pathogenesis GD Approved

Tabletop Kickstarter Alert: ‘Pathogenesis’ 2nd Edition

Gaming GeekDad Approved Kickstarter Tabletop Games

pathogenesisGerms against the human body is a battle that has raged since humanity began. On a microscopic scale, it’s a tale of resilience, persistence, and mucus. Lots and lots of mucus. With battles being fought every day, across the globe, it’s a wonder there haven’t been more board games about the classic struggle on the border between health and sickness. One such game is Pathogenesis, now back on Kickstarter, looking for funding for its second edition and a new expansion. (Coincidentally, Pathogenesis dovetails nicely with last week’s Word Wednesday post for The Atlas of Disease.)

New to Kickstarter? Check out our crowdfunding primer, and visit our Kickstarter curated page for more projects we love.

What is Pathogenesis?

In Pathogenesis, you play bacteria, looking to adapt and exploit weaknesses in the human immune system. There are several ways to play the game. Full competitive for 2-4 players, co-operative (2-4 players), solo, or with 2v2 teams. In all these variants you take the role of germs. The body is represented by three tracts that each hold a set of damage counters representing that tract’s hit points.

Pathogenesis is a deckbuilding game and it plays in a fairly typical deckbuildery way. You can use cards from your hand to purchase new cards from a central row of cards. You then gradually build up your arsenal of hideous germs and mutations to begin assaulting the human body.

What’s a little different is that the body starts fighting back. To begin with, your germs attack the barriers of entry to the body. This is fairly straightforward and easy to do without reply. Once you’ve broken the body’s first line of defense, and start to inflict some real damage, the body wises up to what you are doing and the immune system kicks in. The game then becomes an exercise in keeping your pathogens alive, making smash and grabs on your body tract objectives, hoping not to be taken out by a lurking T-Cell or a beefed up antibody.

Games last around 1-2 hours and, after the usual initial first-play hurdle is cleared, Pathogenesis is an intuitive game that teaches you about the body and its defenses as you play. This meld of education and entertainment, as well as the great look to the game, are enough for me to consider it GeekDad Approved!

Pathogenesis is GeekDad Approved!

The full rules of Pathogenesis can be found here.

Pledge levels start at $22 for the expansion set (for those who already have the base game), $44 for the base game, and $59 dollars for both the base game and the expansion. Prices include free delivery for backers in the US, Canada, and the UK. Worldwide shipping is available.

What’s in the Pathogenesis box?

NB – This description is for what comes with base game. I’ll explain what comes with the expansion later in the review.

A ‘Pathogenesis’ Starter hand.

Cards lots and lots of cards!

4 Decks of Starter Cards.

Most deckbuilders start with a starter seed deck, from which your empire is built. Use it to help your germs multiply and mutate into deadly killers.

The starter decks contain four basic pathogens, two of which can do some damage and two of which have some rudimentary defensive capabilities. There are also 10 DNA cards (of which you’ll choose six for your starter deck). These contain some low-level trickery to help your pathogens get the upgrades they need to be changed from mildly irritating to potentially lethal.

As well as having various in-game effects, the cards from your starter deck also have a genetic value. Genetic value is essentially the currency of the game. When you have cards in hand, you have the choice whether to play them in front of you, in which case they become your active pathogen (or in the case of DNA cards, trigger a specific effect), OR you can discard them and spend their genetic value. Genetic values can be combined to purchase cards from the center row(s).

44 Pathogen Cards.

One of the game’s central rows is formed of pathogens. It’s formed of seven small decks of cards, the Pathogen Supply decks. There are two for each tract of the body (the game has three body tracts, but more on those later). Each tract has a base pathogen deck and a super pathogen deck, with super pathogens costing more to purchase, but also being potentially more deadly. This row also contains another deck of fever cards. Fever cards are generally bad for you, as they do nothing when played. The final deck are the multi-point of entry super-pathogens, the best pathogens in the game that can attack any tract in the body.

The central game area where you can purchase your cards from. Pathogens above and Gene Pool below.

50 Trait, 12 Toxin, and 34 Environment Cards.

The other central row is called the Gene Pool deck. These cards are augmentations for your pathogens. Things to make them more deadly. There are five cards face up at any one time, and again these can be purchased using the Genetic Value of cards from within your hand.

The body’s barrier cards

15 Barrier Cards.

Before your germs can make their way into the human body, they have to make their way through its barriers.

76 Immune system cards.

Once the barriers are down, the immune system kicks in and the body starts fighting back. These cards can do some serious damage to your pathogens. The immune system cards come in two decks. The first deck is reasonably hostile. The second deck is brutal, as its cards signify the body’s final fight for survival.

The body tracts in the Pathogenesis game. The spaces below are for the tract Barrier cards.

Body boards and Petri dishes.

Woohoo! Surfin’ USA! No. Not those sorts of bodyboards.

