An award-winning journalist's page-turning account of the global 100-days mission to catch the next virus outbreak, codenamed DISEASE X by the World Health Organization, before it spreads worldwide.

Foreword. Former British Prime Minister Tony Blair calls for world leaders to properly prepare for the next pandemic. Mentions Covid-19, United Nations, military spending
Introduction: Meet Disease X
Prepare to be Scared
Prepare to Move Fast
Prepare to Take Risks
Prepare to Share
Prepare to Listen
Prepare to Fail
Prepare to Spend Money
Prepare for the Next One...
2027: A Pandemic is Thwarted
Postscript
Resources and Further Reading
Acknowledgements
End Notes
Index

'As Kelland argues cogently, fear of the next outbreak should not paralyse us but instead galvanise us into making sure the terrible toll of Covid-19 is not repeated.

'Just as we do not wait for a formal declaration of war before building up military capabilities, we must be prepared to invest in rapid surveillance, financing, vaccines, treatments and manufacturing capacity ahead of time.

'Disease X is a valuable policy roadmap in a world custom-built for pandemics.'

ANJANA AHUJA, CO-AUTHOR, SPIKE:

THE VIRUS VS THE PEOPLE, THE INSIDE STORY

 

'Covid-19 will not be the last pandemic to cause havoc. Disease X sets out how a mystery pathogen of the future could be contained before it goes global, but only if lessons are learned from SARS-CoV-2 and other global disease threats.

'An engaging, accessible and ultimately optimistic account of how nations, institutions and the scientific community responded to Covid, and how they could work together in future.'

FERGUS WALSH

MEDICAL EDITOR, BBC

How prepared are we to face a future pandemic?

By Joy Phumaphi, Co-Chair of The Global Preparedness Monitoring Board.

As the world rebounds from the COVID-19 pandemic, one undeniable truth remains: another pandemic threat is not a matter of if, but when. While there is global acknowledgement that COVID-19 was a tragedy, this recognition has not yet translated into action with the scale, unity of purpose and agency that is required to prevent it from happening again.

Despite this outlook, there is room for cautious optimism. For the first time in history, we have the tools and resources needed to intercept a future outbreak before it spirals into a global pandemic, but only if we urgently secure the appropriate level of preparedness in advance.

DISEASE X: The 100 Days Mission to End Pandemics, written by CEPI’s Kate Kelland, lays out a realistic strategy to face down a future pandemic threat by rapidly developing vaccines within a little over three months of an outbreak being identified. The 100 Days Mission, as it is known, is bold and ambitious, but it is feasible. It is also essential if we hope to avoid a repeat of the tragic vaccine inequity that marred much of the global COVID-19 response.

For example, if the 100 Days Mission timeline had been applied to COVID-19, vaccines would have reached the global community when 2.3 million people had been affected, rather than at day 326 when the first vaccines were delivered, and approximately 67.7 million people had been infected.

Such ambition will only be possible by first dismantling the entrenched inequities within our R&D and preparedness systems. We need a game changer to ensure innovations are accessible to all countries so that they can be better prepared to act if a threat emerges, ensuring the rapid delivery of safe and effective countermeasures to at-risk communities. Part of ensuring the success of the 100 Days Mission will also require universal and comprehensive surveillance systems, capable of genomic surveillance across every corner of the globe. This capacity needs to be fully integrated into all health system investments globally.

We know how we should prepare, and we know what needs to change, but a fundamental question remains: how prepared are we to face a future pandemic?

The Global Preparedness Monitoring Board (GPMB), for which I serve as Co-Chair, will release its 2023 Report on the state of the world’s preparedness at the end of this month. For the first time, we implemented our Monitoring Framework, a diagnostic tool designed to uncover the most severe gaps in preparedness and underscore the urgent actions needed to address them.

In this year’s assessment, we delved into indicators related to equity, including global R&D coordination, manufacturing capacity and innovation. The report found that while global spending on R&D is at a record high, amounting to approximately U$S1.7 trillion globally, it is concentrated in just ten countries that account for 80% of this investment. While only 3% of the 61,000 products in the development pipeline target R&D Blueprint priority pathogens identified by the World Health Organisation for their epidemic or pandemic potential. Further, although global pandemic vaccine manufacturing capacity has grown significantly in recent years, this capacity is concentrated in Southeast Asia, Europe and North America—which we know directly impacts equitable access to pandemic vaccines.

