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Abstract
Operation Dark Winter, in 2001, and Atlantic Storm, in 2005, were orchestrated by biosecurity think tanks in the United States and attended by influential leaders, such as the former head of the World Health Organization (WHO), Gro Harlem Brundtland, and Madeleine Albright, the secretary of state under former president Bill Clinton (see 'Games without frontiers'). Not long after the 2003 outbreak of severe acute respiratory syndrome (SARS) spread to more than two dozen countries, and killed 721 people in mainland China, Hong Kong and Taiwan, the 194 member states of the WHO agreed to bolster the world's defences against health threats through a set of rules called the International Health Regulations. In January 2017, the World Bank and the Bill & Melinda Gates Foundation in Seattle, Washington, backed a pandemic simulation at the World Economic Forum in Davos, Switzerland - a gathering of global leaders in business, politics and academia. In May 2018, with leaders in the White House and Congress who had never dealt with a major epidemic, Inglesby and his colleagues at Johns Hopkins University hosted an exercise in Washington DC called Clade X. It featured a respiratory virus that was engineered in a laboratory.