Mobilizing the World for Disease X

Risks to Human Health 

     From the moment we enter the world to the moment we leave it, we navigate countless hazards, most of which we accept as part of ordinary existence. Yet when our attention focuses disproportionately on any single threat—when we write about it, broadcast it, and emphasize it without pause—an otherwise fulfilling life can become governed by vigilance and worry.

     Consider a few examples of risks that could, in principle, affect human health:

        ◦ tornado

        ◦ mass shooting

        ◦ earthquake

        ◦ solar geomagnetic storm

        ◦ serial killer

        ◦ stock‑market crash

     Tornadoes, for instance, are undeniably frightening. Using the Tri‑State Tornado of March 25, 1925—the deadliest in U.S. history—as a benchmark, we might imagine that any of the roughly 1,000 tornadoes occurring annually could kill hundreds and injure thousands. If we allowed that singular event to define our expectations, we might conclude that society should undertake a sweeping campaign to rewrite building codes, construct ubiquitous storm shelters, and require personal weather monitors for every citizen, especially in Kansas during summers.

     Mass shootings evoke even deeper fear. Given the number of individuals who legally own firearms, we might argue that any person could suddenly cause a mass‑casualty event. Under that assumption, why not initiate a global mobilization to confront the possibility?

     Earthquakes present similar opportunities for escalation. If the worst seismic events of the past century are treated as the proper benchmark, we might insist that wooden framing in homes be replaced with steel beams and that extensive structural reinforcements become mandatory nationwide.

     Solar geomagnetic storms give cause to anticipate an even worse scenario. The Carrington Event of 1859 is often cited as a reminder that a sufficiently powerful solar storm could threaten not only individual well‑being but the functioning of modern civilization itself. If that historical anomaly is taken as a planning standard, we might ask: Where are the large‑scale investments, the international legal reforms, the disaster simulations, and the governmental restructuring efforts designed to mitigate a recurrence that has not yet happened?

     The list could continue. And the point is straightforward: if we were to fixate on any one possibility, dedicate resources to anticipating it as an inevitable outcome, and elevate its status by placing a prominent “X” after its name, then we could claim that it demands continuous fear, sustained funding, and expansive preparation. By that logic, Tornado X, Mass‑Shooting X, Earthquake X, Solar‑Geomagnetic‑Storm X, Serial‑Killer X, and Stock‑Market‑Crash X would all qualify as urgent public‑health priorities, despite their hypothetical nature.

A Disease That Does Not Yet Exist 

     In 2018, the World Health Organization (WHO) formally added “Disease X” to its list of priority diseases deemed worthy of "accelerated research and development." The designation appears in the WHO publication 2018 Annual Review of Diseases Prioritized Under the Research and Development Blueprint, on page 2.

A subsequent article in a major medical journal elaborates the rationale for devoting substantial time, expertise, and funding to prepare for an unknown pathogen—“Pathogen X”—that might someday give rise to an obscure, as‑yet non‑existent “Disease X.” The authors frame the effort as a necessary pre‑emptive strategy:

Simpson, Shmona; Michael C. Kaufmann, Vitaly Glozman, and Ajoy Chakrabarti (2020). Disease X: Accelerating the Development of Medical Countermeasures for the Next Pandemic, The Lancet Infectious Diseases, Volume 20, Issue 5, E108–E115.

According to that article:

WHO has listed several priority diseases with epidemic potential for which there are no, or insufficient, medical countermeasures. In response, the Bill & Melinda Gates Foundation (with support from PricewaterhouseCoopers) coordinated subject matter experts to create a preparedness plan for Disease X.

Disease X is caused by Pathogen X, an infectious agent that is not currently known to cause human disease, but an aetiologic agent of a future outbreak with epidemic or pandemic potential.

     The logic is straightforward: if a hypothetical pathogen could someday emerge, then preparations for its hypothetical disease should begin now. In this framing, the absence of a known organism, a known transmission route, or a known clinical syndrome is not a barrier to planning; it is the justification for planning. This mindset is technically logical but strategically irrational. It asks society to behave in a way no person ever would: to treat sheer possibility as if it were probability, and to mobilize resources as if the imagined worst case were already unfolding. It demands a level of vigilance and resource allocation that humans reserve only for imminent, evidenced threats—not for abstractions that exist solely in the imagination. It normalizes a posture of permanent alarm, something humans do not—and cannot—sustain in any other area of life without psychological and social harm. This inversion of scientific reasoning creates precisely the conditions in which political interests can reshape public‑health priorities, transforming speculative science into political science. 

Staying Ahead of Nature

     The most tangible expression of inverted scientific reasoning is gain‑of‑function research. Here the incentive is to “stay ahead of nature” by engineering viral mutations of heightened lethality or transmissibility and then developing countermeasures against the very threats that human intervention has created. Once such laboratory‑generated risks exist, they become politically useful: concrete hazards that justify expanded funding, emergency‑oriented governance, and a redefinition of public‑health priorities around hypothetical catastrophes rather than actual disease burdens.

