Experts call it Disease X – the next lethal pandemic that will infect the world and threaten once again to leave Britain stricken and paralysed under lockdowns.
But what will this disease be, and how well (or badly) prepared are we to cope? These questions are currently worrying health experts here and around the world.
A recent survey of more than 100 leading infectious-disease scientists into the ‘state of pandemic preparedness’ warned that the next global plague will most likely be an infection that humans have never encountered before.
It will likely be caused by a ‘pathogen that is highly transmissible’ for which we have ‘no tests, treatments or vaccines’, concluded the report by the Abbott Pandemic Defence Coalition, an international scientific organisation that monitors infectious disease threats.
Meanwhile, a separate report by 200 scientists for the World Health Organisation (WHO) pictures a different scenario. Last year, they compiled a list of the top 30 potential threats and concluded that Disease X could prove to be a deadly foe that we already know – but which suddenly gains devastating new infectious powers.
Their list is led by viruses that originated in animals – flu (from birds), monkeypox (primates), dengue and West Nile virus (mosquitoes) and Lassa fever (rodents).
The WHO experts also fear a lethal plague escaping from a lab, as many suspect happened with Covid-19 at the Wuhan Institute of Virology in China.
Such fears are starkly recognised by the ongoing UK Covid-19 Inquiry, set up to examine our response to, and impact from, the pandemic and learn lessons for the future. Opening its first report, published in July 2024, the inquiry chair Baroness Hallett wrote: ‘It is not a question of ‘if’ another pandemic will strike but ‘when’.
Experts call it Disease X – the next lethal pandemic that will infect the world and threaten once again to leave Britain stricken and paralysed under lockdowns
‘Another pandemic – potentially even more transmissible and lethal – is likely to occur in the near to medium future,’ she warned, urging that ‘lessons be learned and fundamental change implemented.’
But is anyone in power taking such warnings seriously?
Just last month, Dame Kate Bingham, who led the Government’s vaccine taskforce between May and December 2020, warned that Whitehall remains unready to tackle further contagions in a practical way.
She told the UK Covid-19 Inquiry that instead of tackling practical matters, staff are ‘busy writing policy papers and sending each other stuff to review’.
This is a view echoed by leading UK scientists, who warn that our nation remains perilously unprepared for the next pandemic – with little sign of adequate real-world defences against contagion being introduced – and some even being dismantled.
‘Britain is guilty of reverting to its complacent habits,’ Stephen Griffin, a professor of virology at the University of Leeds, told Good Health. ‘There is definitely an impression that we have decided that the next pandemic won’t be for 100 years, so let’s just kick this issue down the road.’
As stark evidence, he says the UK has stopped trying to stockpile drugs such as vaccines and antivirals in readiness for fighting emerging pandemic infections.
‘We now have a very bare cupboard where antivirals are concerned – it’s a desperate situation,’ he says. ‘We should be investing in developing vaccines and therapeutic drugs. But this has all been scaled back to the level that it was before Covid-19.’
Professor Griffin is particularly critical of the Government’s sale of the UK Vaccine Manufacturing and Innovation Centre in 2022, after the UK’s final Covid-19 lockdown ended.
The centre in Oxfordshire had been launched in 2017 as a not-for-profit company that would combine vaccine research and manufacturing. It was sold to US-based pharma company Catalent in the hope of attracting new investment to the facility – yet Catalent has said it’s put all work on hold, prompting fears about the woeful inadequacy of Britain’s future vaccine-manufacturing abilities.
Meanwhile, serious supply problems appear still to be dogging supplies of PPE – with shortages of vital stocks such as gloves and masks afflicting NHS hospitals in the face of this winter’s wave of respiratory infections.
In January, the NHS Supply Chain agency sent a series of bulletins to hospitals warning: ‘The NHS is facing increased demand for PPE products due to rising cases of respiratory viral infections, including RSV, influenza and Covid.’ The agency warned that a number of specific types of protective gloves and masks were either no longer available or were in restricted supply.
On top of apparent shortages of PPE stocks and the loss of a world-leading vaccine-development centre, Professor Griffin warns that Britain is also failing to install new-generation ventilation and filtering systems in our office buildings and public transport.
‘Most pandemics will be an airborne respiratory virus – because that’s the fastest and easiest way a virus can spread through populations,’ he says.
‘If we had improved ventilation systems, it would stop that transmission. That would bring us up to the standards seen in East Asian countries (such as Japan and Taiwan), where such nations did not have to introduce such extreme measures as lockdowns because they had these filtration systems in place.’
Britain also needs to start investing in new equipment for testing people for infection and monitoring the spread that could be mobilised in an emergency, adds Professor Griffin.
A recent survey of more than 100 leading infectious-disease scientists into the ‘state of pandemic preparedness’ warned that the next global plague will most likely be an infection that humans have never encountered before
A prime example of how we’ve failed to do this comes in the shape of the UK’s wastewater surveillance scheme.
