Then the President declared he was running as an independent—the whole “one term for one nation” campaign. The Speaker’s well-laid plans imploded. The centrist wing of the Democratic Party abandoned her for the independent Virginia senator, since he was far more likely to win the general election. Meanwhile, the New Republicans figured he was almost as good as anyone they could field, so they tossed him their support, too. And so on. Yes, the Speaker won the early Democratic primaries handily, but the polls showed her getting trounced in the general election. Rather than face humiliation, she dropped out before Super Tuesday.
After the election, the Speaker and the President tried to patch things up, but it was a superficial effort. To her mind, he was sitting in the seat that should have been hers. The animus was compounded by genuine ideological disagreements. She was coming from the California left; he was coming from the Virginia center. There was plenty of potential common ground, of course, but the first one hundred days—what the President believed should have been his honeymoon—turned into a pissing match with the House of Representatives, for lack of a more accurate description. The Speaker introduced two explosive bills, one proposing a $22-an-hour minimum wage and the other setting aside $100 billion for slavery reparations, a fund that would be dispersed (somehow) among the descendants of American slaves. Neither bill had even a remote chance of passing the Senate, but the President was forced to oppose both of them, which infuriated progressives on the hard left. The Speaker clearly designed the whole effort to strangle the President’s support among her progressive base, and she succeeded brilliantly. To what end? That is what infuriated the President. It was not like low-wage workers or African-Americans emerged from this legislative charade any better off. It was just a lot of political churn to get nowhere.
“She’s not decent,” the Chief of Staff said at one point, almost rhetorically. The Chief of Staff was always more grounded than the others in the room, going home every night to a husband and two teenagers who had homework, acne, boyfriends. More important, she had a heartfelt desire to make the world better. Politics was a way of doing that, but not an end in itself. The Chief of Staff used the word “decent” in a way I had never heard it used before. To her, it was a binary measure of whether one was using government for good or for ill, regardless of ideology or intelligence or political circumstances. The Chief of Staff might meet with a right-wing legislator whose views were completely out of sync with her own, particularly on social issues, but she would return to the White House and say, “He’s decent.” She did not mean it in a begrudging or half-hearted way; it was a serious compliment. What she meant was that this person was intellectually honest and committed to making the world better, even if his or her definition of “better” was not one she shared.
Conversely, she might walk out of a meeting with a lawmaker or lobbyist—even those ostensibly “on her side”—and declare, “He’s not decent,” which meant this guy could not be trusted, or his motives were impure, or for some other reason this person had not come to Washington with the intention of making Americans better off.
The Speaker of the House was not “decent” in the eyes of the Chief of Staff, but come Monday she would be sitting in the Oval Office with us.
22.
MONDAY FELT LIKE SOMEONE TURNED UP ALL THE DIALS. Everything was going faster, bordering on panic for the first time. Because of time zone issues, the President had been up much of the night speaking on the phone with Asian and European leaders. At a “meeting before the meeting,” set up primarily so we could speak among ourselves before the Speaker arrived, the Chief of Staff briefed us on the calls. “It’s not good,” she said. “Most of the countries with meaningful stocks of Dormigen have some Capellaviridae issues of their own, or they’re convinced they might. They’re not going to ship Dormigen out of the country until they have a better sense of what’s going on. Honestly, I don’t blame them. The only countries with enough stock to close our gap are India and China.”
“It’s a shit show,” the President said. He looked paler than normal, with dark circles under his eyes. His body language suggested he really needed a nap. India and China, with over a billion people each, had enormous stocks of Dormigen. Meanwhile, neither country was seeing the same Capellaviridae trends that we were. Either one of them might be able to cover our shortfall.
But, as the Strategist cleverly put it, “India and China are the opposite of Latvia.” What he meant was that Latvia had offered up a paltry quantity of Dormigen as a gesture of solidarity and goodwill. The country was too small to do anything more. On the other hand, India and China were big enough to make all the difference, but the Dormigen donation would not be about solidarity or goodwill. Each was looking to exact a pound of flesh, or, more accurately, a metric ton. Our initial concern about India was that their Parliament would have to ratify the deal, making everything public. We had now reached a point where we could deal with the publicity if it would solve our shortage; our concern about bad publicity felt quaint. The problem was that India’s populist Prime Minister had thrown down a new roadblock. “He wants $100.4 billion,” the President explained wearily.
“My goodness,” the Secretary of Defense said, with a little whistle afterward.
“That’s an oddly precise number,” the Strategist said.
“The licensing deal,” the President said. His comment meant nothing to me, but the Chief of Staff and the Strategist both nodded in recognition. The Chief of Staff explained to the rest of us. Dormigen was still governed by a patent held by an American firm. The drug itself is strikingly cheap to produce. A lifesaving dose of Dormigen can be manufactured for less than the cost of a large cup of coffee. But that is not what the pills cost to buy—not even close. A full dosage was typically priced between five thousand and seven thousand dollars. The economists had no problem with such an extraordinary markup. The pills may cost just a few dollars to produce, but the intellectual property—the research and development that made this medical miracle possible—cost billions. Somehow the pharmaceutical company had to earn back that overhead. If we deprive them of huge profits now, we will not have blockbuster drugs in the future, the economists explained.
