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Two years ago, in a world reeling from the COVID-19 pandemic, an ambitious goal: to prepare the world to respond to and contain future pandemic threats within 100 days. We described this 100 Days Mission as a “moonshot” – a stretching but feasible plan to help humanity get ahead of the next potential pandemic.  

Since that time, there have been multiple sporadic and persistent human outbreaks of deadly viral infectious diseases in countries all across the world. And that’s not including COVID-19. With ever more frequent extreme weather events and ever present environmental and climate change, the risk of new epidemics and potential pandemics has never been higher.   

Some of the recent pathogenic outbreaks are caused by old foes, re-emerging. Others are new, dangerous mutations of previously known culprits.  

In Uganda in late 2022, there was an outbreak of Sudan Ebolavirus—a viral relative of the Zaire Ebolavirus strain that devasted parts of West Africa in 2014-16. In South America, a large outbreak of Dengue fever continues to spread, particularly in Brazil where more than so far this year.  Also in South America—in Brazil, Paraguay, Argentina and Bolivia—as well as in several countries in Asia, epidemics of Chikungunya have been raging for months, causing hundreds of thousands of cases and hundreds of deaths.  

A deadly outbreak of Mpox, a viral relative of the fearsome but now eradicated Smallpox virus, is spreading in the Democratic Republic of Congo where it is increasingly threatening the lives of children and young adults. Nigeria and some of its close neighbours in West Africa are suffering larger and more persistent outbreaks of the rat-borne Lassa fever. In Bangladesh and India, the deadly brain-invading virus Nipah has infected scores of people in sporadic attacks. And in the United States, there’s now a worrying situation with an outbreak of highly pathogenic H5N1 bird flu among cattle and poultry that has already sparked at least 11 human cases of spillover infection.  

“Given the warning signals that these multiple viral disease outbreaks are sending us, it’s clear that the urgency of the 100 Days Mission cannot be overstated,” says �䷡�ʱ�’s Chief Executive Officer Dr Richard Hatchett.  

The 100 Days Mission is a plan that would see the world equipped to be able to deliver medical countermeasures against any potential viral pandemic threat, be it a re-emerging known pathogen or a novel Disease X, within a little over three months. 

So, how close is the world to being mission ready? 

The good news is that the global community now has a vision for how to get ahead of future disease outbreaks by shortening the period between the viral sequencing of a new pathogenic threat and the emergency authorisation of vaccines to just over three months. And it is uniting behind it.  

In September 2023, United Nations Member States approved a declaration calling for concerted action on pandemic preparedness at the UN General Assembly. At COP28, more than 140 countries backed a Declaration on Climate and Health that linked human, animal, environment and climate health and called for intensification of efforts to detect zoonotic spillovers. The 100 Days Mission has been embraced by both the G7 and G20 groups of nations and taken up in specific pandemic planning policies by several national governments, including those of Japan, Korea, the United States and the United Kingdom.  

Importantly, those many political leaders who have endorsed the 100 Day Mission have done so fully recognising that this is not just a scientific challenge, but also a test of global leadership, political resolve and scientific and strategic cooperation.

As ����VR��Ƶ emphasised when it launched the 100 Days Mission, global pandemic preparedness is not a single, simple step. Nor is it something that any one country, organisation or institution can achieve alone. It is a series of incremental gains – broadening, expanding, honing, training, accelerating, refining and sharpening the world’s collective abilities to spot, respond to and ultimately neutralise incipient infectious disease pandemics—coupled with a paradigm shift in the world’s pandemic preparedness and response system.  

But two years on from �䷡�ʱ�’s rallying call for the world to join together on this mission, it’s fair to ask: if there were to be a novel or re-emerging Disease X outbreak now, is the global health security ecosystem closer to being ready and able to respond effectively within just 100 days?

The answer is that it depends. 
 

