As the world eases back to normalcy following three years of COVID-19, the scientific and public health community is already preparing for the next serious outbreak or pandemic. They just don’t know what the disease will be yet.
Scientists have estimated that 1.67 million yet-to-be-discovered viruses exist in mammals and birds, and about half of them have the potential to spill to humans. As far back as 2018, the World Health Organization (WHO) gave this unknown future outbreak a placeholder name: Disease X. It represents the “knowledge that a serious international epidemic could be caused by a pathogen currently unknown to cause human disease,” the WHO explained. One year after that designation, COVID-19 was identified as the first in the mysterious category that scientists had warned about.
Today, more infectious outbreaks seem inevitable.
“It is not an exaggeration to say that there is potential of a Disease X event just around the corner,” says Pranab Chatterjee, researcher at the Department of International Health at Johns Hopkins Bloomberg School of Public Health in Baltimore. “The recent spate of H5N1 bird flu cases in Cambodia is just a case in point.”
It will take creativity and vigilance to track and anticipate the next outbreak, says Peter Daszak, president of EcoHealth Alliance, a New York-based global environmental non-profit organization. “Nature is producing new viruses all the time … What we’re trying to say (with Disease X) is, let’s think creatively about designing vaccines and therapeutics and drugs that not only affect known agents but also can affect future and emerging pandemic pathogens.”
The next Disease X is likely to be zoonotic — caused by pathogens that “spill over” from animals to humans — since that’s the case with almost 75 per cent of emerging infectious diseases. Ebola, HIV-AIDS, rabies and COVID-19 come immediately to mind.
Data suggests that nearly all of the recent infectious diseases of global concern, including COVID-19, are caused by animal viruses that gained human transmission. Hence, zoonotic viruses continue to be the pathogens of interest as future diseases with pandemic potential. Even those that are already from a known source could evolve into something new and threatening, says Barney Graham, senior adviser for global health equity at Morehouse School of Medicine in Atlanta.
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