Who, What, Where, When, How, and Why -The Next Deadly Pandemic

BOSTON: I am a former FDA COO and Harvard faculty member, and a decades-long infectious disease spread risk management expert.

The rate, depth, and breadth of "spread" of infectious diseases counts the most. The bubonic plague of the Middle Ages killed half the world's population. No matter how potent, it likely would have killed less than 1,000 people if it was not highly contagious and there was a way and means for its spread.

At the FDA, I co-led its last major internal reform. At Harvard, I taught policy, law, regulation, and management, including, most prominently, risk management and its vital sub-set: health and healthcare risk management, particularly infectious disease spread risk management, its last frontier.

I also served in the US Military during the Vietnam War.

In my prior jobs, I stayed on top of how best to manage the risks facing our nation and its allies—and their businesses. I continue to do the same.

A few weeks ago, as evidence of the “currentness” of the danger, the CDC reported that a significant (and sometimes deadly or long-term otherwise dangerous) pathogen significantly harmed one hundred twenty-nine passengers and 25 crew members (roughly 150 people) on a cruise ship. The pathogen was undiagnosed. But based on its severe symptoms (such as some two days of diarrhea, vomiting, and dehydration), it is most likely Norovirus.

This contagious disease alone harms 685,000,000 and kills 200,000 annually worldwide. In a little over two years, COVID-19 killed 1.2 Americans and 7 Million people worldwide. WHO says, absent intervention, the next pandemic will likely kill 50 million people worldwide. Infectious disease spread risk management is the last frontier of health and healthcare. It requires far more attention, financing, and preparedness to respond.

When and Where Will The Next Pandemic, Endemic, or Local Outbreak Strike?

 We do not engage in predictions. Just like with weather “predictions,” they almost always are wrong to one degree or another. They are too rigid and, therefore, fragile—and lack sufficient data to support them. However, we do deal with “expectations.” They are far less rigid, more flexible, and far more generalized, but still helpful.

When an expert in a field gives you their view of what they “expect” to happen but does not predict what will happen because there is far too little data to make a bona fide prediction, it is nonetheless valuable.

 In What Form Will the Next Attack Come?

There are four combinations of dangerous pathogens and their distribution:

(1) Fully nature-created (or modified via one of its frequently generated variants) pathogen and fully nature-created and driven ways and means,

(2) Fully nature-created (or modified via one of its frequently generated variants) pathogen and fully human-created and driven ways and means,

(3) Fully human-created (or modified via tailoring one of an existing pathogen’s frequently generated variants) pathogen and fully nature-created and driven ways and means, and

(4) fully human-created (or modified via tailoring one of an existing pathogen’s frequently generated variants) pathogen and fully human-created and driven ways and means.

More than one of these categories might be used depending on several factors. For example, a hostile nation might use both by-hand distribution of pathogens and reliance on prevailing winds to spread the pathogens.

I will not be more specific than this for national security and defense reasons.

We likely will not know for decades what the true nature of the creation of the COVID-19 pathogen was (although there is strong evidence that it was human[1]generated as to that variant). There is some evidence that the ways and means of the pathogen’s spread were at least reckless, if not intentional.

The Director-General of the World Health Organization (WHO) announced at the Davos conference a few weeks ago their belief that the next pandemic, no matter the source, likely will kill 50 million people rather than the 7 million people so far killed by COVID-19. Their warning is worth listening to as well.

The Tail of COVID-19 is Still With Us

An important thing to remember and needs to be better understood by most people is that the COVID-19 pandemic has not ended. We remain at the tail end of that pandemic, and we expect that in a lesser form (although potentially in a more significant form), a variant of COVID-19 will return every winter for decades to come, just as the case with the 1918 Flu.

When and from Where Will the Next Attack Come?

Our expectations regarding the when and where of the next pathogenic attack, two of the most critical considerations, depend on many factors, such as the kind of attack, its source, and the pathogen's dangerousness (deadliness and, most importantly, its ability to spread quickly and broadly under most circumstances).

Let’s deal with the “when” first. Then, the “where” second.

When?

Our expectation (but not prediction) is that a “nature-made” dangerous variant of COVID-19 or some other infectious disease will attack America and possibly our allies at a pandemic or endemic scale in the next three to ten years. Of course, it could occur sooner or later. But this is our expectation.

We expect a “stealth bio attack” to occur in one to three years, even if the next World War (there is always a next world war) does not break out. A stealth bio attack may be the intended trigger for the next World War. Pathogens are more complex or time-consuming to source than nuclear or chemical weapons. We must also keep these considerations in mind.

 Where?

Nature attacks at random. But larger enterprises are better targets—especially larger enterprises where employees travel significantly within danger zones or between company facilities or the facilities of others, such as part-time or temporary replacement workers—or even from floor to floor or shift to shift.