Making Sense - Sam Harris - #436 — A Crisis of Trust

00:00:00.000 Welcome to the Making Sense Podcast. This is Sam Harris. Just a note to say that if you're

00:00:11.740 hearing this, you're not currently on our subscriber feed, and we'll only be hearing

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00:00:26.240 it's made possible entirely through the support of our subscribers. So if you enjoy what we're

00:00:30.200 doing here, please consider becoming one. I am here with Michael Osterholm. Michael,

00:00:38.660 thanks for joining me. Thank you for having me. So you have written an alarming book titled

00:00:44.420 The Big One, How We Must Prepare for Future Deadly Pandemics. You co-wrote that with Mark

00:00:50.980 Oleshaker. And we're going to get into that. I mean, obviously, we're, I think, as a presage to

00:00:58.320 your book. I mean, actually, your book accomplishes much of this as well. I think we should do a bit

00:01:03.240 of a postmortem on the COVID pandemic and what we've learned or failed to learn from that experience.

00:01:09.840 That was as bad as that was. That was a kind of dress rehearsal for the thing you're imagining,

00:01:13.380 which would be quite a bit worse. Before we jump in, what is your scientific background and what are

00:01:18.860 your responsibilities as an epidemiologist at this point? Well, I actually was fortunate enough to

00:01:25.120 know when I was in seventh grade, I wanted to become a medical detective. It turned out that

00:01:29.440 someone in my small Iowa farm town actually subscribed to The New Yorker. And at that time,

00:01:34.440 there were a series of articles in there by Bert and Roger, which were medical whodunits,

00:01:39.700 basically kind of the CDC versions of these outbreaks. And when I read that, I said,

00:01:44.580 this is what I want to do. So when I graduated from undergraduate, I immediately went to graduate

00:01:50.120 school at the University of Minnesota in infectious disease epidemiology, and at the same time was

00:01:57.060 employed by the Minnesota Department of Health. And so I've now been in the business 50 years,

00:02:01.000 of which 25 of those years were split between the university and the state health department,

00:02:05.960 and then 25 I've just been at the university. Throughout that time, I also have had a number

00:02:10.920 of other appointments. And I think for the context of our comments today, I've had a role in every

00:02:15.520 presidential administration since Ronald Reagan, having been involved with HIV AIDS back in the

00:02:20.520 1980s. And during Trump one, I was a science envoy for the state department going around the world,

00:02:26.420 trying to help get us better prepared for a pandemic that was in 2017, 18. Not sure we did so well that

00:02:32.020 way. And then of course, I was on the Biden-Harris transition team. So I'm an epidemiologist by

00:02:36.680 training. Our group has been involved with many, many outbreaks of international importance.

00:02:41.960 And then at the university, I started the Center for Infectious Disease Research and Policy in 2001,

00:02:48.220 the same week as 9-11. And we had already been very involved in the area of bioterrorism. In fact,

00:02:55.240 I wrote a book that was published on September 1st of 2000 that was called Living Terrorist,

00:03:02.320 What Our Country Needs Notice 5, The Coming Bioteros Catastrophe. And right after, of course, 1.00

00:03:07.520 9-11, my book, which I think I had bought 14 of the 18 copies that were sold in the year between

00:03:12.620 its publication and 9-11, then became a New York Times bestseller. I ended up splitting my time

00:03:18.740 between Minnesota and the Department of Health and Human Services in Washington as an advisor to then

00:03:23.100 Secretary Tommy Thompson. So I was very involved in those international activities and have really had

00:03:29.780 a variety of experiences, but I've published a lot even early on on the issue of the potential for

00:03:35.920 pandemics. 2017, I published the book, Deadliest Enemies, Our War Against Killer Germs. And I laid

00:03:42.200 out in three chapters what a serious pandemic would look like, which I had suggested it was an influenza

00:03:48.500 virus. It was obviously a coronavirus, but if you read the three chapters, you would think it was

00:03:53.780 exactly what had happened throughout the course. So I continue to be obviously very engrossed in the

00:04:00.200 issue of pandemic preparedness, but it comes from a lifetime of experience with infectious diseases.

