Disease X

What are we doing to prepare for the next pandemic?

We go behind the scenes at WHO and some of the European region’s major public health institutions to understand what the most likely causes of future pandemics could be and what strategies are in place to avert them. We talk to the experts applying the lessons of previous pandemics and focus in on the systems in place to spot threats and reduce their impact.  We speak to the legion of public health experts getting on with the not very glamorous, but incredibly important work of emergency preparedness— experts in surveillance, genomic sequencing, epidemiology and more. The people who are containing outbreaks and laying the groundwork to mitigate the effects of pandemics, not if, but when they occur.

With Dr Maria van Kerkhove on Disease X, Dr Gail Carson on pandemic preparedness and Roland Driece on the Pandemic Accord.

Find out more about the Pandemic prevention, preparedness and response accord: Pandemic prevention, preparedness and response accord (who.int)

Transcript

Health In Europe - Disease X

Dr Tedros Adhanom Ghebreyesus: The next pandemic is not a question of if, but of when.

Alice Allan: Throughout history, pandemics have swept around the world, leaving devastation in their wake. What are we doing to prepare for the next one? Hello. I'm your host, Alice Allan, and in this special series of health in Europe, I'll be going behind the scenes at WHO and some of the European region's major public health institutions to understand what the most likely causes of future pandemics could be and what strategies are in place to avert them.

I'll talk to the experts applying the lessons of previous pandemics and focus in on the systems in place to spot threats and reduce their impact. I'll speak to the legion of public health experts quietly working away, getting on with the not very glamorous but incredibly important work of emergency preparedness. Experts in surveillance, genomic sequencing, epidemiology and more. The people who are containing outbreaks and laying the groundwork to mitigate the effects of pandemics, not if, but when they occur. 

This is Health in Europe and in this episode we explore Disease X.

Vox pops:

When I say to you disease X, what comes to mind? 

What came to my mind was pandemic immediately. 

Is it some unknown disease or something like that? I'm not sure. 

Oh, uh, a disease. No, I don't really know what X would have to do with a disease, but I don't know. 

Disease X. Um, just a bad disease, I suppose. 

I don't know. Something that isn't known. 

Disease makes me think of COVID, but X makes me think of Twitter. 

True, true. I had the same thought, actually. 

Alice Allan: Disease X. It sounds like something out of a dystopian film about a zombie apocalypse. But as far back as February 2018, Disease X was included in the World Health Organization's updated blueprint list of diseases for which investing in research and development should be an international priority.

But before you start to panic, I should tell you that Disease X is not a single specific disease. It's a hypothetical threat. 

Dr Maria Van Kerkhove: So disease X is a placeholder of a pathogen that we need to prepare for that could cause an epidemic or a pandemic. 

Alice Allan: Dr. Maria Van Kerkhove is the acting interim director of the WHO's Department of Epidemic and Pandemic Preparedness and Prevention. She also leads on COVID 19 emergency management and is technical lead of the WHO Health Emergencies Programme. 

Dr Maria Van Kerkhove: We give it the name disease X because it could be a virus. It could be a bacteria. It could be a respiratory. It could be an arbovirus. It could be waterborne. There are different characteristics of the disease X that we as an organization need to be ready for.

And when I say ready, meaning we need to be able to have diagnostics for early detection of known pathogens, but something new that we would call disease X. We would need to have clinical care and treatments for a novel pathogen, which we would call disease X. We should have vaccine development. So it's a placeholder that signifies the work that we at WHO and our partners are doing to get ready, to be prepared, to anticipate that next pathogen that could cause that big outbreak epidemic or pandemic. There's a lot of technical work that we do to really understand how these pathogens transmit, what disease they cause, what treatments are effective, what vaccines need to be implemented or developed, um, do our diagnostics work, et cetera. So there's a lot of technical work that's there.

And we at WHO, we have a superpower which is a convening superpower, of harnessing the best minds, public health professionals, scientific professionals, multidisciplinary, multi pathogen, to really consolidate everything we know about these pathogens and turning that know how into how to, in guidance, evidence based guidance advice.

Alice Allan: We'll hear more from Maria in future episodes. But to learn more about pandemic preparedness, I spoke to one of those [00:05:00] brilliant public health professionals that she mentions, Dr. Gail Carson. She's the current chair of the Technical Advisory Group for Preparedness 2. 0. That's the name of the strategy and action plan on health emergency preparedness, response and resilience that the WHO Regional Office for Europe is supporting its member states to develop.

I asked her, why do we need to be preparing now for potential threats? 

