The Rationing

by Charles Wheelan

  “And Dormigen is effective against Capellaviridae?” Justman asked.

  “Yes, of course,” Yun assured him.

  “Hold on,” Tie Guy said. “We still have not established that this virus is doing the harm. For all we know, it’s an opportunistic pathogen that happens to manifest itself—”

  “Yes, fair enough,” Justman said, clearly impatient. “But whatever is going on responds to Dormigen. That’s what I’m asking.”

  “Whatever is happening responds to Dormigen, yes,” Yun said. As he answered, he reached into his jacket pocket and pulled out his phone. “Sorry, I should check this.”

  “Of course,” Justman assured him.

  Yun scrolled through a text of some sort and then ran his hand through his short hair, clearly perplexed. “Okay, this is interesting,” he said as he looked at his phone. “I’ve got someone digging into Capellaviridae. Apparently it’s just a run-of-the-mill virus, so common as to be unexceptional.”

  “What does that mean?” someone asked.

  “That’s just what he texted me: ‘So common as to be unexceptional,’ ” Yun answered. He stared at his phone in silence for a few seconds and then looked up at Justman. “Let’s take a break for a few minutes. Can we do that?” As Justman nodded agreement, Yun was already punching a number on his phone and walking out of the conference room. The participants around the table seized on the break to check devices, all eyes staring down as if it were some kind of choreographed dance. When Yun returned just a few minutes later, all eyes went immediately back to him.

  “It’s a common virus,” Yun said, sliding his phone back into his jacket pocket. “That’s why nobody has studied it. There’s really nothing to study. It’s an innocuous virus, found almost everywhere.”

  “Hardly innocuous,” Tie Guy said. This was why people did not like him; it was not just his outsized salary. He always had to be the contrarian. One minute he was arguing that Capellaviridae might not be the real killer, the next he was refuting someone who said the same thing.

  “Yes, innocuous, usually,” Yun answered sharply. “This virus is everywhere. It’s as common as bread mold.”

  “Obviously we’re dealing with a different strain,” Justman said.

  “Not that we can tell,” Yun said. He was starting to look a little flustered. More perspiration had gathered on his upper lip. “Here’s the thing: My people in the lab tested themselves, and most of them are carrying the virus. On a whim, they tested a sample of soldiers at Fort Gail, and most of them are carrying it, too.”

  “They’re all going to get sick?” the Indian-American woman asked.

  “No, I don’t think so,” Yun replied. “My best guess is that this virus is innocuous for most people, most of the time. And now, for some reason, for some people, it’s not.”

  “That’s a big leap,” Justman said. “It’s more logical that we’re dealing with a different strain.”

  “Hold on,” Yun said. “I wasn’t finished. The viruses are identical—from the victims and from my people in the lab. Indistinguishable DNA. But it gets weirder. We went back and looked at some old tissue samples that we have in the lab, ten or twenty years old. Most of them show traces of the virus, too. If I were to guess, humans have been carrying this virus around with no adverse effects for thousands of years.”

  “That doesn’t make any sense,” Justman said. A silence settled over the conference room. There was no panic, more of a puzzle. After all, Dormigen was there to handle the problem, whatever that problem might eventually shape up to be. This group was used to handling outbreaks: the flu epidemic of 2021, the Sam’s Burrito E. coli contamination, and many more exotic things along the way. The formula was the same: treat the victims, find the source. It was always just a matter of time, and Dormigen could buy whatever time they needed.

  Justman started thinking out loud: “We have a virus that is entirely innocuous, has been for decades, until it’s not.”

  “A lurking virus?” a young woman offered. Her tone suggested uncertainty, but that was likely out of deference to those around the table rather than due to a true lack of knowledge. She was a staff epidemiologist, barely out of graduate school. In this case, youth was an asset. Most of the faces around the table were blank. She continued with more confidence. “I studied them in graduate school, just a bit. They are symbiotic with the host, then perhaps there is a trigger of some sort and they become virulent.”

