The Malthus Pandemic

PROLOGUE

No-one asked questions when the Kofi Clinic opened on that hot, dusty and chaotic side street in the centre of Kano, Nigeria’s second city. In Kano, things just happened. People came and then they went.

Perhaps the old lady who sat mending torn clothes or the man next door who mended bicycles saw something. Perhaps, too, the old man who sat every day on an old tyre that lay amongst the accumulated urban debris and watched and listened to the crowds of jostling people, trucks, buses, taxis and carts going to and from the market place also noticed. But no-one cared.

In a crowded city of four million people, where three million lived in poverty, why should they have noticed the stranger, a big man in a long white bubu and wearing a traditional hand-woven cap? Here was a man like everyone else who came and went in the heat and dust. Perhaps only the sewing lady, the bicycle man and the old man who sat on the tyre saw him arrive one morning and take delivery of a second hand desk, some wooden chairs, a metal filing cabinet and a cardboard sign printed with a red cross and the words ‘Kofi Clinic, Doctor A. Mustafa’. Perhaps, too, they were the only ones who watched him fixed that sign above the door with a hammer and two nails.

If anyone had heard him speak, they would have heard Arabic but not Hausa and, anyway, he never stayed long enough to strike up a conversation because he’d quickly head back to his room at the Grand Central Hotel.

It was at the Grand Central that Doctor Mustafa met the white man who joined him for one quick visit to the Kofi Clinic before leaving on a flight to Nairobi.

No-one turned up at Doctor Mustafa’s clinic when one evening, shortly after the white man’s visit, a light was turned on and the door was opened for the first time. No-one turned up on the second night either, but on the third night six men were waiting outside when Doctor Mustafa arrived and unlocked the door. On the fourth and fifth evenings, rumour had spread that the Kofi Clinic was not a place to go if you were sick or felt ill but a place that offered cash for testing new medicines.

Na sana’anta twenty thousand naira, said one enthusiastic volunteer who emerged waving his money to a man still waiting in the queue outside. Easy money, man, he added before heading off to buy a live chicken to take home to his wife and six children.

The Kofi Clinic, its business finished, closed shortly after that and Doctor Mustafa was not seen again. A nail then fell from the sign above the door so that it hung at an angle.

CHAPTER 1

We’ve got a new client, Jinx, Colin said.

Colin often calls me Jinx over the phone or when he’s out of reach.

My real name is Mark Dobson and I was sitting and relaxing with a glass of ice cold Beerlao in the Shangri-La Hotel in Kuala Lumpur having only just finished a job for our last client when he called. We’d even been paid for it so I was reflecting on a job well done. It was also Friday and I was wondering if should treat myself to a well-deserved weekend in Bangkok before heading home.

Colin sensed my lack of interest. It’s a biomedical research company from Boston, USA, he added and I imagined him grinning because he knew I preferred working with higher tech types of business.

The last two clients had been corporates making big brand consumer stuff - blue chips with counterfeit problems. My job was to nip things in the bud before they got out of hand. I’d become good at counterfeit jobs. I was so good I was finding them routine. You get to know the sorts of people involved in rackets like that. You know their ways and where they hang out. I could take you to back streets and even some big industrial estates where counterfeiting is the number one local industry.

The Chinese are good on electronics. The Thais are brilliant at printing jobs like fake passports and if you ever want Gucci handbags, Scotch whisky or nicely packaged copies of Avon or Estee Lauder cosmetics then there’s a small town just outside Ho Chi Minh City in Vietnam I’d recommend as a starting point.

Asher & Asher is the name of the company Colin Asher and I started some years back. If we had a website, which we don’t, counterfeiting might be given a mention but international corporate fraud, industrial espionage and theft of intellectual property would be the highlights. So, when Colin mentioned an American biomedical research company, I put my beer down.

I was thinking of flying up to Bangkok for the weekend, I said.

He gave a short laugh. Ha! How is she?

I told him I’d not seen her for months. She probably won’t even recognise me.

No problem then, Jinx. Come back here. Duty calls.

Colin often talks about duty. Duty calls, he says. He who escapes a duty avoids a gain, he says. Happiness is the natural flower of duty.

What about a duty to myself, I said. You’ve been married twice. Can we forget our duties when it suits us?

It was only banter but, being the same age as Colin and still single, I wasted the next few seconds on considering my private life.

Being single suited Colin just as much as it did me. Being single meant I could jump on a plane with five minutes notice, talk to myself if I felt like it and sometimes forget my own name but it doesn’t bode well for a woman expecting a cosy life with a man who arrives home for dinner on time. I am not a man who can forget the day just gone and leave it in the hallway with his hat and coat.

Sadly, several women with foresight have complained that my passion and commitment for completing a job for a client seemed to take precedence over completing other jobs requiring similar devotion. My reply has always been that passion takes many forms, but I admit I’m not good at defending my own character. Faced by such accusations I find words dry up.

So why am I admitting to a few private weaknesses at the start? Because I was about to face another of those situations and I need to explain why things turned out like they did early on rather than struggle to do so later.

Meanwhile, I was already intrigued by what Colin had just said. Tell me some more, I said.

Virex International. Based in Boston. They do research on viruses and other nasties.

