What is 'Disease X'? Why May It Be The Biggest Infectious Threat To Our World?
Our society is not prepared to handle Disease X
You may have heard of the term “Disease X” and that it’s on the World Health Organization’s (WHO’s) list of priority diseases. That list includes wonderful stuff like COVID-19, Crimean-Congo hemorrhagic fever, Ebola virus disease, Marburg virus disease, Lassa fever, the Middle East respiratory syndrome coronavirus (MERS-CoV), the Severe Acute Respiratory Syndrome (SARS), Nipah and henipaviral diseases, Rift Valley fever, and Zika—basically, a bunch of things that you wouldn’t want at a dinner party. All of these are the result of pathogens already known to cause very bad diseases in humans with one notable X-ception: Disease X. Disease X is not an actual disease yet and has nothing to do with the X-Men or Generation X. It instead represents “the knowledge that a serious international epidemic could be caused by a pathogen currently unknown to cause human disease,” in the words of the WHO. As the saying goes, the most dangerous enemy in the world is the one that you do not yet recognize.
Think about all the major infectious outbreaks and epidemics that have occurred over the past couple of decades or so. How many people thought SARS and MERS specifically would be problems before their outbreaks began in 2002 and 2012, respectively? How people were talking about the Zika virus before 2015? Or the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) before 2020? Heck when most people thought of “corona” before the COVID-19 pandemic, they probably envisioned the beer. Sure, coronaviruses were already on the National Institutes of Health (NIH) be-forewarned-about-these-pathogens list before 2020 especially since SARS and MERS had already shown that coronaviruses could jump from other animals to humans and cause trouble. But the SARS-CoV-2 was a totally novel virus.
Plus, SARS-CoV-2 never really announced, “The year 2019 will be my debut in humans.” Epidemics and pandemics aren’t like the Barbie, Oppenheimer, or Avengers movies. They don’t offer tons of trailers or other heads-ups before they arrive. By the time you’ve heard of them, it can be too late.
The trouble is that too many infectious disease preparedness and response plans have historically been too focused on specific known diseases and reliant on lessons learned from the past rather than being pathogen-agnostic and looking at what may be different in the future. That’s because so much of health and public health research and policy-making has long been siloed into different separate disease areas that don’t cross-talk as much as they should.
For example, when I was in medical school, a professor once told me that the key to career success is to pick one disease and one body part and focus on doing nothing but that for the rest of my career. I didn’t end up doing that because I couldn’t choose a single favorite disease or body part. In my mind, body parts kind of work better when they’re connected to one another.
As another example of the over-siloing of medical and public health research, when you apply to organizations like the National Institutes of Health (NIH) for research funding, it’s typically better to specify on the grant proposal what specific disease you want to focus on for the proposed project. After all, the people reviewing your grant proposal tend to be specialists in single diseases and assess your proposal from that perspective.
Psychologically, it may be easier to identify a clear single enemy, put a face and name to it, and then focus on tackling that specific enemy. However, such an approach can lead to plans that are way too focused and not flexible, so that the plans only work under limited conditions. That’s kind of like having your wardrobe be all Spanx simply because at some point there was a Spanx party where you missed the mark. Plans that focus on the known and not the unknown can soon go to waste. As Mike Tyson, former puncher of faces, once said, “Everyone has a plan until they get punched in the face.” When was the last time that you completely anticipated the biggest challenges that you ended up facing in your life?
Keep in mind that epidemics frequently result more from broken systems than from specific pathogens. Sure, you need a pathogen to actually cause the disease. But faulty systems are what allow a pathogen to go from a smaller concern—such as causing isolated cases—to a much larger one such as an outbreak, epidemic, or pandemic. Think about how much better things could have been had there been adequate systems in place to rapidly detect and contain the SARS-CoV-2 before it had spread further. Consider how many lives could have been saved and how much suffering could have been prevented had the U.S. and other countries had the right systems in place to slow, or even better, stop the spread of the virus in 2020. Instead, the SARS-CoV-2 spread in such an uncontrolled manner throughout February and March of 2020 that political and business leaders felt compelled to enact work and school closures.
Unfortunately, there’s still a lack of adequate systems to prevent and deal with unexpected and rapidly emerging infectious disease threats. There needs to be more Disease X marks-the-spot general approaches to infectious disease prevention and control such as:
Building and maintaining surveillance systems that can detect and follow any new pathogen: There is a need for systems that can detect whenever something is out of the ordinary and concerning—such as a change in climate, animal behavior, or symptoms and healthcare-seeking behavior among people—before it actually becomes a real problem.
Improving our messed up healthcare systems: Making sure that everyone has good access to healthcare is not just a nice thing to do. It also can help ensure that diseases are caught and controlled quickly before they spread to everyone else.
Augmenting systems that can conduct research and development for unknown and emerging infectious diseases before outbreaks, epidemics, and pandemics occur: Much more research and development needs to occur way before problems emerge and not just after the cow has left the barn and the bleep has hit the fan. And such activities should develop solutions that are not simply pathogen-focused but rather will apply to many different pathogens and circumstances.
Fixing and growing supply chain and other delivery systems: Vaccines, medications, and other products can’t work if they don’t get to where they have to go. And during the COVID-19 pandemic, there have been shortages of, well, seemingly everything, as I have described for Forbes.
Establishing financial systems that will pay for everything: If you've figured out how to get something done without money, let me know. Otherwise, when politics and greed stall the allocation of funds to combat epidemics, everyone ends up suffering, except, of course, for the pathogen.
These are just a few of the systems that need to be fixed and further enhanced to deal with Disease X before it inevitably comes. “Preparing for Disease X” is going to be one of the panel discussions during this week’s World Economic Forum in Davos, Switzerland. The description of the panel includes the following: “With fresh warnings from the World Health Organization that an unknown ‘Disease X’ could result in 20 times more fatalities than the coronavirus pandemic, what novel efforts are needed to prepare healthcare systems for the multiple challenges ahead?” With the possibility of 20X more fatalities, shouldn’t the possibility of Disease X get more attention?
oh my! Thanks for sharing this!