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The World Economic Forum and the Deus Ex Machina of Disease-X

The World Economic Forum and the Deus Ex Machina of Disease-X

Public health messaging should provide accurate information so that the public and their leadership can formulate appropriate responses, weighed against society’s competing priorities. Planning should then concentrate resources on areas of greatest need with the expectation that they will achieve the greatest benefit. However, policy can become skewed towards narrow vested interests when private goals, such as financial profit, come to compete with health benefits during the decision-making process. Thus, decision-making must be resistant to conflicts of interest and narratives that promote those interests.

In the case of the recent World Economic Forum’s (WEF) public health policy advocacy in Davos on Disease-X, neither of these measures of legitimacy were met.

On September 17th 2024, the WEF held a meeting on preparing for pandemic health threats, centered on a hypothetical pathogen, ‘Disease-X’. The term Disease-X refers to an unknown infectious agent that could pose a serious threat to humanity and was added to the WHO list of prioritized pathogens in 2018 to stimulate better preparation.

In the build-up to its pandemics panel, the WEF website posed the following question: “with fresh warnings from the World Health Organization (WHO) that an unknown ‘Disease X’ could result in 20 times more fatalities than the coronavirus pandemic, what novel efforts are needed to prepare healthcare systems for the multiple challenges ahead?” This alert was immediately picked up and repeated by many news outlets, which in turn sparked several controversies on social media and via public statements made by politicians and public health professionals. It became polarized, with some defending the use of the hypothetical to respond to an ‘existential threat’ while others suggested it amounted to fearmongering and a ‘globalist takeover’.

The truth is likely somewhere in the middle. There are of course benefits to using hypotheticals in policy planning. Equally, there are of course vested geopolitical and ‘global’ corporate interests represented in Davos. Those interests include more than avoidance of the larger economic costs of the next pandemic, since there are also enticing business opportunities that such a hypothetical and somewhat open-ended narrative could present. It generates attention and potential investment by private stakeholders, but also governments, who have developed a considerable reliance on vaccines as the primary mechanism for pandemic preparedness and response. Furthermore, intergovernmental agencies such as WHO also understand the opportunities that the Disease-X placeholder generates. It helps to create a sense of urgency, enables a clear return on investment narrative, and legitimates its place as an epistemic authority.  To put it bluntly, creating a sense of urgency and future crises will diminish reflection, allowing policies to more quickly manufacture agreement, mobilize resources and reinforce what some have called the ‘structural cartelization’ of medical countermeasures.

One way to determine how appropriately these interests align with public health, and whether they should help determine its future, is to unpack and better understand the assumptions that are driving the WEF pandemic response narrative. In this case, Disease-X.

How big is the pandemic threat?

WEF laid out the reasoning behind convening this week’s pandemic panel in a 2018 article on its website, which was updated for the 2024 meeting. The article states:

“The inescapable truth for those who study disease outbreaks, new viruses, and the spread of illness is a haunting one.

The next pandemic is coming.

Known, incurable diseases lurk in hidden reservoirs all over the world. Thousands of unknown viruses circulate around the globe.”

Much of this statement is technically correct. Though few who study outbreaks may be as “haunted” by these fears, since natural outbreaks of major impact are uncommon and less harmful than many endemic infectious diseases (see below). In addition, it is inescapably true that thousands of viruses do exist and remain undiscovered, since nature’s diversity is vast. Yet, nearly all are harmless to humans, as we have been encountering them or their variants for hundreds of thousands of years. Occasionally, in these everyday encounters, a more significant outbreak will occur. What then matters is its frequency and severity.

In terms of natural pathogenic threats, the WEF listed a priority disease list developed by WHO in 2018, which outlines what it understood to be the potential major threats to human health (Public Health Emergencies of International Concern). Of note, it does not include influenza, as extensive surveillance and response mechanisms already exist for influenza outbreaks:

  • COVID-19 (added to the priority WHO list after the 2018 list was created)
  • Crimean-Congo hemorrhagic fever
  • Ebola virus disease and Marburg virus disease
  • Lassa fever
  • Middle East respiratory syndrome coronavirus (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS)
  • Nipah and henipaviral diseases
  • Rift Valley fever
  • Zika
  • “Disease X”

Beyond COVID-19, the only disease in this list to have more than 10,000 recorded deaths in a single outbreak is Ebola. The West African Ebola outbreak of 2014-15 – by far the largest in history – had a mortality of 11,325. Except for Lassa fever, an endemic West African disease, no other disease in the list appears to have over 1000 identifiable deaths reported globally. SARS and MERS-CoV caused about 800 each.

This is where context is important for understanding public health risk and to give the current WEF policy narrative some perspective. Tuberculosis causes 1.3 million deaths per year, or over 3,500 deaths per day, while malaria kills over 600,000 children every year. Cancer and heart disease kill, globally, many times more people (10 million and 17.9 million). As a result, such ailments cause these outbreak diseases to pale in comparison, but excite less fear as we have become accustomed such numbers, even when, in cases such as malaria, they are readily preventable.

From a public health perspective this is what should excite most interest and until recently received most funding. Relatedly, the major causes of the extension of average lifespan in more developed countries – improved sanitation, nutrition, general living conditions and antibiotics – were a key focus of improving health (and consequently economies in lower income settings).

