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Presented By
Health·public health


‘DISEASE X’ COULD CAUSE THE NEXT PANDEMIC, ACCORDING TO THE WHO—OR EBOLA, SARS,
OR NIPAH. 9 PATHOGENS RESEARCHERS ARE KEEPING A WATCHFUL EYE ON

BYErin Prater
January 12, 2024 at 1:31 PM HST
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The World Economic Forum's run-of-the-mill pandemic preparation session was
blown out of proportion late this week, leading to the phrase “Disease X”
trending on both Twitter and Google at times.
Getty Images


The annual meeting of the World Economic Forum—to be held in Davos, Switzerland,
next week—is on more radars than usual this year, thanks to the name of one of
the sessions: “Preparing for Disease X.”




WHAT IS ‘DISEASE X’?

“Disease X,” according to the World Health Organization, “represents the
knowledge that a serious international epidemic could be caused by a pathogen
currently unknown to cause human disease.”

Indeed, the organization’s head, Director General Tedros Adhanom Ghebreyesus,
will speak at the event, in addition to Michel Demaré, chair of the board of
AstraZeneca, Brazil Minister of Health Nisia Trindade Lima, and Jamil Edmond
Anderlini, editor in chief of Politico Europe, among others.


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The run-of-the-mill pandemic preparation session was blown out of proportion
late this week, leading to the phrase “Disease X” trending on both Twitter and
Google at times. Right-wing social media accounts slammed the session, charging
that world leaders would convene to discuss plans to impose vaccine mandates,
restrict free speech, and even plan pandemics themselves.

On Thursday night, former Trump-era Assistant Secretary for Public Affairs for
the U.S. Treasury Department and Fox News analyst Monica Crowley tweeted a
baseless warning that “unelected globalists at the World Elected Forum will hold
a panel on a future pandemic 20x deadlier than COVID.”



“Just in time for the election, a new contagion to allow them to implement a new
WHO treaty, lock down again, restrict free speech and destroy more freedoms,”
she wrote. “Sound far-fetched? So did what happened in 2020.”

Dr. Amesh Adalja, senior scholar at the Johns Hopkins Center for Health
Security, tells Fortune that those in the medical and public health professions
“have always conducted thought experiments and tabletop exercises to prepare for
pandemics.”

“These exercises serve the vital function of identifying strengths and
weaknesses, as well as highlighting important aspects of response that merit
further refinement,” he says.

“To arbitrarily suggest these exercises and meetings are part of some kind of
conspiracy evades the actual purpose they serve and the problems on which they
are trying to gain traction, all for the nihilistic purpose of compromising
pandemic preparedness and brazen pandering,” he added.

Dr. Stuart Ray, vice chair of medicine for data integrity and analytics at Johns
Hopkins’ Department of Medicine, told Fortune that it would be “irresponsible”
for world leaders not to meet at the forum.



“There have been multiple such events in recorded history, and the recent
coronavirus pandemic taught us that rapid response can save millions of lives,”
he said. “Coordination of public health response is not conspiracy, it’s simply
responsible planning.”

Such meetings should be publicized because “such planning requires oversight,
appreciation for personal impact on personal and economic freedom, and impact on
special populations,” he added. “It makes good sense for a global public health
organization, scientific leaders, and interested private individuals to be
involved.”


THE WHO’S ‘PRIORITY PATHOGENS,’ ASIDE FROM ‘DISEASE X’

The WHO maintains a list of “priority pathogens” that “pose the greatest public
health risk due to their epidemic potential and/or whether there are no, or
insufficient, countermeasures” available.

Last updated in 2018, an updated list was expected last year and is now expected
during the first half of 2024, according to the group.

While the list is far from exhaustive and doesn’t necessarily indicate the most
likely cause of the next epidemic or pandemic, here are the known pathogens
global public health officials are keeping an eye on, in addition to “Disease
X.”


EBOLA & MARBURG VIRUS DISEASES

Viruses in this family cause hemorrhagic, or bloody, fevers, which are typically
accompanied by bleeding from bodily orifices and/or internal organs. The family
consists of five strains of Ebola in addition to Marburg—an extremely similar
virus that made headlines during an outbreak in Equatorial Guinea earlier this
year. 



On average, Ebola kills about 50% of those it sickens, though case fatality
rates have ranged from 25%-90%, according to the WHO. Marburg also kills around
50% of those it infects, though case fatality rates range from around 24% to
88%, experts say. While there are two licensed vaccines for the deadliest strain
of Ebola, Zaire, there aren’t any for the four other strains. Nor is there an
approved vaccine for Marburg, though some are in development.


CRIMEAN-CONGO HEMORRHAGIC FEVER

Like Ebola and Marburg, Crimean-Congo hemorrhagic fever is an acute viral
hemorrhagic illness that can cause bleeding from bodily orifices. Symptom onset
is sudden and can include fever, muscle ache, dizziness, neck pain, back ache,
headache, sore eyes, and light sensitivity. Nausea, vomiting, diarrhea,
abdominal pain, and sore throat may also occur, followed by sharp mood swings
and confusion. 

Two to four days later, agitation may turn into sleepiness, depression, and
lassitude; abdominal pain may concentrate in the upper right quadrant; and the
liver might become enlarged, according to the WHO. 

Other symptoms may include fast heart rate, enlarged lymph nodes, and a
petechial rash (caused by bleeding into the skin) on internal mucosal surfaces
like the mouth and throat, and on the skin. The rash may grow. Hepatitis is
usually present. After the fifth day of illnesses, patients may suffer the
failure of organs like the kidneys, liver, or lungs.

