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Imagine it is 2024. For the last few years, it feels as if the world has largely moved past the COVID moment. There is a widely-shared sense that we have successfully dealt with our generation’s big challenge, and can now resume a calmer life. COVID was the worst pandemic in one hundred years, so we allowed ourselves to believe it would be at least another century before we faced anything so disruptive again. Unfortunately, this turns out not to be so. A new pandemic emerges, shutting down the world again, this time for a full two years.

Such a scenario likely seems farfetched. Not because it imagines a global pandemic shutting down the world—while that may have seemed farfetched two years ago, we now know it to be all-too plausible. No, it seems farfetched because imagining another pandemic so soon after the last one violates our bias towards thinking the world is much more predictable than it actually is. Within the framework of this bias, there is room for unprecedented challenges, but only with the unspoken assumption that, the world being predictable, unprecedented challenge will be followed by a long period of relative tranquility, giving us time to collectively regroup. That another global pandemic could conceivably follow COVID in the next three years speaks to a reality of our existence we do not like to acknowledge—that it is deeply uncertain. Regardless of whether or not we see another pandemic in 2024, the possibility that we could is indeed an uncertainty we must each day face.

Earlier this month, The New York Times ran a story with a headline which spoke to the uncertainty with which we live, “U.S. Finds No Evidence of Alien Technology in Flying Objects, but Can’t Rule It Out, Either.” The story concerned an upcoming government report on Unidentified Aerial Phenomena (UAPs), an updated term for what are more commonly referred to as UFOs. The article contained this eye-catching line:

“[S]enior officials briefed on the intelligence conceded that the very ambiguity of the findings meant the government could not definitively rule out theories that the phenomena observed by military pilots might be alien spacecraft.”

I realize there is a slight element of absurdity in bringing up the topic of UFOs. Given the stigma around the topic, it has been striking to see the subject raised by a range of credible figures, from sitting senators to former President Obama. The upshot of the renewed conversation around UAPs/UFOs is the admission, at the highest level of government officials who should know, that Navy pilots have been encountering objects in the sky that do not seem to behave like any known technology, and whose origins remain a mystery. As a consequence of the new conversation about UFOs, with many mainstream media outlets now taking the phenomenon seriously, 43 percent of Americans now say they are more interested in aliens or UFOs (Figure One—purple are US respondents, teal are UK respondents).  

Figure One
Source: Piplsay Web site. Accessed June 9, 2021.

The UFO story is, in many ways, a fitting complement to our year and a half of COVID. It reflects how suddenly new, unexpected issues can emerge, to dominate our thinking and reiterate the uncertainty of life. Think back to November of 2019. Few could have anticipated that, for much of the next 18 months, the world would be effectively shut down by a global pandemic. In this sense, both UFOs and COVID expose a bias in our thinking, a bias towards normalcy, towards routine. This bias shapes our decisions, influencing how we plan for crises and how we respond when disaster strikes. In disrupting this bias, our present moment has seen a return of radical uncertainty—a term coined by the bookRadical Uncertainty: Decision-Making Beyond the Numbers, by John Kay and Mervyn King. Some thoughts on how the return of radical uncertainty has upended our bias towards predictability, and how we can learn from this inflection point, to make better decisions about health.   

Both UFOs and COVID remind us that we live, always, in a context of uncertainty. It is sometimes possible to forget this. We can live much of our lives assuming that tomorrow will more or less resemble today, as we grow acclimated to the illusion of predictability. We know dramatic shifts can happen, but we tend to think they happen to other people, not to us. 

Yet history provides many examples of big shifts which can shake us out of this complacency. Much of my research has focused on how challenges like warsterror attacks, and natural disasters disrupt the status quo and shape health in the near- and long-term. This work has often brought to mind just how unexpected these events can seem to affected populations, how radically they upset a sense of the familiar, the predictable. We all know, of course, that disasters strike. But when they strike, they nevertheless seem inexplicable, shattering a status quo that seemed like the norm rather than the exception to the frequently chaotic and violent history of humanity. We must wonder: did the 6.6 million refugees of the Syrian civil war anticipate the disruption they faced? Did the victims of Hurricane Katrina see the storm coming, as a force to be reckoned with in their lives? Likely they did not, just as we do not always make the leap from accepting, in theory, the possibility of radical disruption to thinking it will affect us personally.

For example, let us look at our present moment. We long knew the world was vulnerable to pandemics, just as we have long known life on other worlds is distinctly possible, even likely. Nevertheless, COVID, and the sudden seriousness of the UFO topic, both feel like something out of another dimension, far removed from our everyday experience. In this sense, they return us to a feeling of radical uncertainty. This feeling characterized much of the human experience before our present era. For many ages, even the most common events could remind us of this uncertainty. For example, when we did not know where thunder and lightning came from, every storm was like a communication from the gods in whose hands it was widely assumed we all lived. In those days, our bias was towards an understanding of the world that made ample room for radical uncertainty—in contrast with our current era, when our bias is much the opposite. 

