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Mid-Atlantic guy living it up in the Midwest. Father, husband, folklorist, omni-disciplinary scholar, educator, humanist, business and cultural analyst. I'm a fan of all things pop culture, including: sports, sci-fi, television, video games, and transmedia. But my number one love is board and tabletop gaming. Grad student extraordinaire - Ohio State (BA) and BGSU (MA, MBA) alum, current Indiana PhD student, academic advisor, and instructor.

Written Review – Plague Inc: The Board Game


Adaptations are all the rage these days, and in May of 2016 Ndemic Creations launched a Kickstarter campaign to fund a board game adaptation of their famous app-based digital strategy game, Plague Inc. The campaign was a smash, and Plague Inc: The Board Game, designed by James Vaughn, began fulfilling at the end of 2016. With pre-orders currently being taken and the retail release on the horizon, we’re going to take a look at this game and see if it lives up to the hype. Should you seek to contract the Plague, or should you thoroughly inoculate yourself from this game? Read on to find out!

# Players:

1 – 4

Play Time:

30-75 min


Ndemic Creations

What’s in the Box?

The version of Plague Inc that I am reviewing is a Kickstarter edition and contains the Fifth Player, Patient Zero, Single Player, and Virus Expansion packs. My understanding is that the retail version will include the Single Player and Virus Expansion packs from the Kickstarter campaign – the Fifth player expansion will be sold separately and the Patient Zero pack was advertised as a Kickstarter exclusive. That being said, the game is fundamentally the same without these latter materials. In the box, you’ll find:

  • 1 Rule Book
  • 1 World Board
  • 1 Card Mat
  • 1 End Game Bonus Scoring Card
  • 64 Plague Tokens (16 per color – Red, Blue, Purple, Yellow)
  • 4 DNA Point Markers (1 per color)
  • 4 Evolution Slides (1 per color)
  • 49 Country Cards
  • 62 Trait Cards
  • 25 Event Cards
  • 1 Six-sided “Death” Dice (oddly named considering that it’s a singular die, but there is a brief explanation in the rulebook)

Additional materials included in this review:

  • 1 Fifth Player Expansion
    • 16 Plague Tokens (Green)
    • 1 DNA Point Marker (Green)
    • 1 Evolution Slide (Green)
    • 1 Rule Sheet for Five Players
  • 1 Patient Zero Kickstarter Exclusive Pack
    • 2 Trait Cards
    • 3 Event Cards

The retail box with the expansions.

How to Play

At its heart, Plague Inc is a variable board area majority game. Like the similarly themed 2014 game Pandemic: Contagionplayers take on the role of a deadly disease hoping to eradicate humanity. In this game you will battle to spread your plague to available countries, while adapting to the world around you and developing new symptoms so as to spread across the globe. Each Plague will begin with a “Patient Zero” in a randomly chosen country, and you will you spread your infection across the world each turn by placing tokens in new cities, building your own dominance while simultaneously seeking to limit your opponents’ ability to spread.

To set up, begin by placing the World board in a central location that is easily accessible to all players. Each player should be given an Evolution Slide, to serve as their player board, and 16 Plague Tokens in a matching color. For the base game, players should play with the “Bacteria” side of the slide visible. Through the Kickstarter, the alternative “Virus” expansion was unlocked and printed on the reverse of the Evolution Slide. This expansions does not impact the fundamental structure of the game, but the “Virus” abilities are very different than the “Bacteria,” and this creates a somewhat different play experience – beginners should start as Bacteria. Nearby, place the Card Mat, the Bonus Summary Card, and the Death Dice.

Next, have someone shuffle the deck of Trait Cards and deal each player a hand of five cards. The remaining cards are placed in their appropriate spot on the Card Mat. Following this, shuffle the Event Cards, and place those face-down on their assigned Card Mat location – players do not begin with these in their hand. The last stack of cards, the Country Cards, should be separated into two piles – starting countries (marked by red circles on their back) and regular countries. Shuffle all of the Starting Country cards together, and deal one to each player. Then shuffle all of the Country Cards together into one deck. In order to set up the pool of available Country Cards for the game, you will need to count out a specific number of available countries determined by the number of players (24 for two players, 27 for three, 32 for four, and 35 for five). After counting out the appropriate number of Country Cards face-down, return any remaining cards to the box. The cards that you have counted out will form the Country Card deck for your game, and should be shuffled and placed on the marked spot on the Card Mat. The top three cards of the Country Card deck will then be turned over onto the three remaining spots on the Card Mat.

