World Health Organisation warns against dengue vaccine risks

Fresh concerns about the efficacy of the world’s first ever Dengue vaccine has come to light as the World Health Organisation (WHO) noted that there is an urgent need to describe the potential risks of the vaccine.

Therefore, it has advised the countries planning to use the vaccine to screen the population before vaccination. It has strictly directed the countries to vaccinate only seropositive (tested positive for dengue) individuals.

Dengvaxia (CYD-TDV), the vaccine in question is produced by the Pharmaceutical giant Sanofi Pasteur. The Strategic Advisory Group of Experts (SAGE) formulated by WHO is examining the concerns caused by the vaccine.

“Furthermore, although the efficacy against dengue infections in seropositive individuals is high, it is still not complete. Hence, the limitations of CYD-TDV will need to be clearly communicated to populations offered vaccination,” warned WHO.

SAGE also looked at the population seroprevalence criteria (percentage of population affected by dengue) to ensure that only those affected by dengue get the jab.

“SAGE noted that the evidence of the absence of a safety issue in seronegative individuals aged 9 and above was based on the limited data set of 10%-20% of the trial population, and highlighted the urgent need to better describe the long-term benefit-risk ratio of CYD-TDV in seronegative individuals,” said a spokesperson.

http://www.dnaindia.com/

 

Face of Defense: Doctor Builds Partnerships Through Global Health Engagement

FALLS CHURCH, Va. --
Air Force Lt. Col. (Dr.) Elizabeth Erickson’s experiences in military health outreach around the world allows her to build strong partnerships, and her position as a female officer and physician has given her the unique opportunity to work with and learn from inspiring women around the globe.

The Air Force Medical Service participates in international medical outreach efforts, called global health engagements, to strengthen relationships with partner nations that bear fruit diplomatically and medically.

Building Strong Relationships With Allies, Partners

GHEs include a broad range of international medical activities undertaken by the U.S. military. These activities help to build strong relationships with allies and partners, increase military medical interoperability between nations and build global capacity to address health security threats.

“For example, we work with some partner nations on biosurveillance in order to better detect and respond to outbreaks, so they do not become larger health security crises,” Erickson said.

Erickson, a family physician and currently a preventive medicine resident at the Uniformed Services University of the Health Sciences in Bethesda, Maryland, always had an interest in working and studying abroad. Before joining the Air Force, she studied and volunteered in India and Africa.

In the Air Force, after assignments in Turkey and Germany and a deployment to Afghanistan, she was an international health specialist at Pacific Air Forces and U.S. Pacific Command.

“I was always interested in having a global perspective on care, so I gravitated towards these unique opportunities,” Erickson said. “As an international health specialist, I planned and executed GHEs, coordinated Department of Defense health activities across the Indo-Asia-Pacific region, and developed strategies to use health engagements to achieve national security objectives.”

Service in Afghanistan

Erickson’s GHE experiences allow her to apply and expand intercultural, medical and military skills. As a female officer, she had opportunities to support the health and empowerment of women in multiple countries, specifically in Afghanistan.

From July 2009 to March 2010, Erickson served as senior medical officer and director of Women’s Affairs on the Zabul Provincial Reconstruction Team in Afghanistan. She and her team executed programs that supported the local government and improved the health and well-being of the local population, especially women and children. The team engaged with the local Ministry for Women’s Affairs representatives, female health care providers at local hospitals and the province’s only girls’ school.

“It was a priority for our commander to find sustainable ways to improve the lives of Afghan women,” Erickson said. “One project provided women with solar stoves. We found that women were inhaling harmful smoke while cooking with charcoal and wood, and we wanted to provide an alternative cooking method that would ultimately improve their health.”

The three medical Air Force women on the PRT met regularly with local female health care providers.

“We developed strong relationships with them and learned about their challenges,” Erickson said. “We conducted training on basic life support in obstetrics to help them recognize potentially life-threatening events that happen during childbirth and prepared them to manage those events.”

International Women’s Day Event

While in Afghanistan, Erickson participated in an International Women’s Day event. Local women -- including the female nurses and physicians she had worked with so closely -- gave speeches, performed music and recited poetry.

“It was special to see our friends, these women we became so close with, share their hopes for peace and stability in Afghanistan,” Erickson said.

