We should expect more — and worse — pandemics to come

The fundamentals are bad

Madeleine Speed recently wrote a fascinating story for the FT Magazine about a new strain of avian flu that is devastating bird populations globally. As of May, roughly 36 million chickens and turkeys in the United States had been killed in an attempt to halt its spread in farm populations.

But it hasn’t worked.

And the Colorado Springs Gazette reported that by August 21, half the state’s egg-laying chickens have been wiped out. This poultry apocalypse is worsening the already bleak living conditions of chickens and adding fuel to the global inflation fire.

New bird flu strains generally arise in an agricultural system that packs together large numbers of chickens, often in close proximity to pigs and other animals. But as Speed writes, this new strain is so virulent that it’s also crushing some wild bird populations:

In Rajasthan, India, locals looked on in alarm in November last year as Demoiselles cranes, elegant grey-blue birds with long black necks, began showing signs of lethargy and confusion. Three hundred of the three-foot-tall birds, which feature prominently in Indian poetry and mythology, are said to have died. The virus spread west, wiping out 8,000 common cranes in Israel, “the worst blow to wildlife in the country’s history”, according to the environment minister. At Greece’s Lake Mikri Prespa, home to the world’s largest Dalmatian pelican colony, more than half of the enormous, prehistoric-looking birds perished. An annual census of the species across the Balkans in May revealed a 40 per cent decline in the population compared to last year.

While some avian flus can cross over to humans, this particular strain does not seem to have that ability. But that’s essentially thanks to good luck on our part, though the longer it circulates, the higher the risk of a crossover event. Similarly, monkeypox turns out to not be as deadly as prior research indicated. And in both cases, these new epidemics, though bad, are not nearly as bad as the Covid-19 pandemic. But our failure to control either of them wasn’t a calculated decision based on the relatively low risk — we just weren’t able to do it.

Most new viruses won’t be that spreadable or won’t be that deadly. But some will be. And I think the evidence is that the situation is getting worse.

The plagues have come

As a teenager, I was a big fan of Laurie Garrett’s 1994 book “The Coming Plague: Newly Emerging Diseases in a World Out of Balance.”

She argued that the world was making a big mistake treating the HIV/AIDS outbreak as a kind of one-off event. Throughout the 20th century, humanity enjoyed an enormous reduction in the risk of infectious diseases due to the triple punch of improved sanitation, antibiotics, and vaccines, but Garrett claimed that it was a mistake to assume the trend would inevitably continue. On the contrary, she thought it was likely to reverse for several reasons:

1. Antibiotics are miraculous, but resistant strains are emerging faster than we can invent new drugs.

2. Economic development is pushing more people into unfamiliar wildlife habitats where zoonotic crossover events can occur.

3. Just as the transition from hunter-gatherer to agricultural lifestyles increased disease zoonosis, so has the transition from traditional agricultural practices to factory farming.

4. The spread of motorized transportation and the growing affordability of air travel make it more likely that new pathogens will spread rapidly.

5. There are actually a bunch of weird viruses known to be deadly to humans that just haven’t spread much yet.

Her concerns have essentially all been born out over time, though relative to my worries 30 years ago, (5) has been less relevant — the scariest outbreaks have mostly come from entirely new viruses.

Antibiotic resistance remains an underrated problem. It has killed millions of people over the past 10 years, but the victims are primarily in poor countries and/or were already ill, so it doesn’t get enough attention, even as the situation steadily deteriorates.

We also have more people in contact with more animals traveling more quickly to more places. A big new Nature article looks at how deforestation is accelerating disease spread. Statisticians say we’ll likely experience another Covid-scale pandemic in our lifetimes.

It’s also getting cheaper and easier to manufacture new pathogens.

Infectious disease research is risky

The main reason I’m skeptical of the Covid-19 lab leak skeptics is that they seem to treat the idea of a lab leak as inherently improbable.

But I don’t think this is correct.

