The next pandemic is likely to come from an authoritarian country with tight control over the media. The US and other open societies need to figure out the signs that there’s an outbreak in an authoritarian country. The next pandemic may not come from China. It might come from Russia or one of the other former Soviet republics with a cartoonish authoritarian ruler, especially if he doesn’t want to look bad in front of other world leaders. I don’t know much about gathering intelligence but if the country suddenly starts buying up PPE or doctors are mysteriously falling out of windows, that may be a clue that there’s an outbreak and it might be a good idea to start collecting that kind of information. I don’t know how the US would start doing that but that’s what intelligence experts are for.
Classic SARS also came from China and it didn’t become a pandemic in part because of traits of the virus: it was less transmissible and is only transmitted when you’re symptomatic. However, Hong Kong was under leas control from Beijing and it had a much freer press than today. The Hong Kong press really did investigate what was going on. Foreign journalists had more access to mainland China where SARS had first emerged.
For all the many flaws of our media, an outbreak of a novel virus in the US would be something that the media were all over.
The line about base rates was interesting. What if we charged the Dept of Defense with the responsibility for biodefense? The budget required could be found in their couch cushions.
I don't think there is any point to throwing more money at America's public health apparatus without root and branch reform. Despite being far better funded per capita and overall than any peer countries, they completely beclowned themselves throughout the COVID response.
Why should congress entrust these organizations with such a large sum of money?
Nobody wants to pay for insurance. Not only is bipartisan agreement on this not going to happen, if anyone dares to vote for this you can bet they'll be attacked for "wasting" $60 billion (with a b!) on diseases that don't even exist.
If economists would like to do some good for the pandemic (rather than redoing some of the epidemiologists homework or yelling "challenge test" in crowded theaters) they'd figure out how to get people to want to protect against the next pandemic.
One thing that would perhaps help is to make explicit the cost of the next pandemic - somehow codify the cost that we are signing up in a pandemic (automatic stabilizers, etc), so that the insurance can seem like a cost savings.
I'm hugely in favor of expanded pandemic preparation. In fact, I would argue, infectious disease should be the sole thing that the CDC should focus on. It's pivot to things like obesity and smoking have caused a loss of focus.
In that vein, I would support a lot more money for R&D, as well as additional money for rapid testing, as well as subsidies to keep domestic PPE production here and ready.
All that being said, I will never support the BBB. I'm not in favor of expanding the welfare state when we can't even pay for the promises that we've already made. Fix entitlements first. Then we will talk. Note, I would have been very willing to vote for something like the Simpson Bowles Commission.
I'm not totally opposed to CDC becoming involved in issues where the harm of the illness is almost all on the individual as there can still be economies of scale in interventions. Nevertheless, I agree that the main job of CDC ought to be in infectious diseases where the benefits of preventing infection are a multiple of the benefit to the person not infected. And the CDC's messaging ought to reflect that. Even today, I hear in the news (and I have to believe that in some way reflects CDC/FDA messaging) that benefits (to the child) vaccinations of children outweigh the risks. What about the teacher who does not become infected or the parent or relative or other children?
>>But as Noah Smith has written, oftentimes the U.S. gets useful things done (the original Interstate Highway System, the foundation for the Internet, etc.) by calling them national security. There’s no reason the next NDAA can’t find some way to smuggle in billions of dollars for pandemic prevention.<<
Yeah, I don't buy this. Regarding the IHS, while Eisenhower was impressed by Germany's autobahn system, national defense was at best a very minor factor for selling the IHS to the American people: economic growth was the big selling point (https://www.fhwa.dot.gov/interstate/interstatemyths.cfm#question3). And while the creation of the transformational Internet was a serendipitous outcome of the ARPANET, there was zero possibility of anticipating such a thing coming from this infinitesimal part of DoD R&D spending. Sometimes you get really lucky. (Sometimes you get Tang and Teflon, too.)
DoD is focused on traditional ideas of national defense. The idea that we could "smuggle in billions of dollars for pandemic prevention" in the DoD budget is laughable.
Posts like this put one in mind of the "availability" bias trap. We're all focused on the dangers of pandemics because, well, duh. So many of us are focused on doing things because COVID has been such a disaster. That's great. But how will we feel in five or ten years if, as is highly likely, nothing as damaging as COVID has recurred? We'll feel like we have much bigger fish to fry and while preparing for the next pandemic would be great, right now we have to concentrate on crisis X or Y. We'll be like the Obama administration, which cut funds for PPE in the national stockpile because national debt and the deficit were such large concerns.
