Where will the next pandemic come from? The world is getting ready for an attack of disease X [NEW PANDEMIC?]

Modern medicine deals not only with diseases that have been known for years. It also looks into the future, trying to define what threats await us “around the corner”. Experts try to select the most dangerous pathogens and predict the course of possible epidemics. Hence the concept of disease X – as yet unknown, but extremely dangerous and difficult to control. How scientists identify potentially dangerous pathogens, says Prof. Waleria Hryniewicz, MD, PhD.

1. Disease X can be described as a dangerous infectious disease, about which we know nothing at the moment, but we are sure that it will occur
2. It is also known that when disease X appears, we will have neither good diagnostic tools, nor an effective drug, nor a vaccine.
3. COVID-19 is considered by some to be the first example of Disease X. As prof. Waleria Hryniewicz, MD, PhD, meets all the definition criteria
4. In 2015, WHO began to work on the development of an action plan in the event of another epidemic / pandemic. The focus is on the most severe infectious diseases for which there are no preventive options
5. Some scientists believe that disease X will be caused by a zoonotic virus that will adapt to humans as a new host
6. More current information can be found on the Onet homepage.

COVID-19 as defined by disease X

Disease X is not a popular term and probably not many of us know what it is all about. The easiest way to describe it is as an infectious disease, about which we know nothing at the moment, but we are sure that it will occur. We do not know its etiology or features, but we are concerned that it may be very infectious, that it will have a high mortality rate and pose a serious threat to our lives. We have never experienced exposure to a new pathogen before, and our immune system has not developed immunity. At the time of the onset of disease X, we will also not have good diagnostic tools and an effective drug and vaccine.

– Before I focus on disease X, I would like to refer to the current and some previous pandemics that have plagued the world for centuries – begins Prof. Hryniewicz. – Let me start with the still active COVID-19 pandemic. We are already in the third year of its duration and some consider it to be the first example of disease X, as it meets all the definition criteria. Many members of the WHO advisory team have highlighted that COVID-19 is the first example of disease X, caused by the novel zoonotic coronavirus SARS-CoV-2, the RNA virus. Although its etiology was quickly identified, initially there were no good, generally available diagnostic tests, and we waited almost a year for effective vaccines. In the meantime, drugs (such as remdesivir or monoclonal antibodies) of varying efficacy appeared. Developing vaccines and bringing them to market in a record time of 326 days has been a remarkable success as the fastest measles vaccine has so far been obtained, and it took … five years and it was a great achievement at the time.

Data from Worldmeter on April 2 this year. They say the coronavirus pandemic has claimed over 62 million lives so far. However, the real numbers are probably much higher. Publication in the prestigious “Lancet” magazine from March this year. reports that between January 1, 2020 and December 31, 2021, 18,2 million people died from the pandemic, including excess deaths. In addition, Eurostat data indicate that in December 2021, the number of excess deaths among the European Union countries was the highest in Poland and amounted to as much as 68,9%.

WHO recently published three possible scenarios for the evolution of coronavirus infections:

In the first, the most optimistic, coronaviruses will have a low pathogenic potential and cause mild infections, and the immunity obtained after the disease will be long-lasting. Second scenario says the disease will be like the seasonal flu and we will need to get vaccinated and boosted to keep it under control. However, in the third, most dramatic black scenario, the virus will evolve, acquiring new features that make it even more virulent and transmissive, and existing vaccines will prove to be little or no effective.

What do past pandemics tell us about disease X?

Prof. Waleria Hryniewicz recalls that we have experienced many flu pandemics caused by the H1N1 virus.

– I will mention two – says the scientist. – The most dramatic was the Spanish woman from 1918-1919, who killed at least 50 million, and perhaps even 100 million people, which at that time constituted 20-30 percent. world population. Then we struggled with the so-called swine flu (2009-2010), which turned out to be milder than expected. Due to the current epidemiological situation, the so-called flu (first).

The epidemic started in Bukhara in 1889 and lasted until 1894, with at least three waves of disease. It was a highly contagious disease with respiratory symptoms, often causing pneumonia. Many cases were reported, workplaces, schools and universities were closed. The infections spread across many countries and continents, thus meeting the criteria for a pandemic.

– Recently, we have been talking more and more about this pandemic, we are obtaining new clinical and epidemiological data – emphasizes the professor. – We find more and more similarities to the ongoing pandemic caused by the SARS-CoV-2 virus.

flu patients complained of a lack of sense of smell and taste, and we know these symptoms well from the reports of COVID-19 patients. After passing the disease, many of them experienced chronic fatigue / exhaustion, again symptoms similar to those described in the case of COVID-19 (the so-called long COVID). Another similarity: the elderly suffered most from the flu.

Both medical history specialists and virologists see more and more similarities to the current pandemic, and are beginning to find common features that strongly suggest that the late-nineteenth-century flu was caused by the coronavirus. Both the symptoms, the most vulnerable age groups and the epidemic waves are similar to and different from influenza. There are also speculations that the bovine coronavirus (BcoV) species, transmitted from rodents to humans as new hosts, skipped and then spread rapidly in the population. This would meet the definition of disease X.