As such, though we have made incredible progress in the speed of innovation, much work remains to ensure that the most impactful technologies are delivered to those most in need.

At the same time, the GPMB also observed that many of the investments made during the COVID-19 pandemic are at risk of being lost, including for R&D and access to medical countermeasures in the developing world. Urgent action driven by collaboration and strong governance is imperative to preserve and build upon these investments, address gaps, and strengthen our end-to-end R&D system.

This cross-sectoral multi-stakeholder readiness will need to be underpinned by strong leadership and strengthened and sustainably funded health systems. Systems with the tools, technical and digital capacities to provide ongoing health care to populations who need to access these systems daily and not only in pandemic times, or times of outbreaks and emergencies.

Indeed, preparedness is not simply about getting ready for something that will happen in the future. It is about building resilience, making better investments and building collaborations now from the local level to the international level and across different sectors as well as across countries and regions.

An exemplary instance of progress to this end is the establishment of Africa CDC-led Partnership for Africa Vaccine Manufacturing, involving ten existing manufacturers and 17 new ones. This Partnership is already making significant strides to sustainably bolster Africa’s vaccine manufacturing capacity. Collaborations and technology transfer established through the Developing Countries Vaccine Manufacturing Network have further enabled greater global capacity.

It is these projects, and hopefully many more like them, that will give humanity the health-security head start it needs to combat outbreaks and epidemics quickly and effectively, and to be able to stop the next pandemic threat before it becomes a deadly reality, potentially within 100 days.

We cannot afford to, again, leave the world dangerously exposed to the next pandemic. We must redouble our efforts and make the changes needed. I am convinced that we cannot contemplate being able to tackle or contain future pandemics without adequate preparedness. A fundamental prerequisite to this preparedness is monitoring. Robust, continuous, and independent monitoring will ultimately allow us to pinpoint gaps and discern the urgent actions needed to bridge them before the next pandemic strikes.

–ENDS–

Joy Phumaphi delivered a keynote speech for CEPI’s panel discussion, “A Pandemic-Free Future: Building Better Preparedness Through Partnership”,  at The World Health Summit 2023.

Available at: https://cepi.net/news_cepi/how-prepared-are-we-to-face-a-future-pandemic/

Extract from Preface by Sir Tony Blair

Covid-19 was an unprecedented global crisis and should mark a turning point in global health policy and preparedness. Yet, just as we are beginning to emerge from its worst phases, we are also seeing the political will to implement the hard-won lessons we have learned melt away, and the focus on pandemic preparedness shift. In part, this is because several concurrent crises are jostling for the attention of governments. However, health security will never be achieved if we do not build the lessons of Covid-19 into the way our governments and societies operate. To do this today, our governments need to demonstrate the same level of political will, ambition and international cooperation that leaders demonstrated during World War II when they coalesced around the objective of a sustainable peace. This must be applied to the post-pandemic order because, at its heart, health security is national security.

Disease X sets out a game-changing plan for how the world can learn from Covid-19 and be ready for the next pandemic. Global leaders should ready their nations for more frequent serious outbreaks of disease. The past few years have made it abundantly clear that we are living in an increasingly interconnected world where invisible viral threats are emerging more often, leaving all of us more vulnerable.

(continues)

