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The Big One: How To Prepare for World-Altering Pandemics to Come
An urgent, gripping, and prescient warning about the inevitable next worldwide pandemic—and what we must do to prepare ourselves—from the New York Times bestselling authors of Deadliest Enemy.
The Covid-19 pandemic has been the most devastating natural event the world has experienced in the last century. Millions have been stricken, many with lasting debilitating effects; more than 7 million have died around the globe; millions more are out of work, scrambling for basic resources; companies and businesses across the country have failed; social and racial inequities have been brought to the surface and amplified; and the global economy has plummeted. And yet, as horrifying as the Covid-19 pandemic has been, we must realize that it is not actually “the Big One”—the pandemic prospect that haunts the nightmares of epidemiologists and public health officials everywhere, a catastrophe with the potential to alter life across the world on every meaningful level—unless we are properly prepared to deal with it.
In The Big One, founding director of the Center for Infectious Disease Research and Policy Dr. Michael T. Osterholm and acclaimed author Mark Olshaker examine the lessons of past pandemics, show how the United States and other countries failed to apply those lessons and the emerging science in confronting Covid-19, and look to the future, projecting what the next pandemics might look like and the strategies to mitigate them.
The Big One is a comprehensive, compelling, and much-needed wake-up call and reality check from a disease detective who has been on the front lines of outbreak investigations, was one of the first to call Covid-19 a pandemic, and has been consistently correct and accurate about the impact of coronaviruses. The Big One strips away the myths, misinformation, and wishful thinking, such as our ability to prevent a deadly pandemic spread through the air. This book, instead, provides a prescription to survive such a cataclysm with our lives and social order intact. Fail to act, and the Big One could make the devastation of Covid-19 pale in comparison.
This is a book about virus versus humanity, hubris versus humility, lofty vision versus dreams that can turn into nightmares, and what we can do in an ideal world versus the reality of what we must do in the one we all live in.
The Covid-19 pandemic has been the most devastating natural event the world has experienced in the last century. Millions have been stricken, many with lasting debilitating effects; more than 7 million have died around the globe; millions more are out of work, scrambling for basic resources; companies and businesses across the country have failed; social and racial inequities have been brought to the surface and amplified; and the global economy has plummeted. And yet, as horrifying as the Covid-19 pandemic has been, we must realize that it is not actually “the Big One”—the pandemic prospect that haunts the nightmares of epidemiologists and public health officials everywhere, a catastrophe with the potential to alter life across the world on every meaningful level—unless we are properly prepared to deal with it.
In The Big One, founding director of the Center for Infectious Disease Research and Policy Dr. Michael T. Osterholm and acclaimed author Mark Olshaker examine the lessons of past pandemics, show how the United States and other countries failed to apply those lessons and the emerging science in confronting Covid-19, and look to the future, projecting what the next pandemics might look like and the strategies to mitigate them.
The Big One is a comprehensive, compelling, and much-needed wake-up call and reality check from a disease detective who has been on the front lines of outbreak investigations, was one of the first to call Covid-19 a pandemic, and has been consistently correct and accurate about the impact of coronaviruses. The Big One strips away the myths, misinformation, and wishful thinking, such as our ability to prevent a deadly pandemic spread through the air. This book, instead, provides a prescription to survive such a cataclysm with our lives and social order intact. Fail to act, and the Big One could make the devastation of Covid-19 pale in comparison.
This is a book about virus versus humanity, hubris versus humility, lofty vision versus dreams that can turn into nightmares, and what we can do in an ideal world versus the reality of what we must do in the one we all live in.
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Published May 7, 2024
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About the author
Michael T. Osterholm
9 books90 followersMichael Thomas Osterholm (born March 10, 1953) is an American epidemiologist, regents professor, and director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
Osterholm graduated from Luther College in 1975 with a B.A. in biology and political science. He received his M.S. and Ph.D. in environmental health and his M.P.H. in epidemiology from the University of Minnesota.
Osterholm has received honorary doctorates from Luther College and Des Moines University, and is a member of the Institute of Medicine of the National Academy of Sciences. His other honors include the Pumphandle Award from the Council of State and Territorial Epidemiologists; the Charles C. Shepard Science Award from the CDC; the Harvey W. Wiley Medal from the Food and Drug Administration; the Squibb Award from the Infectious Diseases Society of America; Distinguished University Teaching Professor, Environmental Health Sciences, School of Public Health, University of Minnesota; and the Wade Hampton Frost Leadership Award, American Public Health Association. He has also received six major research awards from the National Institutes of Health and the CDC.
Osterholm graduated from Luther College in 1975 with a B.A. in biology and political science. He received his M.S. and Ph.D. in environmental health and his M.P.H. in epidemiology from the University of Minnesota.
Osterholm has received honorary doctorates from Luther College and Des Moines University, and is a member of the Institute of Medicine of the National Academy of Sciences. His other honors include the Pumphandle Award from the Council of State and Territorial Epidemiologists; the Charles C. Shepard Science Award from the CDC; the Harvey W. Wiley Medal from the Food and Drug Administration; the Squibb Award from the Infectious Diseases Society of America; Distinguished University Teaching Professor, Environmental Health Sciences, School of Public Health, University of Minnesota; and the Wade Hampton Frost Leadership Award, American Public Health Association. He has also received six major research awards from the National Institutes of Health and the CDC.
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Displaying 1 - 21 of 21 reviews
April 10, 2025
This book is in the health, mind, body and science genre! It goes over how we all went through the Covid pandemic and warns us that another pandemic is on the way and we need to be prepared! This next pandemic could be The Big One! This could be much worse than Covid! I can’t even imagine going through something like that again, yet worse! This book talks about how we weren’t prepared for that pandemic. Furthermore, the public health response was not prepared either, which made everything worse. While this book made me feel anxious at times, it was very informative and helpful. It was thought provoking, well written and science based! Overall, I rate this book 4 out of 5 stars!
Thank you to NetGalley, authors Michael T. Osterholm and Mark Olshaker and Little, Brown and Company | Little, Brown Spark publishing for this digital advanced reader’s copy of this book in exchange for my honest review. All thoughts and opinions are my own.
This book is set to be released on September 2, 2025!
Thank you to NetGalley, authors Michael T. Osterholm and Mark Olshaker and Little, Brown and Company | Little, Brown Spark publishing for this digital advanced reader’s copy of this book in exchange for my honest review. All thoughts and opinions are my own.
