On November 29, 2024, the Ministry of Public Health of the Democratic Republic of the Congo alerted the World Health Organization (WHO) about an increase in deaths from an undiagnosed illness in the Panzi health zone.

Between October 24 and December 5, 2024, a total of 406 cases of the unexplained disease were reported in the Panzi health zone, located in Kwango Province. The symptoms include fever, headache, cough, runny nose, and body aches. The outbreak has resulted in 31 deaths, yielding a case-fatality ratio (CFR) of 7.6%.

In a press briefing on December 5, the Ministry of Health revealed that several additional deaths had occurred outside of health facilities, in the community. These deaths are still under investigation, and further characterization (such as age, gender, and other factors) and verification are needed.

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While investigations are underway by various government and non-governmental agencies to identify the root cause and source of the disease, some experts are referring to it as “Disease X.” Let’s take a closer look at this placeholder name, Disease X.

What is Disease X?

Disease X is a conceptual placeholder for a potential pandemic pathogen that has yet to be identified. Its purpose is to encourage proactive thinking about emerging threats and to prepare for possibilities beyond known pathogens like influenza. In 2020, experts, including advisors to the WHO, considered COVID-19, caused by the SARS-CoV-2 virus, an example of Disease X, as it met the criteria for an unknown pathogen capable of triggering a global pandemic.

Could Disease X become a reality?

The exact origin and timing of the next Disease X remain unpredictable, yet its eventual emergence is inevitable. This future threat will likely jump from animals to humans, triggering a widespread outbreak. Historical patterns indicate an increasing frequency of severe disease outbreaks, as seen with SARS-CoV-1, MERS, Zika, and various other viral diseases in the 21st century. These incidents point out the urgent need for vigilance and preparedness in combating potential pandemics caused by newly emerging and re-emerging pathogens.

During a podcast conversation, Dr Ana Maria Henao-Restrepo, Co-Lead R&D Blueprint for Epidemics, Health Emergencies Programme at WHO, stated, ‘‘There are many viruses and bacteria that can infect animals, including humans. For a few, we already have vaccines, diagnostics and therapeutics. We know what viruses we need to be alert to, and we know what bacteria we need to be alert to, but there are many thousands of them. So, we need to have a simplified way to refer to them without knowing which one will cause the next pandemic. And we call it Pathogen X.’’

How can we prepare for Disease X?

Proactive planning is crucial for combating Disease X, despite uncertainties surrounding its features or time of arrival. By understanding viral families that are most likely to harbour a novel Disease X, scientists can gain a head start in developing medical defenses. This comprehensive approach includes:

• Studying likely viral families to help scientists develop adaptable medical defenses.
• Rapid development of vaccines and treatments with pre-emptive research.
• Enhanced disease surveillance to quickly identify novel pathogens.
• Ongoing international collaboration to share data and resources for more effective disease management

Such measures can keep us ahead in fighting potential viral threats.

In the fight against emerging diseases, the Congo outbreak is a stark reminder of the need for readiness. The key to recognizing and managing such risks will be funding research, creating adaptable medical instruments, and encouraging international collaboration. This strategy protects public health by ensuring a proactive reaction to future pandemics.