Prologue PROLOGUE
It was only a headache, Lilja Benediktsson reminds herself as she stands beside the gurney inside the chilly room. And Kristjan just couldn’t miss another day of school. The principal had been clear. One more infraction and her son would be suspended from the hockey team. Neither the team nor Kristjan could afford that.

Kristjan’s forehead hadn’t even felt warm to the touch. Why should Lilja have believed her son this time after all the other recent excuses and illnesses he had faked to avoid getting up on school days? Lilja hadn’t even bothered to call Dr. Tómasson. She could hear the old doctor’s stern voice in her head. “Two ibuprofens, a glass of juice, and then off to school. Don’t let the boy manipulate you, Lilja. Boundaries. You both need them.”

It had been a rocky eighteen months since Kristjan’s dad had walked out on them. At first, Lilja and her son had managed all right on their own. But then Kristjan’s grades began to drop, and he spent more and more time alone in his room, surfing the web while listening to that god-awful death-metal music. Lilja tried to reason with him, to explain that he risked his coveted position on the senior hockey team with his lackadaisical attitude. But the more she persisted, the more he withdrew. He used to be such a perfect child. Loving, happy, and outgoing. They were so close until his father left. Kristjan would tell her everything. But Lilja couldn’t reach her fifteen-year-old son anymore. In the end, she resorted to cutting off his Wi-Fi access. That didn’t work, either.

And now he’s gone.

It’s not the lattice-like rash crisscrossing Kristjan’s face or the bloody blisters scattered over his shoulders and neck that Lilja focuses on as she stares down at her son. What catches her attention is how his hands jut out from under the hem of the sheet, one on top of the other, as if clutching his chest. Kristjan would’ve been mortified to know how his hands were positioned.

Did I even say good-bye? Lilja wonders again as another tear falls and beads off the protective gown that hospital officials insisted she wear along with gloves and a mask.

Kristjan was too irritable to let her hug him as he stomped out the door earlier in the morning.

But I did say good-bye, didn’t I? I did tell him I loved him?

That’s the only thing that matters to Lilja now. Not that Kristjan passed away within two hours of reaching Reykjavík’s Children’s Hospital. Not that his school is closed for fear of further spread after two more classmates died. Not even the realization that she will never begin to fill the void that has been ripped through the fabric of her being.

Please God, tell me I said a proper good-bye.


Chapter 1 CHAPTER 1
They’re well dressed. Polite. Attentive. And like any good predators, they’re preparing to pounce.

Lisa Dyer read the mood in the packed auditorium the moment she stepped up to the lectern. She has been Seattle’s chief public health officer for only a few months, but Lisa understands these community health forums go with the territory. Usually, they’re stress-free events. Fun, even, in a nerdy kind of way. Rarely are they anywhere near as well attended as this one.

Or as controversial.

The new policy she has come to present isn’t even her brainchild. It came directly from the state legislature via the governor’s office in Olympia. But this audience is unlikely to focus on such distinctions. Many of them appear poised to shoot the messenger.

Lisa appreciates that not all the attendees are hostile. A number have come to support, or at least to learn more about the new law that mandates immunization for all middle-school-aged girls and boys with the newest HPV vaccine. But she isn’t surprised by the public outcry. Among the anti-vaxxers—or the “vaccine hesitancy” community, as most prefer to be known—the HPV vaccine might be the most outrage-inducing one of all. She has already heard an earful from her own sister yesterday about the new policy. She can’t even imagine how her dad would react to it, nor does she intend to find out.

The rumblings grow throughout her talk, and even before Lisa clicks on the final slide on her presentation, hands shoot up throughout the crowd. Mentally bracing for the onslaught, she points to a willowy woman with a rainbow headband in the second row, who has already sprung to her feet.

“You used the word ‘safe.’ Safe?” The woman’s voice cracks. “How can you say that when we all know what happened to Cody Benson.”

The case of the Utah teenager had become a rallying point for the activists after he died a year earlier from a progressive spinal condition a few weeks after receiving the HPV vaccine.

“What happened to him is tragic,” Lisa says. “But there’s no definitive proof his transverse myelitis was related to his vaccination.”

“How can you even say that?” the woman asks, visibly trembling. “He was dead within two weeks of getting that shot!”

And if he had been hit by a truck two weeks after his injection, would you still blame the vaccine? Lisa thinks. But she understands how emotional the cause is for some, having grown up with like-minded people in her own family. She views the woman solemnly. “In medicine, timing is not always evidence of causality. In other words, just because two things happen near the same time, it doesn’t mean the first is responsible for the second. Millions of kids have been immunized so far. And we’ve only seen a handful cases of degenerative neurological disease among them.”

“But you have seen them!”

“Yes, but the rate is no higher than among nonvaccinated children. Which tells us there is no link.”

Shaking her head in what appears to be disgust, the woman drops back into her seat.

“You talk about your right to protect the community,” another voice calls out from somewhere in the middle of the auditorium. “What about our right to choose? And our individual rights to protect our own children?”

