The Virus (23 page)

Once more he looked up from his text, this time for effect.

“But is a program of this nature really an adequate response to the challenge of the day? We will hear evidence this morning of the progress which has been made in recent months and weeks by the new flu virus which first originated in Japan known” — he looked down at his notes to make sure he had the name right — “as A-Fukushima. We shall be told whether and to what extent this new virus threatens the health of the population of the United States. And we shall have the opportunity to discuss and to decide upon the necessary steps to be taken.

“Ladies and Gentlemen. The SubCommittee recognizes its first witness this morning, Dr Frank Kimble, the Deputy Assistant Secretary for Health at the Department of Health and Human Services. Dr Kimble, would you care to address the SubCommittee?”

Dr Kimble, a short wiry-looking man with close-cropped hair, was an impressive performer. Over the years he had had considerable experience with Congressional committees. He knew how to appeal to the vanity of the men and women before whom he was called to testify, to make them feel that it was their voice and their voice alone which counted in the counsels of state. At the same time, he knew how to cajole and to bully. In spite of the fact that the committees were on the whole well-served from the staff point of view, including the research side, Kimble knew that he disposed of immensely greater resources. He could call on facts and figures to support his case which the committee members barely knew existed. Statistics could be dredged up in the depths of his Department which, as far as the committee was concerned, were irrefutable because they had no access to the raw material on which those statistics were based. Kimble was a master at playing the numbers game. He knew that a good number, like a good photograph, says more than a thousand words.

That was how he began his testimony that morning. With numbers.

“You’ve raised some questions, Mr Chairman, about the extent of the Administration’s flu immunization program for the upcoming flu season. Let me say straight away that it is a by no means negligible effort that we are proposing. Secretary Marshall’s Conference of January this year” — he was referring here to the Secretary of State for Health and Human Services — “recommended provision of Federal support for influenza immunizations for high-risk individuals. After extensive consultation with the Association of State and Territorial Health Officers, a proposal was developed and announced on February 23 by Secretary Marshall. On March 23, the President submitted a supplemental budget request to Congress which included $15 million for this year, of which $10.9 million was to be used as project grant funds for state and local health departments. This level of funding would provide 8-9 million doses of influenza vaccine to high-risk individuals who would not otherwise have received it through private means. This level of activity was based on reports from states as to their expectations of ability to provide Federally supported vaccine . . .”

“With respect, Mr Kimble,” Senator Matthews interrupted his first witness with a somewhat acid comment, “surely the size of the program should not be determined by the ability of the states to use Federal money. If the states don’t believe they can get the vaccine to where it’s needed, surely they must improve their administrative performance? And in any case, you yourself have admitted that the Administration’s proposal was developed in February this year. But this was prior to the outbreak in Asia of A-Fukushima” — this time he had no trouble with the name. “Are you telling the Committee that the Administration’s thinking has not been modified by the appearance of this new flu virus in Asia and the prospect that A-Fukushima will reach the continental United States by the next flu season? Did the President’s supplemental budget request for this fiscal year reflect this fact?”

“No, sir, it did not. Our proposal was based on an evaluation of the states’ capacity to deliver.”

“Not on the medical requirement itself? Not on the need to protect human life and health in absolute terms?” The Senator was thrusting deeply now. The television lights had been turned on to register the brief moment of drama, and the cameras had begun to roll. Matthews was making the most of his opportunity.

Frank Kimble sighed. How he hated politicians! They were all as dishonest as each other.

“Chairman,” he said quietly, trying to repair as much of the damage as he could. “This Administration is cost-conscious. I am sure Congress, including this Committee, would not have it otherwise. In my view, there is no such thing as an absolute requirement to protect human health. The risks must always be measured against the potential benefits. If today the Administration were to recommend to the Congress a substantially enlarged flu immunization program as a result of A-Fukushima, and if the states were to make a maximum effort to deliver that program and if, after all that, there was no outbreak of A-Fukushima in the United States this year, I might find myself accused before this Committee of squandering public funds and resources which could have been better devoted to other programs, including of course medical programs designed to save human life.”

