Bullets as Pathogen–The Need for Public Health and Policy Approaches

This article argues that bullets—not guns—should be treated as the primary agents of harm in firearm violence and addressed using public-health frameworks similar to those applied to infectious diseases, given their measurable lethality and population-level impact. Drawing on case fatality rates, ballistic science, and mass-shooting evidence, the authors show that bullet caliber, velocity, and volume of purchase are directly associated with mortality, particularly among children and adolescents. They call for bullet-specific policy interventions—including purchase limits, licensing, background checks, taxation scaled to lethality, and expanded research—to meaningfully reduce firearm injury and death in the United States.