Disease experts reveal their biggest worries about the next pandemic



There's a disturbing reality that's clear to experts in infectious disease — but the rest of us ignore it on a regular basis.

The next pandemic is coming.

New diseases are always on the rise. Viruses and bacteria can mutate and become more infectious or deadly (or both), and there's a constant risk that new illnesses could find ways to jump from their hosts to humans. As Bill Gates wrote in a recent op-ed for Business Insider, a terrorist attack could involve the creation of a particularly contagious and deadly flu strain.

"Whether it occurs by a quirk of nature or at the hand of a terrorist, epidemiologists say a fast-moving airborne pathogen could kill more than 30 million people in less than a year," Gates wrote. "And they say there is a reasonable probability the world will experience such an outbreak in the next 10-15 years."

Five disease experts recently convened at the American Museum of Natural History (AMNH) to discuss the threat of pandemics.

"A pandemic is something that stretches like a colossus around the world; an epidemic that affects many parts of the world," Tom Frieden, former director of the Centers for Disease Control and Prevention, explained at the event.

In many ways, the experts' thoughts about pandemics were reassuring — over time, they said, we've improved how we respond to disease outbreaks by acting quickly to isolate and care for sick patients. But regions of the world that struggle with poverty or war still struggle to contain disease outbreaks.

"The pandemic of greatest concern is the pandemic of poverty," said Don Weiss, a medical epidemiologist with the New York City Department of Health and Mental Hygiene, during the discussion.

Each expert also explained their biggest worry about the next pandemic. Here are their concerns (with responses lightly edited for clarity):

Lack of trust in scientists and experts: Wafaa El-Sadr, professor of epidemiology and medicine at Columbia University, said that given the recent disregard for scientific facts (like human-caused climate change, for instance), she's concerned that people won't heed experts' warnings.

"I think my biggest worry is mistrust, mistrust of experts in general," she said. "That's worrisome because that has implications for what we're talking about today; and that has implications for everything else."

Learning lessons from the past: Tom Frieden said he's concerned that people won't study responses to recent pandemics enough to improve responses to future ones.

"The world has a unique opportunity following Ebola to close gaps, to address blind spots around the world and to become much safer. If we don't take action very quickly to close the gaps that are being identified, we will lose that opportunity," he said.

