She looked up for a moment, giving Becket and Michael the opportunity to comment. Both remained silent. ‘Okay, the President had the following questions. One, why aren’t we carrying enough vaccine stock and why don’t we at least start up mass production right now so as to be ready for a worst-case scenario. Gentlemen?’
Michael indicated that the CDC Director should go ahead. Becket took a deep breath. ‘Suddenly starting up vaccine production all over again would be a disaster, Toni. First off, far too many people would need to know about it. More important, I come back to the point that the way to deal with this thing isn’t vaccinating everybody and his dog. It’s identifying any cases real quick, quarantining patients, and vaccinating everybody who’s likely been in any kind of close-up contact. The one thing we have going for us is that smallpox isn’t like in the movies – it really isn’t easy to pass on. You’ve more or less got to be up close and personal for some time. We’re talking face to face. And it isn’t infectious at all until it becomes pustular, twelve days or so after being contracted. So we might be able to contain it if we’re really ready and on full alert. Problem is, the more you do to get ready for something like this, the more likely you are to trigger a panic.’
Warren Taylor raised a slow hand. ‘And I have to tell you there’s probably another reason we might not want to go down that route.’ He paused for a long moment. ‘Having consulted with Defense on this, with great discretion I assure you, it appears there’s very little doubt the Soviets would see starting up vaccine production as a hostile act.’ Seeing the lack of comprehension in the eyes of Toni Restelle and Bill Marriot, he looked for support to the two medical men across the table. ‘If I have this thing right, gentlemen, the biology of vaccination can be turned right around to make modified viruses that one side would be protected against but an enemy would be vulnerable to. In other words, biological weapons.’ He waited for the confirmation nods from Becket Bradie and Michael Lowell, then continued: ‘The Soviets would likely assume we’d been lying about bio-weaponry all along, just like they have. Might even tempt them to start getting ready what they deny they’ve got but we know they’re sitting on. And that includes several tons of some kind of smallpox virus stockpiled at Zagorsk. Maybe even a vaccine-resistant strain. We don’t know. At the very least, I think we can safely say it would blow all agreements out of the water. And of course we’d lose any chance we might have of getting them to agree on mutually verified destruction of stocks.’
There was silence around the table for a few seconds before Toni Restelle restarted the discussion.
‘I’ll refer the President to you on that if necessary, Warren, but for both reasons let’s agree to exclude that option. Becket, do we have enough vaccine to do this ring-immunization thing without restarting mass production?’
Becket again glanced at Michael. ‘We have about fifteen million doses in stock at the CDC, so, yes, I’d say we ought to have enough in the short term.’
The Chief of Staff looked across the table, searching his face for any sign of uncertainty. ‘And if the President asks what happens if there’s an outbreak in New York or San Francisco?’
‘Same answer. ID every case within a few days and get the cavalry in place.’
‘And we can be ready to do that?’
‘In theory. As I said, every health department official already has access to a CASE manual. But it’s been a few years since the plans were put in place and we’d need to think about running some kind of refresher course. We might be able to do that while still saying it’s just a routine readiness exercise, but we’d have to go carefully.’
Toni Restelle absorbed the information. ‘Seems to me there’d be no harm in getting that particular ball rolling right now, but we’ll come back to it. Next, the President wants to know if the US armed forces are immunized.’
Becket Bradie indulged in a grim smile. ‘The armed forces and everybody else likely to be in the firing line are still getting their shots. And they’ll continue to do so as long as Moscow refuses to stop vaccinating the Soviet military.’
The Chief of Staff turned to Michael. ‘The President also asked about international implications. Dr Lowell?’