Hey, if we can do things like throw money at research that will lay the basis for general spectrum vaccines, great. Scientists are great at long-term research. But beyond that I cast a gimlet eye.
For example, in the Biden proposal Matt cites, the administration writes: "There should be a centralized ‘Mission Control’, acting as a single, unified program management unit,
that draws on expertise from multiple HHS agencies, including NIH, CDC, BARDA, FDA, and CMS, as well as other departments such as DoD, DoE, and VA." I have no doubt that within five years, and no pandemic emergency in the meantime, this "Mission Control" will be an empty shell of no importance, with at best pro forma meetings and each agency and department pursuing their own agenda and jealously guarding their autonomy.
Memories fade and people will lose any sense of urgency they may have now. That's just life.
Agreed that memory fades. On the other hand, COVID was a REALLY big deal. Look at all the additional security we still have 20 years after 9/11 and that was 3,000 people that died. COVID's over 500,000.
That being said, I think what you want is to make CDC's only job to be infectious diseases/pandemics. Let other agencies handle the rest, that way CDC stays focused
There needs to be some organization that sees disease prevention framed as a question of national defense, not framed as a way to publish research papers. Whether that should be the CDC, a firewalled half of the CDC, or some completely different agency, I'm not sure. But the civil defense voice, that *type* of response, was almost invisible IMHO.
Off the top of my head I would say the moonshot analogy would be apt if the moon evolved constantly and was occasionally trying to kill you. This particular problem dwarfs the moonshot in complexity and scope. I am totally onboard with many of your recommendations with regard to R&D in order to increase preparedness and shorten response time. But this is where I point out that evolution has quite a lot to say about this. Which you noted in your final paragraph. And it is also where I point out that waiting to see what mother nature comes up with in terms and then responding to it is in itself a dangerous strategy. And yes I am speaking of gain of function research. I will note parenthetically that military threat assessments are not based on what you think an opponent might do but what they have the actual capacity to do.
When it comes to viruses we just don't know what it can do. Mother nature is surprisingly good at coming up with new ways to beat defenses. And one can never ignore the fact that humans can, with malicious intent, help evolution along. Which is why I am very much in favor of tightly controlled GOF research to explore exactly what we might come up against regardless of origin. And if you want to hand this over to the DOD fine by me. They are probably doing it anyway.
As an aside on PPE I will go out on a short and very robust limb and suggest that you have never had a fit test. Which is something I have to do annually at least in order to go into the places I have to go. It literally is a respirator fitting for a variety of PPE including the N95 mask as well as cartridge type respirators designed with color coded cartridges designed to filter out specific chemicals like H2S. The very first thing that has to go in order to do a fit test is all your facial hair. No shave, no test. I anticipate an armed revolution if such is ever made a mask mandate for the general population.
Well, if someone lies down on the beach and drowns when the tide comes in, does that make the moon the murderer?
More seriously, some people were doing GOF research on coronaviruses, and it didn't help one bit. In fact, I don't see how it could. Any therapeutic or vaccine will ultimately have to be tuned for the actual wild virus anyway.
Glad to see Matt putting estimates of the economic impact on the table --- context that policy makers understand -- and making the case for a moonshot. Drastically improving the ability to detect and track novel pathogens feels like the easy part compared to drastically improving the ability of governments around the world to work together on this stuff and then, when they detect an outbreak, to act swiftly per well-defined criteria LOL to reduce transmission and buy time for vaccine development and deployment.
Hi Matt, Could you say a little more about what you mean by "base rate issues"? Do you mean that appropriators have a psychological aversion to raising spending by more than a certain amount? That there is some kind of political problem with doing so? That it is impossible to scale up existing programs (but then, what about all the new programs a pandemic preparedness effort would fund)?
Is there a way we can start some policies local and then build up without needing federal involvement early? If companies start requiring daily rapid tests, as prices fall to the $1 range (the way they have been in Europe for months), then we could gradually add new virus tests to those rapid tests. This would then provide a local “weather report” for that region, which others might like to emulate.
