by Daniel Kalla
“On the outbreak front, we tracked down the source of the Bellevue cases. But it’s not very reassuring.” Lisa goes on to explain about Nicola, the asymptomatic carrier who was too frightened to take her post-exposure antibiotics. “There could be several others like her out there, noncompliant with the treatment.”
Nathan groans. “Carrying that bug around like a time bomb, huh?”
“Yeah,” Lisa says. “As far as Neissovax, I think the campaign has gone as well as can be expected. With today’s clinics, we’ve vaccinated almost fifteen hundred people.”
Fiona tilts her head. “But twenty-four adverse events have already been reported on your website. That’s substantial.”
“Nothing we didn’t expect. I’ve gone through them all. Most are just pain and swelling at the injection sites. A couple of them seem like kooks, frankly. Only one genuine allergic reaction, and it was minor.”
Nathan takes a long swig of beer, which tastes particularly satisfying. He’s aware that his fear of the reporting site has begun to verge on paranoid; he spent hours in bed last night with his laptop, carefully reviewing each reported reaction, looking for any hint of possible trouble. So, while they’re nowhere near out of the woods, the relief is profound.
“We just heard this afternoon about another infection in Bellevue.” Lisa’s expression darkens. “This girl is only six.”
“How’s she doing?” Fiona asks.
Lisa just shakes her head.
With a quick glance to Fiona, Nathan says, “We’ve been discussing your request with the head office, Lisa.”
“And?” she asks.
“Delaware is prepared to lower the minimum age of eligibility to six years old.”
“That’s great news. Thank you.”
“Don’t thank me.” Nathan nods to Fiona. “This one convinced us.”
Earlier that afternoon, Nathan was shocked to hear Fiona suggest they go along with the proposal. He had expected her to be even more opposed to it than he was. Instead, she argued that aside from live virus vaccines, such as the one against measles and mumps, most other vaccines like Neissovax contain only partial proteins and are safe for children as young as infants. She reasoned that including younger kids would be unlikely to increase Delaware’s risk or exposure any more than where it already was.
Nathan didn’t require much persuading. He’d already come to realize how poor the optics of Delaware blocking access to its product while younger children were dying would look under growing media scrutiny.
Lisa turns to Fiona. “Thank you. I really appreciate your support on this.”
Fiona raises her glass in another toast. “In for penny, in for a pound. Right?”
“What’s in that Chardonnay?” Nathan motions to her glass with a chuckle. “I don’t even recognize you today, Fee.”
Fiona’s features harden. “Don’t get me wrong, I still think this launch—while maybe well intentioned—is premature. But that bridge is burning way behind us now. And statistically speaking, younger children are less likely to have adverse reactions, such as severe allergies, than older kids or adults.”
“Agreed,” Lisa says.
Fiona points her finger at her. “But what happens when a baby comes down with this meningitis? Are you going to expect us to vaccinate infants, too?”
Lisa turns her head and gazes out the window. “I hope we don’t ever have to find out.”
CHAPTER 28
Darius Washington had assumed he was just getting a cold. The pain from the open sores inside his mouth woke him a few times through the night. He thought about getting up to swallow a couple of ibuprofen tablets but didn’t want to disturb his roommate, Jayden, a notoriously light sleeper. They’re both in the summer engineering co-op program and have to sit the same term-ending physics exam this afternoon.
Shit! I don’t have time for this today, he thinks in the morning, regretting ever going to the vaccination clinic. Always happens. Just like with the flu shot. You get a vaccine, and a couple days later you get sick.
As he struggles to even sit up, Darius realizes he’s not going to be writing any exam. His mouth feels as raw as if it had been scalded by boiling soup. And his throat stings like there are razor blades wedged inside. But his lips bother him most of all. They feel like two sausages stuck on his face, worse than any dental freezing. And he can’t control the drool that streams down onto his neck and chest.
