How to Prevent the Next Pandemic

I have long been inspired by the songs and message of the musical Hamilton. There is a moment in the show when the titular character faces an hour of maximum crisis, when it seems like his world is crumbling. He sings of being in the eye of a hurricane, before declaring “I’ll write my way out,” expressing his intent to use words to both process the chaotic moment and also, hopefully, find some deliverance from it.

That moment particularly resonated with me. I have often turned to writing to make sense of challenging events, and to try to inform a conversation that helps support a better future. And, in recent years, we have all known what it is to feel like we are in the eye of a storm. The COVID-19 pandemic has been a tempest, turning our world upside down, radically changing how we live. We have all processed the pandemic differently. My way has been writing. During the crisis, I wrote about why we found ourselves in the situation we were in, and what it will take to avoid another, potentially worse, pandemic. Those writings became my new book, The Contagion Next Time.

Why Write About a Pandemic During a Pandemic?

While working on the book, I occasionally encountered the question — from others, or posing it to myself — why write about a pandemic during a pandemic? Is it not enough simply to engage with the difficult, day-to-day work of trying to navigate the moment? Why also take on a book project? Was it solely to “write my way out,” to make sense of what at times seemed senseless, to cope with the grief of the moment? Such motives are necessary but not sufficient explanations for why I wrote the book. It is true that I did so to process, to cope. But I also did so because it seemed like our conversation about COVID-19 was missing something important. For roughly two years, the pandemic was just about all we talked of. We discussed the nature of the virus itself, its effect on our lives, the treatments we hoped could help make a difference, and the vaccines that have done much to return us to some semblance of normalcy. What we have not discussed, however — at least, not as much as we should — are the underlying causes of the pandemic.

Now, some may read that and say, “This is not true. The pandemic was caused by a virus, and we discussed that at length.” It is true that SARS-CoV-2 was the precipitating factor for the catastrophe. But the fundamental cause, I would argue, is deeper than that. It is the fact that, in the United States, Black people live shorter, sicker lives than white people. It is people living in dilapidated, rundown neighborhoods with mold in their walls making them sick. It is economic inequality that lets some people work remotely in comfortable suburbs during a pandemic, while others must brave daily interactions with crowds at a low-wage job they are terrified of losing. It is disinvestment in a social safety net that could have provided greater support for those in need when COVID-19 struck. It is a culture of division that stopped us from cohering around concern for the common good at a moment of historic crisis. It is the full range of social, economic, environmental, and political conditions that created a world that is nowhere near as healthy as it should, and could, be. These conditions created reservoirs of poor health in our society that long predated the pandemic, amounting to a tinderbox in which circumstance dropped the lit match of COVID-19.

I titled the book as a tribute to James Baldwin’s The Fire Next Time. Baldwin’s title warns of a conflagration coming to engulf American society if we do not fully address racial injustice. Like Baldwin’s fire, the contagion next time will be precisely as destructive as we allow it to be. We have a choice. We can learn the lessons of the last pandemic in order to prevent the next one, or we can neglect the danger we still face, and suffer the worst when it comes.

Building a Better, Healthier World

What does it mean to learn the lessons of the pandemic? It means nothing less than the creation of a better world, one that is maximized for health. This will take sustained, collective engagement with the foundational drivers of health. Often, what we think is engagement with these drivers is actually engagement with doctors and medicines — the treatments that help us when we are sick but do little to shape whether or not we get sick in the first place. This narrow focus has also characterized our conversation about COVID-19. We have talked about vaccines, we have talked about therapeutics, we have talked about finding ways to stop viruses from jumping from bats to humans, but we have not talked as much about the structural forces that made COVID-19 what it became. This also applies to the books that have emerged about the pandemic. Many have tackled the medical side of COVID-19, and they have been worthwhile reads. But my book is not one of those books. It aims to express a vision for a world where we have addressed the underlying issues that leave us vulnerable to pandemics, to prevent disease from taking hold.

As we move toward a post–COVID-19 future, we have a chance to not merely return to something like the prepandemic status quo but to build a world that is better, by far, than the one that first faced a novel coronavirus in 2019. If we engage with what matters most for health, if we invest in improving the structural drivers of health and disease, we can get to a world that is unrecognizable in the best of ways. If we dither, if we forget, if we neglect the hard lessons of the moment, we could face a disaster unlike anything we have seen in our lifetimes. Why did I write a book about a pandemic during a pandemic? Fundamentally, it was to help make sure that the COVID-19 moment is the last time anyone ever needs to do so.

This piece was first posted on Substack.