Isn’t this in the same category as the earlier stories that masks in general don’t work “, but they need to be fitted to work properly. So for most people most of the time, the best option is probably a different mask that’s less effective but easier to use. ” Sure n95s are less effective if not properly fitted. But surely still much better than just a clothe mask that doesn’t even contain your breath
Yeah categorizing pandemic preparedness as defense spending actually makes sense on the merits as much as it’s politically a good strategy. Like the defenses you need against a natural disease are the same ones you need against a bio-weapon pretty much
Stop pooh-poohing climate change. As nasty as the covid pandemic has been, the effects of climate change are way worse.
That out of the way, your point that governments should invest more in pandemic preparedness is essentially correct, and you identify many of the right targets. I'd add that what we could really do with is *instant* virus tests. With an instant (or, say, 30 second) test of sufficient accuracy and cheapness, we could have stopped covid in its tracks, including Delta, without a vaccine, and without mass lockdowns. Or, at least, sane developed countries could have stopped covid in its tracks. The United States is of course another matter.
Climate change is like HIV. Climate change doesn't kill people, but heat waves, floods, etc. do. Industrialization in the tropics +more AC needed +more humans close to species rich areas +shift in vector populations leads to pandemics. You could even say an increase chance of pandemics starring is a consequence of climate change. So really pandemic preparedness money is Climate change money.
That said, we need rapid testing for everything. Normalize getting a rapid test every day before going to work or school, expand those rapid tests to flu, then other pathogens, then unknown pathogens, and use those results to produce local “weather reports” that people can use to proactively protect vulnerable friends and family.
I would need an easier test. Right now we've normalized "take temperature with infrared scanning thermometer" every morning because the school requires it and it's super easy, barely an inconvenience.
But the few times we've administered the rapid at-home test(due to some symptom that probably-isn't-but-maybe-it-just-might-be-Covid19) it's more of a pain. My 6 year-olds are not fans (and having taken the test myself, not a fan either, although more willing to do it). Subjecting myself to that every day is a tough sell.
I’m treating that as equivalent. Maybe it’s air monitoring in public spaces or something else. But some sort of routing surveillance that gives people a general knowledge of current disease conditions seems like it has to be part of the future.
I haven’t seen much comparison of the impacts of climate change and the impacts of pandemics. You say climate change is worse, but it’s not exactly obvious to me that this is true, if it is. Do you have some sketch of why I should think that?
Certainly this year’s pandemic has been worse than the past year or two of climate-related disasters, and HIV was worse than the previous 40 years of climate related disasters. I see the case that future climate related problems will be worse than the ones of the past few decades, but will they be enough so to outpace future pandemics?
OK, I should have been more precise - the predicted future impacts are potentially way worse than likely pandemics.
Civilisation-threatening pandemics are not that common. Really, only plague and smallpox fit that bill (particularly if accompanied by European invaders). Covid (and a future influenza pandemic) are temporary disruptions. It's been pretty unpleasant to live through, but things are getting back to normal and will continue to do so (at least in societies with the means and the structures to make it so).
By contrast, unchecked climate change is civilisation-threatening (though that possibility is thankfully receding given the mitigations already in place), and unless effective global action is taken there is little we can do personally to avoid immiserating ourselves for the lifespan of our children and our children's children.
Isn't climate change more exponential? Doing something now would be much more helpful than doing the same thing in 10 years. Postponing pandemic prevention for 10 years is only bad if we're unlucky and get another pandemic before then. Otherwise it will make no difference. (Not that we shouldn't worry about getting unlucky, but the risks are just different.)
I think it's hard to compare pandemics and climate change on some levels. Sure, climate change has and will kill people, and so do pandemics, but if climate change causes wet-bulb temperatures to become deadly to humans in southern India for weeks at a time, it's not like everybody in southern India will die; some will, but the rest will move, and those population shifts will cause political and economic disasters elsewhere. Or hurricanes get more powerful, but we also get better at forecasting, so fewer people die but they cause more property damage (which strains local and state budgets, so other essential programs face cuts).
And, pandemics can be related to climate change. As climate change gets worse or as the human processes that cause climate change get worse (thinking of encroachment on natural habitats, convenient cheap air travel), then we might also see more risks of pandemics than in the past. It's an ambiguous relationship, to be sure.
The way to prevent pandemics and epidemics is to eliminate all animal use industries and stop damaging wildlife habitat.
