Disease X: Welcome back to “Science For Everyone”, ABP Live’s weekly science column. Last week, we explained the similarities and differences between clean, green, and renewable energies. This week, we discuss in detail what Disease X is, what kind of pathogen is likely to cause it, how deadly the disease will be, how the world can prepare itself against the disease, whether it will be deadlier than Covid-19, and whether it can be as lethal as Ebola.
Disease X may claim over 50 million lives, according to Kate Bingham, former chair of the UK Vaccine Task Force, media reports said.
Check all the stories appearing in ABP Live’s weekly science column here.
What is Disease X?
Disease X is a term used by the World Health Organization (WHO) to indicate the disease that will be responsible for the next serious international epidemic. In other words, Disease X is the next unknown disease of epidemic potential.
The pathogen which will be responsible for the next serious international epidemic is currently unknown to cause human disease.
In November 2022, the WHO convened over 300 scientists to discuss Disease X. The scientists are updating the list of priority pathogens that are likely to have devastating socio-economic impact, and require further research. The WHO first published the list in 2017, and updated it in 2018.
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The diseases in the current list are Covid-19, Ebola virus disease, Lassa fever, Nipah and henipaviral diseases, Zika virus disease, Crimean-Congo haemorrhagic fever, Marburg virus disease, Middle East respiratory syndrome (MERS), Severe Acute Respiratory Syndrome (SARS), Rift Valley fever, and Disease X. Disease X was included in the list of priority diseases in 2018.
According to a 2021 study published in the journal Infection Control & Epidemiology, a peer-reviewed medical journal published by Cambridge University Press, Richard Hatchett, CEO, Coalition for Epidemic Preparedness Innovations (CEPI), said Disease X night sound like science fiction, but it is something “we must prepare for”.
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Some experts believed that Covid-19 and Zika met the standards to be classified as the first Disease X. But this is not the case because Disease X will be several times deadlier than Covid-19 or Zika.
“Disease X is an imaginary infectious disease that is both highly transmissible and lethal. Imagine if Ebola transmitted with the efficiency of SARS CoV2,” Dr Anurag Agrawal, Dean, BioSciences and Health Research, Trivedi School of Biosciences, Ashoka University, told ABP Live.
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Which pathogen is likely to cause Disease X?
A pathogen called “pathogen X” will cause Disease X. The disease is expected to be a zoonosis, which means it can be transmitted from animals to humans. The pathogen is likely to be an RNA virus, and one that emerges from a region where the correct combination of risk factors highly promotes the risk for sustained transmission, according to the study.
Pathogen X is likely to be a new type of virus that can be transmitted among humans via respiratory aerosols. Respiratory droplets are the fastest disease-spreading mechanism.
Explaining what pathogen X is likely to be, Dr Agrawal said, “It will almost certainly be a new type of virus capable of human to human transmission by respiratory aerosols. These days, better sanitation has broken the faecal to oral link, and indoor life has reduced exposures to insects and pests. Human to human diseases such as HIV, that require exchange of body fluids, cannot transmit this fast. Even touch is slow compared to respiratory aerosols that can infect entire rooms.”
It is not necessary that Disease X will be caused by an emerging zoonotic pathogen. The disease can also be caused by an engineered pandemic pathogen. If such pathogens are released through laboratory accidents or due to bioterrorism, a global catastrophic event will occur.
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Will Disease X be deadlier than Ebola?
The true infection fatality rate (IFR) of SARS-CoV-2 was below one per cent. Disease X is likely to have an IFR of 10 to 20 per cent. Ebola has a greater IFR than this.
“SARS CoV2 true infection fatality rate was well below 1%. A 10-20% IFR is quite plausible. Ebola is more than that,” said Dr Agrawal. He also said that scientists are hopeful that Disease X will not be deadlier than Ebola.
Will Disease X be a respiratory infection?
Since Disease X is likely to spread via aerosols, it is likely to be a respiratory infection, and hence, the lungs will be affected first.
“The transmission has to be respiratory so the lung will be an affected organ. The lethality can come from any of the other organs,” Dr Agrawal explained.
How can the world prepare itself against Disease X?
A lot of surveillance of and research into the emerging potential pandemic agents that can cause Disease X is required.
According to the study, the steps that can be taken to reduce the spread and damage of Disease X, and to be prepared against it include developing international guidelines to control bioterrorism, implementing immediate and appropriate travel restrictions and airport screening to contain the spread of pathogen X, widespread testing and aggressive contact tracing to contain the outbreak, performing active surveillance of virus laboratories to avoid a potential leak of a new virus, obtaining advice from academicians in a timely manner without political involvement, ensuring the collaboration of the world’s scientists, clinicians, and infectious disease experts to investigate, control and eliminate Disease X in a timely way, and performing timely investments to accelerate the development, availability, and approval of medical countermeasures such as diagnostics, vaccines and clinical trials.
Scientists have also proposed a “One Health” approach that offers a complete solution to address the underlying issues for the spread of Disease X. The mechanisms include bridging institutional gaps, emphasising supposed risk factors for subsequent events involving infectious disease pathogens, and defining priority risk areas and pathogens.
“Prevention is better than cure. Early intervention is the only way to contain it. This ultimately depends on high quality surveillance,” said Dr Agrawal.
Since Covid-19 is not the last pandemic, the world needs to be prepared for the next outbreak as fast as it can.
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