Pondering the pandemic and public health

An exclusive interview with Dr. Michael Osterholm

LORI ANN REINHALL
Editor-in-chief
The Norwegian American

JOHN ERIK STACY
The Norwegian American

Dr. Michael Osterholm is a Regents Professor and Director of the Center for Infectious Disease Research and Policy at the University of Minnesota. He is a tireless proponent of public health. He often appears on television news programs as an authority on pandemic intervention and preparedness. For those interested in a deeper dive, he has maintained a YouTube channel throughout the COVID-19 crisis. On Nov. 9, 2020, he was named a member of President-elect Joe Biden’s COVID-19 advisory board. He generously accepted our invitation to be interviewed by The Norwegian American.

Lori Ann Reinhall: Good morning, Dr. Osterholm! Thank you for taking the time for us. To start, I want to ask you about your connection to the Nordic community. The name Osterholm sounds very Swedish.

Michael Osterholm: It is Swedish, actually. And even worse, I was born and raised an Irish Catholic. My mother’s family name was Ryan. But I went to Luther College, and I’m on the board of regents there right now, so I still have a lot of contacts. I’m back all the time. I’ve been teaching at Luther pretty much since I left to go back to the University of Minnesota, so I have a lot of ties back to Luther.

John Erik Stacy: I want to start with a general question: What message would you like to send to the Norwegian Americans who read our paper? 

MO: Well, I think first of all, if I had to pick a single country in the world that has led the way and tried to prepare the world for infectious disease and calamities like we’re seeing right now, it has been Norway— I mean, if you look at what they have donated on a global basis, and particularly given population size. When it comes to trying to develop new and better vaccines and just supporting the overall global response to this effort, it’s Norway. Some of my most fond memories around the issue of infectious disease and vaccines, it’s been in Oslo. I’ve been very involved with activities there. And there’s a group called the Coalition for Epidemic Preparedness Innovation (CEPI). It actually had its genesis in the Norwegian government. And today, it is a leading organization trying to develop vaccines and to make sure that they’re available for the world.

Yes, it all started in Norway. In fact, that’s where I attended numerous meetings three, four years ago, to try to help establish CEPI. I was part of the group that helped set that up, but it was clearly the Norwegian government [that took the lead]. That was the main motivating aspect to that, and many of the leadership positions early on in the organization were filled by Norwegian government officials or public health officials. So, from that perspective, I got to do two things at once. I got to go visit one of the most beautiful countries in the world with some incredible people and also further the science of what it is that we’re trying to do. 

And I might add that, on top of that, there was a gentleman not far from the museum and the office for the Nobel Prize I remember from my each of my visits. He’s a city worker, who during the lunch hour sits on a bench, eats his lunch, and feeds the pigeons—and they know him so well. I have pictures of this. They come and sit on his shoulder, on his hand, and on his arm. And he literally handfeeds them. To me it was one of those signs; it’s almost a lesson on its own. Why did these pigeons come to have such a relationship with this individual and his kindness and his goodness to them? It was symbolic for me of what I think of when I think of Norway. I have to tell you that I would literally leave meetings at lunch to go out and watch him, just because it was such a peaceful and such a giving thing. 

JES: Yes, I think there’s a sort of gentle kindness that you see in Norway. I mean, they’re not only descended from Vikings …

MO: The other thing I might add that is one of the things that has been of interest is that—realizing we have both the Swedish and Norwegian connection here—I think I have been one of the few people who has actually spoken at the Nobel Peace Prize Forum every year. I’ve spoken multiple times, and I’ve had the good fortune to cross over and also speak at the scientific Nobel Prize science annual program at Gustavus [Adolphus College in Minnesota]. And I’m actually one of the speakers again this year, and that one I’ve done multiple times. So, between the two conferences, the Peace Prize conference and the Nobel Prize science conference, I also have that connection back to the Norwegian roots of that activity there.

LAR: Interestingly, the approaches to COVID-19 in Norway and Sweden have been so different. Can you say something about that?

