Lost Immunity

by Daniel Kalla

  The men in orange have dispersed by the time Lisa joins Nathan and Fiona beside a pile of boxes stacked in front of one of the refrigerators. After quick hellos, she says, “I didn’t expect you to show up with all the vaccine today.”

  “Technically, we flew commercial while those were shipped charter.” Nathan motions to the boxes. “You did say you wanted them as soon as possible.”

  “Not complaining. Not at all. Just surprised. And I certainly wasn’t expecting you to book the storage facilities.”

  Fiona squints at her. “There’s no way we would entrust this to anyone else.”

  Lisa glances over to one of the security guards. “Apparently.”

  “This is Delaware’s biggest product release in almost five years, Lisa. We have so much riding on it.” Nathan taps his chest with two fingers. “We have to protect it with our lives.”

  “Your lives aren’t the ones at stake. But I get it.”

  Nathan bends down and flips open one of the boxes near his feet. He cracks open the Styrofoam packaging, extracts a yellow-topped vial, and holds it out to Lisa. “A lot of fuss over something as simple as this, huh?”

  Lisa takes the almost weightless plastic vial between a thumb and index finger and rotates it from side to side, inspecting the clear fluid as it rolls inside. “It’s the standard half-a-ml dose, right?”

  Fiona nods. “Already reconstituted. But it does need to be shaken well before use. And always administer in the deltoid muscle. Preferably the left arm, for consistency.”

  Lisa resists the urge to remind the other woman that she’s not a novice when it comes to vaccinations. “And it has to be refrigerated?”

  “Always. Between four and eight degrees Celsius.” Fiona reaches out for the vial, and Lisa passes it back to her.

  “When do you want to start?” Nathan asks.

  “We had been targeting early next week,” Lisa says. “But since you’ve already brought the supply, we could start as soon as tomorrow. We just need to finalize the locations of the vaccination clinics.”

  Fiona closes the box and looks up at Lisa. “We’ll need to know how many sites you plan to run simultaneously.”

  “And why’s that?”

  “Because we’ll need to have enough team members at each of them.”

  Lisa crosses her arms. “There’s no way anyone aside from my nurses will be administering the vaccine.”

  “They can give the shots,” Fiona says. “But there’s no way anyone outside of my team will be transporting or handling the vials.”

  “We’re all on the same team,” Nathan says. “Think of us as your lackeys, Lisa. Your Amazon Prime for the new vaccine.”

  “Why not? Amazon basically owns Seattle, anyway.” Lisa breaks off eye contact with Fiona. She doesn’t resent her stance. In fact, she admires it. Fiona exudes competence. And Lisa appreciates what it means to be passionate about your job.

  “So how do you plan to publicize the vaccination campaign?” Nathan asks.

  “We’re going to make an announcement later today.”

  He frowns. “A press conference?”

  “A social media launch combined with a press release. No doubt the mainstream media will have plenty of questions. Might as well tackle them head-on.”

  He shakes his head. “Delaware won’t be making any public comments on this trial.”

  “Launch,” Fiona corrects.

  Nathan and Fiona share a quick look, and Lisa wonders if there’s a reprimand in his eyes, but she can’t tell.

  “Whatever you want to call it, we’re not willing to be drawn into the media side of this,” he says.

  “Understood,” Lisa says.

  “Did your office sign off on the patient-consent forms?”

  Lisa nods. The forms contain the standard legalese absolving Delaware Pharmaceuticals of any liability from complications of the vaccination. Lisa knows as well as Nathan that they wouldn’t stand up in court, but it’s a typical deterrent used in all drug trials. “We will get consent from all patients or, in the case of minors, their guardians, before giving the vaccine,” she says.

  “Good.”

  “And have you had a chance to review our app for reporting vaccine-related complications?”

  “We have,” Fiona answers for him. “It looks similar to the existing national VAERS site for reporting adverse events.”

  “It’s meant to,” Lisa says. “We plan to put our link on Seattle Public Health’s home page and plaster it everywhere else we can think of. If there are any early signals of complications, we’ll pick up on them right away.”

