Inspired To Heal
Stories of clinicians, educators, innovators, and researchers who built or led programs of excellence in government health institutions. Each guest has excelled in clinical medicine, program building, or public health. They persevered and succeeded through a clear vision, collaboration, and a passion for the mission of government-run health systems. Their stories will inspire those seeking change in their own organizations.
Inspired To Heal
Outbreak Investigations: Toxic Burgers, Toxic Shock, and Vaccine Talk
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Public health expert Mike Osterholm discusses outbreak investigations, pandemics, and the risky path the United States is taking on vaccine recommendations and abandoning innovative technology. Mike’s motivation to leave his small town in Iowa to become a disease detective was driven by reading a steady diet of “The Medical Detectives” by Berton Roueche, journalist for the New Yorker. Mike helped solve hamburger-associated thyrotoxicosis, tampon-related epidemic of toxic-shock in 1980, and a decades-old cluster of mysterious pneumonia cases “Austin pneumonia”. Recently, he directed his energy toward filling the gap created when CDC’s science-backed Advisory Committee on Immunization Practices was dismantled and replaced with political appointees. He is the author of a new book "The Big One: How We Must Prepare for Future Deadly Pandemics".
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Inspired to Heal, Season 2, Public Health Stories. In this season, we recount important public health advances, whether through outbreak investigations, policies, or program building. In each story, government agencies play critical roles. I'm Bill Trick, your host for Inspired to Heal. Today I am privileged to host Professor Mike Osterholm. Mike is the director of the Center for Infectious Disease Research and Policy at the University of Minnesota, a former state epidemiologist for the Minnesota State Health Department, and a national advisor of public health leaders. He's the author of the New York Times bestselling book, Deadliest Enemy, Our War Against Killer Germs, and a recently published book, The Big One, about the COVID-19 pandemic and how we prevent future pandemics. Over his lengthy public health career, Mike has led many noteworthy outbreak investigations, including the lethal epidemic of toxic shock syndrome related to tampon use in 1980. I look forward to hearing his frontline perspective on outbreaks and about his current public health efforts to ensure vaccine recommendations are science-based and his advice on how to prepare for the next pandemic. Mike, welcome to Inspired to Heal.
SPEAKER_02Well, thank you. Very honored to be here. Thank you.
SPEAKER_00Mike, I'd like to hear about what got you interested in public health.
SPEAKER_02I was a young boy growing up in a small farm town in northeast Iowa. My father worked at the local newspaper office as a photographer. The owners of the newspaper, a husband and wife team, were in every way renaissance people for living in a small town. And the wife actually was a subscriber to the New Yorker, which I don't know if too many people in Iowa at that time that were subscribing routinely to the New Yorker. One day when I was about sixth grade, I happened to be at her place, saw this New Yorker, and she said, You might find this interesting. And it was a Who Did It story by Burton Roger, a famous uh author who wrote for The New Yorker and often would take outbreaks of the CDC at that time, the Communical Disease Center, would work up and turn them into these beautiful stories, these vignettes. And I read the first one and I was just enthralled. I thought, oh man, this is what I want to do. So every time that she got a New Yorker and there was an article in it by Burton Roger, she would call up and say, Oh, I have one and I'm done. I'd quick run up there to her house, get it, and I couldn't wait to devour it. I did that all the way through high school, and knowing that at that time I wanted to go into infectious diseases and that this was the road that I wanted to take. It was interesting because at the time, however, remember in the mid-1970s, which was when this happened, there was a general sense that infectious diseases were dead and gone. We'd taken care of, let's move on. You know, let's deal with the really important problems in health. Nonetheless, I enrolled at the University of Minnesota because they had one of the few last programs in the country that was really dealing with infectious disease epidemiology. I got to the university in 1975. I happened to be rooming with an individual who was an intern at the Minnesota Department of Health, and they needed more help. They'd had an outbreak of encephalitis, Western encephalitis in parts of