Atlantic Storm was a ministerial exercise simulating the top-level response to a bioterror incident. The simulation operated on January 14, 2005 in Washington, D.C. and was created in part to reveal the current international state of preparedness and possible political and public health issues that might evolve from such a crisis. In the scenario, smallpox was released in the following major cities in a covert attack: Istanbul, Rotterdam, Warsaw, Frankfurt, New York, and Los Angeles. Cases were initially reported in Germany, Turkey, Sweden, and the Netherlands, but the pathogen was exported to other nations within hours. Specifically, the 51 cases confirmed in these four nations grew to 3,320 cases with transatlantic spread after no more than 4.5 hours. This rapid spread of disease forced