At ����VR��Ƶ, the focus is on driving forward the most extensive research and the most prolific and strategic innovation before a pandemic emerges. By accelerating future solutions in advance for medical defence development against these threatening viral families, there’s no doubt we’re coming ever closer to being able to develop potentially pandemic-busting vaccines in 100 days. 

“How close we are, and how close we could be, depends on several factors—including the precise nature of the next Disease X pandemic threat, what infectious disease specialists already know about it, and whether the scientific community has already developed and approved safe and effective vaccines for a related virus,” says Hatchett. 

If that threat were to emerge in the guise of another novel Coronavirus, for example, confidence is now greater that the world’s scientific community could develop new vaccines in record time following the game-changing advances in vaccinology made during the recent pandemic.  

If it were a novel Poxvirus—a further mutation or new strain of Mpox for example—the world could equally be more confident of being able to respond more effectively because of the viral and vaccine knowledge scientists harnessed to eradicate Smallpox in the 1980s and have built on with Mpox in recent years.  

If it were a novel Paramyxovirus—a viral relative of Nipah or a mutant strain of Hendra—confidence levels at this stage would be lower, mainly because we still have much to learn about this very large, complex and genetically diverse viral family and about how to develop effective medical countermeasures against it. 

�䷡�ʱ�’s published in late 2022, outlined several critical areas where progress was needed to make delivery of pandemic vaccines within 100 days a reality. 
 
Beyond starting to build a library of knowledge, data and technical know-how on developing rapid-response vaccines against pathogens from the viral families with greatest pandemic potential, the report also identified the need for global networks for clinical trials and laboratory work, enhanced disease surveillance and expanded, diversified manufacturing capabilities.  

On these fronts too, the global health security system is gaining strength and advancing towards being 100 Days Mission-ready. 

The World Health Organization Hub for Pandemic and Epidemic Intelligence, set up in late 2021, is working across countries and regions to enhance the world’s ability to detect new events with pandemic potential and to monitor disease control measures on a real-time basis. Working on the basis that the scientific expertise needed to detect novel and re-emerging disease outbreaks are most useful in the hands of people most directly affected by them, it has developed a framework for collaborative surveillance, established a new International Pathogen Surveillance Network to build vital data-sharing platforms and is exploring new ways of connecting and translating information from multiple diverse sources.  

Joining forces with U.S. researchers using AI to help scan for and spot the next potential Disease X threat, ����VR��Ƶ is supporting the expansion of “SpillOver”, a viral ranking app that directly compares the risks posed by animal and human viruses. The database ranks hundreds of virus, host, climate and environmental risk factors to identify viruses with the highest risk of zoonotic spillover from wildlife to people and to highlight those most likely to spread and cause human outbreaks.  

This enhanced surveillance approach also aligns with work by the World Health Organization, which is updating its list of priority pathogens to pinpoint representative viruses within the most dangerous viral families for more urgent and targeted scientific attention.  

Such new disease surveillance and defence initiatives are already putting us a few steps further along the way to knowing where and when the next Disease X might emerge, what it might look like, and the severity of disease it may be able to inflict on us. 

In laboratory and manufacturing diversity, things are also moving—or rather spreading—nicely. The World Health Organization has set up its first mRNA technology transfer hub in Cape Town, South Africa with the goal of building capacity and capability in Global South countries to produce mRNA vaccines. In late 2023, in a first for Africa, a new commercial-scale mRNA vaccine-making facility was inaugurated in Rwanda.  

Having the capability to produce safe and effective new vaccines against an emerging disease across many countries and all regions—particularly less wealthy ones—will be vital to enabling swift and equitable access to those vaccines. It will also accelerate the pace of any global response, getting vaccines and other medical countermeasures first to those people who are most vulnerable, regardless of wealth—the ultimate aim of the 100 Days Mission. 

����VR��Ƶ too is establishing a global manufacturing network, with partners already on board in South Africa, India and Indonesia, to help shore-up this capability.