Gates Package — page 1069

allowing the virus to go undetected while they spend years passing it to others. A pathogen that operated this way but didn't require intimate contact to spread, as HIV does, would be far worse than the AIDS pandemic. "To put it in perspective," Nathan writes, a single attack that caused 100,000 casualties "would kill more people than were killed cumulatively in all terrorist actions by all parties throughout history. It might take anywhere from 1,000 to 10,000 typical suicide bombings to equal it." It is this scale of catastrophe--the kinds of events that can kill hundreds of thousands, millions, or even billions of people--that deserves far more attention than it gets. Now, I am an optimistic person who's naturally inclined to focus on solutions. But even I have to admit that it's hard to write a list of responses that feels adequate to the threat of bioterrorism. Unlike a natural pathogen, an intentionally made disease can be designed to get around our tools of prevention.. All of the things we need to do to prepare for a deliberate attack are a super-set of the things we need to do to prepare for a natural one. Outbreak exercises can focus on attack scenarios and test our readiness. Better treatments and vaccines are important, no matter what the source of the pathogen is. Better diagnostics that return a result in thirty seconds would make it more practical to screen people at airports or public events, where we'd be likely to see the most spread of an engineered pathogen, and of course would be extremely useful for everyday testing as well. Mass-scale genomic sequencing of pathogens will help in an ordinary flu outbreak and during an attack. Even if an attack never comes, we'll be glad to have all of these tools. We also need some approaches that are specifically designed to deal with deliberate attacks. I am hopeful that we'll have devices in airports and other big gathering places that detect pathogens in the air and sewage, but the technology is still years away. The U.S. government