  Nathan sighs. “No matter how this campaign goes, you’re going to pick up on a whole lot of noise, you do realize?”

  “Always the way with vaccines,” Lisa says sympathetically. “Hopefully, it’s all just precautionary.”

  “It’s not too late to reconsider, Lisa.”

  “To reconsider what?”

  “All of this.”

  “I don’t get it. The early trials have been so promising. Why can’t you look at this as a huge opportunity for Neissovax?”

  His shoulders sag. “There haven’t been as many new cases of meningitis in the past few days, have there?”

  “Another seventeen-year-old died last night,” Lisa says. “You know how it is with meningococcus. It waxes and wanes. It doesn’t behave anything like the flu.”

  “But what if this outbreak is naturally resolving? What if it’s about to disappear just like it did in Iceland?”

  “It’s way too early to contemplate that.”

  “But if it is, and you subject the whole city to an immunization campaign with an experimental vaccine…”

  Lisa doesn’t blame him for his reticence. The same concern has already crossed her mind. As her gaze drifts to one of the rigid security guards and comes to rest on the holster on his belt, she feels the sudden weight of responsibility pressing heavily on her shoulders. The buck does stop with her. As does the potential liability of exposing an entire city to an unproven vaccine.

  A phone rings, and Nathan reaches into his pocket and pulls his out. Lisa sees the name Peter on the flashing screen.

  “Excuse me,” he says. “I have to get this. I’ll just be a minute.”

  “Can’t be easy, huh?” Fiona says to Lisa, once Nathan has stepped out of earshot.

  “What can’t?”

  Fiona’s gaze softens. “Being responsible for controlling an outbreak like this.”

  “It’s not like I’m doing it alone. I’ve got a terrific team,” Lisa says, downplaying the accuracy of the observation.

  “I suppose, but I can still empathize. My role is all about managing risk and exposure.”

  “Yeah, but you seem so… certain to me. Like you never doubt.”

  “And you do?” Fiona raises an eyebrow. “You strike me as supremely confident. Fully in charge. How you persuaded Peter Moore, of all people, to change his mind about releasing Neissovax is nothing short of a miracle. He’s a stubborn as they come.”

  “I’ve had a lifetime of experience with pigheaded men, but to be honest, I’m not the one who convinced him.” Lisa feels herself relaxing, enjoying the moment of candor. “Besides, the deeper I get, the harder it is not to second-guess myself.”

  Fiona smiles. “Maybe we’re both just good actors, huh?”

  “Maybe. But acting only gets you so far.”

  CHAPTER 21

  Yolanda Stern sits at the back of the conference room, listening to the announcement. Unlike the other public-health nurses, she never speaks up at meetings. If she has questions, she saves them for later and emails her boss, Tyra, who’s always so conscientious about answering in a nonjudgmental way.

  Her whole life, Yolanda has been a wallflower. By choice. She avoids public attention at all costs. Her therapist blames Yolanda’s mother for being overbearing and overprotective. But Yolanda knows better. She doesn’t like the sound of her own voice. And she’s never been comfortable in h
er own skin. If she could only shed those stubborn twenty extra pounds, she’s convinced she would feel more confident in group situations. The exercise and diets never seem to work out for her as billed, but that doesn’t stop her from endlessly trying.

  Yolanda does have questions for Tyra, though. This new vaccine rollout has come out of nowhere and seems insanely ambitious, targeting fifty thousand people over the next three to four weeks. How can we possibly achieve that?

  Yolanda already knows what her boyfriend, Max, will make of the vaccination campaign. She wants to tell him, but Tyra has sworn the staff to secrecy until the announcement is made public later today. Besides, Yolanda vividly remembers how much the news of the mandatory HPV vaccine enraged Max. She doesn’t want to add to his burden. The poor man suffers enough.

  Yolanda was thrilled when she matched with Max online, six months earlier. She fell in love with the handsome doctor by the end of their first date. He listened to her in a way no man—especially anyone from a dating app—had ever done. And he was so interested in her career. Most of the other dates didn’t even seem to notice or care that she worked as a public-health nurse. But Max brought it up within minutes of their first meeting.

