The plague started in Indonesia. A viral infection, it spread quietly at first, making its way from person to person with coughing and sneezing its only symptoms. Then someone infected with the virus got on a plane.
As the disease spread around the globe, fever gave way to sweating, nausea, vomiting. Hundreds infected turned to thousands. The virus developed drug resistance. Thousands became millions.
It was all part of Ian Lipkin’s plan.
The Columbia University virus hunter wasn’t using his decades of experience researching infectious disease for evil. He was playing Plague Inc., a game for iPhone, iPad and Android. With more than 15 million downloads since its release last year, Plague Inc. has captured the attention of gamers and public health officials alike. The latter see it as a tool for raising awareness of the real-world risk of pandemics at a time when public funding for medical research is under pressure.
“Right now there’s a dire funding crunch for science in the United States,” Lipkin said in an interview at his New York office. The director of Columbia’s Center for Infection and Immunity, Lipkin consulted on the 2011 film “Contagion,” and gets credit for its terrifying verisimilitude by basing the bug on a real virus. “Games like this reach people who don’t think about the importance of science.”
Plague Inc., which costs 99 cents to download, has made its 26-year-old creator, James Vaughan, a millionaire many times over. The idea of the game is to build a bug and exploit countries’ vulnerabilities -- climate, population density, poverty -- to help it spread. The objective is to wipe out humanity before it can find a cure.
Vaughan isn’t an epidemiologist, and he didn’t build the game with education in mind. While a strategy consultant for Accenture Plc in London, he was looking for a creative project to do after work. He spent less than $5,000 working on the game over the course of a year, collaborating with contractors to do the programming, art and sound.
The game’s popularity and realism soon caught the attention of the U.S. Centers for Disease Control and Prevention. In March, the CDC invited Vaughan to speak to its researchers in Atlanta and agreed to appear in the game in the form of news releases and mock alerts. For example, as the disease spreads, a text-like bubble may pop up saying the CDC has identified patient zero, the first identified case of a disease in humans.
“We think everyone can learn from this,” Dave Daigle, a CDC spokesman, said in a telephone interview. “Public health is one of those things very few of us know about unless something goes wrong.”
The agency has had earlier successes reaching younger people via social media. It built its own game app this year for Apple Inc.’s iPad, called Solve the Outbreak, where “disease detectives” win by finding the cause of infections based on real events. In 2011, the CDC posted to its Public Health Matters blog a tongue-in-cheek primer on how to cope in the event of a zombie apocalypse.
Kids bored by the idea of preparing for a hurricane or tornado were happy to remind their parents to stock up on water, food, medicine and other supplies to survive an onslaught of the undead.
Plague Inc. has the same appeal.
“I get e-mails and tweets and Facebook messages from people teaching 11-year-olds all the way up to people doing Ph.D.s in infectious disease,” creator Vaughan said by phone from London. “Parents are sending me messages saying, ‘Little Timmy was just asking where Bolivia is and he wants to know what climate it’s got. He’s never shown any interest in geography before.’”
Plague Inc. touches on a real-world potential disaster: antibiotic resistance. Poor sanitation, overcrowding, globalization and misuse of antimicrobial medicines have contributed to resistance to available drugs, according to the World Health Organization.
Each year, almost 2 million people in the U.S. develop hospital-acquired infections, leading to 99,000 deaths, most of which are because of antibiotic-resistant bugs, according to the Infectious Diseases Society of America. Simultaneously, funding for medical research is facing cutbacks. The U.S. National Institutes of Health was required to cut 5 percent, or $1.55 billion, from its fiscal 2013 operating budget because of across-the-board spending reductions known as sequestration.
While a 99-cent iPhone app won’t solve those real-life concerns, it can help illustrate people’s vulnerability to infectious disease, especially important in a time of decreased science funding, Lipkin said.
About 30 minutes after Lipkin placed his virus in Indonesia, it had killed 6.75 billion people. Still, he hadn’t won. The virus fizzled out before it could reach the last few thousand surviving citizens of the planet -- the disease failed to reach Greenland. Game over.