The world held a moment of silence during the COVID-19 pandemic, an eerie one, where the busiest streets of the world’s most populated cities were vacant. The emptiness of a smileless face covered with a mask became a sense of safety, a discomforting juxtaposition that many people grappled with.
Healthcare workers were covered in Personal Protection Equipment (PPE) and wore double N95 masks cutting into the back of their ears. Some nurses and doctors shared their frustrations and grief but, for many, emotions could be seen solely in their eyes. Eyes became the only windows into seeing each other’s emotional spirit, and it was dwindling. The COVID-19 pandemic pushed healthcare workers to the breaking point, contributing to a healthcare provider shortage that is still vastly impacting medical institutions today. Although many people have moved on, choosing to forget COVID-19, its consequences are still reverberating. COVID-19’s impact did not just linearly diminish as the number of cases decreased. Therefore, the world cannot just ignore the statistically significant possibility of a future pandemic.
The memories of COVID-19 cannot be shoved under the carpet; living in a false safety that this circumstance will not happen again is an extreme collective denial. Rather, it is vital that the world rebuilds with a new approach to protecting the global population from the next possible source of a global pandemic, what has become more commonly referred to as Disease X.
Disease “X” is the World Health Organization’s (WHO) coined term for an unknown pandemic pathogen. This is a placeholder concept the organization has created for a pathogen that has not yet mutated into a global outbreak but could do so in the near future. Disease X was first introduced in the WHO 2018 Annual Review of diseases prioritized under the Research and Development Blueprint. The Disease X term was needed to discuss the threat of a hypothetical pathogen that is not known or exists yet. It is still largely debated whether COVID-19 (SARS-CoV-2) should be considered the first pathogen given Disease X classification. In fact, experts are also discussing whether COVID-19 is just a small taste of what is to come with a far more fatal Disease X. Ultimately, the Disease X concept is considered a pathogen which will hold the right characteristics and ingredients to create another global pandemic. Recognizing the growing threat, the scientific community has turned its attention to defining which types of pathogens the international community should be urgently monitoring.
For instance, there is specialized focus on zoonotic diseases as the next possible source of Disease X. It takes what is known as a zoonotic jump for an animal virus to become transferable and infectious in human beings. The Center of Disease Control states that an estimate of “more than 6 out of every 10 known infectious diseases in people can be spread from animals” whilst “3 out of every 4 new or emerging infectious diseases in people come from animals.” These statistics highlight that, in most cases, zoonotic spillover is an inevitability not an anomaly.
This is especially the case since the boundaries between species have become increasingly entangled because of deforestation, industrial agriculture, the wildlife trade and climate change. Environmental pressures and human behavior should not be overlooked when addressing zoonotic disease solutions. Notable origins of diseases from animals include Ebola virus, where bats are the suspected virus reservoir; Creutzfeldt-Jakob disease, the human form of the prion disease Bovine Spongiform Encephalopathy (mad cow disease); Zika virus, which is transmitted by mosquitoes; and Avian influenza (bird flu), which originates in birds. These examples illustrate a disease landscape that could serve as the origin of Disease X and has well-established precedent.
Another potential source of Disease X that needs to be scrutinized is an engineered pandemic pathogen. Carl Jung, an influential Swiss psychiatrist and psychotherapist, warns that the “only real danger that exists is man himself.” Bioterrorism is a threat to humans created by humans. Alongside nuclear weapons, bioterrorism has become a new missile in the self-destruction toolbox. The development of biotechnology has allowed for advancements in many health sectors such as pharmaceuticals and vaccines. However, it has also made engineering pandemic pathogens that can be customized to have high virulence and fatality rates possible. During the cold war, viral agents were stockpiled as militarized weapons in the US and the Soviet Union. Viral bioterrorism puts everyone at risk and, whether the release of a bioengineered Disease X could be intentional or accidental, the impact would be globally devastating.
All these factors suggest that Disease X is not a question of if it will cause the next global pandemic — it is a question of when.
Given this, organizations like The Coalition for Epidemic Preparedness Innovations (CEPI) have identified 25 different virus families that can serve as the host to the next deadly virus. CEPI hypothesizes that Disease X will come from one of these twenty-five different virus families. CEPI’s “100 Days Mission” aims to achieve the ability to respond to the next Disease X pandemic in just under three months by preparing globally accessible vaccines. The 100 Day Mission is centered around swift and equitable vaccine deployment that will defend those at highest risk in order to stop the spread of an outbreak. Their research on “the most wanted viruses” provides a library of prototype vaccines to preempt the need for the next crucial vaccine by ideally supplying the world with an expedited prophylactic vaccine to contain the spread of the next pandemic. CEPI’s current diversification into the unknown of the 25 families is reimagining pandemic prevention in research.
