Disease X – this is how we should prepare for the next big virus

“You can get a long way towards being able to produce something that will target a novel virus before that virus even emerges.”

This is how Kate Kelland described the sleuthing work needed to prevent another pandemic of the scale and impact of COVID-19 to Robin Pomeroy on the World Economic Forum’s Radio Davos podcast.

A former Global Health correspondent at Reuters, she is now Chief Scientific Writer at the Coalition for Epidemic Preparedness Innovations (CEPI), and author of the book Disease X - The 100 Days Mission To End Pandemics.

CEPI is a non-profit organization that funds research and development of vaccines against diseases that could potentially become epidemics or pandemics. With the World Economic Forum as one of its founding members, CEPI seed-funded three successful COVID-19 vaccines, including the widely known AstraZeneca and Moderna injections. The organization also works on a range of diseases that could become the next pandemic to spread.

Kelland explained: “It’s a virus that we don't know yet, but we do know is out there, and we do know has the potential to spill over from an animal population potentially into humans, perhaps mutate or adapt itself and then begin spreading and killing people faster than we can contain it.”

If the COVID-19 pandemic hit us unprepared, there is every reason to prevent the next disease from doing the same.

Yet, research has shown that the world is still not adequately prepared for a new pandemic.

“It's about how we learn from what we got right and what we got wrong in the past, including in the most recent past, of course, but also with previous pandemics and outbreaks of disease. This includes the 1918 flu and the 2009 swine flu epidemic, for example,” explained Kelland.

She added that, while COVID-19 was a novel disease, it came from a family of viruses that had already been studied by the global health community. Coronaviruses include severe acute respiratory syndrome (SARS) – which created a global health scare in 2003 – Middle East respiratory syndrome (MERS) and a number of pathogens that cause the common cold.

“So, while we’d never seen this particular virus before, we knew a lot of its family members. We therefore actually had gained quite a lot of knowledge about the sorts of characteristics that this virus had.”

Scientists who had been working on SARS and MERS vaccines had already got key information on the characteristics of coronaviruses and how to target vaccines at them.

Kelland pointed out that, by extension, carrying out research and vaccine development for known viral “families” that could impact humans – of which there are 25 – would give humanity a decided advantage over the next disease.

“We're not talking about 25 viral threats. We're talking about 250 to 300 viral threats,” she told Radio Davos. “It is a big number, but it is finite. So, it's not this kind of unfathomable amount of work. It is a vast amount of work, but it does have an endpoint, and it is doable.”

To put us on the front foot, CEPI advocates for a global vaccine library, the One World Vaccine Library. The purpose of this library is to build knowledge about potential Disease X candidates, undertake preparatory scientific work and make the resulting information available when a new virus emerges.

“The idea is that the world should divide up that work. It's not something that can be done by one institution or one scientific group,” Kelland explained.

“When all of that homework has been done, we will possibly be quite a few steps ahead of any new virus before it emerges. And if we get that done across all of those families, then we're kind of almost ready for anything that these viral families can throw at us.”

To facilitate the global collaboration and scientific work required to prepare for a future pandemic, Kelland highlighted the need for a global pandemic accord as envisaged by the WHO.

“What that treaty needs to do is set up a framework that allows us to be a couple of steps ahead. So on financing, for instance, there should be a pandemic fund already set up and populated with actual money before these situations come about. There should already be agreements about how knowledge and alerts should be shared.”

These are all learnings from the COVID-19 pandemic, when the COVAX vaccine-sharing facility had to be created “on the fly”, with no structures and no funding in place. With a global pandemic accord and a pandemic fund in place, Kelland pointed out, stakeholders would be able to react much faster.

Accelerating the response to a new pandemic threat will also rely on a new skillset for the key stakeholders in the global health community and beyond.

“There are a number of traits, characteristics and skills that we, as a world, have to develop to be able to be ready for whatever the viral world can throw at us. And those are things like preparing to be scared,” Kelland told Radio Davos.

Rather than disregarding a viral threat as it emerges, being concerned and acting quickly will be vital to preventing it from escalating the way COVID-19 did.

“You have to sometimes take decisions when you have a very limited view on what's going on. But then global health leaders and political leaders, have to be able to take what we call low-regret decisions,” says Kelland. This may mean pulling back if a decision proves wrong in retrospect or actions have been taken too quickly. However, it’s critical for decision-makers to take risks because “if you delay, you will almost certainly be too late.”

Again, preparation plays a big part here, she added, both when it comes to funding and in terms of decision-makers being guided by experts.

Kate Kelland’s book closes on a fictional scenario of a Disease X outbreak and how it is handled.

“Some of the vaccine development projects go wrong. Some of the populations are unhappy. Some places have to go into lockdown for a short amount of time. But because these decisions are being made swiftly and the people making them understand that taking risks is part of surviving these things and getting through it quicker and ultimately having a better outcome, those failures or those difficulties are overcome.”

The World Economic Forum is committed to developing more resilient, efficient and equitable healthcare systems. It works with global healthcare decision-makers to create new opportunities to advance the use of data-enabled systems and virtual care to better equip global healthcare systems to face future challenges.