Martin Furmanski, writing for the Center for Arms Control and Nonproliferation (i.e., not someone grinding a particular axe about Covid-19 or China), noted in 2014 that during the smallpox eradication campaign era, in the U.K. “at least 80 cases and 3 deaths were the result of three separate escapes of the smallpox virus from two different accredited smallpox laboratories” within a 15-year span. He also writes about the risks from SARS research:

The existence of SARS “super-spreaders” makes even a single laboratory infection into a potential pandemic. SARS has not naturally recurred, but there have been six separate “escapes” from virology labs studying it: one each in Singapore and Taiwan, and in four distinct events at the same laboratory in Beijing.

Furmanski also documents leaks of foot and mouth disease, Venezuelan Equine Encephalitis, and H1N1 influenza. In the 1970s, a significant anthrax outbreak was caused by leaks from a Soviet lab.

So my overall view of the situation is closer to that of former FDA Commissioner Scott Gottlieb, who says lab accidents “happen all the time,” and we should have a reasonably high suspicion that a novel disease outbreak in a town hosting a virology lab was a lab leak.

That being said, I don’t particularly want to rehash the Covid-19 origin story because I think it’s become counterproductive. Initially, people who were very worried about lab leaks pre-2019 believed that pushing for evidence of a lab leak in Wuhan was constructively engaging people in the larger debate about pandemic risks. I now think it’s become a weird China policy hobbyhorse or grist for the culture war mills, and the important thing to note is that we have all these other examples of things that clearly were lab leaks.

And then there are the near misses. The FDA used to have a laboratory located at the NIH campus in Bethesda, Maryland. In 2014, they moved it to consolidate with other FDA facilities nearby. Because these are reasonably careful and conscientious people, they conducted a formal clean-up before they moved, and during that process they found 327 vials of unclaimed samples of viruses “inside cardboard boxes stored in the back left corner of an FDA laboratory’s cold storage room.” Six of them contained smallpox, one contained Russian spring-summer viral encephalitis (the subject of previous lab accidents), and nine had labels that couldn’t be read.

This wasn’t a clown show operation, but given many thousands of person-days worth of lab research in any given year, even a very low error rate leads to mishaps. But it does mean that scrounging around in caves to try to find new viruses is inherently dangerous, and research that involves deliberately engineering more dangerous pathogens in order to study them is even riskier.

Bioterrorism risk is huge

At the same time, CRISPR has made genetic engineering much cheaper and easier. There was a good Goldman Sachs Asset Management write-up of the implications of this for useful biomedical research last year, but the problem is that it also means it’s getting easier to make deadly pathogens.

Cheaper pathogen engineering expands the universe of dangerous pathogens that researchers are working with.

But the larger problem is we are becoming more and more vulnerable to the risk that a bad actor will try to deliberately engineer deadly viruses at home and release them into the world. The idea of a nuclear weapon being used by terrorists was a staple of 1990s fiction — Tom Clancy’s 1991 book “The Sum of All Fears,” the underrated 1996 John Woo film “Broken Arrow,” and the also-underrated George Clooney/Nicole Kidman movie “The Peacemaker” the following year. As a result, when 9/11 happened, people were primed to worry about nuclear terrorism.

The good news about nuclear terrorism is that as far as we know, building a nuclear weapon requires facilities that are physically large and thus relatively easy to spot. In cinematic terms, this means that a nuclear terrorism story normally involves a heist rather than covert manufacturing, which is good because heist movies are cool.

But in the real world, biological terrorism is a lot more alarming precisely because it doesn’t require a heist. You need considerable skill to engineer a pathogen (I couldn’t do it, and you can’t just watch some YouTube videos), but a reasonably trained person can do it with commercially available materials inside almost any building. Relatively small teams can cook up deadly viruses without even breaking any laws.

The one positive thing about bioterrorism is that unlike a nuclear bomb, it’s really hard to target an engineered virus. There’s no equivalent of “I’m going to blow up Chicago to show the Americans what I think of them.” Your virus is just going to spread around, killing people at random. And we also see this in pop culture: in Frank Herbert’s 1982 book “The White Plague,” the bioterrorist is a true madman who doesn’t really care who he hurts, while in the 1995 movie “12 Monkeys,” the culprit is an ecoterrorist who believes that the mass die-off of humanity will be good for nature.

