‘Bank on the fact’ that more pandemics are coming. Here’s why, and are we ready?

Jennifer Nuzzo has been worrying about the bird flu — since 2004. After all, it’s her job to worry.

An epidemiologist, Nuzzo heads the Pandemic Center at Brown University’s School of Public Health, where she works to strengthen national and local preparedness and response when it comes to infectious disease emergencies.

More than 20 years after she started eyeing the prospect that bird flu (H5N1) could become a pandemic, the U.S. is in the midst of its deadliest outbreak yet among wild and domestic birds.

The potential for viral spillover into humans isn’t clear yet: only one death has been reported thus far, and public health officials continue to message that human risk remains low. But statistically, bird flu or other, “you should pretty much bank on the fact that we will have more pandemics in our future,” Nuzzo said.

This week marks the five-year anniversary of COVID-19, the most consequential pandemic in a century, resulting in more than 1.2 million deaths in the U.S., including more than 22,000 in Massachusetts. Experts in infectious disease, public health and pandemic preparedness are already focused on what could arrive on the country’s doorstep next.

Whether the U.S. is ready is a split answer, experts told MassLive. Over the past five years, there have been leaps in science, but also a social and cultural backpedaling.

• Read more: State officials say bird flu ‘widespread’ in Mass., but human risk remains low

A multitude of scientific and medical advancements have been achieved since the COVID pandemic struck the nation in March 2020 — the development of at-home infectious disease testing, multiple mRNA vaccines, antiviral treatments and even wastewater surveillance to detect viral activity.

The public’s awareness and general literacy of how infectious diseases spread is also elevated now.

In that sense, the country has a new baseline when it comes to facing the next disease epidemic.

But socially, culturally and politically, “we are in worse shape,” Nuzzo contends.

Growing vaccine hesitancy, politicization of public health and actions by the second Trump administration are all alarm bells for Nuzzo — a foreboding for the next pandemic.

President Donald Trump has withdrawn the U.S. from the World Health Organization while tapping a noted vaccine skeptic, Robert F. Kennedy Jr., to lead the Department of Health and Human Services.

Trump signed executive orders in January that will likely result in divestment from health equity efforts — Black and Hispanic communities were disproportionately impacted by COVID, for example.

Meanwhile, the American public continues to suffer from “pandemic fatigue,” often leading to apathetic behaviors and a detachment from related news and education.

And yet, statistics show the likelihood of large-scale pandemics is growing. In 2021, researchers at Duke University’s Global Health Institute estimated the probability of novel disease outbreaks will likely grow three-fold in the next few decades.

“The goal here is, how do we increase our resiliency to these events so that when they occur, they don’t upend our lives in profound ways and cause historic drops in life expectancy?” Nuzzo said.

Animals to humans: Increasing zoonotic diseases

At the core of pandemic probability is the increasing spread of zoonotic diseases — infectious diseases that can be transmitted from animals to humans.

Today, approximately 60% of emerging infectious diseases in humans are zoonotic in nature. SARS, swine flu, bird flu, West Nile virus, Ebola and COVID are all examples.

Ann Linder, associate director of policy and research at the Brooks McCormick Jr. Animal Law and Policy Program at Harvard Law School, said that about one-third of all emerging zoonotic diseases stem from industrial animal agriculture.

" Zoonotic disease threats are deeply tied to human behavior and human use of animals," Linder said during a presentation on bird flu this month. “These human-animal interactions are set against a backdrop of environmental change, marked by warming climates, population expansion and large-scale changes in land use, along with growing demand for animal protein. Each of these forces increases this pressure on wild spaces and the animals who call them home.”

Trump’s second presidency began with an extended pause on all federal public health communications, a move that worried many health experts, particularly amid the growing bird flu outbreak. Last month, the U.S. Department of Agriculture announced it will spend up to $1 billion to fight the spread of bird flu from the perspective of its impact on eggs.

• Read more: 4 snowy owls have died of bird flu in Massachusetts. But that toll may grow

The plan includes boosting bio-safety precautions at egg farms, increasing egg exports and possibly vaccinating domestic chickens.

In a statement, U.S. Secretary of Agriculture Brooke Rollins criticized the Biden administration for its prior approach to bird flu and positioned Trump as “taking the issue seriously.”