Kimble had been looking at the other members of the SubCommittee as he spoke. While some of them, like the Chairman himself, still looked sceptical, he saw from the occasional approving nod that he was not entirely without support.

The discussion continued for some time along these lines. Other Senators intervened and Kimble replied to their questions. Eventually Matthews brought matters to a head.

“Gentlemen, we can go on like this for some time but I think there’s a risk that our deliberations could become purely theoretical. I believe that what we need at this stage is an up-to-the-minute presentation of the A-Fukushima threat. We are not in February or March any longer. We are in mid-summer and this Congress is about to go into recess. If we are going to act or react as far as A-Fukushima is concerned, we have to do so now. If we don’t it may be too late. I propose that we call our next witness, Dr Leslie Cheek, Director of the Center for Disease Control in Atlanta, Georgia. Agreed?”

There was a nod of approval from the other members of the SubCommittee.

“Dr Cheek,” Chairman Matthews continued, “what we would like from you today is your latest evaluation of the threat posed by A-Fukushima or any other flu virus for that matter to the health of the people of this country. And when I say latest, I mean latest. Preferably this morning’s news. If not, this morning, then at least last night’s.” He smiled encouragingly at the next witness.

“You may go ahead, Dr Cheek.”

As he began to speak, Leslie Cheek was clearly uncomfortable. He was a thin, worried-looking man with a scraggy neck that sat uncomfortably on a pair of narrow shoulders. He had a nasty feeling that this neck was at that precise moment near, if not on, the chopping block. He had before him the recommendations of the meeting which had been held a few weeks earlier in Atlanta, under the chairmanship of his Deputy, Dr Lowell Kaplan, head of the Center’s Epidemiology Division. He had carefully studied the conclusions of that meeting. (The record showed that Kaplan had been called away in the middle on urgent business — the Marburg affair as Dr Cheek recalled — and that after his departure the chair had been taken by James McKinney of Virology.) At the time he had agreed with the conclusions of the meeting, when they had been passed up to him. Essentially his experts had advised him that even though there was some evidence that A-Fukushima represented an antigenic shift, rather than a drift, it was not thought to represent a substantial risk. The meeting had not recommended any modification in the existing flu vaccine nor any major expansion in that season’s proposed flu immunization program.

Dr Cheek understood, of course, the reason which lay behind this expert caution. Everyone at the Atlanta Center for Disease Control remembered only too clearly the so-called ‘swine flu fiasco’ of a few years back when a major immunization program had been launched after some Army recruits in training at Ford Dix, New Jersey, went down with an unknown respiratory ailment, subsequently identified as swine flu, which hadn’t been seen in the United States since the late 1920s. And when one of these recruits died the Atlanta people had shown their concern by recommending a massive program of vaccination. As it happened, the swine flu epidemic never materialized. Instead, the Federal Government which, in a totally unprecedented way had assumed liability, was left with a host of negligence and malpractice suits to settle. Some of these were purely frivolous — one claim, alleging not only paralysis but loss of appetite and sleep, sought $900 million. But others had better foundation. The fact was that in a small but measurable number of vaccinees the so-called Guillain-Barré syndrome occurred, with occasionally fatal results.

Leslie Cheek was very well aware that, only that morning, the Deputy Assistant Secretary for Health at HHS had taken a pretty clear line in favour of restricting the immunization program to something fairly modest and limited. That line had, at least to some extent, been based on the conclusions of the meeting chaired by Kaplan and McKinney. If he, Cheek, were now to change that position he would have to have — taking it all together — a very convincing motive indeed.

