There are no ocean boundaries anymore. There are no landmass boundaries. And so we have mixed and matched infectious diseases in ways that we've never had before.

Michael T. Osterholm, Ph.D. Tweet



[00:00:06] Gary Bisbee, Ph.D.: Professor Michael Osterholm is Regents Professor at the University of Minnesota, among other academic appointments, and Director of the center for infectious Disease Research And policy. His epidemiological expertise is widely respected and sought. Mike was stayed epidemiologist at the Minnesota Department of Health and he served on an interim management team at the CDC. His classic book, “Deadliest Enemy: Our War Against Killer Germs” is a must read for those who wish to learn more about COVID. He has published over 315 articles and abstracts. Mike describes the state of the pandemic, which he predicted in his book, “Deadliest Enemy”. We have vaccines and a level of preexisting immunity. However, the threat of new variants is far from gone. Emerging variants are likely to be more infectious. So we need continued investment in testing, treatments and vaccines. We discussed the waning effectiveness of MRNA vaccines. He points out the lessons we can learn from previous outbreaks like SARS and the 1918 flu. Professor Osterholm, speaks to the challenges with boosters misconceptions about herd immunity, and he updates us on immunizations for children.

Well, good afternoon, Professor Osterholm, and welcome.

[00:01:28] Michael T. Osterholm, Ph.D.: Thank you very much. It’s a real honor to be with you.

[00:01:32] Dr. Gary Bisbee: Well, we’re pleased to have you at this microphone. This show is about leadership and your career has been that of a distinguished leader in a variety of different areas as a scientist, public health officia,l author, professor. What do you do in your spare time, Mike?

[00:01:52] Dr. Michael Osterholm: Well, actually first of all, let me just tell you that I have really been blessed by working with a group of individuals that surely make me look a lot better than I might be relative to what gets accomplished. The senior leadership team we have at CIDRAP, the Center for Infectious Disease Research and Policy, have actually been with me for 35 years or more. And so that really makes for a tremendous effort there. There’s no I in team and I think that is one thing that I really, really appreciate very much, is that. And of course, I just am very fortunate to have a lot of colleagues outside of CIDRAP that I’ve worked with over the years. And then finally I kind of run by the rule of the, great, late Satchel Paige, the Negro League baseball player, who one said, “don’t look back, they might be gaining on you”. So I just keep that in mind and just keep going.

[00:02:45] Dr. Gary Bisbee: The best advice, yet. Well, let’s get to know you a bit better, Mike, what was life like growing up for you?

[00:02:52] Dr. Michael Osterholm: Well I had a tumultuous upbringing. I was the oldest of six kids in a family with a father who was a rather severe alcoholic, mental health challenge, who was a very violent man. And so I learned life on the end of a fist for many of my early years. Also financially, it was a challenge in that my father tended to drink away most of his paychecks that he did get. And so from that perspective, I had to learn early on in life that sometimes you have to take your own life issues in your own hands. And no matter what the adversity was, you’re still the one who has to deal with it. So I learned that. But I also learned another very valuable lesson. I had individuals, specifically a couple, who really invested in me as a kid. I don’t know what they saw or why. But they did. And I think that lesson to me has never been lost. Today I’ve been an advisor to over 350 graduate students in my lifetime. And my message to them is they owe me nothing except to pay it forward. And so that’s what I’ve been trying to do for most of my career here is just, from all the benefits that I received from people who supported me and got me into the world that I am in today, that I owe them so much. And, I’m trying to pay it forward as I hope those who I work with continue to do too.

[00:04:19] Dr. Gary Bisbee: Well, obviously you’ve made a super contribution. What did you young Mike think about leadership? And when did you begin to think about leadership, Mike?

[00:04:29] Dr. Michael Osterholm: Well leadership comes in, I think, two categories: that which is planned and intended, and that which just has to happen. And I just had to have leadership to deal with my family and what was happening. I found myself, in more than one occasion, having to be the block and tackle to protect my mother from a violent father. When we were financially strapped, my brothers and sisters going to school in bread sacks during the winter time, because we had no money for boots. You did what you did to earn what you could just to keep food on the table. Those were not choices I made. They were not something that I thought, well, this would be a good thing to do. Those were matters of existence. I think the issue around leadership, where you think about it was, again, comes really from that team concept. I have benefited immensely from teams of people that I work with. And so I think that it becomes easy to be a leader when you are surrounded with other leaders. And I’ve had that opportunity in such a way that it’s a very humbling experience, but at the same time, a very invigorating experience. I feel like our group is just as young now in spirit and heart as they were 40 years ago. The difference is we’re a lot wiser because of all the mistakes we’ve made and learned from. So that’s also a part of leadership.

[00:05:56] Dr. Gary Bisbee: When did you become interested in science?