This book is set to be released on September 2, 2025!
August 8, 2025
Every time I see a person with a flimsy face mask on, I now think of this book. In other words, since reading it, I probably think about this book daily.
In The Big One, Michael Osterholm and Mark Olshaker present a scenario (a “thought experiment”) where an extremely deadly pandemic hits the world, something that experts expect will happen someday and that will make Covid-19 seem tame in comparison.
Although this is non-fiction, each chapter presents a fictional situation where the disaster is escalating in a realistic manner, and where the major world players are dealing with the emergency. This is a clever narrative device since it brings the situation to life, is emotionally engaging, and makes it clear just how much would be at stake. Then in each chapter, the authors leave fiction and discuss a particular part of the crisis, the background (what could happen and what has actually happened in past pandemics), and how it can be dealt with in an optimal, scientifically-based way. This is a lot of information to absorb, so the authors wisely include key takeaways at the end of every chapter.
Everyone should read this book, especially politicians and other policy makers. It’s infuriating to know that so much good advice was ignored for optics – in many countries. At the same time, this book also helped me understand what a horrible position many policy makers were put in. There is no reason that this needs to happen again in the same way, and the authors spell out how this could be done.
The authors present a clear picture of what went wrong and why, during Covid-19, and how we can learn from this. They come across as sincere, open-minded, honest, and science-based. I am not an expert so I can’t actually judge if the science they present is true or some variation of truth, but it is a starting point for discussions and I found it fascinating.
Thanks to NetGalley and Little, Brown and Company for letting me read an advance copy in exchange for and honest opinion.
In The Big One, Michael Osterholm and Mark Olshaker present a scenario (a “thought experiment”) where an extremely deadly pandemic hits the world, something that experts expect will happen someday and that will make Covid-19 seem tame in comparison.
Although this is non-fiction, each chapter presents a fictional situation where the disaster is escalating in a realistic manner, and where the major world players are dealing with the emergency. This is a clever narrative device since it brings the situation to life, is emotionally engaging, and makes it clear just how much would be at stake. Then in each chapter, the authors leave fiction and discuss a particular part of the crisis, the background (what could happen and what has actually happened in past pandemics), and how it can be dealt with in an optimal, scientifically-based way. This is a lot of information to absorb, so the authors wisely include key takeaways at the end of every chapter.
Everyone should read this book, especially politicians and other policy makers. It’s infuriating to know that so much good advice was ignored for optics – in many countries. At the same time, this book also helped me understand what a horrible position many policy makers were put in. There is no reason that this needs to happen again in the same way, and the authors spell out how this could be done.
The authors present a clear picture of what went wrong and why, during Covid-19, and how we can learn from this. They come across as sincere, open-minded, honest, and science-based. I am not an expert so I can’t actually judge if the science they present is true or some variation of truth, but it is a starting point for discussions and I found it fascinating.
Thanks to NetGalley and Little, Brown and Company for letting me read an advance copy in exchange for and honest opinion.
September 10, 2025
"The Big One" is a compelling and timely read that stands out for its unique approach to understanding and preparing for future pandemics. Instead of just focusing on the grim possibilities of what's to come, the book masterfully zooms into past catastrophes, using them as a lens to visualize and prepare for the next "big one." This historical perspective makes the future threat feel tangible and preventable, rather than just abstractly terrifying.
One of the most fascinating aspects of the book is its exploration of how airborne diseases emerge, specifically highlighting the dangers of human populations living in close proximity to wildlife. It's a stark reminder of the delicate balance of our ecosystem and the consequences of disrupting it.
The author provides incredible insights into the complex machinery that swings into action during a health crisis. I found the sections on the manufacturing and distributing vaccines and the intricate design and technology behind the humble N95 mask particularly enlightening. It's a side of pandemic response that is often overlooked but is absolutely critical.
What truly sets this book apart is its treatment of pandemics as the war-like situations they are. It rightfully frames the global response in terms of strategy, logistics, and front-line soldiers. The perspective on physicians as our "sentinels"—the first line of defense watching for emerging threats—was powerful and well-deserved. "The Big One" is not just a book about a potential disaster; it's a blueprint for preparedness and a call to action.
One of the most fascinating aspects of the book is its exploration of how airborne diseases emerge, specifically highlighting the dangers of human populations living in close proximity to wildlife. It's a stark reminder of the delicate balance of our ecosystem and the consequences of disrupting it.
The author provides incredible insights into the complex machinery that swings into action during a health crisis. I found the sections on the manufacturing and distributing vaccines and the intricate design and technology behind the humble N95 mask particularly enlightening. It's a side of pandemic response that is often overlooked but is absolutely critical.
What truly sets this book apart is its treatment of pandemics as the war-like situations they are. It rightfully frames the global response in terms of strategy, logistics, and front-line soldiers. The perspective on physicians as our "sentinels"—the first line of defense watching for emerging threats—was powerful and well-deserved. "The Big One" is not just a book about a potential disaster; it's a blueprint for preparedness and a call to action.
December 14, 2025
Dr. Osterholm spoke at my hospital’s Grand Rounds, and I immediately rushed to put his book on hold on Libby. What sets him apart from many involved in the COVID-19 pandemic response is his willingness to share what we did not do well alongside what went according to plan. This book explores this dichotomy in depth and provides a thoughtful list of recommendations for the next time (and there will be a next time). These actionable activities are mostly geared towards government leaders, policy makers, and frontline healthcare workers, but there are several that apply to everyone as we all have a personal responsibility to contribute to the solution. Unfortunately the people in the community who most need to read this book and take it to heart likely won’t.
While heavier on the science and policy aspect, the book is still accessible to a lay reader. The incorporation of a longitudinal fictionalized “next pandemic” story adds human interest and a bit of a medical thriller feel to the overall message.
Highly recommend!
While heavier on the science and policy aspect, the book is still accessible to a lay reader. The incorporation of a longitudinal fictionalized “next pandemic” story adds human interest and a bit of a medical thriller feel to the overall message.
Highly recommend!