Unfortunately, this recent shift to concentrate on unusual and in most cases low-impact diseases could have significant costs. For example, recent pandemic preparedness and response policy narratives are insisting that countries with higher preventable health burdens, such as malaria, accept diversion of resources to address unknown pandemic risks. According to the G20 report A Global Deal for a Pandemic Age, an estimated $26.4 billion a year in pandemic risk investments will be required from low- and middle-income countries to fill existing preparedness gaps, with an additional $10.5 billion from Overseas Development Assistance.

In the context of recognized outbreaks, COVID-19 is an outlier – and represents by far the most significant pandemic in 50 years in terms of deaths reported by WHO (the 2009 pandemic influenza outbreak killed less than seasonal influenza normally does). In other words, the WHO priority watchlist has a very low disease burden in relation to the world’s biggest and most consistent killers.

That is, of course, until Disease-X strikes.

Disease-X: Manufacturing severity

In terms of evidence, it remains unclear whether WHO claimed that Disease-X should ever be understood as being potentially this severe. In fact, in our search, it was not possible to find where the WHO had made this direct numerical attribution (yet they didn’t publicly correct it either). More interestingly, the claim that Disease-X could be 20 times more deadly than COVID-19 has now been removed from the WEF website, suggesting that this error has now been recognized.

By doing a basic search, the origin of this “20 times” calculation seemingly comes from an article published by the Birmingham Mail on 24 September 2023. It states that “the new disease could be 20 times more deadly than coronavirus, which caused 2.5 million deaths” (it should be noted that 2.5 million is not accurate, official figures are around 7 million, although there remains debate about mortality attribution). This claim of ‘20 times’ is apparently derived from an earlier statement made by Kate Bingham, the former chair of the UK’s Vaccine Taskforce, who told The Daily Mail  “the 1918–19 flu pandemic killed at least 50 million people worldwide, twice as many as were killed in World War I. Today, we could expect a similar death toll from one of the many viruses that already exists.”

Consequently, it appears that the author of the Birmingham Mail article arrived at the calculus of “20 times more deadly” by taking 50 million Spanish Flu deaths and dividing it by 2.5 million COVID-19 deaths to relate the magnitude of severity for Disease-X. For WEF, this multiplier was then seemingly picked up for use on its website. Under this logic, Disease-X would hypothetically amount to 7 million official COVID deaths x 20 = 140 million deaths. This would put Disease-X in truly uncharted territory, far beyond any historical pandemic precedent.

Although it was not cited, another potential explanation might be that the 2.5 million COVID-19 mortality number came from a 2021 pandemic risk report by Marani et al. The report claims that COVID-19 caused about 2.5 million deaths per year, but the estimate used for Spanish Flu is 32 million deaths in total (not 50). As a result, epidemic intensity (number of deaths divided by global population and epidemic duration per thousand) following Marani would be 5.7 for Spanish Flu and 0.33 for Covid, so Spanish Flu is 17 times worse. Thus, this number could have been rounded up to 20. However, this is speculation, and not the logic given by WEF or others. Moreover, using Marani’s estimates is not without contention since it does not consider known confounders such as the discovery of antibiotics (lacking during the Spanish Flu) nor other improvements in sanitation and health over the last hundred years. As a result, even if WEF did have Marani in mind, it would need methodological justification for how it was being used (and its alteration).

This is troubling for several reasons, but mainly in terms of evidence-based policy and the pollution that can occur when forums like the WEF sloppily overstep their remit. Although the use of hypotheticals such as Disease-X can be extremely useful for stress testing preparedness and for wider policy reflections, they should not be devoid of known experience. Therefore, what is required is methodological justification, not just pulling numbers from thin air. In addition, as in the case of its inclusion on the WHO’s watchlist, hypothetical diseases like Disease-X can act as a general placeholder for unknown diseases that should also be taken into consideration in our preparedness efforts (hypothetically worse or less worse than other known outbreaks). But again, this unknown should still be based on ‘known unknowns’, to borrow a cliché.

Evidence-based policy is predicated on the idea that policy decisions should be substantiated by rigorously established objective evidence and not based merely on ideology or common belief. This standard raises several concerns regarding how Disease-X is currently being used and the basis upon which its severity has been purported by WEF and many others (The Daily Mail post Davos).

Public health and Pharma profit are not the same

Planning for outbreaks is a logical priority in public health and we should be prepared. This includes planning for pandemics that could be worse than COVID-19. Yet, allocating resources in the context of competing priorities and understanding the health costs of resource diversion from higher burden diseases is fundamental to such policy development. What is the antithesis of good public health is the promotion of fear, exaggeration, and random hypothetical calculi that have reverberated unreflectively across numerous communication and policy channels for months.

In the context of interest promotion, it makes sense that pharmaceutical corporations, their investors, immediate benefactors, and even the media produce material to display the Disease-X placeholder at the extreme end of a spectrum. It is an issue from which they stand to gain profit and influence. Yet, this should not be mistaken for a legitimate approach to health policy or population health, and it should be rejected outright as a credible approach to the development of public health policy.

Giacomo Torelli, Public domain, via Wikimedia Commons

About Garrett Wallace Brown

Garrett Wallace Brown is Chair of Global Health Policy at the University of Leeds, UK.

About David Bell

David Bell is a global health consultant and clinical and public health physician with expertise in population health, modelling, and epidemiology of infectious disease.

About Jean Merlin von Agris

Jean Merlin von Agris is a PhD student at the School of Politics and International Studies, University of Leeds, UK.

About Blagovesta Tacheva

Blagovesta Tacheva is a Research Fellow in the School of Politics and International Studies, University of Leeds, UK.
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