‘Disease X’

What pathogen might spark the next pandemic? How scientists are preparing for ‘disease X’

Introduction:

• Before the COVID pandemic, the World Health Organisation (WHO) had made a list of priority infectious diseases.
• These were felt to pose a threat to international public health, but where research was still needed to improve their surveillance and diagnosis.
• In 2018, “disease X” was included, which signified that a pathogen previously not on our radar could cause a pandemic.
• While it’s one thing to acknowledge the limits to our knowledge of the microbial soup we live in, more recent attention has focused on how we might systematically approach future pandemic risks.

Influenza:

• Influenza is largely a known entity; we essentially have a minor pandemic every winter with small changes in the virus each year.
• But more major changes can also occur, resulting in spread through populations with little pre-existing immunity.
• We saw this most recently in 2009 with the swine flu pandemic.
• However, there’s a lot we don’t understand about what drives influenza mutations, how these interact with population-level immunity, and how best to make predictions about transmission, severity and impact each year.
• The current H5N1 subtype of avian influenza (“bird flu”) has spread widely around the world.
• It has led to the deaths of many millions of birds and spread to several mammalian species including cows in the United States and marine mammals in South America.
• Human cases have been reported in people who have had close contact with infected animals, but fortunately there’s currently no sustained spread between people.
• While detecting influenza in animals is a huge task, there are systems in place to detect and respond to bird flu in wildlife and production animals.
• It’s inevitable there will be more influenza pandemics in the future. But it isn’t always the one we are worried about.
• Attention had been focused on avian influenza since 1997, when an outbreak in birds in Hong Kong caused severe disease in humans. But the subsequent pandemic in 2009 originated in pigs in central Mexico.

Coronaviruses:

• We knew more about coronaviruses than most people might have thought before the COVID pandemic.
• We’d had experience with severe acute respiratory syndrome (SARS) and Middle Eastern respiratory syndrome (MERS) causing large outbreaks.
• Both are caused by viruses closely related to SARS-CoV-2, the coronavirus that causes COVID.
• While these might have faded from public consciousness before COVID, coronaviruses were listed in the 2015 WHO list of diseases with pandemic potential.
• Previous research into the earlier coronaviruses proved vital in allowing COVID vaccines to be developed rapidly.
• For example, the Oxford Group’s initial work on a MERS vaccine was key to the development of AstraZeneca’s COVID vaccine.
• Similarly, previous research into the structure of the spike protein – a protein on the surface of coronaviruses that allows it to attach to our cells – was helpful in developing mRNA vaccines for COVID.
• It would seem likely there will be further coronavirus pandemics in the future. And even if they don’t occur at the scale of COVID, the impacts can be significant.
• For example, when MERS spread to South Korea in 2015, it only caused 186 cases over two months, but the cost of controlling it was estimated at USD 8 billion.

25 viral families:

• There are about 120 viruses from 25 families that are known to cause human disease.
• Members of each viral family share common properties and our immune systems respond to them in similar ways.
• An example is the flavivirus family, of which the best-known members are yellow fever virus and dengue fever virus.
• This family also includes several other important viruses, such as Zika virus (which can cause birth defects when pregnant women are infected) and West Nile virus (which causes encephalitis or inflammation of the brain).
• The WHO’s blueprint for epidemics aims to consider threats from different classes of viruses and bacteria.
• It looks at individual pathogens as examples from each category to expand our understanding systematically.
• The US National Institute of Allergy and Infectious Diseases has taken this a step further, preparing vaccines and therapies for a list of prototype pathogens from key virus families.
• The goal is to be able to adapt this knowledge to new vaccines and treatments if a pandemic were to arise from a closely related virus.

Pathogen X:

• “Disease X” – an unknown pathogen with the potential to trigger a severe global epidemic.
• To prepare for this, we need to adopt new forms of surveillance specifically looking at where new pathogens could emerge.
• In recent years, there’s been an increasing recognition that we need to take a broader view of health beyond only thinking about human health, but also animals and the environment.
• This concept is known as “One Health” and considers issues such as climate change, intensive agricultural practices, trade in exotic animals, increased human encroachment into wildlife habitats, changing international travel, and urbanisation.
• This has implications not only for where to look for new infectious diseases, but also how we can reduce the risk of “spillover” from animals to humans.
• This might include targeted testing of animals and people who work closely with animals.
• Currently, testing is mainly directed towards known viruses, but new technologies can look for as yet unknown viruses in patients with symptoms consistent with new infections.

Conclusion:

• We live in a vast world of potential microbiological threats. While influenza and coronaviruses have a track record of causing past pandemics, a longer list of new pathogens could still cause outbreaks with significant consequences.
• Continued surveillance for new pathogens, improving our understanding of important virus families, and developing policies to reduce the risk of spillover will all be important for reducing the risk of future pandemics.