Minnesota. So I signed on the first week of school also as a part-time intern. Well, at that time the department was comprised of an EIS officer, an uptimate intelligence service officer from CDC, one individual who had been a former undercover NARC agent, and then three graduate students, and that was it. So I started and I didn't leave for 25 years. I stayed there and eventually took over, built the operation up to when I left. We had over 75 advanced degreed people. Well, during that time, and I was a state epidemiologist, there was a large outbreak in southwestern Minnesota of what was called thyrotoxicosis. People were developing these symptoms compatible with hyperactive thyroid, but their thyroids were shrunken. They were small. We traced it back to what was beginning to be a national phenomena of where with the availability now of genetically modified bacteria making thyroxine, we no longer needed to harvest bivaline thyroids. And so in the bovine population, though, in terms of harvesting them, they still then did nectramming where the head would come down a line and they would take it off, and they were taking off the thyroids because now no longer were they harvesting them. So these cow's thyroids went into shoot that went into a bucket that to put it into boxed beef, which made into hamburger. Well, these people were largely eating thyro burgers, and it wasn't just the workers, but they were the by far the highest risk people because they could buy this really cheaply and take it home, you know, as one of their benefits. So we had this huge outbreak which we solved. Well, how does this all go back to Iowa? Well, it turned out that Burton Roger decided to write a story about this for the New Yorker. And so I got to actually interact with him in that setting regarding thyrotoxicosis, and I got to share with him what he meant to me. That in fact my entire career was really I owed to him. It was a remarkable thing because he died several months after that. You know, I would never have had the chance otherwise to have acknowledged his incredible impact on me. To tie it all together, my journey started with Burton Roger in sixth grade, and it surely was reaffirmed with Burton Roger in the 1990s.
SPEAKER_00That story that you told me, I remember from medical school. It it made it into the medical school curriculum. And yeah, it was small world, isn't it? And I guess it's a maybe a little ironic. You're known internationally for infectious disease epidemiology, but that very interesting outbreak had nothing to do with infectious diseases, but nonetheless, epidemiology.
SPEAKER_02Which you know was interesting, Bill, because part of the uh issue here was the fact that it was uh believed that it was a viral infection. In fact, the viral disease branch, the CDC, was assigned to working these up around the country because they were showing up in other locations, of course, because once you know the thyroid was no longer needed from these cows. And so we went into it thinking it might be an infectious disease in the community in that area, only to find out no, it wasn't. It was a pretty amazing experience. And and the company, IBP, which now is part of Tyson's, had a reputation for being pretty tough to deal with. They turned out to be incredible partners with us. Once we showed them the data, they helped us, and it was them that actually that helped find the meat with the thyroid in it. It turned out that we then at that time urged that the USDA no longer allowed for nectarming to occur like this. We had the double of the time getting the USDA to agree to, you know, outlaw nectrumming. And it was the IBP, the company, that helped us. So it was a strange bedfellow situation where what we had been told would be an incredibly difficult group to work with turned out to be top-notch professionals.
SPEAKER_00Yeah. Yeah, it makes you wonder how often this happened before you picked it up. People were losing weight and eating their burgers.
SPEAKER_02Well, you know, the other thing that happened, it even gets better. We reached out to uh Dr. Lou Braverman, who was an endocrinologist in Massachusetts. We worked with him, but also we worked with one of the senior editors of the New England Journal of Medicine. They flew out here to Minnesota and went to the outbreak with us. They then helped us set up a study at Harvard with Lou Braverman where we actually fed this hamburger to medical students and monitored their thyroxine levels. Two hamburgers a week were more than equivalent to one entire week's long replacement therapy. And so if they were eating, you know, a burger or two every week, you know, man, they they got thyrotoxic too. And so it was a fascinating piece of work that we could uh we could do.
SPEAKER_00And I'm sure those medical students volunteered to eat hamburgers.
