the dreaded ‘disease X’ that the WHO anticipated two years ago, but for which the world has not prepared

In February 2018, a group of experts gathered by the World Health Organization (WHO) published a list of diseases that should be given priority in care and research due to the serious threat they pose to public health.

These included Ebola, Zika, Lassa fever, Rift Valley fever, Crimean-Congo hemorrhagic fever, nifa disease, and respiratory syndromes of Sars and Mers. But the list also brought one last element: “disease X”.

The WHO thus warned of the possibility of “a serious international epidemic that could be caused by a currently unknown pathogen, capable of causing disease in humans.”

Experts said “disease X” would likely result from an animal-derived pathogen that would spread to humans and spread across the planet quickly and quietly, causing high death rates.

Today, two years later, in view of the more than 2 million cases of covid-19 in the world, the question is: do we face disease X that the WHO anticipated?

“Yes, definitely,” says Josie Golding, head of epidemiology at the UK research organization Wellcome Trust.

“Disease X was a concept that represented something unexpected and unknown. Now that we have seen how covid-19 cases have been increasing steadily and after identifying and researching it to see what it was all about, I think it is disease X.”

Limited diagnosis and treatment.

At the WHO meeting, experts discussed and voted on which diseases should be included in the priority list.

“There were several candidates, the pathogens were considered important, and we started with a long list,” says Alfonso Rodríguez-Morales, vice president of the Colombian Association of Infectious Diseases, which was part of the WHO committee.

“But in the end, the group defined a short list in which they decided to include disease X.”

Rodríguez-Morales agrees with Golding, saying that he has no doubts that “Sars-Cov-2 and covid-19 meet the criteria for disease X.”

These criteria predicted that “a pandemic situation would be created for which we have limitations in diagnosis and interventions.”

Preparation

The purpose of the WHO list was to sensitize the world to the appearance of this disease. But if that possibility was anticipated two years ago, why don’t we prepare?

“The inclusion of disease X in the list has influenced companies in the production of vaccines and treatments, with more inclusive approaches and programs to investigate animals and the different viruses and pathogens present in them,” says Golding.

“But of course we can always look back and say that we could have done more to fund preparedness efforts around the world, including ways to identify pathogens that could emerge.”

Lack of imagination

In fact, experts agree that overall the global response to the pandemic was inadequate. Rodríguez-Morales says that it was not believed that “disease X” could really arise on the scale of this pandemic.

“Unfortunately, until a pandemic sets in, many people don’t really believe how serious it can be.”

This, says the expert, has been seen in the past with the chicungunha epidemics in 2013 and Zika in 2015, when they appeared on the American continent.

“Many authorities and health professionals did not give importance to chicungunha. It was thought that, since there were no important consequences of this virus in Africa, it would be the same in America,” says Rodríguez-Morales.

“But we don’t know all of the implications that the evolution of a virus may have in interacting with populations that are biologically different from those it has already affected.”

In response to covid-19, there were many successes, says Golding. “It was quickly detected and recognized (in November) that something different was happening in hospitals in China with the outbreak of unknown viral pneumonia,” says the epidemiologist.

“Then in January, the virus’s genome was also quickly sequenced by China and shared with the world.”

Golding says, however, that there were errors, too, as in diagnostic tests. “We realized that it takes time to do a reliable test and, although there were centers around the world that did very well, we saw that there was a big gap there. When we look back, we will say that we could be better prepared for the diagnosis” . ”

Treatments and vaccines.

There is also a lack of treatments and vaccines for the covid-19 pandemic. “At this point, we are still limited, because we have not yet found a significant way to respond therapeutically to the disease,” says Rodríguez-Morales.

“Undoubtedly, there have been shortcomings in the past few decades, because medical research for emerging diseases has not been sufficiently funded.”

And as the world faces covid-19, scientists are already warning that this will not be the last pandemic and that we must learn to better deal with these events.

“We have the tools, but we do not have the financial resources to implement them,” says Rodríguez-Morales.

According to experts, it would be necessary to invest much more in research on emerging diseases. “We have to investigate further what happens in the interaction between animals and humans, from the biological point of view and the presence of infectious agents in these populations,” says Rodríguez-Morales.

“If we had invested more in it, more rational and smarter steps could have been taken to contain this epidemic, without a doubt.”

Golding agrees: “We can no longer think of a pandemic like the covid-19 as something that only happens in distant lands. It can happen anywhere in the world, and we need to be better prepared for that.”