     An extension of this mindset appears in computational modeling. Here the effort to anticipate nature takes the form of generating hypothetical mutations inside predictive systems, treating model output as a preview of evolutionary pathways. These simulations can produce vast numbers of variants that nature cannot sustain, yet the logic treats them as potential threats requiring preparedness. In this way, computational modeling becomes a digital counterpart to gain‑of‑function research: a method that transforms human imagination into evolutionary forecast and expands the catalogue of hypothetical hazards that institutions can claim to anticipate.

     The “staying ahead of nature” mindset treats human‑created danger as evidence of natural inevitability, collapsing the boundary between what nature might do and what institutions choose to do. In this framing, the ability to engineer a dangerous trait—or to simulate one—becomes proof that nature will eventually produce it. Human imagination is mistaken for evolutionary trajectory, and human intervention becomes a preview of nature’s presumed future behavior.

     This rests on a profound category error: treating what humans can imagine as if it belonged to the same domain as natural evolutionary processes.  Evolution does not follow human imagination; it follows fitness constraints. Nature selects for fitness, not for human nightmares. Most mutations that can be engineered in a laboratory are maladaptive in the wild—unstable, inefficient, or incompatible with natural transmission dynamics. The same is true of most mutations generated by computational models, which can produce variants that are biologically incoherent or evolutionarily impossible. Yet the logic of “staying ahead of nature” treats possibility as trajectory and trajectory as certainty. It assumes that because humans can create or simulate a mutation, nature will someday do the same, and that the responsible course of action is to engineer or model the hypothetical threat now in order to prepare for it later.

     The result is a circular justification cycle. Human imagination generates the hypothetical threat, human manipulation materializes it, and the fact that it can be imagined and materialized reinforces the imagination, driving the cycle forward. The same cycle extends to computational modeling: simulations generate hypothetical variants, those variants are treated as previews of future evolutionary pathways, and that treatment reinforces the impulse to generate still more variants. Risk creation becomes risk evidence. The laboratory and the model become both the origin of the hypothetical threat and the rationale for defending against it. This is not anticipation of nature; it is anticipation of ourselves. 

    A counterpart to the "staying ahead of nature" mindset appears in the hostile‑actor justification for gain‑of‑function research and computational-mutation modeling.   The argument claims that if institutions can engineer or simulate a dangerous trait, then a malicious actor could someday do the same, and that the responsible course is to anticipate that threat by creating it first. But the hostile‑actor justification collapses because the act of preparing for such an actor creates the conditions under which that actor becomes more likely. How? — once an engineered pathogen or simulated variant exists, the method for producing it exists, and knowledge of that method can leak, be copied, or be taken by an insider who becomes unstable, disgruntled, or compromised. Even if such an actor never emerged, any engineered pathogen or simulated variant dangerous enough to worry about would expose the institutions creating it to the very danger they claim to be anticipating —  long before it ever deterred a hypothetical adversary. Consequently, in attempting to preempt an unlikely threat, stakeholders in this mindset end up amplifying it — transforming a remote possibility into a concrete vulnerability by generating the agent, the method, and the knowledge a hostile actor would otherwise lack. In the end, they expose themselves—and the public—to dangers born entirely of their own invention.

     Besides risking accidental exposure to a new pathogen, the routine practice of engineering or simulating a dangerous pathogen creates a dangerous incentive structure where institutions expose the public to potential harms of misguided policy, unjustified governance, and compromised safety. If institutions gain funding, strategic relevance, and political leverage by engineering or simulating hypothetical pathogens, then hypothetical pathogens become institutionally valuable. The incentive structure thereby shifts from studying natural biology to manufacturing scenarios—material or digital—that justify expanded authority, specialized infrastructure, and perpetual emergency preparedness. The physical and computational creation of speculative threats becomes the material foundation for the broader mental handling of risk.

     In this way, gain‑of‑function research and computational-mutation modeling are not merely scientific practices; they are the material and digital expressions of inverted reasoning. They transform imagination into evidence, possibility into inevitability, and human intervention into proof of natural danger. They mechanize speculative logic into active policy, substituting the practice of producing synthetic risk for the process of studying actual risk. As such, they violate the distinction between the pursuit of legitimate scientific inquiry and the manufacture of imagined threats.

Science Deformed by Politics 

     The dynamics described in the preceding section are clearly evident in concrete institutional settings, including the Lancet article (Simpson et al., 2020) that coordinated the Disease X preparedness plan, mentioned earlier. 