Dr Gail Carson: The world should be doing something now to prepare for the next disease X, because if we don't prepare, our response will be inadequate. And look at what happened during the height of the COVID 19 pandemic. We did lose lives. We did lose livelihoods.

The ongoing impact is still felt. There are people living with long COVID, for example. There are people who are still grieving. There are people who are still struggling to get back on their feet. And there's still those people within the population, the vulnerable populations, who struggle to have a voice.

We have to engage them now and get our plans better organized, work collaboratively together within our countries across the different groups, sectors, ministries, right down to community level and replicate that across regions and across the globe. 

Alice Allan: I asked Gail to explain a bit more about Preparedness 2.0. 

Dr Gail Carson: Preparedness 2. 0 is the new strategy for the European region that's currently being worked on. It's in a draft format. It's not just about preparedness. It's actually the whole cycle, through to response and recovery. It's an umbrella strategy recognizing the fact that there are many adequate programs already in place or tools available across the European Region.

But trying to help all those programs work closer together. So it brings together, for example, the non communicable diseases. So, for example, the heart attacks. And how do you make sure that your health system can still respond to the needs of those people during the next big outbreak or other associated health emergency or disaster. Perfection's the enemy of the good. We know we're not adequately prepared. And we have to deal with that. And keep striving to do the best that we can to work across into the communities, to work across sectors, to work across ministries, acknowledging the challenges that we face.

But what's at the heart of that resolution is communication. It's acknowledging that no one's perfect. And so, there will be barriers, there will be issues, there will be political components and fragmentation, but this is where potentially the voice of communities or networks and WHO will yield, can hopefully be in that neutral space, be that arbitrator.

I'm not saying it's going to be easy, but for all the reasons we've already discussed, it's imperative that we try wholeheartedly.

Alice Allan: In response to the COVID 19 pandemic in December, 2021, the member states of the World Health Organization pledged to work together to negotiate a new International Agreement on Pandemic Preparedness and Response. It's an agreement that could strengthen national, regional and global capacities and create more resilience to future pandemics.

This could include better international cooperation on systems that sound the alert if a disease outbreak occurs, data sharing, on research and on the production and distribution of medical public health countermeasures. That means things like vaccines, tests, and personal protective equipment. In [00:09:00] March 2023, the WHO's member states began negotiations on the actual text of a potential agreement with the Intergovernmental Negotiating Body, or INB supporting them through the process. The final draft is expected to be delivered to the World Health Assembly in May, 2024. 

At the beginning of the most recent phase of negotiations, I spoke to Roland Drieser, co chair of the IMB. I asked him why the world needs a pandemic accord. 

Roland Driece: Well, I think that's pretty easy to explain.

The world has been through the biggest global healthcare challenge that we had seen for a long time with the COVID pandemic. And it was also pretty clear that we collectively, we were not ready, maybe countries themselves were not ready, but collectively we were also not ready. We had hardly any infrastructure, so to say, to cooperate in an effective way.

And that partly led to the situation where some countries have a lot of access to, to medical countermeasures, others had nothing, uh, but also that many countries had not really prepared. Uh, or had preventive policies in place to prevent prenemics. There were no systems to, to collaborate in that sense.

So there were a lot of things that. we did not prepare for collectively, which could have helped us in that very difficult situation. And that's what we tried to improve. 

Alice Allan: The pandemic accord is, is going through the process of negotiation. So it doesn't exist in a final state yet, but what could it achieve?

Roland Driece: It depends a little bit on the outcome, of course, and there's a lot of elements on the table, but we have to see in what way all the members of the WHO, so basically all the countries in the world, agree upon them. And so the level of ambition, is still to be established, but if we look at it from the bright side, so to say, things that could improve if we accept the text as it stands today is that we commit to strengthen our efforts to prevent pandemics even from happening. And that's what you want, of course, because if you make sure that the chance of them occurring is as small as possible, then you don't have to prepare or respond to them either. So we say, countries step up your efforts in strengthening all your systems that minimize or to make the chance smaller that pandemics even exist. So for example, policies on spillovers from diseases from animals to humans, for example, making sure that you have all the laboratory capacities, your search capacities in place, but also that you make sure that there is as much as possible unhindered exchange and access to pathogenic information.

So information on diseases. And that is important because then you know what's happening in the world, but it's also important because then you know how to prepare for countermeasures, so to say. But in order to do so, then countries say, well, of course we want to participate in such systems, but then it would be nice if we would also have better access to a product derived from that, because that was not very equitable the last time.

