Time to get ready to fight Disease X – The Star Online

The numbers of microorganisms with the potential to harm humans is very large, but the resources for research and development (R&D) are limited.

To address this problem, the World Health Organization (WHO) convened a panel of scientists and public health experts in December 2015 to prioritise the top five to 10 emerging pathogens likely to cause severe outbreaks and the greatest public health risk in the near future, because of their epidemic potential and/or for which few or no medical countermeasures exist.

The initial list included Crimean Congo haemorrhagic fever, Ebola and Marburg virus, Lassa fever, Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS) coronavirus diseases, Nipah (which first occurred in Malaysia) and Rift Valley fever.

It was intended that these diseases will provide the basis for work on the WHO Blueprint for R&D preparedness to help control potential future outbreaks.

The list was updated in 2018 and 2022.

The current list includes Covid-19, Crimean-Congo haemorrhagic fever, Ebola and Marburg virus diseases, Lassa fever, MERS-CoV, SARS, Nipah and henipaviral diseases, Rift Valley fever, Zika and Disease X.

Disease X

Disease X was the name given by WHO to a currently unknown pathogen that could emerge in the future and cause a serious international epidemic or pandemic.

It was included in WHOs Blueprint list in February 2018 of diseases for which investment in R&D should be an international priority to enable early preparedness for the unknown Disease X.

Disease X does not exist currently.

But the concept of Disease X is a very real and growing threat to human health for which the world must prepare better to respond to.

The most recent Disease X was the SARS-CoV-2 virus which caused Covid-19.

Because the world was unprepared to defend itself against it, Covid-19s rapid spread caused a pandemic, which was reported to have affected more than 700 million people and caused about seven million deaths globally.Malaysia reported more than 5.2 million Covid-19 cases, the highest among Asean countries. Public Health Malaysia Facebook page

Malaysia was not spared with more than 5.2 million cases and 37,000 deaths reported, the highest death rate per capita among Asean nations and maternal mortality of 68 per 100,000 live births in 2021, a number last seen in the mid-1980s.

Scientists at Imperial College Londons MRC Centre for Global Infectious Disease estimated that Covid-19 vaccines saved an estimated 20 million lives globally between December 8, 2020 and December 8, 2021.

In Malaysia, the Institute for Clinical Research reported that vaccines saved an estimated 16,000 to 17,000 lives after half the population got fully vaccinated in September 2021.

Covid-19 is still around, albeit in a milder form, with waves still occurring.

When will Disease X occur?

No one can predict when Disease X will occur.

However, what is certain is that a future Disease X is out there and will, at some point in time, emerge and begin to spread to cause a disease outbreak.

In the past three decades, there have been increasingly frequent outbreaks of pathogens capable of causing severe disease and death to humans.

In the 21st century, there have been outbreaks of SARS-CoV-1, MERS, Zika, Ebola and other new and re-emerging viral diseases such as Chikungunya.

While it is likely that the next Disease X could be a novel disease, there is also the possibility of already known pathogens mutating and/or re-emerging in a more virulent form and then spreading into epidemics or pandemics.

Novel diseases emerge all the time, often making the leap from animals like bats to humans.

Scientists believe that the next Disease X is highly likely to be a virus that will emerge from about 25 families of viruses that have already shown their capability to cause human disease.

Climate change, urbanisation and globalisation are increasing the likelihood and frequency of infectious diseases outbreaks globally.

Scientists from Princeton University, United States analysed a global dataset of large epidemics spanning four centuries.Bats are primary vectors for virus transmission from animals to humans. TNS

They reported: The rate of occurrence of epidemics varies widely in time, but the probability distribution of epidemic intensity assumes a constant form with a slowly decaying algebraic tail, implying that the probability of extreme epidemics decreases slowly with epidemic intensity.

Together with recent estimates of increasing rates of disease emergence from animal reservoirs associated with environmental change, this finding suggests a high probability of observing pandemics similar to Covid-19 (probability of experiencing it in ones lifetime currently about 38%), which may double in coming decades.

In laymans language, the researchers found that the chance of a pandemic, with a similar impact to Covid-19, is about one in 50 in any year.

This means the lifetime probability of anyone reading this experiencing a pandemic similar to Covid-19 is about 38%, which may double in coming decades.

Preparedness critical

Disease X has been described as a hidden but inevitable creeping danger.

Although Covid-19 has had a devastating impact on the world, it has gone, perhaps disappeared, into the background and many healthcare systems have gone back to status quo.

Many governments and politicians have viewed the weak recovering economies from Covid-19 as reason to delay funding for preparedness for another epidemic/pandemic, as a result of which timely effective measures will be in short supply when Disease X comes along.

Whilst there may be anxiety about Disease X and its inevitability, it does not mean that the world is destined to relive the devastating impacts of Covid-19.

Steps can be taken to stop Disease X and reduce its spread and damage by proper and pre-emptive preparation this will be addressed in a subsequent article.

Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email starhealth@thestar.com.my. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the readers own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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Time to get ready to fight Disease X - The Star Online