Disease X is a placeholder name that was adopted by the World Health Organization (WHO) in February 2018 on their shortlist of blueprint priority diseases to represent a hypothetical, unknown pathogen that could cause a future epidemic. [4] [5] The WHO adopted the placeholder name to ensure that their planning was sufficiently flexible to adapt to an unknown pathogen (e.g., broader vaccines and manufacturing facilities). [4] [6] Director of the US National Institute of Allergy and Infectious Diseases Anthony Fauci stated that the concept of Disease X would encourage WHO projects to focus their research efforts on entire classes of viruses (e.g., flaviviruses), instead of just individual strains (e.g., zika virus), thus improving WHO capability to respond to unforeseen strains. [7] In 2020, experts, including some of the WHO's own expert advisors, speculated that COVID-19, caused by the SARS-CoV-2 virus strain, met the requirements to be the first Disease X. [1] [2] [3]
In May 2015, in pandemic preparations prior to the COVID-19 pandemic, the WHO was asked by member organizations to create an "R&D Blueprint for Action to Prevent Epidemics" to generate ideas that would reduce the time lag between the identification of viral outbreaks and the approval of vaccines/treatments, to stop the outbreaks from turning into a "public health emergency". [4] [9] The focus was to be on the most serious emerging infectious diseases (EIDs) for which few preventive options were available. [9] [10] A group of global experts, the "R&D Blueprint Scientific Advisory Group", [11] was assembled by the WHO to draft a shortlist of less than ten "blueprint priority diseases". [4] [5] [9]
Since 2015, the shortlist of EIDs has been reviewed annually and originally included widely known diseases such as Ebola and Zika which have historically caused epidemics, as well as lesser known diseases which have potential for serious outbreaks, such as SARS, Lassa fever, Marburg virus, Rift Valley fever, and Nipah virus. [5] [10] Since then, COVID-19 has been added to the list. [12]
In February 2018, after the "2018 R&D Blueprint" meeting in Geneva, the WHO added Disease X to the shortlist as a placeholder for a "knowable unknown" pathogen. [4] [6] [13] The Disease X placeholder acknowledged the potential for a future epidemic that could be caused by an unknown pathogen, and by its inclusion, challenged the WHO to ensure their planning and capabilities were flexible enough to adapt to such an event. [5] [14] [15]
At the 2018 announcement of the updated shortlist of blueprint priority diseases, the WHO said: "Disease X represents the knowledge that a serious international epidemic could be caused by a pathogen currently unknown to cause human disease". [5] [6] [16] John-Arne Røttingen, of the R&D Blueprint Special Advisory Group, [8] said: "History tells us that it is likely the next big outbreak will be something we have not seen before", and "It may seem strange to be adding an 'X' but the point is to make sure we prepare and plan flexibly in terms of vaccines and diagnostic tests. We want to see 'plug and play' platforms developed which will work for any or a wide number of diseases; systems that will allow us to create countermeasures at speed". [6] [10] US expert Anthony Fauci said: "WHO recognizes it must 'nimbly move' and this involves creating platform technologies", and that to develop such platforms, WHO would have to research entire classes of viruses, highlighting flaviviruses. He added: "If you develop an understanding of the commonalities of those, you can respond more rapidly". [7]
Jonathan D. Quick, the author of End of Epidemics, described the WHO's act of naming Disease X as "wise in terms of communicating risk", saying "panic and complacency are the hallmarks of the world's response to infectious diseases, with complacency currently in the ascendance". [17] Women's Health wrote that the establishment of the term "might seem like an uncool move designed to incite panic" but that the whole purpose of including it on the list was to "get it on people's radars". [18]
Richard Hatchett of the Coalition for Epidemic Preparedness Innovations (CEPI), wrote "It might sound like science fiction, but Disease X is something we must prepare for", noting that despite the success in controlling the 2014 Western African Ebola virus epidemic, strains of the disease had returned in 2018. [19] In February 2019, CEPI announced funding of US$34 million to the German-based CureVac biopharmaceutical company to develop an "RNA Printer prototype", that CEPI said could "prepare for rapid response to unknown pathogens (i.e., Disease X)". [20]
Parallels were drawn with the efforts by the United States Agency for International Development (USAID) and their PREDICT program, which was designed to act as an early warning pandemic system, by sourcing and researching animal viruses in particular "hot spots" of animal-human interaction. [21]
In September 2019, The Daily Telegraph reported on how Public Health England (PHE) had launched its own investigation for a potential Disease X in the United Kingdom from the diverse range of diseases reported in their health system; they noted that 12 novel diseases and/or viruses had been recorded by PHE in the last decade. [22]
In October 2019 in New York, the WHO's Health Emergencies Program ran a "Disease X dummy run" to simulate a global pandemic by Disease X, for its 150 participants from various world health agencies and public health systems to better prepare and share ideas and observations for combatting such an eventuality. [23] [24]
In March 2020, The Lancet Infectious Diseases published a paper titled "Disease X: accelerating the development of medical countermeasures for the next pandemic", which expanded the term to include Pathogen X (the pathogen that leads to Disease X), and identified areas of product development and international coordination that would help in combatting any future Disease X. [25]
