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As the world recovers from the devastating impact of the COVID-19 pandemic, global health authorities are intensifying efforts to identify and prepare for the next major infectious threat. The World Health Organization (WHO) had foreseen the risk of a new, unknown pathogen years before the COVID crisis, with the inclusion of “Disease X” in its 2018 list of priority diseases. This signified a potential pandemic caused by a pathogen previously unknown to science, a reminder of the unpredictable nature of global health threats.
Now, researchers are focusing on systematically addressing future risks by studying known pathogens, anticipating mutations, and monitoring animal populations for potential disease spillovers into human populations.
Known Threats: Influenza and Coronaviruses
Influenza remains a prime example of a “known known” threat. The flu causes small-scale pandemics every year, but significant mutations in its virus can lead to more dangerous global outbreaks. This was seen in 2009 with the H1N1 swine flu pandemic, which originated from pigs in Mexico. Currently, the H5N1 avian influenza subtype is a growing concern, as it has led to the death of millions of birds and has spread to various mammal species, including cows and marine animals. Although human cases have been reported, sustained human-to-human transmission has not occurred yet.
Coronaviruses fall under the “unknown known” category. Before COVID-19, the world had already experienced outbreaks of coronaviruses with Severe Acute Respiratory Syndrome (SARS) in 2003 and Middle Eastern Respiratory Syndrome (MERS) in 2012. Both caused significant outbreaks, but faded from the public eye. Nevertheless, research into these earlier coronaviruses proved crucial in the rapid development of COVID-19 vaccines, with platforms like the Oxford-AstraZeneca vaccine drawing from prior work on MERS.
Preparing for Known Unknowns
Beyond influenza and coronaviruses, scientists are turning their attention to 25 viral families, including more than 120 viruses known to cause human disease. These families, such as flaviviruses (responsible for diseases like Zika and West Nile Virus), are being studied systematically to better understand their common properties and immune responses. This proactive approach allows for the development of vaccines and therapies that can be adapted if a new virus from a closely related family emerges.
The Unpredictable Threat of ‘Disease X’
Despite preparations for known pathogens, the concept of “Disease X” highlights the potential for an entirely new, unknown pathogen to cause a future pandemic. To guard against this, scientists are embracing the “One Health” approach, which considers the interconnectedness of human, animal, and environmental health. Factors like climate change, wildlife encroachment, and intensive agriculture increase the chances of disease spillovers from animals to humans.
Efforts to monitor these risks include targeted testing of animal populations and workers in close contact with animals. New technologies now enable the detection of unknown pathogens in patients showing signs of novel infections, a critical step in early identification of emerging threats.
Looking Ahead
The microbial world is vast and largely uncharted, and while pathogens like influenza and coronaviruses have caused pandemics in the past, the next pandemic may come from a source we have not yet identified. Continued vigilance, research, and investment in surveillance technologies will be essential in mitigating the impact of future pandemics.
By expanding our understanding of existing virus families and preparing for the unknown, scientists hope to minimize the impact of “Disease X” and ensure the world is better equipped for the next pandemic.
