Fatal

CHAPTER 17

With three quick raps, Dr. Richard Steinman gaveled to order the final meeting of the select commission on Omnivax. The scene outside the closed-door session was nothing like the throng of reporters and photographers that had covered Lynette Marquand's speech. But the media was still well represented. The drama of the First Lady's promise to go back to the drawing board with Omnivax if even one member of the august panel voted against it, coupled with the political and medical implications of the project, had kept interest high.

Around the elegant conference room, twenty-two physicians and scientists stopped their conversations and solemnly took their seats behind their name cards around the massive table. One place remained conspicuously empty — that of consumer representative Ellen Kroft.

"I would like to take this opportunity," Steinman began, "to thank each and every one of you for nearly three years of outstanding, deeply committed effort, which will culminate in this morning's vote. You have done a great service to your country, to the medical community, and ultimately to the people of the world. The agenda for this meeting is that you will individually be given the chance to make some final remarks on whatever subject you choose relative to the work we have been doing. After that, we will go around the table and each will vote Yea or Nay. For the purpose of the First Lady's promise to the American people, an abstention will not be viewed as a negative vote."

He paused, looking as if he had just swallowed an underchewed chunk of meat.

"Before we go any further," he said after clearing his throat and composing himself, "there is a statement I have been asked to read to you. It was delivered to me earlier this morning with a note stating that copies of it are being sent to the Washington Post and the New York Times, as well as to all four major TV networks and CNN. It is from Mrs. Ellen Kroft, who will not be here today. I'm sorry there wasn't time to provide each of you a copy, but one will be distributed to you by the time our session is over. I have been asked by Mrs. Kroft to read her statement to you in its entirety."

There was a stirring in the room and an exchange of glances. Some expressions were curious, some unabashedly disdainful. Seated next to Ellen Kroft's empty chair, George Poulos fixed his neutral gaze steadily on Steinman.

"There being no objections, then," Steinman said, "I shall proceed." He again cleared his throat, then adjusted his glasses.

"'Esteemed colleagues, as the lone consumer representative on the Omnivax commission I have approached my responsibilities not as the scientist and/or physician that all of you are, but as a mother and grandmother. From the day of our first meeting, I established three mandates for myself. The first was to learn as much as I was able about the process by which vaccines are developed, tested, approved, and later on evaluated once they are in general use. The second was to acquaint myself in depth with the components of Omnivax — their production, individual characteristics, and interactions one with another. And finally, to speak with a cross section of fathers and mothers in a number of communities, recording their hopes and, yes, their fears about vaccinations in general and Omnivax in particular. I would like to address these tasks in that order.

" 'There are many, including most of you, the First Family, and HHS Secretary Lara Bolton, who believe that one of the primary benchmarks of progress in a civilized society is how thoroughly its citizens are protected against infectious diseases. As you know, but others may not, since nineteen-forty the number of required vaccine doses for our children has risen from three doses of DPT to forty doses of twelve different vaccines. And now, with Omnivax, while the number of shots will drop impressively, the number of vaccines administered will more than double. Omnivax certainly seems like one giant leap for mankind. But will there be negative consequences?

" 'The gold standard for any new drug investigation is the double blind study, in which the subject population is divided into two groups, equal in as many demographic and medical parameters as possible. The larger the study population, the better, so long as the characteristics of each group are equivalent. One of the groups then receives the drug being evaluated, and the other a placebo. The study becomes double blind when neither the patient nor the treating physician knows who is getting what. The longer the evaluation is continued, the more reliable its results. In fact, many new drug studies have been conducted over a decade or more.

"'My research has shown that not once has a vaccine — any vaccine — been evaluated by a prolonged double blind study. The pharmaceutical houses are powerful, and fund much of the drug research done at our universities and medical centers. They also have polished, highly effective public relations offices that have, on a number of occasions, set out to convince the general public that we cannot afford to deprive the placebo group of the lifesaving benefits of a vaccine while waiting until a statistically meaningful double blind study can be completed.

" 'Has this shortcut in scientific process hurt us in any concrete, medical way? That I cannot answer with any certainty. What I can say is that as vaccination rates have climbed, there has been an alarming increase in the incidence of a number of so-called immune-mediated diseases and conditions such as asthma, allergies, and juvenile diabetes, as well as others — autism, ADD, and other learning disabilities — whose classification as immune-mediated remains to be established. Is there a connection? Do vaccinations in some instances disrupt the normal development of the body's immune system? Until long-term, double blind studies are performed on those vaccines, we may never know.'"