Michael looked up at the woman who was preparing to brief the President and who still had not taken a single note. ‘What happens if the virus gets released from some kind of atomizer at JFK, or on a 747 headed for Paris?’ He paused to let the implications sink in. Then answered his own question. ‘What Becket says about the US would still apply. The answer would still be ID and surround. But it would be way more difficult. Most places have shut down routine smallpox vaccination and there are only twenty-or-so countries that still have vaccine in stock. So maybe about a hundred million shots worldwide with no way of knowing if they’re still potent. Plus which the WHO has sixty-eight million shots stored in Geneva and another six million in Delhi. Not enough to cope if anything went seriously wrong. And then you have to think about the increase in international travel and a new generation of public-health officials who mostly wouldn’t recognize a case of smallpox if they saw one. Just to remind you, it has to be ID’d within a very few days. So the short answer is, we’d be in big, big trouble. Most countries don’t have anything like the public-health infrastructure of the US, and most of them would probably be reluctant to restart expensive nationwide surveillance programmes unless there was a compelling reason. If we were to suggest a compelling reason, it would likely trigger panic. And a panic would most likely result in a wrong deployment of limited vaccine stocks, making things a whole lot worse. It would also be a big setback when we’ve persuaded just about every country that smallpox has gone and they can stop vaccination.’
‘Beck?’
‘I agree. Nothing to add.’
Toni Restelle leaned back in her chair. ‘Anybody got any good news I can give the President, or shall we all just put our hands together and say a short prayer for the messenger?’
41 | The cards face up
Over the next half-hour, the Chief of Staff struggled to keep the discussion from sinking axle-deep in technicalities. And, when fresh coffee arrived, she collected up the papers still lying on the table and suggested they take five minutes to stretch their legs before entering the final hour of the morning.
Michael opened the French windows and stepped out on to the balcony, blinking at the sudden glare from the lake. Directly below, a young couple were ice-dancing under a perfect blue sky. Captivated for a moment by the perfection of the scene, he eventually forced himself to raise his eyes to the Shawangunk hills, planning the intervention he had hoped somebody else would make.
Toni Restelle was tapping her spoon on the side of her cup. ‘Okay, gentlemen.’
When they were all seated again the Chief of Staff returned the spoon to the saucer. ‘Okay, we have three-quarters of an hour. Let’s back up aways, get some kind of an overview. Broad outlines of options. Dr Bradie?’
Becket stared out of the window for a moment, collecting his thoughts. ‘Tough it out. President hits the networks. Tells it like it is. Stay calm and co-operate with the health authorities. Government has this thing in hand. Health services prepared. Give ’em the facts. Smallpox can’t be passed on by casual contact. Vaccination can protect even after the event. Need for everybody to be alert to symptoms. Respect any quarantine arrangements. US won’t give in to blackmail. Terrorists got it wrong if they think they can intimidate the administration. American people not easily panicked.’
Toni Restelle absorbed the line of argument, then turned to Michael. ‘Dr Lowell?’
‘It’s an option. For the US. But is every health authority really prepared, Beck? Every first responder, every walkin clinic? They’ve probably all got the manual on a shelf somewhere, but when’s the last time they looked at it? Plus which, you brief hundreds of thousands of health personnel to look out for signs of variola and you’re going to have tens of thousands of paediatricians, physicians, clinic staff, auxiliaries, nurses
, ambulance crews, all of them calling in the cavalry for every case of chickenpox. So getting ready to ID any case anywhere within a day or two is going to have to be some remarkable effort. And, like we said, the more intensive it is, the greater the likelihood of provoking a panic.’
The Chief of Staff kept her eyes on Michael. ‘And globally?’
Michael sighed. ‘We could attempt the same, like we did in the Seventies. But it’d be a whole different ball game. International travel’s been increasing at a rate. Same goes for domestic travel, commuting, people working in large air-conditioned buildings. And I should also point out that the whole surveillance infrastructure’s been wound down since eradication – routine immunization stopped, sentinel sites decommissioned. Most front-line health personnel wouldn’t recognize smallpox. From a global perspective, we’d have to hope it was just the US.’
Bill Marriot was about to protest this when the Chief of Staff interrupted with another glance at the clock. ‘Other options?’
There was silence around the table. ‘Warren?’
