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Eighteen years ago today, as White House physicians looked on, George W. Bush pulled up the sleeve of his shirt so an immunization technician from Walter Reed Army Medical Center could administer an injection in the president's left arm.

At his own direction, Bush was being inoculated against smallpox, a dreaded scourge that over the previous two millennia had killed tens of millions of people. In one sense, Bush was doing what a good commander-in-chief should do: lead from the front. The previous week, he had announced that the Pentagon would administer the smallpox vaccine to 500,000 military personnel in "high-risk" areas, and that it would be made available to willing front-line health care workers.

But why? The answer was a confluence of George W. Bush's martial foreign policy in the wake of 9/11and his personal obsession with pandemics.

In several specific ways, the approaches of George W. Bush and Donald J. Trump to the threat of a global pandemic are polar opposites. Bush's mind tended to run to worst-case scenarios. Trump's impulse, as he explained to Bob Woodward, is to downplay the danger so as not to "panic" the people (or the financial markets). Trump's instincts are those of a glib salesman and someone who is willfully unaware of the past. Bush, the more empathetic of the two, is mindful -- perhaps too much so -- of frightening historic precedents.

At the time Bush received that injection to forestall an ancient disease, a meticulous journalist and ex-football coach named John M. Barry was working on an epic book about the 1918 influenza pandemic. As governor of Texas, Bush had read Barry's 1997 book about the devastating 1927 Mississippi River flood. I know this because Bush and I discussed that book briefly -- I covered the Bush White House -- and the president mentioned Barry's influenza book to me even before it was published.

By then, Bush was a wartime president who had launched preparations for a military invasion of Iraq partly on the grounds that Saddam Hussein's regime possessed "weapons of mass destruction," including biological weapons. When Bush was immunized against smallpox, the Department of Health and Human Services estimated that the vaccine could prove lethal to one or two out of every 1 million people who received it. To many people, this certainly seemed an acceptable risk against a contagion with a documented history going back 2,000 years of killing one out of three people who contracted it -- and which was especially deadly to children,

But why a mass inoculation campaign against a virus that had been eradicated from this planet in 1979? The reasons were global politics and public perceptions, two inevitable factors in human beings' responses to deadly disease -- as has been the case in 2020. As Secretary of State Colin Powell would tell the United Nations later that winter, the U.S. had discovered evidence that Saddam had been researching and stockpiling biological weapons. Smallpox wasn't specifically detected, but with a U.S. military invasion of Iraq looming, the president described the mass inoculations of those on the front lines as a practical precaution.

"It is prudent to prepare for the possibility that terrorists who would kill, who kill indiscriminately, would use diseases as a weapon," he said. "Men and women who could be on the front lines of a biological attack must be protected."

Carl M. Cannon is the Washington bureau chief for RealClearPolitics. Reach him on Twitter @CarlCannon.

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