SPEAKER_02They did actually. They got paid, but they but they were closely monitored, so no one was allowed to get thyrotoxic. But you could see the big jump in their thyroxine levels. It was really something. Well, that's that's a story I didn't expect to hear, and I'm glad I think in fact, another outbreak that uh worked up that is is in retrospect kind of interesting. In 1976, when Legionnaires hit, and of course no one knew what the etiology was. The folks at CDC remembered a 1957 outbreak that appeared very similar, uh, largely among people who worked at the Hormel Mecking plant in Austin, Minnesota. They called it Austin pneumonia. And uh people died, and it was, you know, risk factors were older age smokers, etc. It turned out that they wanted to go back and look at that. Of the people that were there in 1957, there were still some people alive. We tried to track down the information they had collected, and it all had been stored at the Kansas City Regional Lab. That was where they did uh outbreak work like this for the CDC. And that closed in 1971. And they moved all of it to a federal depository in Missouri, which actually burnt down in the late 70s. I decided in 76 I would go back and try to see if I could forensic epidemiology restore the information. Well, we found some information, and I found two of the original investigators that were still alive, but most of the individuals who had been cases that survived were dead. And so we only found 15 that were still alive. But based on those 15 and 15 controls and then community controls, we were able to show that, in fact, serologically it was clear that there was Legionnaire's disease. The reason I tell you all that now is because the last person who had any work knowledge of that outbreak, either worked at Hormel in the medical area or worked at CDC, were now dead. Bruce Dull headed it up. Bruce at that time had been an walk and became an associate director of CDC. Uh Tom Chin, who's now at San Francisco before he died, was part of it. So but it just points out that uh, as you just said, there aren't too many people left around in some of these outbreaks. I guess I've been around too long.
SPEAKER_00Not true. We need we need uh continuity. So there's another outbreak that you were involved in that I wanted to talk about because to me it's an iconic outbreak that demonstrates how a highly functional and activated public health system can work at its best. And what I'm talking about is toxic shock syndrome related to Rely Tampons. I know you were part of that as well. If you could walk us through the history of that and how it was detected.
SPEAKER_02Well, you know, it wa uh it's interesting. Someone who you know, too, Jeff Davis, who is a state ethnologist in Wisconsin, and I were kind of twin brothers of different mothers. And uh the two states were state ethmiologists and adjacent states, and we did a lot of work together on any number of different issues. But in the early spring of 1980, we began to see in both states uh cases of what became toxic shock syndrome in young, particularly menstruating women. And, you know, it was struck us as as odd. We couldn't find out what was going on, but they were basically developing this hypotensive shock picture that was related to a lot of third space leakage. In other words, it wasn't blood loss, it was because they couldn't keep their fluids in their in their circulatory system, and it was a remarkable illness, of which about a third were dying. Well, at the same time, the group at Utah saw some cases and CDC got involved. By early May of that year, that we could put the cases together, it was published in the MWR as a case series hinting that there was something very unique about this menstruating young women risk factor. CDC continued to study it. And then in September, they actually posted an MMWR in which their studies had indicated that it was likely due to rely brand tampons. Staph aureus appeared to be an important part of it. We didn't find those same results. Now, what had happened in the spring and summer of 1980 is Procter and Gamble rolled out Relibran tampons in a major, major marketing effort. Every household in the United States got a free box of them in the mail. So there was this big increase. Well, it was interesting because we we had to learn this ourselves, but eventually learned that all the major tampon manufacturers had a low, moderate, and high absorbency product. The difference was that Procter Gambles Rely started being used by as a high the high absorbency part of their brand by the vast majority of women in this country who were using high absorbency tampons. They had captured that market. So when CDC came out with his study in September, it looked like it was largely rely brand tampons. Well, part of it was an artifact of the name Rely Got Out and was more likely to selectively see cases. In Minnesota, we weren't seeing that. We had very active surveillance for toxic shock syndrome in our hospitals. Jeff set up a similar situation in Wisconsin, and Laverne Winnemeyer, who is a state ethnologist in Iowa, joined us and set up one there. We then put together what we call the tri-state toxic shock syndrome study. We were combining cases from all three states with active surveillance. Then, of course, when the study from CDC came out in September, we ended our study because the bias was remarkable. Back then, before social media, it was judged by the various news services as the number three news story in the country. Only behind the presidential election and the