[00:05:59] Dr. Michael Osterholm: Well it was very interesting. One of the people who had a tremendous impact in my life was a woman who was the wife of the owner of the newspaper. My father worked in, this small Iowa farm town. She was everything about a Renaissance woman, had a degree in journalism from the University of Nebraska, was multi-lingual, et cetera. And I think she was probably the only person in Northeast Iowa at the time who subscribed to the New Yorker, which was something that I ended up becoming very, very interested in because of a single thing. I once read an article in there by the late Burton Roget, who wrote Annals of Medicine pieces, which were really who done it stories, medical detective stories, largely often based on things that were happening at the CDC, then called the Communicable Disease Center. And by the time I was in seventh grade, I just thought this was fascinating. It was a piece of Sherlock Holmes. It was a piece of infectious diseases. And so really because of that, and every time she got a new copy of a New Yorker where the Burton Roget had a story, she would call me when she was done with it. I would run up there with urgency and couldn’t wait to go devour that story. And I might add, just as a footnote, one of the greatest honors of my life was the fact that I led a large investigation in Southwestern, Minnesota, South Dakota, North Dakota, back in the 1990s on a condition called thyrotoxicosis, which actually had its origin, it was thought to be an infectious disease. It turned out to be a cattle bovine thyroid getting into the meat supply, and people consuming it. And the reason I tell you this is because it was the last story that Burton Roget did before he died for the Annals of Medicine. And I had an opportunity to share with him just what he meant to me and how my whole career was really started by the excitement of this one, man. And so it was an interesting twist and turn that should be his last story he ever wrote the investigation that I led.

[00:08:04] Dr. Gary Bisbee: Well, it’s an interesting story. It’s also an indication that you were somebody that could take advantage of an opportunity when presented, so good for you. What was the decision behind going to the Department of Health in Minnesota?

[00:08:18] Dr. Michael Osterholm: I graduated undergraduate from Luther College in Decorah, Iowa, where there, I had another one of those mentors, somebody who, when I was a senior in high school and I was told by my guidance counselor that I probably wasn’t college material, that he had a job at a local auto dealership where I could change tires and, having a lack of confidence in the sense I did okay in school, but he thought that I probably wasn’t college material. And there was a college professor at Luther that I ended up befriending through a variety of different reasons, but he said, no, you’re going to college one day in a Sunday in late May of my senior year of high school. And two days later, I was enrolled at Luther for the next fall and had an incredible financial package. I owe this person everything for having been there for me at that time. When I got done with Luther, I knew I wanted to go into this area to be basically a medical detective. And so I started graduate school at the University of Minnesota two days after I graduated from Luther College. It was just kind of a seamless transfer. I got there and I ended up rooming with someone who was already in graduate school. And it turned out at that time, the Minnesota Department of Health really had but a shell of expertise in the area of infectious diseases. And so several graduate students ended up serving as interns there to help out. And I was one of them. And just to show you the conditions of the time, within three years, when I was still in graduate school, I became head of the unit there. You know, it was almost like a surgical residency. See one, do one, teach one. One of the things, the most proudest accomplishments of my career, and again, it was built on the backs of so many others. When I left the health department to go to the University and start CIDRAP, we had over 70 full-time people in the area of infectious diseases, a third of them doctorate level people. And this was often, most of it, was on soft money. We were out competing for grants and so forth from various areas. And there was a period of time in the 1990s, for over a three-year period, where our little health department had more first author articles in the New England Journal of Medicine than the NIH and CDC combined. And I think it proved really what a determined team of people can do when given that opportunity. And so to this day, I’m incredibly proud of what is still a remarkable state health department. Really it’s truly the model of a educational public health model that really stands, I think, as one of the best in the country.

[00:10:53] Dr. Gary Bisbee: Now, Mike, you have to share with us why you were known as Bad News mike when you were at the health department.

[00:11:01] Dr. Michael Osterholm: Well Gary it’s all about just telling the truth. It’s not so much that it was you know, somehow a sensational, oh my God, the world is all going to come to an end. It’s just what is happening where and how. And we often, at the department, would pick up many, many outbreaks of diseases. It started way back in the 1970s with toxic shock syndrome. The CDC had found that in those early days of the toxic shock syndrome research and outbreak investigation that Rely brand tampons were associated with the disease. We found, no, that wasn’t the case. It was all brands of tampons when it was high absorbency, which Rely brand tampons had captured the majority of that market. And for us, a little health department, to take on the CDC at that time was obviously not something you did lightly. I think that we just continued to do studies and outbreak investigations like this, where that became that message. You can look at us most recently as this past year. A year ago right now, I was pretty much on the outs with a lot of my colleagues and even this administration, which I had been advising, because I urged them, please, do not consider this pandemic over. Do not celebrate a 4th of July independence from COVID because I saw what the variants were doing. And I said this is far from done. Even though we’d come off this big January peak of cases in 2021 and we now had vaccine flowing, seeing these variants that could be more infectious also evade immune protection said, oh my, look what might be coming. Well, that was Bad News Mike. Well look what happened. Delta and Omicron came and, even now with Omicron, we’re looking at all the sub variants. And I think it’s just trying to project, based on the best science and experience we have, what the future might look like. Some would elect to call that bad news. I think it’s just responsible public. health

[00:13:05] Dr. Gary Bisbee: Yeah, for sure. And we were talking before recording here that it’s in early May now, and it looks like we might see another tick up in cases.

