The next pandemic pathogen will surprise us, but it won’t be a surprise.

Maybe it will be influenza. Maybe tuberculosis. Maybe an old pathogenic foe. Or maybe a deliberate act from a bad actor. Whatever the scenario is, we’re not ready.


This is a medical illustration of drug-resistant, Mycobacterium tuberculosis bacteria. The bacteria appear purple on a dark blue background. The bacteria are elongated, almost cigar-shaped, and they are clustered in a group.
Et tu, Mycobacterium?

If you only have a minute, here’s the TL;DR version…

I discuss the possibility of future pandemics and suggest that influenza and drug-resistant tuberculosis are among the most likely candidates for pathogens that cause a pandemic. I also discuss the potential for intentional release of smallpox and the need for pandemic preparedness. The post highlights the importance of public health education and training, as well as the need to unburden healthcare practitioners from political influence.

Okay, so you have more than a minute…

With the COVID-19 pandemic receding — and the Public Health Emergency of International Concern declared over — we epidemiologists and public health practitioners can’t help but wonder what the next pandemic will be. As it is, we have two other pandemics that have been going on for decades before the COVID-19 pandemic, and even before the 2009 H1N1 influenza pandemic. The first one, the Seventh Cholera Pandemic, has been with us since 1961. It’s just that cholera primarily affects developing nations with poor water and sanitation, so it’s not urgent to solve it to most people living in developed countries. The vaccine for cholera is in short supply, with the United Nations and World Health Organization recommending half doses be given to try and stretch the supply.

Like the cholera pandemic, the HIV pandemic has been raging since the 1980s, affecting mostly marginalized communities within developed nations, and causing a crash in life expectancy in developing nations. Unlike other viruses, HIV is a nightmare when it comes to developing a vaccine for it. The virus is a “retrovirus,” and it hides well from the immune systems it destroys. All the coordinated efforts during my lifetime have failed to deliver an HIV vaccine, but there is hope. There are antiretroviral medications people at high risk of infection could take to prevent infection. People living…



René F. Najera, MPH, DrPH

DrPH in Epidemiology. Associate/JHBSPH. Adjunct/GMU. Epidemiologist. Father. Husband. (He/Him/His/El)