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West Point slum in Liberia still struggling after Ebola epidemic
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West Point slum in Liberia still struggling after Ebola epidemic
MONROVIA, LIBERIA - FEBRUARY 09: Children bathe in a bucket in the West Point slum on February 9, 2016 in Monrovia, Liberia. West Point, the most impoverished and overpopulated community in Liberia, was hard hit by the Ebola outbreak. After almost two years, on January 14, 2016 the World Health Organization declared the epidemic over, after the virus had killed some 11,300 people and infected more than 28,500 people in West Africa. (Photo by John Moore/Getty Images)
MONROVIA, LIBERIA - FEBRUARY 10: A restaurant sits empty overlooking the West Point slum on February 10, 2016 in Monrovia, Liberia. Monrovia was hard hit by the Ebola epidemic and the economy has not recovered. After almost two years, on January 14, 2016 the World Health Organization declared the epidemic over, after the virus had killed some 11,300 people and infected more than 28,500 people in West Africa. (Photo by John Moore/Getty Images)
MONROVIA, LIBERIA - FEBRUARY 10: A water tank for washing hands stands in front of a municipal center in the West Point slum on February 10, 2016 in Monrovia, Liberia. The school was cleaned and refurbished following the epidemic. West Point, the most impoverished and overpopulated community in Liberia, was hard hit by the Ebola outbreak. After almost two years, on January 14, 2016 the World Health Organization declared the epidemic over, after the virus had killed some 11,300 people and infected more than 28,500 people in West Africa. (Photo by John Moore/Getty Images)
MONROVIA, LIBERIA - FEBRUARY 10: Members of the opposition Congress for Democratic Change party protest in the West Point slum on February 10, 2016 in Monrovia, Liberia. West Point was hard hit by the Ebola outbreak and remains one of the most impoverished communities in Liberia. After almost two years, on January 14, 2016 the World Health Organization declared the epidemic over, after the virus had killed some 11,300 people and infected more than 28,500 people in West Africa. (Photo by John Moore/Getty Images)
MONROVIA, LIBERIA - FEBRUARY 10: Children play basketball in front of a school, formerly an Ebola center, in the West Point slum on February 10, 2016 in Monrovia, Liberia. The school was cleaned and refurbished following the epidemic. West Point, the most impoverished and overpopulated community in Liberia, was hard hit by the Ebola outbreak. After almost two years, on January 14, 2016 the World Health Organization declared the epidemic over, after the virus had killed some 11,300 people and infected more than 28,500 people in West Africa. (Photo by John Moore/Getty Images)
MONROVIA, LIBERIA - FEBRUARY 09: A child stands atop a sandbag made from a former sack of American food aid sent to the West Point slum on February 9, 2016 in Monrovia, Liberia. West Point, the most impoverished and overpopulated community in Liberia, was hard hit by the Ebola outbreak. After almost two years, on January 14, 2016 the World Health Organization declared the epidemic over, after the virus had killed some 11,300 people and infected more than 28,500 people in West Africa. (Photo by John Moore/Getty Images)
MONROVIA, LIBERIA - FEBRUARY 09: A man smooths out streetside posters in the West Point slum on February 9, 2016 in Monrovia, Liberia. West Point, the most impoverished and overpopulated community in Liberia, was hard hit by the Ebola outbreak. After almost two years, on January 14, 2016 the World Health Organization declared the epidemic over, after the virus had killed some 11,300 people and infected more than 28,500 people in West Africa. (Photo by John Moore/Getty Images)
MONROVIA, LIBERIA - FEBRUARY 09: The Liberian flag flies in front of a school formerly used as an Ebola holding center in the West Point slum on February 9, 2016 in Monrovia, Liberia. In August of 2014 the center was overrun by a mob, who claimed that the Ebola epidemic was a hoax. West Point, the most impoverished and overpopulated community in Liberia, was hard hit by the Ebola outbreak, and health facilities at the time were overwhelmed. After almost two years, on January 14, 2016 the World Health Organization declared the epidemic over, after the virus had killed some 11,300 people and infected more than 28,500 people in West Africa. (Photo by John Moore/Getty Images)
MONROVIA, LIBERIA - FEBRUARY 09: People pray during a seaside church service in the West Point slum on February 9, 2016 in Monrovia, Liberia. West Point, the most impoverished and overpopulated community in Liberia, was hard hit by the Ebola outbreak. After almost two years, on January 14, 2016 the World Health Organization declared the epidemic over, after the virus had killed some 11,300 people and infected more than 28,500 people in West Africa. (Photo by John Moore/Getty Images)
MONROVIA, LIBERIA - FEBRUARY 09: Boys show off their new puppies in the West Point slum on February 9, 2016 in Monrovia, Liberia. West Point, the most impoverished and overpopulated community in Liberia, was hard hit by the Ebola outbreak. After almost two years, on January 14, 2016 the World Health Organization declared the epidemic over, after the virus had killed some 11,300 people and infected more than 28,500 people in West Africa. (Photo by John Moore/Getty Images)
MONROVIA, LIBERIA - FEBRUARY 09: People pray during a seaside church service in the West Point slum on February 9, 2016 in Monrovia, Liberia. West Point, the most impoverished and overpopulated community in Liberia, was hard hit by the Ebola outbreak. After almost two years, on January 14, 2016 the World Health Organization declared the epidemic over, after the virus had killed some 11,300 people and infected more than 28,500 people in West Africa. (Photo by John Moore/Getty Images)
MONROVIA, LIBERIA - FEBRUARY 09: Fish dry as children play in the West Point slum on February 9, 2016 in Monrovia, Liberia. West Point, the most impoverished and overpopulated community in Liberia, was hard hit by the Ebola outbreak. After almost two years, on January 14, 2016 the World Health Organization declared the epidemic over, after the virus had killed some 11,300 people and infected more than 28,500 people in West Africa. (Photo by John Moore/Getty Images)
MONROVIA, LIBERIA - FEBRUARY 09: A woman and her child pass by an internet cafe in the West Point slum on February 9, 2016 in Monrovia, Liberia. West Point, the most impoverished and overpopulated community in Liberia, was hard hit by the Ebola outbreak. After almost two years, on January 14, 2016 the World Health Organization declared the epidemic over, after the virus had killed some 11,300 people and infected more than 28,500 people in West Africa. (Photo by John Moore/Getty Images)
