Coronavirus disease (COVID-19), which is caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), was declared a pandemic by the World Health Organization (WHO) on 12th March 2020. The COVID-19 continues to ravage the global health system, with infection new cases rapidly spreading throughout the seven continents. The disease has had a massive negative impact on the socio-economic status, cultural practices, and livelihood of people globally. With new cases being reported daily, there is a rush against time to contain the spreading pandemic. As a result, accelerated but complex development of diagnostic, therapeutic, and vaccines are on top gear with stakeholders focusing on different priorities, activities, and interests. Nevertheless, as the efforts to contain the novel SARS-CoV-2 intensifies, the question remains; how best is the world prepared for Disease X?
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Disease X is caused by Pathogen X (viruses, bacteria, parasites, fungi, or prions), an infectious agent that is presently not known to cause human disease, although an etiologic agent of a future outbreak with an epidemic or pandemic potential. Disease X can be ignited by the use of pathogenic microorganisms or their derivative toxins and spores as a bio-weapon. Historically, bio-weapons have been deployed in times of war to destroy the enemy.1 For example; in 1346 the Tartars used cadavers of plagues’ victims against their adversaries at the seaport of Caffa. In the most recent past, during the Cold War, the USSR and the USA invested heavily in bio-weapon development. Presently, several countries having bio-warfare capabilities are thought to be holding pathogenic strains within their military complexes. This has generated fears that military-grade pathogens could leak from labs via the black market.
Disease X can as well be sparked by diseases present in domestic and wild animals called Zoonoses. Out of the newly discovered diseases from the beginning of the 20thcentury, about 70 % are zoonotic. For instance, the 2013-2016 West Africa Ebola outbreak that ended up killing over 11,000 people in Guinea, Sierra Leone, and Liberia. The outbreak is believed to have started when a one-year-old boy was bitten by an Ebola-infected bat. The human HIV epidemic, which has infected and killed more than 70 million and 35 million people respectively, began as a result of human interaction with the primates. In 2009, the H1N1 swine flu spread rapidly in over 213 territories, leading to the death of approximately 285,000 people. Currently, it is estimated that 1.6 million unknown viruses exist in birds and mammals compared to about 260 viruses known in humans.2 This estimate and the ever-increasing human-livestock-wildlife interaction is a situation that scientists recognize as a hotspot for the potential spillover of Disease X. This interaction brings together insect vectors, livestock, wildlife and a diverse group of people thus generating a platform for the transfer of pathogens among species.3 The pathogens undergo mutation as they spread rapidly from wildlife to livestock and to humans. Pathogen spreading is mainly through vectors but the fastest moving are airborne. Fast-moving airborne pathogens, according to epidemiology studies, can kill more than 30 million people in less than a year. Experts fear that spillover events like these could become more common in the coming years. More so, with the globalized transportation network, transmissions of animal pathogens into the human population make the risks real.
Apart from the possibility of Disease X occurring as a result of a brand-new pathogen, it may as well be an evolution of existing disease that catches the world by surprise and spreads fast. Diseases, for example, Tuberculosis (TB), Influenza, and HIV have already revealed their potential for devastating epidemic spread. Presently, public health systems use various approaches to keep these diseases under control. Some of the approaches include combined surveillance, public sensitization, treatments, and of course good luck. In case of a mutation of the causative agents of already existing zoonoses, it may be overwhelming to the global health systems. For instance, H151 avian influenza has a mortality rate of about 60% in humans. At present, H151 is not known to spread from human-to-human. However, it could easily undergo molecular changes that allow for human-to-human transmission. With such infectiousness and a mortality rate of 60%, H151 spread would be a threat to public health. HIV is another existing pathogen that could slip out of control. As much as the antiretroviral drugs allow people exposed to the virus to live normal healthy lives, the virus is also becoming resistant to treatment.4
The WHO has warned that the world is likely to experience Disease X, and there is a need to accelerate research, clinical trials, product development, and surveillance approaches that alert the world for potential outbreaks. Today, an evaluation of how the COVID-19 pandemic has negatively impacted the socio-economic status, cultural practices, and peoples’ livelihoods reveal that the world is not ready for Disease X. Evidently; the pandemic has put forth the fragility of global health systems. The COVID-19 serves as a pointer to the public health crisis, socio-economic meltdown, and cultural struggle that more lethal future Diseases X is likely to cause. The pandemic is, therefore, a reminder to governments, scientists, and policymakers across the world of the urgent need for prioritizing strategic investment into working healthcare systems, medical product countermeasures, research, and development. In terms of surveillance, there is a need for scientists to map and profile the places where lethal Pathogens simmer in wait. Researchers and other outbreak responders could consult such databases for sources of an emerging disease and quickly get to work on minimizing transmission and developing potential new vaccines that could save lives. Such an approach may as well be instrumental in managing future outbreaks, and putting off swelling pandemic while they are still localized and small. Additionally, it is critical to establish functioning medical and bio-defense units at national levels to monitor future bio-weapon related disasters.
Just like the past pandemics, the COVID-19 has got the world ill-equipped, but there may be another far worse threat out there. We should be more worried, for the future, about a lethal Disease X which could be probably lurking in the bush. If it shows up, then there is no guarantee we will be lucky. It is therefore important for the world to focus on understanding what may be looming ahead and have a readily available coordinated global response approach for handling Disease X. Reflecting and learning from the COVID-19 pandemic will be a significant determinant of how the world will handle the future Disease X.
- Pal M, Tsegaye M, Girzaw F, Bedada H, Godishala V, Kandi V. An overview on biological weapons and bioterrorism. Am J Biomed Res. 2017;5(2):24-34.
- Olival KJ, Hosseini PR, Zambrana-Torrelio C, Ross N, Bogich TL, Daszak P. Host and viral traits predict zoonotic spillover from mammals. Nature. 2017 Jun;546(7660):646-50.
- Jones B, McKeever DJ, Grace D, Pfeiffer DU, Mutua F, Njuki J, McDermott JJ, Rushton J, Said MY, Ericksen PJ, Kock R. Zoonoses (Project 1): Wildlife/domestic livestock interactions.
- Van de Laar MJ, Bosman A, Pharris A, Andersson E, Assoumou L, Ay E, Bannert N, Bartmeyer B, Brady M, Chaix ML, Descamps D. Piloting a surveillance system for HIV drug resistance in the European Union. Eurosurveillance. 2019 May 9;24(19).
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