So what we also try to do in the treaty itself is establish a system that provides for that exchange, so to say, so as good as possible access to that pathogenic information, but also on the other side of the coin, better and more equitable access to products deriving from it. The vaccines, for example, that is something we do.

We try to coordinate much better, all the financial instruments available for doing all that important work. So there are many more examples of things we try to do them collectively. 

Alice Allan: What sort of thing could the treaty achieve for a typical person? 

Roland Driece: If we make the treaty as strong as we can, you would, as a first step, be less exposed to the chance of pandemics re- happening.

It will never be zero, that chance, but if we do it right, then the chances that pandemics occur in the same way and spread around the world are smaller. So then you don't notice anything, but that's just a good thing. But also if things are not as perfect in prevention and that they do reoccur or do establish themselves, that your countries are much better prepared in dealing with them and that there are systems in place between countries to help each other in that sense, that there is a better possibility of access to medical countermeasures. Another example is that we try to strengthen, for example, production capacity in countries where now there is not so much production capacities.

We try to strengthen research capacities towards products that you can use in pandemic times. So what you would notice is that the chances have become slimmer of having pandemics, but if they occur, that the world is much better prepared. And working together in making the consequences of it as small as possible.

Alice Allan: So who is participating in the negotiations? 

Roland Driece: All countries of the WHO, so being all countries around the world. And all countries in the world commit to working together. That's the strength of it. 

Alice Allan: And can you just briefly try and explain what your role is as co-chair of these member state led negotiations?

Roland Driece: There are two chairs to this meeting, me and a colleague from South Africa, Precious Matsoso. We have a man from the north and a woman from the south, just to acknowledge the fact that it's about all of us. And what we try to do is facilitate, steer, and manage the process of negotiations. We are not in charge of the outcomes of it.

We do not determine what the treaty text will be. That is the membership, the member states of the WHO. But what we try to do is help them in their endeavors, in their negotiations as chairs of this meeting. 

Alice Allan: And what's that like? What are the highs and lows of that experience? 

Roland Driece: Well, the highs are that it's stimulating to do something that you believe in, is good for the world.

It's also nice that people entrust you with such a role because they feel that you have the capabilities but also the personality, so to say, to, to be accepted by them, the person that helps them doing this job. And the lows are sometimes that you have to sit for a very, very, very long time in a room listening to a lot of people repeating themselves many times.

But you have to make sure that when you come back to your hotel, you go to the gym or whatever and do some exercises. Otherwise you'll break down your bones if you sit there for two weeks and do nothing. 

Alice Allan: Some people have made the accusation that WHO is controlling these negotiations. Is that true? 

Roland Driece: No.

Well, it depends a little bit on what WHO is because WHO is an organization being seated in Geneva, but it's also a group of countries coming together and talk about global health. So if you say WHO is those member states, it is correct. But in the stories you refer to, people say it's the Secretariat, WHO Secretariat that drives this all with it's Director General on the top that wants to control a lot of processes that he should not control.

But that is far from the reality. It's the membership that does the negotiation that decide what's in there. And the Secretariat helps us as chairs and as a Bureau to manage the process. 

Alice Allan: And how long have these negotiations been going on so far? 

Roland Driece: Well, just over two years now. And the interesting but also worrying part is that when we agreed that we would go to start this, it was in the aftermath of the COVID pandemic.

And when we started, it was still very fresh in the back of our minds. But what you see happening is that the urgency is slipping and for very understandable reasons. COVID is for most people, it's more like a memory of a couple of years back and not one that they are have very pleasant thoughts of.

So sometimes people rather forget about it. And there are also many other priorities that require our attention. And we have wars in different places of the world. We have climate problems around the world. So we have many things that require our attention and money and efforts. So what you see is that you run the risk that people say, okay, well, the health people, the COVID people, the pandemic people, they had their thing a couple of years back. Now it's the other problems that require our attention. And so finding money, for example, for doing a lot of the things that we deem necessary is not so easy. Compromising is not so easy when you do not feel the urgency as much as three years ago.

I think when we did this three years ago, everybody would say, of course we need to compromise. Of course we need to find each other. Well, but today what you see, well. Why should I give in on something I find important? Yeah, maybe we will not be so prepared next time, but that we will see that next time.

And all the cliches that you have to repair the roof when the sun is shining, or when the DG of WHO says, let's break the cycle of panic and neglect, and everybody repeats that, but before you know it, we make the same mistakes over and over again. 

Alice Allan: So what's at stake? 

