MICHEL MARTIN, HOST:

The United States has now reached and surpassed a milestone that once seemed hard to imagine, 700,000 deaths from COVID-19. And while the summer surge of new cases fueled by the delta variant appears to be slowing, the mounting toll reminds us that this pandemic is far from over. Yet those who watch this field closely say our focus should already be on preparing for the next one. Science reporter Ed Yong wrote about this for The Atlantic this week. His piece is titled "We're Already Barreling Toward The Next Pandemic." And Ed Yong is with us now. Welcome. Thank you so much for joining us.

ED YONG: Hi. Thanks for having me again.

MARTIN: First of all, I just have to ask the basic question. Like, what's the argument for looking ahead to the next pandemic when in the U.S. right now, you know, we are having fights over whether kids should wear masks in schools? I mean, shouldn't we figure out how to end this one first?

YONG: I understand that. But sadly, the answer is no. And that's for two reasons. The first is that while we would love to think of this as a once-in-a-lifetime pandemic, I assure you it isn't. More infectious diseases, more new ones are incoming. They could happen at any time. And we might not have the luxury of only facing down one every decade or even one at a time. But the bigger and more important answer, I think, is that history has shown us that every major epidemic creates a wave of interest and attention that is rapidly followed by a phase of neglect. Experts have talked about this panic-neglect cycle for years, for as long as I have been reporting on this topic. And it means that if we wait until COVID is no more to think about the next pandemic, we will already be well into the point where the window for preparing for the next one has closed.

MARTIN: You know, the Biden administration has introduced a pandemic preparedness plan to do exactly what you said, to address future health crises. It has a price tag of $65 billion. In your article, you say that public health experts don't think that's enough. Why is that?

YONG: Simply because all the estimates we've heard about how much it would take to actually get pandemic preparedness are substantially higher. The bigger issue, I think, is not just about the amount of money but also whether it is sustainable because what COVID teaches us is that you can have all the biomedical, shiny tools that you want. But if you deploy that onto a society with gross inequities, with a public health system that is weak and has been allowed to rot for a century and a health care system that millions of people still can't access, then they lose a lot of that power. We cannot simply expect these panaceas - vaccines and drugs - to get us out of pandemics which are fundamentally a societal problem. They need massive societal fixes to address.

MARTIN: You know, you make this point very strongly in your piece. You say, inequity reduction is not a side quest of pandemic preparedness. It is arguably the central pillar, if not for moral reasons, then for basic epidemiological ones, that infectious diseases can spread from the vulnerable to the privileged. Could you just talk a bit more about this connection between social equality and pandemics? Because the other point you make in your piece is that people used to make that argument...

YONG: Yes.

MARTIN: ...Right? - that...

YONG: Yes.

MARTIN: ...That was an argument that earlier in our history was commonly made but ceases to be so now. So talk a little bit more about why it's important, and talk a little bit more about why we don't talk about it anymore.

YONG: So we - wherever the virus goes, we see that its burden dramatically falls upon people who have less privilege in terms of race, in terms of class and other axes. And there's a tendency, I think, to sort of think of this as like as a yeah, but, as a sidebar to the main issue of the pandemic. It is, in fact, the central issue.

There was a point when we actually recognized this to be true. In the 19th century, a lot of scholars in both Europe and the U.S. recognized that epidemics were fundamentally influenced by factors like poor sanitation or overcrowding. But once we started understanding that diseases were the work of microbes, once germ theory became ascendant, people lost to that social focus. Like, germ theory gave everyone a villain, a target. You could think about diseases entirely in terms of a patient versus a pathogen. And that's still how we think of them. That's very alluring. But it misses out the entire context in which that battle between person and virus takes place. And without that context, we're missing a really important part of what preparedness actually means.

MARTIN: So even taking into account everything that you've said about the way this is all related - it's related to working conditions, it's related to living conditions, it's related to sickly, food, all these things - is there something that in the public health sector that needs to be looked at now to better position the country for the future?

YONG: If you look at health care spending in the U.S., public health received, I believe, just over three cents per medical dollar back in the 1930s. You skip forward almost a century, and now it gets just over two cents. So it's still very much been relegated to secondary status in comparison to medicine. And by public health, I'm talking about things that prevent diseases in communities. I'm talking about people who have to provide services like, well, vaccinations, sanitation. They look after, like, housing conditions. They think about tobacco control and the opioid epidemic. And they have to do all of these things on ridiculously small budgets. And unless we actually get investments to fix that, it just will continue that way. And always, whenever investments are made, they are always eroded. What we need now is a stable source of public health funding that is, you know, immune to the kinds of appropriation cycles that Congress has to go through every year. People need money. And they need a law, right? People have estimated that it will take about $4 1/2 billion every year just to get the system up to scratch, let alone to, like, make it great.

MARTIN: That is Ed Yong. We are talking about his piece for The Atlantic titled "We Are Already Barreling Toward the Next Pandemic." Ed Yong, thank you so much for sharing your reporting and your insights with us today.

YONG: Thanks for having me. Transcript provided by NPR, Copyright NPR.