[00:13:16] Dr. Michael Osterholm: Gary, this is a very, very humbling experience to deal with this virus. It continues to throw 210 mile an hour curve balls at us. And what we’re seeing right now is substantial increase in cases around the country associated with these different variants around the world. We’re seeing increases in cases, again, with these sub variants. BA.1, went to BA.2 to BA.2.1, 2.1 to BA.4, BA.5. I mean, it’s amazing what this virus is doing. And as much as I worry about that and seeing these super spreading events and the case numbers ticking up, the good news is that preexisting immunity, either from vaccines or from previous infection, clearly is providing some real benefit in reducing severe illness, hospitalizations, and deaths. That’s really good news. Now it doesn’t mean we shouldn’t be concerned about it, particularly for those who are at highest risk of serious illness, but it’s good news. But what I worry about, and where people I’m sure will label me as Dr. Doom, is what’s after Omicron. What’s Pi? What’s Sigma? What are the next real variants coming? And there was nothing in the evolutionary tree right now that says to me we should expect the virus to become less infectious. We should expect it to become less likely to evade immune protection. Everything in viral genetics tells me it’s only going to get worse. And I think we have a virus right now that is literally on the cusp of being as infectious as measles. When you see a virus that has evaded immune protection as much as this one is, the next variant could be really a big challenge. Nobody wants to hear that. Nobody. I don’t want to hear it because I’m tired like everyone else with this pandemic. But this is the reality. We gotta be prepared for this. We got to understand we are a long ways from being done with this pandemic.

[00:15:09] Dr. Gary Bisbee: What more should be done at the federal level than is now being done?

[00:15:14] Dr. Michael Osterholm: Well, we have to understand collectively we’re not done with COVID. And I mean, the mere fact that with all the billions of dollars that have been invested in COVID response, the fact that we can’t get the Congress to basically just provide enough resources to assure ongoing vaccine supplies, antiviral drugs, and testing is a testament to where we’re at. People have the sense we’re done and over. We’ve got Ukraine to deal with. We’ve got the federal budget and the national economy to deal with. We’ve got so many other items that are now on the list that have really taken precedence over COVID. Well this is not a disease that’s just going to go away because we want it to go away. It’s not. And I think we surely have that possibility, just as I said a year ago, to be really substantially attacked, you might say, by the virus if a new variant, in particular, emerges. And so our job is really to say, now’s not the time to go and sell all your fire trucks after you’ve just had your last fire because, you know what, they’re probably going to be another fire. And at that point, you’re going to have to go out and buy new trucks. That’s in a sense kind of what we’re doing right now. And so what we need to do is keep investing in our testing infrastructure. We still are seeing major challenges trying to get people tested early and get them to antivirals within that first five day time period when they need to be administered at that time, that whole concept of test and treat. We’re still seeing major problems right now with the vaccines in that, look at where we’re at with the immune evasion with our current vaccines. Again, these were remarkable tools, but they’re far from perfect. We need to be investing right now in generation 2.0, 3.0 vaccines. We need to be expanding substantially the issues around antiviral drug treatment and what can we do with that. And so this is not the time to let up. You know, there’s an old commercial from a number of decades ago from the oil FRAM company, that one on TV. They would say, you can pay me now or you’ll pay me later. And it was clear and compelling that paying later was a lot more expensive. So I think Gary, the thing I worry about is everybody wants to put this in the rear view mirror. And for the moment, from a standpoint of impact on our healthcare system, I can understand that. But don’t assume if you keep looking at your rear view mirror, you’re not going to hit that deer right in front of your car somewhere down the road.

[00:17:44] Dr. Gary Bisbee: Yeah, I agree to that. We’ll come back to that later, but can you share with us, one, a bit about CIDRAP? And two, what about the grants and the research you’ll be undertaking there?