But a 250,000 percent markup? The ethicists were not so sure. Politicians in developing countries like India were apoplectic. Here was a drug that could transform their public health systems, potentially wiping out diseases ranging from tuberculosis to malaria for just a few dollars a pill. The U.S. patent holder had denied these poor countries the right to produce the drug without paying a hefty licensing fee. When the Indian Prime Minister had declared several years earlier that India would violate the patent and produce the drug without paying the licensing fee, the U.S. government had threatened to levy huge economic sanctions. The Indian Prime Minister accused the U.S. government of “going to bat for big pharma” (true). The President, who was in the Senate then, justified the huge licensing fee as “necessary to protect intellectual property and future innovation” (also true). In the end, the Indian government was granted a steeply discounted licensing fee to produce Dormigen, but the dispute obviously still rankled. The Congressional Budget Office had estimated that the economic sanctions threatened against India (but never implemented) would have cost the country $50.2 billion—exactly half what the Indian Prime Minister now was asking for the Dormigen doses.
“What a prick,” the President said.
“He’s got a point,” the Strategist said. “If you look at it from his perspective—”
“Yeah, I get it,” the President snapped. The Indian Prime Minister had been swept into power atop his party as a populist, railing against elites within the country and the perfidy of the “club of rich countries” beyond the borders. He had been a pain in the President’s side ever since. He backed out of several treaties, expelled a handful of U.S. diplomats, and even canceled the license that had allowed the U.S. Embassy to import liquor duty-free. The last one had delighted the Indian press because the
U.S. Embassy was subsequently required to document all of its liquor imports in customs—right down to the vermouth—for public scrutiny. “Americans Drink Martinis as Indian Economy Stumbles,” one headline screamed.
“What about China?” the Secretary of Defense asked. His tone suggested he knew the answer would not be any better.
“Do you want the good news or the bad news?” the Chief of Staff asked.
“It’s all bad,” the President interjected.
“They’ll give us two million doses free,” the Chief of Staff explained.
“Nothing with the Chinese is ever free,” the Defense Secretary said.
“Of course not,” the Chief of Staff replied. “They will ship the doses tomorrow if the President cancels his trip to Australia.”
“That can’t happen, sir,” the Defense Secretary said quickly.
“I know that,” the President snapped. He was as ornery as I had seen him. Several of us looked to the Chief of Staff, who explained the geopolitics of what was going on. The administration had been working for months to reinvigorate an alliance of Pacific nations—Australia, Vietnam, the Philippines, South Korea, and a host of small countries—to push back against Chinese encroachment in the region. The President was scheduled to fly to Australia later in the week to sign the agreement. But it would not be just any flight. The U.S. Navy would be sailing the Sixth Fleet through international waters into the South China Sea—an area illegally claimed by China, according to the U.S. and its allies—where the President was going to land on an aircraft carrier. The leaders of the other nations would join him on the carrier, at which point they would all sign the agreement. It would be the clearest, boldest, and broadest effort to push back against China’s persistent encroachment in the region. “Am I even going to be able to make that trip?” the President asked.
“You have to, sir,” the Secretary of Defense said. “If you don’t show up, the whole thing will collapse.”
The President had already canceled a short trip to Mexico. There were no diplomatic repercussions, but it had raised the antennae of the White House press corps. Word had also leaked out that the President was meeting daily with the Senate Majority Leader and the Secretary of Defense. These three were known to have a close relationship, so their regular meetings were not necessarily newsworthy, but now that the Speaker was joining them, the press corps would quickly figure out that something big was happening. “Where are we on Capellaviridae?” the President asked. As news turned sour among the Dormigen donors, our focus naturally turned in a different direction. Maybe the scientists would rescue us.
“I’m headed to meet with the working group after this meeting,” I answered.
“Tell them to pick it up over there,” the President said. “It’s time to figure out what the hell is going on.” He was tired and cranky and under enormous pressure. Still, I was reminded of the description of him as the kind of guy who would yell at you when you missed a shot—something that rarely helps the next time down the court. Telling scientists to “hurry up and discover something” is not generally a recipe for success, either.
23.
I HAD ACCESS TO THE WHITE HOUSE MOTOR POOL, ONE OF the many strange rituals to which I was becoming slowly accustomed. I signed my name in the log and a Secret Service agent called up a car for me. When the Town Car pulled into the driveway, I told the driver to take me across town to an office building where the NIH had a suite of offices. I slid into the backseat and tried to digest everything I had just heard. My Town Car privileges are relevant only because of an unfortunate coincidence. As my car pulled up in front of the NIH offices, Tie Guy was also arriving. He waited for me in front of the building and we went in together. “How’s it going?” I asked.