Iranian crisis, the people who had been kidnapped. And so it was a lot of publicity, and Rely got heavily hit. Well, our study indicated that it was not such Rely by itself. But the risk factor was tied largely to fluid capacity. So a company like Tampex would have had a Tampex Super Plus, which had roughly the same absorbency as Rely high absorbency product, but hardly anybody used it. Well, Rely was taken off the market in mid-September of 1980. When the CDC came out their information on a Friday, it had been shared with FDA a day before. The commissioner of FDA contacted both Jeff and myself and asked to fly to D.C. on that Friday morning to actually discuss with them what this was, what we thought of it, and we didn't agree that it was just reliably on tampons and that removing it from the market by itself would not be sufficient to address the problem. At that point, Procter Gamble decided to hold what we'd call a scientific advisory group meeting in Chicago at O'Hare the Saturday. So I'd flown back to Minneapolis Friday night, got back in a plane Saturday morning, went to Chicago with Jeff, and a group led by Jim Todd. Dr. Todd was the one who first described Toxic Shock Syndrome as a condition. And we met all day Saturday afternoon, Saturday night, and into Sunday morning about the data we had, what did it show? Well, midway Sunday morning, a private jet lands at O'Hare with all the executive team from Procter Gamble from Cincinnati. They come over to the hotel where we're staying, walk into this large room, and we were having all basic updates, what we heard, what we knew. Finally, it got down to, you know, we were talking about this risk, and the chairman and CEO of Procter Gamble looked at us and said, Look, it, I have two daughters at home who are using Relibrand tampons. Can I, in good conscience, keep them on those? I was the first person they asked, and I said, I wouldn't. We went down the line, everybody said the same thing. At that point, the meeting was dismissed. Very warm, cordial, thanked us. I knew the next day Relibrand tampons were going off the market, and they did, at a huge, huge hit to PG because they had just spent all this money marketing it, getting it out there. Well, what happened? Well, it went off the market, and there were still some cases that showed up with Religh brand tampons because, in fact, you know, that people didn't hear about it or they didn't care, they kept using them. But in a state like Minnesota, we found in the nine months before Rely went off the market, and then with our act of surveillance the nine months after it was off the market, we saw no change in the incidence of TSS in women. What we saw happening was a total reordering of which tampons were being used. But again, fluid capacity led the way. So Tampek Super Plus went from almost no cases because hardly anybody used it when I was on the market to with the number one associated tampon. Our studies eventually demonstrated the importance of the oxygen inside the tampon. And the higher the fluid capacity, the more likely it was to introduce oxygen into the vagina, which was an anaerobic environment as such, and therefore, you know, the staph aureus, the toxin really turned on. There was clear evidence that Reli had a slightly increased risk beyond the other high absorbency tampons. It had something to do with the scrim or the coating of the tampon that enhanced the bacteria. But basically, in the year after all this publicity, all this pointing at Reli, we still saw the same number of cases in Minnesota. But over time, we did see it, in fact, come down substantially, which was likely tied to the staph aureus bacteria colonization issues in the community, how much of this particular toxin-producing staph aureus was there. So it was a real learning lesson for me. I have to say that, you know, I was kind of a snotty-nosed little kid at the time. I had a beard, nobody could even tell. And I learned a lot. I learned a whole lot about this whole issue of outbreak investigation follow-up. And of course, it only further cemented the my my professional brother, Jeff Davis, and I, you know, were again totally attached at the hips.
SPEAKER_00And Mike, subsequently there was a national surveillance system that was set up. And we have seen declines. And you mentioned it might have to do with colonization and the staff species that was circulating at the time.
SPEAKER_02You know, Bill, actually we've just last year we started to see a in uptick in cases again. Dr. Pat Schleavert, who's been working with this, actually has been looking at these isolates, and it appears that we may be seeing some change in this type of staph aureus colonization that's occurring out here. So, you know, that it's not unexpected. You know, long before TSS, we could see outbreaks associated with staph that would differ by phage types of staph aureus, up and down and up and down. And so I think that we're likely to see this stick with us forever. And some sometimes it's just higher ups in terms of numbers and sometimes lower. Some very important litigation that took place. I uh two two different stories on that. One was the fact that one of the companies actually under discovery for they were being sued by one of the cases for using their tampons getting TSS. They didn't realize in the treasure trove of information the company had to turn over was a document that was used by the executive office to do a cost determination of how many cases could they have used the product and die and still make more money than if they didn't.