In April 2020, The Daily Telegraph described remdesivir, a drug being trialed to combat COVID-19, as an anti-viral that Gilead Sciences started working on a decade previously to treat a future Disease X. [26]
In August 2023, the UK Government announced the creation of a new research center, located on the Porton Down campus, which is tasked at researching pathogens with the potential to emerge as Disease X. Live viruses will be kept in specialist containment facilities in order to develop tests and potential vaccines within 100 days in case a new threat is identified. [27]
In January 2024, during the World Economic Forum's annual meeting, Disease X was once again discussed as being a potential threat following the COVID-19 pandemic. [28] [29]
A paper published in 2022 listed the following strategies in preparation for Disease X: [30]
On the addition of Disease X in 2018, the WHO said it could come from many sources citing hemorrhagic fevers and the more recent non-polio enterovirus. [6] However, Røttingen speculated that Disease X would be more likely to come from zoonotic transmission (an animal virus that jumps to humans), saying: "It's a natural process and it is vital that we are aware and prepare. It is probably the greatest risk". [6] [10] WHO special advisor Professor Marion Koopmans, also noted that the rate at which zoonotic diseases were appearing was accelerating, saying: "The intensity of animal and human contact is becoming much greater as the world develops. This makes it more likely new diseases will emerge but also modern travel and trade make it much more likely they will spread". [10] [31]
From the outset of the COVID-19 pandemic, experts have speculated whether COVID-19 met the criteria to be Disease X. [32] [33] In early February 2020, Chinese virologist Shi Zhengli from the Wuhan Institute of Virology wrote that the first Disease X is from a coronavirus. [3] Later that month, Marion Koopmans, Head of Viroscience at Erasmus University Medical Center in Rotterdam, and a member of the WHO's R&D Blueprint Special Advisory Group, [8] [34] wrote in the scientific journal Cell , "Whether it will be contained or not, this outbreak is rapidly becoming the first true pandemic challenge that fits the disease X category". [2] [35] [36] At the same time, Peter Daszak, also a member of the WHO's R&D Blueprint, wrote in an opinion piece in The New York Times saying: "In a nutshell, Covid-19 is Disease X". [1]
At the 2018 announcement of the updated shortlist of blueprint priority diseases, the media speculated that a future Disease X could be created intentionally as a biological weapon. [37] In 2018, WHO R&D Blueprint Special Advisor Group member Røttingen was questioned about the potential of Disease X to come from the ability of gene-editing technology to produce synthetic viruses (e.g., the 2017 synthesis of Orthopoxvirus in Canada was cited), which could be released through an accident or even an act of terror. Røttingen said it was unlikely that a future Disease X would originate from a synthetic virus or a bio-weapon. However, he noted the seriousness of such an event, saying, "Synthetic biology allows for the creation of deadly new viruses. It is also the case that where you have a new disease there is no resistance in the population and that means it can spread fast". [10]
In September 2019, Public Health England (PHE) reported that the increasing antibiotic resistance of bacteria, even to "last-resort" antibiotics such as carbapenems and colistin, could also turn into a potential Disease X, citing the antibiotic resistance in gonorrhea as an example. [38]
In 2018, the Museum of London ran an exhibition titled "Disease X: London's next epidemic?", hosted for the centenary of the Spanish flu epidemic from 1918. [39] [40]
The term features in the title of several fiction books that involve global pandemic diseases, such as Disease (2020), [41] and Disease X: The Outbreak (2019). [42]
Disease X has become the subject of several conspiracy theories, claiming that it may be a real disease, or conceived as a biological weapon, or engineered to create a planned epidemic. [43] [44]
A pandemic is an epidemic of an infectious disease that has spread across a large region, for instance multiple continents or worldwide, affecting a substantial number of individuals. Widespread endemic diseases with a stable number of infected individuals such as recurrences of seasonal influenza are generally excluded as they occur simultaneously in large regions of the globe rather than being spread worldwide.
A zoonosis or zoonotic disease is an infectious disease of humans caused by a pathogen that can jump from a non-human to a human and vice versa.
An epidemic is the rapid spread of disease to a large number of hosts in a given population within a short period of time. For example, in meningococcal infections, an attack rate in excess of 15 cases per 100,000 people for two consecutive weeks is considered an epidemic.
An emerging infectious disease (EID) is an infectious disease whose incidence has increased recently, and could increase in the near future. The minority that are capable of developing efficient transmission between humans can become major public and global concerns as potential causes of epidemics or pandemics. Their many impacts can be economic and societal, as well as clinical. EIDs have been increasing steadily since at least 1940.
Plague Inc. is a real-time strategy simulation video game, developed and published by UK-based independent video game studio Ndemic Creations. The game was inspired by the 2011 film Contagion and the 2008 Adobe Flash game Pandemic 2. The player creates and evolves a pathogen to annihilate the human population with a deadly pandemic. The game uses an epidemic model with a complex and realistic set of variables to simulate the spread and severity of the plague. It was released on 26 May 2012 for iOS, 4 October 2012 for Android and 13 May 2015 for Windows Phone.