Read
November 13, 2025In "The Big One: How We Must Prepare for Future Deadly Pandemics", Michael T. Osterholm and Mark Olshaker deliver an urgent and sobering exploration of how pandemics emerge, how humanity repeatedly fails to contain them, and what must change to prevent the next catastrophic event. Drawing from the lessons of COVID-19, the authors blend scientific insight with moral clarity to reveal how misunderstanding the science, political shortsightedness, and a collapse of public trust combined to turn a health crisis into a global catastrophe. Their central message is that pandemics are not random accidents of nature - they are predictable consequences of an interconnected world that refuses to take prevention as seriously as response. Understanding this reality, they argue, is essential not just for survival but for restoring public confidence in science and leadership.
The book opens with a hauntingly plausible depiction of how the next pandemic might begin - not in a major metropolis but in an overlooked, drought-stricken corner of the developing world. In their imagined scenario, a farmer in southern Somalia falls ill with a mysterious respiratory infection. Within days, his family and neighbors become sick, and soon, the infection spreads through a nearby refugee camp, a densely populated hub where illness moves faster than help can arrive. From there, the virus hitches rides on airplanes through aid workers, business travelers, and students, quietly establishing footholds in global cities before anyone realizes a crisis has begun. The authors’ chilling narrative drives home the point that in the age of air travel, a local outbreak can become a global emergency within days. By the time governments take notice, containment is already impossible. This inevitability underscores a key truth: pandemics do not respect borders or bureaucratic timelines, and humanity’s first mistake is always delay.
That delay is compounded by scientific and policy missteps. One of the book’s most forceful arguments is that the early response to COVID-19 was crippled by a fundamental misunderstanding of how respiratory viruses spread. Public health authorities fixated on droplets - large, heavy particles expelled by coughs and sneezes that fall quickly to the ground. This misunderstanding led to the six-foot rule, plexiglass barriers, and obsessive surface cleaning - what Osterholm calls 'hygiene theater.' But the true danger came from aerosols, tiny airborne particles that linger and float, much like cigarette smoke. The authors use a simple analogy: if you can smell someone’s perfume or cigarette smoke across a room, you can also inhale their virus. Ignoring aerosol transmission led to tragically misplaced resources and misguided policies that provided false reassurance while doing little to stop the spread. The correct approach, they argue, would have followed the Precautionary Principle - assuming airborne transmission from the outset and prioritizing ventilation, air filtration, and high-grade respiratory protection like N95 masks. The failure to do so cost millions of lives and destroyed much of the public’s faith in the experts who were supposed to protect them.
The book then turns to another pillar of modern pandemic defense - the vaccine. The authors praise the rapid development of mRNA vaccines as a monumental scientific achievement, accomplished in record time and responsible for saving millions of lives. Yet, they also expose the sobering limitations of that success. The vaccines’ protection waned after only a few months, requiring frequent boosters, and although they prevented severe illness and death, they did not stop infection or transmission. This shattered the dream of herd immunity and undercut the ethical rationale for vaccine mandates. The inability to clearly communicate these nuances deepened public confusion and fed anti-vaccine sentiment. Osterholm and Olshaker use this paradox to highlight a deeper flaw in global preparedness: the reliance on private pharmaceutical markets to develop tools for public defense. A universal, long-lasting vaccine against respiratory viruses is technologically feasible but economically unattractive. Drug companies, guided by profit rather than public need, invest in treatments for chronic diseases rather than long-term pandemic prevention. The authors insist that pandemic preparedness must be treated as a matter of national security, not private enterprise. Just as governments fund military aircraft carriers years before a war, they must invest in vaccines, antivirals, and surveillance systems long before an outbreak begins.
Even with the best technology, however, the book argues that no defense can succeed without trust. During COVID-19, public health authorities suffered what Osterholm calls 'a collapse of credibility.' Officials issued premature assurances, spoke with false certainty, and changed guidance without explaining why. When new evidence contradicted earlier claims, many leaders chose quiet revision over transparent correction. These failures created an information vacuum quickly filled by rumor, conspiracy theories, and political division. The result was an 'infodemic' - a flood of conflicting messages that left the public overwhelmed and cynical. Basic health measures, like mask-wearing and vaccination, became tribal symbols of political identity rather than tools of survival. The authors emphasize that this was not merely a communication problem but a crisis of leadership. When leaders fail to admit uncertainty or mistakes, they destroy the foundation upon which all collective action depends: trust.
To rebuild that trust, Osterholm and Olshaker propose a two-part strategy. First, they call for a new style of crisis communication modeled on Franklin D. Roosevelt’s Fireside Chats. Leaders must speak to the public with humility and clarity, explaining what is known, what is uncertain, and what is being done to learn more. Honesty, even about fear and confusion, builds credibility. Second, they urge the creation of a national disease surveillance system modeled after the National Weather Service. This system would provide real-time, transparent data on infectious threats, allowing both policymakers and citizens to make informed decisions without political interference. A modernized, depoliticized network of public health intelligence, the authors argue, would do for pandemics what meteorology has done for hurricanes: save lives through early warning and trust in reliable data.
Looking to the future, "The Big One" insists that preparation must begin with the recognition that the next deadly pandemic will almost certainly be airborne. The path forward demands the adoption of the Precautionary Principle as a permanent foundation of public health strategy. This means maintaining national stockpiles of N95 respirators, ensuring clean indoor air standards in schools, offices, and public buildings, and embedding pandemic defense into urban planning and infrastructure design. Equally important is the construction of a durable medical arsenal through long-term public investment in vaccines, treatments, and manufacturing capacity. The authors reject the reactive, short-term mindset of lockdowns and emergency mandates. Real preparedness, they argue, requires sustained commitment - a society that builds its defenses in peace rather than panic.
Yet even the most advanced technology and infrastructure will fail without the human element: a social contract built on truth, accountability, and shared responsibility. The authors call for leaders willing to practice 'radical honesty,' admitting when the science is uncertain and correcting themselves openly when wrong. They envision a society that values evidence over ideology, where misinformation is confronted as a threat to public safety rather than tolerated as free expression. Only by reestablishing this ethical foundation can nations mobilize effectively when the next crisis arrives.
In the end, "The Big One: How We Must Prepare for Future Deadly Pandemics" is both a diagnosis and a prescription. It diagnoses a civilization that has learned almost nothing from its near-death experience and prescribes a remedy grounded in science, humility, and moral courage. The next pandemic, Osterholm and Olshaker warn, is not a matter of if but when. Whether it begins in a remote village or a crowded city, it will exploit the same weaknesses - delay, denial, division, and distrust - that doomed our last response. The difference between survival and disaster will depend on whether we choose to learn. The authors leave readers with a final warning and a challenge: microbes travel faster than lies, but trust moves slower than both. If we cannot rebuild that trust now, the next Big One may be the last.