Adenovirus 5 vector 111 

Adenovirus 26 vector 111 

Africa 55 

and Covid- 19 vaccine access 120 

malaria vaccine testing in 49 

monkeypox in 105, 106 

Rift Valley fever 55 

smallpox in 76 

vaccine- making capability in 144–146 

African Union 89 

Ahern, Jacinda 43 

Alakija, Ayoade 87– 88 

Asia 11, 55, 76, 103 

Aspen Pharmacare 145 

AstraZeneca 60. See also Oxford-AstraZeneca vaccine 

Australia 58, 59, 83. See also University of Queensland 

Avery, Heidi 123 

Aylward, Bruce 63 

Baker, Michael 43 

Bancel, Stephane 39, 46, 51 

Barry, John 32 

Bell, Sir John 52, 148 

Berkley, Seth 37, 77– 79, 80, 118– 120, 124 

Bernstein, Aaron 140 

Biden, Joe 53, 54, 107 

Bill & Melinda Gates Foundation 15, 116– 118 

Bingham, Kate 67 

biodefence 12, 13, 15, 17, 58, 73, 89 

BioNTech 52. See also Pfizer- BioNTech Covid- 19 vaccine 

bird flu 11, 18, 19, 32 

Black Death pneumonic plague 24 

Botswana, mutation of viruses in 85, 87, 104, 105 

Brazil 34, 89, 103, 127 

Breugelmans, Gabrielle 55 

Brilliant, Larry 20, 51, 146– 147, 148 

Brundtland, Gro Harlem 127, 140 

Bush, George W. 16, 32 

Cameroon 105 

Canada 83, 107 

canarypox 109 

canarypox vector 110 

CEPI. See Coalition for Epidemic Preparedness Innovations (CEPI) 

ChAdOx1 47 

Chappell, Keith 57 

Chikungunya 11 

China 42, 63, 65, 66, 129 

Centers for Disease Control (CDC) 27 

lockdown in 33 

preparation for coronavirus outbreak impact 29– 31 

publication of Covid- 19 epidemic situation 27, 33 

SARS in 65, 132, 139 

circuit breaker 66, 67 

‘Clade X’ (fictional disease) 71– 72 

Clinton, Bill 91 

Clover Pharmaceuticals 59 

Coalition for Epidemic Preparedness Innovations (CEPI) 12–15, 46–47, 58, 60, 82, 87, 93, 105, 135 

funding for Covid- 19 vaccines development 60, 114, 115, 116, 134 

100 Days Mission. See 100 Days Mission 

and MARS vaccines development 134, 135, 136 

and Oxford- AstraZeneca Covid- 19 vaccine 47 

and United States 129 

and University of Queensland 58, 59 

Cohen, Joe 49– 50, 117 

contact- tracing 65 

Cote D’Ivoire 121 

COVAX 81, 82– 84, 102, 119– 125 

Covid- 19 10, 19, 142. See also SARS- CoV- 2 

Chinese reports on 27, 33 

emergence of 18, 26– 28 

governments’ responses to 36, 53 

impact of 11, 12 

number of deaths due to 25, 56, 71, 97 

Covid- 19 vaccines 13, 50, 58, 59, 81, 88 

access to 12, 121, 122 

COVAX. See COVAX 

effectiveness of 60 

equal access to 128 

fair allocation of 81, 82 

mRNA technology 123, 145 

Oxford- AstraZeneca vaccine 47, 52, 60, 82, 88, 121, 136, 148, 158 

Pfizer- BioNTech vaccine 52, 88, 123 

sharing mechanism 119 

Covid- 19 vaccines development 12, 46, 56, 58. See also vaccines development 

and delivery speed 62 

funding for 43, 46, 60, 77, 114, 115, 116, 134 

mRNA technology in 78 

pace of 50, 51– 52, 53 

reasons for failure 115– 116 

and trial failures 112 

Crimean- Congo 11 

Cummings, Dominic 66 

CureVac Inc 59, 115 

de Blasio, Bill 45 

de Oliveira, Tulio 85–86 

de Vivo, Cynthia 77, 80 

DEEP VZN (Discovery & Exploration of Emerging Pathogens – Viral Zoonoses) 55, 139 

