Disease X - how the world can stop the next pandemic

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Kate Kelland, author, 'Disease X': A pathogen known as Disease X, a virus that we don't know yet but we do know is out there.

Robin Pomeroy, host, Radio Davos: Welcome to Radio Davos, the podcast from the World Economic Forum that looks at the biggest challenges and how we might solve them. This week: the next pandemic is a matter of when, not if. So how can the world prepare for ‘disease X’?

Kate Kelland: We can actually gain a lot of knowledge ahead of time about something that doesn't exist yet.

Robin Pomeroy: A new book, called Disease X says that, even though we can’t avoid future novel viruses arising, we can prepare for them and prevent a global disaster on the scale of COVID-19 happening again.

Kate Kelland: When all of that homework has been done, we will be possibly quite a few steps ahead of any new virus before it emerges. We're kind of almost ready for anything that these viral families can throw at us.

Robin Pomeroy: Author Kate Kelland says that even in a geopolitically fragmented world, history shows we can still all work together against this common enemy.

Kate Kelland: The vast majority of the smallpox eradication work was done during the Cold War. The US and Russia were pointing missiles at each other, but they were also sharing vaccines. There was this huge push to eradicate this terrible disease.

Robin Pomeroy: Subscribe to Radio Davos wherever you get your podcasts, or visit wef.ch/podcasts where you will also find our sister podcasts, Meet the Leader, Agenda Dialogues and the World Economic Forum Book Club Podcast.

I’m Robin Pomeroy at the World Economic Forum, and with this look at Disease X...

Kate Kelland: Even when the world is in conflict, it is possible to have collaboration against a common, deadly viral enemy.

Robin Pomeroy: This is Radio Davos

COVID-19 was a once in a lifetime experience. Not since the so-called Spanish Flu of the early 20th century had the world been afflicted by such a disruptive, deadly new disease.

But, while we all hope not to go through that again, the fact is that there will be another novel viruses in the future. And factors such as human encroachment into natural habitats and increased contact with host animals are likely to increase the risk.

So what can we do about it?

A new book called Disease X, The 100 Days Mission to End Pandemics sets out what we can do. The good news is that there is a lot we can do to stem the spread of a new virus - even if it is one humans have never seen before. The less good news is that it will take a lot of international cooperation and resources.

I spoke to the author, Kate Kelland, chief scientific writer at CEPI, the Coalition for Epidemic Preparedness Innovations, and asked her to tell us more about the book, Disease X.

Kate Kelland: Disease X is about what the world needs to do and can do to prevent something like COVID-19 from ever happening again.

And it's 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, with the coronavirus pandemic, but also with previous pandemics and outbreaks of disease, things like even the 1918 flu and the 2009 swine flu epidemic, and also things like the original Sars, Mers and Ebola and so on.

The book ultimately shows how we can prepare for these threats much better, and it shows that we can get the world into the state of readiness so that when another disease emerges, we can move much more swiftly and more competently to neutralise its potential to go out of control and become another pandemic.

Robin Pomeroy: Because we're in this phase now of, we like to think we're post-COVID, I do anyway, of kind of a post mortem examination. I know in the UK, where we're both from, there's an inquiry looking at preparations for a disease coming up. And the politicians who were in charge before COVID emerged are being questioned about were they ready. And I think by their own admission, they weren't really.

So it's a good moment, isn't it, to look and say, can we avoid one of these happening again.

You're saying we can. Tell us who you are, why you're in a position to tell the world the good news in this book that we can potentially avoid this again.

Kate Kelland: Well, I'm currently the chief scientific writer at CEPI, the Coalition for Epidemic Preparedness Innovations. And CEPI is a non-profit, science-focused coalition that funds research and development of vaccines and other medical defences against diseases that we think have the potential to become epidemics or pandemics.

So CEPI's mission really is to fill this gap in the vaccine ecosystem by accelerating the development of new vaccines against epidemic and pandemic threats and ensuring that they can be made available to everyone who needs them.

So we have certain priority pathogens, diseases we think are the most important ones to watch because they carry the greatest risk of sparking a dangerous outbreak or an epidemic.

Those are things like Lassa fever, Nipah, Mers, Rift Valley Fever, many people may not have heard of, but they are specifically things that we feel carry a great risk.

And CEPI is also focussed on a pathogen that is known as Disease X, which is 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 a from an animal population potentially into humans, attacks perhaps mutate or adapt itself and then to begin spreading and killing people faster than we can contain it.

I joined CEPI in August 2021, having been a health and science correspondent at Reuters for many, many years covering global health and science at Reuters. And given that it was joining CEPI that prompted me to write a book about how the world can get better at preventing pandemics, I thought it made sense to call it Disease X.

Robin Pomeroy: And that comes through in the book. Let's spoil the book for the readers, because there's a lot about the kind of history of diseases, the science, the politics, the social impacts. I think it's well worth reading for that. But you come to the end of it with an understanding of how the world could protect itself from a disease.

Now to a non-scientist such as myself, if you know the kind of disease that's coming, there are things you can do to prepare for it. But the thing with COVID was it was a novel disease. We didn't know what it was initially. It just didn't exist before. And that's what the disease X will be as well. So how, in a nutshell, could we prepare for it?