The book opens with a hauntingly plausible depiction of how the next pandemic might begin - not in a major metropolis but in an overlooked, drought-stricken corner of the developing world. In their imagined scenario, a farmer in southern Somalia falls ill with a mysterious respiratory infection. Within days, his family and neighbors become sick, and soon, the infection spreads through a nearby refugee camp, a densely populated hub where illness moves faster than help can arrive. From there, the virus hitches rides on airplanes through aid workers, business travelers, and students, quietly establishing footholds in global cities before anyone realizes a crisis has begun. The authors’ chilling narrative drives home the point that in the age of air travel, a local outbreak can become a global emergency within days. By the time governments take notice, containment is already impossible. This inevitability underscores a key truth: pandemics do not respect borders or bureaucratic timelines, and humanity’s first mistake is always delay.
That delay is compounded by scientific and policy missteps. One of the book’s most forceful arguments is that the early response to COVID-19 was crippled by a fundamental misunderstanding of how respiratory viruses spread. Public health authorities fixated on droplets - large, heavy particles expelled by coughs and sneezes that fall quickly to the ground. This misunderstanding led to the six-foot rule, plexiglass barriers, and obsessive surface cleaning - what Osterholm calls 'hygiene theater.' But the true danger came from aerosols, tiny airborne particles that linger and float, much like cigarette smoke. The authors use a simple analogy: if you can smell someone’s perfume or cigarette smoke across a room, you can also inhale their virus. Ignoring aerosol transmission led to tragically misplaced resources and misguided policies that provided false reassurance while doing little to stop the spread. The correct approach, they argue, would have followed the Precautionary Principle - assuming airborne transmission from the outset and prioritizing ventilation, air filtration, and high-grade respiratory protection like N95 masks. The failure to do so cost millions of lives and destroyed much of the public’s faith in the experts who were supposed to protect them.
The book then turns to another pillar of modern pandemic defense - the vaccine. The authors praise the rapid development of mRNA vaccines as a monumental scientific achievement, accomplished in record time and responsible for saving millions of lives. Yet, they also expose the sobering limitations of that success. The vaccines’ protection waned after only a few months, requiring frequent boosters, and although they prevented severe illness and death, they did not stop infection or transmission. This shattered the dream of herd immunity and undercut the ethical rationale for vaccine mandates. The inability to clearly communicate these nuances deepened public confusion and fed anti-vaccine sentiment. Osterholm and Olshaker use this paradox to highlight a deeper flaw in global preparedness: the reliance on private pharmaceutical markets to develop tools for public defense. A universal, long-lasting vaccine against respiratory viruses is technologically feasible but economically unattractive. Drug companies, guided by profit rather than public need, invest in treatments for chronic diseases rather than long-term pandemic prevention. The authors insist that pandemic preparedness must be treated as a matter of national security, not private enterprise. Just as governments fund military aircraft carriers years before a war, they must invest in vaccines, antivirals, and surveillance systems long before an outbreak begins.
Even with the best technology, however, the book argues that no defense can succeed without trust. During COVID-19, public health authorities suffered what Osterholm calls 'a collapse of credibility.' Officials issued premature assurances, spoke with false certainty, and changed guidance without explaining why. When new evidence contradicted earlier claims, many leaders chose quiet revision over transparent correction. These failures created an information vacuum quickly filled by rumor, conspiracy theories, and political division. The result was an 'infodemic' - a flood of conflicting messages that left the public overwhelmed and cynical. Basic health measures, like mask-wearing and vaccination, became tribal symbols of political identity rather than tools of survival. The authors emphasize that this was not merely a communication problem but a crisis of leadership. When leaders fail to admit uncertainty or mistakes, they destroy the foundation upon which all collective action depends: trust.
To rebuild that trust, Osterholm and Olshaker propose a two-part strategy. First, they call for a new style of crisis communication modeled on Franklin D. Roosevelt’s Fireside Chats. Leaders must speak to the public with humility and clarity, explaining what is known, what is uncertain, and what is being done to learn more. Honesty, even about fear and confusion, builds credibility. Second, they urge the creation of a national disease surveillance system modeled after the National Weather Service. This system would provide real-time, transparent data on infectious threats, allowing both policymakers and citizens to make informed decisions without political interference. A modernized, depoliticized network of public health intelligence, the authors argue, would do for pandemics what meteorology has done for hurricanes: save lives through early warning and trust in reliable data.
Looking to the future, "The Big One" insists that preparation must begin with the recognition that the next deadly pandemic will almost certainly be airborne. The path forward demands the adoption of the Precautionary Principle as a permanent foundation of public health strategy. This means maintaining national stockpiles of N95 respirators, ensuring clean indoor air standards in schools, offices, and public buildings, and embedding pandemic defense into urban planning and infrastructure design. Equally important is the construction of a durable medical arsenal through long-term public investment in vaccines, treatments, and manufacturing capacity. The authors reject the reactive, short-term mindset of lockdowns and emergency mandates. Real preparedness, they argue, requires sustained commitment - a society that builds its defenses in peace rather than panic.
Yet even the most advanced technology and infrastructure will fail without the human element: a social contract built on truth, accountability, and shared responsibility. The authors call for leaders willing to practice 'radical honesty,' admitting when the science is uncertain and correcting themselves openly when wrong. They envision a society that values evidence over ideology, where misinformation is confronted as a threat to public safety rather than tolerated as free expression. Only by reestablishing this ethical foundation can nations mobilize effectively when the next crisis arrives.
In the end, "The Big One: How We Must Prepare for Future Deadly Pandemics" is both a diagnosis and a prescription. It diagnoses a civilization that has learned almost nothing from its near-death experience and prescribes a remedy grounded in science, humility, and moral courage. The next pandemic, Osterholm and Olshaker warn, is not a matter of if but when. Whether it begins in a remote village or a crowded city, it will exploit the same weaknesses - delay, denial, division, and distrust - that doomed our last response. The difference between survival and disaster will depend on whether we choose to learn. The authors leave readers with a final warning and a challenge: microbes travel faster than lies, but trust moves slower than both. If we cannot rebuild that trust now, the next Big One may be the last.