00:04:06.160 Well, as you know, management has changed over at the HHS. Since you were there, I think we'll

00:04:10.660 probably get a chance to comment on that. But let's talk about your experience during COVID.

00:04:18.320 Many of us, I think, first discovered you on Joe Rogan's podcast. You appeared fairly early in the

00:04:25.460 pandemic. And I must say, you found yourself talking to a very different Joe Rogan than the Joe Rogan

00:04:32.340 that we have with us now on these topics. What was your experience of trying to message into a very

00:04:41.160 fragmented and fragmenting information landscape during the first months and maybe perhaps first

00:04:48.240 year of COVID? Yeah. Well, first of all, we picked up on this situation in Wuhan actually on December

00:04:55.540 30th of 2019. So we were well aware of what was going on at that time. And of course, we didn't

00:05:02.880 have an infectious agent at the point. But then soon after, we realized it wasn't influenza virus. I

00:05:09.900 thought, well, this is great. We can probably control this because I'd been very involved with both SARS and

00:05:14.560 MERS, two other coronavirus infections that had occurred. In 2003, SARS, a severe respiratory

00:05:21.020 syndrome disease that came out of China, was one that, because I was still at the Department of

00:05:25.480 Health and Human Services, I helped respond on a national level. And what we found was a virus that

00:05:31.260 was not that infectious, except for a few super spreaders, but enough so that we could really

00:05:36.660 control it. But it killed anywhere up to 15% of the people. And then in 2012, we had another

00:05:44.060 coronavirus emerge on the Arabian Peninsula, MERS, Middle Eastern Respiratory Syndrome, a virus that

00:05:49.520 originated from camels. And very much the same picture as we saw with SARS in the sense that it

00:05:55.940 wasn't that infectious. We could really control it. But the difference was 35% of the people who

00:06:01.240 developed MERS died from it. And so that was surely a warning. And in my book in 2017, when I laid out

00:06:08.340 the three chapters that talked about pandemics, one of the chapters after that was on coronavirus as a

00:06:13.800 harbinger of things to come. And so I kind of sensed that we could see a very different world. Well,

00:06:20.000 along comes MERS and following SARS, giving us a sense of what could be really bad. But then, of course,

00:06:27.200 we saw COVID arrive, and it was highly, highly infectious, unlike the other two, but it was not

00:06:32.380 killing nearly as many, one and a half percent of the people, which still is a very real and large

00:06:37.320 number. And so at that point, early in the pandemic, I thought if this was a coronavirus, this is good

00:06:43.620 news. We're going to be able to control it, like we did SARS and MERS. Well, that went out the window 0.98

00:06:47.940 quickly when we recognized that there was clearly a lot of airborne aerosol-based transmission

00:06:54.540 occurring, people not even knowing they were infectious, infecting people at long distances

00:06:58.900 away from them. And on January 20th of 2020, I actually wrote a piece on our website and said,

00:07:05.100 this is the next pandemic, get on with it. And that was not well received by many. They didn't

00:07:11.040 want to believe that such a thing was going to happen. And you noted about the issue with Joe Rogan,

00:07:16.360 actually on March 10th of 2020, I was on Rogan. And at that time, I made a prediction that I thought

00:07:22.900 we could easily see 800,000 deaths in the next 18 months in this country. And I might as well said

00:07:28.320 bad things about everybody's mother, because that too was not well received. And of course,

00:07:32.760 you know what happened. In fact, 18 months later, we were at 790,000 deaths. And so I think that was

00:07:39.520 the hard part was getting people early on to recognize we really were in the face of this. And

00:07:44.140 it wasn't until middle March before the WHO actually declared it a pandemic.

00:07:48.680 What was the resistance to acknowledging the airborne contagiousness of COVID? It's something you talk

00:07:57.600 about in your book a bit. It seemed that we were very slow to admit this. And even as we were starting

00:08:03.400 to admit it, there was this emphasis on droplet spread as opposed to aerosol spread, which perhaps

00:08:09.380 you can take a moment to describe the difference, but it's a very important difference from an

00:08:13.740 epidemiological point of view.

