In Biological War, Jacobsen challenges assumptions about systemic resilience, arguing that the complex, interconnected networks supporting contemporary civilization remain vulnerable to disruption. The book demonstrates how a hypervirulent, engineered pathogen can rapidly overwhelm critical infrastructure. Global healthcare systems, advanced military assets, and fundamental civil services are shown struggling to respond to the scale and speed of the crisis, with failures in one system compounding pressures on others. Jacobsen thus presents the interconnectedness of modern infrastructure as a potential source of vulnerability during a large-scale biological attack.

The narrative first exposes the limits of global healthcare preparedness. Despite lessons from past pandemics, medical systems lack the surge capacity to handle a fulminant disease. The strain on healthcare systems is first illustrated in Santo Domingo, where hospitals are immediately overwhelmed and shutter their doors, leading to riots. Similar pressures emerge elsewhere, but the scenario’s most detailed depiction unfolds in Los Angeles. The city’s largest public hospital, L.A. General, is quickly contaminated and overrun, while major private hospitals lock their doors (p. 147, 278). The book emphasizes the scarcity of specialized facilities, noting that the entire western United States is served by only two high-level biocontainment beds at Cedars-Sinai, a number insufficient for the scale of the outbreak depicted in the scenario. These failures illustrate how even the healthcare infrastructure of a wealthy nation can be rapidly overwhelmed by a large-scale biological attack.

Even the most powerful and secure institutions are shown to be vulnerable to biological attack. Jacobsen illustrates this vulnerability through the U.S. military, whose technological capabilities offer limited protection against a rapidly spreading pathogen. The aircraft carrier USS Theodore Roosevelt, described as “one of the most powerful warships on the planet” (118), is rendered operationally inert after just two infected sailors come aboard. The outbreak spreads so rapidly that its commander anticipates that over half the crew will be dead or dying before it can reach port. Furthermore, the military’s CBRN (Chemical, Biological, Radiological, and Nuclear) response forces, designed for such a crisis, are constrained by mobilization times. The narrative notes that most state-level forces take about half a day to mobilize, while federal units often take one to four days to deploy, even as the pathogen produces a new generation of infections every 18 to 24 hours.

This systemic breakdown extends to the most basic functions of civil society. In Los Angeles, the 911 emergency system is crippled by overwhelming call volumes, leaving citizens with a repeating busy signal in their moment of greatest need. The limitations of public health surveillance become apparent when the CDC’s multi-billion-dollar BioSense program, the country’s “national radar” (175) for outbreaks, misses the initial explosion of cases on Skid Row because it does not monitor data from homeless clinics. This blind spot allows the plague to spread undetected for days, illustrating how gaps in surveillance coverage can undermine an otherwise sophisticated detection system. As police and fire departments are incapacitated by infection and desertion, public safety systems become increasingly unable to function. Across these examples, Jacobsen presents modern infrastructure as vulnerable to cascading failure when the speed and scale of a biological attack exceed the capacity of interconnected systems to respond.