Facing the Unknown: Dr Neha Rastogi Panda on Disease X and India’s Pandemic Preparedness
By Arunima Rajan
In an interview with Arunima Rajan, Dr Neha Rastogi Panda, Consultant-Infectious Diseases, Fortis Memorial Research Institute, Gurugram, talks about the concept of Disease X, its implications and the lessons learned from COVID-19 in an interview with Arunima Rajan
What exactly is Disease X, and why did the WHO feel the need to coin this term in 2018?
Disease X is a term which the World Health Organization introduced to the world in 2018. It refers to the yet unknown pathogen responsible for a severe epidemic or even pandemic. The term serves to be a placeholder for future threats, with an emphasis on powerful, flexible health systems and proactive research into emerging infectious diseases. The WHO's inclusion of the term Disease X in the priority list was a call to action for global preparedness against health crises which cannot be predicted.
The recent outbreak in the Democratic Republic of Congo has brought renewed attention to Disease X. While the cause remains unknown, do you think it fits the Disease X profile? What are the red flags so far?
The ongoing outbreak in the Democratic Republic of Congo raises alarms due to its rapid spread and high mortality rate. Manifesting symptoms like fever, cough, and anemia, it has led to over 100 deaths within weeks. Though the exact pathogen remains unidentified, the situation aligns with the Disease X framework—characterized by unpredictability, potential for rapid transmission, and lack of preparedness. Initial findings, including malaria-positive cases, suggest a complex scenario possibly involving multiple pathogens.
COVID-19 is often considered the first instance of Disease X. What key lessons did the world learn from COVID-19 that can help us prepare for future pandemics?
The COVID-19 pandemic is an example of Disease X, and it has reinforced major lessons:
• Global Collaboration: Proper pandemic response requires international sharing of data, resource reallocation, and coordinated policies.
• Rapid Vaccine Development: It has been demonstrated that the ability to develop vaccines for COVID-19 in record time underscores the need to invest in versatile scientific platforms.
• Healthcare Infrastructure: Proper healthcare infrastructure is of paramount importance to manage spiking cases and ensure equitably distributed care.
Emerging infectious diseases are increasingly linked to human activities such as deforestation and urbanization. Can you explain how these factors contribute to zoonotic spillover and increase the risk of Disease X?
Deforestation, urbanization, and other human activities disrupt natural ecosystems, bringing humans into closer contact with wildlife. This increases the likelihood of zoonotic spillover, where viruses or bacteria jump from animals to humans. Such interactions create fertile ground for new pathogens, including potential Disease X candidates, to emerge and spread.
With over 1.7 million undiscovered viruses in wildlife, many of which could infect humans, how important is investment in surveillance systems and genomic sequencing in predicting and preventing the next pandemic?
There is a need for proactive surveillance. Genomic sequencing enables scientists to detect and track pathogens before they grow into pandemics. Early detection systems can prompt quick public health interventions, reducing the scale of outbreaks and save lives.
The WHO’s priority list of pathogens identifies diseases with pandemic potential. How significant is this list in guiding global research, and where does Disease X fit into it?
Its use will serve as a guide for the global research endeavors, prioritizing diseases having more possibility of impacting a larger percentage of people. Disease X highlights the necessity to be prepared for unknown threats, as funding and scientific efforts must remain responsive to emerging crises.
You mentioned the role of climate change in altering disease transmission patterns. How might changing climates push pathogens to adapt and bring us closer to Disease X?
Climate change is restructuring ecosystems and redistributes disease vectors such as mosquitoes. With the spread of these vectors into new areas, it presents new avenues for pathogens to infect unprepared populations with no immunity against them. This environmental transition speeds up the emergence risk of Disease X, therefore making climate adaptation strategies central in public health planning.
Preparedness for Disease X requires collaboration on a global scale. How can frameworks like the Pandemic Treaty and Nagoya Protocol foster equitable sharing of data and resources during outbreaks?
Frameworks such as the Pandemic Treaty and the Nagoya Protocol further facilitate international collaboration in accessing genetic data, resources, and information. Such collaborations guarantee balanced access to vaccines, treatments, and diagnostics particularly for low-resource regions.
Funding remains a major challenge, especially for healthcare systems in vulnerable regions. What role can initiatives like CEPI and “prototype pathogen” platforms play in accelerating our response to unknown pathogens?
Limited funding remains a significant challenge, especially in vulnerable regions. Initiatives like the Coalition for Epidemic Preparedness Innovations (CEPI) play a crucial role by investing in platforms that develop vaccines for "prototype pathogens." These platforms can be quickly adapted to address unknown diseases, accelerating responses during crises.
Finally, with all the uncertainties surrounding Disease X, is it fair to say its emergence is a matter of “when,” not “if”? How can governments and the scientific community work together to ensure the world is better prepared this time?
Considering the recent scenarios of infectious diseases outbreaks there is a high chance that there might be an emerging infectious disease occurring in the future. It is very important for the governments and the scientific communities to collaborate and work while focusing on health infrastructure and expanding global surveillance systems. Preparations today will translate to impact tomorrow.