00:08:15.180 Well, you know, I hate to admit this, but we still have a challenge today. There's still a core

00:08:19.000 group of people that don't believe that it's airborne. What we mean by airborne and droplet

00:08:23.460 related transmission is how does the virus leave your body such that it would expose others to the

00:08:28.980 virus? And in the case of a respiratory infection in your lungs, in your nasal passages that then you

00:08:34.880 breathe out, basically when I talk or you talk and when we cough, we have these large droplets that

00:08:42.240 actually come out of our mouth, our nose, that if you're in the front two rows of a concert or a

00:08:47.900 play, you can see the actor or singer and you see these drops constantly coming out. Well, they fall

00:08:54.380 to the ground, usually within six to eight feet. And so you could be in the same room with someone 20

00:09:00.200 feet away and never really be exposed if it's a droplet. And there are some diseases that are

00:09:04.860 primarily droplet transmitted. However, an aerosol is that fine, fine material that's coming out of

00:09:11.560 my mouth as I speak right now. And if you could test this room, you'd find my aerosol has actually

00:09:17.220 infiltrated much of the room and you have no idea that it's there. To give you an idea what an aerosol

00:09:23.120 is like, think of walking outside and suddenly you smell cigarette smoke and 30 feet upwind from you

00:09:29.580 somebody smoking. That's an aerosol. That's what floats. If you're in your house and a light, light

00:09:35.020 comes shining through the window and you see all those particles floating in the air, that's an

00:09:38.720 aerosol. They sit there. And that's what is so challenging because they can move great distances. And

00:09:44.840 in fact, one of the classic outbreaks in an airborne related mode was happened right here in

00:09:51.000 Minneapolis, not far from where I am right now at the Hubert Humphrey Metrodome back when we had the

00:09:57.000 Special Olympics here for the world. And on the opening night ceremony, all of the participants,

00:10:04.620 coaches, players, et cetera, marched in from the right field kind of garage, or we call it, filled the

00:10:10.740 infield and outfield. Meanwhile, there were 64,000 people in the stands. We had not had measles in this

00:10:17.080 state for almost five years. Well, after that night, when a young boy from Argentina who stood almost on 0.99

00:10:24.060 home plate was breaking with measles, there was an outbreak that had subsequently occurred over the

00:10:28.620 next 10 weeks, 10 days to two weeks with the players, coaches, et cetera. But in that opening

00:10:34.120 night session, there was also an outbreak of people who had never had any other association with the

00:10:39.240 Special Olympics except being at the opening night session. And we had not, as I said, had

00:10:43.840 indigenous measles in the state. So we figured that this had to be involved. When we actually placed

00:10:49.400 where these people sat that night, they all sat in the very small same section of the stadium at 490

00:10:57.380 feet away from the home plate and where near an outtake fan was located in the stadium. And it

00:11:06.040 turned out that the air was coming out behind home plate, passing this young boy, and then literally

00:11:11.400 traveled through the air to that outtake fan at the time where Mark McGuire on steroids couldn't hit a

00:11:16.920 home run. And it basically infected everybody in that section who hadn't previously had measles or

00:11:23.000 who had not been vaccinated. And so it just shows you how dynamic this virus can be in its movement.

00:11:30.040 And that's measles, but measles and COVID viruses are very similar in how they're transmitted.

00:11:36.340 So you make the point that if the barrier you have put up or the precautions you have

00:11:42.380 made would not prevent you smelling someone smoking a cigarette on the other side of those

00:11:48.620 barriers or precautions, it's not going to prevent the transmission of an aerosol-based

00:11:53.540 respiratory virus.

