Lost Immunity

by Daniel Kalla

  “The nurses went through all of the victims’ social media accounts. Stacy found a bunch of pictures of Alex on Grace’s Instagram page, including a few from Iceland. The parents had no idea Grace and Alex were even dating. That’s why no one made the connection sooner.”

  “Brilliant work, Ty. The whole staff.” Lisa briefly clasps her palms together under her chin. “Is this Alex sick?”

  Tyra shakes her head. “Just spoke to the mom. Alex is fine. And he never got sick over there or since he came home.”

  “You’re convinced he’s the one who brought the bacteria back from Reykjavík?”

  “Yolanda is on her way to collect swabs from Alex’s mouth, nose, and skin. The bacterial cultures should give us confirmation within a day.” Tyra grimaces. “But, come on. Alex would’ve been kissing Grace just last week. What are the chances she had two separate connections to Iceland?”

  “So it did start from an asymptomatic carrier, after all.” Lisa sighs. “First, the spread into the community. Now this. Just when you think it couldn’t get much worse.”

  “Lisa, haven’t I taught you anything?” Angela Chow bellows from somewhere behind her. “It can always get worse.”

  “Apparently,” Lisa says as she turns around. Angela’s complexion is even paler this morning.

  Lisa leads the two women inside her office and closes the door. She gestures to them to have a seat and then sits down across the desk from them. “I just came from Harborview,” she says, and goes on to describe Zeke’s cardiac arrest.

  “He got antibiotics immediately?” Angela asks.

  “Within minutes of reaching the ER,” Lisa says. “Sounds like it was only an hour or two after he felt the first flicker of a headache.”

  “This little fucker is as deadly as bugs come.”

  “And it’s spread into the community now.”

  “Even more reason to vaccinate.”

  Tyra’s forehead creases. “With what? That experimental vaccine you tried to convince the drug company to release?”

  Lisa sinks down into her own chair. “Neissovax.”

  Angela glances at Tyra. “You happen to know of any other effective vaccines?”

  “Still unproven outside of the lab, though,” Lisa says. “They did emphasize that.”

  “Those pharmaceutical types are paid to be overcautious.” Angela shakes her head. “I did a little reading up on my own. Neissovax shows impressive immunogenicity.”

  “What does it matter?” Tyra looks from Angela to Lisa. “You told me they’re not willing to release it.”

  “Maybe we just need to apply more pressure. What if the CDC were to weigh in?” Lisa motions to Angela. “You do seem to have a rapport with Dr. Moyes.”

  “Alistair and I do go back,” Angela says, but there’s no affection in her tone.

  “Can you get him to apply some pressure for us through the CDC?”

  Angela considers it for a moment. “Maybe we don’t need his help.”

  “What are you talking about?”

  “Jesus.” Angela rolls her eyes. “I honestly thought I taught you better, Lisa. If people are blocking your way, and you can’t get past them on either side…”

  Lisa chuckles. “Then go over their heads.”

  “Yup.”

  “Over the executive VP’s head? That would be the CEO, wouldn’t it?”

  “It would.”

  “Why not?” Lisa picks up her phone and dials her assistant’s line. As soon as Ingrid answers, Lisa says, “Can you please try to track down the CEO of Delaware Pharmaceuticals for me? And tell him it’s urgent.”

  Ten minutes later, Ingrid buzzes back announcing that the CEO, Peter Moore, is waiting on the other line. Lisa picks up on speakerphone. She introduces Tyra and Angela and then says, “Thank you so much for taking our call.”

  “Anytime, Dr. Dyer,” Moore says. “Nathan and Fiona both spoke highly of you.”

  Lisa finds it telling that someone as busy as the CEO of a major pharmaceutical company recognizes her name. “I assume you’re aware of the situation here in Seattle.”

  “Nathan briefed me,” Moore says. “But even if he hadn’t, I would’ve known. After all, your outbreak is making national news.”

  “And the situation has worsened since your people left.”

  “I’m sorry to hear that.”

  “Thank you, but we don’t really need your sympathy,” Lisa says. “What we do need is access to your company’s new vaccine.”