Prof. dr hab. med. Waleria Hryniewicz

The current HCoV-0C43 coronavirus in human infections was found to be nearly identical to the BcoV virus. These phylogenetic observations suggest that he was the cause of the flu. Virologists are now ready to test autopsy materials and samples from those who died of flu. Perhaps we will witness a great sensation.

In the early XNUMXs, we experienced two pandemics caused by coronaviruses. SARS-CoV was responsible for severe acute respiratory syndrome (2002/2003 Guangdong, China; 37 countries – 8 cases; 774 deaths). SARS-CoV is practically non-existent, while another virus – MERS-CoV (Middle East Respiratory Syndrome) that causes Middle East Respiratory Syndrome (2012, Saudi Arabia; Arabian Peninsula – 2494 cases; 858 deaths, followed by cases in America, Europe) and Asia), is responsible for the ongoing pandemic with a very high mortality rate (over 30%). Both viruses caused high mortality, but were characterized by low transmissivity and therefore the pandemic caused by them affected a much smaller population than the current COVID-19 pandemic.

Disease X already has a history

The experiences of the SARS-CoV and MERS-CoV pandemics, as well as those caused by Ebola (2014) and Zika (2015) in 2015, member states asked WHO to develop an action plan in the event of another epidemic / pandemic. The stated goal was to take immediate and effective targeted measures to prevent its spread (R&D Blueprint for Action to Prevent Epidemics). A panel of expert advisers has been set up, chaired by Sir Dr. Jeremy Farrar, director of the Wellcome Trust. Dr. Farrar is responsible for preparing proposals that will shorten the time from the discovery of an epidemic to the identification of the causative agent (virus) and the development of vaccines / drugs that will stop its dynamics so that it does not become a public health threat. The focus is on acute, most severe infectious diseases for which we have no preventive options. The list was to be made up of no more than the 10 most serious diseases.

– Every year the list was to be updated – reports prof. Hryniewicz. – It includes zoonotic viruses: COVID-19, SARS and MERS-CoV, Ebola and Marburg, Zika, Lassa Fever, Crimea-Congo, Rift Valley, and Nipah, as well as disease X.

Following the meeting in 2018, the WHO listed disease X as a disease with epidemic potential caused by a previously unknown pathogen that will cause human infections. John-Arne Rottingen, a member of the team, said it may seem strange to put disease X on the risk list, but an action plan should be prepared in the event it does occur. We need to develop plug and play technology platforms that allow the rapid identification of many infectious agents and the rapid development of diagnostic tests and vaccine development, eg mRNA technology, vector vaccines that have proven their worth in the fight against the COVID-19 pandemic.

Dr. Fauci, an American NIH expert, emphasized that it is important to understand the commonalities of potential pandemic agents, which will allow for rapid anti-epidemic / anti-pandemic measures. He primarily pointed to flaviviruses. Viruses causing haemorrhagic fever have also been typed, and recently also enteroviruses other than polio.

Rottingen believes that the disease X will be caused by a zoonotic virus that will adapt to humans as a new host. This vision is also supported by prof. Marion Kooppmans from the Medical University of Rotterdam, also a member of the WHO advisory team, highlighting the intensified human-animal contacts, the frequency of travel and the increased trade as contributing factors to the spread of zoonotic microorganisms.

Other groups of specialists were also involved in predicting future pandemic threats. For example, they included the avian influenza virus (H7N9) and synthetic viruses as components of biological weapons.

– An interesting position was taken by the British Public Health Agency, pointing to resistance to last-line antibiotics such as carbapenems and colistin, selecting gonorrhea resistant to treatment as a potential disease X – adds the professor.

A foundation called Coalition for Epidemic Preparedness Inovations (CEPI) is a great support for the above activities of WHO. Its activities began in 2017 and received financial support from the Bill and Melinda Gates Foundation, the Wellcome Trust and the governments of India and Norway, as well as the European Union and the UK government. It focuses on supporting research into vaccines against emerging infectious diseases on the WHO (blueprint priority diseases) list, including disease X, as vaccines are a key element in the fight against infectious diseases.

– The sooner we introduce them, the faster and more effectively we can reduce the pandemic – says Professor Waleria Hryniewicz. – The Foundation has great ambitions, plans that its activities will allow to obtain an effective vaccine against X disease within 100 days! Thus, leading to a rapid limitation of the spread of the pandemic microorganism.

‘We need good microbial / infection monitoring programs and rapid identification of microbes / infections, which is now possible with modern diagnostic tools,’ he says. – The mRNA technology platforms and those based on viral vectors, developed to combat the COVID-19 pandemic, can be rapidly deployed and converted to the preparation of vaccines for Disease X. In fear of another pandemic, it was planned to prepare a panel of 100 prototype candidates (antigens) from various virus families, for possible use in future vaccines, which is to allow for the rapid introduction of an effective vaccine. We know disease X will come, we just don’t know when, so let’s be as prepared as possible.

But who will pay for all these preventive measures? Both the WHO and national centers for disease control (eg CDC) and / or investing in science have a low budget in relation to the needs. After the pandemic is dealt with, we will soon forget about it and politicians will again be reluctant to spend money on infectious disease prevention and science. Therefore, the operation of CEPI is of great importance for our safety.

– Remember that the COVID-19 pandemic can cost the world $ 28 trillion if we calculate its costs by 2025. Prevention is cheaper than the disease – appeals the professor.

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