Dark Winter and the spring of 1972: deflecting the social lessons of smallpox.

This article examines how the master status of bioterrorism has distracted professional and political attention from the social lessons of smallpox. I illustrate this by comparing an influential bioterrorism simulation known as Dark Winter with the social history surrounding the Yugoslavian smallpox epidemic of 1972. Dark Winter's epidemiological premises were largely based upon what was learned from the Yugoslavian outbreak. Yet, although this epidemic was non-deliberate, the exercise did not attend to the social conditions within which it developed. Most notably, it did not consider that this epidemic was mainly borne by marginalized communities of Kosovan Albanians and that difficulties in controlling it were linked to the relative lack of pre-existing public health infrastructure among these people; instead, the Dark Winter exercise mainly focused upon the proximate determinants of violence and its immediate management. This distraction from the social dynamics of infectious diseases has major implications for the prevention and management of future outbreaks, regardless of whether or not they are deliberately initiated.