Diseases X, Y, Z: Are We Ready?


By Andy Oppenheimer

In February of this year, the Director-General of the World Health Organization (WHO), Dr. Tedros Ghebreyesus, issued a stark new warning about the likelihood of a new pandemic and­ the spread worldwide of a “Disease X”.

He said it was “a matter of when, not if” a new pathogen will strike humanity and exceed the catastrophic damage wreaked by COVID-19 over the past four years and which continues to take lives and sicken thousands.

In a speech delivered at the World Government Summit in Dubai, Dr Tedros said civilization was “unprepared” for the next pandemic, adding that similar warnings were issued six years ago. The WHO had previously warned that a “Disease X” – a hypothetical disease or pathogen that humanity is not equipped to deal with – could kill up to 20 times more than coronavirus. Assuming that COVID-19 was Disease X, we are now looking at Y and Z.

“The painful lessons we learned are in danger of being forgotten as attention turns to many other crises confronting our world. But if we fail to learn those lessons, we will pay dearly next time – and there will be a next time. The cycle of panic and neglect is beginning to repeat.”

Dr. Tedros Ghebreyesus, Director-General, World Health Organization

By the end of 2023, COVID-19 had killed more than seven million people worldwide, with millions more suffering from “Long COVID”, as well as subsequent illnesses such as stroke and heart attacks related to single or repeat infections. In the U.K. alone, as many as two million are estimated to have Long COVID.

Previous Warnings

In January 2023, a group of humanitarian agencies issued a similar warning about the lack or absence of preparedness for the next pandemic. Citing the 2021 Global Health Security Index backed by the Johns Hopkins Institute, the report released by the International Federation of Red Cross and Red Crescent Societies assessed almost 200 countries based on their health emergency preparedness. On a scale of 100, no country scored above 80. The global average stood at a pitiful 39.

In May 2023, the head of the private medical provider BUPA, Iñaki Ereño, told the BBC that governments and healthcare organizations had not learnt lessons from COVID-19 and were not prepared for the next pandemic.

“The planning was not good, we cannot empty the hospitals and the clinics just for [a disease like] COVID,” he said, recommending that hospitals should be segregated or separately designated for treating future pandemic victims. 

Global health experts had long warned that another pandemic equal to the Spanish Flu outbreak of 1918 was imminent. The biggest pandemic of modern times resulted in social distancing, enforced school and shop closures, and transportation restrictions.

Adequate planning could have anticipated major economic shocks of the kind that were experienced. However, we have since lived in a totally different time characterized by air transportation, overpopulation, and greater freedoms manifesting itself in public resistance to restrictions. This was exacerbated by the spread of conspiracy theories on social media.

For many years researchers have conducted analyses of hotspots to identify the presence of vectors, land use, and climate change to identify where vector-borne illnesses would occur. Reviews of lab security also warned against possible accidental release of deadly microorganisms. Despite these efforts, the world – with a few exceptions in the Far East – was unprepared for COVID-19.

Provisional statistics for COVID-19 fatalities and Nucleic Acid Amplification Test (NAAT) percent positivity, by week, in the U.S. reported to CDC. COVID-19 still ranks as the 10th most common cause of death in the U.S. ©CDC

The COVID Inquiry

In the two years that saw lockdowns and unprecedented measures to counter the spread of the virus, many mistakes were made. The U.K.’s COVID Inquiry that began in June 2022 is highlighting a catalogue of errors and misjudged decisions. These have included inadequate PPE provision, poor timing of the start and finish of lockdown, and the reopening of businesses under the Eat Out to Help Out scheme. Ten years of austerity was found to be a prime factor in inadequate preparations.

Providing evidence at the inquiry, chair of the British Medical Association (BMA), Prof. Phil Banfield, said in particular that inadequate PPE, poor testing infrastructure, and inadequate public safety measures contributed to the government “losing control” of the pandemic.

While he worked on the frontline throughout the pandemic, he saw how the lack of sufficient PPE and inadequate guidance surrounding its use had contributed to the spread of the virus, most notably outside ICU units. He said that staff were “treating people with no masks, or with fluid-resistant surgical masks which did not protect from an airborne virus”. Prof. Banfield also said that the BMA “could not understand the decision to abandon contact tracing made on March 12”.

An exhausted anaesthesiologist in Pesaro, Italy, March 2020, ©Alberto Giuliani/Wikimedia Commons

Mistakes Made

In 2016, Public Health England had undertaken a one-day planning exercise on coronaviruses – Exercise Alice – which focused on the need to stockpile PPE, border control measures, and plan for mass contact tracing. But soon after becoming PM in July 2019, Boris Johnson stood down a team of senior ministers set up to advise on how to prepare the public for a pandemic.

The Threats, Hazards, Resilience and Contingency Committee (THRCC), a sub-committee of the National Security Council (NSC), was also sidelined by previous PM Theresa May to focus on Brexit. Six months later, coronavirus had spread to Europe. Similarly, in 2018 the Trump Administration dismantled a National Security Council directorate at the White House charged with preparing for a pandemic. 

Basic countermeasures learned from COVID-19 that should have been applied earlier include increased ventilation and wearing an FFP2/N95 facemask in all busy indoor settings. As the disease spread, it took some time to emphasize that it was airborne and required protection by wearing FFP2/N95-level quality masks. There was excess initial emphasis on hand washing and insufficient advice on, or implementation of, mask wearing. 

Mr. Ereño also questioned whether countries had enough PPE in stock and if it was of the requisite quality. In May 2023, a BMA also report criticized PPE preparedness in the NHS before the pandemic. This was high on the list of lessons to be learned.

“…since Covid-19 the NHS has been hit by a sequence of challenges including staff striking across the sector, the Ukraine war creating supply chain disruption and high energy costs…  it’s very hard for NHS managers to focus on the next pandemic.”

Iñaki Ereño, Director, BUPA

Preparing for the Next Pandemic

Vaccination was developed rapidly and emerged in the second year against COVID, arguably saving millions more lives and preventing severe illness. The offer of booster vaccinations as a vital countermeasure against this and any future highly infectious and unpredictable virus may meet with another wave of “antivaxxer” opposition. Many people, including politicians and the media, also think it’s all over and talk of “post-COVID”.

Overpopulation and overcrowding, increased travel, and many other aspects of modern life that many take for granted may be our undoing. But the above lessons would have to be applied at the first notice of an initial spread of a novel or altered pathogen with countermeasures applied urgently and universally.

In the U.K. the unprecedented number of hospital admissions caused by COVID-19 put the NHS under severe strain. These problems continue to plague public services in the U.K. and elsewhere, with health worker absences and long waiting lists. Any future lockdown will also hit struggling businesses and public services. Many other crises – some of them unprecedented and equally global in their enormity – are likely to overshadow preparedness efforts by governments, authorities, and the public to defend against the next pandemic. Much still needs to be put in place if Dr Tedros’ warning is not to be borne out.

Andy Oppenheimer is the author of IRA: The Bombs and the Bullets – A History of Deadly Ingenuity (2008) and a former editor of CBNW and Jane’s NBC Defense. He is a Member of the International Association of Bomb Technicians & Investigators and an Associate Member of the Institute of Explosives Engineers, and has written and lectured extensively on CBRNe since 2002. 

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