[00:17:56] Dr. Michael Osterholm: Well first of all, the Center for Infectious Disease Research and Policy, as I said, it was really an effort by a group of us from the Minnesota Department of Health to pull this together. I can tell you when I knew for certain that this was important to establish a center like this. Back in 1999, I had been serving as an advisor to His Majesty King Hussein of Jordan on issues around bio-terrorism. It was an experience of a lifetime for which I’m very grateful that I had that opportunity. And I had a suitcase packed and I was ready to head to Duluth, Minnesota at the time that day. Early that morning, we had an outbreak of meningitis at a college campus, and we had a team of people heading up there after being on calls all night. Well, I got a call early that morning from the ambassador from Jordan to the United States saying His Majesty wanted to see me right away. And I thought that meant within the next week or two or something. And he said, no, right now, and they’d already gotten my airplane tickets for Minneapolis to London, where at that time, His Majesty was at his estate, Ascot. And I remember being in a plane at 10 o’clock that morning, heading to Washington, DC onto a connection to London thinking I need to be back at the health department. At the same time, I was very involved with the international issues around bioterrorism, bio warfare. And that’s what His Majesty wanted to talk about was smallpox withsome real urgency. I knew at that point, as much as I loved the state health department, I wanted to stay at the state health department, I couldn’t stay at the state health department and really do my job as I was really at that point in the position of doing on a national, international level. So CIDRAP really came out of that with the idea, we need to be able to combine policy and research. It’s like chocolate and peanut butter. It’s a food group. And so to me, it was really important to be able to say you can have the best science in the world, but if you can’t convert it into meaningful policy, it’s useless. It just sits in a journal somewhere. On the other hand, if you have policy without good science, policy can be dangerous when it’s not well-informed. And so our goal was really to blend the best of both of those and put them together. And that’s what we’ve done with the vaccine issues. Dating back to 2014/15, when Ebola emerged in Western Africa, we took on a major effort with Wellcome Trust to develop basically roadmaps for Ebola vaccines, what we needed to know, what was it that we didn’t know, what would it take for us to actually have a finished product that could be marketed, could be manufactured, could be made available and be effective. And then as a result of that, the WHO asked us to do similar ones for Zika, Nipah, and other viruses like that. And then we took on with Wellcome Trust the major one, which was influenza, a major roadmap effort where we brought together hundreds of international experts in all areas of vaccines, from basic R&D and human immunology right up to manufacturing and finance and everything in between. And there is now a living document, it’s on our website for the world, keeping track of what’s happening out there with all the vaccine research and development around influenza. So we were kind of a natural to do the same thing with a pan coronavirus vaccine. And so that at this point we were funded by Gates and Wellcome and Rockefeller and with administrative support from Wellcome Trust to actually do that for the coronavirus vaccines. And we have an all star cast steering group, globally the best of the best. And we have basically a large number of consultants that are working with us on this and our staff that has done the previous roadmaps are doing this one. And our goal is to hopefully help provide kind of the roadmap to get us to 2.0, 3.0, and 4.0 vaccines, which I think we clearly have demonstrated we desperately need.

[00:21:59] Dr. Gary Bisbee: Yeah, for sure. Well, again, congratulations on that and we’ll be interested in tracking the progress and love to have you come back on the show. Let me ask a lighter question, which is you’ve just gone through, you’ve just recently completed your 100th podcast. And I’m wondering what a self-respecting regents professor is doing with his own podcast. Why did you start it and are you having fun with it?

[00:22:26] Dr. Michael Osterholm: Well let me start out with one of the basic premises that I hold near and dear to my heart. And that is, you’re never too old to learn and you’re never too young to teach. Okay. Never. And it turns out that I have the benefit of being surrounde at CIDRAP by some very young, very talented epidemiologists who are also with the current real world life experience. And so it was in March of 2020, they said you got to go on this Joe Rogan podcast. I had never heard of Joe Rogan’s podcast. I had never done a podcast. I didn’t know any of this, okay. They literally carried me into the 21st century at that point, okay. And so of course I did it and ended up having almost 20 million downloads of that first week. That was, when I said back in March and April of 2020, that in the next 18 months, it was likely to see 800,000 deaths in the United States. Again, Bad News Mike. 18 months later, we hit 800,000 deaths. And so that really started it. And there was such a response to that podcast, we said, well, maybe we should just try a couple of ourselves, okay. We have an incredible team of people that put these together. The moderator for the podcast with me is a former NPR reporter, who is now part of CIDRAP News, highly talented, very capable. And so we started these with the idea that we’d do them as long as we needed them, hopefully it wouldn’t be that long. Although I always had that fear in the back of my brain that this might be a long-term activity. And as you just pointed out, we’re now more than two years into it. We’ve just passed our hundredth podcast. And the reception has been remarkable. We hear from a lot of people. We learn all the time. We get tremendous feedback in terms of telling us what we do right, what we do wrong, what would be more helpful, what wouldn’t be helpful. And I’m sure it’s akin to what you get with your outstanding effort here. And so we’re just continuing to put the information out there. It’s unvarnished. And when I don’t know, I say I don’t know. If I do know, I say how I know and what the information is that supports it. And if nothing else, it really also tries to combine a combination, I think, of humility and kindness. Right now, the world needs some kindness and we have found in this podcast, people actually want to hear about not just the science, but what are we doing to get through this pandemic? And at the heart of that is surely a sense of kindness.

[00:24:57] Dr. Gary Bisbee: Well, it’s definitely a top quality podcast and I advise anybody interested in this space to listen to it. You’re a super engaging person. So when you want a new career, Mike, you’ve got it.

[00:25:10] Dr. Michael Osterholm: I’ll come work for you, Gary. Okay.

[00:25:12] Dr. Gary Bisbee: Well, we’d love that.

[00:25:13] Dr. Michael Osterholm: I’d love that. I’d love that. You’re pretty darn good at this yourself, you know that.

[00:25:18] Dr. Gary Bisbee: Well, thank you, sir. Appreciate that. And on to “Deadliest Enemy”. This book, and I’m an epidemiologist by training, this book is by far the best compendium of information about infectious disease that I’ve ever read. And if you want to know more about the pandemic, why we’re in it, what to expect going forward, I advise you to read the book. Let me just, if we could Mike, ask a couple of questions about it. One is, why did you put it together? Thank you for doing that, but why did you put it together in the first place?