MO: Everyone has had a different theory about how best to contain this virus, and without exclusion, everyone has been wrong. And I say that in the sense that for four months early on in the pandemic, people kept saying that if you just did what Sweden did, you would see very different control aspects. And, of course, now we know that that wasn’t true at all. Sweden had major challenges with it. And we’re even seeing that in a country like China today with what I would call heavy-handed control measures, they’re still having a challenge. Just this past week, the third largest port in China was closed because of COVID-19. And so, you know, I don’t think any country has it exactly right. Clearly, vaccines are our first, second, and third best weapon against this virus. And to that extent, that’s what we all, I think, can agree upon is what’s really, really important.

JES: Do you have any ideas about how messaging could have been improved or can be improved for the future?

MO: Well, I think the answer to the question is, why are we where we’re at today? What has broken down in a human fight against a virus that would cause us to make it a human fight against humans? And I think that, by itself, it is still an unknown, and it’s not unique to the United States, although it’s probably more pronounced here than anywhere else. You’ve seen it, just look at what’s happening in Europe, look what’s happening even in places like Australia, and so forth. And so, I think the challenge we have today is that we’ve just assumed that we have this superiority over viruses or any other infectious agent, and they’re going to do whatever we tell it to do. And we each have a right as a citizen to have a voice in what we tell that virus to do. 

And first of all, we’ve learned that that’s a very simplistic way to look at it because these viruses are going to do what they damn please. And unless we have very specific tools, we’re not going to be able to change that. Again, coming back to vaccines, it is really the leading issue. 

Second of all is the fact that if you deny something, it doesn’t mean that it changes what happens. I can deny gravity. And then when I fall off a roof or a ladder, I come, unfortunately, very quickly to the reality of what gravity is all about. We’ve had a sizable portion of our population that has denied the existence of COVID-19 or its implications. And, unfortunately, today you can’t run the game clock out on this virus, which is highly infectious, and it means that if you’re not vaccinated, if you don’t have protection from previous infection, this virus will find you; this virus will infect you, and your outcome is then more in the hands of the virus. And, to some degree, the medical community in terms of what they can do for you.

JES: Is there more political will for a “bugs to drugs” and other readiness programs now, post pandemic?

MO: I think, you know, post this pandemic right now, you know when you’re up to your back side in alligators, it’s a hard time to think about draining the swamp, but we’ve got to, we’ve got to do that. And I wrote a lot about this in my 2017 book Deadliest Enemy: Our War Against Killer Germs. That was the whole layout of what we need to do and how to be better prepared. And so that remains true. And we are now realizing the power of this, of infectious agents and the fact that we can’t bend them at our will, you know, they bend us at their will. We have to basically outsmart them, and that’s where vaccines become very key. So, that is why the very question you’re asking is front and center. And we’ve got to learn from this pandemic, why investments in these tools are so critical in terms of saving lives, but also the economic cost to the world.

JES: If this had been a bioterror attack, I think people’s attitudes would be a lot different.

MO: I would like to think you’re right. But actually, everything speaks against that. And look at the fact that people all want to blame China, as if somehow it was an intentional attack against us. So, the whole Wuhan lab issue is front and center there. And it actually made it even more politically charged, in many cases, because of that issue. So, the logic you apply is absolutely right, but unfortunately the reality is different.

JES: What did the United States do right during the pandemic?

MO: I think clearly the whole vaccine initiative, operational work speed, getting these vaccines developed, was something very right. I think a lot of local and state public health agencies tried very hard to provide the most accurate and up-to-date information possible. And in that regard, I think the public had access to good information, whether they chose to use it or not, or if they relied on mis- or disinformation—whatever—but we’ve given them a lot of information.

JES: I believe that Minnesota suffered about 10 times the number of deaths than Norway [total deaths attributed to COVID-19 at the time of this writing are 7,760 in MN and 811 in Norway]. Norway and Minnesota have about the same number of people. Do you know what the different countries did differently?