  Yun gave a strange head nod, not a clear yes or a no, suggesting that he was familiar with lurking viruses while simultaneously discounting the theory.

  “A lurking virus?” Justman asked.

  “The pattern looks just like what we’re seeing,” the young epidemiologist continued. “An innocuous pathogen turns deadly, then, even more puzzling, they sometimes turn innocuous again.”

  Justman was clearly nonplussed that he had never heard of a lurking virus before. “In humans?” he asked skeptically.

  “No, no,” Yun said. “Not even in rodents. Only reptiles, as far as I know. Isn’t that right?” he asked, looking at the young epidemiologist.

  “I just read one paper in graduate school. It was salamanders or frogs. But the pattern looked just like what we’re seeing,” she said.

  “What pattern?” Tie Guy interjected, prompting eye rolls around the table. “If we’ve established a pattern, I missed it. We do not have any sense of what’s going on.”

  Justman looked at his watch. “Okay, we’ve run over time. We need to gather a lot more data. I think we can agree on that. In the meantime, we should notify the folks over at HHS that we are likely to see a higher than average demand for Dormigen in the coming months. We should probably also learn more about these lurking viruses.”

  The meeting broke up, and two things were set in motion. A formal notification was sent to the Department of Health and Human Services notifying the department of a projected spike in Dormigen demand—a so-called “Kaufman notice,” named for the Congresswoman who wrote the bill requiring such notice. And the epidemiologists on the task force made some calls to inquire about the lurking virus. They called some people who called some people who called me.

  13.

  AL GOYAL, THE CHAIRMAN OF CENTERA BIOMEDICAL GROUP, was meeting with a group of Brazilian suppliers in the elegant sitting area of his office when his CFO appeared at the office door. “Al, do you have a minute?” the CFO asked.

  “We’re just wrapping up here,” Goyal said.

  “If you could just step out here for a second,” the CFO insisted. The Swedish CFO of Centera Biomedical was not a pushy guy, and because of that, Goyal’s impulse at that moment was panic. Perhaps there was a family emergency. He excused himself and walked briskly into the corridor with Swensen.

  “We just got a call from Health and Human Services,” the CFO reported. He stopped, as if that were all Goyal needed to know.

  “Yes?” Goyal asked, perplexed.

  “Health and Human Services,” Swensen repeated. “They would like to exercise their option. The Dormigen. We owe them twenty million doses.”

  “Jesus Christ,” Goyal muttered. “Why?” he asked.

  “Why what?”

  “Why do they want it?”

  “I don’t know,” Swensen answered, growing more flustered. “They don’t have to tell us that. It’s a simple contract. If they exercise the option, we owe them up to twenty million doses.”

  “How much are they asking for?”

  “All twenty million. Some of their stock was destroyed in a fire.”

  “Why do they need so much?” Goyal asked.

  “I just told you, I don’t know,” Swensen said angrily. “It’s not really important.”

  “We don’t have twenty million doses,” Goyal said, panic creeping into his voice.

  “Well, we do. We do—but it’s old,” Swensen said.

  There was some disagreement at trial over the balance of the conversation. Since Goyal and Swensen each blamed the other for ha
tching the original fraud, they also disagreed about the attempted cover-up. For the American public, it was a distinction without a difference. (The jury found likewise.) As I noted earlier, and most of the world now knows, Centera had burnished its balance sheet by keeping the old Dormigen, rather than destroying the stock and creating a new batch as the contract with the U.S. government required. Centera had more than twenty million doses of Dormigen in its warehouses,§ but every one of them was past its date of expiration.

  “Have you tested the effectiveness of what we have?” Goyal asked.

  “I was waiting for your permission,” the CFO answered. Centera policy had explicitly forbidden any testing of the Dormigen shelf life. If the drug proved effective for longer than six months, or could be reformulated to last longer, then Centera could no longer charge HHS for producing and destroying the drug every six months. More knowledge might mean lower profits.