The next pandemic is likely to come from an authoritarian country with tight control over the media. The US and other open societies need to figure out the signs that there’s an outbreak in an authoritarian country. The next pandemic may not come from China. It might come from Russia or one of the other former Soviet republics with a cartoonish authoritarian ruler, especially if he doesn’t want to look bad in front of other world leaders. I don’t know much about gathering intelligence but if the country suddenly starts buying up PPE or doctors are mysteriously falling out of windows, that may be a clue that there’s an outbreak and it might be a good idea to start collecting that kind of information. I don’t know how the US would start doing that but that’s what intelligence experts are for.
Classic SARS also came from China and it didn’t become a pandemic in part because of traits of the virus: it was less transmissible and is only transmitted when you’re symptomatic. However, Hong Kong was under leas control from Beijing and it had a much freer press than today. The Hong Kong press really did investigate what was going on. Foreign journalists had more access to mainland China where SARS had first emerged.
For all the many flaws of our media, an outbreak of a novel virus in the US would be something that the media were all over.
The line about base rates was interesting. What if we charged the Dept of Defense with the responsibility for biodefense? The budget required could be found in their couch cushions.
I don't think there is any point to throwing more money at America's public health apparatus without root and branch reform. Despite being far better funded per capita and overall than any peer countries, they completely beclowned themselves throughout the COVID response.
Why should congress entrust these organizations with such a large sum of money?
"Defund the public health apparatus!"
Nobody wants to pay for insurance. Not only is bipartisan agreement on this not going to happen, if anyone dares to vote for this you can bet they'll be attacked for "wasting" $60 billion (with a b!) on diseases that don't even exist.
If economists would like to do some good for the pandemic (rather than redoing some of the epidemiologists homework or yelling "challenge test" in crowded theaters) they'd figure out how to get people to want to protect against the next pandemic.
One thing that would perhaps help is to make explicit the cost of the next pandemic - somehow codify the cost that we are signing up in a pandemic (automatic stabilizers, etc), so that the insurance can seem like a cost savings.
I'm hugely in favor of expanded pandemic preparation. In fact, I would argue, infectious disease should be the sole thing that the CDC should focus on. It's pivot to things like obesity and smoking have caused a loss of focus.
In that vein, I would support a lot more money for R&D, as well as additional money for rapid testing, as well as subsidies to keep domestic PPE production here and ready.
All that being said, I will never support the BBB. I'm not in favor of expanding the welfare state when we can't even pay for the promises that we've already made. Fix entitlements first. Then we will talk. Note, I would have been very willing to vote for something like the Simpson Bowles Commission.
But it violated the Prime Directive of Republican ideology: do not tax the rich.
Given the SALT discussion - I think there may be nuance entering that conversation.
I guess I should have said the rich that live in red states. It's quite OK to incentivize the blue rich to move.
I'm not totally opposed to CDC becoming involved in issues where the harm of the illness is almost all on the individual as there can still be economies of scale in interventions. Nevertheless, I agree that the main job of CDC ought to be in infectious diseases where the benefits of preventing infection are a multiple of the benefit to the person not infected. And the CDC's messaging ought to reflect that. Even today, I hear in the news (and I have to believe that in some way reflects CDC/FDA messaging) that benefits (to the child) vaccinations of children outweigh the risks. What about the teacher who does not become infected or the parent or relative or other children?
Really good article! Wish these kinds of articles were more popular rather than clickbait culture war stuff
>>But as Noah Smith has written, oftentimes the U.S. gets useful things done (the original Interstate Highway System, the foundation for the Internet, etc.) by calling them national security. There’s no reason the next NDAA can’t find some way to smuggle in billions of dollars for pandemic prevention.<<
Yeah, I don't buy this. Regarding the IHS, while Eisenhower was impressed by Germany's autobahn system, national defense was at best a very minor factor for selling the IHS to the American people: economic growth was the big selling point (https://www.fhwa.dot.gov/interstate/interstatemyths.cfm#question3). And while the creation of the transformational Internet was a serendipitous outcome of the ARPANET, there was zero possibility of anticipating such a thing coming from this infinitesimal part of DoD R&D spending. Sometimes you get really lucky. (Sometimes you get Tang and Teflon, too.)
DoD is focused on traditional ideas of national defense. The idea that we could "smuggle in billions of dollars for pandemic prevention" in the DoD budget is laughable.
Posts like this put one in mind of the "availability" bias trap. We're all focused on the dangers of pandemics because, well, duh. So many of us are focused on doing things because COVID has been such a disaster. That's great. But how will we feel in five or ten years if, as is highly likely, nothing as damaging as COVID has recurred? We'll feel like we have much bigger fish to fry and while preparing for the next pandemic would be great, right now we have to concentrate on crisis X or Y. We'll be like the Obama administration, which cut funds for PPE in the national stockpile because national debt and the deficit were such large concerns.