Setup for a four player game.

Setup for a five player game.

After setting up all of the card decks, each player will take their Starting Country Card and place it onto the board in the Continent Zone matching their card. Each card is tied to one of the six Continent Zones (as marked on cardface), however it is not important where in the zone a card is placed. Once you have placed your card, you will take one of you Plague Token and put it on any City Space (the small black hexagons) on that card. This marks your “patient zero,” your initial point of infection preparing you to begin plaguing the world.

To determine who begins the game, the rules suggest that the player who most recently washed their hands goes first. This is a clever way to begin, but you can determine the starting player however you’d like. After the starting player is chosen, play will move clockwise from there. The first player will place her DNA Point Marker on the 0 position on the DNA Points Track. The player to her left will place their Marker at one, and so on. To offset the disadvantage of playing later, players lower in the turn order start with more DNA Points, and these points are used both as currency within the game and victory points. After determining turn order, the game is set and you are ready to begin.


In this example, the player controlling the Purple Plague is the first player, followed in clockwise order around the table by Blue, Green, Red and finally Yellow.

There are five phases of the game that take place on each player’s turn – and these are conveniently printed on right hand side of every Evolution Slide. On their turn, players will begin with the DNA Phase and then move through the Country Phase, the Evolution Phase, the Infection Phase, and the Death Phase in order.

In the DNA Phase, the active player will score 1 DNA point for every country that they control. Control is determined by having the most tokens in a given country with a minimum of 1 token and ties being shared for scoring purposes. Given that every player starts with one token in their starting country, the first player will always score at least one DNA point on the first turn (two when playing on the “Bacteria” side of the slide thanks to the pre-printed power on the slide – more on that later). After scoring DNA points, the active player will move to the Country Phase. In this phase, the player must choose a Country Card to place on the World Board or discard from the game. The player may choose from the three countries that are face-up on the Card Mat, or they may blindly draw from the top of the deck. If they choose from the face-up cards, that card is immediately replaced with the top card of the Country Card deck. If the player chooses to place the country on the board, they will choose a spot in the matching Continent Zone and place the card there. This action creates new countries for all players to potentially infect, control, and destroy. If the Continent Zone matching the selected card is full, the player must discard their chosen card. When a player chooses to or must discard the Country Card, the card is removed from the game, and that player must also discard all of the Trait Cards in their hand, drawing five new cards from the deck. Discarding can be done out of necessity (no open spaces) or strategy (to deny access to your opponents or to refresh your hand with new cards). Discarding Country Cards is, for the most part, the only way you will draw new Trait Cards throughout the course of the game.


An Evolution Slide at the start of the game (after setup, but before the first turn).

After the Country Phase, the active player moves to the Evolution Phase. In this phase, the player may choose to pay DNA points equal to the cost (located in the upper right-hand corner) of one trait cards in their hand and place that card on any spot on their Evolution Slide that doesn’t already contain a card. This phase is optional, and players are not required to evolve their plague. In order to evolve, you must have at least the number of points equal to the cost of the card you are playing, and you will move your DNA Point Marker back a number of spaces equal to the cost of the Trait Card. So, for instance, if Purple has 10 DNA points at the beginning of their Evolution Phase, they can pay 2 points for the “Cannibalism” Trait Card in their hand; however, they could not pay 12 to place the “Skin Lesions” card from their hand onto their slide. If they chose to play “Cannibalism,” they would move their DNA Point Marker from 10 to 8 and place the card on an open spot on their Evolution Slide.