SPEAKER_01Oh boy.
SPEAKER_02And and I mean it was as ruthless and as damaging as you could imagine. Yeah. The second one, though, I have to tell you, again, lessons learned. When I was at the State Health Department in Minnesota here, I pretty much had an assistant attorney general live in my back pocket. I found, you know, the critical, critical nature of the law and public health. And of course, when the TSS litigation took off, we were not an active party to that at all. But you know, if records were needed, we had to supply them if the courts ordered we did. As some may know, when you're in litigation, there basically are the changes in what can be obtained under discovery. In other words, an individual has the right to defend themselves. So whatever records were being used to potentially implicate that person or cause them to be possibly guilty, they have access to those data. Even if you had a state law that provided confidentiality for the records, they had to be turned over to the court. Well, we made the case that in fact, if we turned all those over, these cases would become public available. You know, they would be known who they are, and that would simply be destructive to public health. Who would ever participate again? Remember with the studies we did, we had cases we interviewed, but we also interviewed age-matched girls. So 16, 17-year-old girls giving us voluminous amounts of information about their private life, including their sex histories, et cetera, that could not get out. So we filed back and said, no, even as even though you have the right of discovery here, this would be too damaging. At that point, the judge made a decision to say, okay, that you have to supply him, but you can black out anything that would be. Identifier. We consulted with our attorney. We looked at this and said, look at these medical records. These, you know, here's a small town in Minnesota with 650 people. Now they know somebody was hospitalized at St. Gabriel's Hospital there on such and such state. They can figure out who that is. This will literally shut down public health as we know it. We then decided, well, the only way to really block this out was to basically block out the entire record. So we photocopied 18 large legal boxes of records where we put a piece of paper on it, put it on the copier, took it off, put it together, and we had a nine-page blank document. But it was the real document. It just had all been blocked out. Well, one of the companies who had been difficult to deal with throughout the process basically requested all of our records that way. So we had these boxes sitting in a conference room at the Minnesota Department of Health, and they flew into town on their private jet and their three-piece suits and came to get the records. No pleasantries whatsoever. So they opened the first box and they pull out a document that's paperclipped, but it's empty. And then they looked at more and more and more and they realized the whole box was full of empty paper as such, and nothing on it. And they just got irate. At that point, our lawyer, who was remarkable, just sat there and explained to them. And the individuals from the tampon litigation company got up and looked at us and said, You assholes, and they stormed out of the room and left. And our lawyer had the audacity as they were walking through, I say, These are your boxes or yours. You need to take these, okay? And of course, that that didn't go over real well. But but the bottom line is I'm sitting there kind of like, oh my God, what just happened? You know, and and and my lawyer looked at me, this incredible uh lawyer. He looked at me and he said, They're right, you know. I said, What do you mean they're right? He said, I am an asshole, but remember never forget I'm your asshole. I had to tell that story because, in a sense, as much as I don't want to you know upset anybody here, I learned a lot about how important it was to have that kind of input and and that kind of support. I I learned a lot that outbreak. I learned a lot.
SPEAKER_00And if you or anyone's ever read Thank You for Smoking. Yes, yeah, yeah, I have, I have. Yeah, yeah, yeah. You realize the corporate world can really eat us for lunch, us in public.
SPEAKER_02Absolutely. You're you nailed it. You nailed it. Yeah, that's exactly right. Thank you for bringing back all those memories. You know, the old cobwebs were moving.
SPEAKER_00And what I also liked was clinicians bringing this to public health. They had an avenue to where they recognized the problem and they had someone to turn to that can collect the data across the state or the nation.