00:11:55.440 You know, we engaged in so much hygiene theater where people wanted to feel safe. They wanted to

00:12:01.720 say, if you stay six feet away from me, it'll be okay. We spent millions and millions of dollars

00:12:06.800 on plexiglass shields that were supposed to protect people. They provided no protection

00:12:12.260 whatsoever. And I think that's a lesson that really needs to be brought forward for future

00:12:17.360 pandemics. We need much better respiratory protection. We need better air quality. You

00:12:22.440 know, when you and I drink water out of a tap or eat in most cases our food, we assume it's pretty

00:12:27.260 much safe, but we never think about the air. And in fact, that's one of the real challenges

00:12:31.740 right now is for the future. How do we help protect people trying to stay, you know, in line

00:12:37.760 with their everyday life, but at the same time, keeping them from getting infected. And one way

00:12:42.460 to do that would be have a much more effective type of respiratory protection mask. The one we have

00:12:48.500 now is called an N95. Basically, it's one where if you think about where does a mask leak, it never

00:12:55.180 leaks in the material as such, just like a swim goggles don't leak in the lens, they leak in the seal.

00:13:00.080 N95s are meant to be really tight to the face. The problem with that is if you have something 1.00

00:13:05.740 that's too occlusive, meaning it's blocking air, you suffocate. So what is unique about these N95 1.00

00:13:11.960 respirators is it's a material that's made to have enough porous space for air to move readily through

00:13:17.100 it, but they have an electrostatic charge built into it. So it traps all the virus if I'm breathing

00:13:21.900 it out or if I'm inhaling it in. And unfortunately, those type of respirators, as we call them, are really

00:13:28.980 somewhat uncomfortable to wear for long periods of time. We should have been investing during

00:13:35.140 and after the pandemic and coming out with much better respiratory protection to deal with

00:13:40.080 this airborne transmission issue.

00:13:42.240 Yeah. So we're going to talk about what we would want to prepare ourselves for the next

00:13:46.760 pandemic. Again, that could be quite a bit worse from COVID. I mean, one of the things we're dealing

00:13:52.820 with here, I think, is a kind of a background of fundamental skepticism about this topic because

00:13:59.700 it's been widely perceived that in some ways we overreacted to COVID, right? And we implemented

00:14:07.680 things that were just dogmatically asserted to be true, which in retrospect weren't. There was a lot

00:14:16.380 of confusion around what we knew. And when we knew it, COVID was a moving target. And the scientific

00:14:21.420 messaging around that movement was often inept. Half of our society seems to imagine that the

00:14:27.840 COVID vaccines were more dangerous than COVID itself. I believe we have someone running the HHS,

00:14:35.380 RFK Jr., who is a fabulist and confabulator and liar and loon to a degree that it's a little hard to 0.96

00:14:43.540 exaggerate, who is one of these people. I think he seems to believe that the vaccines were in fact 0.91

00:14:49.380 more dangerous than the illness. And we may talk about the implications of that, but there's a lot

00:14:54.240 of confusion here. So to be clear, I think we should say whatever we want to say about the lessons

00:14:59.800 learned or not from COVID. But in talking about what you call the big one, we are talking about

00:15:05.560 something that is unambiguously awful, where the mortality rate is an order of magnitude or worse

00:15:12.500 than the mortality rate of COVID. And this will be something where the bodies will in fact be

00:15:18.360 stacking up in the streets. And it'll be completely unambiguous as to whether this is a lethal pathogen

00:15:24.720 that we need to worry about. And so the first thing you have just put forward as something we

00:15:28.820 really should have in hand and don't is a mask that is much easier to wear, much more comfortable

00:15:36.480 to wear, perhaps one that's washable, perhaps one that people will not hesitate to wear if they

00:15:42.000 needed it, and that it's at least as good as an N95 that we have today. And so who's building that?

00:15:48.620 I don't know, but somebody should get to work on that, given what we're about to say.

00:15:52.460 You know, to add context to this, because I appreciate very much how you just laid it out.

00:15:56.920 I think you were very accurate in what you had to say. But, you know, I have experienced throughout

00:16:01.520 my entire career a kind of bad news mic momentum. You know, I wrote the book on bioterrorism and what

00:16:07.300 anthrax could do. It ended up doing it. In 2017, when I wrote about what a pandemic could look like,

00:16:15.020 that's what COVID actually became. In each of those instances before the events happened,

00:16:19.920 everybody just said, you're just a scary guy. Well, let me just be really clear about this idea

00:16:24.940 of what could be the big one. And in fact, I mentioned earlier that the coronaviruses

00:16:31.120 that we have identified causing serious illness in humans, SARS, MERS, and COVID,

00:16:36.500 basically what has fortunately kept those apart from their worst details are literally just

00:16:43.800 something that's a temporary basis. What I mean by that is that COVID could very well have been

00:16:49.420 much more seriously causing illness, but it didn't. It was 1.5% deaths. Well, it turns out that

00:16:56.140 right now we've identified new coronaviruses in the wild, in animals that have the infectiousness

00:17:02.640 of what COVID was, but it has on board also the genetic packages that could kill like MERS and SARS.