There are two important things to acknowledge here. The first is about scoring – at the end of the game, you add the value of each trait card visible on your Evolution Slide to your final score. So you don’t really “spend” your victory points unless you choose to devolve a trait you’ve previously played. And that leads us to the second important thing: At any point on your turn, you may devolve a trait on your Evolution Slide. To devolve, you simply remove a card from your board and place it in a communal discard pile. This does not take an action or cost any DNA points – however, you do not earn the cost of that trait card back, nor do you count it in end of game scoring.

Each slide has 6 open slots where you can place your evolved Trait Cards; however, there are some pre-printed abilities on each Evolution Slide. You only benefit from these abilities when they are visible, so if you place a Trait Card on the “Outbreak” or “Bonus DNA” slots on your “Bacteria” Evolution Slide, you lose those abilities. There is a careful decision making process at play here, where you have to weigh the costs of your DNA and visible benefits against the benefits of the Trait Card you’re planning to evolve. To me, this is one of the most interesting parts of the game. Each Trait Card that you evolve is going to give you new abilities. Some contribute to your Infectivity or Lethality (more on that later), some give you climate resistance allowing you to expand into new countries with extreme climates, and some allow you to spread more quickly by making you an Airborne or Waterborne disease. All of these traits are important to spreading your plague around the globe and eliminating humanity.


Evolution in process, throughout the course of the game.

After evolving, the active player will move to the Infection Phase. In this phase, the player will count the number of yellow “Infectivity +1” spaces visible on their Evolution slide. Before evolving, this number is always 2 on the Bacteria side of the Evolution Slide, but will increase as players play Trait Cards. The player will then take a number of their Plague Tokens equal to their Infectivity, and place those tokens in cities on the board. You can place all of your tokens on one Country Card or spread them around to as many eligible Country Cards as you can infect. The choices you make have to do with your strategy. You may seek to control as many Country Cards as possible (remember, this gets you points!) or you may try to establish a small infection in lots of countries, hoping to spread more later. Ultimately, the choice is yours and there are benefits and drawbacks to each approach – and you must keep in mind that you have a maximum of 16 Plague Tokens you can place on the board at once. If you run out of tokens, you cannot continue to infect new City Spaces. The infection process isn’t as simple as just counting your Infectivity and placing tokens on the board, though. In order to infect a City Space, your plague must be connected to the associated Country Card and Climate Resistant. Let’s start by discussing connectivity.

You can be connected in a number of ways. If you are infecting a city on the same Continent Zone where you have already placed Plague Tokens, you are connected. So, if you already have Tokens in China and you want to place tokens on a new played Country Card in the Asia Continent Zone, Japan for example, you can do so because they are both in the same Continent Zone, and so “connected.” This sounds simple, but can become far more complicated later, especially when you want to move out of your starting Continent Zone.

There are two primary ways to extend your connectivity. The first is to become “Airborne.” If you evolve the Airborne trait, and you infect a Country Card with the purple Airport Icon, you are connected to all other Country Cards in play that also have an Airport Icon. Thematically, you are able to travel across the world by infecting travelers on airplanes, which is a nice touch. You can also develop the “Waterborne” trait, which works the same as “Airborne,” but instead of allowing travel between Country Cards with the Airport Icon, you can travel between Country Cards with the green Seaport Icon. Developing these traits early can be the key to spreading out quickly and earning lots of DNA points.

When using the “Bacteria” side of the Evolution Slide, you may also spread your plague by using the “Outbreak” power (as long as it’s visible). This power allows you to skip your normal Infection Phase and instead, move one of your currently in play Plague Tokens to any other open City Space on the board, ignoring all restrictions. Initially, this doesn’t seem powerful – but it can be a great way of tactically opening up new areas of the board where your plague can grow.

Now that we’ve talked about connectivity, we should address the need to be Climate Resistant when you want to infect. Most countries have cities represented by blank hexagons. These countries have neutral climates. However, many of the Country Cards have City Spaces that have black hexagons containing either a Hot Climate (represented by a Sun Icon) or Cold Climate (represented by a Snowflake Icon).  In order to infect these countries, your disease must develop a resistance to the extreme temperatures of these locations. In order to infect a City Space with a Sun Icon, your disease must have “Heat Resistance.” Likewise, to infect a city with a Snowflake Icon, you must have developed the “Cold Resistance” trait. The inclusion of various climates really adds theme and much needed balance, as it often prevents one player from quickly dominating the board in the early game.