Erickson’s experiences serve as an important reminder that female military leaders and medical personnel are vital for full-spectrum global health engagement, and she encourages other female medical airmen to pursue opportunities in GHE.

“There are some really inspiring women in our partner nations, and it was a rewarding experience to meet and work with them,” Erickson said. “Many times, my female counterparts and I built a special bond and we worked together to move health cooperation between our militaries forward.”

She added, “We should encourage more women to become leaders on both sides of the GHE community to improve our engagements with our partner nations and the global military medical community.”

source: https://www.defense.gov/News/Article/Article/1496686/face-of-defense-doctor-builds-partnerships-through-global-health-engagement/ 

 

Australia to join global health and climate change initiative

The Lancet Countdown report on health and climate change was published in October 2017 by The Lancet and will be updated annually through to 2030.

It tracks progress on health and climate change across 40 indicators divided into five categories: climate change impacts, exposures and vulnerability; adaptation planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement.

Dr Ying Zhang, a senior lecturer in the University of Sydney's School of Public Health, and Associate Professor Paul Beggs, from Macquarie University, wrote in the MJA that, from an Australian perspective, "with our high level of carbon emissions per capita, it will be important to reflect on our progress and how it compares with that of other countries, especially high-income countries".

"A group of Australian experts from multiple disciplines is commencing work on our first national countdown report," Zhang and Beggs wrote.

"The project recognises the importance of the climate change challenge in Australia, including its relevance to human health, and also the unique breadth and depth of the Australian expertise in climate change and human health.

"The Australian countdown will mirror the five domain sections of the Lancet Countdown, adopt the indicators used--where feasible and relevant to Australia--and include any useful additional indicators.

"The inaugural Australian report is planned for release in late 2018 and is expected to be updated annually. We hope to raise awareness of health issues related to climate change among Australian medical professionals, who play a key role in reducing their risks," the authors concluded.

"The Australian countdown is also envisioned as a timely endeavour that will accelerate the Australian government response to climate change and its recognition of the health benefits of urgent climate action."

###

The University of Sydney appointed Dr Tony Capon as the world's first professor of planetary health in 2016. Learn more about the mission and activities of the University of Sydney's Planetary Health Platform.

source: https://eurekalert.org/pub_releases/2018-04/uos-atj041218.php

 

World Health Day : Nestlé Nutrition Institute Africa empowers Health Care Professionals

As people across the globe joins World Health Organisation to celebrate World Health Day on April 7, Nestlé Nutrition Institute Africa (NNIA) commemorated the Day in collaboration with the Ogun State Ministry of Health by training primary healthcare professionals in Abeokuta on Friday April 6, 2018.

With the 2018 year theme, “Universal Health Coverage: Everyone, Everywhere,” NNIA in observance of the organisation’s vision which focuses on ensuring that all people can get quality health services, where and when they need them, without suffering financial hardship embarked on the training of healthcare professionals to key into the mandate.

The one day training held at Nigeria Medical Association (NMA) house in Abeokuta by experts from NNIA witnessed various primary healthcare professionals from 110 Primary Health Care Professionals from Abeokuta North local government area of Ogun state who participated in the training on Malnutrition in the First Years of Life: Its Assessment and Management.

Giving a welcome address at the flag-off of the training, the NNIA representative, Dr. Omotayo Omoteso shed light on the objectives of the training. He said, “Global studies have shown that malnutrition is an underlying factor in 55 percent of all child deaths, with Nigeria largely affected by the scourge. Each year, about 1 million Nigerian children die and more than half of these deaths are traceable to malnutrition.”

According to him, this situation calls for urgent multi-stakeholder action. “Nestle Nutrition Institute Africa is therefore happy to collaborate with the Ogun State Government in its efforts to address malnutrition in the first 1000 days of life. This is in line with our commitment to bridge the gap between science and the practical application of nutrition to ensure a healthier, brighter future for children. We therefore welcome this opportunity to contribute through the development of the capabilities of Primary Health Care Professionals here in Ogun State.”

Addressing the press at the Ogun State Secretariat where the training took place, Ogun State Commissioner for Health, Dr. Babatunde Ipaye said it is sad to note that millions of people across the globe suffer financial hardship in obtaining essential health services due to poverty.