The body is made up of three tracts, represented by three boards (the expansion will add a fourth)—Respiratory, Gastrointestinal, and Tissue—those places microbes love to get a foothold (or whateverhold it is that bacteria have). The tract boards hold what can be considered the finest and most appropriate game component of any game I’ve ever played: the Petri dishes.

A simple addition, but one that makes takes the game’s tactile experience up a notch. Everything feels just that little bit more clinical. All these dishes do is hold the body’s damage counters (effectively hit points), but they are an inspired addition. Once a Petri dish is empty, that tract has been defeated. Depending on which mode you are playing, this may trigger the end of the game.

Card Dividers.

Some handy (and extremely attractive) card dividers to keep the plethora of card types separate in the box.

Pathogenesis tokens
The tokens (and cards) in this game are things of beauty.


There are lots of tokens in this game too. Most of them are the aforementioned damage counters, but a few denote things such as the chemical markers the body uses to better target your filthy pathogens.

How do you play Pathogenesis?

The exact card quantities and victory conditions are dependent on which variant of the game you are playing and how many of you there are. The back of the rules has a handy setup table that tells you how many cards to use, how many immune cards you’ll be battling against, and the number of damage counters you need to deplete to clear out a body tract. Pathogenesis can be set up with differing difficulty levels and durations. Harder games will use fewer immune cards as depleting the immune deck results in an immediate loss for all players. You can also increase the number of damage tokens to allow a longer game. I have to say, the quick game is a good length of time to play. For me, at least.

I covered game setup in the component descriptions. Once all the cards have been laid out and players have their starter decks, the game is ready to play. It’s worth noting that extra currency is given to second and subsequent players to offset the advantage of playing first.

Pathogenesis is split into five phases.

1. Buy and Play cards.

This can be done in any order. You can buy cards from the active gene pool (whereupon they go into your discard pile) or play cards in front of you to either create new pathogens or enhance existing ones.

2. Preemptive attack.

This phase is invoked far fewer times than it is skipped. If you’re fortunate enough to have a pathogen that has a preemptive attack ability (gained through card enhancements), you can use it to attack the body before its defenses kick in. This type of attack can mean the difference between winning or losing, because Phase 3, the Immune Response Attack, can be brutal for your pathogens.

The brutal immune system cards. Note helper t Cells do ten damage! The cards to the right are stage two cards (marked by the spots at the bottom right of the card). Stage 2 is tougher than stage 1.

3. Immune Response Attack.

Phase 3 is skipped at the beginning of the game, but once one of the body’s barriers has been destroyed, the body fights back. This involves drawing cards from one of the two immune decks, and carrying out the text on them. Some of these cards can be very hard-hitting and can wipe out your lovingly built pathogens. Some pathogens have defensive capabilities, which may mean they survive long enough to get to phase 4.

4. Pathogens Attack the Body.

All pathogens have an attack rating (though this can be zero). This is how much damage they can do to the body. Cards played on your pathogens can boost their effectiveness.

In the first instance, your pathogens have to work their way through the barrier decks. There is a barrier deck for each tract of the body, each containing five cards. Barrier cards are drawn off the top of the decks at random and each have a defensive value. If the attacking pathogen has an attack rating equal to or greater than the barrier defense, the barrier card is overcome. Each barrier card has a genetic value. The player who destroys it, gets genetic value tokens to the same amount as the barrier card was worth. These tokens can be spent to buy cards in phase 1.

Once the first barrier is destroyed the immune system is invoked. From now on, all players will have to navigate phase 3. Any damage inflicted on a tract that has no barrier cards will come straight out of the tract’s Petri dish. In a competitive game, the tokens collected from inflicting damage count as victory points. The player at the end of the game with the most damage tokens is the winner.

5. Clean Up.

All cards used and purchased this turn go into the discard pile. As do cards used as currency. Any environment cards used this turn are discarded along with dead pathogens and any unused cards in your hand that you wish to discard.

You can then draw back up to five cards.

After stage 5 is complete play passes to the next player. Play continues until the Game End condition is met (this differs depending on which variant of the game you are playing). After which, the collected damage points are totaled. The person with the most wins. Damage points from all tracts are counted together.

The game also ends if all the Immune Response cards are used. In this case, the body wins and all players lose.

How do I build my Pathogens?

The key to winning Pathogenesis is building strong and effective Pathogens. Here’s a quick crash course in how it’s done.

There are four types of Pathogen, one for each body tract, respiratory, gastrointestinal, and tissue, and the more versatile multi-entry point pathogens, that can attack any part of the body. All types exist in two versions, Normal and Super.