Darius instinctively reaches up to touch his face. His fingers meet the taut, tender blisters that run all the way along his swollen lips. Fear grips him as he realizes the fluid pouring down his chin isn’t saliva but liquid leaking from those blisters.
He opens his mouth to call for help, but all that emerges is one long, barely audible croak.
CHAPTER 29
It’s a factory. Even though the gymnasium is clean, and the process runs in an orderly manner, the whole setup still reminds Max of some kind of sweatshop. Probably because he finds it all so toxic.
Max didn’t plan to stay as long as he has at this vaccination clinic. It looks no different than the other two he already visited. And they all function just as Yolanda described.
I’ve got to be careful with her, he reminds himself. Despite her gullibility and eagerness to please, even Yolanda is beginning to tire of his constant questions and requests. She doesn’t understand why he cares so much. She couldn’t, though, could she?
Max is discouraged to see the line for today’s clinic is even longer than the previous ones. But it only hardens his resolve. On the pretense of searching for someone, he moves forward relatively unnoticed until he’s standing beside a family at the front of the line. He watches intently as the nurse at the nearest desk raises a yellow-topped vial in her hand. She pops off the cap, flips it upside down, and pokes the syringe’s needle in it, withdrawing the clear liquid.
He is so focused on the procedure that he doesn’t even notice the woman beside him until she says, “Hello.”
He looks over to see Seattle’s chief public-health officer at his side. “Oh, hi.”
“You’re a naturopath, right?” she says. “You questioned me at the public-health forum. I’m sorry, I can’t recall your name.”
“Max Balfour.”
“Lisa Dyer,” she says. “Based on our last conversation, Dr. Balfour, I wouldn’t have expected to see you at one of these clinics.”
“I have a teenage son.” He shrugs. “I’m worried about this meningitis, just like any other parent.”
Her expression is skeptical. “And you’re planning to get him vaccinated?”
“I’m considering it. I wanted to understand the process for myself. To wrap my head around it.”
“Would be a big step for you and your son, wouldn’t it?”
“It would.”
“So you’re not opposed to all vaccines?”
“Not all. Vaccines have their place. Smallpox was a good example. Although the disease was naturally waning anyway.”
“It only waned because of the vaccine.” She frowns. “Smallpox used to kill one out of every seven children in the world. When we developed enough herd immunity through global immunization, the virus died out. That’s how vaccines work.”
“That’s how they’re supposed to work,” Max counters. “But they don’t always, do they? Take the tuberculin vaccine. It was meant to cure tuberculosis. But it only ended up killing more people than it helped.”
“That was a hundred years ago.”
“There are more recent examples.” He speaks louder, aware that the people nearest them have begun to listen in. “Like the Cutter incident in the 1960s, when forty thousand people were infected with polio through the vaccine that was meant to protect them from the same virus. Or the swine flu vaccine in the late seventies that caused hundreds of people to be incapacitated by that neurologic disease, Guillain-Barré syndrome, after being vaccinated against a nonexistent threat. It led to the biggest class-action lawsuit settlement in the history of m
edicine.”
“You can’t compare historical incidents to today’s standards. Quality control is far more rigorous now. By law, every single batch of vaccine is individually tested for purity and compliance.”
Max motions to the chair where a young girl is being jabbed in the shoulder. “So tell me. What’s your standard for this vaccine?”
“To begin with, it has already undergone vigorous phase-three clinical trials involving well over a thousand recipients without any concerning outcomes.”
“Phase-three trials don’t always replicate results in the real world, do they? That’s why there’s a phase four. Postmarketing surveillance. To study the real-world clinical outcomes.”
“I understand how trials work, Dr. Balfour.”
“Then you must remember the first rotavirus vaccine that came out not twenty years ago?”
She sighs heavily. “Yes.”
“It sailed through phase-three trials, didn’t it, Dr. Dyer? It was only after they started to broadly distribute it that they discovered that it caused kids’ intestines to twist until the blood supply was cut off.”
