We need to stop what drives mass epidemics rather than just respond to individual diseases.
By
Mr. Daszak is a disease ecologist.
In early 2018, during a meeting at the World Health Organization in Geneva, a group of experts I belong to (the R&D Blueprint) coined the term “Disease X”:
We were referring to the next pandemic, which would be caused by an
unknown, novel pathogen that hadn’t yet entered the human population. As
the world stands today on the edge of the pandemic precipice, it’s
worth taking a moment to consider whether Covid-19 is the disease our
group was warning about.
Disease X, we
said back then, would likely result from a virus originating in animals
and would emerge somewhere on the planet where economic development
drives people and wildlife together. Disease X would probably be
confused with other diseases early in the outbreak and would spread
quickly and silently; exploiting networks of human travel and trade, it
would reach multiple countries and thwart containment. Disease X would
have a mortality rate higher than a seasonal flu but would spread as
easily as the flu. It would shake financial markets even before it
achieved pandemic status.
In a nutshell, Covid-19 is Disease X.
Even as there are signs that the epidemic’s spread might be slowing in China, multiple communities and countries have now reported sustained transmission in their midst. The number of confirmed cases has exploded in South Korea in recent days. In Italy, villages and towns are on lockdown, Fashion Week in Milan has been disrupted
and festivals are being canceled while public health authorities search
for patient zero to identify who else is likely infected and may spread
the disease in Europe. Iran appears to have become a new hub of transmission. The looming pandemic will challenge us in new ways, as people try to evade quarantines, and misinformation campaigns and conspiracy theorists ply their trade in open democracies.
But
as the world struggles to respond to Covid-19, we risk missing the
really big picture: Pandemics are on the rise, and we need to contain
the process that drives them, not just the individual diseases.
Plagues are not only part of our culture; they are caused by it. The Black Death spread into Europe in the mid-14th century with the growth of trade along the Silk Road. New strains of influenza have emerged from livestock farming. Ebola, SARS, MERS and now Covid-19 have been linked to wildlife. Pandemics usually begin as viruses in animals that jump to people when we make contact with them.
These
spillovers are increasing exponentially as our ecological footprint
brings us closer to wildlife in remote areas and the wildlife trade
brings these animals into urban centers. Unprecedented road-building,
deforestation, land clearing and agricultural development, as well as
globalized travel and trade, make us supremely susceptible to pathogens
like coronaviruses.
Yet the world’s strategy for dealing with
pandemics is woefully inadequate. Across the board, from politicians to
the public, we treat pandemics as a disaster-response issue: We wait
for them to happen and hope a vaccine or drug can be developed quickly
in their aftermath. But even as Covid-19 rages, there still is no
vaccine available for the SARS virus of 2002-3, nor for HIV/AIDS or Zika
or a host of emerging pathogens. The problem is that between outbreaks,
the will to spend money on prevention wanes, and the market for
vaccines and drugs against sporadic viral diseases isn’t enough to drive
research and development.
During its
World Health Assembly in 2016, the W.H.O. set up the R&D Blueprint
to bridge this gap and announced a priority list of pathogens that most
threaten global health and for which no vaccines or drugs were in the
pipeline. SARS made the list, as did MERS, Nipah, Ebola and other rare
but serious diseases caused by epidemic viruses. The Coalition for Epidemic Preparedness Innovations
— a global partnership between public, private, philanthropic and civil
society organizations launched at Davos in 2017 — stepped up to the
plate and sourced funding to develop vaccines and therapeutics against
some of these.
To escape from the Age
of Pandemics, we’ll need to treat them as a public health issue and
start working on prevention in addition to responses. Our first goal
should be to broaden our armory against potential mass epidemics. When
some of us added “Disease X” to the W.H.O.’s priority list
two years ago, we wanted to make the point that it’s not sufficient to
develop vaccines and drugs for known agents when the next big one is
likely to be a different pathogen — a virus close to SARS, say, but not
close enough that the same vaccine can work against both.
As Covid-19 strikes today and a spate of
other pathogens are ready to emerge in the future, we continue to butt
up against nature. Scientists estimate that there are 1.67 million
unknown viruses of the type that have previously emerged in people.
Discovering and sequencing them should be a priority — a simple case of
“know your enemy.” In the aftermath of SARS, research on coronaviruses
originating in bats has discovered more than 50 related viruses, some of
which have the potential to infect people; this information can now be
used to test for broad-action vaccines and drugs. Scaling up this effort
to cover all viral families, as the Global Virome Project proposes to do, is a logical first step toward prevention.
A
radical shift is also needed in the way that tests, vaccines and drugs
are designed so that entire groups of pathogens are targeted instead of
individual pathogens that are already known. The National Institute of
Allergy and Infectious Diseases in the United States is working on a universal flu vaccine
that would cover all known strains of influenza; a universal
coronavirus vaccine, an Ebola-virus vaccine and others will also be
needed.
With a smaller investment, we
can also try to get ahead of pandemics by working with communities in
hot spots of emerging diseases. Disease surveillance should be focused
on farmers, rural communities and anyone who has extensive contact with
wildlife, to look for unusual illnesses, test for novel pathogens and
work with people to develop alternatives to high-risk activities such as
the wildlife trade.
Pandemics are
like terrorist attacks: We know roughly where they originate and what’s
responsible for them, but we don’t know exactly when the next one will
happen. They need to be handled the same way — by identifying all
possible sources and dismantling those before the next pandemic strikes.