And yet, in spite of it all, he felt uncomfortable. There were still another three or four months to go before the flu season proper began in the United States. A flu virus could travel a long way and do a lot of damage in that time. It was no good waiting until October or November to see if or how the danger developed. If the manufacturers were going to produce the vaccine in massive quantities, they had to have ample advance warning. As a public health man, he felt it made sense to err on the side of caution. He hadn’t been at the CDC at the time of the swine flu affair, so he hadn’t been among those who cried wolf and got egg on their faces. He didn’t feel constrained in the same way.

But there was one overriding reason why Dr Leslie Cheek decided, as he took the floor that morning, to depart from his prepared text. That reason had to do with a call he had received earlier that morning.

He had been about to leave for the Hill when the telephone had rung in his room at the Madison Hotel.

“Leslie? This is Tom Stevens.” It was a voice from the past but none the less familiar. When Leslie Cheek had been with the National Institutes of Health before he went down to Atlanta, he and Stevens had been members of the same country club in Chevy Chase. They had often played tennis together and taken their drinks by the pool later. Cheek knew that Tom Stevens was “in government” somewhere but he had never found out exactly what the other man did. Tom had always been rather vague about it.

“Tom. Good to hear you! How did you know I was in town?”

“Oh, word gets around, you know.” The upper-class drawl of the Princeton man was pronounced.

Stevens came to the point.

“I know you’re going down to the Hill in a minute or two. Senator Matthews’ Office put out a list of the witnesses they’ll be hearing from this morning and it came across my desk last night. There’s something I want to talk to you about before you testify. Do you think I could stop by in a few moments and give you a lift? It’s on my way.”

Leslie Cheek had been delighted to accept the offer. The two men had ridden down Pennsylvania Avenue together in Tom Stevens’ car and, as they drove, Stevens had explained his problem.

“Look, Leslie,” he said. “This is strictly personal. Between us. I called you because I know you.”

They swung past the Executive Office Building and then the White House loomed up to the right, resplendent in the morning sun.

Stevens nodded in the direction of the historic building. “Believe me, Leslie, this is on the level. There are people in there who know I’m talking to you this morning. I don’t say the Man himself knows. He doesn’t need to know. Not yet. But there are guys on his staff, my kind of guys, who know and who approve. John Shearer is one of them. Do you follow me?”

Dr Leslie Cheek followed him. He had heard of John Shearer, the young man from California who served in effect as the President’s Chief of Staff. He nodded and waited for what was to come next.

But Tom Stevens had not been particularly forthcoming. He had simply said, as they were passing the new wing of the Smithsonian: “I can’t tell you the background. Not now. I may never be able to tell you the background. I just want you to know that there are very powerful reasons indeed for going ahead with a large-scale flu immunization program this fall. The Administration made a mistake in recommending the modest effort it did. But it’s not practical politics, for any number of reasons, to go in now with a new proposal. The HHS people will scream. But, frankly, if Senator Matthews’ SubCommittee came out with some fairly radical upgrading, we wouldn’t mind in the least.”

Leslie Cheek looked at his friend, as he drove.

“Why don’t you get to Matthews?”

A smile circled round the edge of Tom Stevens’ lips. “Oh, we have. Believe me, we have.” Taking his eyes off the road for a moment, he looked Leslie Cheek straight in the eye.

“Don’t get me wrong, Leslie. I’m not asking you to violate your personal or professional conscience. I’m simply saying that if you have any doubts about the Administration’s proposal, then for heaven’s sake don’t keep them to yourself. Of course, if it doesn’t work, we’ll simply have to come at it some other way. If necessary, we can work on HHS to reformulate. But it would be neater, much neater if this thing came from the Committee — on its own initiative as it were. We feel the Administration needs to keep a certain distance on this one.”

It was delicately put. Leslie Cheek appreciated the tact that had informed the other man’s presentation. No one should ever ask a scientist to lie. But under certain circumstances it is quite permissible to ask a scientist to change the emphasis here and there.

“Tom,” he said as he got out of the car in front of the Dirksen Building, “I don’t really understand what you’re getting at. And I don’t suppose that I’m meant to understand, but I hear what you say and I’ll think about it.”