deforestation, impact of 106 

delayed response, impact of 40, 41, 45, 68 

Democratic Republic of the Congo 34, 105 

diarrhoea 117 

Disease X (generally) 10, 11, 112, 137, 143 

Duke University 142 

early stages of pandemic 

decisive in 68 

decisive moves in 40 

interventions during 65 

need for proactive interventions 42 

non-pharmaceutical interventions 44 

early warning 34, 54, 55, 70 

Ebola 10, 11, 24, 49 

exponential growth risk 24– 25, 62– 65 

failure of programmes 109– 125 

fair(er) system 81, 90, 91, 176 

Farrar, Jeremy 14, 35, 42, 67, 87 

Fauci, Anthony 44, 77, 109, 111 

fear 21– 38, 90, 143 

Financial Intermediary Fund (FIF) 146, 148 

financial risk 71 

Foege, William 75 

Ford, Gerald 69 

fractious societies 149 

funding 71–72, 122, 126– 141. See also investments 

from CEPI 15, 46–47, 59, 60, 114, 115, 116, 134 

emergency funds 12, 122 

Financial Intermediary Fund (FIF) 146, 148 

from Gates Foundation. See Bill & Melinda Gates Foundation 

for global surveillance 141 

for pandemic prevention 125 

for research and development 14, 125 

from USAID 54, 71 

for vaccines development 81, 134, 136, 141 

for vaccines library 14 

G20 countries 15, 53, 71, 72, 132, 139 

G7 countries 15, 53, 71, 72 

Gates, Bill 99, 116–118 

GAVI (Global Alliance for Vaccines and Immunisations) 77, 78, 82, 121 

genetic sequencing 27, 50, 53, 55, 71, 103, 136 

genome sequencing 51, 85, 89 

geopolitics 147, 149 

Germany 15, 42 

Ghana 84, 121 

Ghebreyesus, Tedros Adhanom 34, 77 

Gilbert, Sarah 47, 59, 60, 61, 115, 136 

GISAID 85, 89, 157 

Glassman, Amanda 50 

Global Alliance for Vaccines and Immunisations (GAVI) 77, 78, 82, 121 

global health security 38, 85, 93, 125, 141, 143, 144, 149 

globalisation, impact of 106 

Global Malaria Eradication Programme 118 

Global Pandemic Preparedness Summit 52, 83, 87, 105, 119 

Global Preparedness Monitoring Board’s reports 126–128, 140, 148 

global surveillance networks 12, 54, 90, 141 

Global Virome Project 55, 139 

Gove, Michael 100 

governments. See also specific countries 

ambitions of 148 

category mistake by 130 

early moves by 68 

political policies 68 

Gray, Glenda 110 

Green, Catherine 47 

groupthink 64, 65, 68, 70 

Guillain- Barré Syndrome 69 

Guinea 13, 34 

Guterres, Antonio 70 

H1N1 swine flu (2009) 11, 34, 44–45, 49, 68, 69, 80, 90 

cost of 127 

outbreak 33, 41 

Harvard Global Health Institute 41 

cost of 127 

outbreak 13, 26, 34, 41, 149 

economic downturns 64, 140, 149 

Ehanire, Osagie 83, 145 

The Elders 127 

11th September 2001 attacks 22– 24 

Elias, Chris 37 

emerging pathogens 18– 19 

epidemiology 24– 25 

Erfurt, Julika 119 

Europe 72, 76, 88, 103, 107 

European Union 15, 83, 132 

 

Hatchett, Richard 15– 18, 28, 35, 36, 66, 68, 71, 73, 80, 81, 96, 123, 130, 165 

analysis of Spanish Flu pandemic 43 

analysis of swine flu pandemic 68 

analysis of threats to United States 32– 33 

and Bancel 39, 46, 51 

experience at Ground Zero 22– 24 

on exponential growth risk 62 

on funding 130 

funding/ investments by 60, 77, 134 

global fear 31 

on ignorance of pandemic effect 65 

on inequities 81, 87, 122 

and Inovio 77 

and Johnson 97, 99 

and Koonin 120 

and Melanie 114 

and Moderna 39– 40, 43, 77 

on need for speed to act 43 

on non- pharmaceutical interventions 98 

and Obama 44 

observation of Chinese response to SARS- CoV- 2 30– 31, 33, 44, 59 

predictions and warnings 37, 38, 95, 96, 97, 104, 105, 108 

preparedness for pandemic 29, 30 

on reliance on Serum Institute of India 122, 123 

on response to coronavirus threat 38 

and Saville 31 

sensemaking exercises 68, 97 

and Seth 118– 120 

and Solberg 95, 96 

trip to Norway 93, 94 

and Ulstein 95, 97 

and U.S. Medical Reserve Corps 32 

on vaccines 112 

on vaccines development 123 

and Venkayya 93– 94 

view on Covid- 19 variants 103– 105 

view on government’s reaction to pandemic 45 

view on vaccine nationalism 86 

warning about coronavirus 21– 22 

white paper of 81 

worry about pandemics 61 

Hatchett, Susan 22, 37 

Heckler, Margaret 111 

Henderson, Donald A 76, 77 

Hendra bat- borne virus 11 

Heymann, David 87 

Hill, Adrian 61, 115, 133, 134 

Hilleman, Maurice 50 

HIV. See human immunodeficiency virus (HIV) 