The case fatality rate for this illness—spread by ticks and the tissue of
infected animals during and after slaughter—is around 30%. Most patients who die
do so in the second week of illness. Those who recover generally begin to
improve after the ninth or tenth day of illness.


LASSA FEVER

Like Ebola, Marburg, and Crimean-Congo hemorrhagic fever, Lassa fever is an
acute viral hemorrhagic illness. But with a case fatality rate of 1%, it’s far
less deadly. The vast majority of those infected with Lassa fever—80%—have no
symptoms.



For the other 20%, disease is severe. Symptoms usually start with non-specific
ailments not unlike COVID or the flu—fever, weakness, and malaise—and then
progress to headache, sore throat, muscle pain, chest pain, nausea, vomiting,
diarrhea, cough, and stomach pain. Facial swelling, collection of fluid in the
lung cavity, and low blood pressure may develop, in addition to shock, seizures,
tremor, disorientation, and coma. Multiple organ systems are often damaged.
Those who survive may suffer from temporary or permanent deafness, in addition
to transient hair loss and gait disturbance.

Those who die of the virus usually do so within two weeks of onset, according to
the WHO. Eighty percent of pregnant women in their third trimester who are
infected die, in addition to their fetus. Rodents carry the virus and also shed
it in their urine and feces.


SEVERE ACUTE RESPIRATORY SYNDROME (SARS-COV-1)

The world’s first known coronavirus pandemic occurred in 2002, when SARS-CoV-1
was reported in China. It spread to more than two dozen countries in North and
South America and Europe before being contained seven months later. SARS is
thought to have originated in an animal population, perhaps bats, before being
passed to civet cats—a tropical animal that looks like a mix of a dog and an
ocelot—and then to people. A spillover could happen again, experts say.

Symptoms include headache, body aches, mild respiratory symptoms, possible
diarrhea, an eventual dry cough, and pneumonia in most. SARS sickened nearly
8,100 people and killed just under 10% of them from 2002 to 2003. There is no
licensed vaccine for SARS, though researchers are working on universal
coronavirus vaccines that could target both SARS and COVID, among other
coronaviruses.


MIDDLE EAST RESPIRATORY SYNDROME CORONAVIRUS (MERS)

SARS was the world’s first identified killer coronavirus, and MERS was the
second. Discovered in 2012 in Saudi Arabia, it caused about 2,500 cases and 800
deaths. SARS has not been detected since 2004, but MERS continues to be reported
sporadically, with the latest report—of three infections and two
deaths—occurring in Saudi Arabia in August 2023.


COVID (SARS-COV-2)

As Dr. Maria Van Kerkhove, head of WHO’s emerging diseases and zoonoses unit,
said at a January presser, the world is still in a COVID pandemic, whether or
not it wants to recognize it. So far, the official COVID death toll sits at 7
million, though it’s thought to be at least three times higher.



While the public health emergency of international concern (PHEIC) status ended
in May 2023, a WHO committee could always choose to reinstate it, especially if
the virus evolved into a more severe form, according to Van Kerkhove. And that’s
entirely possible.

“We are concerned—deeply concerned—that this virus is circulating unchecked
around the world, and that we could have a variant at any time that would
increase severity,” she said Friday. “This is not meant to be a scare tactic.
This is a scenario we plan for.”


NIPAH AND OTHER HENIPAVIRAL DISEASES

Nipah is a henipavirus, the most lethal of paramyxoviruses. It was first
identified in pigs in Malaysia and Singapore in the late 1980s, though its
natural reservoir is fruit bats. The other henipavirus known to infect people,
Hendra, was first noted in racehorses and humans in Australia in 1994. Both
feature respiratory illness and severe flu-like symptoms, and may progress to
encephalitis—inflammation of the brain—along with other neurologic symptoms and
death.

Nipah kills between 45% and 75% of the people it infects. No licensed vaccines
exist, though a vaccine by Moderna, in coordination with the U.S. National
Institute of Allergy and Infectious Diseases Vaccine Research Center, is being
evaluated.


RIFT VALLEY FEVER

This virus is known for causing massive devastation among livestock. While it
can be transmitted from animals to other animals and to humans as well, it’s not
yet known to transmit from humans to other humans. But with viral evolution,
that could change.



Human infections occur through inoculation—for instance, via a wound through an
infected knife, or through broken skin. Humans can also be infected via aerosols
produced during the slaughter of infected animals. Human infection may also be
possible through drinking unpasteurized or uncooked milk of infected animals,
according to the WHO. Additionally, human infection could occur through the
bites of infected mosquitoes or blood-feeding flies.

Most infected humans don’t develop symptoms; if they do, cases are mild.
Symptoms include the sudden onset of a flu-like fever, muscle pain, joint pain,
and headache. Neck stiffness, light sensitivity, appetite loss, and vomiting are
also possible. Such cases may be mistaken for meningitis.

Around 3% of cases will develop severe disease, and less than 1% will die.
Severe disease usually takes one of three forms: ocular, meningoencephalitis, or
hemorrhagic.


ZIKA VIRUS

Like COVID, Zika virus-related microcephaly (a brain-related birth defect) was
once declared a PHEIC by the WHO, from February through November of 2016. Most
who are infected with the virus—transmitted primarily by Aedes mosquitoes—don’t
develop symptoms. Those who do usually experience rash, fever, conjunctivitis,
muscle and joint pain, malaise, and headache for two to seven days.

More troubling, infection during pregnancy can result in infants with congenital
malformations, in addition to early birth and miscarriage. It can also result in
Guillain-Barré syndrome, neuropathy, and myelitis in adults and children,
according to the WHO.

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