How Disease X shaped the global response

A framework for an unknown pathogen was put in place in 2018 and is helping with our recovery

IF A vaccine or treatment for Covid-19 is discovered at what Donald Trump, the US president, calls “warp speed”, it will be partly because scientists were encouraged to plan for an unknown pathogen for which there was no obvious defence.

This is the view of a panel of leading scientific experts who, in early 2018, added “Disease X” to a watchlist of diseases for which there were no known “countermeasures” in the form of treatments, diagnostics or vaccines. The story of Disease X was picked up at the time by The Telegraph and went viral.

Those on the original panel say the inclusion of Disease X in the list – or at least the concept of encouraging pandemic planners to plan for the unknown – is now paying dividends in the fight against this new coronavirus.

They say organisations like the Coalition for Epidemic Preparedness Innovation (Cepi), which is leading the way in the race for a vaccine, and the World Health Organisation’s (WHO) clinical trials framework, which is researching the treatment of Covid-19, owe much to the thinking behind Disease X.

Even the rapid testing and social distancing measures that countries across south-east Asia took early to suppress the virus, including the stockpiling of PPE are, to some extent, a response to the idea that they needed to plan for the unknown. On the downside, say several on the WHO panel, the concept of Disease X may have come too late.

Although some countries adjusted their plans, most major Western economies were still in the process of updating theirs or, as is the case in Britain, were resisting the idea.

Dr Ana Maria Henao-Restrepo, the WHO official responsible for overseeing the R&D blueprint, and a team of more than 20 scientists from around the world came up with Disease X and the WHO’s strategy for the rapid rollout of research during pandemics.

Its aim is to “fast-track the availability of effective tests, vaccines and medicines” that can be used to save lives during a crisis of the sort we face now.

Dr Henao-Restrepo said the idea of planning for an unknown or “novel pathogen” was first adopted by the WHO in 2015. The concept was popularised in 2018 when it was renamed Disease X, but had been shaping research and planning priorities for much longer, she said.

She said the group’s work from 2015 included rolling out “generic” clinical trials frameworks and vaccine development strategies which are being used now to fight Covid-19. But not all the planning for Disease X was completed.

“We discussed our priorities in December of last year, our internal plan of action was to complete all the work for the pathogen X. We didn’t manage to do that but we have a lot of foundations there from our earlier efforts,” she said.

This included the WHO’s Global Forum, a diverse group of experts who can be scrambled quickly in crisis.

“Because we had a network that existed as part of our work, we were able to mobilise more than 400 scientists in a very short period of time,” she said.

Dr Jimmy Whitworth, professor of international public health at the London School of Hygiene and Tropical Medicine, was also on the committee and says Covid-19 can be characterised as Disease X. “The aim was to have a thought experiment about how we would respond to a totally unfamiliar pathogen that is causing an epidemic.

“That probably all sounds quite familiar [now]. Covid-19 is, to some extent, entirely new. But then it’s also related to other coronaviruses, so we’re not starting completely from scratch. It’s somewhere in between – some elements for Disease X and some elements of [other] coronaviruses apply”.

Dr David Brett-Major, an infectious diseases physician from the University of Nebraska, thinks he may have been responsible for coining the name Disease X. “I’m not sure if it was me or another, but I think it was me”, he said.

Dr Brett-Major said the “disease agnostic” vaccine platforms pioneered by Cepi were the most high-profile innovations to come out of the process of preparing for Disease X.

But, in hindsight, he thinks the world put too much focus on “what we need to have rather than what we have to do” when new pathogens breakout.

“There is a gap in what we are experiencing now with the application of social [lockdown] measures,” he said. “We really have no idea to what extent they have to be employed or how they work, so we are using them blind.”

‘The aim was to have a thought experiment about how we would respond to a totally unfamiliar pathogen’