AABB2025: Preparing for “Disease X”

In the long shadow cast by SARS-CoV-2, blood banks and transfusion services are facing a challenge: how do we protect the blood supply from potential emerging infectious diseases while maintaining adequate inventory levels to meet patient needs? 

In Sunday’s educational session, “Planning for Disease X: To Ensure a Safe and Sufficient Blood Supply during the Next Emerging Pathogen Event,” Evan M. Bloch, MBChB, MS, from Johns Hopkins University School of Medicine; Jed B. Gorlin, MD, MBA, from New York Blood Center Enterprises; and Steven Drews, PhD, FCCM, D(ABMM), from Canadian Blood Services, highlighted the critical balance between blood safety and sufficiency, drawing lessons from past outbreaks that transformed transfusion medicine. The HIV crisis of the 1980s serves as a stark reminder of what can go wrong, while the arrival of West Nile virus (WNV) in 1999 illustrates what can go right.  

The response to WNV demonstrated that rapid action is possible. Less than a year after recognizing the virus could be transmitted through blood transfusions, nucleic acid testing was implemented nationwide.  

When the first case of locally acquired Zika virus occurred in the continental United States in 2016, it sparked debate about the costs and benefits of aggressive screening. The U.S. was the only country to implement universal donor testing, despite no documented clinical cases of transfusion-transmitted Zika. The price tag is steep: $137 million annually in screening costs. 

While COVID-19 proved not to be transmissible through blood transfusion, the pandemic still led to significant issues with blood supplies. Collections dropped as public fear kept donors at home and blood drives were cancelled. The crisis exposed dangerous vulnerabilities in the system, particularly blood centers’ heavy reliance on high school and college blood drives that were impossible while schools functioned remotely. 

Hurricanes in Puerto Rico revealed another critical weakness: the island is a major manufacturer and exporter of blood bags. When natural disasters strike manufacturing centers, the entire national blood supply becomes vulnerable. 

Experts are now focused on preparing for “Disease X,” the name given to the next unknown pathogen that could threaten blood safety. New approaches include: 

• Horizon scanning: Using artificial intelligence and machine learning to detect early warning signals of emerging threats. 

• Agnostic detection methods for emerging/re-emerging pathogens: Developing tests that can identify unknown pathogens. 

• Regional coordination: Improving communication and blood sharing between centers during crises. 

While the blood supply is extraordinarily safe in developed countries, it remains vulnerable to disruption from emerging pathogens and natural disasters. Success requires constant vigilance, rapid response capabilities and planning before a crisis hits. The key is building relationships, protocols and backup systems before the next emerging pathogen strikes.