[00:25:54] Dr. Michael Osterholm: Well, as you know after reading the book, I’ve realized that the growing modern world that we live in, a world where one out of every eight people who’s ever lived is on the face of the earth right now, where international trade and travel are just a given, there are no ocean boundaries anymore, there are no landmass boundaries. And so we have mixed and matched infectious diseases in ways that we’ve never had before. We’ve watched a world that has gone in the last a hundred years from a pre antibiotic era to an antibiotic era. And now we’re entering a post antibiotic era because of drug resistance and the inability to outsmart and-out speed the microbes. And then of course the pandemic. I have been very concerned, as you know in that book, chapter 13 was called “SARS and MERS: A Harbinger of Things to Come.” The story about Coronaviruses. I was very involved with both the SARS outbreak investigation in 2003 globally, and also then 2012 to 2015 with MERS. And in addition I’ve written a lot on pandemic influenza and what pandemics in general would do. You know, everything from the immense impact it would have on our health and our healthcare systems, but even supply chains. You know, I wrote in there about the disruption that would occur when China would be really severely impacted and that they had become the global supply chain source for so many critical things we need. I repeated that in a January op-ed piece in the New York Times this year, and people all thought, there he goes again. Dr. Doom. Well, now you’re seeing what’s happening in China, where they’re not able to control Omicron like they could the previous variants. The previous variants to them were more like severe forest fires where eventually they could bring them under control. Omicron’s like the wind. They can’t control the wind. They can divert it, but they can’t stop it. And so I think that book was really about just saying we have to be prepared for these things. In a world of modern science, modern technology, the microbes, which were here before us, are here now while we’re here, and they’re going to be here after we’re gone, really are a formidable foe that we have to take on. And that’s why we call them the deadliest enemies. And, you know, we leave you with a 10 point plan, what to do about it. I always am very reluctant to ever wade into anything with just the problem. You’re going to talk about the problem, then give us some solutions too. And we tried to do that in this book. And I might add, Mark Olshaker, my coauthor, and I are now writing another one which is a follow-up to this one and what we’ve learned with this pandemic.

[00:28:34] Dr. Gary Bisbee: Yup. We can’t wait for that. Mike, what did we learn from the 1918 flu a hundred years ago?

[00:28:41] Dr. Michael Osterholm: Well, I think, first of all, we learned of just what an impact an infectious disease can have on the world. It’s hard to express this, but if you take a look at the battlefield cemeteries of World War I, even though H1N1, the 1918 flu virus, was only around for a couple of months towards the end of the war, there are many more American soldiers buried in Europe having died from flu than died from the entirety of the war. Just that few months, it was amazing the impact. We learned in 1918 that it could be swift, even in a world where we surely didn’t have the same kind of global transportation system we have today. And we also learned that if you look back at 1918, 1919, and 1920, which was actually the entire duration of the pandemic, it wasn’t over in one year, as many people think, by the time we got to the end of 1919 and early 1920, which we still saw some big peaks and waves of cases, the public basically gave up. They were done. The recommendations the public health community had were no longer being accepted or acted on. And isn’t that ironic? It’s about the same thing here. By the time we got two years into this pandemic, folks said, we’re done. And so I think there were some even sociologic lessons to learn from that. And my dear friend and colleague, John Barry, who I think has written the definitive piece on the 1918 pandemic, will tell you the same thing, that people said, well, that’s then, that’s not now. And yet we’re finding a number of lessons learned from 1918 that are very applicable to what’s happening now.

[00:30:29] Dr. Gary Bisbee: The book makes the point that vigilance and vaccines are both necessary to combat these germs and the book further calls for new versions of vaccines. Does mRNA fit that description? Is that kind of the new version of vaccines that you were thinking about?

[00:30:49] Dr. Michael Osterholm: Well mRNA vaccines have literally saved millions of lives. There’s no doubt about that and what it’s done in the last two years. But I consider them really right now as a delivery system to still be 1.0, not 2.0 or 3.0. So I think that we will see really newer vaccine technologies that will come along that will be much more immune enhancing. Let me give you a case in point early. On with the mRNA vaccines, we got these very rapid antibody rises that were substantial and obviously very protective. Right out of the shoot, 90, 95% protection against infection. Well, we didn’t understand with this antibody response that the mRNA vaccines gave us that it waned over time and it wasn’t a long time. It was months. And that’s where in fact, the whole third dose booster, now fourth dose booster, came along. Well in the meantime, the adenovirus vaccine vector, that J&J vaccine, was initially met with okay, one dose, but you only get 60, 65% percent. The mRNAs are much better. Well, this vaccine, however, is able to actually impact much more T cell immunity, which is long-term durable immunity. And now if you look out, 6 to 10 to 12 months out from the original mRNA series and the original J&J series, the J&J vaccine has higher efficacy than the mRNA vaccines. It didn’t drop. It just kept climbing and climbing as we saw more maturation of T cells, whereas the mRNA vaccine were like fireworks went off. Boy, that was great. But in fact, over time, it waned. There is an example right there of lessons learned that we have to very careful look at and say, you know what, these T-cells are going to be really important. And so that whatever vaccines we use, for antigens or delivery systems, we got to understand we need a very complex immune response, not just one arm of the immune system.