Haiti

Context:

• Haiti violence: At least 3,661 killed this year; six lakh people displaced, says UN

News:

• “More than 3,600 people have been killed this year in the “senseless” gang violence ravaging Haiti,” the United Nations said.
• Haiti has plunged into virtual anarchy, with gangs taking over the capital Port-au-Prince and the security and health systems collapsing.
• Criminal groups are vying for power in a vacuum left by a political crisis and weak state authority.
• The Office of the High Commissioner for Human Rights (OHCHR) urged the Haitian authorities and the international community to do more to protect people on the Caribbean island.

About Haiti:

• Haiti, officially the Republic of Haiti, is a country on the island of Hispaniola in the Caribbean Sea, east of Cuba and Jamaica, and south of The Bahamas.
• It occupies the western three-eighths of the island, which it shares with the Dominican Republic.
• Haiti is the third largest country in the Caribbean, and is the most populous Caribbean country.
• The capital and largest city is Port-au-Prince.
• The government of Haiti is a semi-presidential republic, a multiparty system wherein the president of Haiti is head of state and elected directly by popular elections held every five years.
• The prime minister of Haiti acts as head of government and is appointed by the president, chosen from the majority party in the National Assembly.
• Executive power is exercised by the president and prime minister who together constitute the government.
• Haiti is a member of a wide range of international and regional organizations, such as the United Nations, CARICOM, Community of Latin American and Caribbean States, International Monetary Fund, Organisation of American States, Organisation internationale de la Francophonie, OPANAL and the World Trade Organization.

Sumatra Island

Context:

• At least 15 killed after a landslide struck an illegal gold mine on Indonesia’s Sumatra island

News:

• A landslide triggered by torrential rains struck an unauthorized gold mining operation on Indonesia’s Sumatra Island, killing at least 15 people, officials said.
• Informal mining operations are common in Indonesia, providing a tenuous livelihood to thousands who labor in conditions with a high risk of serious injury or death.
• Landslides, flooding and collapses of tunnels are just some of the hazards facing miners.
• Much of gold ore processing involves highly toxic mercury and cyanide and workers frequently use little or no protection.

About Sumatra Island:

• Sumatra, Indonesian island, the second largest (after Borneo) of the Greater Sunda Islands, in the Malay Archipelago.
• It is separated in the northeast from the Malay Peninsula by the Strait of Malacca and in the south from Java by the Sunda Strait.
• In the 11th century the influence of the Srivijaya Empire, based in the southern city of Palembang, reached most of Sumatra as well as other islands and mainland regions.
• Sumatra’s climate is hot, except in the highlands, and extremely moist.
• Vegetation includes monster flowers, myrtles, bamboo, rhododendrons, orchids, and such trees as the Sumatran pine, palm, oak, chestnut, ebony, ironwood, camphorwood, sandalwood, and rubber-producing types.
• The island’s animal life includes orangutans, various apes, elephants, tapirs, tigers, the two-horned Sumatran rhinoceros, gibbons, tree shrews, flying lemurs, wild boars, and civets.

Tsangyang Gyatso peak

Context:

• Tsangyang Gyatso peak: Mountaineers name peak in Arunachal Pradesh after Dalai Lama; China reiterates claim over land

News:

• China is miffed over Indian mountaineers naming a previously unnamed peak in Arunachal Pradesh after the 6th Dalai Lama, reiterating its territorial claims over the area.

More on the news:

• A team from the National Institute of Mountaineering and Adventure Sports (NIMAS) scaled an unnamed and unclimbed 20,942 ft high peak in Arunachal Pradesh and decided to name the summit after the 6th Dalai Lama Tsangyang Gyatso, who was born in 1682 in the region of Mon Tawang.
• NIMAS, located at Dirang in Arunachal Pradesh, functions under the Ministry of Defence.
• Naming the peak after the 6th Dalai Lama is a tribute to his timeless wisdom and his profound contributions to the Monpa community and beyond.
• China calls Arunachal Pradesh Zangnan.
• Also, China has been renaming places in Arunachal Pradesh since 2017 to assert its claims.
• India has rejected China’s claims over Arunachal Pradesh, saying it is an integral part of India and assigning “invented” names does not alter this reality.

About National Institute of Mountaineering and Adventure Sports:

• NIMAS is a premier institution dedicated to providing world-class training in all three verticles (Land, Aero and Aqua) of adventure and presently imparts adventure course certification in mountaineering, mountain terrain biking, white water rafting, scuba diving, paramotor and paragliding.
• With a focus on holistic development and excellence, NIMAS aims to cultivate skilled, resilient, and environmentally conscious adventurers.