Hooper, Rowan 130–131, 132 

Human Genome Project 51 

human immunodeficiency virus (HIV) 24, 58, 139 

emergence of 26 

vaccines 109–112 

100 Days Mission 48, 53, 150, 179 

database navigation 157–160 

financial arrangements 164–166 

initial alert 156– 157 

non-pharmacological interventions 163– 164 

overview 11–12 

vaccination trial 166– 170 

vaccine administration and rollouts 175–177 

vaccine manufacturing 170– 172 

vaccine trial results 173–175 

WHO’s daily situational report after vaccination rollout 177– 178 

WHO’s investigation of the outbreak 170–172 

WHO’s report to governments and responses 160–163

 

Hunt, Jeremy 64, 67 

IDT Biologika 136 

India 15, 88, 103, 121– 122 

inequities 12, 81, 84, 87, 90, 122. See also sharing approaches 

information sharing 27, 33, 89, 91, 156 

Inovio Pharmaceuticals 46, 59, 77, 114, 115, 136 

Institut Pasteur 59, 106, 115 

intensive agriculture, impact of 106 

investments. See also funding 

in Covid- 19 vaccines development 46, 114 

into defence and security 73 

in preparedness 15, 90, 141 

in public health prevention 141 

in research and development 14, 132, 133, 134 

in surveillance systems 90 

in vaccines development 38 

Italy 97– 98, 142 

Janssen Vaccines 136 

Japan 15, 34, 83 

Jenner Institute 136 

Jenner, Edward 76, 107 

Jha, Ashish 41 

Johnson & Johnson 111 

Johnson, Boris 41, 66, 88, 97, 98– 99, 100 

Kaelin, William 52 

Keenan, Margaret 82 

Kenny, Charles 50 

Kenya 145 

Koonin, Lisa 120 

Krammer, Florian 137 

Kuenssberg, Laura 98 

Kundera, Milan 30 

Lai, Shengjie 56 

Lander, Eric 53 

Lassa fever 11, 46, 47, 135 

Latin America 55 

Levin, Stephen 46 

Liberia 13, 34 

Lipsitch, Marc 43 

listening to warnings 93– 108 

lockdowns 24, 33, 41, 42, 43, 44, 55, 65, 66, 67, 87, 99, 101, 102 

London School of Hygiene and Tropical Medicine 41 

Lurie, Nicki 40 

Mahmoud, Adel 14 

malaria 55, 117, 149 

eradication programmes 117, 118, 132 

vaccines 49– 50, 117, 118 

Marburg 11, 55 

Mazumdar- Shaw, Kiran 122 

measles 78, 79, 90, 115 

Mecher, Carter 17, 29, 43, 44, 68, 96 

meningitis 78 

Merck & Co 110 

MERS. See Middle East Respiratory Syndrome (MERS) 

Mexico 68 

Middle East Respiratory Syndrome (MERS) 11, 19, 27, 28, 46, 47, 55, 65, 107, 132–136, 137, 139, 149 

military defence, spending on 128– 130, 131, 141 

Moderna 40, 43, 46, 50, 59, 77, 114, 123, 145 

molecular clamp 57, 58, 115, 159 

Mologic 99 

money factor. See funding 

monkeypox 34, 105–108 

Morrison, Scott 58 

Mosquirix 49 

Moyo, Sikhulile 85 

MRK-Ad5 110 

mRNA hub technology transfer project 89 

Munich Security Conference 37, 71 

Munro, Trent 57 

Musk, Elon 131, 138 

 