Hey, if we can do things like throw money at research that will lay the basis for general spectrum vaccines, great. Scientists are great at long-term research. But beyond that I cast a gimlet eye.
For example, in the Biden proposal Matt cites, the administration writes: "There should be a centralized ‘Mission Control’, acting as a single, unified program management unit,
that draws on expertise from multiple HHS agencies, including NIH, CDC, BARDA, FDA, and CMS, as well as other departments such as DoD, DoE, and VA." I have no doubt that within five years, and no pandemic emergency in the meantime, this "Mission Control" will be an empty shell of no importance, with at best pro forma meetings and each agency and department pursuing their own agenda and jealously guarding their autonomy.
Memories fade and people will lose any sense of urgency they may have now. That's just life.
Agreed that memory fades. On the other hand, COVID was a REALLY big deal. Look at all the additional security we still have 20 years after 9/11 and that was 3,000 people that died. COVID's over 500,000.
That being said, I think what you want is to make CDC's only job to be infectious diseases/pandemics. Let other agencies handle the rest, that way CDC stays focused
There needs to be some organization that sees disease prevention framed as a question of national defense, not framed as a way to publish research papers. Whether that should be the CDC, a firewalled half of the CDC, or some completely different agency, I'm not sure. But the civil defense voice, that *type* of response, was almost invisible IMHO.
Off the top of my head I would say the moonshot analogy would be apt if the moon evolved constantly and was occasionally trying to kill you. This particular problem dwarfs the moonshot in complexity and scope. I am totally onboard with many of your recommendations with regard to R&D in order to increase preparedness and shorten response time. But this is where I point out that evolution has quite a lot to say about this. Which you noted in your final paragraph. And it is also where I point out that waiting to see what mother nature comes up with in terms and then responding to it is in itself a dangerous strategy. And yes I am speaking of gain of function research. I will note parenthetically that military threat assessments are not based on what you think an opponent might do but what they have the actual capacity to do.
When it comes to viruses we just don't know what it can do. Mother nature is surprisingly good at coming up with new ways to beat defenses. And one can never ignore the fact that humans can, with malicious intent, help evolution along. Which is why I am very much in favor of tightly controlled GOF research to explore exactly what we might come up against regardless of origin. And if you want to hand this over to the DOD fine by me. They are probably doing it anyway.
As an aside on PPE I will go out on a short and very robust limb and suggest that you have never had a fit test. Which is something I have to do annually at least in order to go into the places I have to go. It literally is a respirator fitting for a variety of PPE including the N95 mask as well as cartridge type respirators designed with color coded cartridges designed to filter out specific chemicals like H2S. The very first thing that has to go in order to do a fit test is all your facial hair. No shave, no test. I anticipate an armed revolution if such is ever made a mask mandate for the general population.
Well, if someone lies down on the beach and drowns when the tide comes in, does that make the moon the murderer?
More seriously, some people were doing GOF research on coronaviruses, and it didn't help one bit. In fact, I don't see how it could. Any therapeutic or vaccine will ultimately have to be tuned for the actual wild virus anyway.
It's been going on quite a while now. So the risks are apparently manageable.
Glad to see Matt putting estimates of the economic impact on the table --- context that policy makers understand -- and making the case for a moonshot. Drastically improving the ability to detect and track novel pathogens feels like the easy part compared to drastically improving the ability of governments around the world to work together on this stuff and then, when they detect an outbreak, to act swiftly per well-defined criteria LOL to reduce transmission and buy time for vaccine development and deployment.
Hi Matt, Could you say a little more about what you mean by "base rate issues"? Do you mean that appropriators have a psychological aversion to raising spending by more than a certain amount? That there is some kind of political problem with doing so? That it is impossible to scale up existing programs (but then, what about all the new programs a pandemic preparedness effort would fund)?
Is there a way we can start some policies local and then build up without needing federal involvement early? If companies start requiring daily rapid tests, as prices fall to the $1 range (the way they have been in Europe for months), then we could gradually add new virus tests to those rapid tests. This would then provide a local “weather report” for that region, which others might like to emulate.
In five years, how many people will be getting those frequent tests? (Hint: any answer above zero will led to loss of points).