Warren Taylor, who had hardly spoken all morning, stared thoughtfully at the polished surface of the table, allowing a few more seconds to elapse. ‘There are maybe a couple of other options we haven’t considered. First is – do nothing at all.’ The others looked up to see if the suggestion was serious. The National Security Adviser looked at each in turn. ‘Like Mr Marriot here says, these people aren’t deranged.’ He gestured towards the papers on the table. ‘They don’t come across like loony-tunes. And what they’re about is protecting kids, not killing people. Chances are, they’re not contemplating releasing the virus. They’re hoping the threat will be enough. Wanna take the risk, we could just sit on our fannies, call their bluff.’
Toni Restelle considered the suggestion in silence for a moment or two. ‘It’s an option, Warren, but it’s a pretty big call. Even if they don’t intend to go all the way they might well be prepared to carry out what they’re threatening right now, which is to go public. And from the Administration’s point of view …’
Warren Taylor shrugged. ‘Yeah, they might go for second base.’
Toni Restelle looked slowly around the table, inviting other contributions.
Michael breathed in deeply, staring at the papers on the table. The moment had come. The silence seemed suspended in time, the world stilled, save for the maddeningly slow back and forth of the pendulum in the grandfather clock. But as he was about to look up and catch Toni Restelle’s eye, Warren Taylor intervened again.
‘There is of course one other option.’
In the long moment that followed it dawned on all around the table what that option might be. Several more seconds passed. Michael relaxed his shoulders just a little.
‘I realize it’s an unwelcome thought.’ Warren Taylor allowed time for another pause, taking his time. ‘A heretical thought to some, I would imagine. But it seems to me we should set out the full deck and leave it to the President to make the call.’ The National Security Adviser paused, offering an opportunity for anybody else to come in. Becket Bradie leaned his elbows on the table. ‘I must admit I was working around thataways, too. So long as we’re running through options.’
Bill Marriot could contain himself no longer. ‘Let’s have the cards face up here. You guys want the Government of the United States to consider giving in to blackmail?’
Warren Taylor chose to reply in the same slow, quiet voice. ‘I’m proposing we take just a moment to look at the practical consequences of such an alternative, Mr Marriot.’
Michael stared up at the portraits of the Smiley family on the wall. To the right, through the closed French windows, the skaters were still making fleeting appearances out on the lake.
‘Just to give this a little context’ – Becket also ignored Marriot’s attempted interruption – ‘let me point out that these people, whoever they are, are not trying to force the US into anything it’s opposed to. There isn’t a thing in that’ – he waved a hand at the papers lying in front of the Chief of Staff – ‘that the Government of the United States doesn’t already support. Matter of fact, there isn’t a thing in it that it’s not already signed up to.’
Bill Marriot glared his incredulity. ‘What’s that supposed to mean?’
Becket’s expression implied that the answer ought to have been obvious. ‘It means that what’s being demanded here is actioning a commitment the US made when we voted in favour of UCI at the World Health Assembly.’ Seeing the frowns around the table, he glanced across the table at Michael.
Michael spoke quietly. ‘Universal Childhood Immunization. The World Health Assembly adopted it as a target to be reached by the end of the 1980s. The US voted for it, along with ’most every other government.’
Bill Marriot slapped the table. ‘So what? These resolutions don’t mean diddly. But now we suddenly think we might get around to doing something about it?’ He turned to Toni Restelle, looking for support. When none was forthcoming he held up both hands, as if to stop proceedings. ‘Let me ask this again. You wanna recommend to the President that the Government of the United States gives in to blackmail?’