  “Do it now. Don’t tell the lab why we need to know,” Goyal instructed.

  “Obviously.”

  “I’m sure it will be fine,” Goyal said earnestly. He really believed it. After all, the government had imposed ridiculous padding everywhere else in life. Did we really need to know that our coffee was served hot? Would drinking milk one day after the expiration date do any harm? Goyal testified that he had purchased a lawn mower with a warning telling him not to use it to cut his bushes. The expired aspirin in his cabinet seemed to work fine, year after year. What difference would a few months make for Dormigen?

  14.

  A FEW MONTHS MAKES ALL THE DIFFERENCE, IT TURNS OUT. The FDA clinical trials had clearly established that seven months was the upper bound for the effectiveness of Dormigen and six months was the maximum recommended shelf life. Unlike aspirin, or even milk, Dormigen was alive. That is what made it such an extraordinarily effective drug. Dormigen was genetically engineered—human antibodies inserted into chicken embryos—and after about six months the medicine dies, literally.

  Neither Goyal nor Swensen knew this, supposedly, which was the crux of their defense at trial. Neither was a genetic engineer; neither had any scientific training at all. In fact, not a single member of the Centera senior management had even a bachelor’s degree in one of the hard sciences. Much was made of this fact in the months after the Outbreak—“the bean counters had elbowed aside the scientists,” as the Atlantic described it. Much of this criticism misses the point, not because a science company does not need scientists in management, but because it lets the bean counters off too easy. There were thirty or forty scientists on the Centera payroll alone who could have told Goyal and Swensen that their plan would be deadly if the Dormigen doses were ever needed. Besides, one does not need a Ph.D. in virology to know that violating the terms of a contract with the federal government is a bad thing to do.

  It is technically true that Goyal and Swensen did not willfully put the public at risk. They were not fully aware of what they had set in motion. The jury found this irrelevant. As the Washington Post–USA Today elegantly put it on the day of their conviction, “Neither Swensen nor Goyal knew that the gun was loaded when they pulled the trigger. But they also never cared to ask, which is just as awful in its own way.”

  Goyal and Swensen did understand one thing: Dormigen takes twenty-one days to produce. No one had ever found a way to shorten this process, in part because there had never been any need. The process was cheap and easy and foolproof, if you have three weeks. “We have to make more,” a panicked Goyal told his CFO.

  “I’ve already set that in motion,” Swensen said. The two men were hoping the expired doses of Dormigen would still prove effective. If not, they would have twenty million new doses in three weeks. One has to give Goyal and Swensen some credit. When they found themselves in a hole, they did stop digging.

  Swensen figured, and Goyal concurred, that they could always stall the delivery to HHS by three weeks. It was the federal government, after all. There were two weekends and a state holiday in those twenty-one days. “So, worst-case, we deliver it a little late,” Goyal said, trying to reassure himself and Swensen. “Right?”

  Under normal circumstances, he would have been correct. Of course, under normal circumstances, the federal government would not need twenty million extra doses of Dormigen.

  * Yes, this is the very same firm where Al Goyal worked early in his career.

  † Again, I feel compelled to point out that this was not heroism or genius on her part. It was her job. The NIH had binders spelling out in picayune detail exactly what low-level employees (e.g., Tatiana) were supposed to do in such situations. When Amazon put her photo on every digital receipt—dressed as a nurse, for no apparent reason—with “How many lives did she save?” splashed above her sultry pose, many of us in the scientific community answered, “Probably none.”

  ‡ The detail here comes from the Outbreak Inquiry Commission hearings, during which a group of Tea Party senators were obsessed with the idea that the NIH, the CDC, and the Federal Reserve had somehow—and for some reason that I never fully grasped—colluded to cover up early evidence of the Outbreak.

  § Because Centera was trying to reduce costs by postponing the destruction of expired doses, the actual number was closer to forty million.

  PART 2

  DO THE RIGHT THING

  15.