  “Dr. Dyer, we took your department’s request very seriously. That’s why Nathan and Fiona flew out to see you.”

  “To let me down in person.”

  “To show you how much we respected your predicament and your request,” Moore says. “It was a very difficult decision for Nathan.”

  “But the situation has changed since our conversation,” Lisa argues. “We now have community spread.”

  There’s a brief pause. “That is concerning,” he says quietly.

  “And, as you pointed out, the outbreak is making national headlines. If Delaware were to get involved, imagine the free publicity it would provide.”

  “Maybe so, but despite the old saying, not all publicity is good,” Moore says. “Besides, this is about far more than just marketing. I appreciate how serious this infection is. But our company is not… prepared for the potential medicolegal ramifications of an American release.”

  “If the release were on compassionate grounds, you’d be protected, Mr. Moore. You would also be covered through NVICP.” Lisa cites the initials for the National Vaccine Injury Compensation Program. The elaborate federal program was created thirty years prior as a substitute to class-action lawsuits to protect patients while limiting potential damages against manufacturers to ensure that companies continued to develop new vaccines. Even so, the adjudicated program had already cost the industry billions in payouts.

  “A pharmaceutical company protected by the NVICP? That’s almost an oxymoron.” Moore chuckles. “Truth is: nothing could protect us from the fallout of an unexpected or untoward outcome.”

  “How would a massive trial in Reykjavík be any less risky?”

  “To begin with, it’s not on US soil. Not subject to American laws… or lawyers. And we’d have the control. The infrastructure. The safety valves. All in place. It’s a trial that has been in development for several months. Not a kneejerk reaction to a brand-new crisis.”

  “That’s the point. This is a crisis. And, as a colleague of mine loves to say, ‘Never let a crisis go to waste,’ ” Lisa says with a nod to Angela.

  “I like that.” Moore laughs again. “However, I have to defer to Nathan’s opinion. After all, he’s responsible for product development and release.”

  Before Lisa can respond, Angela jumps in. “Mr. Moore, it’s Dr. Chow here.” She brings a finger to her lips, and then says, “Lisa reports to me on this. And, of course, my co-lead, Dr. Moyes, with the CDC.”

  “I see.”

  “Very soon, it will not just be Seattle Public Health making this request. It will come from the CDC, the state, and potentially even federal authorities.”

  “And we would entertain any and all such requests that would come through those channels,” he says coolly.

  “Good.” Angela appears unfazed, even though Moore just called her bluff. “Also, do you happen to be familiar with MENGOC-BC?”

  “Not particularly.”

  “It’s a vaccine developed in Cuba in the late eighties,” Angela explains. “It was hugely successful in fighting off a meningitis outbreak at the time in Havana.”

  Lisa remembers reading about the legendary vaccine, but she hasn’t heard it mentioned in years. Sensing where Angela is heading, she begins to shake her head.

  “Because of obvious political differences, it was only ever granted a research license in the US,” Angela continues. “And it has never been trialed outside of Cuba on any large scale.”

  “I’m not sure—” Moore beg
ins, but Angela cuts him off.

  “The very preliminary testing on our pathogen at the CDC labs suggests that MENGOC-BC produces strong immunogenicity against the same Icelandic bug.”

  Lisa holds up her palms and mouths the words, “What are you doing?”

  Angela waves her off.

  “Does it?” Moore asks.

  “It appears to,” Angela says. “Of course, since it’s only an experimental drug here, we would face the significant challenge of where to mass-produce the MENGOC-BC vaccine. But with the resources of the CDC, the state, and the federal government behind us, that’s surmountable.” She taps her temple and looks at both Lisa and Tyra. “In the past, the government has even seconded existing manufacturing plants to urgently produce vaccines. And I understand Delaware has a brand-new facility in Massachusetts.”

  She pauses, and when Moore doesn’t comment, she continues. “I understand you already have fifty thousand doses of Neissovax ready for Iceland. Efficacy aside, that could save us vital weeks in our response versus having to produce the Cuban vaccine from scratch.”

  There’s a long delay before Moore replies. “I’ll tell you what, Dr. Chow,” he says in a somber tone. “In light of the worsening outbreak in Seattle, we will revisit your department’s request again with Nathan and the rest of our team.”

