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May 11, 2023, marked the end of the federal COVID-19 Public Health Emergency. COVID-19 resulted in the death of almost seven million people. After such an ordeal, it is normal to feel a sense of relief, the need to relax. Some are afforded this luxury but not so for those who must prepare us for the next pandemic. A pandemic of the same, or greater, magnitude is not statistically expected for some time. Yet, it is a fact that the next pandemic can occur at any time. Thus, we must be ever vigilant and in a state of constant preparation. The benefits of such preparation will be greatly enhanced if the most likely type and magnitude of the next pandemic can be anticipated. The author believes that there are signs pointing to this source.

In pandemic preparation the worst-case scenario employed by many planners is based on the 1918 Spanish influenza. The highest mortality estimates indicate that the pandemic resulted in the death of between 50 and 100 million people. It is difficult to imagine a more intense pandemic. Yet we must. While the 1918 pandemic was the most intense we have experienced, it is certainly not the most intense that we can experience.

“Disease X” is a placeholder name which represents a hypothetical pathogen that the World Health Organization lists as a priority disease on its R&D Blueprint which is a global strategy and preparedness plan. The author believes that it is both naïve and dangerous to employ the 1918 pandemic as a worst-case scenario. It is necessary to think beyond this level. Granted when one does so one is venturing into hypothetical territory. Yet, this must be done to even have a chance at adequately preparing for the next pandemic. This article proposes avian influenza as Disease X. The virus is known but is not currently transmissible between humans. If this becomes possible (and nature is working to make this a reality) the estimated death toll can be expected to exceed a world-changing 1.3 billion.

While this article looks at avian influenza as Disease X it also recommends the preparations necessary to be made for the global society to even hope to survive it.