“Currently, about 800 million people, which constitute 12 per cent of the world’s population, spend at least 10 per cent of their household budget on health needs. Of this number, about 100 million suffer financial hardship because of out of pocket health expenditure and half of the world’s population is unable to obtain essential health services, due to poverty.” Ipaye stressed.

Dr. Ipaye said that the World Health Day 2018 celebration and intervention programme provided another opportunity for strengthening the health care system in Ogun State which was made possible by the partnership with stakeholders like Nestlé Nutrition Institute Africa (NNIA) who supported the state’s efforts by delivering a capacity building training to primary Health Care Professionals (HCPs) on Friday.

Dr. Babatunde Ipaye also revealed some of the measures the state has put in place to improve maternal and child health. One of these according to him is a state funded social insurance scheme popularly called “Araya”. He disclosed that since its inception in 2014, the scheme has enrolled over 23,000 people. The commissioner expressed his appreciation to Nestlé Nutrition Institute Africa (NNIA) for providing support towards the delivery of the health mandate of the administration. He also thanked the HCPs for making themselves available for the training and encouraged them not to keep the knowledge to themselves, but also to do well to transfer the same to their family members and colleagues who did not have the opportunity to participate in the training.

Meanwhile, Nestlé Nutrition Institute Africa, NNIA is an institute that shares leading science-based information and education with Health Care Professionals. It was founded on the credo that good nutrition begins before birth, continues through the lifecycle and is nurtured by the knowledge and consumption of a nutritionally adequate and appropriate diet. It aims for a future across the African continent where individuals are nourished healthier and live longer lives.

Furthering the understanding of the science of nutrition of the HCPs is envisioned to go a long way in bridging the gap between the science of nutrition and its practical application. Right now, there are over 20,000 Health Care professionals who have registered and benefits on the Nestlé Nutrition Institute Africa’s website.

Read more at: https://www.vanguardngr.com/2018/04/world-health-day-nestle-nutrition-institute-africa-empowers-health-care-professionals/ 

 

Tuberculosis services in Moscow extend “health for all” even to the most vulnerable

Karam is a 23-year-old from the Khatlon region of Tajikistan. He came to Moscow in 2015 to work in construction, and 2 years later fell ill with a high fever and headache. He felt as though he had no strength, but nevertheless tried to carry on. When his condition became so severe that he was barely conscious – a state described by his doctors as the edge of life and death – Karam’s uncle, with whom he lives, called an ambulance.

At the hospital, Karam was diagnosed with tuberculous meningitis. Up until that point, he knew nothing about tuberculosis (TB). He felt afraid and unsure, wondering how he would pay for the treatment he needed to get well. But then he learned that his treatment would be completely free, provided by the Moscow Research and Clinical Center for Tuberculosis Control. This was part of an initiative undertaken by the city of Moscow to ensure that all people, including migrants like Karam, have access to the TB services they need.

A new model of TB services

The city launched the initiative in 2012. Though at that time the TB rate among the resident population of Moscow was declining, increasing numbers of migrants, who are often more susceptible to the disease, made it necessary to change the traditional approach to TB control efforts.

The city created a new organizational model in the spirit of providing universal health coverage to everyone, without causing financial hardship. It based the model on key components that include:

  • providing people-centred care;
  • strengthening human resource capacity for TB; and
  • monitoring the epidemiological situation.

The Chief TB Specialist of the Moscow City Department of Health oversees these activities.

In 5 years, the new model resulted in significant changes to TB care in Moscow. Most importantly, it allowed the city to provide quality services to all vulnerable populations, including migrants and homeless people.

Intensive work with latent TB infection and TB contacts has helped to reduce TB notification rates among permanent residents in Moscow by 11.7% (to 12.8 per 100 000 population) and among children by 23.8%. New approaches to treating multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) have also been applied, with positive outcomes.

In 2016, an increased focus on prevention among the migrant population in Moscow contributed to the detection of an additional 1605 TB cases. Since 2012, the number of TB deaths in the capital has decreased by 22%, and the number of registered patients with MDR-TB has decreased by 44% (to 3.4 per 100 000 population), making it the lowest in the country.

The benefits of Moscow’s new approach to TB services are perhaps felt most deeply on the individual level. For Karam, the news that his treatment would be provided free of charge came as a great relief. It took 2 months of intensive therapy before his condition stabilized and began to improve. He was treated and observed by several specialists over the course of 11 months.