SPEAKER_02You know, one of the things I will never forget, and it has such an influence on my career. Remember in in 1980, I was in my mid-20s, okay? And in charge of this thing. One of the first cases that died in Minnesota was admitted to a local hospital here in the Twin Cities. I remember walking into her room in intensive care. I mean, uh she just looked like a big overstuffed animal. I mean, you couldn't make her face, everything was just bloated badly. The way the toxic shock system did, what it did is it caused leakage of the circulatory system. So all the fluid leaked out. And the shock was because you didn't, you had more than enough fluid. It just wasn't in their circulatory system. People would get this major swelling. Well, when I looked at her, I mean, it was really sad. And her mother took me by the hand and said, Please come here a second. We walked out of the room and we walked next across the hall to a little conference room that was there. She took a picture out of her pocket of her beautiful, beautiful 16-year-old daughter. And she looked at me and said, I just want you to remember what she really looked like. I mean, it was a sad moment. I mean, I'm telling you, it broke me up badly. And I went back in the room, and that's what I saw was that beautiful girl. And I've never forgotten that for my whole life. And what I told that mother, I don't know why I said it, but it surely hit home, was I said, We'll get to the bottom of this. We're going to figure this out. We'll we'll solve this. And, you know, that's all she wanted to hear. And she wanted to make sure that I knew that she'd had a beautiful daughter. And the young lady did die that night.
SPEAKER_00Wow. Thanks to the New Yorker, you got um motivated into that career, you know.
SPEAKER_02Yeah, well, you know, the fact that I could thank Burton Roger was by far just what an ironic situation. The fact that he died just months later. You know, I I just it was it was an incredible experience. And I mean, that's that, and you understand this well. That's what public health all about relationships. I mean, you know, the best work that gets done in our business, it's people who work with people. And it's, you know, bringing the teams together. It's really that's that's to me the exciting part of this business.
SPEAKER_00I I do remember at CDC hearing in my first year, a quote of uh Tip O'Neill, you know, the speaker of the House, is all politics is all politics is vocal, and you learn that in public health. You really think that's a good thing.
SPEAKER_02You do, don't you? Yeah, yeah. And and you know, I I teach that to my graduate students. I said the most important lesson I can teach you here is one that you probably wouldn't think of, is it's all about relationships. Everything. I mean, the work we're doing right now with the Vaccine Integrity Project and moving forward, this whole issue with the vaccine assessment, it's all based on relationships. All my career, all the different outbreaks we've been involved with, it's been team after team after team that it's all about relationships. And I mean, that's one of the things for people listening on here who might be young, upcoming students. Trust me, public health is a team sport.
SPEAKER_00So I can think of two directions to go now, Mike. There are more than two, but one is your book.
SPEAKER_02I was gonna say you probably have a lot more than two.
SPEAKER_00But uh the the vaccine integrity project and your book.
SPEAKER_02Well, I think I think the integrity project is immediate right now. Maybe we can do both quickly. Uh you know, I uh I realized in November that this was going to be an administration unlike any we'd ever known. And I went back and reread the 2025 document the night of the election when it became clear that Mr. Trump was going to win, looked at the public health aspects, and of course the attack on vaccines was immediate and real. And then when Mr. Kennedy was nominated to become Secretary of HHS, I knew that we were in big trouble. In fact, in November, I published a piece in the New York Times with Zika Manuel saying, America, you're you we could stand to lose our vaccines here. Do you understand this? You know, I think most people didn't think that that was a reality. And so I had the good fortune, I've worked closely in the past with uh Christy Walton and her foundation, the Alumbra Foundation. And I went to her and said, you know, we need to stand up something to to respond to this vaccine issue. And within several days, we had wonderful philanthropic support from her to do this. One of the first things we looked at was what was going to happen to the ACIP. And I actually had said, I don't believe this organization is going to stay in one piece for very long. And it ACIP, the advisory community practices. And that's exactly what happened. We were very concerned about how vaccines were going to be approved, how they were going to be continued to be on the market. So what we did was a major focus group approach with eight different groups from the vaccine enterprise all across the horizon. At that point, learned what were the things that if ACIP went down and CDC could not be a credible voice and in a believed voice in science, what could we do? There's no way any private organization, academic organization can replace the SCIP. It's very important. We came up with eight different lessons or ideas out of that focus group that could be and should be done by public health somehow, somewhere. And the one we picked is in fact trying to provide the information on the vaccine data for the all vaccines, but right now the seasonal vaccines in particular, because the recommendations are coming up. And so we're pulling that together with the idea that now there's a definitive body of information systematically collected and evaluated, much like ACIP would have done. We do not have data from the companies, as that would, we don't have the coverage to have that. But so we've worked closely with the medical societies, five of them in particular, who make their own recommendations for vaccines, often based on what ACIP did and what they put out. But at this point, we know that most of the societies, if not all, are going to use our information as a baseline evaluation for that. Hopefully it'll help keep the facts to the vaccines and not the fantasy or the nightmares. And so we'll see where we go with it.
