Gates Package — page 1067

*** So far in this book, I've stuck to writing about naturally occurring pathogens. But there is another, even more unsettling scenario that disease exercises must account for, a pathogen that's intentionally deployed with the goal of killing or maiming huge numbers of people: bioterrorism. The history of turning viruses and bacteria into weapons stretches back for centuries. In 1155, Frederick I, the Holy Roman Emperor, lay siege to the town of Tortona (in modern-day Italy) and is said to have poisoned the local water wells with dead human bodies. More recently, in the eighteenth century, British soldiers distributed blankets used by smallpox patients to Native Americans. In the 1990s, members of the Aum Shinrikyo cult released sarin gas in the Tokyo subway, killing thirteen people, and reportedly released botulinum toxin and anthrax four times without causing any casualties. And in 2001, a series of attacks using anthrax sent through the U.S. mail left five people dead. Today the natural pathogen that would make the most fearsome weapon is surely smallpox. It's the only human disease that has ever been eradicated from the wild, though samples are still kept in government labs in the United States and Russia (and possibly in other countries too). What makes smallpox especially scary is that it spreads fast and has an extremely high mortality rate--killing around one third of everyone who's infected--it spreads very easily through the air, and because most vaccination programs stopped when it was eradicated in 1980, almost no one is immune to it anymore. (The United States does have a stockpile of smallpox vaccines large enough to protect everyone in the country, but as we've seen with COVID vaccines, distributing the doses would not be a simple matter--especially when people are panicking about an attack--and it's unclear how the rest of the world could be protected.)