Rolled out by the UK Health Security Agency (UKHSA) in summer 2020, this tested sewage for evidence of Covid-19 infection – meaning public-health bosses could be warned of outbreaks, as the virus sheds tiny fragments of its DNA in people’s poo, even if they have no symptoms.
This DNA can be detected in sewage weeks before surging infection rates indicate a local outbreak is already under way.
But instead of building on the scheme’s success, in 2022 the UKHSA quietly scrapped wastewater Covid surveillance in England. This is the opposite of what experts such as Professor Griffin desperately want to see. He says: ‘We need to have broader surveillance of how infections are breaking out and spreading.
‘If we have this surveillance, along with clean air, public virus-testing, new vaccine designs and drug therapies, we will be so much better prepared that we will not have to impose the harsh lockdowns we saw last time.’
Professor Adam Kucharski, co-director of the Centre for Epidemic Preparedness and Response at the London School of Hygiene and Tropical Medicine, says Britain should copy other countries’ successful strategies.
‘Asian countries such as Japan used their infection-testing technology effectively so that they could identify people transmitting Covid, then track the virus’s spread, institute local restrictions and ramp up vaccinations. They had more freedom but fewer cases and morbidity than us,’ he says.
Professor Kucharski says the UK authorities not only failed to track where Covid-19 was spreading, but there was no agreement on how to stop it.
‘We had blanket quarantine because we did not know these things,’ he says. ‘We could build scientific understanding of pandemic contagion and agree what restrictive measures can be put into place – doing this ahead of the next pandemic would make a massive difference.’
Professor Garrett Wallace Brown, chair of Global Health Policy at the University of Leeds, witnessed first-hand the policy chaos at the start of the pandemic – because in January 2020, he was a scientific adviser on the Cabinet’s Covid-19 taskforce.
‘I know how under-prepared we were,’ he says. ‘Cabinet made big decisions that seemed politically expedient but were not scientifically sound. I don’t think we’ve learned from that. If another pandemic comes along, we will probably do another set of knee-jerk responses such as lockdowns which may not be necessary.’
Professor Brown warns that, globally, countries are rushing into ill-considered policies that could prove disastrously expensive and ineffective.
He also worries that world leaders now believe, mistakenly, that humankind can develop vaccines that will defeat the next pandemic disease, as happened fortuitously with Covid-19.
‘It’s a bad plan just to think you can respond to the next pandemic by finding the pathogen and then producing a vaccine,’ says Professor Brown. ‘It puts all our eggs in one basket by assuming that we can produce such a vaccine. But that’s not guaranteed.’
But not all experts agree. Professor Tom Solomon, director of the Pandemic Institute at the University of Liverpool, believes we should spend millions continually getting vaccines to a prototype each time a threatening new pathogen emerges.
‘The single most important thing is to have the medical countermeasures up to a stage of readiness,’ says Professor Solomon, who is also the director of the National Institute for Health and Care Research’s Health Protection Research Unit in Emerging and Zoonotic Infections.
‘It was vaccines that got us out of the Covid pandemic. It took a year for us to develop them, thanks to previous work on other contagious viruses giving us a strong start point.’
He adds: ‘You have to accept that you have to spend money on these things that pandemic-wise may never actually rear their ugly heads. Defence works.’
Professor Solomon is working to develop a decision-making tool for government that will estimate the social benefits and costs of introducing infection-control rules in the next pandemic – everything from compulsory handwashing and mask wearing, to complete lockdowns.
‘This tool should mean that when the Prime Minister is making the decision, they can do it better,’ he says. ‘We will need to keep funding this research to understand societal restrictions, so we only introduce the ones that work. If we don’t, then people will regret it.’ All the experts we spoke to agree that we need to get our NHS back into shape if we want a chance at surviving an emerging new Disease X pandemic.
‘If we want to be more prepared, we need to make our health systems more adaptive and resilient, says Professor Brown. ‘But every week the NHS is on the point of collapse. Adding 100 more emergency patients into a local NHS system, as in an early pandemic, will collapse it.’
Professor Griffin concurs, adding: ‘We can’t just ignore those hard times and pretend they never happened. I hope this Government will do the right things.’
One hopeful development is the Government’s plan to create a world-first ‘early warning system’ for pandemics, which will use cutting-edge DNA-reading technology to read the gene code of contagious new viruses or bacteria more quickly than ever before.
In November, the Government announced it will partner with Oxford Nanopore, a technology spin-off from Oxford University, to create the system.
This will enable hospitals rapidly to read the genetic codes of individual patients’ respiratory infections, so that they can be diagnosed and treatment begun within six hours.
Another positive move is the Government’s announcement last month that it will run an unprecedentedly large national pandemic-response exercise.