[00:32:53] Dr. Gary Bisbee: Is it too late for those of us that have had an mRNA vaccine to get a J&J version?

[00:32:59] Dr. Michael Osterholm: Well, actually what data we have says, yeah, it probably is. If you think about this, and this is a very simplistic example and I hardly profess to be an expert in vaccine immunology, but we see this with influenza, the concept of energetic synth, i.e. the very first hit you get predetermines in a sense the kind of memory immune response that you have. So that as kids, if you get hit with a flu virus of say one particular hemagglutinin type, that that determines to a certain degree what your future responses be to additional flu assaults, whether it’s a vaccine or a viral infection. Well, the same appears to be true likely with COVID, that if you had that original vector vaccine, the adeno virus vector, that you do get a much more robust response. If you had the mRNA, you get more like the laser response. And unfortunately later doses don’t reverse that. So if I had mRNA vaccines initially, and I get hit later with another dose of a vaccine, say, for example, the J&J, I still will likely respond in a similar way to which I did to that very first antigen. So this again is all part of the learning and you know, this is one of those stay tuned moments. Come ,back in a year from now and we may find a very different kind of finding than I have right now.

[00:34:22] Dr. Gary Bisbee: Yeah, might be. But it does feel to me, like with mRNA, you need a shot every six months or so, don’t you?

[00:34:31] Dr. Michael Osterholm: We’re learning that. And I think as you know very well, we can’t boost our way out of this pandemic. It’s not going to happen globally. I mean, even look in the United States. For those who have had two doses of vaccine, the original vaccine regimen, only about 45% of those have gone on and gotten a third dose that has been highly recommended because we do know how important the third dose is now. Well, now imagine who’s going to get a fourth dose? Remember, these are not people that were vaccine hostile or vaccine hesitant. They did get two doses. But we can’t get them to get the third. Do you think we’re going to get a fourth in them? So I think you have a diminishing return here. And again, I think, Gary, this comes back to the concept, never, never confuse the fact that a vaccine and a vaccination are very different. They’re very different. You can have all the vaccines in the world that you want, but if you can’t get it in people’s arms, what good is it going to be?

[00:35:25] Dr. Gary Bisbee: One other thing the book talked about was the biomedical technologies and specifically this gain of function. And basically the book said, watch out. There’s been some suggestion that maybe there was gain of function research in Wuhan and that is possibly what originated this. Any truth in that? Any version of that make sense?

[00:35:49] Dr. Michael Osterholm: I, again, just go with the science and I can say right now that I have not seen any smoking guns that would support that this was, first of all, an engineered or manufactured vaccine, or that it originated from the Wuhan lab that everyone talks about. I am agnostic on it. I would be willing to look at any data that would support that and evaluate it as such. I do know that with the presence of this virus or precursors to this virus in so many animal species, particularly bat populations in Asia, this just doesn’t surprise me that it emerged from an animal population, no different than SARS emerged from the wet markets of the Guangdong province back in 2002 and 2003. And so at this point, I regret that we don’t have more information. People have often used this almost as a litmus test. Are you for the likelihood that China basically is responsible for releasing this from a lab or are you against it? That’s unfortunate. I think what we have to do is stick with the data, the science, and say, this is what we know. But I will say, having been on the National Science Advisory Board from 2005 until 2012, I know very well the challenges of trying to provide oversight of gain of function research. And I was one of those that was strongly opposed to H5N1 gain of function research at the time, without a much, much higher level of assurance that it would never leak out if we did end up making a million transmissible H5N1 that could by itself start a worldwide pandemic. People forget that in 1978, basically, we saw the release of the flu virus at that time that the Russians were working on, H1N1 that ended up becoming a seasonal flu virus. It was not an intentional release, but it was released. And it was then that we actually saw in 1978 the emergence of a two virus season, H3N2 and H1N1. It was all likely out of a release in an accidental way out of a Russian lab. So these viruses can take on really major global importance when we’re working with them and should they leak out into the world.

[00:38:15] Dr. Gary Bisbee: So there was a press release from CIDRAP recently about bird flu, H5 bird flu, and there’s 30 some states where that exists in birds. But there’s a new version that a human in Colorado, I believe, has this. Is this something that we should be concerned about or how concerned should we be, Mike, about that?