Finally, after infecting City Spaces in appropriately connected and acclimatized countries, the active player moves to the Death Phase. In this phase, the player will roll a die to determine if any fully infected Country Cards that they control are wiped out by their plague. Control is determined here the same way as in the DNA Phase, having the most Plague Tokens on a Country Card, including ties, gives you control of that country. If the Country Card has every City Space on it filled with a Plague Token, regardless of color, it is fully infected. During this final phase, the active player will identify every fully infected Country Card that they control, and then attempt to “kill” these countries.

To do this, they will announce each country one at a time, count the number of grey “Lethality +1” spots on their Evolution Slide, and then roll the Death Dice.  If it number on the die is greater than your lethality, the country survives for now and you move on to the next fully infected Country Card that you control.  If the die value is less than or equal to your leathlity, you kill and score that country. When you kill a country, all Plague Tokens on the card are returned to the owner’s pool and each player scores 1 DNA point for every token returned to them in this way. That’s right – killing a country can give your opponents points! Each player who had a Plague Token in that country also draws an Event Card, beginning with the active player and going clockwise. Players can only ever have a maximum of 3 Event Cards in their hand, and if they have reached the maximum they do not draw a new card when countries are killed.

Event Cards haven’t been explained to this point, so this seems like as good a place as any to talk about them. What are these secretive things that we haven’t spoken of since the set up? Well, Event Cards are powerful, one time use abilities that reflect the things going on in the world around you as civilization crumbles in the face of global pandemic. These cards each have specific triggers, and can be played anytime those triggers are met on any turn after you’ve received the card. This will trigger a one time event that might allow you to spread your plague quickly, lock a country down so diseases can’t spread, evolve more efficiently, or even launch a nuclear strike, wiping out a whole country and all the diseases festering there. These cards introduce a degree of imbalance to the game, and can swing situations wildly – but that seems to be their point. They are one time, important events happening as the world descends into chaos, so it makes some thematic sense for them to introduce a little strategic chaos to the game, even at the expense of a consistent play experience.

Back to the Death Phase: After the active player has killed a country and all players receive their Plague Tokens, DNA points, and Event Cards, the active player collects the Country Card and keeps this in their possession for scoring at the end of the game (it is best for each player to keep these separated by Continent Zone). If the player failed to kill the country, they just move to the next one they want to attempt to kill. When the active player has rolled the Death Dice for each fully-infected country that they control, their turn ends and play moves to clockwise to the next player who begins at the DNA Phase.

I realize that I’ve written a fair amount about these phases, and they could seem complicated and time consuming. Yet they all move remarkable quickly. There are some elements of the board state that must be checked throughout a player’s turn, but since the iconography on Trait and Country Cards is relatively clear, all of the checks happen very fast and a players turn is frequently completed in well under a minute.

Under the Microscope

Working your way through the each of the five phases of the game is the bulk of what you’ll be doing in Plague Inc. Yet there are some important elements of the game that need to be discussed. First, it is possible for your disease to be wiped off the map. Perhaps you developed your lethality too quickly and killed all of your host countries, or perhaps you’ve been unlucky every time your opponents rolled the Death Dice. Whatever the reason, if a player has no Plague Tokens remaining on the board, they are not eliminated from the game. Instead, when they begin their next turn they will have to reintroduce their plague into the world before doing anything else. To do this, the player will choose a Country Card from the top of the Country Card deck. If it can be placed onto the board, it must be placed. Then the active player will place one of their Pague Tokens on any open City Space on the World Board, ignoring all Climate and Connected restrictions. After this, the player must pay a 7 DNA point penalty. They then begin their turn as normal with the DNA Phase.