“American farmers need relief, and American consumers need affordable food,” Rollins said. “To every family struggling to buy eggs: We hear you, we’re fighting for you, and help is on the way.”

Meanwhile, the Trump administration is weighing the possibility of pulling $590 million in federal funding previously awarded to Massachusetts-based biotech giant Moderna — one of the first companies to develop a COVID-19 vaccine in 2020 — for the accelerated development of a bird flu vaccine for humans.

• Read more: Mass.-based Moderna could be first to manufacture bird flu vaccine

There’s much the U.S. still doesn’t know about the current outbreak, Linder said, and “there seems to kind of be this feeling of ‘Don’t look for what you don’t want to find.‘”

She cited mistrust and skepticism in public health, especially in rural communities, as additional challenges to overcome when communicating about bird flu.

Nuzzo, of the Brown University Pandemic Center, views the USDA’s planned approach as “wack-a-mole” — one that’s not proactive or looking at public health long-term.

Even if today’s bird flu outbreak doesn’t become a pandemic affecting humans, any preventative and preparedness work done now will “be used in the future one way or another,” Nuzzo said.

What about future mask and vaccine mandates?

There were plenty of critics of former President Joe Biden’s COVID approach, as well as the approach of many governors and local leaders when it came to enacting mask and vaccine mandates.

What should be considered for the future, Nuzzo said, is the benefits of masking and mask mandates shouldn’t be lumped together — someone can believe in wearing a mask for public health but be against a government mandate to do so. The two are not mutually exclusive, she said.

Jeffrey Singer, a general surgeon and senior fellow in the Department of Health Policy Studies at the Cato Institute, a national libertarian think tank, agreed the nation is likely not ready for its next pandemic in terms of attitudes. But there are concrete lessons, he said, that can be learned from COVID mask and vaccine mandate dissenters that may help the country the next time around.

“When the next (pandemic) comes, and there will be another one, the best approach is persuasion rather than coercion,” Singer said. “You’ll get much more cooperation that way. And explaining to people that you don’t have all the answers. If you’re upfront with people, they’ll roll with the punches with you.”

Singer, a self-labeled “big advocate of vaccines” who still believes in individual autonomy, said the rhetoric toward people who chose not to get vaccinated during the COVID pandemic labeled them as “the problem.”

“People were being ridiculed,” he said. “That’s not a way to get people to get vaccinated. People in general recoil when they’re told by other people, ‘you must do this,’ and in our society, that’s almost an American instinct.”

Because of the politicization, Singer foresees barriers in the future when another disease outbreak strikes.

“I think people have such a bad taste in their mouth from the shaming and the dismissing of any sort of heterodox ideas or suggestions,” he said. “They’re still licking their wounds, I think.”

Divesting in health equity

COVID laid bare countless health inequities as certain populations were stricken by the virus at higher rates than others or had less access to information, prevention and care.

Those realities keep Dr. Simone Wildes up at night. An infectious disease physician at South Shore Hospital in Weymouth and member of the state’s COVID advisory groups on health equity and vaccines, Wildes said her “heartbeat is health equity.”

She worries about people of color if the next pandemic hits under this Trump administration.

In Massachusetts, Black and Hispanic residents had the highest COVID death rates, according to state data.

“I was deeply traumatized by what happened in my communities of color,” Wildes said. “Not only access to vaccines but also just access to information, access to the care. It was not the same. I struggle each day to think about all the different impacts that the current administration is going to have on the communities of color, the immigrant communities. People are going to lose their lives.”

• Read more: Mass. health care faces deluge of confusion after Trump DEI, gender orders

During his first week in office, Trump signed multiple executive orders targeting diversity, equity and inclusion, commonly known as DEI. In some instances, health centers, providers and researchers received memos informing them they would lose federal funding if they did not follow the executive orders.

Trump’s efforts have primarily targeted purported progressive policy initiatives as he tries to rein in government spending.

Wildes said a lot of time and money was spent on improving trust and transparency in communities of color over the course of the COVID pandemic. Much work remains in that regard, she said, but she worries Trump is pressing rewind.

“Now more than ever we need to be collaborating with people,” Wildes said. “The odds of us having another pandemic are significant, so this is not the time to be moving away from working with others.”