With this bias comes, I would argue, a certain lack of humility about our place in the world, informed by a slight overrating of what we know. So much of our sense of predictability rests on our capacity to understand the world through science. We no longer fear the gods when we hear thunder because science now tells us where thunder comes from. Even during the disruption of COVID, the expectation that we would soon have a vaccine helped temper the shock of the moment. This meant that much of the conversation about reopening society was shaped by the assumption that the pandemic would not stretch on indefinitely. This assumption allowed many to take more absolutist positions than they may have taken had it seemed like there was no vaccine in sight. Because of what we knew about making vaccines, we were able to feel like we knew something else, something we could not know—the future. This is a mistake to which we as humans are susceptible. Science provides us with a basis for understanding which helps mitigate the radical uncertainty of our natural state. All we have learned through science can make it possible to forget that our knowledge remains—indeed, may always remain—meager compared with all we have yet to learn. 

Nevertheless, we continue to make decisions about our health as if we knew far more than we actually do, as if the context in which these choices are made was far more settled than it is. Throughout the pandemic, I was struck by how much these assumptions informed the conversation around decisions made by various authorities. COVID was a time of deep uncertainty, as we faced a novel threat. Everyone who made decisions did so in a context of incomplete and changing information. It was a time which emphasized the importance of systems thinking in our approach to problems. Systems thinking is a perspective based on the premise that our lives are nested in a context of ever-evolving complexity. In this context, no choice is ever linear, in the manner of 1 + 1 = 2. Complexity means that decision-making must adopt a more multidimensional view, with the understanding that, even then, the presence of complexity means few choices will be entirely good or entirely bad. Contingency and unintended consequences abound, meaning that the best we can do is align our bias with the reality of uncertainty, try to see as much of the big picture as possible, and then make our choices. This is what many leaders had to do during COVID. Yet we constantly acted as if there were clear right or wrong answers, founded on a basis of empiricism, and that to make a choice that resulted in a mix of good and bad outcomes, with the bad sometimes outweighing the good, meant that the decision maker had ignored the science and simply acted out of foolishness or malice.         

An awareness of radical uncertainty helps us to see a more complicated picture. We need not discount the virtues of science or absolve leaders when they have made genuinely poor decisions to accept that choices made in a context of uncertainty will always be, to some extent, compromised, limited in scope, and subject to changing circumstances. This does not just apply to decisions made in times of crisis. The emergence of COVID was a reminder that uncertainty is always present. For this reason, a bias toward accepting uncertainty can help us to create a healthier world not only when navigating crises, but when times are good. Uncertainty calls to mind our shared vulnerability, a vulnerability which persists at all times and in all places. When we see this vulnerability, we can then work to create a more resilient society, understanding that, at any moment, this resilience might be tested.     

From this perspective, then, we can see how responding to a crisis like COVID means taking steps to prevent pandemics even when such crises do not seem imminent. This is the focus of my upcoming book, The Contagion Next Time, which explores how we can prevent the next pandemic by investing in the creation of a healthier world. In an uncertain world, where anything can happen and we are all vulnerable, supporting health means investing in the socioeconomic drivers of health, to help build our collective resilience. It means not resting with the development of vaccines, but going further, to close health gaps, build healthier cities, shape a fairer economy, and pursue social justice, so that no one is excluded from the social and material resources that support health. In my writing about natural disasters, I have framed this imperative through the lens of charity versus sustained investment in health. In the US, we are very good at providing charity to populations in need after a disaster, but less good at investing in communities before disasters, so that they are less vulnerable when the worst happens. To rely entirely on charity is to implicitly endorse the idea that our own circumstances will always keep us in a position where we are able to give when necessary. But the future is uncertain. At any moment, our own wellbeing could depend on our common investment in creating a healthier world. At that time, there may not be someone in a position to offer charity. Given this possibility, it will be all the more important that we have the humility to invest, in the present, in shaping a world which is healthier for all. 

Finally, it is important to note that accepting uncertainty has implications for how we live. When we accept that the future is radically uncertain, we have a greater incentive to live each moment with compassion, to seize the day, and to recognize health is a means to living a rich, full life, and not merely an end in itself. When we can do this, we are in a far better position to do right by our health, now and in the years to come. 


  • Sandro Galea is Dean and Robert A. Knox Professor at the Boston University School of Public Health. He has been named an "epidemiology innovator" by Time and one of the "World's Most Influential Scientific Minds" by Thomson Reuters. A native of Malta, he has served as a field physician for Doctors Without Borders and held academic positions at Columbia University, University of Michigan, and the New York Academy of Medicine. His new book, The Contagion Next Time, was published in fall 2021, and is available to order here:

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