Today, Karam has made a near-complete recovery. He appreciates the work of the doctors who have treated him, supported by the city of Moscow. “When I got here, I felt very bad. I had no strength at all,” he says. “After the treatment started, gradually I became better. I believe I will one day have enough strength to return to work.” When he is well, he hopes to return to his native Tajikistan and his large extended family still living there. He plans to work in his family’s lemon grove.

source; http://www.euro.who.int/

 

Building Resilient Health Systems to Climate Change Among SIDS

Health Ministers and Environment Ministers, Experts, Officials and other key stakeholders from Small Island Development States (SIDS) of Africa and South East Asian regions, namely Cabo Verde, Comoros, Madagascar, Maldives, Mauritius, Reunion Island, Sao Tome and Principes and Seychelles participated in the World Health Organization (WHO) Third Global Conference on Climate Change and Health on 21-22 March 2018 in Mauritius. This special Initiative was launched by the WHO in view of supporting SIDS countries in the adoption of a streamlined and concerted approach to climate change and health. During the conference, the participants focused on climate change and health, with a vision that by 2030 all health systems in SIDS will be resilient to climate variability and change. The importance of a collaborative approach towards having a regional and national institutional mechanism for mitigating the impacts of climate change has been stressed upon by the WHO.

Dr (Mrs) Joyce St John, Assistant Director-General Climate and Other Determinants of Health in WHO Head Quarters, Geneva, Dr Magaran Bagayoko, delegated by Dr Moeti, Regional Director of the WHO Regional Office for Africa, and representatives from various international institutions, including United Nations Environment Programme (UNEP) and the Indian Ocean Commission participated in the conference. Dr St John addressed the representatives from the different SIDS countries at the opening of the conference and said that ‘SIDS should speak in one strong voice to make them heard by the whole world as SIDS countries contribute little to climate change and yet, they suffer most of the adverse effects of climate change.’ She reiterated her full support and commitment in supporting SIDS countries in mitigating the impacts of climate change. She pointed out that ‘the outcome of the deliberations once finalized will be submitted in the form of a Regional Action Plan at the forthcoming World Health Assembly in May 2018 in view of obtaining support and assistance to enable SIDS to cope with health and climate challenges’. During the two days conference, the SIDS countries recognised that climate change cannot be dissociated from health as it affects, in profoundly adverse ways, some of the most fundamental determinants of health, including clean air, safe drinking water, sufficient food and secure shelter.

Dr. M. Bagayoko from WHO AFRO highlighted the global initiatives taken by WHO to mitigate impacts of climate change such as the United Nations Framework Convention on Climate Change (UNFCC) in 1992 which recognises human health and welfare as a priority response for climate change and Paris Agreement 2015 which cites the right to health to implement the agreements as a public health treaty. It was recalled that WHO launched the Small Islands Development States (SIDS) initiatives in collaboration with UNFCC and Fijian Presidency of COP-23 in view of providing the SIDS countries all the necessary technical and financial support to build climate resilient health system to address the effects of climate change. According to Dr Bagayoko, SIDS countries from African and South East Asian Region (SEAR) will have to lead the way for developing sustainable climate resilient model of health systems that will also focus on diseases prevention through integrated diseases surveillance and early warning system. In the same line, he emphasized the need for SIDS countries to ensure sustainable funding for addressing the impacts of climate change at national and regional levels. It was noted that the WHO special initiative on climate change and health in SIDS was launched by Dr Tedros Adhanom Ghebreyesus, Director General of WHO, who made health impact of climate change and environment on SIDS Countries ‘one of his main priorities’ and consequently, climate change and health was incorporated in the WHO Global Programme of Work for 2019-2022.