MO: It’s also just a different population. If you look in this country, racial disparities have played a huge role in the increased occurrence of our cases that have occurred and how they’ve occurred. The other thing that was very key is how we handled our response to those who are older, the elderly 65 years of age and older. And the idea of long-term-care facilities was a major challenge. When you look at essential workers, meatpacking plants, for example, and so forth, we saw major increases in cases. And so, I think that the demographics lent themselves to a different response. If you were to look, there are places in Minnesota that looked a lot more like Norway than the state itself would look. And so, I think that’s the big difference.

JES: And then there were the urban versus rural aspects, too. I know the population of Norway is more spread-out than that of Minnesota, and its urban centers are smaller.

MO: Also, the Norwegians were not as inclined to take the public health messaging as a violation of their personal rights versus community good; I think that there was a much greater sense of community good. The question was, “What do we do to protect our communities?”  Here in this country, we said, “What are my rights?” Don’t tell me what to do or how to do it.” [These are] very different approaches. That’s one aspect of it. But clearly, again, the demographics made a big difference.

JES: Another thing that seems more prevalent here is the “disinformation as entertainment industry.” It seems that’s the kind of thing that gets clicks on YouTube.

MO: It’s been a challenge. I have to say in my 46 years in the business, I had never experienced getting death threats, and today, I just expect it. The amount of very unfortunate email and other messages I get is just remarkable. It’s a very different environment than I’ve ever experienced in my entire career. My job has never been political. I’ve served in roles in the last five presidential administrations. I was a science envoy for the State Department on pandemic preparedness during the Trump administration. I’ve been advising this administration through the Biden advisory transition advisory board, and now more formally, and, and yet people see this as all as politically motivated, and it’s just not. This has been a challenge.

I actually had a Civil War historian who I think actually gave us a very interesting perspective when he talked about what was happening with COVID-19 in the country and families. And he said, “For the first time in my life, I really better understand that sense of what it must have been like back in the Civil War to have half your sons go fight for the North and half for the South.”

Everything is seen through two prisms today. One is science and one is politics— and that’s unfortunate in that the light from one can cancel out the light from another, in this case, political light can cancel out science light. I have a cartoon that’s—I’m tongue in cheek—funny but also painful. It’s a gentleman at a computer screen, and he’s in a kind of office at his home. And his wife is in the background in the kitchen. And the quote is, “Honey. I just found all this information. None of the experts I’ve ever seen on vaccines now understand it.” You know, the citizen “scientist” takes over…

LAR: Dr. Osterholm, where are we at today? I’m based in Seattle. We were so happy when we could start taking off our masks and meeting people in larger groups again, but now things are changing again with the Delta variant. What’s your advice for the next month or so?

MO: Surges are going to be a challenge for us as a country. I mean, part of it is a psychology. You know, many people on the 4th of July were reeling to declare independence from COVID-19 day—and it wasn’t anywhere near ready. And for some of us who had been saying that, well, we were very unpopular—very unpopular. Now the reality is it’s here. And I think the next six to eight weeks are going to be very challenging. As I sit here today in Minneapolis and we’re on divert [emergency departments having patient load exceeding ability to treat additional patients promptly] for pediatric cases in the state and the city right now. There’s not a pediatric intensive care bed that’s open in the Twin Cities. And that’s happening in many locations around the country. And so, I think that’s what we have to deal with as the reality right now that this is going to be a real challenge.

LAR: Do you think the summer travel is playing into this as well?

MO: Any contact like that, the big fairs and festivals clearly, you know, we’ll see what Sturgis did last week. I’m interested even to see what happens after the CNN New York City welcome back concert. That’s going to be held this weekend, and they’re expecting a 100,000 people to come to that. And we’ve got 2 million people coming to the Minnesota State Fair starting at the end of next week. [This interview was recorded on Aug. 16. The CNN central park event was held on Aug. 21, and the Minnesota State Fair opened on Aug. 26.]