  SO THERE WE WERE. THE SEVEN PEOPLE IN THE WORLD who appreciated the magnitude of what was happening: the President, his Chief of Staff, the President’s Strategist, the Majority Leader, the Secretary of Defense, the Director of the National Institutes of Health, and me—the person who supposedly knew more about lurking viruses than anyone else in the world. The President was sitting at his desk reading papers as we filed in. He was wearing reading glasses; I had never seen him in glasses before. I later learned that he did not like to be photographed with his glasses on because he felt they made him look old.

  There was no grand plan for this first meeting. No one spent hours figuring out exactly who should be in the room. The President convened a small group of people with relevant expertise, and, more important, whom he trusted. The Secretary of Health and Human Services should have been there, but she had become embroiled in a scandal involving her private investments in a pharmaceutical company. She would resign two days later. The Attorney General should have been involved from the beginning, but he was attending a conference in South Africa on post-conflict justice and could not be called home without attracting undue attention. The head of the Centers for Disease Control (CDC) would later claim, rightfully, that he was excluded for political reasons from the early White House deliberations. He was a holdover from the previous administration whom the President never fully trusted (mostly because he had a habit of leaking self-serving information to the press). And so on.

  Meanwhile, there were some people in the room who literally did not know the difference between a virus and a bacterium. The Majority Leader was there because the President wanted some representation from the legislative branch. He and the President had developed a strong working relationship. The Senate Majority Leader, a former funeral director from central Illinois, looked much less impressive in person than on television. He was short and fat—not middle-aged heavy, but fat. When he put on his suit jacket, one did not notice as much, but when he took off his jacket and sat down, his prodigious paunch sometimes made it hard for him to pull his chair all the way to the conference table. Funeral directors are often pillars of the community. The Majority Leader had started his political career on the school board before making the leap to the state legislature and then to Washington. He never finished college; no one in the Senate had ever confused him for the resident intellectual. If anything, he was quick to criticize the “pointy heads.” For all that, the Majority Leader was a brilliant politician, in the sense that he had a keen sense of the fears and hopes of people on the street. He was plainspoken, hardworking, and honest. In four decades of public life, he had made a lot of enemies, but no one had seriously accus
ed him of breaking his word. Neither his friends nor his enemies ever doubted that he would use every tool in the legislative toolkit: flattery, bribery (the legal kind—a stadium here, favorable tax treatment there), persuasion, and threats (never idle).

  The Majority Leader was a relatively new member of the Senate in 2024 when the final spasm of political realignment swept away what was left of the Republicans and Democrats. He was quick to jump on board with the New Republican Party, helping to shape it into the pragmatic, Main Street party that it is today. He could speak effectively, if not eloquently, about the needs and desires of small businesses and working people. “I don’t have much use for books, other than political history,” the Majority Leader told me once over a coffee break.

  How does one respond to that? I was tempted to say, “If you read more books, you might understand the difference between a bacterium and a virus.” Or that when someone mentioned Willa Cather in the course of discussion, you would not ask, “Who is he?” The Majority Leader was also a big fan of simple solutions for complex problems. He was skeptical of “fancy studies,” as if there were some logical alternative for advancing the frontier of human knowledge.

  The Majority Leader was an unabashed patriot, so much so, he said, that he never felt the need to leave our beloved country. When he was younger, he made one trip with his high school Spanish class to Mexico City. “That was enough,” he told Rotary Clubs and New Republican Party conventions. He said it in a way that made people cheer. Don’t get me wrong: He was no buffoon. You do not get elected to the U.S. Senate three times—not anywhere, not ever—without some prodigious talents. He could talk in an informed but vague way to Chicago business groups about “oppressive taxes and regulations.” He would rattle off some examples of wasteful federal spending that were both telling and humorous, such as the earmark in the farm bill to study the mating habits of potbellied pigs. That always got a chuckle. As the laughter faded away, he would say, “I can tell you how they mate for a lot less than two hundred and fifty thousand dollars!” The audience would roar again.