That’s pretty nutty, but back at the 2020 World Economic Forum in Davos, the eminent primatologist Jane Goodall said, “What was the population in the year 1500? About 500 million. What on earth could take place that would cause a planet with 9 billion people on it to be reduced by 95% to 500 million? Hmmm…I wonder if a virus could do that?” Some dopes on the internet revived those comments years later as proof that a nefarious cabal of elites deliberately engineered Covid-19 as part of the environmental agenda. You can be pretty certain that’s not true because a deliberate program of destruction would almost certainly kill way more people. But Goodall’s joke does illustrate that it’s not totally inconceivable that a skilled scientist would decide this was a good idea.

Things could get so much worse

Fictional accounts of infectious disease apocalypse, whether they feature terrorists or a lab leak (as in “The Stand”) or zoonosis (“Contagion”), normally involve one pathogen that is just super-duper deadly.

This seems pretty unlikely. In the real world, even the deadliest plagues are somewhat limited in the number of people they kill, both because the immune system is pretty impressive and also because viruses need survivors in order to spread. But what can be much worse than any single pathogen is what the Native Americans experienced when European colonizers showed up: exposure to multiple novel pathogens simultaneously.

A would-be killer could release engineered smallpox and a novel coronavirus and a new flu strain and a new henipavirus optimized for human transmission all at once. That would kill tons of people and also throw our basic response systems into chaos. And there’s no particular reason that a sophisticated killer would need to stop at four. Engineering new viruses requires skills most people don’t have, but for those who do, I don’t believe it’s the case that each modification is like a delicate masterpiece that takes forever to assemble. You could unleash many variants roughly simultaneously and provoke a potentially civilization-collapsing disaster.

With Covid-19, we worried a lot about people not wanting to comply with non-pharmaceutical interventions and thus harming the vulnerable. But throw some more deadly viruses into the mix — especially ones that kill kids — and we’ll end up with the opposite problem where essential workers don’t want to show up and things start falling apart.

None of this is particularly likely, but after 9/11 we turned the world upside down out of fear of nuclear terrorism. The bioterror risk seems graver, more real, and also like something we could address with measures that are much less costly than launching wars.

There’s so much more we could do on biodefense

People who like to follow Covid news have started paying attention to wastewater monitoring because it’s a great way to get broad-spectrum information in close to real time.

What we ought to be doing is setting more communities up with routine wastewater monitoring and building systems that don’t just check for a particular virus but all unusual DNA. That way you could find a virus you’re not already looking for. We should be investing in ventilation (which everyone says) but also basic testing of commercially available air purifiers. You should be able to find out easily which one is really the best at clearing out viruses, and that should become a basis for commercial competition.

Recent research indicates that far-ultraviolet light can kill viruses and make indoor space as safe as outdoor space. I’d want to run three or four more rigorous studies on that before I put far-UVC lights everywhere, but we should do that research and, if it pans out, put the lights everywhere. And we should be paying people lots of money to design new kinds of masks that are as effective as KN95s but more comfortable, or equally comfortable but more effective, or ideally both. There ought to be huge prizes for inventing masks like that and advanced purchase commitments to get them from manufacturers.

We also ought to have spacesuit-type supersuits lying around so that we can keep basic social infrastructure up and running in the event of a huge catastrophe.

And finally, we need to put the pedal to the metal on the universal coronavirus vaccine project and then work with equal alacrity on universal vaccines for the other families. Part of the power of the family-wide vaccine concept is it will offer protection against pathogens that don’t yet exist, which is far and away the best hope for getting ahead of engineered pathogens.

None of this — ventilation, special light, better PPE, better vaccines — is exactly existing science and technology. But it’s close, visibly within grasp, just as the possibility of simultaneously releasing dozens of separately engineered viruses is visibly within reach. In the race between the two, the bad actors’ advantage is they don’t need to follow the rules and protocols that slow things down. The good actors’ advantage is that developed world governments have at their disposal enormous financial resources. They just need to be persuaded to actually use them.