MONROVIA, LIBERIA - FEBRUARY 09: Women walk through the refuge-strewn shorline of the West Point slum on February 9, 2016 in Monrovia, Liberia. West Point, the most impoverished and overpopulated community in Liberia, was hard hit by the Ebola outbreak. After almost two years, on January 14, 2016 the World Health Organization declared the epidemic over, after the virus had killed some 11,300 people and infected more than 28,500 people in West Africa. (Photo by John Moore/Getty Images)
MONROVIA, LIBERIA - FEBRUARY 09: Women dance during a church service on the beach in the West Point slum on February 9, 2016 in Monrovia, Liberia. West Point, the most impoverished and overpopulated community in Liberia, was hard hit by the Ebola outbreak. After almost two years, the World Health Organization this January 14 declared the epidemic over, after it killed some 11,300 people and infected more than 28,500 people in West Africa. (Photo by John Moore/Getty Images)
MONROVIA, LIBERIA - FEBRUARY 09: Children stand outside a cinema in the West Point slum on February 9, 2016 in Monrovia, Liberia. West Point, the most impoverished and overpopulated community in Liberia, was hard hit by the Ebola outbreak. After almost two years, on January 14, 2016 the World Health Organization declared the epidemic over, after the virus had killed some 11,300 people and infected more than 28,500 people in West Africa. (Photo by John Moore/Getty Images)
MONROVIA, LIBERIA - FEBRUARY 09: A caretaker stands in a classroom, empty of students while on a school vacation, in school formerly used as an Ebola holding center in the West Point slum on February 9, 2016 in Monrovia, Liberia. In August of 2014 the center was overran and patients sick with Ebola were removed by a mob, who claimed that the Ebola epidemic was a hoax. West Point, the most impoverished and overpopulated community in Liberia, was hard hit by the Ebola outbreak, and health facilities at the time were overwhelmed. After almost two years, on January 14, 2016 the World Health Organization declared the epidemic over, after the virus had killed some 11,300 people and infected more than 28,500 people in West Africa. (Photo by John Moore/Getty Images)
MONROVIA, LIBERIA - FEBRUARY 09: A man rests in the afternoon heat at his sidewalk clothing stand in the West Point slum on February 9, 2016 in Monrovia, Liberia. West Point, the most impoverished and overpopulated community in Liberia, was hard hit by the Ebola outbreak. After almost two years, on January 14, 2016 the World Health Organization declared the epidemic over, after the virus had killed some 11,300 people and infected more than 28,500 people in West Africa. (Photo by John Moore/Getty Images)
MONROVIA, LIBERIA - FEBRUARY 09: Chidren play on the beach of the West Point slum on February 9, 2016 in Monrovia, Liberia. West Point, the most impoverished and overpopulated community in Liberia, was hard hit by the Ebola outbreak. After almost two years, on January 14, 2016 the World Health Organization declared the epidemic over, after the virus had killed some 11,300 people and infected more than 28,500 people in West Africa. (Photo by John Moore/Getty Images)
MONROVIA, LIBERIA - FEBRUARY 09: Ebola survivor Banganelee Yougi, 22, smiles while passing a market in the West Point slum on February 9, 2016 in Monrovia, Liberia. West Point, the most impoverished and overpopulated community in Liberia, was hard hit by the Ebola outbreak. After almost two years, on January 14, 2016 the World Health Organization declared the epidemic over, after the virus had killed some 11,300 people and infected more than 28,500 people in West Africa. (Photo by John Moore/Getty Images)
MONROVIA, LIBERIA - FEBRUARY 09: Caretakers eat lunch at the entrance of a school formerly used as an Ebola holding center in the West Point slum on February 9, 2016 in Monrovia, Liberia. In August of 2014 the center was overrun by a mob, who claimed that the Ebola epidemic was a hoax. West Point, the most impoverished and overpopulated community in Liberia, was hard hit by the Ebola outbreak, and health facilities at the time were overwhelmed. After almost two years, on January 14, 2016 the World Health Organization declared the epidemic over, after the virus had killed some 11,300 people and infected more than 28,500 people in West Africa. (Photo by John Moore/Getty Images)
MONROVIA, LIBERIA - FEBRUARY 09: Women walk with their wares through the West Point slum on February 9, 2016 in Monrovia, Liberia. West Point, the most impoverished and overpopulated community in Liberia, was hard hit by the Ebola outbreak, and health facilities at the time were overwhelmed. After almost two years, on January 14, 2016 the World Health Organization declared the epidemic over, after the virus had killed some 11,300 people and infected more than 28,500 people in West Africa. (Photo by John Moore/Getty Images)
MONROVIA, LIBERIA - FEBRUARY 09: Boys carry wood for construction along the refuge-strewn shorline of the West Point slum on February 9, 2016 in Monrovia, Liberia. West Point, the most impoverished and overpopulated community in Liberia, was hard hit by the Ebola outbreak. After almost two years, on January 14, 2016 the World Health Organization declared the epidemic over, after the virus had killed some 11,300 people and infected more than 28,500 people in West Africa. (Photo by John Moore/Getty Images)
MONROVIA, LIBERIA - FEBRUARY 09: A teddy bear sits on a bed where a feverish baby Benson, 2 months, was taken to an Ebola treatment center in October 2014 in the West Point slum on February 9, 2016 in Monrovia, Liberia. Benson died two days later from Ebola. West Point, the most impoverished and overpopulated community in Liberia, was hard hit by the Ebola outbreak. After almost two years, on January 14, 2016 the World Health Organization declared the epidemic over, after the virus had killed some 11,300 people and infected more than 28,500 people in West Africa. (Photo by John Moore/Getty Images)
MONROVIA, LIBERIA - FEBRUARY 09: Cinema goers come to watch a movie in the West Point slum on February 9, 2016 in Monrovia, Liberia. West Point, the most impoverished and overpopulated community in Liberia, was hard hit by the Ebola outbreak. After almost two years, on January 14, 2016 the World Health Organization declared the epidemic over, after the virus had killed some 11,300 people and infected more than 28,500 people in West Africa. (Photo by John Moore/Getty Images)
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Antibiotic resistance: Laurie Garrett, Pulitzer Prize-winning science journalist and author of several books on disease and public health, points to a related problem as her primary concern.

