Osterholm is also the director of the Center for Infectious Disease Research and Policy at the University of Minnesota and author of The New York Times bestseller « Deadliest Enemy: Our War Against Killer Germs. » Our conversation was edited for clarity, and the views expressed are his.
BERGEN: And that was by Dr. Anthony Fauci.
OSTERHOLM: Yes, his comment was obviously interpreted by most to mean that the pandemic was over. I realize that he was referring to the fact that we’re out of the big peak of cases right now, which is true.
One of the key parts of the administration’s request for additional support is the need to secure a variant-specific vaccine. But such vaccines, like the ones being developed for the subvariants of Omicron, may be less effective against any new emerging variant.
And finally, when considering what our future with this virus looks like, we must consider waning immunity protection. How long has it been since people had their last vaccination, booster or previous infection? No one knows what the impact of waning immunity will be in the months ahead. And we must have the humility and the honesty to say that.
I’ve heard people say over and over again, « This thing is as infectious as it’s going to get, » and yet it keeps getting more infectious. Obviously, there’s a limit to that increasing infectiousness. It can’t go to the speed of light, but surely, you can expect to see new variants that survive and capitalize on microbial evolution by being more infectious.
Also, the whole issue of waning immunity is really an underappreciated situation, but the key point is that we don’t know what’s going to happen six months from now. So, we could have 100 million cases, but on the other hand, if we don’t see a new variant develop, maybe we won’t. I think that that’s the uncertainty that we have to convey to everyone and make clear that we’ve got to prepare for the worst and hope for the best.
The virus is not done with us yet. We are going to have an ongoing pandemic with this virus for some time now.
Taiwan acknowledged that it can’t control Omicron. So, we have to understand that we’re now living with this virus, and no one has the perfect plan to get us out of it.
For the past two years, if I had a nickel for every time someone said to me, « Well, if we just did it like China or we did it like Taiwan, we would control this. »
And look what’s happened to each of those countries. Over time, no one in the world had the perfect solution for controlling this virus.
At the same time, you can’t let this thing just go willy-nilly, and that’s why vaccinations still remain so key. Getting antiviral drugs to those at highest risk for severe disease is also a really important aspect of our response.
BERGEN: What about vaccinations for the under 5s?
BERGEN: Should people get the second booster if they’re over 50 or are immunocompromised?
OSTERHOLM: The whole issue with boosters is going to be a challenge. What is it going to look like in October and November for those people who had their booster in March and April? I don’t know.
These are not vaccine-hesitant people. We need to better understand why they haven’t gotten a third dose and ask ourselves whether uptake is going to get any better with a fourth dose. And what if we need a fifth dose?
And so I think that we have to take a step back right now and ask ourselves what can we accomplish with our mRNA vaccines, and be prepared for the possibility of a brand-new variant. Will we set ourselves back if we adopt an Omicron-specific vaccine, only for a different new variant to emerge?
We’re very fortunate that the number of deaths per number of cases has decreased dramatically, but if you are in high risk, if you’re over 65, you’re overweight, you have diabetes, you have hypertension, these are all risk factors for severe disease. Vaccinations will surely help provide some critical protection, but I know way too many of my younger, otherwise healthy colleagues right now who are at home, sick for seven to 10 days even though they have been fully vaccinated with the booster dose.
I think the additional challenge right now is that people want to get out and live their lives like they did before the pandemic. But my question is, what do you do if we see a new variant? Will people be willing to adapt, isolate or distance themselves again? I don’t think they will at this point.
BERGEN: Did you go to the White House Correspondents’ dinner?
OSTERHOLM: I wasn’t invited, and if I had been, I would not have gone. I’ve not been out in indoor public places like that.
BERGEN: Was the White House Correspondents’ dinner an accident waiting to happen?
BERGEN: What’s surprised you about the last couple of years?
OSTERHOLM: I’m surprised that more people won’t admit that they’re surprised.
We need to stay humble and realize this virus is throwing 210-mph curveballs at us, day after day. Who would have thought that Omicron, which wreaked havoc in December, January and early February, would rear its ugly head and come back at us with all these subvariants?
We haven’t seen that biologic array of subvariants before. We didn’t see them with Delta or Alpha, Gamma and Beta. What we’re learning is that this virus really has a very dynamic ongoing evolutionary process. And what does that mean relative to the future? That’s a trillion-dollar question I can’t answer.
BERGEN: Speaking of the future, how well-positioned are we for the next pandemic?
From a public health standpoint, I’m not seeing any systematic changes that would suggest we’re in better shape to face future pandemics. Our health care systems have done little to reform themselves around the world.
OSTERHOLM: Yes, but if you have a virus that is highly infectious early on even before symptom onset, you’ve already lost control of virus transmission. All you can do is try to contain the impact globally. Think about what happened with Omicron and what we saw happening in South Africa after scientists there sounded the alarm. Countries responded by issuing travel bans against South Africans.
That doesn’t mean you give up. What it says is you’ve got to be prepared. If you can’t prevent the fires from happening, you’ve got to have a good fire department. And what we don’t know yet is how would we make new vaccines for the next bad bug. We were fortunate with the mRNA vaccines that saved millions of lives. That may not work for the next pandemic.