  Yolanda had never met a naturopath before, but she was wowed by the breadth and depth of Max’s knowledge and the way he made her feel so at ease from the outset. She did have some serious reservations when she first learned about his fierce anti-vax beliefs. Vaccinations are an essential part of her job. And before meeting Max, she had never once questioned their necessity. But he was so persuasive. So dogged. He sent her scientific article after article, filled with data, to back up his passionate views. It was enough to make Yolanda question the value of some vaccines, like the one against HPV. It definitely gave her more sympathy for the anti-vax side, especially once she learned how much his poor son struggled with what Max blamed on a vaccine injury. Besides, she was already so smitten that Max could’ve probably told her the moon landing was faked and 9/11 was an inside job, and she still would’ve stuck with him.

  “So tomorrow morning at nine a.m., we’ll open the first clinic,” Tyra announces, drawing Yolanda back to the moment. “It’s going to be all hands on deck. We’re hoping to get at least five hundred clients through. And there’s bound to be lots of kinks to iron out. After the first clinic, we’ll divide up and run multiple sites across the city.” Her gaze circles the room. “Tomorrow is our dress rehearsal, people. Let’s get it right.”

  “Hey, Tyra,” calls Felix. He lifts a copy of the generic consent form that Tyra handed out before the meeting. “You expect us to go through this whole form with each client and/or parent before every single vaccination?”

  “No vaccine without a signature.” Tyra wags her finger. “But that’s why there’ll be two of you at each station. One nurse reviews the consent form while the other labels a syringe and draws up a fresh vial of the vaccine.”

  “Fun,” Felix grumbles.

  “You get to swap halfway,” Tyra says. “And word around the office is that you love to swap, Felix.”

  Even Yolanda laughs. Felix and his wife are devout Catholics, but the joke has followed him ever since they showed up at last year’s Halloween party—the theme of which was “come as you aren’t”—dressed as swingers.

  “And while the vaccine is a huge priority for us, so is the continued contact tracing,” Tyra says. “We still need to follow up with every single new meningitis victim and ensure all their close contacts are started on appropriate antibiotics.”

  A collective moan rises in the room.

  Tyra blows them an exaggerated kiss. “This is why I love you folks so much! There’s nothing this team can’t do when we set our mind to it.”

  But fifty thousand vaccinations in two weeks? Yolanda thinks. Oh my God, Max is going to lose his mind.

  CHAPTER 22

  “Have you called Mom yet??” Amber’s text reads.

  Lisa can practically hear the accusation in her sister’s written words. The guilt creeps up again.

  She peeks at the time. The communications team sent out a press release and launched the supporting social media campaign earlier in the afternoon, but the response from the media was so overwhelming they decided to hold a formal press conference. Lisa still has forty-five minutes before she has to face the reporters.

  No time like the present.

  Lisa picks up her phone and calls her mom’s number. It’s the landline for both of her parents, since neither of them carries a mobile. Something about cell towers and electromagnetic fields. She can’t even keep up with all her dad’s conspiracy theories.

  Her parents still live on the same farm in eastern Washington, about forty miles outside of Spokane, where Lisa and her sister grew up. It began as a decentralized farming commune that was intended to be a self-sufficient nirvana for the enlightened and the disenfranchised. It bore all the stereotypical attributes of such a commune—or a cult, as she sometimes thought of it in her teen years: group parenting, potluck meals, homeschooling, “gentle forestry,” beekeeping, natural building, varied crafts, and live arts. In retrospect, Lisa suspects that free love and open marriages could have been part of the post-hippie lifestyle there, too, but she never confirmed the hunch.

  As a young child, Lisa loved the vibrant environment. The thriving grounds were filled with families and other kids to play with. She remembers music constantly playing, with live performances almost every evening. But petty squabbles—many of which her father instigated—and natural attrition eventually set in. By the time Lisa and Amber were teenagers, most of the other families had departed and there was only a skeleton crew left to manage the farm. It felt like a dying community, and Lisa couldn’t wait to escape it and her father’s domineering presence.

