The Lamen

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Jan 24, 2024 | Health

Is the world prepared for a “Disease X” deadlier than COVID?

Disease X is hypothetical, but there’s no denying that another viral pandemic is brewing out there.

Image: Generated with Bing AI

The twenty-fourth letter of the alphabet is a mysterious rebel, a long-standing representative of the unknown. This limitless potential of the letter X has swooned the world’s richest man, representing a purpose beyond satisfying personal taste — it’s a diva that demands your attention.

This may explain the World Health Organization’s intention in 2018 when a group of experts convened by the agency coined the term “Disease X”: a hypothetical illness that would be caused by a pathogen that hadn’t yet been seen in humans.

Disease X would likely emerge from a virus originating in animals, the panel claimed, in a part of the world where infrastructure had trampled upon wildlife. It would be deadlier than seasonal flu but would spread just as easily among people. The virus would cross the borders of its continent of origin within weeks — bringing the global economy and residents of multiple countries devastated.

Disaster struck just a year later as reports of a mysterious disease turned up. The Wuhan pneumonia, as it was initially called, was caused by a virus that fit the template almost perfectly. Though epidemiologists and the WHO had been supposedly preparing for an oncoming unknown illness, the infection brought the world to its knees. A global crisis lasting nearly three-and-a-half years ensued, resulting in over 20 million deaths with several more suffering from its aftereffects. The “first” Disease X had a name: Covid-19.

Disease X has since become a placeholder that “represents the knowledge that a serious international pandemic could be caused by a pathogen currently unknown to cause human disease.” A panel of healthcare experts gathered during the World Economic Forum’s 2024 annual meeting brought renewed attention to the conceptual condition — urging policymakers to prepare for the next epidemic.

“It’s not a new idea,” said World Health Organization director-general Tedros Adhanom Ghebreyesus. In 2022, the WHO convened over 300 scientists to look into 25 virus families and bacteria — creating a list of priority pathogens with the potential to cause a “serious international epidemic.”

However, social media quickly started misrepresenting the conversation as a warning of an oncoming condition. A report from CBS claimed that Disease X could be 20 times deadlier than COVID-19. “There are some people who say this may create panic,” Tedros noted. “It’s better to anticipate something that may happen because it has happened in our history many times, and prepare for it.”

The coronavirus pandemic served as an extreme demonstration of where healthcare systems shined, and how they faltered. Much of the blame may fall on the WHO for not announcing an international emergency sooner and on the governments that failed to grasp the immediate threat. However, it was the lack of a global disease surveillance system that landed the initial blow.

The pandemic was a reality check: Viruses don’t play by the book

Epidemics throughout history have altered societies they inflicted, and the last one was no exception. Despite repeated warnings, the unpreparedness against coronavirus was sobering: Officials dismissed the threat, and communication of scientific data to the public was repeatedly quenched by misinformation. The government erroneously limited access to testing, fought over the decision to mandate masks, and remained divisive over inoculating the masses.

It spread unencumbered with ferocity in its initial weeks, proved variable in its effects, and even for the world’s strongest nation, resulted in some of the highest per-capita deaths in the world. The lockdowns called all forms of misery, slashed incomes, and led to mass layoffs — a direct consequence of our failure to isolate the virus.

The pandemic was plentiful in highlighting dysfunctional healthcare systems around the world. India, with its population second only to China at the time, was among the nations hardest hit by the coronavirus. Hospitals ran out of beds, ventilators, and oxygen cylinders while black marketeering of life-saving equipment was reported across several cities.

High-quality care was something only the wealthy could afford, but the complete lack of state protection made even basic testing and medical care inaccessible to the poor. With a nationwide lockdown leaving millions of rural-to-urban migrant families jobless, hunger became the primary concern for many.

The real eye-opener, however, was how the coronavirus pandemic upended nations with bolstering economies — particularly the U.S. A slow start to testing led to an uninformed response and consequent burdening of the healthcare system. Cases outpaced medical response and revealed shortages even in basic equipment and hospital beds. The social determinants of receiving healthcare were illustrated, and even health literacy came under the radar.

The coronavirus presented us with a surprising reality: there may be an airborne virus, that can be transmitted among people even if they don’t have symptoms, and continually mutates and disrupts daily life until the world achieves herd immunity. It also showed how vaccination coupled with robust guidelines can prevent grief for many.

A reservoir of pathogens unknown to humans, animals will most likely cause the next ‘Disease X’

With habitat destruction, we’ve brought animals closer to our doorsteps. Rising temperatures have turned our planet into a pathogen’s fantasy, making even a video game-esque post-apocalyptic future seem plausible. Covid-19 was a preview of how serious a threat animal spillovers represent.

It’s not the wildlife’s fault for carrying these viruses, but a result of how we’re trampling ecological boundaries that put us more in contact with these otherwise isolated viruses. Experts now believe that the next pandemic will most likely be zoonotic since “humanity has speezed the world’s wildlife in a crushing grip — and viruses have come bursting out.”

In search of habitable conditions, animals are on the move — and any inter-species interactions that happen along the way could result in terrifying consequences. Different species act as reservoirs to different viruses and bacteria, and these interactions present the microscopic pathogens with a unique opportunity: infecting an entirely new species that has evaded them for thousands of years. An unknown virus could similarly passed down to humans somewhere down the line.