October 30, 2025
I heard about this book as a mix of speculative pandemic fiction combined with sober assessment and prescription. I knew of Dr. Osterholm from the COVID days and his Osterholm Update podcast from Centers for Disease Research and Policy (CIDRAP).
OK, so what do we have here?
There are eight chapters:
* Virus versus Humans
* The Air We Breathe
* Mandates
* Medical Countermeasures
* Effective Communication
* Surveillance
* Politics and Policy
* Where Do We Go From Here?
Tying the chapters together is a fictional story of an airborne coronavirus pandemic that is 2-3 times more deadly than COVID. The point is to shock the reader (who is intended to be a policy maker / public health official / news media / informed member of the public) that whatever you thought of the havoc COVID wreaked, it could be worse if the virus is has a higher case fatality rate). The fictional story reads like the history of the COVID pandemic with vaccine delays, supply chain disruptions, health care system collapsing, fighting over masks, state vs state politics, deliberate disinformation, etc -- except more people die. It is not thriller-level fiction.
The book, though published in 2025, seems to have mostly been written before the 2024 election and presumes a President and cabinet of rational people. It is not until chapter 8 that Osterholm acknowledges the first few months of the Trump and RFK Jr. administration
So, we get the closest thing in writing that I've seen that attempts to analyze the US response to COVID through the lens of the eight aforementioned chapters. Owning up to mistakes is included.
Sadly, the bottom line from Osterholm, as he tries to be prescriptive, is that we're woefully unprepared for a more serious pandemic - and this is even before things like NIH and mRNA vaccine funding were cut in mid 2025.
Osterholm hammers home the point again and again that if a pandemic is spread by airborne aerosol transmission (as was COVID), that the only protection is N-95 masks, properly fitted. Closing the borders is pointless. Six feet of separation is pointless. Wiping down surfaces is hygiene theater. The money thrown at air flow enhancements was mostly squandered and would likely be squandered again.
Osterholm goes on to say that vaccines will take many months to be developed, presuming an mRNA-based solution, and even then, will only be effective for a few months before the virus mutates to a new variant (viz alpha, omicron). The only true hope would be a mucosal vaccine that a) prevented transmission and b) was variant-resistant. Osterholm says this will take billions of dollars and many years to develop and should be a national priority. Of course, the US HHS has decided that vaccines cause more problems than they solve so should the next "Big One" hit the globe, in my opinion, expect lots of dead US citizens and residents.
Osterholm goes on to say that communication from the government is key - especially to explain that the science of a new virus will evolve and we just won't know the answer to many questions early or even midway through the pandemic. Countering the sea of misinformation and "authoritative-sounding" but utterly wrong talking heads will be difficult. Leveling with the populace is key, and not being assertive on prescriptions that prove to be wrong can bring back trust.
Bottomline, when I read this book I came away depressed, a sense of "we're doomed". It is not that Osterholm is negative, he thoughtfully analyzes our COVID response and suggests action items. But knowing our current political system and social media hothouse, one doubts the US will deliver an effective response. We may need to just wait it out until other countries unhampered by conspiracy cranks come up with workable vaccines for export. By that time, a lot of us will be sick, debilitated, or dead. Hence, three stars. A combination of a fictional scenario fleshed out solely as a scaffold to hang the analysis/recommendations that one would get from a lecture series.
No photos, charts, or diagrams.
Definitely worth reading if you want to relive COVID from an analytical/prescriptive perspective, especially if you have some responsibility to do better the next time. I suspect most people would rather just forget COVID ever happened and wish away a pandemic from happening again. Again, in my opinion, the US has just gotten stupider than it was in 2020 so this book might be a fitting item to be buried with current administration and state (2025) health officials after their last gasps for breath in a ventilator.
OK, so what do we have here?
There are eight chapters:
* Virus versus Humans
* The Air We Breathe
* Mandates
* Medical Countermeasures
* Effective Communication
* Surveillance
* Politics and Policy
* Where Do We Go From Here?
Tying the chapters together is a fictional story of an airborne coronavirus pandemic that is 2-3 times more deadly than COVID. The point is to shock the reader (who is intended to be a policy maker / public health official / news media / informed member of the public) that whatever you thought of the havoc COVID wreaked, it could be worse if the virus is has a higher case fatality rate). The fictional story reads like the history of the COVID pandemic with vaccine delays, supply chain disruptions, health care system collapsing, fighting over masks, state vs state politics, deliberate disinformation, etc -- except more people die. It is not thriller-level fiction.
The book, though published in 2025, seems to have mostly been written before the 2024 election and presumes a President and cabinet of rational people. It is not until chapter 8 that Osterholm acknowledges the first few months of the Trump and RFK Jr. administration
So, we get the closest thing in writing that I've seen that attempts to analyze the US response to COVID through the lens of the eight aforementioned chapters. Owning up to mistakes is included.
Sadly, the bottom line from Osterholm, as he tries to be prescriptive, is that we're woefully unprepared for a more serious pandemic - and this is even before things like NIH and mRNA vaccine funding were cut in mid 2025.
Osterholm hammers home the point again and again that if a pandemic is spread by airborne aerosol transmission (as was COVID), that the only protection is N-95 masks, properly fitted. Closing the borders is pointless. Six feet of separation is pointless. Wiping down surfaces is hygiene theater. The money thrown at air flow enhancements was mostly squandered and would likely be squandered again.
Osterholm goes on to say that vaccines will take many months to be developed, presuming an mRNA-based solution, and even then, will only be effective for a few months before the virus mutates to a new variant (viz alpha, omicron). The only true hope would be a mucosal vaccine that a) prevented transmission and b) was variant-resistant. Osterholm says this will take billions of dollars and many years to develop and should be a national priority. Of course, the US HHS has decided that vaccines cause more problems than they solve so should the next "Big One" hit the globe, in my opinion, expect lots of dead US citizens and residents.
Osterholm goes on to say that communication from the government is key - especially to explain that the science of a new virus will evolve and we just won't know the answer to many questions early or even midway through the pandemic. Countering the sea of misinformation and "authoritative-sounding" but utterly wrong talking heads will be difficult. Leveling with the populace is key, and not being assertive on prescriptions that prove to be wrong can bring back trust.