00:17:11.540 So, you know, I already said, you know, we've documented MERS killed 35% of the people it infected.

00:17:17.320 You know, so the idea of what I'm putting forward is even if it's 7% or 10% case fatality rate,

00:17:22.680 the percent of people who get sick and die is still a lot less than what MERS could present to us

00:17:28.160 if it was highly infectious. So I think people cannot deny that this is in fact truly a possibility.

00:17:35.380 And the fact that we've actually identified this virus in nature is really important.

00:17:39.900 Remind me, is MERS more like 30% fatal?

00:17:43.060 30, 35%.

00:17:44.400 And again, I worked on that extensively. I was noted an advisor with the Royal Family of the United

00:17:52.500 Air at Emmerichs, and I was actually on the Raven Peninsula working on that. And then when a, in 2015,

00:17:57.540 when an individual who had been to the Middle East came back home to Seoul, Korea, they came home

00:18:03.980 with MERS, not realizing that they were hospitalized in Seoul and created several hospital-based outbreaks

00:18:12.060 where they had been seen. And again, had that very high case fatality rate. I was

00:18:17.040 in Seoul helping with that outbreak investigation. So I've seen SARS and MERS up close. And I can tell

00:18:24.100 you under no conditions would I want to see either one of them develop the ability to be transmitted

00:18:28.740 like COVID.

00:18:29.980 So, well, perhaps we should linger on the controversy around the origins of COVID. As far as I know,

00:18:36.600 the jury is still out and it would be rational to consider a lab leak origin and a wet market origin

00:18:44.180 as something on the order of a coin toss. I mean, I know people are biased in one direction or the

00:18:48.780 other, but neither thesis is crazy. Is that still the state of our understanding?

00:18:53.760 Yeah. And let me add context to that. You know, I was on the National Science Advisory Board for

00:18:58.160 Biosecurity, the newly appointed committee in 2005 that was supposed to oversee national research at the

00:19:05.140 federal government level and in other labs around the country for reasons of safety. And so, you know,

00:19:10.960 I was very involved with that. In 2012, I actually was one of several people on the NSAV that raised real

00:19:16.480 concerns about how some of the flu research was being conducted. So if anything, many people would call

00:19:21.580 me a hawk on lab safety and the challenges about transmission. Having said that, I am completely on

00:19:28.140 board with what you just said. We're never going to know. It's a calling toss. Was it, you know,

00:19:34.320 a lab leak? Was it a spillover from nature? And my whole point is get over it and move on because

00:19:40.740 what we're not doing is getting prepared for the future, which could again be either one,

00:19:44.880 a lab leak or a potential spillover. And so I think, you know, as long as we keep fixated on that

00:19:51.680 question, which we'll never provide, we'll never have an answer that will provide us any comfort

00:19:56.380 as to knowing what happened, we need to prepare for the future.

00:19:59.620 So in hindsight, what would you say we did wrong during COVID? What were the most, if you could

00:20:08.820 just take the top three mistakes and not make them, what would you change about our response to the

00:20:15.880 pandemic?

00:20:16.600 Well, all three of the examples I'm going to give you really come back to humility and

00:20:21.140 communication. Okay. Let me take the first one. I wrote a piece in the Washington Post in early

00:20:27.140 March of 2020 saying, don't do lockdowns. They'll never work because of the fact we were talking

00:20:32.280 about something that was likely to last up two to three years. And could we really lock down for

00:20:37.700 that long of a time period? And the answer was absolutely no.

00:20:41.080 What about slow the curve?

00:20:43.620 Well, that's where I'm going to come next.

