DRAFT - Awaiting COP Review and Approval: In addition to those death tolls associated with battles and violence, disease outbreaks often plagued wars and led to further devastation. The measles virus added 551 fatalities on the Union Army side during the first year of the Civil War alone. Additionally, smallpox outbreaks exacerbated the already grim war and health horizon during this era. During the Second World War, 1 million cases of Diphtheria were reported in Europe. The memory of such outbreaks remains strong and vivid, accelerating a mass wave of smallpox vaccinations during the anthrax attacks of 2001 and the threat of another prolonged global crisis.