The Coalition for Epidemic Preparedness Innovations was born after the Ebola outbreak highlighted just how ill-equipped state and non-state actors are at containing epidemics. The WHO is often criticized for their inefficient reaction and response to the 2014 Ebola outbreak. The WHO did not have efficient intergovernmental cooperation nor the proper funding needed to execute a cohesive effective response. The Ebola outbreak sheds light on the significant gaps in the global health system, harkening the need for an innovative multifaceted approach to respond to epidemics and pandemics. Ebola should have been the wake-up call. Now, the COVID-19 pandemic is the writing on the wall.
The COVID-19 Pandemic exposed global governments to a new crisis, a war against a common enemy — a virus.
Sovereign states have the responsibility to protect and provide for the population in crisis. During the COVID-19 pandemic global health security was threatened. However, instead of nations banding together to contain COVID-19, there was global division and politicization of healthcare. The pandemic introduced two predominating questions: who was responsible for COVID-19 and what international actors were going to contain it?
There needs to be a new framework to instill global cooperation, one that begins with framing viruses as a shared enemy rather than a localized problem. This reframing shifts responsibility not only to individual nations or institutions, but to collective action by changing the narrative to global commitment and shared responsibility. COVID-19 could have been a moment of unification, but it became a moment of polarization. This was not just seen on a global scale. Personally, many people in my own community that didn’t have immunocompromised family members decided it was not their responsibility to protect people from the spread of the virus. This is why framing the virus as a shared enemy and responsibility could create a stronger collective action against the next pandemic.
After World War II, global cooperation created the United Nations to prevent future conflict and another devastating world war. The U.N. served as a preemptive measure to ideally maintain peace and established a permanent institution for conflict resolution. Over time, the U.N. has become a platform for diplomacy and has helped shape postwar international order. In addition, the U.N. launched specialized agencies such as the World Health Organization (WHO), founded in 1948 to address global health issues. The WHO was established from the premise that health is inseparable from peace and security. Ten years after the WHO’s Constitution was created, the Soviet Union (USSR) proposed a WHO-led smallpox eradication program that would become a profound example of global health governance. In 1977, the last confirmed case of smallpox was identified and, by 1980, the WHO declared smallpox eradicated. This success was attributed to a moment of unprecedented global political commitment, even during the height of the Cold War, where the US and the USSR both agreed upon this shared goal of eradication. The program’s strength lay in its measurable objective for complete eradication thus countries systematically reported case detection and worked with the WHO. Nations shared the responsibility by sharing resources. The program had political backing and funding for over a decade. The WHO had a Smallpox Eradication Unit that was led by experts in the field like Donald Henderson, who later founded the Center of Civilian Biodefense Studies at Johns Hopkins. The smallpox eradication campaign can serve as a powerful model for international cooperation. Smallpox remains “the only infectious disease to achieve this distinction.”
The evolution of the WHO and the International Health Regulations (IHR) have made expansive strides in global healthcare. However, the accelerating pace of globalization and the changing global health landscape have revealed critical limitations. The WHO struggled to enforce effective governance during the COVID-19 pandemic. It was unable to coordinate an international response, delayed declaring COVID-19 as an international emergency and was not able to hold nations accountable for disease surveillance and timely reporting. The COVID-19 pandemic revealed domestic political agendas which led to a fragmented response and its politicization fueled skepticism on scientific advice globally. What this highlighted is that the WHO has arrived at a critical inflection point where the future of successful pandemic response must be able to transcend political pressures.
Although the WHO has had a historical commitment to global health, another moment of international solidarity is needed — one where a global crisis becomes the catalyst for cooperation just as World War II served as the platform for creating the U.N. A virus may not be treated as a world war, yet its global consequences and strains are not unlike the destructive impacts of warfare. There are extensive fatalities, governmental instability, economic implications and a shared sense of fear and crisis. So, why isn’t there an international institution or organization solely dedicated and committed to preventing the next global pandemic?
In 2015, Bill Gates performed a TED Talk where he outlined that the world is not prepared for a pandemic. Fast forward 10 years to today in 2025 the global health system is still not prepared for a pandemic.
Bill Gates has now proposed a systematic multifaceted solution to prevent the next global pandemic. This solution is the Global Epidemic Response and Mobilization (GERM) team.
The GERM team would be a permanent institution and organization that can combat and coordinate rapid responses to new potential infectious outbreaks. Ultimately the GERM team could be seen as another functional unit of global cooperation and governance. Additionally, they would be coordinated with the WHO. The GERM team would become a multinational unit that comprises over 3,000 full time specialists in epidemiology, vaccine development, genetic engineering, data science, computer simulation, emergency medicine, communications and diplomacy. The GERM team would be actively monitoring and researching threatening outbreaks. Disease X would be contained before it becomes a global health threat. Bill Gates states in his TED talk that if COVID-19 was caught in the first 100 days it would have saved over 98% of the lives lost. The first 100 days are crucial to stop the spread of an epidemic and the GERM team would be equipped to do so.