[00:38:37] Dr. Michael Osterholm: Well H5N1, it has been by far the biggest challenge we’ve had with avian viruses infecting humans. Remember, the natural reservoir for flu viruses are in birds, avian species, where the virus largely resides in the GI tract of the bird. Only sometimes does it cause mortality in birds. We call it a high-path virus. And typically these viruses very rarely if ever infect humans. H5N1 has been the exception. Between 1997 in Hong Kong until now, there’ve been several thousand cases, but we’ve not seen any sustained transmission into humans. Now this H5 is a bit different than the one that we were dealing with years ago, when we were more concerned about that spillover into humans. So at this point, I would say I don’t see any evidence that this is yet likely to be the next influenza pandemic virus in humans. But this is one where you, again, you have to always sleep with one eye open. It could be. And there is no question about. the fact that we will have more influenza viruses emerging that will be pandemic in nature. And that by itself should be enough of a wake up call to people to say, we gotta be better prepared even for flu.

[00:39:53] Dr. Gary Bisbee: You make the point about the difference between vaccines and vaccinations. But in terms of the under 5-year-old group, Moderna now has data in front of the FDA and sounds like Pfizer will have shortly. What’s your feeling about that vaccine? Any sense of efficacy and how useful that’s going to be?

[00:40:13] Dr. Michael Osterholm: Yeah. Well, what we’ve seen so far is the vaccines basically provide anywhere from 40 to 50% protection against clinical illness. And that is again for a limited time period. We don’t know for how long. Most people will say, well, that’s not very good. Well, on the other hand, we’re looking also at what might be the likelihood of reducing severe illness, hospitalizations, and deaths. We know that at least 475 children under the age of five have died from COVID. We know that, if you look at the number of cases, we’ve had thousands and thousands of cases and kids who have been hospitalized in this age group because of COVID. So, I mean, anything we can do to eliminate that will be a big deal. The vaccines may not protect you against the clinical aspects of this, or even, could you transmit the virus? But I think we have every reasonably that they could be very important again in reducing this incidents of severe illness. So I think they will get approved. And I think that they can be a very useful tool. My concern though, in following on the theme that we’ve been talking about here, if you look only about a third of the kids between the ages of five and eleven who have been eligible to receive those vaccine have gotten vaccinated. Most parents have not vaccinated their kids. And if we’re not doing better in that age group, I wonder how much better we’ll do in the under five-year-old age group in terms of vaccination versus just having vaccine available.

[00:41:36] Dr. Gary Bisbee: I mean, I totally agree with that. I can guarantee you that my two grandchildren under the age of 5 are going to get it, Mike.

[00:41:43] Dr. Michael Osterholm: Yeah, I agree.

[00:41:44] Dr. Gary Bisbee: Everybody’s kind of thinking about, hey, it’d be great if we had an annual vaccine for this. And yet as you read about it, it looks like we’re far away from that. How do you view it?

[00:41:56] Dr. Michael Osterholm: Well, I think we are. I think though that one of the things that’s going to be the ultimate decider of this is the virus itself. What happens if we get new variants? What kind of cross protection we get with different vaccines? I’m already concerned. If you look at data just from this past week, we can show that if you’ve had BA.1 infection, BA.4 and BA.5 may neutralize substantially the protection you get from BA.1. Well, this is all Omicron. So I think the idea that we may have a specific variant vaccine doesn’t necessarily mean you’re going to get protection even within all the sub variants of that particular variant. Now add in the idea of brand new variants, that Pi or Sigma I talked about. So I think we have a lot of questions yet to answer about just how well these vaccines might work over time. I think the second piece of it though is is that we need better durability. We need much broader protection. And so that’s where I, again, come back to saying that I think 2.0, 3.0, 4.0 are warranted, necessary, and we will find them in the future to some degree.

[00:43:05] Dr. Gary Bisbee: Mike, what about natural or herd immunity? We were talking earlier and you indicated really that there isn’t such a thing. But can you help us work our way through that?

[00:43:14] Dr. Michael Osterholm: Well, herd immunity is a concept that actually comes on to the veterinary world. So of course it’s better explaining what we mean by herd. But it’s that if you have enough of a population in a closed area immune to that particular infectious agent, it can’t be sustained. It can’t transmit itself because it will run into dead ends each time it hits someone who is already immune. And this was something that, of course, we talk about with measles and other vaccines where there is durable long-term immunity. And if you can keep enough people vaccinated, or unfortunately in some cases, having had measles, then it’s very hard for the virus to really take off. Now there’s some real challenges with that, because I can say 98% of Minnesota kids are vaccinated against measles, but if there’s pockets of under vaccinated in certain communities, certain areas, you can still have outbreaks. Well, initially early on, I think people wanted to believe that the way we’d get out of this pandemic is either from vaccine or natural infection. We’d have enough people immune. The challenge was that they didn’t understand that waning immunity is huge. It’s very, veru difficult to ever obtain herd immunity when you have waning immunity in the human host. You may get a year or two of protection, maybe even less than that as we’re now seeing, but it’s not going to be long-term. So you have to keep going back to the well over and over again, vaccinating people or them getting infected. And so I don’t see any potential at this point for herd immunity with this virus. I see that we surely can reduce again, as I pointed out, serious illness, hospitalizations, and deaths. And hopefully with better vaccines, even give people longer protection. But I think herd immunity is a concept for now that is best put on the shelf, only brought back out if we see a fundamental change to the vaccines.

