The illusion of illness can be just as destructive as the real thing
Among the many ways experts warn AI could bring about humanity’s downfall, one scenario reads like a comic book plot: a rogue actor using advanced biology tools—supercharged by AI—to engineer a deadly pathogen capable of wiping out billions in months.
While I share deep concern about the long-term risks of AI and synthetic biology being used to create novel pathogens, my years spent tracking and controlling real-world outbreaks have led me to a more urgent fear: a rogue actor using current AI tools not to launch a real attack, but to simulate one—triggering mass panic, destabilizing governments, and wreaking global havoc without ever releasing a single germ.
It’s not the futuristic nightmare that worries me most—it's the threat hiding in plain sight. Today’s AI tools could already enable someone to fake a bioterror attack, sparking panic, collapsing systems, and destabilizing entire regions—all without releasing a single pathogen. Of all the alarming ways experts warn AI could threaten humanity, one stands out for its sci-fi flair: a rogue actor using AI and modern biotech to engineer a killer pathogen capable of wiping out a billion people within months.
Throughout history, false claims about disease have fueled fear, violence, and tragedy. During the Black Death in the mid-1300s, European Catholics accused Jewish communities of deliberately poisoning wells to spread the plague. On the Spanish peninsula, these baseless accusations intensified anti-Semitic violence, forcing many Jews to convert, flee, or face persecution—culminating in their official expulsion in 1492.
Centuries later, in 1983, the Soviet Union launched a disinformation campaign claiming the U.S. military had engineered HIV as a bioweapon. This conspiracy theory spread through media and scientific channels, ultimately delaying HIV awareness and prevention in South Africa—contributing to millions of avoidable infections and over 300,000 preventable deaths.
During the height of the COVID-19 pandemic in the United States, conspiracy theories didn’t just circulate—they went mainstream. Politicians, health professionals, and media figures accused “Big Virology” of misleading the public about the virus’s origins, risks, and how to respond. Misinformation blurred the lines between science and politics, and belief that the vaccine was more dangerous than the virus itself often followed political lines—fueling vaccine hesitancy and resulting in countless preventable deaths.
In the past, words alone were enough to spread fear, ignite violence, and cost lives. But what happens when those words are reinforced by images, audio, and video—so convincing they’re nearly indistinguishable from reality? That’s the chilling new frontier AI has opened. Today, anyone with internet access can use free AI tools to create hyper-realistic “deepfakes” that deceive the senses, not just the mind. The danger isn’t just whether you believe a conspiracy—it’s whether you’ll start to doubt what your own eyes and ears are telling you.
Here’s a nightmare scenario that keeps me up at night: two nuclear powers accusing each other of bioterrorism.
Imagine it’s July 2025. WhatsApp group chats across India begin circulating disturbing videos. Patients writhe in agony on hospital cots, their bodies marked by a horrific rash resembling smallpox. The footage claims these scenes come from a remote clinic along the contested Line of Actual Control—the volatile border zone in the Himalayas where India and China regularly clash. Panic spreads. People demand answers. Tensions skyrocket. But what if none of it is real?
Then the videos go global. They flood platforms like X, Instagram, YouTube, Facebook, and TikTok—now accompanied by new “leaked” images showing makeshift isolation wards set up outside a rural hospital in India. The content is shared by multiple sources at once, including politicians and social media influencers, creating the illusion of independent confirmation and urgency.
Soon, audio recordings begin to surface—voices of frantic healthcare workers speaking in local dialects, the sounds of a chaotic hospital in the background. They plead for help, saying the hospital is overwhelmed with patients showing fever and rashes, and that they themselves are unprotected and unvaccinated against smallpox.
Then come the clips of local government officials in an emergency meeting. They're caught on camera discussing a possible outbreak of smallpox—a disease thought to be eradicated decades ago—and floating the need for lockdowns and military intervention near the tense, disputed border with China. The panic is no longer local—it’s political, and it’s international.
In reality, the entire panic is built on a lie. The audio, images, and videos were all expertly fabricated by an extremist group using easily accessible AI tools—and amplified by social media algorithms designed to reward shock and urgency.
But the truth is drowned out. A handful of experts raise red flags, suspecting the content is fake, but their warnings are lost in the noise. The narrative has already taken hold.
The Indian military, treating the supposed outbreak as a serious biological threat, begins mobilizing troops to the volatile Line of Actual Control. Tensions mount as local Indian officials demand immediate access to Chinese medical facilities—convinced they’re dealing with a cross-border health crisis. The world stands on edge, reacting not to reality, but to a perfectly manufactured illusion.