At the opening of the Global Conference, the Health Minister, Dr Hon. Anwar Husnoo, pointed out that ‘climate change constitutes potential threats to SIDS due to their small size, geographical remoteness, level of development and vulnerability to national disasters’. He added that ‘SIDS are in the front line exposed from acute to long term risks, from extreme weather events including torrential rains, flash floods, storm to impending risks as a result of water and food borne infectious diseases, and the rise in sea level constitutes imminent danger and hazard to healthcare facilities especially those on coastal areas.’ He highlighted that the average temperatures in Mauritius have increased over the region by 0.74 °C to 1.2 °C since 1950 and the minimum temperature has increased by a larger magnitude. On the other hand, summer temperatures have been observed to be increasing more rapidly than winter ones and the number of days with maximum temperatures above the threshold value of 30 degrees Celsius is on the rise over the entire Republic of Mauritius. He recalled that Mauritius has already been experiencing the adverse effects of climate change during the flash flood that occurred in 2013 causing the loss of lives.

Dr Husnoo stated that as a small island, Mauritius remains highly vulnerable to climate change, given that the Aedes mosquito and Anopheles mosquitoes, the local vectors of dengue and malaria are present in the country, and with the recent heavy rainfalls, there is high risk of proliferation of these mosquitoes, rendering the country highly vulnerable to emergence of mosquito related infectious diseases. He stressed upon all the precautionary measures taken by the Government of Mauritius at points of entry to reinforce surveillance of communicable diseases. Mauritius though not endemic for dengue fever, has already experienced several outbreaks so far, namely in 2009, 2014 and 2015 when locally transmitted cases were reported. About ten years ago, an epidemic of Chikungunya affected about 30% of the population. Dr Hon A. Husnoo also highlighted the ageing of the population of Mauritius as a factor that increases the vulnerability of the country to communicable and non-communicable diseases.

Dr Laurent Musango, the WHO Representative in Mauritius, in his opening remarks said that ‘climate change among SIDS is no longer a distant threat’. He added that climate change is ‘a shared problem in need of a global solution, and above all, multilateral, integrated and coordinated approach and solutions’ It was pointed out that SIDS countries will require massive technology transfer and financial support to take climate-friendly measures. Dr Musango, stated that ‘developed countries not only need to reduce their emissions adequately but they are also expected to help meeting the technology and financial needs of developing countries, including SIDS countries.’ He made an appeal to all the representatives of the SIDS countries present to join forces to build solidarity and re-commitment to a global partnership for sustainable development.

During the course of the meeting, the Framework for action on climate change was discussed. SIDS countries realise that the challenges for small islands are the same and joint actions are necessary to raise a strong common voice at global level. Action points along the four strategic line actions, namely empowerment of leadership, building evidence, implementation and facilitating access to resources were discussed and targets and indicators were identified to address the challenges through participative approach.

The deliberations of the Conference will adequately inform the formulation of a regional action plan on climate change for the period of 2019 to 2023 for SIDS in the African and South East Asian Regions. In the same vein, the SIDS countries agree to leverage the existing regional mechanism to ensure that health and climate change is placed high on the agenda at regional and global levels. It was also agreed to strengthen the collaboration between different sectors at country level for evidence generation, surveillance, building capacities and resource mobilisation. Further, it was highlighted that existing networks for evidence generation needs to be strengthen in terms of human resource capacity in the areas of data generation, data use and dissemination across various regional and global platforms. Other recommendations from the participants from the Global Conference include placing the health agenda item at the UNFCC and AOSIS (Alliance of Small States) so that voices of SIDS countries are heard at the highest level possible, be it at WHO level or other bodies.

source: https://reliefweb.int/

 

 

 

Lassa fever: The killer disease with no vaccine

Since the beginning of the year, Nigeria has been gripped by an outbreak of a deadly disease. Lassa fever is one of a number of illnesses which can cause dangerous epidemics, but for which no vaccine currently exists.

Lassa fever is not a new disease, but the current outbreak is unprecedented, spreading faster and further than ever before.

Health workers are overstretched, and a number have themselves become infected and died.

The potentially fatal disease is a so-called "viral haemorrhagic fever", which can affect many organs, and damage the body's blood vessels.

But it is difficult to treat.

Most people who catch Lassa will have only mild symptoms such as fever, headache and general weakness. They may have none at all.

However, in severe cases, it can mimic another deadly haemorrhagic fever, Ebola, causing bleeding through the nose, mouth and other parts of the body.

Lassa fever normally has a fatality rate of about one per cent. But in the Nigerian outbreak it is thought to be more than 20% among confirmed and probable cases, according to the country's Centre for Disease Control.