  “Thank you, Mr. Moore,” Angela says. “And remember, time is spread.”

  As Lisa disconnects the call, she can’t believe Angela’s ruse might have worked. And she can’t fight off her smile.

  “Angela.” Tyra folds her arms across her chest, her expression scolding. “Maybe you shouldn’t have said all that.”

  “Why not?”

  “Because it’s not true?”

  “It might be.” Angela runs a finger along the bony protuberance of her cheek. “Besides, what can they do to me that cancer and fucking chemotherapy haven’t done already?”

  CHAPTER 16

  “You don’t believe that BS about Cuba, do you?” Nathan asks from where he sits across the teak desk from Peter Moore, inside the CEO’s expansive thirty-ninth-floor corner office.

  Nathan still hasn’t adjusted to Peter’s new look since his boss recovered from what he insists on describing as “only a ministroke.” The new beard is foreign enough, but lately Peter has traded his Italian suits and loafers for outfits like the Indian print sweater and khakis he’s wearing now. “There’s a lot of mystery surrounding that Cuban vaccine,” Peter says as he sips tea from an owl-shaped mug.

  “They’re bluffing, Peter.”

  “Oh, probably. But it doesn’t really matter.”

  Nathan doubts the Peter of old—the driven, Machiavellian executive he used to be prior to his stroke—would’ve accepted any of this with such philosophical calm. Then again, the old Peter wouldn’t have been caught dead wearing a cardigan or drinking tea from a bird-shaped mug. And especially not sporting a beard.

  “How can it not matter?” Nathan struggles to keep his tone even.

  “It’s inevitable now,” Peter says. “Particularly, if there’s no there there to the Cuban story.”

  “How do you figure?”

  “Because it would make us the only game in town when it comes to possible vaccines,” Peter says. “Meningitis is spreading in Seattle, and they’re desperate. What with kids dying, and all. The pressure on us to release Neissovax is only going to intensify. Even if Dr. Chow is just blowing smoke, I bet we’ll soon hear from the CDC and all levels of government.”

  “We’re not ready for this.”

  “Ready or not, soon we won’t have a choice. They know we have a stockpile.”

  “Can’t we stall them?” Nathan asks. “Long enough until we can dispense the vaccines in Reykjavík? After all, we do have an existing contract with the Icelandic government.”

  “Dumping our stockpile so they can’t force our hand?” Peter grunts. “When did you become so cagey, Nathan?”

  “I’m worried, Peter,” he says genuinely. “It’s all too rushed. Even the Reykjavík trial is premature. But this? Seattle? Dropping us into the middle of a raging epidemic without any real controls…”

  Peter sits up straighter and lowers his mug onto a zebra-print coaster on his desk. “I’ve been around long enough to see that we’re not going to be able to outmaneuver them. The best we can do is get out in front of this. Be proactive.”

  Just the thought of the logistics involved makes Nathan’s heart palpitate. His gaze drifts to the floor-to-ceiling windows behind his boss. His office, though not quite as big or as strategically situated as Peter’s, shares the same view. Nathan’s eyes are often drawn to the United Nations’ Secretariat Tower that looms at the river’s edge only a few blocks away. It isn’t one of his favorite buildings in Manhattan, but the simple blue-tinted glass tower has become the visual equivalent of earplugs for him when he needs to drown out the background noise and find his focus.

  “Fiona is going to lose it,” Nathan mutters as he turns back to Peter.

  “Can’t even imagine. Which is why I don’t plan to be around when you break it to her.” Peter’s expression darkens. “You’re both going to need to be on the ground in Seattle for this. Do we agree?”

  Nathan thinks of Ethan and Marcus and their planned father-sons road trip to Quebec. They’re supposed to leave next week. He promised Ethan, who got his learner’s permit last month, that he’d let him drive some of the quieter stretches. “Wouldn’t dream of being anywhere else.”

  “We’re also going to have to delay Iceland,” Peter says.

  By “we,” Nathan knows he means him. “I’ll take care of it.”

  Peter reaches for his mug. “Someone told me recently that you should never let a crisis go to waste.”

