Are We Ready for Disease X?

Are We Ready for Disease X?

By Pallabi Munsi

Even before the coronavirus pandemic, cracks were appearing in the global partnerships that have helped the world combat HIV/AIDS and fight other recent crises such as Ebola.


There are 1.67 million unknown viruses. Global fissures are making it even harder to find the one that will attack next.

By Pallabi Munsi

  • As the world grapples with a health crisis that still hasn’t peaked, researchers, governments and global agencies like the WHO are scrambling to prepare for the next pandemic.
  • It’s a daunting challenge: There are 1.67 million unknown viruses.
  • The growing mistrust increases the risks of a pathogen that might otherwise be stopped from turning into the next global killer virus.

The diagnosis of a sick herdsman in China’s Inner Mongolia region last week has sent the world into a tizzy. No, he doesn’t have COVID-19; he has the bubonic plague. Informed of the case, the World Health Organization (WHO) said: “At the moment, we are not considering it high risk, but we’re watching it, monitoring it carefully.”

That overwhelming caution over a centuries-old disease betrays a deeper unease that’s undermining the medical fraternity, governments and global agencies such as the WHO. The coronavirus curve is far from flattened — more than 550,000 people have died, and cases are rising rapidly in the United States, Brazil and India, the three worst-affected nations. But researchers are already beginning to focus on what the next pandemic might look like and how to fight it.

In late June, scientists announced they had discovered a new strain of the H1N1 flu strain spreading among pig farm workers in China, and cautioned it could turn into a pandemic unless controlled. This past week, the Chinese Embassy in Kazakhstan warned its nationals about an “unknown pneumonia” with a higher fatality rate than COVID-19 spreading there.

Kazakh authorities have dismissed the claims. But Dr. Krutika Kuppalli, an infectious diseases expert, vice chair of the IDSA Global Health Committee and biosecurity fellow at the Johns Hopkins Center for Health Security, says the past 40 years have seen a fourfold increase in the number of emerging pathogens that have led to major outbreaks — SARS, H1N1, MERS, Nipah, Zika and Ebola among them. There are 1.67 million unknown viruses in the world today, with an estimated 827,000 with the capacity to infect humans.

We can’t make the same mistakes again.

T. Jacob John, virologist, Christian Medical College, Vellore, India

One key reason for our growing vulnerability to these diseases, Pulitzer-winning author Laurie Garrett writes in her book The Coming Plague, is humankind’s “complacency born of proud discoveries and medical triumphs,” which leaves us “unprepared for the coming plague.”

Kuppalli concurs.  

“It is the emergence of what we call ‘Disease X’ that causes the most concern,” she says. “Disease X is a disease that we don’t yet know about.… This is why developing strong surveillance and laboratory systems with rapid response networks is important.” 

The big challenge? The growing mistrust among countries and of global bodies is undercutting these efforts.

Dr. Aneel Advani, an associate professor at Johns Hopkins University’s Bloomberg School of Public Health, says it’s critical to “not be dumb” and to learn from the mistakes made in the handling of COVID-19. He says it’s important to learn lessons from countries like Taiwan and Vietnam, which has had no deaths from the virus recorded so far.

Dr. T. Jacob John, one of India’s foremost virologists and professor emeritus at the Christian Medical College, Vellore, says the response to COVID-19 shows just why it’s critical for governments to work in tandem with public health experts and not make decisions based on political considerations. One lasting legacy of the coronavirus crisis, he suggests, will be the damage to the credibility of the WHO, the attacks on that institution from some countries and, in the U.S., President Donald Trump’s unwillingness to work with the Centers for Disease Control and Prevention.

Even before the pandemic, cracks were appearing in the global partnerships that have helped the world combat HIV/AIDS and fight other recent crises such as Ebola. Late last year, the Trump administration began to wind down Predict, an Obama-era program that stationed American virus hunters in several countries, including China, to track potentially dangerous pathogens before they reach humans. Some experts believe that this move may have compromised America’s ability to gain valuable, early information about the coronavirus that has now killed more than 130,000 people in the U.S.

But with the intensifying mudslinging and blame game between countries over the pandemic, experts see a future where collaboration or transparency between nations will become even more difficult. In turn, that will increase the risks of a virus spreading throughout the world. At least 16 countries and Taiwan are suspected of having biological weapons programs. With growing distrust among nations, the chances of any country owning up to an accidental virus leak, already low, shrink even further.

Researchers and public health experts say there are other lessons that the current pandemic has taught us. Kuppalli says the crisis has demonstrated the need to enhance investments in the training of health care personnel, in infrastructure and in building greater capacities for laboratories to track and fight future infectious diseases. Countries, she says, need to also build better systems to scale up the production of personal protective equipment and other resources essential for front-line professionals or for patient care.

“We can’t make the same mistakes again,” says John. Kuppalli remains worried. There’s little evidence, she says, that we’re learning the right lessons from the crisis. “If COVID-19 has shown us anything,” she says, it’s “that we are not prepared for the next pandemic.”