Lassa fever outbreak in Nigeria

22% fatality rate among confirmed and probable cases

1081 suspected cases (1 January - 25 February)

90 deaths

14 health care workers affected in six states

Nigeria Centre for Disease Control and World Health Organization

About 90 people are thought to have died so far, but the true number may be much higher, because Lassa is so hard to diagnose.

Women who contract the disease late in pregnancy face an 80% chance of losing their child, or dying themselves.

In the early stages it's almost impossible to distinguish from other common diseases like malaria and dengue.

With no readily available test, the only way to confirm a diagnosis is to analyse a blood or tissue sample in one of small number of specialised laboratories.

The disease was first identified in the Nigerian town of Lassa in 1969, after an outbreak in a mission hospital.

It has since been seen in many West African countries including Ghana, Mali and Sierra Leone.

However, this outbreak is causing particular concern because the number of cases is unusually high for the time of year.

Health officials are working to understand why.

Outbreaks can be influenced by seasonal weather conditions, which affect the numbers of the virus's natural host - the multimammate rat.

These small mammals are common across West Africa, where they easily find their way into homes.

Another possibility is that the high number of cases reflects heightened public awareness.

Or it's possible that something about the virus has changed.

Most people catch Lassa fever from anything contaminated with rat urine, faeces, blood or saliva - through eating, drinking or simply handling contaminated objects in the home.

It can also pass from person to person through bodily fluids, meaning healthcare workers and people taking care of sick relatives without protective equipment are particularly at risk.

The incubation period for Lassa is up to three weeks. Researchers are trying to work out whether - like Ebola - Lassa can stay in the body and be passed on through sexual contact even after illness subsides.

Nigeria has a strong public health system, and is used to dealing with epidemics like this.

The World Health Organization (WHO) is working with Nigerian authorities to help coordinate the response and the UK government has deployed a team of experts from its Public Health Rapid Support Team.

Those living in affected areas are being advised to take basic precautions: blocking holes that may allow rats to enter their homes, disposing of rubbish in covered dustbins, and storing food and water in sealed containers.

People are advised to wear protective gloves when caring for anyone who may have Lassa fever, and to carry out safe burial practices.

Despite these measures, the fight against Lassa - and other infectious diseases - is hampered by a lack of effective medical tools like diagnostic tests, treatments and vaccines.

It is likely that a vaccine could be found for Lassa - reducing the possibility of an outbreak becoming a global health emergency - but as with other epidemic diseases that mainly affect poorer countries, progress has stalled.

Vaccine development is a long, complex and costly process. This is especially true for emerging epidemic diseases, where a prototype vaccine can usually only be tested where there is an outbreak.

A new organisation called CEPI (Coalition for Epidemic Preparedness Innovations) - set up in 2017 with financial support from the Wellcome Trust, national governments and the Bill & Melinda Gates Foundation - hopes to accelerate vaccine production.

Lassa is one of the diseases on its hit list and it's hoped one or more promising vaccines will be ready for large-scale testing in the next five years.

The WHO has drawn up a list of other serious, but often poorly understood diseases, with the potential for devastating outbreaks, including MERS, Nipah, Rift Valley Fever and, of course, Ebola.

It plans to highlight gaps in our knowledge of these diseases and to begin further research.

But research alone isn't enough.

Stronger health systems are needed in the countries where epidemics are most likely to arise.

This could mean building better healthcare facilities and training staff to recognise and respond to outbreaks.

It will also mean working with communities to understand how to identify outbreaks at an early stage and prevent their spread.

 

source: http://www.bbc.com/

 

 

The World Health Organization Wants You To Worry About “Disease X”

Every year, the World Health Organization commissions an expert committee identify the most threatening infectious diseases of the upcoming year. The idea is to prioritize research and development on diseases and pathogens that pose a major risk to global health, but lack effective treatments or vaccines.

The committee met early in February this year, and the prioritized list of diseases has been released. The list is made up of familiar threats, including Ebola, Zika, Lassa Fever and a respiratory illness in the Middle East known as MERS.

And then there’s “Disease X.” It is the last on the list, and most mysterious.

What is Disease X?

Disease X is quite literally a mystery disease. It’s a recognition that we can’t see everything coming. In 2018, it’s entirely possible that we’ll see a brand-new pathogen. Or, as with Zika, an old disease will suddenly demonstrate a new way to harm us.

