Only a Game?

It is 9 a.m. Eastern Standard Time. You are the president of the United States, or the chancellor of Germany, or the British prime minister. You switch on the news and learn that three members of a Turkish family, recently arrived in Munich, have been diagnosed with smallpox. Across Europe, there are rumors of further outbreaks. You know that smallpox has been eradicated in nature and that its appearance can only signal a terrorist attack. You know that a few cases will quickly multiply, killing one out of three victims. What do you do?

That was the question that a group of current and former government officials had to answer last Friday in Washington, during a bioterrorism war-game exercise called Atlantic Storm. The eminently plausible scenario, which the players did not know in advance, assumed that a breakaway al Qaeda faction had obtained the smallpox virus from a bioweapons factory in Russia. In early January, using technology available on the Internet, it had released a dry-powder version of the virus on the Rotterdam and Warsaw subways, in the Istanbul bazaar, and in the Frankfurt and Los Angeles airports. By 11 a.m. on Jan. 14 there were 956 cases. By 2 p.m. there were 3,320. Within a month, there would be hundreds of thousands of cases and hundreds of thousands of deaths. As borders closed and trade ground to a halt, the global economy would collapse as well.

Of course there are limits to how much can be learned from these sorts of games, particularly when the players find it hard to shed their everyday personalities. Pretending to be the American president, Madeleine Albright, the former secretary of state, could not resist mocking her “predecessor,” at one point donning an Air Force flight jacket, despite the fact that she had not fought in Vietnam either. Pretending to be the French president, Bernard Kouchner, the flamboyant co-founder of Doctors Without Borders, could not resist lecturing the audience of journalists and experts — which he was supposed to pretend was not there — on the need to fund AIDS research.

At the same time, the fact that everyone playing the game had participated in real, high-level ministerial meetings gave the exercise a flavor of reality. In the first hour and a half, for example, the “heads of state” wasted time going around the table making little speeches. Later on, despite anti-Muslim riots in Rotterdam and mass panic at international border crossings, they argued bitterly about which multilateral institutions should do what. “Just like real life,” whispered a European diplomat sitting next to me.

But even going through the somewhat stilted motions, it was possible to see some of the consequences of a real smallpox outbreak. While the United States and a handful of other countries have enough smallpox vaccine to protect their populations, most do not. Almost immediately, Turkey — a NATO ally, a moderate Muslim country — requested that NATO declare the outbreak an “Article 5” attack on the alliance, and demanded immediate shipments of vaccine. Just as quickly, the American public objected to helping countries that didn’t help us in Iraq. “A lot of Americans are saying, ‘Why cooperate with them anyway?’ ” Albright said at one point, reacting to simulated phone calls from Congress.

It turned out that there are few international stockpiles of vaccine, and no mechanism for international distribution. It turned out that popular demand forced many governments to drop plans for targeted, limited vaccinations and move quickly to mass vaccinations, putting a further strain on resources. It turned out that despite the players’ passionate defense of the principle of open borders, Germany and Holland wound up closing theirs. In general, it turned out that the (frequently stated) multilateralism of most of the assembled officials could not be reconciled with the self-defense instincts of their voters.

This rang true, too: While a military attack on the West probably would have a unifying effect, a biological attack might prove divisive. Fighting battles requires mobilization and cooperation. Fighting epidemics requires quarantine and isolation. It’s easy to be generous and internationalist after an event such as the tsunami, when terrible things are happening somewhere else. It’s much harder when the enemy is a disease that might kill or disfigure you and your children.

The game did not, in the end, provide any answers, but it did pose a number of questions. Until now, we’ve mostly thought about homeland security preparation as a matter of buying fire engines, not fixing our rickety public health system. We’ve mostly thought about international preparation in terms of border control, not sharing vaccines. But we live in an age in which bioterrorist attacks are not science fiction, in which a smallpox epidemic is not the worst-case scenario. If the disease were one for which there was no cure and no vaccine, casualties could rival those of a nuclear war. If the real president and his real homeland security secretary are looking for a focus for the next four years, they could do worse than playing a few rounds of Atlantic Storm themselves.

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