The Best American Magazine Writing 2020

by Sid Holt

  So how many children died as a result of Dengvaxia? That remains a controversial question. Sanofi’s answer: “There is no clinical evidence that any reported fatalities were causally related to vaccination.”

  While the PAO has been publicizing every “Dengvaxia” death and autopsy, a DOH-sanctioned task force has been quietly reviewing cases of Dengvaxia recipients who have died. Of the 891,295 individuals vaccinated in the government program, there had been 315 deaths as of October 25, according to the DOH. And 41 of those cases were due to dengue. (There have been a total of 6,171 cases of dengue and 124 severe dengue among those vaccinated.) While the work is ongoing, DOH says that at present it has not directly linked any deaths to Dengvaxia itself, as the PAO asserts or to “severe” cases of dengue precipitated by the vaccine, as Sanofi warned about. As for the 41 deaths due to dengue, there is currently no clear way to determine if they were related to the immune-enhancement effect according to the DOH and the WHO.

  As for the number of people who may die from dengue without the protection of a vaccine, well, that too is unknowable for now—but the number is likely to be many, many times larger.

  “You’ve got a vaccine against this disease, which has an enormous public health burden. The population benefit is clear, but there are a small number of people who would be exposed to more severe disease,” says Jeremy Farrar, the director of the Wellcome Trust, who cochaired the SAGE committee that recommended Dengvaxia’s use in 2016.

  “There are people that argue the public health benefits are the most important issue, and the numbers are hugely in favor of vaccination,” he adds. That said, many people, Farrar included, believe there is an obligation to test prior to vaccination if it’s possible to identify those at risk. To not, many point out, is a violation of medicine’s do-no-harm principle.

  The seemingly easy answer is to give Dengvaxia only to those who are not at risk of harm, as in those who have suffered a previous dengue infection. This is not an easy thing to do, though.

  An estimated three-fourths of dengue infections are asymptomatic—meaning the majority of people who get dengue will never know they had it. There are tests that can tell you, but they are relatively expensive, not sufficiently accurate (they can’t reliably distinguish Zika from dengue, for instance), and can take labs days or weeks to process. That’s not a feasible solution for a government that hopes to protect its population against an epidemic.

  And that’s precisely what the Philippines’ dengue outbreak became this August. The escalation forced a short-lived and somewhat awkward national conversation: Was it time to bring Dengvaxia back?

  Many in the medical community thought so; the vaccine could be used responsibly and benefit many in the private market. There also seemed to be demand—a smattering of Filipino celebrities and politicians had made news by visiting Singapore and Thailand for dengue inoculations.

  Despite the cases the government had filed over Dengvaxia-related deaths, President Rodrigo Duterte expressed openness to the possibility. Though he had been silent on most Dengvaxia matters, he told reporters he trusted that local experts knew what to do.

  The Health Department didn’t reinstate Dengvaxia’s license, but in mid-August it said Sanofi Pasteur could reapply, which the company is in the process of doing. Jean-Antoine Zinsou, Sanofi Pasteur’s general manager in the Philippines, expresses confidence that the product will be back eventually.

  This year’s epidemic, meanwhile, has proved worse than any before in the country, with some 360,000 cases and 1,373 deaths through September. Among the infected was Duterte’s teenage daughter Kitty, who had reportedly received Dengvaxia. She was hospitalized in October but made a full recovery.

  A Brief History of the Dengvaxia Scare

  1993: French pharma giant Sanofi begins its pursuit of a dengue vaccine.

  2009: Still years away from launching the vaccine, Sanofi builds a $398 million plant outside Lyon to produce it.

  2011: Sanofi begins its two Phase III trials of its vaccine, involving 31,000 children in ten countries.

  December 2015: Now named Dengvaxia, Sanofi’s vaccine wins first approvals in Brazil, Mexico, and the Philippines.

  February 2016: Eminent researchers Scott Halstead and Philip Russell publish a paper in Vaccine arguing Dengvaxia should not be given to people who have not had a previous infection.

