The next few years could see a disastrous confluence of events: the emergence of a lethal bird flu pandemic at a time when the nation’s public health leadership team is ill-equipped to deal with the consequences. What could possibly go wrong?
To be clear, there is no certainty the world will face an H5N1 avian influenza (“bird flu”) pandemic next year, or at any future time. There are significant genetic barriers involved in the adaptation of the avian virus to high-level replication in humans. But it would be highly imprudent to ignore the possibility of a pandemic, with terrible consequences to America, and indeed the world. Other writers share these concerns.
An H5N1 influenza outbreak in humans could be orders of magnitude more lethal than SARS-CoV-2, a virus that killed over 1 million people in the U.S. alone. Moreover, influenza viruses, once adapted to a new host (in this case humans), are usually highly transmissible, so the rate of spread across the nation could be quick. For decades now, infectious disease scientists have been worried about a new influenza pandemic; indeed, modeling scenarios in the decades before 2020 were typically based on influenza viruses, not a coronavirus.
An H5N1 influenza outbreak in humans could be orders of magnitude more lethal than SARS-CoV-2, a virus that killed over 1 million people in the U.S. alone.
The H5N1 virus that’s infecting multiple bird species worldwide, and is increasingly spreading in the nation’s cattle herds, can be transmitted to humans, but only sporadically at present. As of this writing, there have been 58 cases of human infections identified by the U.S. Centers for Disease Control and Prevention. These American cases have mostly been tracked back to contacts with chickens, other birds and, more recently, cattle on farms. The human infections have only rarely been severe — the symptoms are generally mild and of short duration. But the more the avian virus spreads, the more likely it is that key genetic changes will take place that enable the virus to replicate to high and dangerous levels in humans and be spread directly from one person to another. At that point, a pandemic would be quite likely.
Influenza virus evolution is a numbers game; the more human infections occur, the more chances a virus has to mutate, and the more likely it is that dangerous mutations will emerge. We cannot know when, or even if, that would happen. But it would be highly irresponsible to pretend it couldn’t.
Dealing with a pandemic threat requires advance planning and, when appropriate, decisive action. At present, we are in a transition between the Biden administration’s health care leadership team and Trump’s current picks to replace them. Transitions in times of danger are never ideal, but this one seems particularly problematic. Trump’s chosen leaders lack experience with public health administration and infectious diseases. In several cases, they have exhibited strong opposition to standard public health measures.
Robert Kennedy Jr., whom Trump has picked to lead the Department of Health and Human Services, has said to NIH scientists: “God bless you all. Thank you for public service. We’re going to give infectious disease a break for about eight years.” That’s hardly an encouraging sign. Kennedy, Martin Makary (the potential next head of the Food and Drug Administration) and Jay Bhattacharya (tapped to lead the National Institutes of Health) have made multiple statements opposing the standard public health measures that limited virus spread during the initial phase of the Covid-19 pandemic in early 2020. Would these officials push for the use of effective masking, social distancing and lockdown strategies if an even more deadly respiratory virus started to spread rapidly in American cities? If they refused to do so based on their personal philosophies, the body count could soon be enormous. Vaccines are our best tool to curtail a pandemic. The Covid-19 vaccines, particularly those based on mRNA technology, eventually broke the back of that pandemic in 2021 and 2022 by reducing the rates of severe disease and death rates to more manageable levels. These vaccines are estimated to have saved millions of American lives, and trillions of dollars in health care costs. Conversely, Covid vaccine refusal fueled by misinformation, with conservative media outlets playing a key role, likely contributed to the approximately hundreds of thousands of avoidable deaths in nonvaccinated people. Sadly, key Trump administration nominees have attacked vaccines in general, and mRNA vaccines in particular. Sadly, key Trump administration nominees have attacked vaccines in general, and mRNA vaccines in particular. Kennedy and potential new CDC head Dave Weldon have long records in the anti-vaccine movement, and Bhattacharya has been a prominent adviser to vaccine-opposing Florida Surgeon General Joseph Ladapo. Would they, then, support the further development and rollout of ongoing avian influenza vaccine development programs, whether using the traditional egg-based or the more modern designs, including the safe and efficient mRNA technology? A failure to act in a timely manner would be a deadly mistake. The Department of Defense is responsible for protecting America against external military threats. It’s unimaginable that this department could be headed by pacifists who ban the use of bombers, tanks and warships. An avian influenza virus could kill vastly more Americans than would die in any conventional war, and yet we are on the cusp of appointing a health care leadership team that has dismissed infectious disease threats and rejected the best weapons available for humanity’s never-ending war on lethal viruses. The United States Senate must fulfill its constitutional requirement and flag public health nominees who may fail the nation in a foreseeable crisis. Because we simply cannot predict when the next one might strike.
John P. Moore
John P. Moore is a professor of microbiology and immunology at Weill Cornell Medicine in New York City. 