Roland Driece: Well, the stake is that you will be condemned by a lot of people saying, should you not have prepared for this whenever it might reoccur? And that we make the same mistakes again next time.

And it's all, again, it's all very understandable, but it's also a shame that we as human beings, I would almost say, are not so good in solving problems which are not there anymore or, or not yet. And, and so people find it easier to put 50 billion on the table when the problem is there than 1 billion when the problem is not yet there.

And that's, that is something that is worrisome in a way, but what we have to see how we can deal with that. 

Alice Allan: So what's the next phase of the negotiations 

Roland Driece: We will recommend and then we will start our talks and well, the difficult thing is that we do not have much time left. So we just have a few more days of negotiations ahead of us the next two weeks and maybe a bit longer, but then it has to be done.

And well, we have to see how much preparedness there is from countries to compromise. And if that preparedness is not there, we have to really think about how to steer this towards the main meeting of the World Health Assembly in order to present the ministers of health of the different countries with.

Alice Allan: I think I read somewhere that you've had 385 hours of formal meetings so far. That must be extremely tiring. 

Roland Driece: It is. And that's why I say you have to go to the gym in the evening and have a beer to recover, but not too many. 

Alice Allan: And it sounds like, you know, you're motivated by this bigger picture, of this being a really once in a generation chance.

Roland Driece: You have to believe, and that's not just me, but I think all the colleagues that are involved, you have to believe that we are doing something good. Otherwise you could better do something else with your time. And it's a very time consuming process. And maybe if you ask ChatGPT to draft something and just do it, that goes much faster, but that's not the way we do it.

Alice Allan: No. 

Roland Driece: No. 

Alice Allan: Unfortunately, there's a huge amount of misinformation circulating about the pandemic accord. For example: 

Misinformation:

YouTube 1: The idea is to create a whole new set of laws and ignore the existing human rights laws and other laws under the pretext of pandemic preparedness and the biosecurity agenda. 

Nigel Farage: They're now proposing a pandemic treaty that would absolutely commit us to spending lots of money preparing for the next pandemic and give them the power to order lockdowns, tell us what vaccines we could use. It is literally a globalist treaty that takes away the power of the nation state. 

Robert F. Kennedy Jr.: That treaty lays out a blueprint giving the WHO unprecedented authority. Those powers go into effect the moment that the WHO declares a pandemic, which it can do at any moment, even if no true pandemic exists.

Alice Allan: I asked Roland Driece if I could put a few pieces of this misinformation to him to see what he makes of these accusations. 

So: “If countries sign this pandemic accord or treaty, they would be giving up their sovereign power”. 

Roland Driece: Well, read the article on that, read the text on that. And sometimes people even approach me directly and I say, have you taken the liberty of going to the website of WHO, because all the texts that we have are there for the public to see.

Is there anything you can read in that text? That says anything about handing over sovereignty? No, nothing. Nothing at all. So that's what I would like to say to them. It is not about that. It's about cooperation between member states. 

Alice Allan: Okay. So number two, “If there was a pandemic, WHO would be able to force countries or force people in those countries to comply with things like lockdowns or mandatory vaccination.”

 Roland Driece: Do you really think that the government of the United States or the government of Russian, the government of the Netherlands, or whoever, would ever sign up to something like that? I mean, as if the countries around the world would give up sovereignty to the Director General of the WHO, it's, it's, it's almost…it's of course, never going to happen and rightly so.

Alice Allan: Okay. Third question, “The pandemic accord does not respect human rights.” 

Roland Driece: Well, there is one of the principles we have in there that we live up to all agreed principles on human rights. It's in there. What more can we say about it? That all the treaties on human rights are being respected. But yeah, it's sometimes difficult to convince people when they do not read it themselves, but rather listen to what others tell them that supposedly is in that text.

And that's a reality we have to live with, but it's sometimes difficult to address it. Read it yourself, read the text yourself. There are much nicer books around there and there are nicer Netflix series to watch in the evening. But if you're really concerned, read it and it takes you two hours, maybe. And you will be sure that you can’t find anything that will justify your concerns in that respect.

Alice Allan: In future episodes, I'll talk to experts on subjects like influenza, mpox and dengue, who are tracking disease outbreaks, trying to understand them better and preparing for future pandemics, not if, but when they happen.

Health in Europe is produced by the World Health Organization. Music for this episode is by Raphael Mark, Sofia Domancic, Ben Howells, Richard Dutnell and René Muenzer. Sound engineering is by David Barrett. 

My name is Alice Allan. Thanks for listening.