USU Alumnus Leads ‘Disease X’, Deadly Emerging Infections Research and Development

Health care providers adjust personal protective equipment before entering an Ebola treatment unit in Liberia. Ebola is on the WHO list of “Priority Blueprint Diseases”. (Photo Credit: U.S. Army)

By Sharon Holland

Nearly eight years ago, at the request of its members, the World Health Organization (WHO) developed a research and development plan to prevent epidemics. The WHO hoped to get well ahead of public health emergencies caused by disease outbreaks by reducing the amount of time between discovery and identification of the outbreak and the approval for vaccines or treatments. An advisory group identified a list of about 10 emerging infectious diseases – the priority blueprint diseases – that were among the most serious in the world, and for which few treatment options existed, to include in the plan. Among those on the list were Nipah virus, Marburg virus, Ebola, Lassa fever, Rift Valley fever, Chikungunya virus, Zika, SARS and MERS.

Dr. Timothy Endy
USU alumnus, Dr. Timothy Endy, is leading research and
development efforts for the CEPI 2.0 Disease X program.
The WHO classifies Disease X as "the knowledge that a
serious international epidemic could be caused by a 
pathogen currently unknown to cause human disease."
(Photo courtesy of Dr. Timothy Endy)
However, in 2018, the WHO added “Disease X” to the list. According to an announcement made by WHO at the time, "Disease X represents the knowledge that a serious international epidemic could be caused by a pathogen currently unknown to cause human disease". By adding Disease X to the list, WHO was trying to make sure that planning and capabilities could adapt to this unknown pathogen and potential outbreak. 

Enter Dr. Timothy Endy. For the past year and a half, Endy, a Uniformed Services University School of Medicine class of 1986 graduate, has led the Disease X research and development efforts for the Coalition for Epidemic Preparedness Innovations (CEPI). It’s Endy’s responsibility to develop a plan and products, in partnership with international organizations, non- governmental and governmental agencies, and WHO to execute the methods necessary to contain a newly-emerging pathogen before it becomes the next pandemic.

In a 2020 New York Times op-ed, WHO advisory group member Peter Daszak wrote, “we knew Disease X would likely result from a virus originating in animals and would emerge somewhere on the planet where economic development drives people and wildlife together. Disease X would probably be confused with other diseases early in the outbreak and would spread quickly and silently; exploiting networks of human travel and trade, it would reach multiple countries and thwart containment. Disease X would have a mortality rate higher than a seasonal flu but would spread as easily as the flu. It would shake financial markets even before it achieved pandemic status.” Daszak also said, “Pandemics are on the rise, and we need to contain the process that drives them, not just the individual diseases.” 

CEPI, a non-profit foundation headquartered in Norway, was co-founded and co-funded in 2017 by the Bill and Melinda Gates Foundation, the Wellcome Trust, and the governments of India and Norway. The European Union joined in 2019, and the United Kingdom in 2020. CEPI funds independent research projects to develop vaccines against emerging infectious diseases, and its focus is on WHO’s blueprint priority disease list. According to CEPI, recent events have demonstrated that “delivering at scale and ensuring access are as important as the raw speed needed to develop new vaccines against epidemic threats. During the response to COVID-19, unprecedented speed and scale was achieved, but access to life-saving vaccines for the poorest countries has lagged terribly.” 

Endy’s work is part of “CEPI 2.0”, a new initiative to plan and prepare for the next potential epidemic/pandemic disease. Its goal is to execute a containment plan, including a vaccine, within 100 days of detecting an outbreak.  

“Disease X signifies that we have to plan and prepare for an unknown pathogen and disease,” says Endy. “Using our knowledge and expertise we will have a very good idea on what family of viruses and those that have a zoonotic (animal virus) component increasing the threat of a new pathogen jumping from animals to humans.” 

Endy says that COVID-19 offered a “painful lesson” on how the world is unprepared to detect, plan and prepare for a pandemic that results in human deaths and economic loss.  