  April 4, 2016: The Philippines launches the first-ever public vaccination program against dengue, targeting one million schoolchildren.

  April 15, 2016: The World Health Organization recommends Dengvaxia for highly endemic dengue countries.

  November 29, 2017: Sanofi issues an “update” on Dengvaxia, recommending the vaccine no longer be given to people who have not had a previous dengue infection.

  December 2017: The Philippines suspends its Dengvaxia program as well as Sanofi’s ability to sell the vaccine in the country and calls for a refund from the pharma company.

  March 2019: The Philippines’ Department of Justice indicts twenty individuals, including six Sanofi executives, for their roles in the Dengvaxia immunization program.

  August 2019: The Philippines declares a dengue epidemic. President Duterte says he’s open to a return of Dengvaxia.

  Jordan Kisner

  Las Marthas

  The Believer

  FINALIST—FEATURE WRITING

  “Two months after hearing a story about the borderlands debutante ball where Mexican American girls dress up in full period costume and pretend to be Martha Washington, I arrived in Laredo from the north,” writes Jordan Kisner in “Las Marthas.” She is there, in “a city that’s American on its north side and Mexican on its south side,” to witness the Martha Washington Colonial Pageant and Ball. But she is also there to explore what she describes as her own “in-betweenness,” both as the daughter of an “undetermined WASP mix” father and a Mexican American mother and as a woman “in love with a woman.” The National Magazine Award judges said that Kisner writes “with humanity and wisdom as she considers the complexities of ethnicity, femininity, identity and class.” A nine-time National Magazine Award finalist, The Believer was founded in 2003 and is now published by the Black Mountain Institute at the University of Nevada, Las Vegas.

  The dresses take a year to sew, and the girls spend a year learning how to wear them: how to glide, how to float their arms out so they never touch the skirts, how to hold their heads under the weight of the coiffure. The look is Marie Antoinette in her let-them-eat-cake days, and the dresses, like Marie’s dresses, weigh so much—up to one hundred pounds—that they hurt the girl. They leave bruises at the shoulders and hips where the dress bones pull down on girl bones. The dresses, like the gestures, are passed down from mother to daughter.

  Each girl needs five dressers, who first lace her into her corset, then affix the “cage” of the hoop skirt to her waist, sneaking a pillow between the cage and her body so her skin isn’t rubbed raw. Then come petticoats, and the dress on top. The dressing occurs over a tarp with a hole cut into its center, and once everything is in place, the women pick up the girl and the tarp together and walk her to the stage so that the dress never touches the ground. If it is raining, they wrap her in plastic too.

  When she walks, she takes the smallest steps possible so she appears to be borne along on a current of air. Large steps make the giant hooped skirt slap back and forth, and, anyway, a stately, exhibitive gait is key. Her arms remain at attention, hovering lightly above the hips of the dress, elbows soft, wrists tilted, hands in the Barbie claw. These subtle positions are a staple of the contemporary pageant: the ritual gestures, all bodies made to form the same shapes—back rod-straight in the corset, head erect, smile mannered.

  For the girls, the hardest task is the curtsy, learning to sink to the floor gracefully and then rise again as if the monument on their hips were only a trick of light. They teach me to do it in a little group in the salon, all of them laughing in flip-flops and sweatpants with their toenails an
d lip liner already done. You go slowly onto one knee, they explain, and then, while remaining motionless from the waist up, tuck the other knee underneath for extra support. Slowly, we sit down and back on our heels and bow magisterially over our imaginary skirts, keeping our chins up, up, up until the last moment, when we finally accede to the skirt, turning the right cheek. It looks in this final phase like the girl is cocking one ear to her dress, listening for what’s underneath.

  Why? I ask. Why is this the bow?

  They shrug. It’s always been this way. That’s how they taught it to us.

