When I was younger, I wanted to be an Epidemic Intelligence Service officer with the CDC. You know: a bug hunter, a disease detective, one of the brave (and some—not I—would say, foolhardy) souls who travel the world containing outbreaks of Ebola, cholera, and the like.
My wife, as you can imagine, was thrilled.
At the time, I was in thrall to Richard Preston’s The Hot Zone and Laurie Garrett’s The Coming Plague—two books I still highly recommend—but I was serious enough about it to pursue a PhD in microbiology at the University of Virginia’s School of Medicine, with a focus on infectious diseases.
The program turned out to be a poor fit for me, because I lacked the dedication to devote every waking hour to science. How could I, when I had all these stories nattering in my head?
So I dropped out of my grad program, took a job in a laboratory, and devoted my nights and weekends to writing.
For the first thirteen years of my writing career, science kept the lights on, but rarely found its way into my work. I’ve often wondered why that was, since my passion for it never waned. I suspect it was partly a matter of church and state—when you do science all day long, thinking about it on your off time is no fun—but it was also partly fear. In the land of fiction, bad science abounds, and thrilling tales built on good science are few and far between. Could I present a scientific premise in an entertaining way without compromising the factual underpinnings on which it’s built? Would I, in my quest for verisimilitude, be sucked into a black hole of research, never to return?
The answer to the first question is kinda up to you. The answer to the second is, yeah, almost.
The book you’re holding in your hands is the result of countless hours of research. Though it’s obviously a work of fiction, the science behind it is very real, as is the existential threat that it portends.
My selected bibliography—while acknowledging several publications to which I’m particularly indebted—represents a tiny fraction of the resources, scholarly and otherwise, that have informed my thinking throughout the course of this book. That said, the story I chose to tell required no shortage of interpretation, interpolation, and extrapolation, all three of which are riddled with potential pitfalls. If, despite my best efforts, you happen across any errors in this text, I assure you that the fault is mine.
You might be wondering, as you read this, why bother showing your work? You’re writing fiction, not a textbook; who cares what’s real and what’s made up?
The fact is, I do—and, if you place any value in modern medicine (or the occasional steak dinner), so should you. The grim vision of our future that Child Zero represents is all too plausible, given the path we’re headed down, but I wouldn’t have spent so much time and effort writing it if I thought that future was impossible to avert.
Thing is, the time to act is now.
We need to become better stewards of the antibiotics at our disposal by curtailing unnecessary prescriptions and agricultural overuse. Better sanitation and increased vaccination rates would go a long way toward reducing the number of bacterial infections in humans and animals, while faster, cheaper diagnostic tools would ensure our antibiotics are more strategically employed.
We also need to get new treatments into the pipeline, which means incentivizing the development of novel antibiotics and vaccines, as well as research into such promising avenues as probiotics, immunotherapy, and phage therapy.
And we must reject the nationalist tendency to assume our interests and responsibilities end at our own borders. As COVID-19 chillingly demonstrated, we’re all in this together, so it’s high time we started acting like it. Moral obligations aside, the incubation period for pneumonic plague is one to two days—far shorter than most diseases, but still long enough for someone carrying it to circumnavigate the globe.
Speaking of moral obligations, I’d be remiss if I didn’t take a moment to discuss a topic at the beating heart of Child Zero: namely, the intersection of race and public health.
Many readers are likely familiar with the Tuskegee syphilis experiment, in which proper diagnoses and effective remedies were denied to hundreds of impoverished African American men with latent syphilis infections, so that doctors could observe the disease in its untreated state. I wish I could tell you it was an isolated incident, but the fact is, our nation’s history of violating the bodily autonomy of minorities in the name of science dates back centuries—and continues to this day.
James Marion Sims, often referred to as the father of modern gynecology, developed new surgical techniques by operating on enslaved women without anesthesia. The American eugenics movement resulted in the forced sterilization of tens of thousands of minorities throughout the twentieth century, including an estimated 25 percent of Native American women, and there’s evidence that similar abuses have been perpetrated against undocumented immigrants in recent years. Immortal human cell lines (so named because they’re capable of dividing indefinitely) are a vital tool in biomedical research; the first of them (which Salk used to test his polio vaccine, and is still in use today) was created using cells taken from an African American cancer patient named Henrietta Lacks without her knowledge or permission. And a 2018 study indicated that African Americans are enrolled in clinical trials that don’t require patient consent (such as those comparing various CPR methods) at a disproportionally high rate (29 percent, despite comprising roughly 13 percent of the total population).
Writing a child migrant of mixed race isn’t something that I entered into lightly. Mat’s identity is essential to the story for a number of reasons, both scientific and thematic, but I’d be lying if I said the responsibility of portraying him (or, for that matter, several of the novel’s supporting characters) respectfully from a place of privilege didn’t weigh on me.
I bring this up in part because, by story’s end, Mat is forced to make a choice—one so difficult, I suspect many readers will question his decision. For what it’s worth, I think he chose correctly—although, in truth, it’s not worth much.
Mat’s choice was his alone to make.
And that, dear reader, is very much the point.