Disease X Is What May Become The Biggest Infectious Threat To Our World

Someday, Disease X will cause a scene like this.


The World Health Organization (WHO) has now added Disease X to its Blueprint list of priority diseases. What? WHO? What the heck is Disease X? No, this is not Wolverine getting a bad hangnail, Mystique getting jaundiced, or some other X-Men problem. Nor is it caused by Generation X, the generation supposedly "steeped in irony, detachment, and a sense of dread." And, no it isn't a bad bottle of Dos Equis XX.

After the second annual review of the Bluprint list occurred February 6-7, 2018, Disease X appeared at the end of the following list of diseases for which the WHO determined accelerated research and development is urgently needed:

• Crimean-Congo haemorrhagic fever (CCHF)
• Ebola virus disease and Marburg virus disease
• Lassa fever
• Middle East respiratory syndrome coronavirus (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS)
• Nipah and henipaviral diseases
• Rift Valley fever (RVF)
• Zika
• Disease X

If this list were the answer in a Jeopardy contest, the question would be: what would you not want to get? Or what do you not want to invite to a dinner party? Or what could cause a public health emergency? And what diseases don't have adequate drugs and/or vaccines to prevent and treat them?

You've probably heard of Ebola, Zika, MERS, and SARS. Lassa Fever is spread by rat pee and poop and can cause you to bleed in lots of places and kill you. CCHF is spread by ticks and can cause you to bleed in lots of places and kill you. Marburg Virus is spread person-to-person through body fluids and can cause you to bleed in lots of places and kill you. (Are you detecting a trend here?)




Healthcare workers in protective equipment bury a 13-year-old boy dying of Lassa fever at a specific location on March 5, 2014 in Bo district, Sierra Leone. In some parts of Sierra Leone, 10-16% of hospitalized patients have Lassa fever, an acute viral hemorrhagic fever endemic to parts of West Africa. Sierra Leone a high child mortality rate and in addition to this one of the highest maternal mortality rates in the world, with a maternal mortality rate (MMR) of around 890 deaths per 100, 000 live births. With the introduction of an ambulance referral system and access to 24-hour emergency obstetric care amongst other initiatives, MSF have managed to drastically reduce these deaths. Doctors Without Boarders (Médecins Sans Frontières) started the Gondama Referral Centre in collaboration with the Sierra Leone Ministry of Heath and offers free heath care to pregnant women and children under the age of 15. (Photo by Lam Yik Fei/Getty Images)

You can catch the Nipah virus from infected bats, pigs, or people (depending on whom you tend to hang out with) and then subsequently develop inflammation of the brain that can lead to neurological problems, convulsions, personality changes, and death. Livestock can transmit the RVF virus to you. While you may have only mild symptoms like fever and some liver abnormalities, in some cases, you can develop eye problems (including going blind), suffer inflammation of the brain, and, yes, bleed in lots of places.

What can happen with Disease X? Who knows? (Not who as in WHO but who as in no one really knows.) That's the point. There is a high probability that the next big epidemic will come from a completely unexpected source, a pathogen that has not yet revealed itself. And as they say, the most dangerous enemy is the one that you don't know. It's not as if most people were expecting the Zika epidemic to occur in 2015 to 2016. Before 2015, very few people in the world paid attention to the Zika virus. A dangerous virus or some other pathogen won't call or Tweet everyone and say, "yeah, I'm getting antsy. Watching Real Housewives of Beverly Hills isn't really doing it for me. Here's a heads up that I will probably start causing trouble in about a year. Cheers."

Thus, Disease X represents "the knowledge that a serious international epidemic could be caused by a pathogen currently unknown to cause human disease." As philosopher and former puncher of faces Mike Tyson once said, "everyone has a plan until they get punched in the face." When is the last time that you completely anticipated the biggest challenges, the biggest threats in your life?



A quote from former US heavyweight boxer Mike Tyson (L) applies to life and epidemics.

That's why planning for an epidemic or a pandemic should not be entirely focused on particular disease or pathogen. About 3 years ago, I attended the Ebola Innovation Summit, hosted by Paul G. Allen Philanthropies, USAID, and the Skoll Global Threats Fund. Whereas many interesting discussions occurred, a lot of the focus was specifically on finding ways to detect, control, and treat the Ebola virus (hence the name of the Summit), rather than developing systems that can detect and deal with different and unexpected pathogens and diseases. While it may be easier psychologically to identify a clear single enemy and put a face to it, specifically targeting a very specific enemy can lead to solutions that are too focused, not flexible, and only work under limited conditions. This would be like buying underwear that you can only wear while riding a unicycle and juggling candles in Antarctica on an glacier next to penguins.

Many epidemics result more from broken systems than from specific pathogens. Sure, you need a pathogen to actually cause the disease. But what allows a pathogen to go from isolated cases to an outbreak to an epidemic to a pandemic are faulty systems. Ebola got out of hand largely because the health systems in West Africa were not adequate. If Ebola had been detected and contained very quickly, the outbreaks may not have been as bad. Until the health systems in West Africa are fixed, they may serve as a Mad Libs for infectious diseases. Just fill in the blanks with a different pathogen name when you say such-and-such pathogen started spreading and led to an epidemic.

Many systems around the world are just not set up to deal with rapidly emerging unexpected threats. To better prepare our world for Disease X, here are examples of systems that need to be improved:

• Surveillance systems: There is a need for systems that can detect early when something is out of the ordinary and concerning, such as a change in climate, animal behavior, or symptoms and health care seeking behavior among people. Such surveillance systems must extend to communities that may be neglected and thus good breeding spots for new pathogens.
• Health care systems: Making sure that everyone has good access to health care 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.
• Financial systems: If you've figured out how to get something done without money, let me know. Otherwise, when politics stall the allocation of funds to combat an epidemic (such as what happened in the U.S. Congress during the Zika epidemic), everyone ends up suffering, except for the pathogen. Moreover, there needs to be more funding for less disease-specific activities. Currently, it is often easier to get funding if you want to develop a new technology for a particular disease rather than a broader set of possible diseases.
• Research and development systems: There needs to be systems in place to more rapidly develop new vaccines, medications, and other technologies to combat an emerging epidemic. This situation is getting worse with attempts to cut government funding for scientific research and many pharmaceutical companies shifting more resources to marketing and selling existing products rather than developing new ones. Things may look up in various ways if Viagra can be used to effectively combat an infectious disease. Otherwise, not having more adequate resources and flexibility to design and test new interventions may mean that anything designed for Disease X won't come in time.
• Supply chain and other delivery systems:Vaccines, medications, and other products have to get to health care workers and the people to actually have any effect. However, many of the systems responsible for such delivery are inadequate or broken.

These are just a few of the systems that need to be fixed and further enhanced to deal with Disease X. Again, it may seem easier to put a face on an enemy and then just target the enemy. But that's not how life really always works.

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