The Coalition for Epidemic Preparedness Innovations (CEPI) is a foundation that takes donations from public, private, philanthropic, and civil society organisations, to finance independent research projects to develop vaccines against emerging infectious diseases (EID).
John-Arne Røttingen is a Norwegian medical scientist, research administrator and civil servant. He is currently the Chief Executive Officer of the Wellcome Trust. Previously, he served as Ambassador for Global Health in the Norwegian Ministry of Foreign Affairs, and has been a special advisor to the World Health Organization (WHO).
Richard Hatchett is an American oncologist and epidemiologist who has been serving as chief executive officer of the Coalition for Epidemic Preparedness Innovations (CEPI) in Oslo and London since 2017. He was awarded the Secretary of Health and Human Services's Award for Distinguished Service.
Syra Madad is an American pathogen preparedness expert and infectious disease epidemiologist. Madad is the Senior Director of the System-wide Special Pathogens Program at NYC Health + Hospitals where she is part of the executive leadership team which oversees New York City's response to the Coronavirus disease 2019 pandemic in the city's 11 public hospitals. She was featured in the Netflix documentary series Pandemic: How to Prevent an Outbreak and the Discovery Channel documentary The Vaccine: Conquering COVID.
Michael Joseph Ryan is an Irish epidemiologist and former trauma surgeon, specialising in infectious disease and public health. He is executive director of the World Health Organization's Health Emergencies Programme, leading the team responsible for the international containment and treatment of COVID-19. Ryan has held leadership positions and has worked on various outbreak response teams in the field to eradicate the spread of diseases including bacillary dysentery, cholera, Crimean–Congo hemorrhagic fever, Ebola, Marburg virus disease, measles, meningitis, relapsing fever, Rift Valley fever, SARS, and Shigellosis.
Christian Heinrich Maria Drosten is a German virologist whose research focus is on novel viruses (emergent viruses). During the COVID-19 pandemic, Drosten came to national prominence as an expert on the implications and actions required to combat the illness in Germany.
Pandemic prevention is the organization and management of preventive measures against pandemics. Those include measures to reduce causes of new infectious diseases and measures to prevent outbreaks and epidemics from becoming pandemics.
Nahid Bhadelia is an American infectious-diseases physician, founding director of Center for Emerging Infectious Diseases Policy and Research (CEID) at Boston University and an associate professor at the Boston University School of Medicine. She served as the Senior Policy Advisor for Global COVID-19 Response on the White House COVID-19 Response Team.
Peter Daszak is a British zoologist, consultant and public expert on disease ecology, in particular on zoonosis. He is the president of EcoHealth Alliance, a nonprofit non-governmental organization that supports various programs on global health and pandemic prevention. He is also a member of the Center for Infection and Immunity at the Columbia University Mailman School of Public Health. He lives in Suffern, New York.
Maria Petronella Gerarda Koopmans is a Dutch virologist who is Head of the Erasmus MC Department of Viroscience. Her research considers emerging infectious diseases, noroviruses and veterinary medicine. In 2018 she was awarded the Netherlands Organisation for Scientific Research (NWO) Stevin Prize. She serves on the scientific advisory group of the World Health Organization.
Sylvie Champaloux Briand is a French physician who is Director of the Pandemic and Epidemic Diseases Department at the World Health Organization. Briand led the Global Influenza Programme during the 2009 swine flu pandemic. During the COVID-19 pandemic, Briand launched the WHO Information Network for Epidemics which looked to counter the spread of COVID-19 misinformation.
David Hayman is a New Zealand-based epizootic epidemiologist and disease ecologist whose general multi-disciplinary work focuses on the maintenance of infectious diseases within their hosts and the process of emergence and transmission to humans specifically related to bats. He has gathered data on the relationship between ecological degradation due to anthropogenic actions, and increased pathogen emergence in humans and animals. During COVID-19 he was involved as an expert in several international collaborations, some convened by the World Health Organization, and was a regular commentator in the New Zealand media about the country's response to the pandemic. He has had lead roles in research organisations at Massey University and Te Pūnaha Matatini and was the recipient of the 2017 Rutherford Discovery Fellowship Award. Since 2014 Hayman has been a professor at Massey University.
Gary P. Kobinger is a Canadian immunologist and virologist who is currently the director at the Galveston National Laboratory at the University of Texas. He has held previous professorships at Université Laval, the University of Manitoba, and the University of Pennsylvania. Additionally, he was the chief of the Special Pathogens Unit at the National Microbiology Laboratory (NML) of the Public Health Agency of Canada (PHAC) in Winnipeg, Manitoba, for eight years. Kobinger is known for his critical role in the development of both an effective Ebola vaccine and treatment. His work focuses on the development and evaluation of new vaccine platforms and immunological treatments against emerging and re-emerging viruses that are dangerous to human health.
By listing Disease X, an undetermined disease, the WHO is acknowledging that outbreaks do not always come from an identified source and that, as it admits, "a serious international epidemic could be caused by a pathogen currently unknown to cause human disease".
This hope now looks forlorn with the sudden emergence of the respiratory disease Covid-19, which has rapidly acquired most of the characteristic of a Disease X.