mutants 11, 53, 84, 87, 103, 104, 119, 121 

NASA data 55 

nationalism of vaccine. See vaccine nationalism 

New Zealand 42– 43, 48 

Nigeria 83, 84, 105, 145 

Nipah 11, 47, 154 

Nkengasong, John 145 

non- pharmaceutical interventions (NPIs) 43– 44, 45, 55, 96, 120 

Norland College 113 

North America 76 

Norway 15, 93, 97 

Novavax Inc 59 

NPIs (non- pharmaceutical interventions) 43– 44, 45, 55, 96, 120 

Obama, Barack 69, 123 

Omicron 66, 84, 86, 87, 89, 104– 105 

ONE Campaign 82 

organisation and structure, need for 23 

original position 91– 92 

orthopoxviruses 106, 108 

Oxford- AstraZeneca vaccine 47, 52, 60, 82, 88, 121, 136, 148, 158 

Oxford Biomedical Research Centre 134 

Oxford University 59, 115, 136 

pandemic- potential pathogens 14– 15, 137 

Pandemic Speed 53, 54, 55, 58, 136 

Pandemic Treaty. See Treaty on Pandemic Prevention, Preparedness and Response 

pandemic worrier approach 15, 27, 61, 149 

Pasteur, Sanofi 62 

Peru 103 

Pfizer 52 

Pfizer- BioNTech Covid- 19 vaccine 52, 88, 123, 145 

Phambili trial 110 

Piot, Peter 34 

Plotkin, Stanley 14, 69, 70 

pneumococcus 78 

pneumonia 21, 26, 33, 40, 78, 79, 90, 117, 136, 152 

polio 34, 117, 118 

polio vaccine 117 

poor/ poorer countries 14, 79, 81, 82, 83, 84, 89, 122, 123, 125 

PREDICT project 54– 55, 71, 139 

pre- prepared vaccines 108 

probability of pandemic threat 142 

‘Project Light Speed’ 52 

Project Trillion 130, 131 

“A proposal to establish a globally fair allocation system for Covid- 19 vaccines” 81 

prototype antibody tests 99 

prototype vaccines library 14– 15, 70, 125, 138, 159 

prototype viruses 108, 137 

public spaces, closure of 43, 44, 46, 68, 96, 98, 135 

quantitative easing 131 

quarantining 43, 55, 65, 135 

rapid response vaccines 47, 146, 158, 159 

Rawls, John 91 

research and development 60, 90, 141, 146 

investment in 14, 125, 132, 133, 134, 136 

risks in 59, 62 

of vaccines. See vaccines development 

Resolution Foundation 102 

responding to warnings 93– 108 

Rift Valley fever 55 

ring vaccination 75 

risks taking 57– 73 

R nought (basic reproduction number) 24 

 

rotavirus vaccine 51, 78 

RV144 trial 109 

Rwanda 121, 145 

Ryan, Mike 41, 65 

SAGE 66 

Sanger, Frederick 51 

SARS. See Severe Acute Respiratory Syndrome (SARS) 

SARS- CoV- 2 25, 30, 46, 47, 53, 55, 62, 71, 85, 97, 115, 126, 129, 132, 137, 143. See also Covid- 19 