Here, Steinman paused for some water and to make eye contact with those on his committee. Several of them rolled their eyes in exasperation at being forced to listen to the shopworn, simplistic revelations of the one member of their panel with no research credentials.

"I can see what you're thinking," Steinman said, "but I am going to finish Mrs. Kroft's statement. She has done us all a great service by deciding to abstain from this vote. In our laboratories and clinics, we are powerful and influential. But in the court of public opinion, the consumer representative has more clout than almost any of us. When this meeting is over and our vote has been taken, we are each going to have to respond publicly to the issues she is raising. Any questions?"

"Just get it over and let's vote," one of the pediatricians groused.

"Thank you, Mel," Steinman said. "That is just what I intend to do." He straightened his glasses and took another drink.

'"And what about Omnivax?' Mrs. Kroft goes on. 'First, let me say how impressed I am with the research and medical technology that has gone into the development of this amazing product. But once again, I must ask, Where is the double blind study? Where is the long-term evaluation? Once a drug or vaccine is released, the CDC and FDA rely on a post-marketing evaluation system of physician adverse reaction report forms. Studies have shown that only a small percentage of doctors have ever filled out such a form, despite knowing or sensing that many conditions they have encountered may be vaccine- or medication-related. Some are too busy or simply can't put their hands on a form at the moment they need one. Those who fill out such forms generally do so only when the suspected reaction occurs within a short time after the medication is taken and, more often than not, is spectacular. I would be remiss not to point out that there is no evidence at this juncture that Omnivax has caused problems in preliminary test subjects of a magnitude that even remotely approaches the mortality of the diseases it is preventing. But I would also be remiss not to point out that Omnivax is only as strong as its least extensively evaluated component.

"'Thirty vaccines, no double blind research. But also no obvious major adverse effects. For me those three facts make the decision on Omnivax a tough call.

" 'That brings me to my final task, that of being a true consumer representative. Parents are frightened that government agencies and the pharmaceutical industry are keeping information on vaccine side effects from them. Those parents who wish to decline vaccinating their children are prosecuted sometimes even when they can show that doing so violates their basic religious beliefs. This shouldn't be happening in America. Wherever I go, parents are clamoring for three things: information, research, and choice.

"'So where does that leave us? We have a remarkable product that will unquestionably save lives. We have a basic, essential research design that has been skipped over just as it has for every other vaccine or vaccine combination we have ever used. We have parents wanting more information and more control over what is injected into their children's bodies.

" 'After reviewing all these facets and issues, I have decided I can neither wholeheartedly endorse Omnivax nor vote to deprive the American public of its lifesaving gifts. I therefore have decided to abstain from the final vote on its approval. I wish my colleagues on the commission all the best and thank them for their forbearance and education over these past thirty-two months.'"

Richard Steinman set his glasses aside. Around the room, expressions clearly said that none of the participants were the least bit moved by what Ellen had written. After several silent seconds, George Poulos raised his hand and spoke.

"I would like to move at this time that we dispense with the final comments and proceed right to a vote."

"Second," a weary voice called out.

"Objections?" Steinman asked. "Okay, then. George, suppose we start with you."

"I vote Yea."

At the moment of the historic vote, Ellen was a hundred miles to the north of the FDA building, driving in no particular hurry through the lush landscape of Maryland's Catoctin Mountains, headed for the cabin of Rudy Peterson. Two hours before that, she had picked up Lucy at her home and driven the child to a small wooded park, bisected by a gently flowing stream. There she led her to a bench and sat beside her, holding her close, rocking in synchrony with her. Not far away, on a small playground, half a dozen children were playing on the swings and jungle gym. Lucy's gentle scent, scrubbed and clean, was no different from those kids', Ellen thought. Her hair, her skin, her beautiful eyes — all were perfectly normal. Yet here she was, as different from those children as if she had come from another planet.

Ellen scanned about, wondering if she and Lucy were being followed and observed. The notion made her queasy. There was no obvious candidate that she could see, but that meant nothing. The people up against her were professionals.

"I'm going to find that man, honey," Ellen whispered softly. "I'm going to find that man and I'm going to find out who hired him, and I'm going to hurt them. I'm going to hurt them like they have never been hurt in their lives."

For fifteen minutes, they sat there, Ellen's tears dampening her granddaughter's hair. The children had all raced off to class. The playground was empty. Lucy, rocking less than usual, stared vaguely off in that direction.

"I love you, baby," Ellen said finally, helping the girl to her feet and back toward the car. "Come on, let's get going. Gayle is waiting for you at school."

