Q&A: COVID-19 experience a ‘wakeup call’ for Disease X

PPE training in Nigeria - MAIN
Nigerian physicians being trained by the World Health Organization (WHO) on use of personal protective equipment (PPE). WHO said in a report last year that countries need to invest in supporting other countries to be prepared for epidemics. Copyright: CDC Global, (CC BY 2.0).

Speed read

  • Influenza monitoring has fallen off during COVID-19 outbreak
  • Disease X more likely to be spotted as a result of COVID-19 experience
  • Shows rare diseases can become global pandemics if left unchecked

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[LONDON] COVID-19 has been a wakeup call for countries, making them better prepared for the next global outbreak of an unknown disease, according to Dr Josie Golding, epidemics lead at Wellcome, the world’s second-largest non-government funder of health research.

Known as ‘Disease X’, a previously unknown illness that becomes a pandemic is seen as one of the greatest threats to humanity by many health policymakers.

In an online interview with SciDev.Net, Golding said that COVID-19 had highlighted that diseases such as Ebola, which currently affect a small number of countries, can become global epidemics if left unchecked.

Learning from the experiences of the COVID-19 pandemic, what changes might Wellcome want to make to the way it supports pandemic preparedness?

I think at the moment CEPI, the Coalition for Epidemic Preparedness Innovation … has been a fantastic preparedness platform, though they have been focussed on very few diseases that WHO [World Health Organization] has highlighted as being a problem over the last few years, but also on Disease X.

[Before the COVID-19 outbreak] they were only really in the early phase of doing that type of project so I think going forward that the type of work that CEPI have done, we would like to see it continued, because we think … having that knowledge and data and understanding on these types of platforms will help them be more adaptable for a future pandemic, if it happens.

One group within [the International Severe Acute Respiratory and Emerging Infection Consortium – ISARIC] is called ALERRT [African coaLition for Epidemic Research, Response and Training] and they have been supported by the European Commission now for a few years. This is a pan-African network of clinical researchers, so they already were in existence but we have added additional funding so they can now work in … countries and try and provide standardised care, try and provide collection of data … that is the kind of thing going forward I can see is going to be built on.

Where do you see the risk for future epidemics and what can be done to minimise this?

The WHO did a press conference [on June 15] … and one of the opening remarks from [WHO director-general] Dr Tedros was that because of COVID we’re not seeing the type of reporting on the flu viruses that are circulating, we’re not having the virus being shared between countries where there is a lot of missing surveillance and, of course, this was down to [the fact] that those systems, and surveillance systems, put in place are being impacted by the COVID response.

We are probably going to be missing information about what is circulating, what is out there, when it comes to flu and the risk of a pandemic flu. So, I think that is still one of the major diseases that hasn’t disappeared, that risk is still there. It is number one of the UK risk register. That would be my worst fear, to have a pandemic flu.

“So, I think that is still one of the major diseases that hasn’t disappeared, that risk is still there. It is number one of the UK risk register. That would be my worst fear, to have a pandemic flu.”

Dr Josie Golding, epidemics lead at Wellcome

Dr Josie Golding

What about so-called Disease X, what kind of disease might that be, what can be done to mitigate the risk?

Global experts are convened by WHO going from 2015 onwards to review this exact question. WHO have put together a list, the WHO R&D Blueprint priority list of diseases, and although COVID specifically wasn’t listed, the coronavirus family was listed along with MERS, so I think that is a good place to start. Similar to the risk around influenza and having surveillance systems being jeopardised, this is also the case for those diseases. Not a lot of funding and investment comes into [many of these diseases] partly because they are so rare. So, I think Disease X is likely to be that — unless you’re really looking for it, it is going to be missed.

And so similar to [the situation with] COVID, we have to remember why that was detected when it was. It was because there was experience in the country [China] from SARS and from avian influenza, there were systems in place to detect strange pneumonia coming up. So I do think COVID is going to put a lot of those systems and experience in countries, to detect abnormal things more than ever now, because the countries who dealt with it better and faster at the beginning were the ones who had that historical knowledge. I think that is going to make a big difference when it comes to the next Disease X.

You said COVID-19 has increased surveillance and awareness and that will help us in a future pandemic, but what about the wider political and institutional support?

One of the initiatives that Wellcome has already been involved in through our director, Jeremy Farrar, has been the Global Preparedness Monitoring Board. This followed from one of the recommendations that came out of the [2014-2016] West Africa Ebola outbreak and it is a group of world experts working with WHO and World Bank and they put forward a report last year back in September. This report said — what people already knew — is that countries need to invest in supporting other countries to be prepared for epidemics, countries need to invest in research. So those global calls for actions have been ongoing.

My only hope is now that [we have the outbreak of] COVID, it is a wakeup call and that people do understand this really can affect everybody in the world. A lot of the diseases that Wellcome has invested in, such as Ebola, have only affected a very small number of countries [but] epidemics, if unchecked, they can grow and affect everybody in the world. So that is what my biggest hope is, I do think COVID is going to be that wakeup call.
This interview has been edited for brevity and clarity.