  * * *

  There are many debutante balls in Texas and a number of pageants that feature historical costumes, but the Society of Martha Washington Colonial Pageant and Ball in Laredo is the most opulently patriotic among them. In the late 1840s, a number of European American settlers from the East were sent to staff a new military base in southwest Texas, a region that had recently been ceded to the United States after the Mexican-American War. They found themselves in a place that was tenuously and unenthusiastically American. Feeling perhaps a little forlorn at being so starkly in the minority, these new arrivals established a local chapter of the lamentably named Improved Order of Red Men. (Members of the order dressed as “Indians,” called their officers “chiefs,” and began their meetings, or “powwows,” by banging a tomahawk instead of a gavel.)

  The Improved Order of Red Men fashioned itself as a torchbearer for colonial-era American patriotism, and its young Laredo chapter was eager to enshrine that culture down at the border. So it formed the Washington’s Birthday Celebration Association (WBCA). For the inaugural celebration, in 1897, they “laid siege” to the Old Laredo City Hall, pretending to be a warring native tribe conquering the city. (The optics here must have been confusing, as the order was made up of white men, while most of the city’s residents were either Mexican by birth or indigenous.) A young woman was appointed to play Pocahontas, and after brokering peace between the tribe and the city, she received the keys to Laredo in appreciation of her efforts.

  The siege was done away with long ago, but every February since 1898, the WBCA has thrown a massive festival—America’s largest, most elaborate party for its first president. Lately, the festival includes a Comedy Jam for George, a Founding Fathers’ 5K Fun Run, a Jalapeño Festival, a Princess Pocahontas Pageant and Ball, an Anheuser-Busch-sponsored citywide parade, and so on. The prestige event of the season is the pageant and debutante ball hosted by the Society of Martha Washington, which was started by WBCA wives in 1940 with the aim of adding glitz to the festival. Their daughters dress up in what is creatively imagined to be Martha-like attire (in fact, the dresses are not much like what Martha Washington would have worn), playacting historical figures who might have known her. Each year, one adult Society member is chosen to play Martha herself, and a man from the WBCA is asked to play George.

  The WBCA was started by members of Laredo’s mostly white upper class, but in the almost one hundred years since the association’s founding, the city has become almost entirely mixed-ethnicity: on the 2010 census, 96 percent of the population identified as Hispanic. Through intermarriage, the upper class of Laredo has come to include not only the Lyndeckers and the Bunns (two original WBCA families still prominent in the Society) but also families named Rodriguez, Gutierrez, Martinez, and Reyes. Today, Martha, George, and the girls are mostly Mexican Americans. Many of them descend from the original WBCA families, but just as many are descended from the people who were categorically oppressed—and, in several instances, massacred—by an American colonialist expansion set in motion by the Founding Fathers they dress up to honor.

  In Nahuatl, there’s a word for in-betweenness: nepantla. The Aztecs started using the word in the sixteenth century when they were being colonized by Spain. Nepantla means “in the middle,” which is what they were: between a past they wrote themselves and the future that would be written by their conquerors, in the middle of the river between who they had been and who they were allowed to be now. Twentieth-century theorists have used the word shattered to describe the liminal existence of nepantleras, indicating both brokenness and the possibility of making something radically new. The word has also been used to describe the borderlands experience, the mixed-race experience, the experience of anyone who lives both in and outside their world of origin. As Gloria Anzaldúa wrote, nepantleras are “threshold people.”

  Two months after hearing a story about the borderlands debutante ball where Mexican American girls dress up in full period costume and pretend to be Martha Washington, I arrived in Laredo from the north. I’d flown into San Antonio, where my grandmother lives, and driven the 150 miles of interstate down to the border. When I checked into my hotel, the front desk attendant warned me not to miss the last exit on the freeway. If you don’t get off at the last exit, she said, there’s no turning around and you’ll wind up across the border in Nuevo Laredo and need a passport to get back. “It’s OK,” I assured her. “I’m from a border city too.”