Finally, the end of the game has an interesting, multi-leveled trigger. Sudden Death Mode is triggered when the last remaining Country Card in the deck is either placed on the World Board or discarded. This symbolizes the collapse of civilization as we know it, and slightly alters the way the game is played until it finally ends. To begin, every player will now skip the Country Phase, meaning that once Sudden Death begins, there are only four phases per turn. The game will then end in one of two ways:

  1. If any player has all of their Plague Tokens removed from the World Board, they have been eradicated and the game ends when the active player finishes their turn.
  2. If any player is unable, on their turn, to either place new Plague Tokens or roll the Death Dice, the game immediately ends. This ending condition can seem complicated at first, but it seems as though it should be checked at the active player’s Infection Phase. If the player is unable to Infect a new City Space, then check to see if they will be able to roll the Death Dice to try and kill a fully infected country that they control. If they do not control a fully infected Country Card, the game ends and final scores are tallied.

Now on to final scoring. Here’s where things can get… complicated. Indeed, several players in my groups have described this as actively frustrating – and it feels as though it takes as long to tally the score as it does to play the game. In order to calculate final scores, every player will begin by adding the DNA Costs of the Trait Cards currently visible on their Evolution Slide into their DNA Points. This usually changes scores dramatically, and is best done one player at a time. Then, three rounds of “bonus” scoring occur. For real. Three rounds (though it feels more like eight).

The first is easy: the player who has the most Plague Tokens remaining on the World Board is awarded +4 DNA Points. The next is the most complicated and, to some, burdensome. Each player will count the number of Country Cards they have killed for each of the six Continent Zones. The player who has the most Country Cards in their possession for each Zone will be given +6 DNA points. This means that you will check who was responsible for killing the most countries 6 individual times, awarding a total of at least 36 points. I appreciate the idea at play here, but the process of checking each zone can seem awkward, and many of the folks I played with grew frustrated at this point in the game (though, in fairness this is a common complaint among people who aren’t wild about Euros). Finally, players will check to see who killed the “largest” country by determining who possess the Country Card containing the most City Spaces. This awards the winner +7 DNA points. In each of these rounds of bonus scoring, ties are treated as though all tied players “won”. So if two players both killed six County Cards in the Europe Continent Zone, both players would be awarded +6 DNA, and so on.

And that’s it. There are some interesting variants included in the rulebook, including a solo “Plaguebot” version, and the “Virus” side of the Evolution Slide – but I’ll leave those for you to discover on your own. This basic rules review should get you up and running, ready to destroy the world in no time.

Contracting the Plague

So. Now you know the fundamentals of how to play Plague, Inc.. Should you? Yes. This game isn’t without its flaws, but it is an absolutely solid entry into the area majority genre, and is innovative enough to belong in almost any collection. I do have issues with game balance and component quality though.

Let’s start with game balance. To begin, some of the Trait Cards are just better than others – and what you get is entirely dependent on the luck of the draw. The cost/benefit ratio is sometimes wildly out of proportion, and if you draw a bunch of “junk” in the early portion of the game, you’re constantly disrupting your ability to expand the board with potential areas of infection. Further, sometimes the board “locks” into place with Country Cards with extreme climates, and the game devolves into a mad dash through the Trait Card deck as players search for evolutions that can open up those hot or cold cities. This is less than ideal.

Additionally, some of the Event Cards are incredibly powerful. I mentioned earlier that they seem to be intended to introduce a little strategic chaos, which feels right. But some of them are practically game-breaking. They can really swing the board state and fundamentally alter strategic positioning – particularly with two players. Now that’s not to say it isn’t a fun game or that you can’t overcome a bad hand of Trait Cards or your opponent drawing into a great Event Card – it just feels very uneven at times. Frankly, the game plays fairly well with almost any player count even with these balance and consistency issues. Solo is a totally different experience than the main game, and five players seems to drag on forever – but with two, three, and four the game works well. If there is a sweet spot, it probably depends on how you prefer to approach your games. Two players is far more strategic because you are better able to control the board and make long term plans. Four and five players becomes all about short-term tactical response to the board state. Three is a good number for an even mix of tactics and strategy and for time constraints – but you can’t really go wrong here. Even though the game can be swingy, it’s still good and a different experience almost every time.