LAR: Well, I think that as Americans, we’re not all that patient; we want a quick fix to everything, but it’s not just the next couple of months …

MO: This is where the Norwegian perspective comes in. Norway has always understood that it is part of a global community, and that’s why they’ve always interacted so effectively because of that understanding, that mindset, this pandemic will go on as long as it’s spreading around the world. I mean, the very scientific integrity of our vaccines, whether are they working or not, is going to be challenged by new variants. And while we’re concerned about variants developing here, there are 6.4 billion people who live in low- and middle-income countries, for which less than 2% has had any access to vaccine. If you want to know where the variants are going to come from, that’s where they’re going to spin out, and that would very well challenge how well our vaccines work one day. So, we have got to be mindful of that. And, you know, you can argue that, trying to take care of the rest of the world is a humanitarian effort. And it surely is, but it’s also a strategic effort because that’s how we’re going to save our vaccines we have today from the pressure of these new variants. And so, I think that that’s one of the aspects of the leadership that, you know, Norway has always provided is that global perspective. And they’re doing it today, too. So, I say that I wish more of the world were like Norway.

LAR: So, do you think at some point this will be more like a flu virus?

MO: We’ll find out. I think we’re all learning yet. I mean, this is also where you need a dose of humility. You know, there are a lot of things we know, and we’re starting to put those forward, but there’s a lot of things also, we’re still learning, and it’s a combination of that. And you know, science by its very nature is what I call corrective science. We, as scientists, should always be correcting our work, meaning that we learn more, we apply it, we learn more, we apply it, and it doesn’t mean we were wrong before. It’s just that we’re learning more. It’s kind of like tacking a sailboat: you’re a little over this way, a little bit over this way until you get to the other end of the body of water. And unfortunately, I think that that’s what people today are impatient with. They think that we’re somehow not being truthful, or that we don’t know what we’re doing, but what you want is for science to always improve—you want it to get better. And the way that that happens is that you continue to work with it: you study it and you summarize it, you provide the data, and then you get better. So, I think that’s the challenge we have today, because most people don’t understand this. They want immediate answers. “Look what you said to us six months ago,” they say. And I think, that’s the challenge [we have] for people to understand.

LAR: Prime Minister Erna Solberg said last spring that maybe not everything Norway did was necessary, but it was the right thing to do.

MO: Yes, you have to make that assumption. You’re trying to contain a crisis, and you know you’ll always be accused of having not done enough, and you will always be accused of having done too much, all in the same sentence. Right? I think that’s what public health is all about. You know, my job, if I do it well, is not to be a historian and record cases. My job is to be an interventionist and prevent those cases from occurring.

JES: The Moderna and Pfizer vaccines are very “high tech” and require careful handling. Should there be a push to get the most robust vaccines out to the people who need them in all the corners of the world? Could the vaccines made in China and Russia help?

MO: We’re clearly looking at that in a way to evaluate how well they work. For example, there’s been some real challenges recently to how well [the Chinese made vaccines] Sinovac and Sinopharm are working. They’re not necessarily as effective as other vaccines. I think this is part of what we’re doing, as we’re building this plane at 30,000 feet to hold on and keep it from going down. And, yes, it’s getting better, but we still have more to do.

LAR: So, I guess the final question is whether we can be optimistic about the outcome of this.

MO: I believe in human ingenuity. I believe that we can accomplish a lot, and I choose to believe that it’s going to get better, because I have five grandchildren that I’m counting on every day that the world that I will be part of to leave for them will be a better world, even with COVID-19. That is one of the challenges.

LAR: Dr. Osterholm, thank you so much on behalf of The Norwegian American and our readers.

MO: Well, thank you, guys. And again, I’m very honored to be part of this whole area here, even as an honorary Swede. Okay, yes, sweet Irish Catholic—what a combo! See you later.

This article originally appeared in the Sept. 3, 2021, issue of The Norwegian American. To subscribe, visit SUBSCRIBE or call us at (206) 784-4617.