New book warns a far deadlier pandemic could arrive and says the world is unprepared

Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy, warns in a new book that the world remains vulnerable to a future pandemic that could be far deadlier than COVID-19.

In The Big One: How We Must Prepare for Future Deadly Pandemics, co-written with journalist Mark Olshaker, Osterholm argues that modern society has spent billions preparing for military threats while devoting far less to defending against microbes. He cautions that a pathogen combining the transmissibility of SARS-CoV-2 with the lethality of viruses such as SARS or MERS could trigger a catastrophe that would far outstrip the global disruption seen in 2020 and 2021.

Osterholm begins the book with a personal anecdote: on Dec. 30, 2019, while driving to the airport, a colleague told him of reports about an unusual pneumonia in Wuhan, China. He likened the moment to a seismologist hearing early tremors and not knowing whether a major quake would follow. That uncertainty, and the rapid global spread that followed, underpins his warning that the next pandemic could arrive faster and be more destructive.

To illustrate the stakes, Osterholm uses a hypothetical scenario in which a novel respiratory virus emerges in a rural Somali village and, through modern travel, seeds outbreaks on multiple continents within days. In the fictional chain of events, community-health workers and humanitarian staff initially confront the disease without diagnostic tools or effective therapeutics, and the pathogen moves at "the pace of modern life," he writes. The scenario ends with scientists identifying a new coronavirus and a grim assessment that the world is on the verge of dramatic change.

Osterholm frames that narrative through historical precedent. He cites the 1918 influenza pandemic, which killed an estimated tens of millions worldwide, HIV’s decades-long toll of more than 40 million deaths since the early 1980s, and more recent surprises such as Zika, which unexpectedly caused birth defects in Brazil. He also recalls his on-the-ground work during the 2014 West Africa Ebola outbreak, when he led a team of experts and co-authored a report in the journal mBio concluding that Ebola viruses had the potential to adapt to respiratory transmission. That assessment met fierce pushback at the time; Osterholm says he has not changed his scientific view that respiratory transmission could occur in a future outbreak.

The book assesses how the 2020–21 COVID-19 pandemic exposed weaknesses beyond the laboratory. Public-health messaging, he argues, was inconsistent and at times counterproductive. He recounts the March 2, 2020, tweet by the U.S. surgeon general that said, "Seriously people- STOP BUYING MASKS," and the subsequent reversal by the Centers for Disease Control and Prevention weeks later recommending face coverings. "The only currency public health has is trust," Osterholm writes, adding that public confidence was eroded by shifting guidance, the spread of misinformation and political interference.

Supply chains, Osterholm says, proved fragile: hospitals rationed personal protective equipment, testing capacity lagged, and even wealthy nations found they lacked surge capacity. While scientific advances produced vaccines, antivirals and diagnostic tools in record time, he insists those technologies cannot substitute for coherent leadership, transparent communication and public cooperation. "The best vaccine in the world is useless if people won't roll up their sleeves," he writes.

Osterholm identifies cultural and political obstacles to effective responses. He contends that the success of containment and mitigation depends heavily on individual behavior, such as mask-wearing and vaccination, and criticizes resistance framed as personal freedom. He calls for public-health officials and political leaders to work together, acknowledge scientific uncertainty, and build public trust before a crisis. Without that cooperation, he warns, any future outbreak could be met with the same delays, confusion and politicization that hampered responses to COVID-19.

The book contrasts the scale of COVID-19 with what Osterholm calls potential "Big One" scenarios. SARS had an estimated case fatality rate near 15%; MERS has killed more than a third of confirmed cases in some outbreaks. A pathogen that combined high transmissibility with such lethality, he argues, would pose an existential threat to societal functioning. He emphasizes that viruses can change through mutation or recombination and that today's familiar pathogens can become tomorrow's emergencies.

Osterholm also examines how modern interconnectedness amplifies risk. Dense populations, global travel and large-scale human-animal interaction create conditions he describes as "an extraordinarily efficient biological mixing bowl" that accelerates viral evolution and spread. He notes the speed advantage microbes have: some viruses can complete a new generation in hours, giving them many opportunities to adapt while humans respond more slowly.

The book calls for concrete steps to reduce vulnerability, including strengthening public-health infrastructure, ensuring reliable supply chains for critical equipment and medicines, increasing global surveillance, and investing in research on broadly protective vaccines and antivirals. Osterholm stresses that these technical measures must be coupled with improved governance and communication to maintain public trust and compliance.

Critics of alarmist accounts might point to the rapid scientific response during COVID-19 as evidence of progress. Osterholm acknowledges technological advances but cautions that they are not enough if political will and public confidence are absent. He frames preparedness as a combination of scientific, logistical and social capacities that must be sustained in peacetime.

The book offers a warning rooted in experience and a call to action: pandemics are recurring features of human history, and modern life may make the next one arrive faster and strike harder. By documenting failures during COVID-19 and outlining possible future scenarios, Osterholm and Olshaker aim to press policymakers and the public to treat pandemic preparedness with the same seriousness as other national security priorities.

The Big One was published by Little, Brown Spark. Osterholm's warnings underscore long-standing debates in public health about how to translate scientific knowledge into resilient systems that can withstand a fast-moving, high-lethality outbreak. If the policy choices he recommends are not enacted, he writes, the next pandemic could do far greater damage than COVID-19 and arrive before society has had time to learn from the last one.