At the World Economic Forum (WEF) in Davos Switzerland this past week, leaders were discussing what to do about Disease X. This wasn’t about what the heck has happened to the social media platform formerly known as Twitter. Rather, the Disease X being discussed at the WEF refers to the big unknown disease that’s been on the World Health Organization’s (WHO’s) Blueprint list since 2018. This Blueprint list includes known baddies—such as Crimean-Congo hemorrhagic fever, Ebola, Lassa fever, Zika and, of course, Covid-19—that the WHO believes should be international priorities for more research and development to tackle. But as the saying goes, better the devil you know than the devil you don’t know. The biggest and most worrisome threat in the coming years may be a yet-to-be-identified disease. That’s where Disease X marks the spot. It represents the next unknown pathogen that will wreak havoc sometime in the near future. And the operative word here is “will” and not “may.”
That’s why Tedros Ghebreyesus, PhD, the Director-General of the World Health Organization (WHO), emphasized at the WEF the need for countries around the world to sign on to the WHO’s pandemic treaty by this coming May. Such a treaty would help countries better pool resources and cooperate to research and develop new strategies and technology in order to prevent and prepare for the next big infectious threat that may turn into another pandemic. Otherwise, many countries will end up getting caught off-guard and preventable suffering and deaths will occur.
Gee, when has this happened before? Umm, how about now? Many political and business leaders still don’t know quite what to do about Covid-19. They’ve been treating the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sort of like the surprise blind date that never went home from the date and instead moved into your house. Ignoring the issue and wondering, “Maybe he or she will just move out one day,” is not going to solve the problem.
Covid-19 was sort of the Disease X before late 2019, as the name SARS-CoV-2 didn’t even exist then. Sure, there were warnings about coronaviruses in general, especially after the Severe Acute Respiratory Syndrome (SARS) outbreaks of 2002-2003 and the Middle East respiratory syndrome coronavirus (MERS-CoV) outbreaks starting 2012. That’s because much of the whole family of coronaviruses had already known tendencies to mutate rapidly. And some coronaviruses had already jumped from other animals to humans. So there was the risk that some new coronavirus could leap from bats or other animals eventually to humans. Nevertheless, prior to the Covid-19 pandemic, when you heard the word coronavirus, you may have thought that it had something to do with the beer.
So, in effect, Disease X is the devil that we do not know yet. It is the hypothetical disease that in theory could strike when we least expect it. It is what the SARS-CoV-2 virus and Covid-19 were before 2020. It is the great unknown. It is a disease that will have unknown characteristics and may behave in a completely unexpected manner and cause unanticipated problems in humans, besides the whole may kill you thing. It is what’s behind door number one.
So, why use the name Disease X so that it sounds like something caught between being a Baby Boomer and a Millennial? The answer is human nature. Many humans need something concrete to prepare for and target. There can be a big difference between saying, “Someday you will meet the love of your life so maybe be careful about where and how loud you fart in general,” versus “Hildegarde, whom you desire, is right over there. Try not to fart.” Therefore, it does help to give a potential enemy some kind of a face and a name. Otherwise, our society may not prepare properly since our society in general has proven to be very bad at preparing for the unknown.
Just look at what happened in 2020 when many political and business leaders got caught with their figurative pants down. The U.S. throughout 2020 had leaders claiming that Covid-19 was no big deal (it was a big deal), that it was no worse than the common cold (it was worse than the common cold) and that the pandemic was somehow rounding the corner (it wasn’t). Although 2020 was by far the most disorganized the U.S. had been during the four years of the pandemic, it’s not as if the response has gotten like totally amazing since then. The subsequent years have been plagued by flip-flopping in policies and unclear directions. At this point it isn’t even clear what the U.S.’s longer-term strategy is in dealing with the SARS-CoV-2. Is it ignore-it-and-it-will go away? Yeah, how has that worked out so far? As of today, in the U.S., there have already been over 6.750 million hospitalizations and over 1.17 million deaths attributed to Covid-19 per the Centers for Disease Control and Prevention (CDC). Then there have been not-completely-counted number of people suffering with long Covid. So maybe calling for a plan for Disease X will help establish some sort of real longer term pandemic plan.
Using the term Disease X is also an attempt at keeping the world focused on pandemic preparedness and control. The concern is that once the Covid-19 pandemic began fading from news headlines, the attention of so many people shifted back to celebrity worship, trading likes on social media, buying unnecessary stuff and other distractions from reality. On top of that, there have been a slew of Covid deniers, trying to minimize all those deaths and that suffering that has occurred and claiming that society should have covered business as usual in 2020. The risk is real that the U.S. and other countries will be even less prepared when the next pandemic rolls around.
The other problem is how science, medicine and public health are structured right now. You can utter a low sigh about how silo’ed different scientific and health disciplines have become with a shortage of people seeing and working with the entire system of factors that affect the spread and impact of infectious diseases. A professor in medical school once told me that the key to success in medicine is to pick one disease or body part and do nothing but that. People who go super deep in an area are certainly needed. But too much research and development, funding and planning is dominated by siloed thinking.
Again, Disease X will arrive at some point, likely in the near future, perhaps within a decade. Not properly addressing climate change could hasten the jumping of a new pathogen from other animals to humans. The big question is will the world be better prepared? You may want to put an X on that right now.
