On Wednesday, I was making rounds on our patients when I was seized with uncontrollable shivering and profound weakness. Perspiration soaked my clothing as if I were standing in a thunderstorm. My temperature at that moment, as taken by one of the nurses, was 105 degrees Fahrenheit. Within an hour, I was a patient in my own hospital, moaning piteously from the pain in my muscles and joints, unable to take fluids because of the gaping, deep ulcers in my throat, and soiling myself and my bed with uncontrollable diarrhea. The next morning, I was delirious. My temperature had risen to 107 despite vigorous efforts to keep it down. For days, I am told, I lay unconscious, unable to take nourishment or fluids, oozing red blood from my rectum, and coughing up blood as well.
From the beginning, the diagnosis of Lassa fever was strongly suspected. My associate Dr. Janet Pickford made valiant efforts to fly experts from the CDC to Nigeria along with serum from a woman who had recovered from the disease and had circulating antibodies against it. Unfortunately, the government of Nigeria, angry about having the disease named for the village of Lassa, located along the Nigerian border with Cameroon, delayed issuing visas to anyone involved with my case. Finally, those State documents were approved, and on the tenth day of my illness I received an infusion of the woman's convalescent serum. By then I had required more than a dozen blood transfusions, and had been delirious or in a coma for almost the whole time. I had lost nearly thirty pounds from a frame that was slender to begin with, and was a mass of bruises and sores. My urine and stool were bloody, as was the mucus from my chest.
Incredibly, within just two days of receiving the serum, my condition began to improve. A miracle, everyone said. Gradually, the hideous ulcers in my mouth began to heal, and I was able to take nourishment. Over the next two weeks I regained much of my strength as well as my will to live. What I did not completely regain was my hearing, which was lost to the virus in both ears, and which has only returned slightly in my right. I would wish the illness of Lassa fever on no one, and pray that, with time, a cure or vaccine for this most terrible hemorrhagic virus might be found.
Ellen closed the book called Closer Than You Think — Infectious Diseases in a Shrinking World, and sank down in her chair, staring across the library at nothing in particular. Sixty-one. That was how many cases of Lassa fever had been reported in the U.S. over the past couple of years. Sixty-one and counting. Not that it mattered to Ellen whether the cases were here or in Africa, but for the time being at least, Omnivax was going to be administered here. And the Lasaject component of the supervaccine was, she had come to believe, the weak link in the chain. Now, a day after a very sobering, highly charged meeting at the office of Dr. Richard Steinman, she wasn't so sure.
Lynette Marquand's startling pledge that if even one of the vaccine panel's twenty-three experts expressed misgivings, release of Omnivax would be put on hold until those problems could be satisfactorily addressed had hit her life like a wrecking ball. Following the pronouncement, Ellen had done her best to continue with business as usual, but that state of existence had proven highly elusive. Less than a day after Marquand's speech, Steinman had requested that she meet with him at his office at Georgetown. When she arrived, she found the renowned physician and scientist waiting for her, along with George Poulos. On the corner of Steinman's desk was a copy of the day's Washington Post. A headline on the front page proclaimed:
First Lady promises to rethink Omnivax if panel vote is not unanimous
The article, which Ellen had read, did not mention her by name, but did say that debate among members of the select commission on Omnivax would continue until the vote, to be held in just three days. Steinman, who had a certain amount of charm and warmth, was nevertheless extremely formal, and even after nearly three years addressed all of the commission members by their title.
"Well, Mrs. Kroft," Steinman began, "I appreciate your coming up here to meet with me. I hope you don't mind my having taken the liberty of inviting Dr. Poulos to join us."
"No problem," Ellen said, still smarting some from the exchange with Poulos at the final commission meeting.
"After Mrs. Marquand's speech, I, um, felt it was essential to review our conversation with Dr. Steinman," Poulos said. "I felt that in view of the First Lady's promise to the nation, he should know that the final vote might not be unanimous."
"I suppose I would have done the same thing in your position," she said, somewhat coolly.
"Mrs. Kroft," Steinman said, "I confess I was somewhat taken aback to learn that, at least before Mrs. Marquand's speech, you were planning to vote against the implementation of Omnivax. Over the years we have been meeting together, I felt that you honored your mandate as a consumer on our committee quite admirably, by questioning issues until you understood them and always being prepared for our sessions. I wondered from time to time if you might vote against approval when yours was only one ballot of twenty-three. But now that your vote can effectively stop the entire Omnivax program, I thought, if it is all right with you, that we might review together what is at stake."
Of all those on the Omnivax panel, Steinman was the one Ellen respected the most. He had guided every session evenhandedly, and had always been patient and encouraging when she began one of her "Excuse me, but as a nonphysician, I was wondering if…" questions.
"I am open to any input or point of view," she said. "Despite what Dr. Poulos may have told you."
Poulos tried unsuccessfully to inject some warmth into his grin.
"I admit that, right or wrong, I do recall your saying something to the effect that you didn't plan on voting in favor of approval."
The man was right, but holding most of the high cards, Ellen didn't feel it necessary to respond.
Steinman passed two computer-generated pages to her.
"I know how you feel about statistics, Mrs. Kroft. As malleable as chicken, I believe you said. But you still must acknowledge that often in science, statistics are all we have."
"I understand."
"This is a distillation of material we have discussed in great detail in our meetings. It is, in short, our estimate of the lives that will be saved by Omnivax over one, five, and ten years, broken down disease by disease. Please believe me when I say that this summary was put together by statisticians who are as unbiased in their opinions as it is possible to be."
Ellen scanned the list which was, as Steinman said, a summary of precisely what was at stake. Measles was included, as well as the other vaccines now legally a part of every child's immunizations. But with or without those vaccines, the number of lives to be saved was staggering. The one-year figure for Lassa fever was 240, which seemed in keeping with the statistics she knew. By five years, however, the death toll would be over eight thousand, and in ten, nearly fifty thousand. Ellen gazed out the window, thinking about Lucy and the hundreds of other tragedies represented in the files and photos of PAVE. Those were real flesh-and-blood lives, not statistics. Then there were the myriad cases of ADHD, learning disabilities, asthma, diabetes, multiple sclerosis, sudden death, Asperger's syndrome, and other forms of autism, whose possible link to their childhood shots still begged investigation.
"I'll think about this," she said, slipping the data into her briefcase.
"Ellen, look at those numbers," Poulos blurted out. "Don't you see what these numbers mean?"