A research published in Nature suggests that of at least 10,000 viruses with the ability to infect humans, the majority continue to hide inside wild mammals. Climate change and land-use scenarios by 2070 could drive 4,000 of these previously isolated viruses to spread between mammals for the first time — including humans, they predict.

An illustration of ancient viruses lying dormant beneath the surface.

Image: Generated with Bing AI

Migrating animals is far from the only cause of concern. Others fear that the next pandemic could be caused by a disease we know. Dengue and malaria are making a comeback owing to their spread being exacerbated by climate change. A meta-analysis revealed that climate change could aggravate over 50 percent of known infectious diseases in humans. Shifting temperatures and rainfall patterns present bacterial, fungal, as well as parasite-caused infections to spread and even evolve into more infectious agents.

There’s the possibility that pathogens frozen for centuries may thaw out — exposing us to infections against which no immunity currently exists. The Arctic, warming nearly four times faster than the rest of the world, has begun to release ancient microbes that long lay dormant. Rising permafrost temperatures paint a future where a long-forgotten virus could return to infect us in a time when our defense against them is non-existent.

The next ‘Disease X’ doesn’t have to turn into a pandemic

COVID, Ebola, SARS, MERS, and Zika all originated in animals. Vast amounts of funding have since flooded initiatives looking to predict what virus might jump into humans.

The Global Virome Project proposes cataloging 99 percent of all unknown viruses that pose a pandemic/epidemic threat. The idea is considered, however, a far stretch in the scientific community: prior knowledge about a virus doesn’t ensure preparation. There’s the added risk of unknowingly triggering an epidemic through the act of virus-hunting.

While a wide genomic survey would vastly advance our understanding of viruses, but it will “be of little practical value when it comes to understanding and mitigating the emergence of diseases,” commented infectious disease specialist Edward C. Holmes.

Careful surveillance of new emerging diseases in humans and animals is undoubtedly critical in predicting and preventing another outbreak. Genomic sequencing and a shared database of viruses are just some of the pillars that strengthen global defenses. More comprehensive wildlife surveillance efforts as well as better health care for those most at risk of spillovers — wildlife hunters, cattle rearers, and poultry farmers — can ensure some degree of protection against unencumbered spread.

But wildlife stakeouts don’t fix the problem: Covid-19 illuminated the less sensationalized threat of “spillback,” when viruses move from humans into animals.

“There are two reasons we’re concerned about spillback: the conservation and the public health components,” veterinary microbiologist Anna Fagre told Wired. “If this virus spills over into a species that is already hugely threatened by things like climate change, habitat loss, and other stressors, what kind of conservation impact does that have? And we’ve seen in the past that it’s much more difficult to eradicate a pathogen when it has a wildlife reservoir.”

Investigations in Iowa found that many of the state’s white-tailed deer tested positive for SARS-CoV-2, catching scientists off-guard. Research in Canada indicated that a highly mutated version of the virus found in white-tailed deer had been passed into humans. Lodged into a new animal species, such viruses could disperse even farther while going down a completely different evolutionary path, eventually coming back to haunt us with an altered genetic makeup.

“Outbreaks are inevitable, pandemics are optional,” said epidemiologist Larry Brilliant, who played a key role in eradicating smallpox in the 1970s. “If we can have early detection systems all over the world, and sequencing so we know what the virus is, then the risk of a virus jumping and becoming a pandemic is low, almost zero.”

The two most obvious domains would be bolstering healthcare access and the preparation of vaccines. The accelerated efforts by researchers around the globe involved two new ways to make vaccines — one of them being the mRNA vaccine. But we make vaccines based on the versions of viruses we currently observe, not the ones that may appear in the future.

Virology professor Florian Krammer suggests that researchers could instead curate a list of 50-100 pandemic-potential viruses and produce candidate vaccines for each. The vaccines could then be subjected to initial trials and serve as a template for when a future viral pandemic emerges — aligning with the idea of developing a so-called “universal vaccine.”

The question that remains: Where does the money come from? Krammer predicts that such a project would cost up to $3 billion, and notes that the plan “might be entirely unfeasible from a regulatory, political, or technical perspective.” However, there’s a clear need for large-scale investment in preventing another widespread disease.

Government spending on pandemic prevention has been declining for much of the last two decades. Four organizations — including the Bill & Melinda Gates Foundation and the global vaccine organization Gavi — “jumped ahead of the governments in charting the global nature of the response” in the first three months of the pandemic, per Politico.

meeting among the world’s most prominent health funders in early 2022 sought to shift focus toward amassing billions of dollars in funding for governments and similarly aligned health organizations to prepare for the next pandemic. Global authorities also recognize a similar effort as being the first move.

These funds would need to be allocated toward improving access to therapeutics and creating a library of antivirals. A more expansive disease-monitoring system, especially in regions like Asia and Africa where human-animal interactions are widespread, would allow for the detection of potential pathogens. Finally, building robust healthcare systems — especially in low-income countries — to provide basic care as well as reliable treatment to allow equitable access to healthcare.

Experts note how the financial damages caused by the Covid-19 pandemic far outweighed the costs of preventing such an event. An analysis predicts that preventing the next pandemic would cost just 2 percent — or $260 billion — of the damage the pandemic dealt to the world economy.