The World Health Organisation (WHO) has produced a list of diseases and pathogens that are prioritised for research and development, distinguishing “which diseases pose the greatest public health risk due to their epidemic potential and/or whether there is no or insufficient countermeasures”. At present, these priority diseases are: COVID-19; Crimean-Congo haemorrhagic fever; 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; Zika; and “Disease X”. The WHO states Disease X “represents the knowledge that a serious international epidemic could be caused by a pathogen currently unknown to cause human disease”.
Dr Josie Golding, epidemics lead at Wellcome, the world’s second-largest non-government funder of health research, said coronavirus has been a wake-up call for countries, enabling them to be better prepared for the next global outbreak of an unknown disease.
But the expert fears the devastating impact Disease X could have if it were to ever strike, revealing it is her “worst fear”.
She said the impact from the coronavirus pandemic may be inadvertently shifting focus away from other viruses that are circulating around the world and information about potential hidden diseases is therefore not being shared as quickly and efficiently as it should.
In an interview with SciDev.Net, Dr Golding said: “I think at the moment CEPI, the Coalition for Epidemic Preparedness Innovation, has been a fantastic preparedness platform, though they have been focused on very few diseases that WHO has highlighted as being a problem over the last few years, but also on Disease X.
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“Before the COVID-19 outbreak they were only really in the early phase of doing that type of project so I think going forward that the type of work that CEPI have done, we would like to see it continued, because we think having that knowledge and data and understanding on these types of platforms will help them be more adaptable for a future pandemic, if it happens.
“One group within the International Severe Acute Respiratory and Emerging Infection Consortium – ISARIC – is called ALERRT (African coaLition for Epidemic Research, Response and Training) and they have been supported by the European Commission now for a few years.
“This is a pan-African network of clinical researchers, so they already were in existence but we have added additional funding so they can now work in countries and try and provide standardised care, try and provide collection of data that is the kind of thing going forward I can see is going to be built on.
But Dr Golding warned: “The WHO did a press conference on June 15 and one of the opening remarks from WHO director-general Dr Tedros was that because of COVID we’re not seeing the type of reporting on the flu viruses that are circulating.
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Dr Josie Golding fears the devastating impact ‘Disease X’ might have
“We’re not having the virus being shared between countries where there is a lot of missing surveillance and, of course, this was down to the fact that those systems, and surveillance systems, put in place are being impacted by the COVID response.
“We are probably going to be missing information about what is circulating, what is out there, when it comes to flu and the risk of a pandemic flu.
“So, I think that is still one of the major diseases that hasn’t disappeared, that risk is still there. It is number one of the UK risk register. That would be my worst fear, to have a pandemic flu.”
Dr Golding warned Disease X is in danger of being “missed” unless you’re “really looking for it”, as surveillance systems are being “jeapardised” by other diseases and because they are so rare, there is also a lack of funding into them.
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The WHO said ‘because of COVID we’re not seeing the type of reporting on the flu viruses that are circulating’
But the expert added the coronavirus pandemic could also act as a wake-up call for countries, making them better prepared for the next global outbreak of an unknown disease.
When asked what can be done to mitigate the risk of Disease X, Dr Golding said: “Global experts are convened by WHO going from 2015 onwards to review this exact question. WHO have put together a list, the WHO R&D Blueprint priority list of diseases, and although COVID specifically wasn’t listed, the coronavirus family was listed along with MERS, so I think that is a good place to start.
“Similar to the risk around influenza and having surveillance systems being jeopardised, this is also the case for those diseases.
“Not a lot of funding and investment comes into many of these diseases partly because they are so rare, so I think Disease X is likely to be that — unless you’re really looking for it, it is going to be missed.
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“And so similar to [the situation with] COVID, we have to remember why that was detected when it was. It was because there was experience in the country [China] from SARS and from avian influenza, there were systems in place to detect strange pneumonia coming up.
“I do think COVID is going to put a lot of those systems and experience in countries, to detect abnormal things more than ever now, because the countries who dealt with it better and faster at the beginning were the ones who had that historical knowledge.
“I think that is going to make a big difference when it comes to the next Disease X.”