Lisa scans the rows to spot the questioner, a brunette whose outstretched hand reveals a glimmering rock on her ring finger that’s big enough to be seen from the podium. “All the medical evidence suggests that’s just what this HPV vaccine will do,” Lisa says. “Protect your children. From developing cervical cancer, of which there are forty-three thousand new cases every year in the US.”

“Evidence planted by the drug companies to protect their profits!” someone else calls out from near the back of the room.

Lisa takes a breath. “No. Evidence such as the massive population study in Denmark that reviewed a million vaccinated children and found no increase in adverse outcomes compared to the general population.”

“With enough money and influence, you can buy any result you want!”

And so it goes. It was as if she hadn’t bothered to give her carefully crafted, data-filled presentation that reviewed the many benefits of the vaccine and debunked the myths about its risks. A few people in the audience voice their support. And there are moments of infighting among the crowd. But for the most part, Lisa faces a flurry of emotional outbursts that are as disconnected from logic or science as she could imagine. One distraught woman even raises the old myth about how a vaccine that prevents sexually transmitted cancer will lead to promiscuity. It feels like being back at her parents’ dinner table.

Lisa points to the man in the front row who has been patiently holding his arm up for the past while. In a blazer and jeans with hair gelled back and wire-rimmed glasses on, he reminds Lisa of the physiology professor she had a crush on in medical school.

“Excellent presentation, Dr. Dyer.” The man’s self-assured grin and square jaw evoke even stronger memories of her old prof. “Thank you for taking the time to share such important information on such a vital threat.”

“You’re welcome,” Lisa says. But his use of the word threat raises her guard. “Did you have a question?”

“A few, as a matter of fact,” he says, rising languidly to his feet. “You covered a lot of ground in your slideshow. But there were a number of things you left out. For example, the more recent Danish study that found a link between the vaccine and neurologic complications.”

“That was a study of only thirty-five participants. And the EMA—the European equivalent of the FDA—found no evidence to support its claim.”

“And yet, the American College of Pediatrics claims that this vaccine is responsible for numerous bad outcomes, all confirmed through the VAERS database.”

“That database—the Vaccine Adverse Event Reporting System—is only for self-reporting vaccine reactions.”

“Exactly,” he says. “Real reported cases, not nebulous population studies.”

“We use the VAERS database to identify potential patterns of reactions.” For the first time, Lisa struggles to keep the exasperation from her tone. Breathe. “But picking and choosing individual entries from VAERS is like substituting bad Yelp reviews for scientific evidence.”

A ripple of chuckles run through the room.

The man only shrugs. “All right, then why did the Japanese government suspend the very same program that you are now proposing?”

“That was a political decision.”

“And this isn’t?” He frowns. “After the Japanese vaccination program was introduced, didn’t they see a spike of neurologic diseases among the vaccinated? Memory loss, chronic pain, seizures? Some children lost the ability to walk.”

“Again, all self-reported. Never verified in studies.”

“But they did happen, Dr. Dyer.”

He goes on to cite other studies, most of which Lisa recognizes as being tainted by pseudoscience, bias, or outright fraudulent data.

Five senses, she reminds herself as he speaks. The mindfulness exercise has been her latest coping skill at home as the fights had worsened.

Sight: the ring of condensation along the rim of her water glass. Sound: the silky cadence of the man’s voice. Feel: the lectern against her fingertips. Smell: the faint scent of her own perfume—vanilla and tonka bean—OK, I might have stolen that one right off the label Taste: the residual mint from her toothpaste.

Feeling calmer, Lisa waits for the man to finish. “We could argue all day over the quality and accuracy of the evidence,” she says. “But the truth is that every major academic body has reviewed the data and endorsed the safety and effectiveness of the HPV vaccine. And I respect that kind of science.”

“I’m extremely respectful of science, too. After all, I’m also a doctor. A naturopath.” He pauses. “But academics aren’t always right, are they? Science changes. Mendel’s theory of genetics was dismissed as nonsense by his contemporaries. Copernicus was ridiculed for suggesting the earth revolved around the sun. The examples go on and on.”

Lisa almost smiles. He’s doing what they do so well. Twist real facts and examples to support their unsupportable beliefs. Their religion. She might as well be arguing with a flat-earther or a climate-change denier.

“Listen, Doctor…?”

“Balfour. Max, please.”

“Dr. Balfour, you’ve obviously done your research. But cervical cancer is a devastating disease that kills thousands of young women every year. And it’s one of the few cancers we can actually prevent. Wouldn’t you want to protect your daughter from that?”

“I don’t have a daughter. But I do have a son.” The smile leaves his lips, and his gaze drifts downward. “When Jack was one, I wanted to protect him from everything, Dr. Dyer. But right after we gave him the measles vaccine, he developed autism.” His Adam’s apple bobs. “And, maybe, that’s what I really should have been protecting him from all along.”

Several people in the audience break into spontaneous applause.

Before Lisa can respond, her phone buzzes on the lectern. She can’t help but glance down at the health advisory from her office that pops up on the screen. “Four dead from meningitis. All attended the same local Bible camp.”