Kate Kelland: Of course, COVID-19 was a disease X before it got its own name. You're right, it was a novel disease. We had never seen it in humans before. But the truth is it came from a family of viruses and that family of viruses included Sars, the original Sars, Mers, the Middle East Respiratory Syndrome, which emerged in 2012 and also includes a number of viruses that cause the common cold.

So you're right that 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 that virus had.

And specifically, what we did was, because scientists were working for decades or more on Sars vaccines and also on Mers vaccine, they found out some very key pieces of information about coronaviruses, one of them being that the spike protein is an extremely important aspect of the virus and if you can stabilise it, it becomes a very useful vaccine target.

So in fact what we had done before COVID emerged was we'd actually done quite a lot of work on finding out about a virus that didn't exist yet.

And so essentially what this book is saying is that if we do that kind of homework on every one of the 25 or so viral families that we already know have the potential to cause disease in humans - so each one of those families has already produced a virus that can can jump into humans and has jumped into humans - then we can actually gain a lot of knowledge ahead of time about something that doesn't exist yet.

It sounds bizarre, but it but but the proof is in the pudding in terms of that's what we did with COVID.

And it's also, as it happens, the situation that we were in with monkey pox, We already knew an awful lot about that virus and we actually already had a vaccine that worked because it came from the same family as smallpox, camel pox, all sorts of other viruses, and they share common traits. So scientifically, it's about doing that basic research and the vaccinology work. And actually you can get a long way towards being able to produce something that will target a novel virus before that virus even emerges.

Robin Pomeroy: It's interesting, you said there are 20 or so 25, did you say virus families, that scientists should be looking into. Is the expression, a library, a kind of a vaccine library? Tell us what that would be.

Kate Kelland: The idea behind the global vaccine library - we're calling it the One World Vaccine Library - is exactly that kind of knowledge, the homework, the preparatory scientific work, should be done and stored and made available to anyone who needs it at a time when a novel pathogen emerges.

And 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. Then when all of that homework has been done, we will be possibly 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.

Robin Pomeroy: It's quite reassuring again to a non-scientist to hear 25 families, because I'm just reading in the book here, scientists estimate there are around 100 million types of viruses on Earth. It's just baffling the the enormity and how minuscule these things are. If we're able, though, to get a grasp on those 25 families and put us that many steps ahead, it should be very reassuring.

So what's the bad side then? What's standing in our way of doing that?

Kate Kelland: One of the bad sides is, there are 25 families, but the coronavirus family itself, for example, has already given us Sars, Mers, COVID, you know, pretty bad. We're not talking about 25 viral threats. We're talking about 250 to 300 viral threats. It is a big number, but it is finite. So so it's not this kind of unfathomable amount of work. It is a vast amount of work, but it does have an end point and it is doable.

Robin Pomeroy: This is kind of a call to action. This book, what is it? Is it money that's required, investment? Is it international cooperation? Is it something else?

Kate Kelland: You know, the way I've structured the book, as you say, is a kind of call to action. And there are eight chapters in which I start with 'Prepare to'.

So what I identify in the book is a number of traits and 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. So making sure the alarm system, our alerting systems, are well-honed. And when a new viral threat emerges, we don't spend really any time at all thinking, 'Oh, that's nothing to worry about'. We should be worried and we should act quickly.

So there's chapters, 'Prepared to Move Fast', 'Prepare to Take Risks'. You have to sometimes take decisions when you have a very limited view on what's going on. You have very limited knowledge. But then global health leaders, political leaders, have to be able to take decisions, what we call low-regret decisions that if you move too quickly or you move with a large investment, you may have to pull back. But if you delay, you will almost certainly be too late.

So it's about preparing to spend money, preparing to listen to the experts. Also 'Prepare to Fail' is another chapter that I talk about, and the key one is collaboration.

So there's a big chapter called 'Prepare to Share'. And that is not only about sharing the vaccines, which was clearly a big problem during COVID. This idea of sharing knowledge, the preparatory knowledge, which is where the library comes in, that when we do know a little bit more about the paramedics of virus family, we know that there is a certain protein in this family of viruses that's a good target, that knowledge has to be shared and it has to be shared ahead of time so that everybody has the means to respond quickly.

Robin Pomeroy: You mention in your book there's work under way at an international level on a global pandemic treaty. Tell us something about that. And is that something that would go some way to achieving what you are talking about in this book?

Kate Kelland: I think it's now called a pandemic accord. It's already been through a couple of name changes. 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 the knowledge should be shared, the information should be shared, alerts should be sent around, and so on.

So it's basically about enshrining all of these behaviours and contracts into the treaty.

One of the problems with COVID was that when they, organisations that set up COVAX, which is the vaccine sharing facility, when they did set it up, they were literally starting a new organisation and trying to get funding at the same time as they were also trying to buy the vaccines that they would then be able to share. I mean, it was totally on the fly.

So even having one of those elements there, i.e. a pool of money set aside for in the event of the next disease X to be used to procure vaccines or start manufacturing of vaccines, that's something that the pandemic treaty and the pandemic fund can provide.