  “Hello?” Her mother’s voice pulls Lisa from the memories.

  “Hey, Mom.”

  “Lisa!” says Elizabeth Dyer, whom most people know as Beth. “How are you?”

  “I’m good. Fine. Very busy at work right now.”

  “I can only imagine.”

  For a moment, Lisa considers telling her mom about the meningitis outbreak. But she realizes it will mean little to her and probably only lead to an argument. Her mother has never been as vehemently opposed to Western medicine as her father is, but she would never defy his opinion, either. Beth doesn’t so much share her husband’s views as she absorbs them for her own. Lisa has come to see her mother as more of a disciple than a wife. As a teenager, Lisa vowed to never let a man dominate her in the same way, but sometimes she wonders if she hasn’t ended up with a partner who’s just as obstinate as her father.

  “How’s Dom?” Beth asks, as if reading her daughter’s mind.

  “He’s all right,” Lisa says. “You know how it is, Mom. There are ups and downs in every marriage.”

  “I suppose,” Beth says, sounding unconvinced. “But you two are hanging in there? Working things out, I hope.”

  “We’ll be fine,” Lisa says, opting to bend the truth. “How are things on the farm?”

  “Busy. We’re still selling corn, literally by the bushel.”

  Lisa clears her throat. “And Dad?”

  “Your father goes nonstop. Almost seventy, and he hasn’t slowed one iota.” She hesitates. “He would love to hear from you sometime, darling.”

  “OK. I’ll call him soon,” Lisa lies again. “I’ve only got time to catch up with you today.”

  “You’re not calling with… news, are you?”

  “What news?” Lisa asks, fully aware that her mother is hoping for word of a positive pregnancy test.

  “Any kind, darling. After all, you don’t call very often.”

  “Maybe I inherited that trait from you, Mom?”

  “Amber and Allen brought Olivia over last weekend,” Beth says, ignoring the barb. “That little one is growing up so quickly. She talks about you nonstop. It’s kind of adorable.”

  “Liv’s so headstrong,” Lisa says, happy
for the change in subject. “Were Amber or I like that at her age?”

  “Both of you, in a way,” Beth says. “Mainly you, though. You always needed a concrete explanation for everything. The sun, the moon, the seasons. So scientific. So skeptical of anything spiritual or faith-based. I’m not surprised you ended up as a doctor.”

  There’s no judgment in her mother’s tone, but no praise, either. Lisa doesn’t understand why she still seeks her mom’s approval, but she does. “This is the right life for me, Mom.”

  “I’m sure it is. Just as this farm is the right life for us.”

  “And Dad really is doing OK? He’s still taking his medication?”

  “Yes, darling. Every day. I promise.”

  “OK,” Lisa says. “Well, it’s good to hear your voice.”

  “Likewise. It would be even nicer to see your gorgeous face…”

  “I’m only a couple hours’ drive away, Mom.”

  “As are we, darling.”

  Lisa looks up to see Tyra standing expectantly at her door.

  “I love you, Mom,” Lisa says as she hangs up with the glum realization that there’s considerably more than a hundred miles of highway keeping her and her parents apart.

  Lisa and Tyra ride the elevator down to the conference room on the main floor in silence. Lisa wishes Angela was with them. Her friend would know how to handle the press. But she hasn’t had any updates from Angela, who hasn’t replied to the text or voice mail she sent this morning.

  The room is as noisy and full as Lisa expected. Each of the forty or so chairs is occupied. A few reporters are forced to stand alongside the cameramen and photographers in the aisles. Along with a whiff of body odor, Lisa picks up on an unsettled vibe. She senses the room could turn on her quickly.

  The noise only dims when she steps up to the lectern. She introduces Tyra and herself and then reads verbatim the brief press release, which officially announces the launch of the vaccination campaign. Looking up from her notes, she says, “The first vaccine clinics will open tomorrow morning at nine o’clock. We will publish the list of other sites and schedules on our web page and other social media sites. To reiterate, we are offering the vaccine to anyone between the ages of ten and twenty-five. We’ll take a few questions now.”