00:20:45.200 Okay.

00:20:45.340 And so what I'd proposed is we use a concept of snow days. And what that was all about was the

00:20:51.380 idea that at that early part of the pandemic, we had no vaccines, we had limited drug availability.

00:20:57.960 But what was the one thing we could do to keep people from dying is providing them good supportive

00:21:02.520 medical care. And if your hospital is at 140% census where people are in the hallways and beds in 0.70

00:21:09.320 parking garages, you are getting bad care and a lot of people are going to die. And so my whole

00:21:14.940 purpose here was to say, you know, what method would help us here reduce that? Well, let people know

00:21:21.600 what the hospital census is every day. You know, make it your hospital has a public number. You can go

00:21:27.020 look it up. And if we got to 90, 95%, we would ask people to voluntarily back off of public events,

00:21:34.740 maybe even schools, et cetera. And then when that number came back down, then you could begin to resume

00:21:41.800 these activities. And again, we'd keep doing that day after day. That would have given us both a public

00:21:48.020 awareness of what was happening and the fact that our really most important job was to keep the hospitals

00:21:53.540 from being overrun.

00:21:55.060 Michael, sorry to interrupt, but isn't this epiphany contingent upon understanding that it's an airborne

00:22:00.420 illness? And if we're, if you're, there was a moment there where we were, you know, wiping down

00:22:04.920 our packages because we were worried about fomites. So at what point was it absolutely obvious that we

00:22:10.940 were, at least to those who are willing to admit it, you know, that we're, this was the worst case

00:22:14.820 scenario with respect to infectiousness. At what point was it obvious that this was airborne and aerosol

00:22:20.660 and that you were not going to, you're not going to lock down so successfully so as to prevent it

00:22:26.560 spread?

00:22:27.000 Yeah. There was a group of us early on that published information on this issue, clearly

00:22:32.680 demonstrating this was airborne. So this was as early as February and March. And we were very

00:22:39.020 critical at that time of the WHO and to some degree parts of the CDC because they were not on board with

00:22:45.940 this, even though there was a very significant data supporting it. So that did happen. But I think

00:22:52.040 again, coming back to why people stayed apart, whether it was airborne or whether it was droplet

00:22:59.060 particles, they still did. And, and so one of the things I think there's a lot of revisionist,

00:23:04.860 revision of history going on right now with COVID. And one of those was lockdowns. And it turns out that

00:23:11.880 in March of 2020, 41 states initiated some kind of what they called lockdowns. Now you have to

00:23:18.660 understand, I don't know what a lockdown really is when you think about all the different things

00:23:23.360 that were tried, but take the state of Minnesota. We technically went into a lockdown in March

00:23:28.100 of 2020. Our governor issued a directive order, basically telling all non-essential workers,

00:23:35.120 basically to stay home. The problem was 82% of our workforce was deemed as essential workers.

00:23:40.240 Now that wasn't a lockdown. And even with that, by early June, all but one of the 41 states had

00:23:48.140 eliminated those lockdowns. So people keep talking about lockdowns that lasted for months and months

00:23:54.580 up to several years. That was not the case. There were surely localized activities where people

00:24:00.080 canceled events, schools were decided, but it wasn't based on a national federal level. And I think

00:24:05.800 the challenge we had was people just were fearful of being in public places. And particularly as some

00:24:11.200 of these waves of the virus continued to greatly see increased cases. And so I think the challenge

00:24:18.000 we have was with lockdowns was they were mischaracterized what happened. Imagine if we had done snow days

00:24:25.180 over a course of six to 12 months before vaccines arrived, I think people would have been much more

00:24:30.780 compliant than just feeling like I'm locked up. Now I'm not. Yeah. Okay. So what other mistakes

00:24:36.820 come to mind when you look back? Number two, I think, was with the vaccine. And this is a remarkable

00:24:43.700 effort, this vaccine. I know some will be critical of it, but mRNA technology was in the works for at

00:24:49.820 least 15 years before the pandemic. If you'd like to continue listening to this conversation,

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Making Sense - Sam Harris - October 03, 2025

#436 — A Crisis of Trust

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