Bottomline, when I read this book I came away depressed, a sense of "we're doomed". It is not that Osterholm is negative, he thoughtfully analyzes our COVID response and suggests action items. But knowing our current political system and social media hothouse, one doubts the US will deliver an effective response. We may need to just wait it out until other countries unhampered by conspiracy cranks come up with workable vaccines for export. By that time, a lot of us will be sick, debilitated, or dead. Hence, three stars. A combination of a fictional scenario fleshed out solely as a scaffold to hang the analysis/recommendations that one would get from a lecture series.
No photos, charts, or diagrams.
Definitely worth reading if you want to relive COVID from an analytical/prescriptive perspective, especially if you have some responsibility to do better the next time. I suspect most people would rather just forget COVID ever happened and wish away a pandemic from happening again. Again, in my opinion, the US has just gotten stupider than it was in 2020 so this book might be a fitting item to be buried with current administration and state (2025) health officials after their last gasps for breath in a ventilator.
October 7, 2025
Michael T.Osterholm is here in Minnesota where I live! I think he has a lot of valuable information to share with us. He has decades of experience working in epidemiology and public health. I have read other books by him and listen to him on podcasts. I respect his work and viewpoints. This is a very thorough book and had lots of good information. It took a very good look at what we did during the last pandemic and how will we get ready for the next one. It is worth reading or listening to. I listened to it on audiobook from the library.
November 14, 2025
BLUF (Bottom Line Up Front)
This book taught me how to separate real protection from the rituals we performed to feel protected, and it changed the way I prepare for whatever comes next.
Executive Summary
Michael T. Osterholm—internationally recognized epidemiologist, director of CIDRAP, former advisor to the U.S. Department of Health and Human Services, and a leading authority on emerging infectious diseases—argues that another major pandemic is inevitable and that global systems remain fundamentally misaligned for it.
Key ideas and my tightened, practical responses:
* ISSUE #1: Global surveillance networks detect emerging pathogens far too slowly.
MY RESPONSE: I assume early detection is already late. I keep a small readiness baseline—N95s, disinfectants, essential supplies—and have a simple, pre-planned shift in family behavior when early signs appear (fewer crowded indoor spaces, heightened caution in airports and transit hubs).
* ISSUE #2: Supply chains for PPE, antivirals, and basic pharmaceuticals collapse under stress.
MY RESPONSE: I maintain a modest reserve of durable essentials. Not stockpiling—just enough to buffer through supply disruptions without panic.
* ISSUE #3: Effective response requires pre-commitments between governments, health systems, and industry—not improvisation.
MY RESPONSE: I don’t count on institutions to coordinate flawlessly under pressure. I’m ready to act on evidence even when official messaging lags or conflicts. It’s not paranoia; it’s acknowledging how real-time decision-making breaks under chaos.
* ISSUE #4: Public trust and clear communication matter as much as medical infrastructure.
MY RESPONSE: When guidance sounds too tidy, I dig into the epidemiology behind it. The “six feet” rule made sense only before airborne transmission was confirmed—a nuance most people never heard. That gap in explanation says everything about why trust eroded.
* ISSUE #5: Future preparedness depends on systems built before the crisis begins.
MY RESPONSE: I keep an ample supply of N95s—the only widely accessible protection that consistently works against airborne pathogens. They don’t expire and take almost no space. It’s the most straightforward preparedness step I’ve taken.
Review
Osterholm begins by clearing away the noise. Before he critiques policy or culture, he simply explains what actually happened during COVID-19—and what didn’t. That clarity sets the tone for everything else in the book and for how I now see public-health behavior.
Only after that clarity is established does the cloth-mask memory hit me: during the pandemic, I’d quietly judge the folks wearing saggy cloth masks over full beards, barely covering their noses. They treated those masks as symbolic, and—uncomfortable as it is—they weren’t wrong. Against an airborne virus, a cloth mask is basically a screen door on a submarine. That single comparison sharpened my sense for the difference between actions that look protective and actions that are.
From the perspective of a learning scientist, the more damaging pattern was how quickly people defaulted to cognitive shortcuts. We reached for simple rules, loud voices, and old assumptions because they felt manageable. That’s not unique to pandemics—it’s classic human mislearning—but COVID made the consequences unavoidable. Some of these failures tie directly to the book’s core tension of truth versus theater. Others sit at the edges, but they still illuminate how systems and individuals slip into false confidence.
The next major pandemic, as Osterholm argues and as the data supports, will hinge on two weaknesses: structural unpreparedness and emotional unpreparedness. Stronger infrastructure, clearer plans, and better supply chains matter—but they only work if people trust the guidance enough to follow it. Emotional readiness is the more fragile side of the equation. Families need to understand the broader strategy, discuss their own plan, and name the fears that will distort judgment when the stakes rise. Fear skews risk perception. Fear fuels magical thinking. Fear pushes us toward comforting rituals instead of effective action. To avoid repeating the same mistakes, we need both solid systems and steady minds.
In the end, the book’s greatest strength is its objectivity. It let me reconstruct the COVID timeline without partisan fog or media distortion. Seeing what truly unfolded reframed the next pandemic as a design problem—a solvable one—if we stop performing safety and start practicing it.
Similar Reads
The Premonition by Michael Lewis — narrative exploration of U.S. pandemic response gaps.
Apollo's Arrow by Nicholas A. Christakis — sociological and behavioral account of COVID-19.
The Rules of Contagion by Adam Kucharski — clear, accessible breakdown of how diseases spread and how risk perception fails.
Authorship Note: This review was co-authored using a time-saving GPT I built to help structure and refine my thoughts.
This book taught me how to separate real protection from the rituals we performed to feel protected, and it changed the way I prepare for whatever comes next.
Executive Summary
Michael T. Osterholm—internationally recognized epidemiologist, director of CIDRAP, former advisor to the U.S. Department of Health and Human Services, and a leading authority on emerging infectious diseases—argues that another major pandemic is inevitable and that global systems remain fundamentally misaligned for it.
Key ideas and my tightened, practical responses:
* ISSUE #1: Global surveillance networks detect emerging pathogens far too slowly.
MY RESPONSE: I assume early detection is already late. I keep a small readiness baseline—N95s, disinfectants, essential supplies—and have a simple, pre-planned shift in family behavior when early signs appear (fewer crowded indoor spaces, heightened caution in airports and transit hubs).
