The Economist – Since 2015 the World Health Organisation has released an annual list of up to 10 “blueprint priority diseases” requiring immediate attention based on their epidemic potential or lack of sufficient countermeasures. The list has consistently contained now-well-known deadly viruses such as Ebola, Zika and SARS, as well as less-known diseases such as Lassa fever and Marburg virus disease. The difference this year is that included among the regulars is something called Disease X. What exactly is this mysterious disease and why has it been included?
The WHO’s selection, known as the 2018 R&D Blueprint, was started as a response to the Ebola crisis in 2014, which has since infected nearly 29,000 people and killed more than 11,000. The list serves as a warning to governments that research and development needs to be an integral part of the response to epidemics. No one was ready for Ebola when it hit West Africa at that time. By listing Disease X, an undetermined disease, the WHO is acknowledging that outbreaks do not always come from an identified source and that, as it admits, “a serious international epidemic could be caused by a pathogen currently unknown to cause human disease.” Experts now recognise that moving fast to find a vaccine involves creating so-called “platform technologies” in advance. These involve scientists developing recipes for vaccines that can be customised. When an outbreak happens, scientists can sequence the unique genetics of the particular virus and enter the correct sequence into the platform to create a new vaccine. In the case of Ebola, this meant an effective vaccine could be developed and tested in 12 months rather than the usual 5-10 years.
Disease X could strike at any time. It could be a mutation of an already known disease, such as influenza. The infamous Spanish flu pandemic of 1918, one of the deadliest in history, infected half a billion people and killed more than 20m. Or it could be a yet undiscovered disease transmitted to humans from animals, such as HIV, which spread from chimpanzees and has infected 70m people and killed more than 35m since 1983. Disease X could also be deliberately developed and spread by humans. Biological warfare is nothing new. In 1346 the Mongols catapulted the corpses of people who died of bubonic plague into the Crimean town of Caffa which they were besieging. In modern times 16 countries including the United States, have had or are suspected of having biological weapons programs.
Despite the existence of the 1972 biological weapons convention, North Korea is not only believed to be in possession of 13 agents, including anthrax, smallpox and the plague, but also capable of weaponising them. In 2014 a captured Islamic State computer was found to contain instructions on how to use plague, gleaned from infected animals, as a weapon of mass destruction. The recent poisoning of a former Russian spy in the English city of Salisbury reiterated the fact that biological weapons such as nerve agents are not all safely under governmental lock and key, and revealed there has been woeful underinvestment in chemical and biological warfare defence-preparedness. In 2002 America’s then Secretary of Defence, Donald Rumsfeld, was derided for his talk of “known unknowns”. Today, one of them is called Disease X, and no one is laughing about it.