At eleven, Ellen was just a few miles from Rudy's cabin. She flipped on the radio and found a static-filled news broadcast just in time to catch the report from Rockville. In the unanimous vote promised by First Lady Lynette Marquand, general use of the Omnivax multivaccine had been approved. In just a few days, she would be present at a Washington, D.C., neighborhood health center as Secretary of Health and Human Services Dr. Lara Bolton administered the first injection of the drug. After that, inoculation with Omnivax would be required for all newborns and eventually for all older children as well.

Let the games begin, Ellen thought bitterly.

She felt anxious but keyed up as well. There really had been no choice for her. She had done what she had to do. If she had plowed forward with a negative vote on Omnivax, and something had happened to Lucy, she would simply have been unable to go on.

There was no mention in the news report that Ellen had abstained from voting. Rather, the focus of what she heard of the report was the political implications of the Marquand administration keeping a pledge made to the American public. Perhaps over the next day or so, she thought, her statement would get some press. Perhaps not. It really didn't matter.

Her hands tightened on the wheel as her mind's eye pictured the arrogant thug sitting so calmly in her living room, reeking of cigarette smoke. The bastard had done his job well. He had convinced her that, if he so wished it, none of her loved ones would be safe, and there really wasn't a damn thing she could do about it. What she hoped he did not know was that he had only won the first round. She had thrown a light jab in the form of her press release, but she felt certain her statement was nothing that would bring reprisals. Now she had to find a way to strike a more substantial blow — ideally a mortal one. In addition to protecting Lucy, by allowing the vote to proceed she had bought the time needed for Rudy Peterson to complete his work.

She cut off the main road onto an unmarked gravel drive that cut through a meadow festooned with wildflowers. Sunlight glinted off the colors. The sound of insects and scent of late summer filled the air. At the end of the drive, nestled in a young wood, was Rudy's rough-hewn cabin. Rudy had been Howard's college roommate and, later, best man at their wedding. He was for many years a biostatistician at the FDA before he was prematurely nudged into retirement by reorganization. But that hardly told the story of the man. Despite his long-term friendship with her husband, Ellen had always thought of Rudy Peterson as the anti-Howard. Where Howard was handsome and dashing, Rudy was introspective, philosophical, and hardly the physical specimen women would chase after. Howard's humor was slapstick and ridicule; Rudy's, droll and subtle, with just a pinch of cynicism. Howard had turned out to be more flash than substance. Rudy continued to be a steady, loyal friend, who had never said a strongly negative word about his former roommate. In fact, he was the only one of their pre-divorce acquaintances who had managed to maintain a relationship with both of them.

Ellen parked behind Rudy's ancient pickup, surveyed the house, then walked around to the back. There was no sense looking for him inside on a day like this. A narrow, well-worn dirt path wound from the small backyard through the woods to Rudy's pond. It was a neat little pond, five acres he had said, fed by mountain streams, and stocked with trout and bass by a company who made a business of doing that. Rudy, in his rowboat, was out there in the middle, gazing up at the hills, pausing now and then for a cast. He was wearing his trademark Tom Sawyer — style straw hat. Even at this distance, Ellen could smell the cherry tobacco from his pipe. According to a well-run study from Scotland, he had told her, one pipeful a day of cherrywood tobacco added 3.2 healthy years of life, whereas two or more pipefuls were responsible for minus 5.

She sat down in the shade on the shore, but it wasn't long before he spotted her and waved.

"Ahoy," he called out. "Be right in."

Ellen watched as he reeled in, shipped his rod, and rowed toward her. As soon as he had been let go by the FDA, Rudy had closed up his apartment in Rockville and moved out to the cabin full-time. Never married, he had a brother and a niece and nephew, some good friends, and passions for carpentry and classical piano, which he played better than most. Still, Ellen always worried that he spent too much time alone, and she made it a point to call once a week or so, and to drive out for an overnight every few months, bearing enough home-cooked food to last a few weeks. Since her appointment to the select commission on Omnivax, the calls and visits to her friend had been more frequent.

Rudy tied up on the trim little dock and then exchanged kisses on the cheek. He had a round, boyish face that looked as if it had yet to feel a razor. The hair on his head was completely gone, save for a silver monk's fringe. Ellen and others felt he bore enough resemblance to actor Gavin MacLeod to call him Captain. He had responded by painting "The Love Boat" on the stern of his skiff.

"Where are the fish?" she asked.

"I throw them back. By this time of the season most of them know me by my first name. They bite on the hook just to come up and visit. Once in a while one of them will mess himself up enough that I'll have to bring him home and make a meal of him."

"It's good to see you."

She put her arm around his shoulders as they walked back to the cabin.

"So," he asked after fixing two cups of tea, "how did the vote go? Did you throw a monkey wrench into their machine?"