* ISSUE #2: Supply chains for PPE, antivirals, and basic pharmaceuticals collapse under stress.
MY RESPONSE: I maintain a modest reserve of durable essentials. Not stockpiling—just enough to buffer through supply disruptions without panic.
* ISSUE #3: Effective response requires pre-commitments between governments, health systems, and industry—not improvisation.
MY RESPONSE: I don’t count on institutions to coordinate flawlessly under pressure. I’m ready to act on evidence even when official messaging lags or conflicts. It’s not paranoia; it’s acknowledging how real-time decision-making breaks under chaos.
* ISSUE #4: Public trust and clear communication matter as much as medical infrastructure.
MY RESPONSE: When guidance sounds too tidy, I dig into the epidemiology behind it. The “six feet” rule made sense only before airborne transmission was confirmed—a nuance most people never heard. That gap in explanation says everything about why trust eroded.
* ISSUE #5: Future preparedness depends on systems built before the crisis begins.
MY RESPONSE: I keep an ample supply of N95s—the only widely accessible protection that consistently works against airborne pathogens. They don’t expire and take almost no space. It’s the most straightforward preparedness step I’ve taken.
Review
Osterholm begins by clearing away the noise. Before he critiques policy or culture, he simply explains what actually happened during COVID-19—and what didn’t. That clarity sets the tone for everything else in the book and for how I now see public-health behavior.
Only after that clarity is established does the cloth-mask memory hit me: during the pandemic, I’d quietly judge the folks wearing saggy cloth masks over full beards, barely covering their noses. They treated those masks as symbolic, and—uncomfortable as it is—they weren’t wrong. Against an airborne virus, a cloth mask is basically a screen door on a submarine. That single comparison sharpened my sense for the difference between actions that look protective and actions that are.
From the perspective of a learning scientist, the more damaging pattern was how quickly people defaulted to cognitive shortcuts. We reached for simple rules, loud voices, and old assumptions because they felt manageable. That’s not unique to pandemics—it’s classic human mislearning—but COVID made the consequences unavoidable. Some of these failures tie directly to the book’s core tension of truth versus theater. Others sit at the edges, but they still illuminate how systems and individuals slip into false confidence.
The next major pandemic, as Osterholm argues and as the data supports, will hinge on two weaknesses: structural unpreparedness and emotional unpreparedness. Stronger infrastructure, clearer plans, and better supply chains matter—but they only work if people trust the guidance enough to follow it. Emotional readiness is the more fragile side of the equation. Families need to understand the broader strategy, discuss their own plan, and name the fears that will distort judgment when the stakes rise. Fear skews risk perception. Fear fuels magical thinking. Fear pushes us toward comforting rituals instead of effective action. To avoid repeating the same mistakes, we need both solid systems and steady minds.
In the end, the book’s greatest strength is its objectivity. It let me reconstruct the COVID timeline without partisan fog or media distortion. Seeing what truly unfolded reframed the next pandemic as a design problem—a solvable one—if we stop performing safety and start practicing it.
Similar Reads
The Premonition by Michael Lewis — narrative exploration of U.S. pandemic response gaps.
Apollo's Arrow by Nicholas A. Christakis — sociological and behavioral account of COVID-19.
The Rules of Contagion by Adam Kucharski — clear, accessible breakdown of how diseases spread and how risk perception fails.
Authorship Note: This review was co-authored using a time-saving GPT I built to help structure and refine my thoughts.
September 23, 2025
John Barry (author of The Great Influenza: The Story of the Deadliest Pandemic in History) noted that a peculiarity of the influenza of 1918 was that we forgot it. Indeed, statistical detail and news was suppressed even as it was going on because of the Great War; one reason it was called the Spanish flu was because Spain, as a non-combatant, was among the only countries to publicize their flu statistics.
Now we have Michael Osterholm's The Big One, which does remember.
Osterholm was one of the experts we saw on the news explaining what was going on during COVID. Osterholm is the long-time founder and Director of the Center for Infectious Disease Research and Policy (CIDRAP). He was also Minnesota's State Epidemiologist from 1984-1999. He knows his onions. He was famous at the time for arguing very strongly that the infection was spread as an aerosol (not just as drops) and that masks other than a N95 just wouldn't work. In April of 2020, he predicted that there would be 800,000 deaths over the next 18 months from COVID: He was called a fearmonger and alarmist. The figure turned out to be somewhat more than 700,000. As Osterholm put it, "[N]o one wants to be right about something like that" (p. 98). Another of Osterholm's divergences was that he was among the first people to remind us that the vaccines would reduce infection less if people could get re-infected post-shot. He also told us that solving the problem of managing air inside of buildings would be very difficult indeed.
Now we have his book, co-written with Mark Olshaker.
Read this book. The science and policy parts can get a bit dull, and there's some "I told you so" going on here, but it's enlivened by a fictional walkthrough of the next pandemic. And its a doozy. The portrayal of the next pandemic is written like a tabletop exercise, and you could get a lot out of it reading as a group and then discussing what the characters should be doing next. The particular pandemic is much more like MERS, which you may recall had a more significant fatality rate than COVID. These parts of the book are set forward in italics. There's a character who is a thinly-veiled version of Osterholm himself. Then follows the Osterholm/Olshaker discussion. In the future pandemic, the various teams get a lot right. For one thing, the President gets the communications challenge, and conducts FDR-style fireside chats to keep the message consistent. The President uses language to help the population understand the challenge without telling them that it will all be solved right away.
However, in the book there is much that the next pandemic cannot get right because of lack of spending in the prior years on programs that would get the United States ready in advance. Osterholm mentions the space race a number of times and contends that only that level of spending could really tee us up for strong mitigation. Meanwhile, he stresses the global context, were for one country to get right, all countries have to get right.
This book is also good because like Osterholm himself, the claims here are backed up with copious notes to the science and policy. Osterholm rarely speculates. I'm afraid that unless this is made into a movie, though, the messages here won't get very far. Recommended.
Now we have Michael Osterholm's The Big One, which does remember.
