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Disease X: Exploring the Unexplored, Knowable Unknown

The glaring uncertainty regarding the identity of certain pathogenic bio-agents having potential for a severe global public health security threat has spurned the international health agencies to classify it as Disease X, which has been added to the “blueprint priority diseases” as a placeholder name for a “knowable unknown” pathogen by the WHO. The zoonotic diseases of viral origin and the synthetic viruses are acknowledged as the most likely agents of Disease X causing public health emergencies of international concern in times to come. The challenges in the rapid containment of Disease X pandemics could be the inability for early detection of the infectious agents, presence of a large immunologically naïve population, lack of knowledge of clinical spectrum, no pathogen-specific effective drugs and/ or vaccines and sudden surge of patients requiring hospitalisation which collectively compromise the public health system especially in resource stricken countries and leads to its eventual collapse. Well-equipped field laboratories, sentinel surveillance centres for viruses and other microbial pathogens are needed in strategically important and sensitive areas of concern for monitoring for early detection of possible bio-agents of Disease X, if any. In a changing geo-socio political scenario, use of the synthetic viruses as a potential bio-weapon for mass destruction and/ or for the economic breakdown of a targeted country should not be ruled out. Thus, capacity building, global technical collaboration and stringent international regulations to prevent the development of bio-weapons are also obligatory to prevent any possible future pandemics of Disease X.