  Laredo and Nuevo Laredo are often described as neighboring cities, but geographically they are one city, the Laredo–Nuevo Laredo Metropolitan Area, bisected by the U.S.-Mexico border and the Rio Grande. It’s a city that’s American on its north side and Mexican on its south side. The river is narrow as a straight pin at this portion of its journey from Colorado to the Gulf of Mexico, and only fifty yards across. It’s a city of bridges: there is the Juárez-Lincoln International Bridge, the World Trade Bridge, the Colombia Solidarity Bridge, and the Gateway to the Americas Bridge, all roughly a thousand feet long. Thousands of people cross from one place to the other each day, to work or to school or to see family. Laredo’s adopted nickname is “the Gateway City,” though the border is tightly regulated. Of the major ports for trade, trafficking, and immigration between the United States and Mexico, Laredo is among the very busiest, often outranked only by San Diego, where I am from.

  In this country, major border towns share some common features. They contain armies of immigration and customs enforcement officers; if you drive down near the border, you’ll see ICE vehicles ferrying migrants between detention centers. Everyone knows people who are undocumented, which lately means that everyone knows someone who has vanished without warning or notice. The radio traffic reports always include estimates for the delays at each of the crossings. And then there’s the fence.

  Unlike Laredo, San Diego County remains majority white and segregated in ways designed by city planners and codified by city councils decades ago. Speaking generally, white and affluent people—categories that blur in San Diego—populate the west and north of the county, the parts that have the beaches. While all the beaches in California are public land, people who own beachfront property own the views of the ocean. They own the right to see horizon. With some exceptions, lower-income families, immigrants, and most Mexican Americans live to the south and east, on the sides of the county that face the desert and the border.

  I was a teenager when I first went to the beach at Border Field State Park with some friends and we wandered until we ran into the fence. I was startled to see the wooden posts jammed deep into the sand and extending out into the ocean. I’d never known that the border went beyond the water’s edge. This reveals more than I wish it did about the teenager I was and the city I lived in.

  But every Easter, we would travel as a family to Mission, Texas, which is a border town an hour southeast of Laredo, farther down into the Valley, as Texans call it. Hidalgo County—which contains Mission, where my great-grandparents lived, where my grandparents were raised, and where my mother spent long periods of her childhood—is consistently ranked among the poorest counties in the United States. My earliest memories of Mission are of my great-grandmother Carmen Garcia, whom everyone called Grandma Carmen; billboards with letters missing; a dusty pickup with its bed full of watermelons.

  All the Garcias would gather each Easter at my great-grandparents’ house. There were always so many people th
at we’d have to go to a park for a proper picnic—aunts and uncles, second and third cousins, in-laws, and dozens of grandchildren. It is a tradition among Mexican families in South Texas to do the Easter egg hunt with cascarones, eggshells that have been hollowed out, filled with paper confetti, and resealed with colorful tissue paper. Once the children had hunted down all the cascarones, there’d be a smashing melee, where everyone ran around and broke the eggs over one another’s heads so the confetti exploded in showers around you, settling into your hair and sandals. At the end, everyone would be in stitches, and inevitably one child would be bawling and the ground in that corner of Mission would look as if a parade had blown through. As a child, I spent a lot of time playing in the colorful, littered dirt of that park and understood it to be, in some important ways, dirt that belonged to me, and me to it.

  Still, I always felt slightly out of place in Mission. My father is a somewhat undetermined WASP mix by way of New Jersey, and when I was young I looked mostly like him. The last time we went to stay with Grandma Carmen, I was a teenager, and I spent the whole time feeling pale and giant. There’s a photo of us standing outside her front door: Grandma Carmen and my brother and me. He’s thirteen and I’m fifteen, and next to us she looks like a child, not even five feet tall, barely ninety pounds. My brother looks plausibly related to her; I look like a guest. We didn’t talk much, but she would grasp me by my arms and peer into my eyes and smile. I remember her in her kitchen, holding my mother’s hands and laughing, saying, “Mi’ja, no sé lo que les gusta comer.” Always, we would get on a plane and fly back to the ocean.

  * * *

  I met 2018’s Martha Washington at a strip mall in north Laredo, where we had agreed to have lunch between her nail appointment and her hair appointment. The Martha, a blonde woman in her fifties named Tami Summers, was two days away from concluding her duties.