We are currently unprepared for Disease X

Although Disease X does not currently exist, healthcare experts believe it’s only a matter of time before an unknown microorganism emerges to trigger this disease and cause an outbreak. — Stocksnap

“Disease X” was the name given by the World Health Organization (WHO) to a currently unknown pathogen that could emerge in the future and cause a serious international epidemic or pandemic.

It was included in February 2018 in the WHO’s R&D Blueprint list of diseases for which investment in research and development should be an international priority to enable early preparedness.

Disease X does not exist currently.

But its concept is a very real and growing threat to human health for which the world must be better prepared to respond to.

The most recent Disease X was the SARS-CoV-2 virus that caused Covid-19.

Because the world was unprepared to defend itself against it, Covid-19’s rapid spread caused a pandemic that reportedly affected more than 700 million people and caused about seven million deaths globally.

Political will

Politicians in some countries demonstrated remarkable leadership in handling Covid-19, which lessened the impacts on their populations’ health and economies.

However, in many countries, politicians’ behaviour has been nothing short of disgraceful.

The United States is a typical example of the impact of politicians’ behaviour on population health.

US states with Democrat governors adhered to health professionals’ recommendations, whereas those with Republican governors did not.

The latter had much higher death rates than the latter.

The Sabah elections in September 2020 illustrated that instead of being part of the solution, politicians exacerbated the virus’ threats to the population.

A study, published May 2021 in the journal PLOS Computational Biology, looked at how a novel synthetic control framework could provide estimates for direct and spill-over impacts of mass-gathering events on community transmission of Covid-19.

The scientists from Singapore and the United States used the 2020 Sabah state elections as their example.

They reported that: “Results indicate an estimated (i) 70.0% of Covid-19 case counts within Sabah post-state election were attributable to the election’s direct effect; (ii) 64.4% of Covid-19 cases in the rest of Malaysia post-state election were attributable to the election’s spill-over effects.”

Some politicians, including some ministers, flouted the rules of the movement control order, in their pursuit of governmental change.

This writer had previously called for a Royal Commission to look into Covid-19 management.

However, the government has not published its findings, if any, on the lessons learnt from its management of Covid-19.

The Dewan Rakyat’s Public Accounts and Health Committees have only addressed some aspects of the financial management of Covid-19, nothing more.

Getting ready

No one can predict when Disease X will occur.

However, what is certain is that it is out there and will, at some point in time, emerge and begin to spread to cause a disease outbreak.

The global response to Covid-19 and other emerging diseases like Middle East Respiratory Syndrome (MERS), Ebola and Zika have been largely reactive.

The Covid-19 experience has demonstrated the need for proactive strengthening of global capacity to detect, respond to and prevent priority diseases and the growing threat of antimicrobial resistance (AMR).

Is the world prepared for Disease X by making tests, vaccines and anti-viral agents faster than during Covid-19?

The answer is no, simply because there are very few countries that have sustained dedicated funding for countermeasures to unknown viral threats.

The development of the Covid-19 vaccines was only possible because of the more than 15 years of prior coronavirus research, which expended more than US$12 billion (around RM55 billion).

The preparedness for Disease X has to be national and international.

The resilience of the Malaysian health system has to be improved markedly so that when an outbreak occurs, routine prevention, wellness, treatment and mental health services are not frozen by a stretched health system trying to cope with the impact of the outbreak on service delivery.

Governmental agencies have to:

• Strengthen health policies for Disease X and allocate sufficient funding for epidemic preparation in annual budgets
• Establish early warning systems to detect and monitor potential infectious threats
• Undertake timely and prompt responses and control measures whenever an outbreak occurs, and
• Establish a section for Disease X in the Prime Minister’s Department and Health Ministry that is solely responsible for the prevention and control of Disease X.

The international community has to:

• Enhance proactive research for early identification of infectious threats that will allow for the rapid development of diagnostic tests, vaccine and treatment options
• Seek advice and reommendations from global healthcare professionals and scientists
• Implement measures to prevent cross-border spread in the event an outbreak occurs, and
• Enhance global collaboration and information-sharing.

The WHO has established an international accord with principles, priorities and targets for pandemic preparedness and response, with the aim to:

• Build resilience to pandemics
• Support prevention, detection and responses to outbreaks with pandemic potential
• Ensure equitable access to pandemic countermeasures, and
• Support global coordination through a stronger and more accountable WHO.

This accord is supported by proposed changes to the International Health Regulations (IHR) that were presented at the World Health Assembly in May (2024) for ratification by countries.

The Health Minister announced a month ago (June 2024) that Malaysia will be establishing a National IHR Authority this year (2024).

Push needed

No one wants a recurrence of the Covid-19 nightmare in Malaysia, which had more than 5.2 million cases and 37,000 deaths – the highest death rate per capita in Asean – and a maternal mortality of 68 per 100,000 live births in 2021 – a number last seen in the mid-1980s.

One of the lessons of Covid-19 is that Malaysian civil society has to take the lead in addressing the country’s preparedness for Disease X.

A starting point would be for everyone to ask their parliamentary representative at every opportunity, what the government is doing about Disease X, in particular, details about the ratification of the IHR and the establishment of the National IHR Authority.

Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email [e-mail]. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.