Outside of a board game store, when people talk about Pandemic, there sometimes comes a realization that you need to specify whether or not you're discussing the tabletop version revolving around the Scooby Gang of anti-infectious disease workers trying to save the world, or the internet version where you are the illness trying to literally end the world through your power, except those motherfuckers in Greenland always close off the port before you can get over there.
The upshot is, if you fear an imminent apocalypse, go to Greenland. No one's going to nuke it either.
The other upshot (can you have two? I say yea) is that now there's another 'that disease game' for the tabletop surface, which also starts with a 'P' and is not going to make this conversation a whole lot simpler, except the game's only ok (spoiler) and probably no one's going to know what it is in the first place.
Pathogenesis works with 1-4 players, and can be played either cooperatively or competitively, which should be a warning sign right there. In both modes, there's an ephemeral body with three systems for the players' diseases to attack--respiratory, gastrointestinal, and tissue--and the goal for all players is to kill the body by removing point counters from those systems. If that's not done before the immune system deck is drawn through twice, the body lives and all the players lose. The difference between cooperative and competitive is that in competitive, you only need to remove the counters from one system (two if playing 2v2 teams), while in cooperative you need to empty all three systems. Functionally, then, this determines whether or not you care if the other players have highly effective viruses attacking the body; you can leave good cards for other players in cooperative, for example, but you can't directly assist in making their diseases stronger (e.g. by handing them cards).
Other than that, this is a deckbuilding game in the vein of... all of them. Starting decks have ten cards, you draw five per hand, most of the cards help you buy better stuff, and so on. The differences are in how pathogens work. All pathogens have an attack and defense value; attack determines how many point counters are removed from the appropriate system of the body, whereas defense is used to protect the pathogens from attacks by the immune system. The base values of the pathogens aren't enough, though, especially when the second immune system deck gets shuffled in; fortunately, pathogens have nodes for additional abilities (these are the cards purchased from the gene pool), many of which have stat bonuses that help strengthen the pathogen. Therefore, you need enough attack on your pathogens to gather up point counters, but even more you need defense to limit the immune system's chances of wiping them out.
One thing that becomes apparent quickly is that it does very little good, and later on is in fact detrimental, to play weak pathogens without boosts. Once the immune deck comes into play, every pathogen is attacked, which means the immune deck loses cards faster if you have a bunch of pathogens in play. Furthermore, unless the pathogen has an ability that lets it attack before the immune system can react, the immune deck can kill your pathogen before it has any effect at all. At first your weaker pathogens are fine to play because you have to work through a small deck of starter cards in each system before the immune response comes into play, but you need to amp them up fairly quickly or else accept they're going to die and just focus on better, system-specific pathogens you purchase for your deck.
The best part about this game is its scientific validity. Everything works in a logical function and is based on the actual battle between diseases and bodies that our fragile mortal frames deal with constantly. Anyone who's taken high school biology (and didn't routinely skip class to make out behind the bleachers) should recognize how all of this works in at least a conceptual sense. It also mirrors the ramp-up of the immune system against particular diseases, in that the disease has a little bit of time to exist before being recognized as a threat.
But this is a game, and it needs to be best as a game. It's not.
The main issue is the randomness of the immune deck in a competitive game, especially with four players. Immune system responses vary from attaching new types of cells to pathogens that can combo off other immune cards on later turns to cards with a huge attack value almost no pathogen can survive. That's a cool concept, but if someone's 7/7 pathogen draws a combo cell and someone else's 7/7 draws an 8-damage immune card, the first person scores their seven points while the second doesn't, and seven points is over ten percent of the available points for any given system. That's a big advantage to take on one turn, and there's no guarantee the combo cell will blow up the first person's cell on the next turn while the second person's pathogen and its add-ons have to shuffle back through the deck.
There are different ways to set up the game to change game length and difficulty, which is all well and good in theory, but going from a quick game to a normal one only adds four cards to each immune deck, which means twelve more cards overall. Going through that deck twice, depending on how many pathogens people have out, might buy you two extra turns in a four-player game, but even then what you really need is for something to kill the opposing pathogen before that player's lead spirals too far out of control. Playing on hard just changes the odds of killing the body so that somebody wins, without affecting this basic problem of someone getting an unlucky draw and having a long climb back into contention.
'Alright, you picky fucking butthole,' I hear the voices say, 'it has competitive weaknesses. But it's a learning game, so what about cooperative?' And I acknowledge that it's probably cleanest in a cooperative setting. The immune deck runs out faster than you'd expect, so you have to work to ramp up your diseases quickly enough, while also planning with each other who should buy what cards in order to maximize the odds of success. This is also the mode where the other main difference between this and most deckbuilders--the ability to hold cards from turn to turn--comes into play, because waiting until you have a hand that lets you drop a monster pathogen all at once doesn't have many drawbacks in co-op. Because you want to set up pathogens that are likely to survive brute force attacks, the immune combos are also more likely to have an impact here.
However, the immunity randomness strikes again, because success in co-op requires building pathogens with the maximum chance of survival, ie. high defense. There really is no other way to succeed, which means you're taking the gene pool cards and deciding what variation on that defense theme to pursue as opposed to having genuinely different options for attacking the body.
And maybe that's the intent. Maybe that's the most scientifically valid way of showing how diseases attack the body, and the conditions under which they can succeed--the difference between cellulitis and MRSA as displayed through the abstraction of a card game. I really like the idea, and I'm glad this game was made. It just doesn't hold up fun-wise for as many playthroughs as most people are going to want out of their games.
Score: Eighteen dilated pupils out of thirty-four (one guy's all fucked up)