Ellen had spoken to him after Lynette Marquand's promise, but not since the visit from the man with the harelip scar.

"I didn't go in for the vote."

Rudy's eyebrows arched just a bit.

"So," he said, "I assume our friendly neighborhood vaccine is now the law of the land."

"Twenty-two to nothing."

"With one abstention."

"With one abstention. The first dose is scheduled to be given in a few days."

"The first of millions."

"Tens of millions, thank you," she corrected glumly.

"It's not ready," he said.

She brightened up.

"You have proof?"

"Not exactly. But as I told you before, we're closing in on something."

"Tell me."

Rudy looked at her kindly, then shook his head.

"You first," he said. "I'm a patient man, but there's a hole the size of Georgia in the middle of this conversation."

"I'm sorry, Rudy. I know how worried you used to get about me after Howard left. I wanted to tell you what caused me to abstain without having you get too upset. I just couldn't figure out how."

"Now, that's what I call one hell of an interest-piquer."

Ellen smiled ironically.

"I suppose it is," she said. "I'm sorry. You know me, the queen of worrying about people worrying. Rudy, the day before yesterday a man broke into my house and was waiting for me when I got home. He was huge and reeked of cigarette smoke, and had a thick scar right here above his lip. He sat there smiling while he produced pictures of Lucy, at school, in the yard, even one in her bedroom, and implied that she would be kidnapped and killed in a horrible way if I cast the vote that sent Omnivax back to the drawing board."

Rudy exhaled, whistling softly. "I'm sad to say I'm not that surprised. This big daddy vaccine means a lot of things and a lot of money to a lot of people. You can describe the bastard?"

"Of course, but what does that accomplish?"

"It's a start."

"He was so damn sure of himself, Rudy. He just sat there smirking, knowing there wasn't a single thing I could do except listen. He said that if I went to the police, they would be able to do nothing, and he would find out."

Ellen felt herself beginning to unravel. She bit on her lip and brushed some tears away with the back of her hand.

"He's probably right on both accounts," Rudy said. "I'm really sick that this happened to you." He reached over and awkwardly patted her hand. "Was there anything else you remember?"

"After he finished threatening Lucy, he made a call from his cell phone and a car pulled up. He walked out of the house as calmly as any door-to-door salesman and drove off, just like that. I tried to get the license number of the car, but it was gone too quickly."

"Did he say anything at all that gave a hint as to who had hired him?"

Ellen shook her head. "I don't think so. He said he was employed by someone who wished to get Omnivax into circulation as soon as possible. I asked if he worked for President Marquand or the drug companies, but he brushed that off."

"I wonder," Rudy said. "My money's on someone on the manufacturing end of all this. From what I know about Lynette Marquand, I doubt she's capable of hiring someone like this, but I can't speak for her staff — or her husband's, for that matter."

"Wait, he said 'employers.' Plural. I remember that distinctly."

"Well, here's some paper. I'd like you to write down every single thing you can remember about the man. His appearance, clothes, mannerisms, phrases he said, everything."

"What good'll that do?"

"I don't really know yet, but as my granny used to say, it couldn't hurt. Maybe something you forgot will pop into your mind."

"Maybe. I want to find him, Rudy. I want to find him and… and hurt him. I close my eyes at night and there's his hideous face leering at me. I wake up in the middle of dreams, soaked in sweat. Early this morning I actually got sick. I wanted so much to go to the police, but after what he said, I just couldn't."

"Easy does it, El. I'll help you. If he's out there, we'll find him. But first, get the facts down on paper. You know me. I need data. Let me get you some more tea while you do that."

"Then you'll tell me what's been going on with you?" "Then I'll tell you," Rudy said.

Rudy's study was the small second floor of the cabin, once an attic. The skylights, beamed cathedral ceiling, knotty pine paneling, and floor-to-ceiling bookshelves helped make the room as comfortable as the man. Occupying much of the space was a large oak desk bearing a computer and other sophisticated electronics. A reading area with two worn leather easy chairs and a shared ottoman took up the rest. By the lone window, a telescope looked out across the yard toward the pond.

After she had finished writing down what she remembered of the well-dressed, well-spoken killer, Ellen kicked her shoes off and settled into one of the easy chairs. Rudy took the other. As he stretched his legs onto the ottoman, his bare foot brushed against hers. He quickly pulled it away and muttered an apology, his expression a strange mix of embarrassment and… and what? Ellen wondered. Then she noticed the heightened color in his cheeks.

"So?" she asked, as he replaced his foot on the ottoman a respectable distance from hers.