SPEAKER_00Yeah. If sanity returns and the ACIP stands back up, how Oh, we would support the ACIP in a heartbeat.
SPEAKER_02I mean, we want to see it shut down. The CDC, right now you can't trust anything that's coming out of it. But that's not because the vast majority of people aren't incredibly talented, dedicated public health people. It's the leadership, and they determine in the end what comes off the spigot. And so I think that's the challenge we have, is many people in the community are really hurting to get good information. And can they trust the federal government sources, whether it be FDA, NIH, or CDC right now, and they can't. And that's the real problem.
SPEAKER_00So well, it's good you have that bridge and standing it up so quickly. So as immunization rates decline and we have recurrence of outbreaks like measles, we we are in danger of the next big one. And I think that brings us to your book is we're setting ourselves up for a pandemic. It might not be something that we can prevent by vaccines, but it also could be one of our prior vaccine-preventable diseases that comes, yeah, comes back.
SPEAKER_02You know, I've been studying pandemics literally since the 1970s, early 80s. I was very involved in 1976 at the Minnesota Department of Health in identifying the first cases of Guillaume-Barre syndrome that occurred with the swine flu vaccine. So over time, I came to realize that once a a virus, it's a respiratory virus as I call it in the book, w with wings, takes off, you don't stop it. Best you can do is respond. And in this book, actually, what I do with the big one is it has a scenario that starts with the first chapter. It builds on each subsequent chapter, but it gives you a sense of what an unfolding pandemic, a big one, would look like for three years. Much of it we you know we've already experienced with uh COVID. It really is an attempt to say that the best we can do is have good vaccines on hand ready to go. And if we're not ready to go, hopefully they can be ready as quickly as possible. I think that's what's really, really important. And of course, that's just what we've just gutted. I mean, most people don't realize today that if we had an influenza pandemic, for lack of a better term, we'd be screwed. Because the capacity we have globally right now to make flu vaccine with embryated chicken eggs, which is largely the model we use, we can make enough vaccine globally to cover about one quarter of the world in 15 to 18 months. Well, that's not nearly enough vaccine. Where we really were hopeful is mRNA technology could give us an equivalent vaccine at least, maybe even a little better, but more importantly, we could make it very quickly, and we estimate that we could probably have enough vaccine for the world in the first 12 months. If you wonder what's kept me up at night the last few weeks is the decision by the administration to basically withdraw support for mRNA platforms, with no data to support that. It was amazing to me that when Mr. Kennedy first made the announcement, he said it was because of the fact that COVID vaccines, specifically and coronavirus vaccines in general using mRNA technology were dangerous. You know, that the risk was much greater of an adverse event taking the vaccine than not. That's just simply not true. Okay, it's just not true. But then four days later, the head of the NIH comes out and says, Well, no, Mr. Kennedy made the decision, but he just made the decision because of the fact that at this point the public won't use the vaccine, so why invest in it? Well, the reason that the public has what many of the concerns they do have is because it came right from Mr. Kennedy, who called the vaccine poison. Right now, if we were to have an influenza pandemic, we'd be in big trouble. The big one, as I talk about it in the book, actually all the things that I hoped we would have learned from the COVID pandemic and applied them here would in fact help us be better prepared, but we're going just the opposite way right now, just the opposite way.
SPEAKER_00Unfortunately, it might take an outbreak or a pandemic to wake people up again and have them realize if people are dying, the vaccine will suddenly become desirable, regardless of how it's manufactured. Trevor Burrus, Jr.