The GERM team is an exemplary theoretical model solution that can transition into becoming a groundbreaking reality. For the GERM team to come into fruition it needs funding. Governments spent an immense amount of funds during COVID-19. Money was poured into economic relief programs, healthcare infrastructure and other aid response measures. The U.S government spent 4.6 trillion dollars and created the Coronavirus Aid, Relief and Economic Security (CARES) Act during the pandemic. The International Monetary Fund (IMF), a major U.N. financial agency, estimates that COVID-19 has cost the world around 14 trillion dollars. To put the GERM team’s funding into perspective, spending money on the GERM team now would save nations from spending trillions of dollars later. The GERM team will cost the world 1 billion dollars annually to maintain all the resources and on-the-ground manpower. This is a worthy investment for the survivability of our future. To apply Bill Gates’ motto here — “This is the billions we need to spend in order to save millions of lives and trillions of dollars.”
The funding needed for the GERM team would have an expansive impact beyond stopping Disease X. It could provide another opportunity to advance medical tools for efficiency in many different specialties. To prepare to prevent a pandemic there needs to be investment in diagnostic tools, vaccines and deliverance which will subsequently address health disparities and global accessibility. A case study on microneedle patch vaccines exemplifies the reach the GERM team could have on closing the health security gap.
The GERM team would fund new research in vaccine deliverance such as microneedle patches. Microneedle patch vaccines provide an efficient delivery system to the dermis and epidermis layers of the skin. Research on this deliverance method has shown higher immunogenicity for some vaccines than the traditional intramuscular needle route. Microneedle patch vaccines could revolutionize immunization strategies because it allows fast global vaccine deployment and mass production. More importantly, this vaccine method does not need large infrastructure or manpower to distribute. The vaccine patches do not require refrigeration, making delivering vaccines in remote areas and rural regions easier, thus improving accessibility. As illustrated, the GERM team’s impact on healthcare development could provide more than just pandemic prevention but could also help remedy the gaps in global health security that disproportionately devastate populations that do not have access to proper healthcare infrastructure. New diagnostic tools and therapeutics, disease surveillance, strengthening existing healthcare infrastructure in low-income countries and pathogen genomic data sharing are just a few more examples of how the GERM team’s impact addresses narrowing the health gap.
In this era of increasing interdependence between nations, international institutions play a critical role in global governance and are vital forums to address global crises. The United Nations, the World Health Organization and the World Trade Organization are international institutions that are fundamental to global stability in governance, economy and health security. Yet the capacity to respond through these institutions has been undercut by political resistance. The Trump administration, for example, has demonstrated a strong aversion towards global multilateral commitments and institutions. Recently, the administration has cut thousands of programs under the United States Agency for International Development (USAID). USAID has long supported global health, education, humanitarian relief and economic development for nations recovering from conflict or disaster. Increased efforts to defund and discredit governmental agencies and organizations such as the WHO have further politized healthcare and weakened international cooperation. The GERM team could have direct funding that could be insulated from shifting political pressures which would bypass bureaucratic delays and geopolitical conflicts. Detailed frameworks for pandemic response are still under development, but the most important promenet is addressing the governance and enforcement gaps by embedding pandemic preparedness into the core agendas of nations.
The current geopolitical climate has revealed the fragility of global health governance within the hands of today’s leaders. The tension underscores the relevance of Complex Interdependence Theory, founded by Keohane and Nye, which establishes a framework where states are not solely driven by military power or security concerns. Instead, nations are deeply interconnected through shared economies, trade networks, security interests, technological advancements, international institutions, shared health dependencies and environment (Keohane and Nye). States do not operate in isolation. While interdependence is a defining feature of global order, many states perceive it as a liability during global crises, precisely when collective action is most critical. Disease X will not happen in isolation either, it will thread itself through the web of international interdependence.
Globalization has fueled more interconnectedness among states, making global cooperation the cornerstone for global stability. A global pandemic is a wicked problem characterized by its complexity. It requires a multifaceted approach that necessitates international cooperation and robust global governance. A single nation is not able to stop a global pandemic alone, yet a single nation’s outbreak can trigger a chain reaction sending the world into crisis. The GERM team is strategically and uniquely positioned to interrupt the chain reaction. However, the question still remains: Who is responsible for Disease X? The answer is everyone — Disease X is our shared global foreign enemy, and it is our collective responsibility to confront it.
The views expressed in opinion pieces do not represent the views of Glimpse from the Globe.