genome sequences 89 

variants 87, 103– 105 

Saudi Arabia 134 

Saville, Melanie 22, 31, 47, 58, 61– 62, 112– 116 

Schmutte, Caroline 37 

schools, closure of 42, 43, 44, 46, 48, 68, 96, 98, 135 

scientific advances 12, 51. See also vaccines development 

scientific collaboration 89 

self- interest 82, 125, 147 

Sencer, David 69, 75 

Senegal 145 

sepsis 78 

Serum Institute of India 122, 123, 145 

Severe Acute Respiratory Syndrome (SARS) 10, 11, 28, 50, 65 

cost of 127 

outbreak 28 

sharing approaches 74– 92 

short- termism 149 

Sierra Leone 13, 34 

Singapore 34, 42 

smallpox 74, 76, 77, 106, 107 

as bio- weapon 32, 107 

eradication programmes 20, 74, 75, 76, 88, 147 

outbreaks 75 

as a prototype 108 

vaccines 82, 107, 108 

Snowden, Frank M. 18 

social distancing 43, 44, 45, 55, 96, 120 

Solberg, Erna 37, 95– 97 

Soros, George 99 

South Africa 84, 85, 89, 103 

HIV vaccine trials in 109, 110 

mutation of viruses in 87, 104, 105 

South America 72, 76 

Southampton University WorldPop research programme 55 

South Korea 34, 42, 66, 88, 134 

MERS in 65, 133, 135, 139 

response to Covid- 19 48, 65 

South Sudan 121 

space science 55 

Spanish Flu (1918) 18, 24, 43, 127, 128, 142 

speedy response 

and money 136 

need for 39– 56, 62 

spillover hotspots/ threats 54– 55, 71, 139, 149 

Sputnik V Covid- 19 vaccine 111 

STEP trial 110 

Stuxnet 36 

Sunak, Rishi 101 

super- fast new coronavirus vaccines 88 

surveillance systems 12, 54, 70, 71, 73, 90, 140, 141, 148, 149 

Tatem, Andy 56 

Thailand 34 

Themis Bioscience 115, 116, 135 

Treaty on Pandemic Prevention, Preparedness and Response 92, 144, 148 

Trump, Donald 68, 81, 100 

Tsang, Alan 85 

Uhambo trial 109, 110 

UK Vaccine Network 134

Ulstein, Dag- Inge 94–95 

uncertainty 27, 40–41, 42, 60, 61 

United Kingdom 15, 83, 87, 89, 105 

National Institute of Health Research 134 

parliamentary ‘lessons learned’ report 64 

United Nations 41, 82, 89, 121 

United States 16, 32, 42, 83, 84, 89, 103, 107, 132, 142 

Agency for International Development (USAID) 54, 71, 139 

Centers for Disease Control and Prevention (CDC) 75 

and CEPI 129 

Medical Reserve Corps 16, 32 

military defence spending 129 

National Institute of Allergy and Infectious Diseases 46, 109 

Operation Wrap Speed 52 

pandemic preparedness 123 

University of Hong Kong 59 

University of Padua 142 

University of Queensland 46, 57, 58, 59, 77, 114, 115 

urbanisation, impact of 106 

vaccine nationalism 82–85, 86, 87, 125, 144 

vaccines 13, 69, 79 

access to 104, 105 

countries’ capability to make 144–146 

for Covid-19. See Covid- 19 vaccines 

for Ebola 13, 115 

equality in distribution of 125 

global sharing system 119, 120, 125. See also sharing approaches 

for HIV 77, 109–112 

for malaria 49, 117, 118 

market failure of 13 

mass vaccination 75 

for MERS 133, 134, 135 

and mutant variants. See mutants 

for pneumococcus 78 

for polio 117 

potentiality of 49 

pre- prepared 108 

prototypes 14–15, 70, 125, 138, 159 

public’s confidence in 69 

rapid response 47, 146, 158, 159 

ring vaccination 75 

for rotavirus 51, 78 

for smallpox 74, 82, 107, 108 

super- fast 88 

for swine flu 80 

trials 166– 170 

for Zika 46 

vaccines development 47, 132, 138. See also Covid- 19 vaccines development; 100 Days Mission 

failure of projects 115 

funding for 14, 38, 134, 136 

geographical imbalance in capability 89 

large-scale 61 

and microbe isolation 50 

molecular clamp technique 57, 58 

progress in 50 

risks in 71 

speed of 13, 49– 50, 51 

Vallance, Patrick 101– 102 

Variant of Concern 103 

Variant of Interest 103 

vector-based techniques 115 

veil of ignorance 91–92 

Venediktov, Dimitry 76 

Venkayya, Rajeev 17, 93–94 

viruses (generally) 25–26 

Wellcome Trust 15 

West Africa 

Ebola epidemic 13, 26, 41, 149 

economic cost of epidemic in 127 

Whitty, Chris 101–102, 105 

WHO. See World Health Organization (WHO) 

Wilder, Dick 22, 58, 60 

The Wolverines 17, 97 

work-from-home 48, 120, 168 

“A World At Risk” report 126–128 

World Bank 71, 146 

World Health Organization (WHO) 10, 26, 33, 35, 41, 82, 92, 103, 146 

Covid-19 Candidate Vaccine Landscape and Tracker 112 

Event Information System 33, 156 

Incident Management Support Team (IMST) 33, 156 

International Health Regulations 34 

International Health Regulations Emergency Committee meeting 34 

Public Health Emergency of International Concern (PHEIC) 34, 35 

“A World in Disorder” report 141 

World Population Review 129 

Yang, George 50 

Yates, Kit 25 

Young, Paul 57 

Zika 10, 11, 34, 49 

cost of 127 

vaccines 46 

zoonoses 139 

zoonotic diseases 25, 55, 106, 139, 140, 154, 155, 162