“It’s called ‘intussusception.’ And that’s an exaggeration. It was only slightly more common among the vaccinated kids but still rare.”
You people! Max struggles to hide his disgust. “I’m guessing you would view it differently if it had happened to your child?”
“And that’s why we have also set up such a rigorous surveillance system. To monitor for any unexpected outcome. Have you seen the website?”
“Yeah, I’ve seen it. Even if it does alert you to dangerous complications, it won’t help the initial victims of any serious vaccine injuries, will it?”
“That’s a big if, Dr. Balfour.”
He shrugs. “It’s a bit of a coincidence, isn’t it?”
“What is?”
“This new strain of bacteria. It’s never been seen before. Until Iceland. And now here in Seattle.”
“That’s what pathogens—especially bacteria—do. They mutate. New strains appear all the time.”
“Oh, I understand that,” Max says. “But isn’t it coincidental that it happened to mutate exactly at the same time that Delaware Pharmaceuticals was ready to market the perfect vaccine against it?”
CHAPTER 30
Lisa had to postpone the Outbreak Control Team meeting until the morning Neissovax clinics were complete. She walks into the conference room at two in the afternoon to find it fuller than any previous daily meeting since the first one. There’s a buzz of anticipation around the table that is, at least in part, fueled by the intense media coverage of the pediatric cases in Bellevue.
“Dead children,” Angela said matter-of-factly just before she and Lisa walked in together. “They tug at the heartstrings even more than dead teenagers. Great for hits and engagements online. ‘Earned media value,’ as the publicists call it.”
Despite Angela’s cynicism, Lisa is glad to have her back in her usual seat.
Lisa calls the meeting to order and advances to the second slide of her presentation. A map of Seattle appears, highlighting the city’s two geographical hot spots. “It’s day nine of the outbreak. As of this afternoon, we’ve had twelve deaths among twenty-eight confirmed cases in the Delridge area—home of the original Camp Green cluster. Meaning there’ve been only four new cases there in the past three days. But the news isn’t nearly as hopeful in Bellevue, the second cluster. We’ve had eight cases there in the past three days with two deaths, and two critically patients still in the ICU. All these victims between six and eight years old.”
Tyra motions to one of the screens. “We’re aggressively tracking and treating all contacts within both clusters with antibiotic prophylaxis.” Her professional façade momentarily gives way to a pained expression. “The girl who died this morning was only six.”
Lisa can’t help but think of Olivia. She has already studied the map and discovered that the nearest victim lived less than a mile away from Amber.
“Have we figured out how it spread from Delridge to Bellevue?” asks Benning, the insightful woman from the department of health.
Tyra nods. “The culture swabs from Nicola Ford’s nose grew meningococcus, confirming she was the one who carried it from the first cluster to the second.”
“The asymptomatic carrier,” Angela emphasizes. “Just like the boy who brought this disease back from Iceland. God knows how many other Typhoid Marys we’ve got running around this town.”
“Even more reason to accelerate the vaccination program,” Tyra says.
“And on that front, we do have some good news.” Lisa looks over to the medical microbiologist. “Dr. Klausner…”
Klausner clears her throat noisily. “We have analyzed the early post-immunization blood samples from the first group to be vaccinated with Neissovax.” She stops to clear her throat again. “We have seen strong immunogenicity within forty-eight hours of inoculation. The levels of the antibody titers against this specific Icelandic strain appear to be high.”
“That quickly?” Angela’s nose wrinkles. “Holy crap!”
“It is somewhat unusual,” Klausner concedes. “Normally, it would take weeks to generate this kind of immune response. But that does bode well for the effectiveness of the vaccine.”
“Does this mean the vaccinated kids will be immune to this meningitis?” Benning asks.
Klausner pushes her glasses back up the bridge of her nose. “We never draw clinical conclusions from lab results…”
“What a classic pathologist’s disclaimer.” Angela laughs, and then turns to Benning. “The answer is yes. Or more accurately, Hell, yes! Those who got Neissovax are now immune.”