"I'm increasingly very worried about broad spectrum drug resistant plasmids emerging in a huge range of bacterial populations and the high probability that we'll lose the efficacy of much of our antibiotic armamentarium," she said.

In other words, bacteria around the world are adapting and becoming resistant to our existing antibiotics. As this continues, we could return to an era where a simple scratch becomes deadly — unless we find new types of antibiotics to stay ahead. (Garrett also says that a particularly bad strain of influenza is a very real pandemic threat.)

Destruction of species and environments that might hold the keys to future medical breakthroughs: Mark Siddall, an AMNH curator and principal investigator at the SICG Genomics Lab, said the natural diversity humans are destroying might hold solutions to many of our problems.

"As a biodiversity specialist here at the Museum of Natural History, my concern is that the next artemisinin, which is a drug for malaria; or the next cephalosporin, which was discovered in a soil fungus; or the next avermectin, which was found in a soil bacterium, is going to be wiped out from somebody burning a forest down before somebody figures out what it is," he said.

Funding for public health workers: Don Weiss said he hopes the people on the front lines when a new disease pops up will have the resources they need.

"I would like to shout out to all the students out there who want to go into public health and who want to get a job in public health ... I'm hoping that there will be funding so that we can hire you and that when I hang up my calculator that I will be able to hand the mantle off to a new crop that will be funded and well supplied with whatever they need to do the job," he said.

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