On 26th March 2020, the first COVID-19 lockdown came into effect in the UK. It was the first-time in modern history that every person, no matter where they were, felt the harm that a global health threat can have. However, this harm was not felt equally. The pandemic led to 7 million deaths, ushered by the unequal and unjust global response that saw the Global South starved of essential vaccines, tests and treatments. 

Now, on the fourth anniversary of the first lockdown, there are many lessons still to be learnt. As the UK COVID-19 inquiry reflects on those lessons locally, the same lessons and more are needed for the global response to COVID-19 before the next pandemic – known as Disease X – appears. One of the most important of these is that we must be ready to respond more rapidly and equitably with vaccines, tests and treatments, especially for low- and middle-income countries. One of the ways to do this is through an initiative called the ‘100 Days Mission’.

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Colourised scanning electron micrograph of a single filamentous Ebola virus particle (colourised red). Credit: NIAI

Disease X

Contrary to what a conspiracy theorist will tell you, Disease X is not a nefarious human-made disease. It is instead the catch-all code name used by the World Health Organization and given to the currently unknown next disease-causing virus, bacteria or microorganism that could have epidemic or pandemic potential. The focus on having a plan for the next pandemic-potential disease is essential because the probability of an outbreak similar to the scale of COVID-19 appearing is estimated as being between 47% and 57% within the next 25 years. This is due to increased interaction between humans, wild and domesticated animals and the environment.

Manufacturing of the Oxford-AstraZeneca COVID-19 vaccine “Covishield” at Serum Institute of India (SII). Credit: Gavi/2020.

100 Days Mission

As for the 100 Days Mission, it is not the next title for a Tom Cruise Mission Impossible movie. Instead, it is a global initiative for Pandemic Preparedness, Prevention and Response (PPPR, for short) that aims to have a safe and effective vaccine, tests and treatments for Disease X within 100 days of an outbreak (unlike in the case of COVID-19, which took 300 days). If the COVID-19 vaccine had been developed within this proposed timeline, millions of lives could have been saved and trillions of dollars of economic damage averted. Achieving the 100 Days Mission could make this prospect a reality for Disease X.

The mission has been championed by different G7 and G20 leaders across the UK, India and Japan since 2021. Yet are we any closer in 2024 to the mission being complete? To help assess this, a report on the progress towards the 100 Day Mission has been published by the International Pandemic Preparedness Secretariat (IPPS) – an independent time-limited organisation dedicated to bringing together governments, industry and global health institutions to catalyse efforts towards the 100 Days Mission. Its 2023 report provides a stock-take on the progress the world has made towards achieving the 100 Days Mission, including what problems it faces and what opportunities there are to solve them. Some standout messaging includes:

  • Only the Coronaviruses and Ebola disease groups have a full complement of approved vaccines, tests and treatments, and even though they have been developed, they are not available to the countries that need them. The funding for these measures are also heavily reliant on the US Government when they should be funded from multiple sources so they are more secure.
  • Among the other disease groups, such as Zika virus and Lassa Fever, funding is lacking, and what does exist is generally focused on the development of vaccine candidates. This means that both funding and coordination of the development of tests and treatments for these other disease groups are being neglected. Therefore the world is underprepared for an outbreak of most of the disease groups that are currently of pandemic potential as identified by the World Health Organization.
  • There needs to be better alignment from country to country on the testing and clinical trials of vaccines, tests and treatments for more efficient and streamlined approval processes.
100 Days Blog
Researchers in the Department of Infectious Disease at Imperial College London. Credit: Thomas Angus/Imperial College London

Though much of the report is on technical progress, the 100 Days Mission does not exist in a vacuum, but against a backdrop of economic strife, geo-political tension and disinformation. Four years on from the start of the UK-wide lockdown, the experience of COVID-19 has seared itself into the national psyche. Because of this, the public and politicians are exhibiting ‘pandemic fatigue’, a state of exhaustion and avoidance that sets in when trying to address the matter of a future pandemic. 

Instead, we must face up to the failures of dealing with COVID-19 so that in the future we can equitably respond to a global threat with effective vaccines, tests and treatments within 100 days of the appearance of Disease X. That is why having informed policy-makers who support investment in initiatives like this is essential. It is why advocates, grassroots campaigners and civil society must continue to make the case about the value of Pandemic Preparedness, Prevention and Response and the 100 Days Mission. On this fourth anniversary as the UK reflects on its own experience of a pandemic, the world should reflect on the fact that it is not ready for Disease X and what this means for the most vulnerable. The 100 Days Mission is one that the world cannot afford to fail.