Disease X, a hypothetical illness with the potential for 20 times more fatalities than the COVID-19 pandemic, will be the focal point of a panel discussion in Davos, Switzerland, on Wednesday, where international leaders will gather to deliberate on the potential looming threat.
The World Economic Forum is slated to hold a meeting called Preparing for Disease X, with a panel of speakers including the World Health Organization (WHO) and pharmaceutical company AstraZeneca, who will discuss “what novel efforts are needed” to prepare the health-care system for the potential challenges ahead.
“Disease X represents the knowledge that a serious international epidemic could be caused by a pathogen currently unknown to cause human disease,” the WHO states on its website. The goal is to be prepared as much as possible for an unknown “Disease X,” it added.
“Disease X is a hypothetical scenario where a very nasty disease, which is more powerful than COVID-19, emerges,” explained Kerry Bowman, a professor of bioethics and global health at the University of Toronto.
“It is the preparation for a hypothetical situation in terms of how the entire world would respond to a rapidly emerging disease threat.”
Preparation vs. prevention
Although preparation is a great tool, Bowman worries that prevention has not been highly discussed, especially since the COVID-19 pandemic broke out. He believes the greatest Disease X threat would be zoonotic, which means a disease that emerges in an animal.
An example of a zoonotic disease is the H1N1 influenza virus, commonly known as swine flu.
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“And with the amount of animals that are being decimated around the world and the amount of loss of forest, we’re opening up that threat more and more,” he said. “One of the concerns I have is: does it not make more sense to focus on prevention as well as preparation?”
Approximately 1.67 million undescribed viruses are thought to exist in mammals and birds, up to half of which are estimated to have the potential to spill over into humans, according to a 2021 study published in the Indian Journal of Medical Research.
The risk of the emergence of these yet-to-be-identified threats grows larger with increasing human population, loss of biodiversity, changing climates, aggressive land use for human habitation and agriculture, all of which contribute to the expanding interfaces between humans, animals and the environment, the authors state.
The most recent example is the novel coronavirus, SARS-CoV-2, which started spreading globally in late 2019. The virus has since infected hundreds of millions of people and resulted in more than 6.8 million deaths worldwide, according to the latest data collected from Johns Hopkins Coronavirus Resource Center.
How the coronavirus initially began affecting people remains unclear. However, international scientists who examined previously unavailable genetic data from samples collected at a market close to where the first human cases of COVID-19 were detected in China said they found suggestions the pandemic originated from animals, not a lab.
When was Disease X first discussed?
Recognizing the importance of emerging infectious diseases (EIDs), the World Health Organization (WHO) highlighted Disease X, a currently unknown pathogen capable of causing a serious human epidemic, as a target for research and development in its 2018 Blueprint of Priority Diseases.
Because of this lingering threat, in 2018 the WHO gave this unknown future outbreak a placeholder name in its R&D Blueprint: Disease X.
Disease X isn’t yet known to exist, but health officials recognize that the next big outbreak could come from a virus they’ve not yet encountered, so they want to be ready.
The document lists the illnesses that the WHO believes could pose a serious risk to public health, such as the Ebola virus, the Zika virus and severe acute respiratory syndrome (SARS).
‘There’s a missing piece’
Bowman suggested that, given the global shortcomings in planning for COVID-19, particularly in safeguarding vulnerable populations, it is essential to examine the lessons from COVID-19 before embarking on preparations for future pandemics.
“I don’t see how we can prepare for the future without dealing with the past. It just doesn’t make sense to me,” he said. “Disease X is a preparation for the future and I don’t see how we do that without taking stock of what we’ve learned so far. There’s a piece missing there.”
For example, he said we made “a lot of mistakes” within our own country, particularly in the long-term care of older adults.
“We really did very little to protect them,” Bowman said.
In July 2023, the BMJ medical journal called for an independent inquiry into Canada’s COVID-19 response. In a series of articles, experts from 13 organizations across Canada, including doctors, nurses, researchers, and law and humanitarian specialists, wrote about the shortfalls in Canada’s COVID-19 response. This included difficulty reaching vulnerable and marginalized populations who were most at risk, the catastrophic deaths in long-term care homes and inconsistent public health messages across provinces and territories.
“Lessons from a previous outbreak of, SARS-CoV-1 — which in 2003 impacted more Canadians than anywhere else outside of Asia— went unheeded and left the country’s governments and health authorities ill-prepared for COVID-19,” one of the articles states.
The articles also acknowledge successes in Canada’s pandemic response, including a vaccination rate of more than 80 per cent.
Bowman expressed concern that little progress has been made in terms of future preparedness and prevention since the onset of COVID-19. He suggested the potential implementation of surveillance measures and homemade vaccines.
“A lot of Disease X talks tends to be how we can get vaccines out there the fastest way possible,” Bowman said. “But what did we learn from COVID-19 and how will that inform planning for Disease X?”
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