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that’s why we have also set up such a rigorous surveillance system. To monitor for any unexpected outcome. Have you seen the website?”

“Yeah, I’ve seen it. Even if it does alert you to dangerous complications, it won’t help the initial victims of any serious vaccine injuries, will it?”

“That’s a big if, Dr. Balfour.”

He shrugs. “It’s a bit of a coincidence, isn’t it?”

“What is?”

“This new strain of bacteria. It’s never been seen before. Until Iceland. And now here in Seattle.”

“That’s what pathogens—especially bacteria—do. They mutate. New strains appear all the time.”

“Oh, I understand that,” Max says. “But isn’t it coincidental that it happened to mutate exactly at the same time that Delaware Pharmaceuticals was ready to market the perfect vaccine against it?”

CHAPTER 30

Lisa had to postpone the Outbreak Control Team meeting until the morning Neissovax clinics were complete. She walks into the conference room at two in the afternoon to find it fuller than any previous daily meeting since the first one. There’s a buzz of anticipation around the table that is, at least in part, fueled by the intense media coverage of the pediatric cases in Bellevue.

“Dead children,” Angela said matter-of-factly just before she and Lisa walked in together. “They tug at the heartstrings even more than dead teenagers. Great for hits and engagements online. ‘Earned media value,’ as the publicists call it.”

Despite Angela’s cynicism, Lisa is glad to have her back in her usual seat.

Lisa calls the meeting to order and advances to the second slide of her presentation. A map of Seattle appears, highlighting the city’s two geographical hot spots. “It’s day nine of the outbreak. As of this afternoon, we’ve had twelve deaths among twenty-eight confirmed cases in the Delridge area—home of the original Camp Green cluster. Meaning there’ve been only four new cases there in the past three days. But the news isn’t nearly as hopeful in Bellevue, the second cluster. We’ve had eight cases there in the past three days with two deaths, and two critically patients still in the ICU. All these victims between six and eight years old.”

Tyra motions to one of the screens. “We’re aggressively tracking and treating all contacts within both clusters with antibiotic prophylaxis.” Her professional façade momentarily gives way to a pained expression. “The girl who died this morning was only six.”

Lisa can’t help but think of Olivia. She has already studied the map and discovered that the nearest victim lived less than a mile away from Amber.

“Have we figured out how it spread from Delridge to Bellevue?” asks Benning, the insightful woman from the department of health.

Tyra nods. “The culture swabs from Nicola Ford’s nose grew meningococcus, confirming she was the one who carried it from the first cluster to the second.”

“The asymptomatic carrier,” Angela emphasizes. “Just like the boy who brought this disease back from Iceland. God knows how many other Typhoid Marys we’ve got running around this town.”

“Even more reason to accelerate the vaccination program,” Tyra says.

“And on that front, we do have some good news.” Lisa looks over to the medical microbiologist. “Dr. Klausner…”

Klausner clears her throat noisily. “We have analyzed the early post-immunization blood samples from the first group to be vaccinated with Neissovax.” She stops to clear her throat again. “We have seen strong immunogenicity within forty-eight hours of inoculation. The levels of the antibody titers against this specific Icelandic strain appear to be high.”

“That quickly?” Angela’s nose wrinkles. “Holy crap!”

“It is somewhat unusual,” Klausner concedes. “Normally, it would take weeks to generate this kind of immune response. But that does bode well for the effectiveness of the vaccine.”

“Does this mean the vaccinated kids will be immune to this meningitis?” Benning asks.

Klausner pushes her glasses back up the bridge of her nose. “We never draw clinical conclusions from lab results…”

“What a classic pathologist’s disclaimer.” Angela laughs, and then turns to Benning. “The answer is yes. Or more accurately, Hell, yes! Those who got Neissovax are now immune.”

Lisa nods. “And in light of the Bellevue outbreak, Delaware Pharmaceuticals has approved lowering the minimum age of vaccination to six.”

“I’m delighted the drug company is behind an expanded market for their product.” Moyes speaks up for the first time. “What about this committee? Do we approve it?”

“What choice do we have, Alistair?” Angela asks. “This thing is starting to ravage young’uns.”

Moyes strokes his beard with the back of his hand. “This vaccine has never been given to children under the age of ten. Not even in any of the trials.”

“Six? Ten? What difference does it really make?”

“Well, we don’t know, do we, Angela?”

Her eyes lock on to his with uncharacteristic ferocity. “We do know that kids of that age are dying. How many vaccines are you aware of that are tolerated by ten-year-olds but not six-year-olds? Are we going to let a theoretical risk stop us from protecting the group that is currently the most vulnerable?”

Ignoring Angela, Moyes turns to Lisa. “What do we know of the adverse reactions to Neissovax so far?”

Lisa advances a few slides until she reaches the one with a summary of all reported side effects. “With over two thousand doses administered, we have received forty-six reports of adverse events through our website and the hotline. None required hospitalization. None met the criteria to qualify as serious. And almost all have subsequently resolved.”

“The vaccine is safe, Alistair,” Angela says.

“So far,” Moyes says. “Two days’ worth of data isn’t enough to draw conclusions. Are you forgetting what happened with the rotavirus vaccine?”

“I don’t forget anything,” Angela snaps.

“You thought it was safe, too, though, didn’t you?”

Angela only glares back in response.

Lisa is struck again by the tension between Angela and Moyes. She wishes she understood their background better. But at this moment, she’s more concerned about focusing everyone’s attention on the necessary next steps. “We need to revise our publicity campaign to include the lower age group,” she says, nodding to the goateed publicist, who’s typing madly on his laptop. “Kevin?”

“I’ve drafted a new press release, encouraging parents to bring

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