SPEAKER_02Well, you know what's also challenging right now, I'm convinced of this, you know, we were spoiled by the 2020 availability of vaccine because it was available here. Many parts of the world couldn't get it. We were at the front of the line from the very beginning of the first days of vaccine. If in fact it were to happen in the months ahead, and particularly if it was influenza, and other countries were making an influenza vaccine with mRNA technology, we'd be at the end of the line. I mean, we were there's no love for America right now out there in many of these countries in terms of, well, wait, wait, we want that vaccine. Wait a minute, aren't you the ones that wouldn't allow the research on it? You know, so I think this is going to be a huge challenge.
SPEAKER_00In the description of your book, you talk about the lessons that we've learned on prior pandemics. Were there others that we've learned other than you know the importance of having good vaccine technology during COVID?
SPEAKER_02Yeah, I think we learned a lot. And what I tried to do is capture it in a way that would be s really felt like what happened with 9-11 and the bipartisan commission that basically came together at the end and basically said, you know, these are the lessons we learned. There wasn't finger pointing. Nobody blamed anybody. It was a remarkable effort to see that type of review helped us greatly learn from what we should have learned with 9-11. I could only wish we would have done something similar with COVID. It's still not too late, but I think it's maybe almost too late to try to get something like that done. The partisanship in Washington right now is would never allow that to happen. But we learned a little should have learned a lot of lessons. Just as a simple example, uh early on, I saw people starting to make decisions that were really, I wouldn't call them knee-jerk, but almost that. In the month of April, May, we saw this country go into a lockdown, which I have to say, first of all, I have no idea yet really what the hell that means, okay? Because it means so many different things to different people. Minnesota was one of the states that went into a lockdown for six weeks, and yet they said if you're an essential worker, you didn't have to abide by it. And 82% of our workers are considered essential workers. I early on argued, don't do lockdowns, and said the most important thing we can do right now is to keep the hospitals in this country as open as possible and not overrun. And so, well, you're going to have to be prepared to do that for maybe many months, a number of years. If you're in a lockdown, you can't do that. It won't, it won't work. And the Chinese proved that to us when they put certain areas of their country in a lockdown, opened it up, you know, two years later, and they had a huge epidemic that wiped through that population with you know many deaths. So what we I had proposed was a snow day approach with good surveillance, if we had it, and we knew how many beds were occupied on any one given day. You could give the public that reading, much like we do now, you know, with with the weather as such, and say, once you get to 85 or 90 percent hospital capacity, please take snow days right now, for a few days for a week or two, to see if we can slow transmission down so that we can keep these hospitals from being flooded. And that's what will save more lives if you can provide the care. That fell on deaf ears. And the lockdown, of course, on average, only lasted through early June. So when people come back and keep complaining about what the lockdown did, I say, no, what are you talking about? Individual companies may have changed things, you know, public restaurants, et cetera. But in the whole, on a national level, the lockdowns are all gone by June. And so I think I would say for the future, a lesson learned is we need to come up with this snow day approach. We need to be able to say, what we got to do is get through potentially two, three, four years of this in such a way that we keep our hospitals as open as possible. And that'll save more lives than anything else.
SPEAKER_00I encourage people to go and buy the big one. It's coming out September 2nd. So, Mike, I have a final question. Sure. And and that's if you could put one item in your public health backpack, what would it be?
SPEAKER_02I think it would be a universal vaccine that would cover all the infectious diseases, a few cancers, and even possibly men broken hearts. And if I had that vaccine in my backpack, you know what? I think I'd be in pretty good shape. Yeah, we all need that. Yeah, yeah. Well, I I hope so. I hope so.
SPEAKER_00Well, what a treat to be able to hear all those uh outbreak investigations. It was more than I expected, Mike. And uh I really appreciate you taking the time to talk to me.
SPEAKER_02Well, thank you. Thank you for doing this. It was great to talk to you and uh to relive some of these old memories. I tell you, they I yeah, I I forget their 20, 30, 40 years ago, you know, but uh they come back.
SPEAKER_00Many thanks to our guests for sharing their words, but more importantly, their acts of service. Please email us your inspiring governmental healthcare or public health stories at info at inspired to heal.net. Thank you for listening.
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