It's really about getting as much of these things done and set up as possible so that when you are on the starting line of one of these crises, you can start.

Robin Pomeroy: The final chapter in the book, you set out this scenario of a fictionalised disease X arrives, and this is how we would cope with it if all the things work out okay. The finance is there, the sharing of knowledge and the sharing of resources.

But there are things obviously that could go wrong in a scenario like that. Disease X arrives too quickly and then this stuff hasn't been put in place yet.

But also, as we saw with COVID, and it was quite surprising to some of us, the scepticism among some people towards vaccines and towards other policies, lockdowns, this kind of thing. Do you give much thought to this, Kate, in your role as kind of a communicator on this issue - once you're not talking to the scientists and the policymakers? There's research by King's College London, something like a quarter of the UK population thinks COVID was a hoax. It's no longer in the fringes, is it? I mean, what would you, as a communicator, have to do or I, as a communicator, have to do to engage with that and to address that?

Kate Kelland: I mean, we're really talking about the misinformation, and that took all sorts of forms during the pandemic.

If you think about the sort of anti-vax movement during the pandemic, there were vocal minorities in many countries. But it is important to remember that they were minorities and that, in fact, if you look across the world, the information that was available and the vaccines that were available were taken up by the vast majority of populations that had the choice.

Yes, there was misinformation around, but on the whole, in the vast majority of cases, if people have access to the information and it's clear and open and there are risks associated with getting ill and there are risks associated with being in parties or getting on buses or whatever, then most people do actually come to a decision in the end of how to protect themselves and their families. They do, on the whole, make a sensible decision.

The final chapter is actually the playing out of this 100 days mission. And there is this scary disease. It's definitely not beyond the realms of possibility that such a virus could emerge. But things do go well. 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 again, 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, then those failures or those difficulties are overcome.

My broad feeling is that misinformation is definitely a problem, but I am reassured if you take a big view of what happened during the pandemic is, when people were faced with all of this information, the good, the bad and the wrong, they made a decision that was how to protect themselves and their family, and most of them made the right decision.

Robin Pomeroy: Let's talk about some of your personal experiences. You talk about a vaccination scar you have on your shoulder. This is an interesting - there is a generational thing here because my parents grew up with the threat of polio, for example, and that's gone. We never think about it now, you know, and we all have these scars from tuberculosis jabs, and none of us get that in countries where those policies have been pursued, it's seen as a good thing. It always was. You know, except for a minority of people who are very sceptical about vaccines. So what was this thing you had on your shoulder? What was that about?

Kate Kelland: Yes, I mean, it's interesting that you mention polio and TB because, of course, we in the wealthy world are all very fortunate not to have to think or even remember polio or TB, but that is definitely not the case in other places.

And polio is proving extremely difficult to eradicate, that last 2% or 1.5%, and and it can crop up anywhere. TB is also a big problem in South Africa and other places where we now have a drug resistant form of it that is spreading.

So I mean, these are very much not diseases of the past for many places in the world.

The scar on my left shoulder is from a smallpox vaccine because I was born in northern Nigeria, in Sokoto, when my parents were on VSO. So I was one of the last people really in the world to get a smallpox vaccine. And in 1980, the World Health Organisation declared that smallpox had been eradicated across the world, and it is the first and only human disease ever to be eradicated.

So I use that as an example in the book, not just of the fact that the world can and has done this scientifically, has the capability to be able to take out these diseases. But it's really also in the book used as an example of collaboration, because of course the vast majority of the smallpox eradication work was done during the Cold War when the US and Russia were pointing missiles at each other, but they were also sharing vaccines and making sure that there was this huge push to eradicate this terrible disease.

So again, it is used as an example of how even when the world is in conflict, it is possible to have collaboration against a common, deadly viral enemy.

Robin Pomeroy: Kate Kelland is chief scientific writer at CEPI, the Coalition for Epidemic Preparedness Innovations. Her book is called Disease X, The 100 Days Mission to End Pandemics.

To find out about the World Economic Forum’s work on pandemic preparedness, check out the links in the shownotes to this episode and on the episode’s page on our website.

You can read about the Forum’s Regionalized Vaccine Manufacturing Collaborative, which is co-chaired by the head of CEPI, Richard Hatchett. That aims to establish vaccine manufacturing in regions of the world that currently don't have any manufacturing facilities and those that were last in line to receive vaccines during COVID-19.

Also, find out about the Forum’s Pathogen Surveillance Initiative, which aims to develop new public-private-partnership ways to more rapidly identify and track emerging and known pathogens to prevent the next pandemic.

As I say, links in the shownotes and more information on the World Economic Forum’s website page for the Centre for Health and Healthcare.

Please subscribe to Radio Davos wherever you get your podcasts. Please leave us a rating or review. And join the conversation on the World Economic Forum Podcast club -- look for that on Facebook.

This episode of Radio Davos was presented by me, Robin Pomeroy. Editing was by Jere Johansson. Studio production was by Taz Kelleher.

We will be back next week, but for now thanks to you for listening and goodbye.