As for components, everything seems just a little off. Don’t get me wrong, everything is fine – but there’s just a weirdness about the whole affair that seems off-putting in the modern hobby game market. The board is weirdly sized, and relatively small. The cards are all an uncommon size and oddly thick and stiff, making them difficult to shuffle. The art and graphic design, while reminiscent of the video game, seems slightly amateurish and in some cases, ugly – particularly on the Event Cards (though in fairness, the Country and Trait Cards have outstanding iconography). The “custom” Death Dice is, for all intents and purposes, a normal speckled die that seems to be oddly weighted leading to statistically improbable rolls (anecdote: in one game we rolled a 6 on nine consecutive rolls, which seems odd until you realize that there are more red plastic “speckles” on the opposing 1 side of the die, likely leading to the die being poorly weighted…).

All of this would be fine for a company’s initial foray into the hobby game industry, particularly in a Kickstarter game, if so much attention had not been paid to the Plague Tokens and DNA Point Markers. Making the tokens embossed hexagons is cool and all, but colored wooden or plastic cubes would have been just as effective and cheaper. The same goes for the DNA Point Markers. The DNA helix is nice, but round wooden tokens would’ve accomplished the same thing. Spending time, energy, and resources on these unnecessary component upgrades instead of ensuring better quality in the card stock, the board, the graphic design, and/or the die seems like a small (but not insignificant) misstep. The cards, board, and dice components working are integral to playing the game in a functional sense – scoring and control tokens, less so. I’m not trying to knock Plague Inc too much here, and I’m not saying a publisher must have the same set of concerns as I do, but this seems like fairly basic stuff. As I said, this is Ndemic’s initial offering into the board gaming world, and we’ve all played plenty of games from bigger, more seasoned companies (and designers!) that have less than stellar art, graphic design, and components (*coughThe Castles of Burgundycough*), but this is worth noting. In the modern hobby game market, we expect games that are innovative, creative, and fun while also being aesthetically pleasing with components that are high quality. Ultimately, the physical quality of the game is slightly disappointing – but it doesn’t ruin an otherwise great game.

Is the game fun? Yes. Does it allow you to make meaningful decisions while scaling well to various player counts? Absolutely. Does it allow you to adjust your tactical and strategic approaches throughout the course of the game based on the board state you’re presented? Yup. Is it also overly reliant on the luck of the draw creating wild and unpredictable swings while being presented in a less than ideal package? Unfortunately, yes. Is it still a good game that I would almost always be willing to play if it were suggested at a meet up? Definitely. While it has some issues, Plague Inc is a really solid entry into the area majority genre, and if you enjoy classics like El Grande, then you should absolutely give this light, but innovative game a shot.

A great first entry into the hobby game market. Not without some small issues, but still a lot of fun.


  • Innovative mechanics that allow all players to develop variable abilities and compete on a variable board
  • While a Euro at heart, this game still drips theme – evolving a plague and killing the world has never been so much fun
  • Scales well to from 2-4 players, each with a slighlty different experience
  • A solid solo mode


  • The Trait and Event Cards are inconsistently powered and can create wild swings in the game
  • The components are less than stellar, but not so bad as to ruin the game
  • At 5 players, the games drags quite a bit

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2 Comments on “Written Review – Plague Inc: The Board Game”

  1. Leon Fletcher August 28, 2017 at 8:19 AM #

    Maybe a good way to deal with the continent killer bonus would be to make every player have six piles of killed countries, each pile for a different continent. It should make the counting go a lot faster

  2. Bob Green June 17, 2018 at 3:58 AM #

    Played this game with my wife and our best friends last night. I had played before, the others were new to the game. Only took a few rounds for everyone to get comfortable with how to play.

    No question that the event cards make a huge deal in the game, especially at end game. That said, everyone got at least one that was good for them, so it balanced out. Counting points at the end wasn’t a big deal – no worse than playing Ticket to Ride or something similar.

    All in all, we really enjoyed it. We’ll be playing it again.

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