"Well, you know the problem I've been encountering trying to check up on this Omnivax. It isn't that there are any incriminating research data, there aren't. It's that, for a project this massive, there ain't that much data at all. And as a statistician, I like playing around with piles and piles of data almost as much as I like fishin'. The megavaccine has been field-tested, but not in any controlled way, and the components have all been tested individually and in some combinations, though not in any controlled way, either. Every piece of this lummox of a vaccine seems to work just fine, but only as far as it's been evaluated. I have no doubt that Omnivax protects people against every infection they say it does."

"I hear a but coming on."

"But, if this were a new arthritis medicine or birth-control pill, there is no way it would have been approved for general use on numbers this scant."

"To the best of my knowledge there has never been a tightly controlled double blind study of a vaccine."

"To the best of my knowledge, that is correct. Physicians and the pharmaceutical industry and some of my dear old friends at the CDC and FDA would rather take the chance there are no problems with a vaccine than risk depriving the public of protection against even one a them goldurn microbial buggers."

"Go on."

"Well, like I think I told you, I decided to focus what little time and resources we had on examining the weakest links in the Omnivax chain. So I weeded through the blocks of data available on each of the less common disorders — what I call the fringe players. And like I mentioned, this vaccine against Lassa fever heads that list. It's relatively new. So are the outbreaks of infection it was created to protect us against. It was approved for general use by the FDA about ten years ago. From a statistical point of view — my statistical point of view, at least — it was rushed into use too soon."

"They were afraid a major epidemic was brewing here in the States."

"I know, only it didn't happen — at least not then it didn't. Well, there are no major problems with the vaccine that I can tell, but it sure hasn't been tracked very thoroughly."

"I already know about that," Ellen said, hoping her tone didn't reflect her deep disappointment. "That's what you have?"

Rudy took her reaction in, though, and for a few seconds he just sat there. Then shook his head and grinned proudly.

"Nope," he said. "As a matter of fact it isn't what I have at all. I made some calls. One of them was to an old pal from the CDC I used to do projects with. His name's Arnold Whitman and he's an epidemiologist and a microbiologist. Arnie's been looking at these outbreaks of Lassa fever for us on the QT. If he gets caught mucking around in someone else's territory it could be his job. Anyhow, what he found may be nothing, but Arnie doesn't think so, and Arnie is very high on my list of very smart people who aren't wrong about science a hell of a lot."

"You should be on that list," Ellen said.

"Oh, I am. Seriously, listen to this. The incubation period for Lassa fever from exposure to symptoms is seven to fourteen days, twenty-one days tops. Eighteen of the cases in the U.S. appear to have brought the infection in with them from Africa. The rest of the cases are believed to have caught the virus from those eighteen. Given the known incubation period, it seems as if every one of the eighteen cases became infected on or about the very day they left Africa for the U.S."

"Weird."

"More than weird, my friend. This is the stuff my statistics were born to make sense of. And guess what?"

"They can't?"

"Precisely! They can't make sense of those eighteen cases all becoming infected as they are about to leave for the U.S., because something's wrong."

"But what?"

"That is the conundrum. I can't say, at least not yet. But wait, there's more. In the countries where it occurs frequently, Lassa fever has a clear-cut seasonal predominance for the months of January and February. In fact, here's a little graph I put together with cases that occurred three years ago, which I got from a Sierra Leone health ministry report via my pal Arnie."

"Impressive," Ellen said.

"Not overwhelming, but the January/February pattern the textbooks write about is certainly there. Now look at our eighteen cases."

Ellen held the second graph next to the first. There was only one case in January, none in February. Most of the rest were in the summer.

"And your statistics say?"

Rudy pressed an imaginary buzzer, adding the sound effect.

"Once again the numbers say that something's wrong. And need I remind you that these are my numbers, and my numbers never lie. From what I can tell, in the months of May, June, and July, you have a much greater chance of catching Lassa fever by flying to the U.S. than you do by staying in Africa."

"What do we do with this information?"

"We try and turn it into a working hypothesis," he replied, "a scenario that fits and explains the data. We need to come up with some facts."

"Starting where?"

"I would say starting at the Sierra Leone embassy in D.C. A friend of mine in the State Department tells me they have access to a passenger manifest of every flight out of their country. Plus, I'd be interested in how many Americans got Lassa fever in Africa as opposed to after they came home. I believe you could get that information from the Sierra Leoneans as well. Data! I crave data!"

Ellen jumped up and threw her arms around Rudy's neck.

"I knew you'd come through. Rudy, you've been just the best friend in the world to me."

"That's not exactly the hardest thing I've ever had to do," he said, looking away.