[00:45:11] Dr. Gary Bisbee: Could we talk for a moment about the CDC? You played important roles there back when Dr. Gerberding was there and were one of the leaders of the CDC in that interim period of time. It seems that whether, for reasons of budget, politics, maybe just size, I don’t know, the CDC has kind of lost its position as the unquestioned source of trust in terms of data around this sort of thing. What say you about that, Mike?

[00:45:42] Dr. Michael Osterholm: Well, I think you actually described it very well, unfortunately. I think this pandemic has caused us to really take a step back and ask ourselves, what is the agency, the CDC, that we need for the future? You know, I have been very concerned myself about the fact that, while we keep using that term, we’ll follow the science, I think there’s been some real bad science at CDC, whether it be on respiratory protection, issues around messaging of what do we do in communities with this virus. Even to the extent that the studies that we were able to glean from places like Israel and the UK that were very instructive in understanding how vaccines were working just really didn’t get done at CDC. Now I will in their defense say that when you have a fractured healthcare system like we have, where information collection sometimes is so monumental, it deserves a Nobel Prize in and of itself, that is hard to get that kind of information. But yes, I think CDC is an organization that went from a period during the first year of the pandemic, under the previous administration, where there were challenges about who could say what about what, to a second year where they didn’t have those same challenges anywhere near like that, but they still had problems. So I know that this is being looked at. I know that Rochelle Walensky the Director, is somebody I have great respect for, is aware of this. And we’ll see what happens over the course of the next few months in terms of review and follow-up.

[00:47:16] Dr. Gary Bisbee: Mike, this has been a terrific, absolutely terrific interview. I’ve got two additional questions, if I could. One of them is that, of course, epidemiologists have gained a lot of visibility during this pandemic. There’s going to be a number of young people that want to pursue a career as an epidemiologist. What advice do you have for somebody like that?

[00:47:39] Dr. Michael Osterholm: Number one, we need you. So I can tell you right now that even looking at a place like our center at the university, we need young, bright, capable individuals to come into this business. And so, we’ll find you a job. Second of all is that, if you’re looking for a job with great satisfaction that gives you back that warm feeling every day of what you’re doing is making a difference, then don’t come into this area. Go into medicine or nursing because you have grateful patients. But if you’re someone that can see the big picture, and a picture that I’ve shared often with our staff, particularly at the state health department, when I say to them, do you realize that tonight there are kids all over this country whose parents were tucking him into bed, kissing them, goodnight, reading them a story, but for you, they wouldn’t have existed? They’d be dead. What you do makes that kind of difference. You’ll never know it. You won’t see grateful patients. But you do make that happen. So if you want to be in that mindset, you want to feel that difference you make, then this is a business we need you in. And so I hope that they do. And last but not least, dream big. Shoot for the stars and it may very well take you at least to the moon. So I hope that we do see more and more people recruited into this area. And there’s a lot of us right now that are looking forward to the next generation of epidemiologists has taken over and doing a better job than we’ve done.

[00:49:09] Dr. Gary Bisbee: Well said. The last question is more the generic up and coming healthcare leader. And you’ve certainly taught and mentored who knows how many people like that. But what advice do you have for the up-and-coming healthcare leader?

[00:49:25] Dr. Michael Osterholm: Don’t ever forget that health is not just a result of treatment. Health is part a state of mind. Health is in part the way you live. Health is in part the way you suffer. That’s all health. And then I think our healthcare systems of today really have become far, far too embraced in disease care. And we don’t do it nearly enough, I think, to really assure healthcare. And that doesn’t get the wiz-bang kind of wow technology outcomes, but it can make a big difference. And I think if nothing else we’ve learned, in an age when we could come up with these incredible vaccines, we still can’t get people vaccinated. That’s exactly the point. If you can’t turn a vaccine into a vaccination, that’s also saying to someone in healthcare, we’ve got a lot more work to do to understand how do we improve the health of our society. And I don’t want anybody to shy away from that challenge. It’s important. It’s very important. And for all I can tell you, the work that you do today for health and healthcare may be the very thing you benefit from in your later years. And you’ll be really glad that you were part of the solution.

[00:50:45] Dr. Gary Bisbee: Professor Michael Osterholm. This has been enjoyable, incredibly informational. I advise everyone to get this book, “The Deadliest Enemy”. It is the resource that will help you understand the pandemic more. And if you have a spare minute, listen to Mike’s podcast because it’s a good one. Thank you.

[00:51:04] Dr. Michael Osterholm: Gary, can I just say, thank you. I have been interviewed by many, many people over the course of my career and even through this pandemic. And I must say you’ve asked me questions no one’s ever asked me before. And the way you’ve tied them together I think speaks so much to your capabilities and your understanding and the homework that you’ve done. And so I just want to say it was a real honor to be with you. Thank you.

[00:51:27] Dr. Gary Bisbee: Thank you, sir. My pleasure.

Subscribe for Updates​

For exclusive access to Think Medium content and program updates, subscribe here.