Priority Blueprint Diseases list: Ebola virus, Nipah Virus, Lassa fever, Rift valley fever, Marburg virus, Crimean-Congo Haemorrhagic fever, Zika virus disease, Middle East Respiratory Syndrome Coronavirus (MERS-CoV), Severe Acute Respiratory Syndrome (SARS), Chikungunya virus, Disease X
The WHO's Blueprint Priority Diseases list includes diseases that are among the world's most serious, and for which few treatment options exist. (Image credit:
Linda Culp, USU)

“The response to this pandemic was extraordinary with the new vaccines available in 300 days. But we, the scientific and public health community, have the expertise to do better and to meet our 100-day goal,” he says. “The occurrence of the next pandemic is not an ‘if’ but a ‘when’ and what the next pathogen will be. We must plan and be prepared to stop an outbreak before its global spread.” 

Endy is no stranger to emerging infectious disease research. An epidemiology major prior to medical school, he credits former USU president and dean Dr. Jay P. Sanford, an infectious disease researcher, with being a role model and stoking his interest in the field. Endy, an Army physician, later served as chief of Virology at the Armed Forces Research Institute of Medical Sciences in Bangkok, Thailand; chief of Virology at the U.S. Army Medical Research Institute of Infectious Diseases at Fort Detrick in Frederick, Md.; and director of Communicable Diseases and Immunology at the Walter Reed Army Institute of Research in Silver Spring, Md. Following retirement from the Army, Endy continued his clinical research overseas work in virology as chief of Infectious Diseases and chair of Microbiology and Immunology at the State University of New York Upstate Medical University, where he was later bestowed professor emeritus status before joining CEPI. Endy, who is extensively familiar with vaccine research and development, served on and chaired numerous scientific and safety committees for vaccine developers and institutions, and is regarded as an international key opinion leader in infectious disease medicine and immunology, particularly in the field of arboviruses (e.g. dengue, Chikungunya).

Since he began his role at CEPI in early 2021, Endy has also taken on the lead as manager for the Chikungunya vaccine program. Currently, Endy says, they are supporting two vaccines for advanced development. The Valneva vaccine is the most advanced and they are in the process of submitting a license application to the FDA this year and the European Medicines Agency next year. Endy says a CEPI-backed technology transfer to the Institute Butantan in Brazil for production of the vaccine for low- and middle-income countries will also take place next year. 

Endy reports significant steps forward in the Disease X program as well. In November, they announced a collaboration with the University of California, Davis (UC Davis) to “advance and expand the application of ‘SpillOver’, a viral ranking app that directly compares the risks posed by hundreds of animal and human viruses. The database ranks hundreds of virus, host, and environmental risk factors to identify viruses with the highest risk of zoonotic spillover from wildlife to humans and to highlight those most likely to spread and cause human outbreaks.”

This scanning electron microscope image shows SARS-CoV-2 (orange) - also known as 2019-nCoV, the virus that causes COVID-19 - isolated from a patient in the U.S.,
emerging from the surface of cells (green) cultured in the lab. (Photo credit: National Institute of Allergy and Infectious Diseases)

UC Davis researchers will also work to pioneer a new system, using artificial intelligence (AI). 

“We have a contract with UC Davis to use a machine learning environment to calculate the likelihood of a Disease X emergence for each virus family. We have two institutes near contract signing to create a computational antigen design consortium which will rapidly design vaccines for any viral disease and will support the development of a vaccine library,” Endy says. “We also have a contract in place with SK Bio to use their mRNA platform in support of the vaccine library and its preclinical and clinical development.” 

Endy says his background in military medicine and his current role have positioned him to help prepare the global community for the next potential pandemic, whatever and whenever it may be. 

“I am grateful for the outstanding education that USU imparted to me and the opportunities that military medicine provided in creating the foundation for my career in infectious disease research. I am fortunate to now be part of a great organization that has the vision, mission and expertise to address future global health needs and, in particular, in preparing and preventing the next Disease X outbreak”.