This gripping narrative traces the history of the efforts to eradicate smallpox in the 1970s, the top-level decisions to keep a few vials of it for emergency purposes in American and Soviet freezers, and the reemergence of smallpox not only as a health threat, but as a potential bioweapon of unequaled destructive power. Preston details maverick natural cases that surfaced after worldwide eradication efforts, how it was discovered that undocumented reserves of smallpox were not only being kept, but researched and possibly "weaponized," and how hotly, in the US, teams of scientists and military intelligence personnel debated funding new smallpox research in the US with a view to developing a new vaccine as a defense.

The ethical issues in those debates are unprecedented in the scope of the possible public health threat and the variables that might make traditional vaccination ineffective against the weaponized virus. As in his previous books on biological threats, The Hot Zone and The Cobra Event (see annotation), Preston follows the work and lives of several key scientists and includes scenes from interviews with a variety of persons involved in confronting the political, ethical, and medical dilemmas posed by smallpox research and efforts to track and control it.


The combination of graceful, readable, and sometimes gripping prose, a novelist's sense of character, scene and plot, and meticulous research makes even a book about a terrifying reality a great read. Preston not only trusts the intelligence of his readers, but assumes a readership that would rather be informed than kept in comfortable ignorance. One emerges from the book reminded of what it means to have an "informed citizenry" and musing not only on medical ethics, but on what kind of accountability we can and should demand from those who make immensely consequential decisions for us all.

This book makes accessible matters that many might prefer to avoid, but in such a way as to remind us that we're all in it together, and that our freedom inheres partly in consenting to be informed. Justifiably a best-seller, the book is timely and relevant to current questions about what war might look like and why waging peace may be more urgent now than ever before.


Random House

Place Published

New York



Page Count