It might sound like science fiction, but Disease X is something we must prepare for

The Democratic Republic of Congo is battling to contain an outbreak of Ebola which has killed 18 people so far 
The Democratic Republic of Congo is battling to contain an outbreak of Ebola which has killed 18 people so far  Credit: Mark Naftalin/AFP

Ebola is back and the authorities in the Democratic Republic of Congo, with the support of the World Health Organization (WHO), are rushing to contain it.

The return of the disease that ravaged West Africa in 2014 serves as a potent reminder of the threat that emerging diseases pose. Fortunately, with the experience we have gained dealing with Ebola over many years, we know how to stop it.  And we now have a vaccine.

But imagine we’d never seen it before. Imagine that a pathogen were to emerge for which there was no known cure, for which we have no known vaccine, and which threatens thousands – maybe even millions – of lives. Imagine the impact such a disease would have on the global economy.

This isn’t the stuff of science fiction.  This is a scenario we have to prepare for.  This is Disease X.

Disease X is not science fiction

And preparation requires investment. It’s precisely because a serious international epidemic could be caused by a currently unknown pathogen that Disease X was recently added to the WHO’s blueprint list of priority diseases, alongside diseases we know all too well, like Ebola, Zika and Severe acute respiratory syndrome or SARS.

The Blueprint list highlights infectious diseases for which we lack medical countermeasures.  The publication of the list is intended to focus research and development efforts where they are most needed to enhance preparedness.

By including Disease X, the WHO is warning that newly emerging pathogens present significant risk. Developing vaccines and therapeutics for known diseases is one thing, but how can we protect the public from a disease that is currently unknown?

If vaccines and therapeutics are to be part of the solution, we will need the capability to perform research and development in real time, especially in the developing countries at greatest risk.  The WHO has helped focus international efforts through its new and increasingly effective mechanism to respond to epidemics. Strong and sustained support, with corresponding funding, for WHO’s work in this area is an urgent priority.

I’ve seen first hand how small the world becomes when we are rocked by global threatsRichard Hatchett

We know what might happen otherwise. When Ebola struck West Africa in 2014, the world was woefully unprepared. The Ebola epidemic surprised the world with its intensity, but the virus that caused it had been discovered in 1976 and decades of work had been invested in the development of vaccines and therapeutics.

This gave the world a head start, but moving those countermeasures into the field proved immensely challenging and their deployment was significantly delayed. Ultimately, multiple clinical trials were initiated and demonstrated the striking efficacy of one of the vaccines, though too late to change the course of the outbreak, which killed more than 11,000 people.

This tragedy unfolded with a disease we knew. Could we hope to fare any better against a virus or bacteria we have never encountered before?

As a responder to the attacks on the World Trade Center in New York, Richard Hatchett recognises how small the world is when it's under attack Credit: Robert Giroux/Getty Images

I have worked in African communities affected by Ebola, in a New York City emergency room during the anthrax scare, in emergency operations centers during SARS, at the White House during the swine flu pandemic in 2009, as a responder to 9/11 attacks on the World Trade Center and in the responses to many infectious disease epidemics since.  I’ve seen first-hand how small the world becomes when we are rocked by global threats.

Tackling these challenges is the reason that the Coalition for Epidemic Preparedness Innovations (CEPI) was created. CEPI was established in early 2017 by the governments of Norway and India, the Bill & Melinda Gates Foundation, the Wellcome Trust and the World Economic Forum and it represents a partnership between public, private, philanthropic and civil organizations. Its mission is to finance and coordinate vaccine development to protect the world from future epidemics.

One way CEPI will do this is by supporting the development of 'platform technologies' that will speed the production of vaccines against new and unknown pathogens such as Disease X.

The idea with platform technologies is that the process for developing a new vaccine is worked out in advance, (ideally) fast-tracking its production for a new disease.

Such technologies would provide the world with a ‘just-in-time’ response that could quickly control an expanding epidemic. And this is exactly what is needed, given that a virulent respiratory virus behaving like influenza could reach all major global capitals within 60 days.

The UK has an extraordinary track record of contributing to epidemic preparedness, playing a leading role in responding to the West Africa Ebola outbreak, providing medical staff, infectious disease experts, treatment centres, training of frontline workers, and military, modelling and laboratory support.  

A virulent respiratory virus like influenza could reach all major global capitals within 60 days

Given the UK’s strong pharmaceutical sector, world-renowned research institutions and depth of scientific and infectious disease expertise, it can and should play a leading role in addressing the threat of Disease X and the other diseases on the Blueprint list, both directly and through its support of international institutions.

SARS, avian influenza, Ebola, Zika, plague, cholera, Yellow Fever, Lassa. The list is familiar but all were once Disease X.  What is happening in the DRC at the moment reminds us that epidemics are a present danger that requires focus, commitment, and investment.

Epidemic disease is a global threat that requires collective action. We cannot prevent new pathogens from emerging but together we can prevent the devastation they cause. Because if we know one thing, it is that Disease X, when it strikes, will not respect borders.   

Dr Richard Hatchett is chief executive of CEPI

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