     The article is available as an online publication and a downloadable pdf. Only the online version contains a statement of the authors' declaration of interests and the link to a separate pdf supplementary appendix listing additional contributors involved in developing the “preparedness plan” discussed there. The pdf version of the article — which is the one linked to at the beginning of this discussion —does not reveal a declaration of interests nor a path to discover the other contributors.  I amended the pdf to include the declaration of interests; the other‑contributor information appears at the following:

Supplementary Appendix to: Shmona Simpson, Michael C. Kaufmann, Vitaly Glozman, and Ajoy Chakrabarti (2020). Disease X: Accelerating the Development of Medical Countermeasures for the Next Pandemic, The Lancet Infectious Diseases, Volume 20, Issue 5, E108–E115.

     The declaration of interests and acknowledgment sections read as follows:

Declaration of interests
SS (Shmona Simpson) and AC (Ajoy Chakrabarti) are employees of the Gates Foundation at the time of writing; however, this Personal View does not necessarily represent the views of the Gates Foundation. MCK (Michael C. Kaufmann) and VVG (Vitaly Glozman) are employees of PricewaterhouseCoopers at the time of writing; however, this Personal View does not necessarily represent the views of PricewaterhouseCoopers. We declare no competing interests.

Acknowledgments
We thank the subject matter experts and members of the Disease X Working Group who gave their time and extensive experience towards this endeavour (listed in appendix).

     The article itself states plainly that the Gates Foundation, with support from PricewaterhouseCoopers, coordinated all experts involved in the project. The Declaration of Interests likewise states that two of the authors were employees of the Bill & Melinda Gates Foundation, and the other two were employees of PricewaterhouseCoopers, at the time of writing. The supplementary appendix reveals that the Disease X Working Group consisted of thirty‑three people, eleven of whom were employees of the Gates Foundation, and one of whom was an employee of PricewaterhouseCoopers.

     Additional background shows that the Gates Foundation—while also being the second‑largest contributor to WHO—has funded previous studies published in The Lancet. A member of the Gates Foundation Scientific Advisory Committee also sits on the board of The Lancet. Even so, the authors write:

We declare no competing interests.

     If the authors are employees of the organizations coordinating the entire project, and one of those organizations has funded studies for—and has a relationship with—the journal publishing the paper (while also being a major funder of the organization that originated the concept of “Disease X”), then such a declaration does not align with the facts.

     What becomes clear is a collective of overlapping institutional interests has produced a plan published in one of the world’s most prestigious medical journals, thereby presenting the plan as an endorsement of public‑health policy by that same journal. The shared interest among these parties is a global health‑security agenda that promotes a questionable, arguably overly alarmist medical‑countermeasure framework—one that relies on disease fear‑messaging as a strategic tool. This framework enhances WHO’s global governance authority and benefits pharmaceutical industry revenues, while potentially undermining public health itself.

Disease Mongering 

     Before 2018, the phrase “Disease X” was not a widely used or fashionable term. After WHO officially added it to its list of “priority diseases with pandemic potential,” it became a media sensation. A flood of headlines followed, many of them breathless, sensational, or outright theatrical. A few examples illustrate the tone:

DISEASE X… IT’S END OF THE WORLD: NEW BIRD FLU WARNING
Daily Star, London (UK). June 16, 2018: 21.

"SUPER FLU" SET TO KILL 80 MILLION: Warning of Disease X pandemic
Daily Star, London (UK). September 19, 2019: 16.

DISEASE X: CHILLING NEW THEORY AS EUROPE PANICS — EXPERT FEARS VIRUS MUTATION DEATHS TOLL ‘COULD BE 80M’
The Sun, London (UK). February 25, 2020: 4.

These examples represent only a small sampling from the deluge of headlines and titles that have saturated the information sphere.

     An observant reader cannot help but conclude that popular news media have become propaganda machines for disease mongering, and respected scientific journals have become marketing tools for the same phenomenon.

     Michael A. Vance (2011) has described disease mongering as the promotion of diseases to sell medical goods or services:

Vance, Michael A (2011). Disease Mongering and the Fear of Pandemic Influenza, International Journal of Health Services, 41(1):95-115 doi:10.2190/HS.41.1.g

Disease mongering is simply the pharmaceutical industry and other interests using their resources to maximize sales and profits or government dole, as any good business would.

Vance argues that the scientific community has lost its ability to review and sustain its priorities:

Disease mongering explains why these priorities and perspectives are out of balance.

And he warned:

When disease mongering is legitimized by government and promoted by credentialed scientists, perceived by the public—and even worse by themselves—as objective thinkers immune from self‑deception, a passive, uncritical populace is created.

     From this perspective, “Disease X” appears to represent the crème de la crème of disease mongering. Introduced as a speculative label in a WHO document, the phrase and the mindset it legitimizes have since become cultural fixtures—amplified by media, legitimized by institutions, and marketed as a permanent feature of global‑health discourse. In this environment, “Disease X” functions less as a scientific category and more as a tool of persuasion, shaping public perception and policy through the steady manufacture of fear. It exemplifies the institutional decision to treat fear of the unknown as a valid organizing principle for public‑health planning—a decision that distorts priorities, erodes trust, and ultimately undermines public health itself.

.pdf copy of this article