China refuses the inspection request, citing a violation of its sovereignty. Instead, it escalates—deploying military forces under the pretense of “medical quarantine enforcement.” The response becomes militarized, but the threat remains entirely fictional.
State media in both countries begin pointing fingers. Chinese outlets dub the illness “the India virus,” claiming it originated in Indian labs with ties to U.S. researchers. Indian news, in turn, accuses China of unleashing the outbreak—calling it “another COVID-style cover-up.”
Military leaders from both sides call for “preventive action” to avoid further bioterror threats. Politicians and media figures even float the unthinkable: that a smallpox attack could warrant a nuclear response. The world teeters on the edge, spurred by convincing lies spun from pixels and code.
So where are the public health authorities in all of this? Ideally, they’d be the voice of reason. The first step in any outbreak response—something every field epidemiologist learns—is to confirm whether an outbreak is even happening. That means deploying trained teams to the scene, examining patients, checking records, and testing biological samples in certified labs.
But verification isn’t always easy, even in the best of times. Take what happened in the Democratic Republic of Congo in December 2024. Global headlines warned of a mysterious “Disease X” outbreak. Experts sounded alarms. And yet it took over two weeks to uncover the truth: there was no new pathogen. Careful lab work and data review revealed that the deaths—primarily among women and children—were due to malaria and malnutrition. Routine diseases, tragically overlooked.
In a world where panic can spread faster than pathogens—and deepfakes can be mistaken for diagnosis—verifying reality is no longer just a medical task. It’s a geopolitical necessity.
Imagine if “Disease X” suddenly erupted in a region already teetering on the edge of conflict between two nuclear-armed rivals. From my experience handling anthrax scares in New York City—the infamous “white powder incidents”—I know firsthand how a health crisis can quickly spiral into a high-stakes national security nightmare.
Who takes charge when an outbreak blurs the lines between public health and military intelligence? Will health officials lead the investigation, or will they fall under the shadow of armed forces and spies? Who controls the critical evidence—collecting samples, maintaining their chain of custody, and running the tests that could determine the fate of millions? What level of proof separates a routine illness from a deliberate biological attack?
In the tense scenario I fear, health experts might rely on visible symptoms and initial lab results to rule out smallpox, but security agencies will demand far more stringent evidence—paralyzed by the risk that any mistake could be exploited as weakness.
Which nation will be the first to admit it was fooled? And will a skeptical public, already fueled by anger and mistrust, even believe that the threat was false? Could military leaders seize this chaos as a pretext to escalate a volatile border conflict?
This is more than a health crisis—it’s a powder keg of suspicion, fear, and power struggles with consequences that could ripple across the globe.
While the WHO and numerous health agencies have ramped up efforts to prepare for accidental or deliberate biological attacks, a more immediate and insidious threat is emerging: AI-fabricated outbreaks. Even if such a scenario unfolds in a relatively calm region, it could still cripple health systems, shatter public trust, and ignite social unrest.
We urgently need health and security agencies to elevate awareness of this hidden danger. Just as they conduct drills for suspected bioterrorism, they must now practice verifying whether audio and video reports are genuine—and agree on the standards of evidence required to make that call. But these exercises can’t happen in a vacuum. They must involve close collaboration with leading technology and media companies to build robust, adaptive protocols for detecting and verifying deepfakes tied to infectious disease threats.
Equally important is engaging the public through widespread media conversations, so everyone understands the risks and complexities. Governments also need clear policies that empower health and security officials to openly acknowledge mistakes if an outbreak turns out to be a deepfake—because transparency will be key to maintaining trust in a world where seeing is no longer believing.
Public health officials must be equipped with cutting-edge training and technology to verify the authenticity of media, while governments at every level should enact laws that hold creators and distributors of deepfakes accountable.
As we navigate two transformative scientific revolutions—AI and synthetic biology—the urgent lesson is clear: we must strengthen and invest in the foundations of public health. This means training and expanding the workforce of skilled epidemiologists capable of swiftly investigating suspicious events, boosting lab capacity in low- and middle-income healthcare settings to accurately test for infectious diseases, and ensuring public health systems have the resources to collect, transport, and analyze specimens—whether the threat is natural, accidental, deliberate, or digitally fabricated.
The existential risks posed by AI are undeniable. Yet right now, it’s the danger of “fake” outbreaks that feels most immediate—and demands our urgent attention.
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