A parasitic infection linked to tainted lettuce has left thousands of people doubled over in pain this summer. Two people have died. For RAND's Saskia Popescu, the outbreak has been a reminder—of America's vulnerabilities, and of what it will take to close them.
Popescu is an epidemiologist by training—a disease detective—and a policy researcher at RAND. Her work focuses on helping the U.S. health system prepare for, and guard against, health threats, whether from an AI-engineered pathogen, a pandemic virus, or some bad lettuce.
Her career before RAND took her from the front lines of disease response to advising on an international treaty against biological weapons. During COVID, she coordinated testing, tracing, and disease prevention for Netflix across dozens of film productions. It's the kind of work she always wanted to do. She pulled on her first biohazard suit when she was eight years old, dressing up for Halloween as a virologist.
As a biosecurity expert, what stands out to you about this summer's Cyclospora outbreak and the response to it?
We call the food system America's soft underbelly, because it's so critical but so vulnerable. This outbreak really highlights that. I wasn't surprised that it was so tricky to identify the source. For these outbreaks, you're trying to identify likely sources and trends across dozens of cases, doing testing and tracing, even calling people and asking them what they ate weeks before. I knew early on, oh, this is going to be a challenge.
With an outbreak like this, it's not just about having funding and resources available, although that's critical. You also need coordination across agencies, public support, and effective communication. You need people in place who can take the information coming in and translate it into action. Identifying and closing any gaps in those areas would help us be more prepared for the next outbreak.
What health threats most concern you?
It's how we frame threats that worries me the most. We focus everything on a few big threats at the cost of others. But there are things we could be doing that would address the whole spectrum of threats. Investing in pathogen early warning systems like wastewater surveillance, for example. Scaling up manufacturing of personal protective equipment or PPE. Improving coordination across agencies and with the private sector.
AI is a big component of this. It has so much potential to pull information from all the different networks and nodes and really enhance our biosurveillance capabilities. But there's also a possibility that it could soon help someone develop a biological weapon or spread mis- or disinformation that could hinder a critical response. That's one of the big questions we're working on at RAND: How do you address those risks while ensuring that the guardrails we put up don't hinder legitimate science?
If you were advising policymakers on the next steps the United States should take to be ready for future threats, what would you recommend?
The first is just really making sure our biosurveillance network is as robust as possible against human, animal, and plant pathogens. And be loud about it. I was just recently part of an expert workshop at RAND looking at how to strengthen resilience and deterrence against biological threats. We need our adversaries to know that they won't be successful if they test our biodefenses, and that they will be caught.
Beyond that, we could build up our supply chains to make sure frontline workers have adequate respiratory protection when they need it. We just published a report on how to strengthen PPE manufacturing capacity in the United States, which highlights the role small- and medium-sized companies can play and how we can make our infrastructure more robust. We could also make sure hospitals don't just have plans in place to deal with public health emergencies but that they train for them regularly. We could work to get ahead of the health misinformation and disinformation campaigns that we know our adversaries invest in.
And then, we really need to rebuild public trust—in the federal response, in state responses, and in science. We have a public right now that is less likely to follow public health guidance, and we need to address that.
We have a public right now that is less likely to follow public health guidance, and we need to address that.
How does your experience in the field shape the work you do now at RAND?
We've been looking at that gap in biosurveillance between what we need and what is currently in place. I worked several years ago on Ebola response and analysis, and one thing we saw was a disconnect between detection and response. It's like a fire alarm at your house. When it goes off, you need to be home, you need to hear it, you need to know what it means, and you need to be able to call 911. In health, there's too often a gap between when reports start coming in and when an effective response gets underway.
So we're looking at existing programs and trying to define: What is the perfect state of biosurveillance? But more broadly, we're really working at RAND to help build resilience to the whole spectrum of threats. It's not just the intersection of AI and biotechnology. It's not just about building more robust biosurveillance networks. It's looking at how we can improve our entire response, upstream and downstream.
