Michael Palmer - Fatal

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?"

"Yes, I see, Doctor," Ellen countered. "I see perfectly. But do you see what it's like to have the life of a perfectly happy, healthy child suddenly ruined or snuffed out altogether by something that was done to her by her physician?"

"George, please," Steinman said, discarding formality. "Mrs. Kroft, we do understand that. Believe me, we do. Risk-benefit ratio is the bedrock on which all medical treatment is built. And not one of us would deny that there are some immediate adverse consequences of immunizations for some children. All we can ask of you is that you do exactly as you have said you would, think things over. But I feel I must underscore all that is at stake here."

"And I do appreciate that, Dr. Steinman," Ellen said, standing to indicate that she had heard enough — especially from George Poulos. "I won't make any pronouncements about what I'm going to do, but I do promise to consider all the issues. I hope that's enough for the time being."

"It will have to be," Steinman had concluded.

Ellen had left Steinman's office in something of a daze. Why in the hell had Lynette Marquand done this to her? Things were fine when she believed that her vote would make a statement. Now that her vote could halt the project altogether, the pressure was immense.

She left Georgetown and spent much of the rest of that day in Bethesda at the NIH library. Now, after a second day of research, it was time to discuss matters with Cheri and Sally at PAVE, prior to making a final decision as to which way she was going to vote. Whatever that decision ultimately was, Suzanne O'Connor's gripping account of her battle with Lassa fever would be a strongly considered factor.

Lost in thought, she gathered up her things and headed out to her car. Following Marquand's speech, it was certainly expected that she would speak personally with Cheri and Sally. Yet she had kept putting off that meeting. Cheri Sanderson, however, hadn't waited too long before calling her. She was hardly a fool, and Ellen's uncertainty, however minimal, still resonated loud and clear.

"This is big stuff now, Ellen," she had said over the phone. "I'd be lying if I said that it wasn't important for us suddenly to be on center stage, and that you are in a position to put us there."

A mile into the drive, Ellen used her cell phone to call Rudy.

"Peterson here."

"Rudy, it's me," she said, imagining him sitting at his desk on the second floor of his cabin.

"Well, greetings. Are you going to be famous?"

"You mean, am I going to vote against Omnivax?"

"That would certainly put you on the Oprah show."

"I suppose it might. I met with the head of the committee yesterday, and now I'm on my way to speak with the moms at PAVE."

"And?"

"I don't know anymore, Rudy. Do you have any information on Lasaject that might help me out?"

"I'm waiting for a call from a friend of mine at the CDC. All I can tell you at the moment is that the preliminary research on the vaccine was a bit sloppy in its design and severely limited in its scope. But as I said before, there are some other things that may be going on. That's what this call from Arnie Whitman at the CDC is all about."