Role-playing gamers are often spotty-faced teenagers – but on that May day, the bustling Berlin conference room was mostly filled with middle-aged men and women.
But then the players were not fighting zombies, dragons or alien invaders – they were senior government officials and experts at last year’s inaugural meeting of G20 health ministers.
And they were planning what to do if a deadly epidemic in a lower-income nation became a virulent global pandemic.
Preparing for ‘Disease X’
Last year’s G20 host, Germany’s Chancellor Angela Merkel, is a former research scientist.
She reminded the heads of the world’s most powerful states that the 1918 Spanish flu pandemic killed more people than World War I.
And she added: “If the Spanish flu… were to spread again today, then we would probably not be sufficiently prepared for it.”
Medical experts around the world agree another flu pandemic is overdue.
But they also fear even deadlier diseases – perhaps ones unknown or long forgotten – could wreak global havoc.
Which is why the World Health Organization (WHO) has included a “Disease X” in its latest plans for coping with unexpected pandemics: “X” means “unexpected”.
Image: US deaths caused by the Spanish flu outbreak of 1918-19 compared to other diseases.
Expecting the unexpected
In February 2018, the WHO released details of its infectious disease Research and Development (R&D) Blueprint. This listed diseases likely to cause future epidemics, including the Ebola and Marburg haemorrhaging viruses, Lassa fever, Rift Valley fever, Zika – and “Disease X”.
The blueprint’s creation was prompted by the 2014-16 Ebola outbreak in West Africa that killed more than 11,300.
Marie-Paule Kieny, a former WHO assistant director-general for R&D during that crisis, said that emergency “showed us in no uncertain terms that R&D for medical products needs to be an integral part of any response to epidemics and public health emergencies.
“During Ebola, WHO worked alongside numerous governments, public and private entities and scientists.
“That effort resulted in the first-ever fully effective vaccine against Ebola, developed and tested in 12 months as opposed to the five to 10 years such a process would normally take.”
The organization is now preparing R&D roadmaps that give a profile for the kinds of medicines and diagnostics needed to combat individual diseases. The aim is to reduce the time needed to create responsive medicines and treatments for each illness.
Kieny added: “So far, four target product profiles have been developed for vaccines and diagnostics to address Zika, Nipah virus and Lassa fever.
“These ‘standards’ will guide the research of our partners and will ensure that everyone works according to the same parameters for quality, safety and efficacy.”
Disease X, the WHO says, “represents the knowledge that a serious international epidemic could be caused by a pathogen currently unknown to cause human disease”.
Like many phobias, our fears of diseases are reflected in Hollywood films that show some of the frightening ways they can be transmitted.
In 1934’s Bulldog Drummond Strikes Back, a profit-hunting luxury fur trader risks spreading cholera in Edwardian London via infected pelts. In 1995’s Outbreak, a smuggled pet spreads an Ebola-like illness across the United States.
Real-life outbreaks are just as unpredictable. They follow no particular time scale while the “vectors” – or means of transmission – and outcomes can be hard to predict.
For example, there are thought to have been nine flu pandemics between 1729 and 1968. A 2007 article from the University of Minnesota’s Centre for Infectious Disease Research and Policy (CIDRAP) said that, while the 1918-19 pandemic cost 50 million to 100 million lives, 1 million people died in the 1968 outbreak.
There is also the risk that diseases can transmute so they cross the barriers between species, but preparing for such risks is difficult.
CIDRAP noted: “H5N1 [bird flu] has been around at least since 1997 without becoming capable of efficient human-to-human transmission.
“Does that mean that it probably won’t? We don’t know.”
It went on: “H5N1 has proved incredibly deadly to both poultry (millions) and people (scores). Does that mean that if it becomes capable of efficient human-to-human transmission, the pandemic it launches will be a severe one? We don’t know that either.”
Others, including health philanthropists Bill and Melinda Gates, have raised the spectre that diseases that have been turned into weapons could pose one of the biggest risks to humanity.
And, like in the movies, our global interconnectedness could provide one of the reasons for our downfall. Melinda Gates said in an interview: “A bioterrorist event could spread so quickly, and we are so unprepared for it.
“Think of the number of people who leave New York city every day and go all over the world – we’re an interconnected world.”
The G20 did not reveal the outcome of the health ministers’ pandemic preparedness exercise last year.
But there is a very real danger that when they meet in future, it may not be a rehearsal.