Isn’t this in the same category as the earlier stories that masks in general don’t work “, but they need to be fitted to work properly. So for most people most of the time, the best option is probably a different mask that’s less effective but easier to use. ” Sure n95s are less effective if not properly fitted. But surely still much better than just a clothe mask that doesn’t even contain your breath
Yeah categorizing pandemic preparedness as defense spending actually makes sense on the merits as much as it’s politically a good strategy. Like the defenses you need against a natural disease are the same ones you need against a bio-weapon pretty much
Stop pooh-poohing climate change. As nasty as the covid pandemic has been, the effects of climate change are way worse.
That out of the way, your point that governments should invest more in pandemic preparedness is essentially correct, and you identify many of the right targets. I'd add that what we could really do with is *instant* virus tests. With an instant (or, say, 30 second) test of sufficient accuracy and cheapness, we could have stopped covid in its tracks, including Delta, without a vaccine, and without mass lockdowns. Or, at least, sane developed countries could have stopped covid in its tracks. The United States is of course another matter.
"the effects of climate change are way worse."
maybe eventually, but surely not right now
Climate change is like HIV. Climate change doesn't kill people, but heat waves, floods, etc. do. Industrialization in the tropics +more AC needed +more humans close to species rich areas +shift in vector populations leads to pandemics. You could even say an increase chance of pandemics starring is a consequence of climate change. So really pandemic preparedness money is Climate change money.
That said, we need rapid testing for everything. Normalize getting a rapid test every day before going to work or school, expand those rapid tests to flu, then other pathogens, then unknown pathogens, and use those results to produce local “weather reports” that people can use to proactively protect vulnerable friends and family.
I would need an easier test. Right now we've normalized "take temperature with infrared scanning thermometer" every morning because the school requires it and it's super easy, barely an inconvenience.
But the few times we've administered the rapid at-home test(due to some symptom that probably-isn't-but-maybe-it-just-might-be-Covid19) it's more of a pain. My 6 year-olds are not fans (and having taken the test myself, not a fan either, although more willing to do it). Subjecting myself to that every day is a tough sell.
...do you also watch the screenrant movie pitches?
Yes sir I do.
Wastewater monitoring and the like is a much better stategy for mapping local conditions
I’m treating that as equivalent. Maybe it’s air monitoring in public spaces or something else. But some sort of routing surveillance that gives people a general knowledge of current disease conditions seems like it has to be part of the future.
I haven’t seen much comparison of the impacts of climate change and the impacts of pandemics. You say climate change is worse, but it’s not exactly obvious to me that this is true, if it is. Do you have some sketch of why I should think that?
Certainly this year’s pandemic has been worse than the past year or two of climate-related disasters, and HIV was worse than the previous 40 years of climate related disasters. I see the case that future climate related problems will be worse than the ones of the past few decades, but will they be enough so to outpace future pandemics?
OK, I should have been more precise - the predicted future impacts are potentially way worse than likely pandemics.
Civilisation-threatening pandemics are not that common. Really, only plague and smallpox fit that bill (particularly if accompanied by European invaders). Covid (and a future influenza pandemic) are temporary disruptions. It's been pretty unpleasant to live through, but things are getting back to normal and will continue to do so (at least in societies with the means and the structures to make it so).
By contrast, unchecked climate change is civilisation-threatening (though that possibility is thankfully receding given the mitigations already in place), and unless effective global action is taken there is little we can do personally to avoid immiserating ourselves for the lifespan of our children and our children's children.
Isn't climate change more exponential? Doing something now would be much more helpful than doing the same thing in 10 years. Postponing pandemic prevention for 10 years is only bad if we're unlucky and get another pandemic before then. Otherwise it will make no difference. (Not that we shouldn't worry about getting unlucky, but the risks are just different.)
I think it's hard to compare pandemics and climate change on some levels. Sure, climate change has and will kill people, and so do pandemics, but if climate change causes wet-bulb temperatures to become deadly to humans in southern India for weeks at a time, it's not like everybody in southern India will die; some will, but the rest will move, and those population shifts will cause political and economic disasters elsewhere. Or hurricanes get more powerful, but we also get better at forecasting, so fewer people die but they cause more property damage (which strains local and state budgets, so other essential programs face cuts).
And, pandemics can be related to climate change. As climate change gets worse or as the human processes that cause climate change get worse (thinking of encroachment on natural habitats, convenient cheap air travel), then we might also see more risks of pandemics than in the past. It's an ambiguous relationship, to be sure.