This rehearsal will involve thousands of participants from government departments and local health services from around the UK. It will span several months and take place on various days throughout the autumn.
Such plans may indeed help Britain to become better prepared for a future pandemic and more resilient in the face of it.
However, as our experts all starkly agree, unless our other defences are strengthened – and our perilously fragile NHS is revitalised to cope with a sudden new pandemic – all such grand-sounding plans may crumble to dust.
A spokeswoman for the Department of Health and Social Care told Good Health: ‘Together with the UK Health Security Agency, the Government is ensuring we’re prepared and ready to respond to any current and future health threats.
‘Since the Covid-19 pandemic, stockpiles of PPE for pandemic preparedness have been replenished and include some excess stock originally obtained for the pandemic response.’
5 years after Covid, how Britain’s health is still suffering
Anxiety, depression… and even a reduced IQ
Higher rates of anxiety and depression – fuelled by worries about the virus itself, financial concerns and the impact of lockdown isolation – were common during the Covid-19 pandemic.
But some Covid patients were still suffering troublesome psychiatric problems up to three years after being infected, recent research by Oxford and Leicester universities found.
They scored significantly lower on memory and attention tests and had above-average rates of depression and anxiety. Even their IQ was affected – down about ten points on average from when they first got ill with Covid.
Researchers believe the impact of their infection was linked to the severity of their illness – all had needed hospital treatment.
Heart dangers that linger long-term
Early in the pandemic, research established that those infected were more than twice as likely to have a heart attack or stroke than those who didn’t catch it – probably because of the inflammation it caused throughout the body, including in blood vessels which then became blocked.
And a new study of 650,000 Covid patients suggests dangers can linger for at least nine months after the infection ran its course.
Having Covid increased the risk of a heart attack or stroke by 34 per cent, the study by the University of British Columbia in Canada, found. Other research has shown that people who had Covid were 57 per cent more likely to develop atrial fibrillation, an irregular heartbeat that can lead to stroke, more than a year after recovering from Covid.
Obesity likely to worsen in children
Long-term health problems may also be linked to weight gain due to lack of exercise during lockdown, with many people losing muscle mass and replacing it with fat, says Naveed Sattar, a professor of metabolic medicine at Glasgow University.
‘We’ve done research that shows the average weight gain during lockdown in patients who now have long Covid was 10kg (22lb). That’s a huge amount to gain.’
Weight gain among ten to 11-year-olds during the pandemic will add £800million to NHS treatment costs for weight-related complications such as type 2 diabetes over the next few decades, according to a 2024 report by Southampton University.
Researchers found obesity jumped by 45 per cent during the pandemic in four to five-year-olds, and by 35 per cent in ten to 11-year-olds, due to a combination of reduced physical activity, unhealthier eating habits, increased screen time and changes in sleep schedules.
Rates have since dropped, but are still higher than pre-pandemic – putting an estimated 56,000 UK children at greater risk of diabetes, stroke, arthritis and some cancers when they’re older.
We’re more prone to colds and bugs
Our immune systems took a heavy battering before vaccines became available, and one result is that some are now less able to deal with more familiar adversaries such as the common cold.
A 2024 study in the journal Allergy found that even mild Covid infections could produce long-term changes in the immune system, weakening defences against other pathogens.
Research also suggests lockdown isolation weakened our immune systems by reducing exposure to common bugs.
This is thought to have contributed to a resurgence in the winter bug respiratory syncytial virus (RSV – it can lead to pneumonia, or inflammation of the lungs).
Cases of whooping cough have also surged, partly because ‘the impact of the pandemic means there is reduced immunity in the population’, according to the UK Health Security Agency.
Mystery surge in diabetes cases
Early in the pandemic, doctors worldwide began reporting an inexplicable surge in type 1 diabetes, where the immune system attacks cells in the pancreas, destroying its capacity to produce insulin, vital for controlling blood sugar levels.
It’s thought the Covid virus somehow caused such extensive damage to the pancreas that some people, particularly children, were developing the disease out of the blue. Five years on, it’s estimated that up to one in 20 new cases of type 1 are due to the pandemic bug. Another explanation is that lockdowns meant diagnoses were delayed.
Could lockdown have damaged your bones?
Lockdowns may have put many more people at risk of fractures by reducing bone density – due to sedentary behaviour and unhealthy eating habits, according to a recent study by Lancaster University Medical School.
This found that people referred to hospital for bone scans had much lower bone density than those seen pre-pandemic, and were 49 per cent more likely to be diagnosed with osteoporosis.
Children’s language skills harmed
Lockdowns stymied language development in infants, which could potentially slow their progress in school, research shows.
Experts at the University of Lisbon in Portugal analysed language skills in dozens of children born during the pandemic, comparing them with those of babies born before.
By the age of two-and-a-half, pandemic babies showed poor vocabulary and communication skills compared to those who had been born earlier.
Pat Hagan