“Okay,” he said. “I’ll know a lot more tomorrow.” He did not ask why a mid-level scientist had arrived in the backseat of a black sedan, but he was a guy paid to draw inferences from patterns and was starting to see one. We took the elevator up to the third floor, where the task force had set up camp. I was, in theory, returning to my comfort zone—back with the scientists. I had left behind all the talk of “projecting strength in the South China Sea” and other concepts entirely foreign to my experiences. Except that at the NIH office I still felt alien, as if I were staring at the scene from outside a window on a dark night. Yes, I recognized most of the task force members sitting in cubicles and conference rooms arrayed across the floor, but their body language and the pace of their work made me feel estranged from them. Two of the younger staff members were laughing at something on a screen; when I walked closer I could see it was a YouTube video of baby giraffes. This was just another workday for them. Yes, it was an urgent task force, but these kinds of “urgent assignments” come and go. These people would all head to the health club after work, or maybe go out for drinks. They had no idea what was happening. I did, and that set me apart from them, almost like a physical separation.
Justman wandered up to me and shook my hand. “Guess what?” he asked cheerily.
“What?”
“Dust mites.”
“What about dust mites?” I asked.
“That seems to be the transmission mechanism for Capellaviridae.”
“Why didn’t you text me?”
“Sorry, I didn’t want to bother you over the weekend,” he said apologetically. “Yeah, it’s dust mites. They don’t usually bite, but there is a subspecies of the American dust mite that apparently does. And it’s a host for Capellaviridae—”
“That’s the transmission mechanism?”
“Yes. Man, you wouldn’t believe how many animals we’ve been testing: deer, squirrels, five species of mosquito—”
“But we still don’t know what triggers the virus to turn fatal,” I said.
“No,” Justman replied, visibly disappointed that I was not more excited by his news. “But now we know the vector. That’s huge. At least we know where this thing is coming from. It explains the patterns we’re seeing—why everyone has it in some places, no one has it in the tropics, that kind of thing.”
He was right. Understanding the “vector”—the mechanism by which a virus is carried and spread—is a huge deal. Because viruses cannot live independently, they must have a host. For smallpox, that was humans, and only humans. No other animal carries the smallpox virus, which is why we were able to wipe out the disease. On the other hand, a disease like Ebola is much harder to contain because bats and monkeys are also hosts. Even when we stop an Ebola outbreak in humans, as we did in Liberia and Sierra Leone in the 2010s, and again in the Congo in 2018, the virus still resides deep in the jungle, ready to leap back to the human population the next time some poor soul eats flesh from an infected monkey (“bushmeat”) or gets bitten by an infected bat. So yes, in Justman’s world, the dust mite discovery was a huge, exciting, relatively speedy development. In my world, we had a spreadsheet telling us that a lot of people were going to die if things did not move much, much faster.
One of the executive assistants clapped loudly to get the attention of the room. Justman and I paused our conversation to see what was going on. “Okay, everyone,” the young woman said, projecting her voice across the open work area. “Today is Saurav’s birthday.” There were some claps and cheers from the room. “We have cupcakes in the kitchen, if you are hungry.”
“Do you want a cupcake?” Justman asked. “They’re really good. They come from a little bakery around the corner.”
“No, I’m fine,” I said. “Look, we need to know why Capellaviridae turns fatal for some people and not others.”
“I know, I know,” Justman assured me. “We’ll get there, but this is huge progress. I’ve got people working around the clock here.”
“Thank you, I appreciate that.”
“Tomorrow we’ll have all the sampling data analyzed. You’ll be at that briefing, yes?”
“Of course.”
“That will be another piece of the puzzle,” Justman said confidently.
“We’ll figure this thing out. We just need a little time.” He gave me a little encouraging pat on the shoulder.
“I understand,” I said.
“Are you sure you don’t want a cupcake?” he asked.
“No, I’m fine, thanks.”
24.
WE MET IN THE OVAL OFFICE AGAIN THAT AFTERNOON. There was no new information, but it was the first official meeting with the Speaker of the House present. We started nearly forty-five minutes late because the President had to do a short news conference. An ex–police officer had shot thirteen people in a Cleveland shopping mall and then killed himself. The motive was not yet clear. Because the shooter was African-American and a former cop, it did not fit the pattern of previous shootings. The President made his statement, extending his condolences to the victims and their families, offering up all available federal resources, and so on. When he arrived back at the Oval Office, we already had a problem. The Speaker had been briefed that morning on the Capellaviridae situation and was told to keep all the information in the strictest confidence. Yet she turned up at the White House with her top aide. “He knows everything,” the Speaker declared. “He might as well sit in.” And so it began.
The President, already emotionally spent from dealing with the Cleveland shooting, was apoplectic. “We ought to just arrest her,” he spluttered when the Chief of Staff told him what was going on.
The Rationing Page 11