Disease X is a placeholder for disaster we can’t imagine yet.
New diseases appear all the time. Deadly Nipah virus appeared in Malaysia in the late 90s; we have no prior evidence of the disease. Severe fever with thrombocytopenia syndrome appeared in China in 2009, mostly likely carried by a tick from a wild animal reservoir. Heartland virus, another tick-borne pathogen with a wild animal reservoir, was first isolated in the US in 2009. Disease X could be one of these such diseases.

Will Disease X come from animals?
While there are a lot of possible sources for Disease X, one very likely reservoir of pathogens is the zoonotic disease. These are disease present in animals – wild or domestic – than can also be transmitted to humans. HIV was originally a zoonotic disease, which probably transmitted to humans for the first time when someone killed and ate a wild chimpanzee. HIV was present in chimpanzees long before it made the jump to humans – at some point the virus evolved to infect us well. Ebola virus disease is also a zoonosis; the most recent pandemic began when a one-year-old boy in Guinea was bitten by an Ebola-infected bat. Approximately 70% of new diseases are zoonotic.

One candidate for disease x could be Brucellosis. This is a bacterial infection that’s a lot like tuberculosis and is prevalent in an estimated 10% of farmed dairy cattle around the world. Humans are infected when they eat dairy products from infected animals. Right now, it’s kept in check by testing of commercial dairy products and cattle vaccination, and it doesn’t spread among people. Raw milk consumption, and a minor bacterial mutation could change that.

Avian influenza is a similar case. It can already be transmitted by birds to humans, but it doesn’t spread human-to-human — not yet, at least. There are plenty of flu viruses that do spread person-to-person, though, so it is probably just a matter of time before avian influenza evolves to do it. Avian influenza and brucellosis, or other domestic livestock diseases, then, could be Disease X.

Disease X could also be a previously unknown pathogen from an animal reservoir. Human beings are pushing into the last wild spaces on the planet, and those wild places also contain new diseases. Farming the rainforest or developing the jungles of Madagascar means exposing humans to diseases we’ve never met before. In 1999, Nipah virus killed 109 people in Malaysia – infected fruit bats infected pigs which infected people – and we’d never even heard of the virus before 1998. Disease X could be an utter wild card like Nipah, a hemorrhagic virus or virulent airborne bacteria previously unknown to global health.

Will Disease X come from people?
Humans have been using diseases as weapons since 1500 BC, when the Hittites sent people infected with plague into enemy territories. In recent history, both the US and the USSR experimented with bioweapons. One favorite among the Soviets was anthrax; an accidental release in 1979 killed 66 people. Anthrax can last for decades in storage and remain dangerous, and we don’t know how many former Soviet republics still possess poorly protected anthrax stockpiles.

Newer bioweapons are a threat, too. Just a year ago, North Korean leader Kim Jong-Un’s half-brother was killed by a biological nerve agent called VX. In December, a North Korean defector was found to have anthrax antibodies in his immune system, indicating he had probably been vaccinated for anthrax. Security observers are reasonably certain that North Korea develops secret bioweapons on an ongoing basis.

Disease X could come from a deliberate attack. It could be an act of war from a state entity using bioweapons developed for the purpose, or a terrorist attack from a group who was able to purchase a bioweapon on the black market.

How do we prepare for Disease X?
Disease X thinking is big thinking.

First, it admits that even the best tools we current possess cannot forecast every problem. We had absolutely no idea that Zika could cause microcephaly in pregnancies until 2015, even though the disease was first identified in Uganda almost seventy years prior.

To fight a disease outbreak – any disease outbreak – you need health care providers who can treat the disease, laboratories to diagnose the disease, and supplies and equipment to support diagnostics and treatment. Those things together make up a health system. Strengthen the health system means better preparedness for Disease X, no matter what X may be.

That means we prepare for disease X by using systemic approaches that make us better at fighting every disease. If we improve the skills of laboratory technicians in developing countries, and equip those laboratories with better equipment, we increase our global ability to diagnose and treat all diseases. If vaccine manufacturers are able to rapidly change their production lines from one kind of vaccine to another, we’re more prepared to fight a new pandemic. New technology can also help – the faster and closer to an outbreak we can start lag diagnostics, the more rapidly we can develop treatments, cures, and vaccines.