Osterholm was one of the experts we saw on the news explaining what was going on during COVID. Osterholm is the long-time founder and Director of the Center for Infectious Disease Research and Policy (CIDRAP). He was also Minnesota's State Epidemiologist from 1984-1999. He knows his onions. He was famous at the time for arguing very strongly that the infection was spread as an aerosol (not just as drops) and that masks other than a N95 just wouldn't work. In April of 2020, he predicted that there would be 800,000 deaths over the next 18 months from COVID: He was called a fearmonger and alarmist. The figure turned out to be somewhat more than 700,000. As Osterholm put it, "[N]o one wants to be right about something like that" (p. 98). Another of Osterholm's divergences was that he was among the first people to remind us that the vaccines would reduce infection less if people could get re-infected post-shot. He also told us that solving the problem of managing air inside of buildings would be very difficult indeed.
Now we have his book, co-written with Mark Olshaker.
Read this book. The science and policy parts can get a bit dull, and there's some "I told you so" going on here, but it's enlivened by a fictional walkthrough of the next pandemic. And its a doozy. The portrayal of the next pandemic is written like a tabletop exercise, and you could get a lot out of it reading as a group and then discussing what the characters should be doing next. The particular pandemic is much more like MERS, which you may recall had a more significant fatality rate than COVID. These parts of the book are set forward in italics. There's a character who is a thinly-veiled version of Osterholm himself. Then follows the Osterholm/Olshaker discussion. In the future pandemic, the various teams get a lot right. For one thing, the President gets the communications challenge, and conducts FDR-style fireside chats to keep the message consistent. The President uses language to help the population understand the challenge without telling them that it will all be solved right away.
However, in the book there is much that the next pandemic cannot get right because of lack of spending in the prior years on programs that would get the United States ready in advance. Osterholm mentions the space race a number of times and contends that only that level of spending could really tee us up for strong mitigation. Meanwhile, he stresses the global context, were for one country to get right, all countries have to get right.
This book is also good because like Osterholm himself, the claims here are backed up with copious notes to the science and policy. Osterholm rarely speculates. I'm afraid that unless this is made into a movie, though, the messages here won't get very far. Recommended.
November 10, 2025
Epidemiologist, founder of CIDRAP-Center for Infectious Disease Research and Policy at the University of Minnesota Michael Osterholm has written an excellent, definitive book about what happened during the 2020 pandemic. That one was simply the forerunner to a more series one in The Big One: How to Prepare for World-Altering Pandemics to Come. He is joined by author Mark Olshaker. Remember the 2020 pandemic? Typically most Americans don't want to remember; but I recall all the misinformation by the Trump administration. "Hey, inject some bleach and it will go away like a miracle before Easter." Ridiculous, angering and hundreds of thousands of people needlessly died because of the lies, incompetence as he went to get vaccinated. Osterholm is a breath of fresh air who is completely credible. Everyone who cares about humanity needs to read this book as Osterholm lays out what needs to be done (don't use worthless masks, those plastic barriers put up at pharmacies do nothing) and what is not being done (stockpiling supplies, creating a commission to review what went wrong) to prepare for the inevitable. His case for vaccinations is rock solid. The CIDRAP website offers the opportunity to sign up for newsletters; knowledge is power.
September 7, 2025
The book is a mixed bag of fictional imagination of the next pandemic and options for prevention and mitigation. Several options are denigrated because they are not perfect. The authors claim that surgical masks are ineffective in blocking viruses, but results of studies vary widely, with some finding them equivalent to N95 masks. They say that preventing incoming flights from high-risk countries is ineffective when the virus is already in the country, but adding more carriers spreads more virus. They say that Finland, Norway, and Sweden had similar COVID-19 death rates due to "social cohesion", but Sweden had 2.6 times the death rate per population of Norway. Various policies that increased or reduced the incidence, hospitalizations, and deaths in some countries and US states are ignored. For example, they say that contact tracing is ineffective when there are asymptomatic carriers, but countries that had good tracing had lower incidence and death rates. They ignore studies finding that on-demand testing increased the spread because those who tested negative traveled more and were exposed and infected. Leon S. Robertson, Yale University School of Public Health
April 3, 2025
In The Big One, Dr. Michael T. Osterholm and Mark Olshaker deliver a sobering and urgent warning: Covid-19, as devastating as it was, may only be a precursor to an even deadlier pandemic. With clear-eyed analysis, they dissect past failures in public health response, expose dangerous misconceptions about disease containment, and outline critical strategies for preparedness. This book is both a wake-up call and a roadmap for survival— a critical call to action for future global health crises.
Many thanks to NetGalley and Little, Brown and Company for providing an eARC of The Big One:
How We Must Prepare for Future Deadly Pandemics prior to publication.
Many thanks to NetGalley and Little, Brown and Company for providing an eARC of The Big One:
How We Must Prepare for Future Deadly Pandemics prior to publication.
December 12, 2025
Osterholm has correctly predicted 8 of the last 3 calamities. He does have a tendency to elevate the threat level but that is his core competency. He can see what could be the final result of an early warning
He advocates for an extensive public health network and preparedness for “the next big one”. His dissection of failures of response to COVID are insightful and spares no one (except perhaps himself) it will become a required book for public health leaders
He advocates for an extensive public health network and preparedness for “the next big one”. His dissection of failures of response to COVID are insightful and spares no one (except perhaps himself) it will become a required book for public health leaders
December 19, 2025
Interesting but not helpful. All things that will actually help have to be done by government so yeah that’s not happening! Basically I’m just going to put my hear between my legs and kiss my butt goodbye!
November 13, 2025
Scary, yet sensible. The big problems are the political establishments and health authorities
Read
November 13, 2025Good recap of the Covid history with critical commentary and proposals for future preparations--which won't be followed.
November 26, 2025
Grew up listening to State Epidemiologist, Michael Olsterholm on the news. This is a great read and an important book.
December 9, 2025
I have listened to Michael Osterholm's podcast for several years and this is why I knew about this book and chose to read it. It is very well written and I recommend it to everyone.
December 12, 2025
Probably sponsored by big pharma.
December 15, 2025
3.75 stars.
May 30, 2025
I loved the set-up of the book: a plausible scenario about a future pandemic and then text giving context and explanations. I found the book highly informative. All the science was explained crystal clearly and with a conversational tone. I also loved the chapter-ending take-home messages. This book should be read by anyone interested in public health. It provides a great roadmap that will hopefully be followed in the next pandemic, and there will be a next one. Thank you to Netgalley and Little, Brown Spark for the advance reader copy.
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