NIH Directors: The World Needs a New Pandemic Playbook
Over the past two decades, scientists built a pandemic-preparedness playbook that has failed catastrophically. Born from fears sparked by the emergence of highly pathogenic avian influenza in 2003 and the swine flu pandemic of 2009, it shaped billions of dollars in U.S. National Institutes of Health (NIH) investments—investments that failed to prepare the world for Covid-19. Worse still, the playbook itself may have helped cause the disaster.
The playbook is breathtaking, even utopian, in ambition. It rests on three steps. First, scour the planet for every pathogen imaginable: send researchers into remote locations, from African forests to Chinese bat caves, collect wildlife samples, and return them to urban laboratories—sometimes in city centers like Wuhan.
Second, assess the danger of each pathogen by testing its ability to infect human cells—sometimes even genetically modifying it to enhance that ability. This is the controversial category now known as dangerous gain-of-function (dGOF) research. To the uninitiated it sounds deranged, but in this playbook it is considered essential. The goal is to predict how a pathogen might mutate into a human threat.
Third, having identified the “high-risk” viruses, governments preemptively develop vaccines and therapeutics and award large contracts to pharmaceutical companies to manufacture and stockpile these countermeasures.
Every step carries profound risk.
Sending scientists into remote regions to collect exotic pathogens can spark spillovers that may never have occurred naturally. Laboratory manipulation—even when not formally classified as dGOF—poses serious dangers. Lab leaks happen far more often than the public realizes, and biosafety standards differ wildly across countries. As a result, potentially pandemic-capable viruses are often handled in facilities with shockingly lax security.
President Trump’s executive order to tighten oversight of dangerous gain-of-function research was a step in the right direction, but global compliance is essential. The entire scientific community must adopt a culture that seriously weighs risks and benefits—regardless of the experiment’s classification.
From an evolutionary and historical perspective, the traditional playbook makes little sense. Any pre-designed countermeasure will almost certainly fail to match the actual pathogen that emerges. Evolution is messy, nonlinear and unpredictable. The virus that triggers an outbreak will differ significantly from the lab-studied strains used to design vaccines and therapeutics.
This leaves governments stockpiling expensive medical defenses that provide little real protection—a false sense of security that empowers officials to impose lockdowns, mandates and sweeping social controls. Covid proved just how dramatically this approach can backfire, harming populations while eroding trust in public health.
The playbook also creates powerful vested interests. Well-funded researchers benefit from hyping potential threats while downplaying the dangers of lab accidents. These are the same scientists whose careers depend on perpetuating the old preparedness model—an extreme conflict of interest.
It creates an industry of pharmaceutical manufacturers who receive vast sums of taxpayer money to produce medical stockpiles that, by design, cannot be tested in human populations until disaster strikes.
So what should be done?
We should abandon the traditional playbook. We do not need to hunt for new viruses or tinker with pathogens that pose hypothetical risks. Instead, we should focus on the diseases already known to afflict humans and develop better treatments and preventive strategies for those threats.
And we should learn from recent history: a metabolically healthy, physically active population will always fare better against a novel pathogen than one ravaged by chronic disease. Sweden—with no lockdowns or school closures—recorded the lowest age-adjusted, all-cause excess mortality in the world from March 2020 to December 2024. Sweden succeeded in part because its population is comparatively healthy. The United States, by contrast, entered the pandemic amid a chronic-disease crisis—and paid for it with one of the world’s highest mortality rates.
Encouraging Americans to improve their health—whether quitting smoking, managing hypertension or diabetes, exercising more or simply improving diet—would dramatically strengthen our resilience against the next outbreak.
Ultimately, the best pandemic-preparedness plan for the United States is straightforward: make America healthy again.
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