Every week or so, scientists issue another warning that the bird flu H5N1 is about to explode into a pandemic. Despite facing a pandemic that broke out less than five years ago, the U.S. has no solid plan for handling a new one—nor have our leaders done anything to incorporate the lessons learned from its less-than-ideal handling of Covid-19.

Too many Americans have died from Covid because the public health community was slow to issue warnings, slow to create tests to assess the condition, and slow to broaden its response to include airborne transmission data. The lockdown much criticized could have been less disruptive and saved more lives if they had been adjusted periodically as data changed about who was most at risk and what activities were most dangerous.

Already, some of the same mistakes can be seen in the response to H5N1, which began in poultry before a new strain began infecting the country’s dairy cows. The US Department of Agriculture announced last week that it would begin sampling the nation’s milk to test for the virus. California proceeded with a recall of certain raw milk and raw milk products after the samples tested positive. But there is much more that could be done to reduce the chances of this situation turning into a pandemic.

Trump’s controversial choices in the event of a pandemic

In addition, the choices of President-elect Donald Trump to lead the nation’s top public health agencies — the officials who would be responsible for any pandemic response — have raised concerns among scientists and health experts. They include him Robert F. Kennedy Jr., a vaccine skeptic and raw milk enthusiast, for the top job of secretary of the Department of Health and Human Services. It also has ties to the California producer whose farm was the subject of a state recall after several batches of fresh dairy products tested positive for the virus. The farmer told Politico that he was asked to apply for the position of “raw milk adviser” at the Food and Drug Administration.

THE former Rep. Dave Weldon, who Trump chooses to lead the Centers for Disease Control and Prevention, promoted false theories about childhood vaccines as a member of Congress and was a critic of the CDC and its vaccine program. And to lead the National Institutes of Health, Trump named Jay Bhattacharya, author of the Great Barrington Declaration, which criticized the government’s response to Covid and advanced the theory – based on bad science – that the pandemic would end quickly through herd immunity. THE Marty Macariwho Trump picked to lead the FDA, promoted the same concept of herd immunity as he promised that even without a vaccine, Covid would disappear in several months.

We likely won’t know how these officials might handle the next crisis until Senate confirmation hearings early next year.

H5N1 warnings

Since the mid-1990s they have been noted periodic outbreaks of H5N1, commonly called bird flu, in the domestic bird population. But while fewer than 1,000 people worldwide have tested positive for the virus since then, scientists are concerned because it has killed half of those known to be infected. In 2022, the virus began showing up in mammals — foxes, bears, raccoons, sea lions, porpoises and mink — and then, in March of this year, in US dairy cows. Millions of chickens in the US have been euthanized to control outbreaks in poultry flocks, and in October, officials confirmed that the virus had been found in a pig here for the first time.

In a study of supermarket milk last April, virus fragments appeared in 58 of 150 samples. The scientists who conducted the study said the heat from pasteurization would kill the virus. But raw milk from infected cows is swarming with live virus—enough to kill splashed barn cats.

At least 60 confirmed cases of bird flu in humans have been reported this year in the US, including two in Arizona. Most were farm workers who had contact with livestock or poultry and their symptoms were mild. More troubling are the few cases whose origins remain a mystery, including a teenager in British Columbia who was hospitalized with a mutated version of the virus and a child in California who was diagnosed with moderate symptoms in November. There have been no confirmed cases of person-to-person transmission.

“In my opinion, it’s only a matter of time before we start seeing documented human-to-human transmission of this virus… because we continue to let this virus infect people and allow it to adapt to peoplesaid Seema Lakdawala, an immunologist at Emory University School of Medicine.

To reduce that chance, he says efforts should focus on minimizing outbreaks among cattle. This means not only tracking certain milk samples, but identifying individual infected cows and making sure they are isolated and their milk safely disposed of so it doesn’t get into irrigation water where it could infect other animals. He said that even if these cows are not killed, isolating them could prevent further spread.

The pandemic clock is ticking

Each new infection allows the virus to create millions slightly mutated copiesincreasing the chances of gaining the ability to easily jump from person to person. A study recently published in Science showed that the variant currently spreading in hundreds of herds needs a single mutation to gain the ability to attach to receptors on human cells.

Much remains unknown, including why bird flu has not started a pandemic. But at some point there will be another pandemic, said Michael Osterholm, an epidemiologist who has advised every president since Ronald Reagan and is now director of the University of Minnesota’s Center for Infectious Disease Research and Policy. “Tthe pandemic clock is ticking. We just don’t know what time it is“, he said.

Osterholm has researched Ebola, Zika and other deadly viruses. However, coronaviruses and influenza are by far the most likely to develop into global pandemics because they are easily transmitted through the air.

This means we need to plan for the eventuality – before it happens. And we need something more detailed than the National Security Council manual drafted during the Obama administration and famously ignored by Trump. He described organizing an initial pandemic response, such as connecting political leaders with scientific experts. But it did not include details about things like shutdowns, mask orders or other measures taken during Covid. Osterholm said writing a new plan should start with a bipartisan inquiry into how to handle Covid-19 — like the 9/11 commission. “Not to point a finger”he told me, but to prepare for next time.

A new book should also consider long-term sustainability. Osterholm said data available in spring 2020 showed that Covid was so easily contagious that the pandemic could last for years. And yet, no one wanted to hear it.

He argues that the US and China could have saved many more lives by briefly closing restaurants and other high-risk establishments when cases were rising. This strategy could have been maintained as long as the threat remained. In China, which lifted its strict lockdown of three years of zero Covid before the threat receded, the CDC estimates that 1.4 million people died in the first three months that the restrictions had been relaxed.

A new preparedness plan should also include more protections for essential workers and their families. During 2020, many people with known risk factors or elderly relatives at home were thrown into dangerous work situations.

The US suffered waves of deaths in the winter of 2020-2021 when many Americans could no longer bear to stay in their homes. Sustainability would matter even more if the next pandemic had a higher fatality rate.

While it is often repeated that more than a million Americans died, we have no breakdown of how they were infected and how they were at risk. It was not bad behavior but poor policy. Good politics is designed to work for human beings as we are. With Covid, everything was created on the fly. It doesn’t have to be like this next time.

FD Flam is a Bloomberg Opinion columnist covering science. He has the “Follow the Science” podcast.