NIH director Jay Bhattacharya’s pandemic plan: Why “make America healthy again” may leave the next outbreak unchecked

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In a recent essay, Jay Bhattacharya, director of the National Institutes of Health, laid out a strikingly different vision for how the United States should prepare for the next pandemic: do almost nothing during the outbreak itself and focus instead on making Americans physically healthier long before any pathogen arrives. Writing with his deputy Matthew Memoli, he argued that the country should abandon the established pandemic playbook and prioritise “metabolic health” as its central defence, the New York Times reported.

Their proposal rejects many of the public health tools that defined the early response to Covid-19. Social distancing, masks and even large-scale vaccine efforts such as Operation Warp Speed are dismissed as the wrong approach. Instead, they argue that a fitter population—leaner, more active and less burdened by chronic disease—would be able to withstand whatever infectious threat emerges.

The premise and its critics

The claim rests on a simple idea: healthier bodies perform better under stress. But critics say the logic oversimplifies both infectious disease and human vulnerability. More than 38 million Americans have diabetes, over 100 million have heart disease and roughly the same number are living with obesity. Even dramatic improvements in these numbers would still leave tens of millions at elevated risk if a dangerous pathogen emerged.

Public health experts also argue that this approach shifts responsibility away from government and onto individuals, creating what they describe as a form of “D.I.Y. pandemic response.” The concern is that such a framework could prioritise the survival of the fittest rather than protecting those most vulnerable.

Lessons from Covid: what mattered most

Research conducted during the Covid pandemic shows that chronic conditions did increase an individual’s risk of severe disease or death. However, age was by far the dominant factor. The risk associated with obesity or diabetes—roughly a 20 to 30 percent increase—was real but modest compared with the effect of being a decade older.

The data reveals that a fit 50-year-old was still at far greater risk than an obese 40-year-old. These findings challenge the idea that fitness alone can substitute for public health interventions in a fast-moving outbreak caused by a novel virus.

Why future pandemics will not look the same

The debate over how to respond to a future outbreak is complicated by the unpredictability of the next pathogen. Future pandemics may not resemble Covid-19, just as Covid-19 did not resemble SARS, MERS, H1N1 or HIV/AIDS. Some may spread more slowly, target children rather than older adults, or cause severe disease even among the healthy.

This uncertainty raises questions about whether it is wise to discard proven tools before scientists know what they will be facing. Behavioural measures like limiting indoor gatherings may matter greatly for one pathogen and be irrelevant for another. Preparing for the next pandemic, experts argue, requires flexibility rather than ideological commitments.

What Americans say they want in future emergencies

A recent poll found that Americans largely supported pandemic mitigation policies in retrospect, despite the political backlash that defined much of the Covid era. Respondents rated Democrats more positively than Republicans on handling the pandemic, believed school closures were necessary at the time and overwhelmingly supported routine vaccination schedules.

Yet when asked whether they would support similar measures in a future pandemic, the numbers shifted sharply. Only half said they would support restrictions on large indoor gatherings, fewer supported mask or vaccine mandates, and only a minority backed school closures—even under similar conditions.

The paradox of pandemic memory

This divergence reveals a deeper contradiction: Americans believe the measures taken during Covid were necessary, but they do not want to endure them again. The attitude reflects a broader social pattern in which difficult experiences are acknowledged as necessary in hindsight but resisted prospectively.

How long this consensus lasts is unclear. Memories of past crises—wars, epidemics and social upheavals—fade with each generation, reshaping how societies respond to new threats. In the early days of Covid, many believed that the shock of the pandemic would lead to more robust preparedness. Instead, the dominant national sentiment appears to be something far simpler: people do not want to live through anything like it again.