Lisa nods. “And in light of the Bellevue outbreak, Delaware Pharmaceuticals has approved lowering the minimum age of vaccination to six.”
“I’m delighted the drug company is behind an expanded market for their product.” Moyes speaks up for the first time. “What about this committee? Do we approve it?”
“What choice do we have, Alistair?” Angela asks. “This thing is starting to ravage young’uns.”
Moyes strokes his beard with the back of his hand. “This vaccine has never been given to children under the age of ten. Not even in any of the trials.”
“Six? Ten? What difference does it really make?”
“Well, we don’t know, do we, Angela?”
Her eyes lock on to his with uncharacteristic ferocity. “We do know that kids of that age are dying. How many vaccines are you aware of that are tolerated by ten-year-olds but not six-year-olds? Are we going to let a theoretical risk stop us from protecting the group that is currently the most vulnerable?”
Ignoring Angela, Moyes turns to Lisa. “What do we know of the adverse reactions to Neissovax so far?”
Lisa advances a few slides until she reaches the one with a summary of all reported side effects. “With over two thousand doses administered, we have received forty-six reports of adverse events through our website and the hotline. None required hospitalization. None met the criteria to qualify as serious. And almost all have subsequently resolved.”
“The vaccine is safe, Alistair,” Angela says.
“So far,” Moyes says. “Two days’ worth of data isn’t enough to draw conclusions. Are you forgetting what happened with the rotavirus vaccine?”
“I don’t forget anything,” Angela snaps.
“You thought it was safe, too, though, didn’t you?”
Angela only glares back in response.
Lisa is struck again by the tension between Angela and Moyes. She wishes she understood their background better. But at this moment, she’s more concerned about focusing everyone’s attention on the necessary next steps. “We need to revise our publicity campaign to include the lower age group,” she says, nodding to the goateed publicist, who’s typing madly on his laptop. “Kevin?”
“I’ve drafted a new press release, encouraging parents to bring younger children to the vacci
ne clinics,” says Kevin. “We’ll be circulating it through the usual media and social media channels.”
“The press is going to lap that up,” the balding rep from city hall grumbles. “Seattle’s outbreak is already regularly headlining CNN.”
“Not just cable news,” Kevin says, as if almost proud of the coverage. “The big networks all covered the story last night. In prime time, too. Since COVID, this kind of story is a huge deal.”
“Do we even have the capacity to expand the program to younger kids?” Benning asks.
“The manpower, yes,” Lisa says. “In terms of supply, we calculated that the initial fifty thousand doses would be enough to cover the original demographic target of youths and young adults. But with the younger kids included, Delaware will have to ship us more vaccine.”
“This product launch just keeps growing bigger and bigger,” Moyes says.
Something in his tone and his earlier comment about rotavirus reminds Lisa of her conversation with Max. She wrote off the naturopath’s insinuations about the pathogen emerging contemporaneously with the new vaccine as little more than the musings of a conspiracy theorist. But the coincidence is undeniable. And besides, what the hell was Max really doing at that clinic? He clearly had no intention of getting his son vaccinated.
Lisa ends the meeting with the slide that lists the schedule of the upcoming vaccination clinics, and then opens the floor to a roundtable discussion. People have little more to add and quickly file out of the conference room.
Lisa’s assistant, Ingrid, is waiting for her at the door. “Your sister’s in your office,” she tells her.
“Amber?” Lisa frowns. Her sister has never visited her at work before.
Inside the office, Amber greets her with a tight hug, and Lisa picks up on a whiff of marijuana. She understands that her sister works in the industry and is a relatively regular user of weed, particularly for insomnia or stress, but she’s never smelled it on her before.
Lisa slips out of the embrace. “What’s up, Amber? Everyone OK?”
Amber nods. “I was just in the neighborhood.”