Two example pathogens. The pathogen on the right is a respiratory super pathogen. These have four connecting points. The Pathogen on the left is a basic pathogen, which have two. The three body tracts have their own color associated with them. The one shown is blue, a respiratory pathogen. All upgrades played on the pathogen must be blue. The exception to this is purple upgrades, which represent multiple entry point pathogens. Purple cards may be played on any pathogen and multi-entry point pathogens may have any color played on them.

Even a non-upgraded Super-Pathogen won’t get you very far. Each pathogen you play needs to be upgraded using cards purchased from the Gene Pool. Each pathogen has a number of attachment points, with super pathogens having more places to attach upgrades (4) than normal pathogens (2). That’s why they’re “super.” As well as adding new traits to your pathogens, it is also possible to upgrade the pathogen from a normal into a super pathogen, though its type (e.g., respiratory) must stay the same.

Some upgrades allow your pathogens to more easily attack the body, others will make it harder for them to be overwhelmed by the body’s immune system.

What can you upgrade pathogens with?

There are three card types found in the Gene Pool.

Traits augment the attack and defense capabilities of your pathogens. Some traits enable you to ignore specific aspects of the immune system.

Toxins are attack cards that boost your pathogens’ ability to harm the body.

Environment Cards aren’t played directly on a pathogen but are one shot cards (such as an open wound) that gain your pathogen a temporary advantage against the body. Often they allow a preemptive strike which means you can score some damage against the body before running the gauntlet of its immune system.

Why play Pathogenesis?

When you first sit down to play Pathogenesis it feels a little overwhelming. There’s a host of brightly colored cards, many with pretty but incomprehensible pictures on them. Many of the cards have complicated names, ones that without a medical background might not mean a great deal. But that feeling doesn’t last for long.

Once the game is set up, the gameplay is incredibly intuitive. Especially if you have some experience of deckbuilding games (The core mechanic is very similar to the Ascension series). The need to break down the body tract barriers first means that new players of the game can form an understanding of the game’s basic mechanics before being thrown into the meatier parts of the game that involve immune system AI at full tilt.

After a few rounds, the pictures become evocative representations of microbial murderers and their complicated names trip off the tongue. The rulebook and card flavor text are filled with medical explanations of what’s going on, making the game great for learning more about the body, bacteria, and their battle for supremacy. Playing the game is as informative as it is entertaining.

The components of the game are first rate. The cards are of decent quality stock but are elevated to greatness by the fascinating artwork. The tokens are good quality and come in a variety of pleasing shapes. Many of these aren’t used until the immune system kicks in and the opportunity to use the varied array of different counters takes the sting out of having your pathogens obliterated.

The game’s mechanics are finely balanced. Every game I’ve played has come down to the wire, with several cooperative games coming down to the very last damage counter remaining on the body. Pathogenesis is a true cooperative game, as you work with your fellow players to collaboratively to reach your goals. None of the games we played suffered from alpha-player syndrome. They all provoked discussion amongst all parties and prompted combined decision-making processes. It also never feels like a process of crunching the algorithm to achieve the best outcome. There are just too many variables, thanks to the large number of different types of card used in the game.

Building your pathogens is a nuanced affair. There’s little point in building a killer virus, if it isn’t tough enough to survive the immune system, but building a super-tough pathogen probably means you won’t do very much damage. There is some riding of luck. Often your best turn is when your pre-emptive environment card drops at the right time, or the hardcore immune system response attacks your weakest pathogen, whilst your strongest pathogen is left unscathed. Nevertheless, the player with the best strategy will win out.

There’s a curious inversion in playing the game. We spend our whole lives trying to fend off germs and generally consider illness a terrible thing. In Pathogenesis we want the body to fail. We cackle with glee as we suppurate an open wound. We force the body to be a smoker. Anything that gives us the edge.

All in all, Pathogenesis is an excellent playing experience. Personally, I marginally prefer the cooperative game. There’s something about the educational nature of the game that supports a collaborative approach, rather than a combative one.

pathogenesis expansion
The ‘Pathogenesis’ Expansion (prototype shown).

What’s in the Pathogenesis Expansion?

But there’s more. This second edition Kickstarter also comes with the opportunity to pick up an expansion. This is one of the few times in life where you actually want to pick up an STD!

Yes, the Pathogenesis expansion adds the Genitourinary tract and the fun pathogens that go with it. It also adds a new rule: “collateral damage.” This is a feedback mechanic that enables your pathogens to bounce back some of the damage done by the immune system, if they survive the body’s attack.

Other than that, the expansion plays in the same way as the core game. Some versions (the competitive ones) will use all four body tracts, others (the co-op ones) only use three, and players can choose which one to remove.

And that’s it. Pathogenesis is an excellent and educational game, that I found to be sufficiently different from the norm to warrant repeat plays. This is definitely one I shall return to, particularly as its co-operative mode is so strong.

If you enjoyed this review. Check out the Kickstarter today!

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Disclosure: GeekDad received a copy of this game for review purposes.

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