Preparing Now for the Next Disease X

Tom Achoki, Lawrence Were & Ahmed Ogwell

Tom Achoki, a former Sloan fellow at MIT, is an adjunct faculty member at Baylor University and Co-Founder of the Africa Institute for Health Policy in Nairobi, Kenya. Lawrence Were is an assistant professor in the Department of Health Sciences at Boston University. Ahmed Ogwell, a former deputy director general of the Africa Centers for Disease Control and Prevention, is Vice President of Global Health Strategy at the UN Foundation.

NAIROBI/BOSTON/WASHINGTON, DC – On December 12, 2019, a group of patients in Wuhan, China, started showing symptoms of an atypical pneumonia-like illness that did not respond well to standard treatments. Ninety days later, with more than 118,000 cases reported in 114 countries and 4,291 deaths, the World Health Organization (WHO) declared COVID-19 a pandemic.

While COVID-19 lockdowns and travel restrictions brought the world to a standstill, decision-makers’ response to the evolving crisis, including in high-income countries, betrayed serious information gaps and institutional shortcomings that prevented them from taking decisive action. Thousands, if not millions, of deaths, and much economic devastation, could have been averted.

As early as 2007, researchers at the University of Hong Kong discovered that “horseshoe bats are the natural reservoir for SARS-CoV-like virus” and that “civets are the amplification host.” The authors warned that human-wildlife interactions in farms and wet markets could act as sources and amplification centers for emerging pathogens.

And yet public-health systems were caught unprepared by COVID-19, which brutally exposed the inadequacy of existing pandemic-response capabilities. The crisis overwhelmed supply chains and procurement mechanisms for essential medicines and supplies, straining many national health systems beyond their limits.

Meanwhile, many richer industrialized countries embraced vaccine nationalism and hoarding, leaving many regions without access to life-saving treatments and calling into question established principles like global solidarity and multilateral cooperation. By challenging long-held assumptions regarding localized viral epidemics such as Ebola and yellow fever, especially in Africa, COVID-19 also underscored the need for a nuanced understanding of pandemics’ potential impact on different regions.

To address these challenges, governments must adopt a more thoughtful and proactive approach to pandemic preparedness. In 2018, the WHO warned that an unknown pathogen (“Disease X”) could trigger a global pandemic, urging global policymakers to invest in vaccine research and development. While COVID-19 marked the world’s first encounter with a “Disease X” scenario, the accelerating pace of climate change and human encroachment on wildlife habitats significantly increase the risk of exposure to more deadly pathogens.

That is why leading experts, believing that it is only a matter of time before the world faces another pandemic, emphasize the importance of strategic planning and decisive action. But how can health systems in resource-constrained countries and regions prepare for and respond to a potential “Disease X” scenario?

Strengthening disease-surveillance systems is crucial to detecting and responding effectively to emerging epidemics. Given that human interactions and movements facilitate the rapid spread of viruses, governments must establish agile and integrated tracing systems capable of processing numerous data streams and offering actionable insights.

Policymakers can take several steps to improve disease surveillance. First, they could bolster predictive models by harnessing emerging technologies such as machine-learning algorithms and artificial intelligence for data capture and analysis. Second, investing in training programs that develop analytical, communication, and advocacy skills could help increase capacity. Third, governments could facilitate integration of surveillance systems covering areas like veterinary health, weather forecasts, and border control. Lastly, establishing robust and resilient response systems requires well-defined public-health contingency plans and dedicated resources.

It is no less important to foster global solidarity and coordination within and between established multilateral organizations such as the Africa Centers for Disease Control and Prevention, the European Union, and the WHO, and the World Bank is crucial for resource mobilization. Bilateral and multilateral emergency preparedness drills, akin to those conducted by militaries around the world, could further strengthen such partnerships.

Fortunately, policymakers do not have to reinvent the wheel. They can leverage the WHO’s Building Blocks framework to monitor and assess their national health systems. The data they collect could then be used, particularly in developing countries, to design and implement necessary reforms.

Throughout history, humanity has grappled with numerous pandemics, from the Antonine Plague of 165-180 BC to COVID-19. The WHO should be commended for sounding the alarm and urging the international community to prepare for a “Disease X” scenario. Policymakers must heed this warning and act now or pay a much higher price later.