The number of emerging diseases is large. It only takes one to cause extinction.

To most people, COVID-19 appears to be an anomaly; it isn’t. The 20th century began with devastating waves of Spanish flu that killed from 50 million to 100 million people worldwide. About one new disease is emerging each year.1 Not all have human-to-human transmission, but enough do (e.g., severe acute respiratory syndrome, Middle East respiratory syndrome coronavirus, Ebola virus disease) to scare those tasked with monitoring the world’s health. To highlight the danger and to prioritize research, each year the World Health Organization (WHO) commissions an expert committee to update its list of the most threatening infectious diseases that lack effective treatments or vaccines. The current list (Table 1) contains COVID-19.3 That is no surprise, given that the entire world is now focused on that pathogen. What should act as a wake-up call to seriously fund the surveillance of, research into, and treatment of the wide variety of potential pandemic agents is the entity at the end of the short list: Disease X. Since 2015, the WHO has used this designation for a disease that could cause a pandemic due to a pathogen currently unknown to cause human illness. Last year’s Disease X now has a name, COVID-19. The next unknown and unnamed entity may already be lurking. One might ask: Why don’t we devise a plan to identify such pathogens early and mobilize scientists, the healthcare community, politicians, and the populace to fight these scourges? The answer is, we already have. We know what steps to take to limit a pandemic. WHO, the Centers for Disease Control and Prevention (CDC), and the Departments of Homeland Security and Health and Human Services have produced and disseminated detailed plans.4–7 After the SARS pandemic, for example, WHO itemized the steps needed to control a pandemic (Table 2). These vital steps were ignored during the initial period of the COVID-19 pandemic.1 WHO, chronically underfunded, is saddled with a bloated, slow, and uncoordinated bureaucracy that has to answer to 194 countries. It has been condemned for both overreacting (2009 H1N1 pandemic) and severely underreacting (2014 Ebola epidemic and the COVID-19 pandemic) and for failing to act.8–11 The CDC is chronically underfunded and has no political power. Academics are voices in the wilderness whose advice is usually sought too late in the process for it to have much effect. As the COVID-19 threat lessens, politicians will make grand promises to implement plans to stop, or at least to prepare for, the next pandemic. The recovering economy will be too weak at first to support the effort, although more funding will be promised in the future. Politicians will ultimately make changes that are politically expedient and will fail to authorize the changes necessary to produce faster, more flexible responses. The memories of angst and societal disruption during COVID-19 will recede. Our bulwarks against pandemic diseases will remain underfunded and inadequate to the task. Even so, multiple Disease Xs are clearly in our future; we need to be prepared.