  “Wish I believed that.”

  “If this goes smoothly, Nathan, it could be better for Delaware than Iceland ever would have been.”

  And if it doesn’t, it’s probably not going to be your head.

  Nathan rises from the chair. “I better let them know in Seattle. We’ll also need to get legal to draw up some paperwork.”

  As he is turning away, Peter says, “Nathan?”

  “Yeah?”

  “My hands are tied on this one.”

  “I get it, Peter.”

  “Good,” Peter says with a small laugh. “So make damn sure nothing goes wrong in Seattle.”

  Nathan wishes his boss were only joking. “It’s what I do.”

  He heads out of Peter’s office and walks down the hall and around the corner to find Fiona at her desk, typing at her computer. Her office is less than a quarter the size of Peter’s, and the smaller windows peer directly onto the neighboring high-rise.

  Nathan raps at the open door. “A word?”

  The moment Fiona looks up and makes eye contact, her face falls. She yanks off her reading glasses. “He didn’t!”

  Nathan shrugs. “Says he has no choice, Fiona.”

  “This will be a nightmare.”

  “It’s decided.”

  She nods, her expression turning businesslike. “When?”

  “Yesterday, ideally. Realistically, how soon could we ship?”

  “The supply is already packaged and ready to go.”

  Nathan pulls his phone from his jacket pocket. “We might as well let them know.” He taps the phone number and hits the speaker icon so Fiona can hear, too.

  “Lisa Dyer,” the public-health officer answers on the second ring.

  “Hello, Lisa. It’s Nathan Hull. From Delaware Pharmaceuticals. I’m here with Fiona Swanson.”

  “Oh, hi,” she says without sounding the least surprised. “I wasn’t expecting to hear from you so soon.”

  “We’ve been reconsidering your request, Lisa.”

  “That’s great.” Her tone warms noticeably. “What have you decided?”

  “Under the right conditions, we might be willing to release our supply of vaccine to Seattle instead of Reykjavík. On compassionate grounds, of c
ourse.”

  “Wonderful! What conditions?”

  “First, it would have to be the full distribution of the vaccine as we were planning for in Iceland. Not just targeting the highest-risk group. For the reasons we discussed in person.”

  “So we would have to inoculate fifty thousand people?”

  “Yes.”

  “Hmm. And if we still need more doses after that?”

  Fiona squints at him, looking as surprised as Nathan feels. “Then we’ll provide it,” he says.

  “I think we can commit to the full round of inoculation, yes,” Lisa says. “Providing, of course, we don’t see any significant adverse reactions among the early vaccinated groups.”

  “It’s a new medicine.” Fiona interjects. “There will be reactions.”

  “And overreactions,” Nathan adds. “And phantom reactions. With it being a vaccine and all, public outcry and social media fallout is inevitable.”

  “I realize,” Lisa says. “I’m only speaking of significant and objectively verified adverse events. Not imagined or hysterical ones.”

  Nathan glances at Fiona, who shrugs her acceptance. “We can live with that, yes,” he says. “The second condition is that Fiona and I will be present to help oversee the distribution.”

  “Oversee?”

  “Yes,” Fiona says. “We’ll need full access to the storage facilities, the distribution plans, and any sites where Neissovax is to be dispensed.”

  “You don’t trust us to run our own vaccination program?”

  “This might be your program, Lisa, but it’s our product and our reputation on the line,” Nathan says.

  “We need to be convinced of absolute quality control and compliance,” Fiona adds. “It’s my job. And I take it dead seriously.”

  After a slight pause, Lisa says, “All right, I can guarantee that.”

  “OK,” Nathan says. “Oh, and one final condition.”

  “Another?” Lisa says warily.

  “You need to shelter us from the anti-vaxxers.”

  Lisa sighs. “We’ll do our best to keep Delaware out of it. We don’t even have to publicize the company’s name until when and if the campaign is a success.”

  Nathan knows it’s an empty promise. Delaware’s logo is stamped on every vial. But he doesn’t bother to argue. He shares a despondent look with Fiona, each aware that the release of Neissovax in Seattle is inevitable. “We can be there tomorrow,” he says.