Warren Taylor looked up from the table. ‘I repeat, we’re talking about setting out options, Mr Marriot. And, while you could of course call it giving in to blackmail, you could also call it doing what we said we’d do. You could call it doing something in practice that we’re committed to in principle. And I guess if you were really having a good day you could also call it doing what’s right—’
‘So what?’ Marriot’s anger now spilled over the rim of protocol. ‘These guys can wear as many white hats as they like, they’re still a bunch of terrorists trying to blackmail the US—’
Warren Taylor carried on in an even voice as if there had been no interruption. ‘… And I guess if you happened to be so disposed you could also call it the United States of America leading the way towards what many might see as a great humanitarian achievement. As someone said, we’re quite aways here from your usual kind of terrorist threat …’
Marriot ignored a warning look from the Chief of Staff. ‘What you’re forgetting, if I might say so, sir, is what all appeasers forget’ – ignored also the slight narrowing of the National Security Adviser’s eyes – ‘You give in to these kind of threats and the bastards come back for more. Always. Always. Anyone who’d pull a stunt like this isn’t going to stop here. And the next time they have an even tighter grip on your balls because you can’t ’fess up that you caved in the last time around.’
Toni Restelle looked at her watch. ‘I hear what you’re saying, Warren, but Bill has a point. White hats or not, there’s a big principle in the pot here.’
Warren Taylor gave her a look that might have been taken as fatherly but was also respectful. ‘I wouldn’t argue with that, Toni. Whether it’s an absolute, now, is for the President to say. Thing like this – in my experience we’re usually looking for the least bad way to get ourselves out the other side, not some principle that sets a shining example for all time.’
Toni Restelle conceded the point and turned to the others. ‘Let’s run with it two more minutes. Anybody else? Dr Lowell?’
Michael tried not to let his face show the speed his mind was moving at as he decided to address Marriot. ‘Not really a medical point, but I don’t think we need necessarily see it as giving in, or at least not all the way.’ Bill Marriot looked up with some suspicion as Michael continued. ‘Mr Marriot’s people seem to have been given nothing at all to go on. And I’m not sure how much more help Beck and I can give. Even so, I’d back his people to find whoever’s behind this thing if the time scale was two years instead of two weeks.’
Bill Marriot, mollified without wishing to be, said nothing. Becket Bradie eventually broke the silence. ‘I think maybe I’d like to add something here. Seems to me there’s got to be at least a possibility that, if we go with this, it just might be the last we hear of it. At least for the rest of the decade. And even suppo
sing they do come back for more, like Mr Marriot here says, we wouldn’t be in any worse position than we are now.’
‘What would it cost?’
It took a moment or two for Toni Restelle’s sudden change of tack to register, and Michael became aware that both the Chief of Staff and the National Security Adviser were looking to him for an answer. He paused only for a moment. ‘The bottom line here isn’t dollars and cents. What’ll make the difference is the muscle the US can put behind it. Anything like eighty per cent vaccination coverage means governments getting serious, not just making speeches and buying in a few more air-conditioned Jeeps. And not just today’s governments. Incoming administrations as well, at least for the next few years. Some of them are going to want to get on with the job of their own accord and they’ll welcome all the help they can get, and others are going to need pushing every step of the way. You can always get a minister of health or a provincial governor to say he’s on board, but nothing really happens unless their political masters make it clear it’s for real – that it’s more than just another paper priority. It’s when the funds are there waiting to be drawn down, when the logistical difficulties are made to disappear, when the Cabinet insists on a monthly progress report, when it’s spelled out that jobs are on the line – that’s when you get action. It isn’t only or even mostly about the money, it’s just as much about keeping feet to the fire.’
Toni Restelle glanced first at Warren Taylor then back to Michael. ‘I hear you, Dr Lowell, but for present purposes I still need a figure. Bottom line for Uncle Sam.’
Michael met her eyes. ‘Whoever these people are, they’ve done their homework. The figure in that statement is in the right ballpark. Five or six hundred million a year for the rest of the decade. For the US, I don’t know. Depends on how much other countries could be persuaded to chip in at some kind of pledging conference. But’ – and Michael at this point looked deliberately from one to the other of the officials around the table – ‘I’m not going to apologize for coming back to this. In the end it would come down to political leverage, and very probably some heavyweight leaning on governments that were all talk and no action.’
The Kennedy Moment Page 24