Never heard of them, I replied.

Nor me until their president, Charles Brady, called. Something about our reputation spreading far and wide.

I’ve always said word of mouth marketing beats a website.

So, don’t ruin it, Jinx. If you get here within twenty-four hours you could meet him off the plane with a fancy placard saying ‘Welcome Charles’. What a great start that would be.

So, I cancelled my vague private plan and, while finishing my beer, sat with my phone and booked a flight to London instead of Bangkok.

Little did I know then that I’d end up in Bangkok within forty-eight hours and become an expert on a killer virus that made COVID-19 look like a poor counterfeit.

I was in London for two nights and one day.

Most of the day was spent waiting for Brady's delayed flight to arrive from Boston and by then Colin and I had pieced together a lot more about Virex International. They worked on vaccines and did complicated research on viruses that caused influenza and other human disease. Their problem, according to Colin’s brief conversation with Charles Brady was that they’d lost some sort of research material, but Brady had been reluctant to say much over the phone.

Colin and I swapped views and listed some questions. What sort of research material? How and when was it lost? That sort of thing. Whatever it was we dismissed break-in and common theft by a local cat burglar. It looked more like sophisticated industrial espionage to us so I was quite looking forward to meeting Virex’s Charles Brady.

When I saw him, though, he wasn’t quite what I’d imagined. He was a slightly overweight middle-aged guy with a nice tan and wearing a crumpled beige suit, wide-striped shirt and flowery tie. He reminded me more of a gay jazz musician I once met than a scientist in a white coat who would sit analysing electron microscope images all day long, but at least I got invited into the American Airlines arrivals lounge for coffee.

Once we’d settled, he began a long explanation about his flight delay while all I waited was to pose my list of questions. In exasperation and because he was already looking at his watch to go somewhere else, I finally asked him to get to the point. So, what exactly have you lost, Mr Brady?

He seemed to be in some doubt which intrigued me. He then said they’d lost some phials of frozen virus samples but instead of a description of the virus itself I got a full technical explanation of the freeze-drying process. It was like a distraction as if he didn’t want to come clean. After a full minute I asked him, What sort of virus, Mr Brady?

First, he wiped his forehead as if the answer would cause him to break out in a sweat. Then he sniffed. A type of coronavirus, he said.

I nodded knowingly. Every man, woman and child across the globe knew about coronaviruses. Fake news and a thousand different opinions had done nothing to ruin their newly acquired expertise. There was nothing more to know about them. Coronaviruses were like mosquitoes. Some people got bitten and barely noticed it. Others got bitten so bad they died.

Similar to COVID-19? I asked showing my own deep knowledge of such things.

He shook his head and wiped his brow again. No. Not exactly, he said.

I suppose if he’d mentioned he’d lost some Ebola, smallpox or rabies virus I would have sat up but hearing it was ‘not exactly COVID-19’ I relaxed, wondering what all the fuss was about.

Brady then checked his watch again. He’d mentioned something about a meeting in Cambridge later so I decided to move things along. What I needed was a fix on the cost of what I imagined were a few frozen test tubes. Costs always put things into perspective.

Give me a figure, Mr Brady, I said. What’s the financial cost of the loss?

That threw him again. He sniffed once more but eventually put a value of a few million dollars on it. It wasn't an exact sum and not as big as I imagined it might be. It was probably big for a company of Virex’s size but before I could react, Brady said something else. One of our scientists left around the same time.

I heard what he said and it registered with me but it blended in with a sudden but belated flow of other useful information that ended with: If you need more information, there’s a conference on infectious diseases in Bangkok that starts on Tuesday. Amos Gazit, our Head of Research will be attending.

It was the mention of Bangkok that fully registered. Everything I’d been doing recently, seemed to centre around south east Asia. What exactly do you want Asher & Asher to do, Mr Brady? I asked.

He again checked his watch. Talk to Amos. Ask questions and see what turns up, he said.

I was still pondering on the return to vagueness when he stood up saying he had to go or he’d be late. We left the lounge, I shook his greasy hand and then watched him walk away pulling a case on wheels and wiping his face as if I’d given him hot flushes.

I was to remember Charles Brady’s manner at that first meeting. I pondered on it for a while as I watched him go but then put it aside and called Colin in the office.

He’s gone, I said. He provided a few more facts but left behind still more unanswered questions but I assume we’ll take Virex on as a client.

Colin grunted which meant he was too busy to talk but that he agreed.

In that case I’ll leave you to discuss the fee etcetera, I added. He was in a hurry but suggested I talk to his head of research, a guy called Amos Gazit, who’s at a conference.

Colin grunted again so I added, So, I’m flying to Bangkok tonight to meet Gazit at the conference.

That woke him up. Christ Almighty, he said. If that had been me, he’d have told me his head of research was at a conference in Kazakhstan or Bolivia.

CHAPTER 2

Philippe Fournier had been working on his plan for days.

At its heart of it was a need to impress a young Italian nurse called Mara so he’d invited her to join him for a Saturday drive in a rented Jeep to the small town of Kijabe fifty kilometres outside Nairobi.

It was supposed to be a weekend treat, away from work at the Kenyatta National Hospital, a chance to distract Mara away from a group of other foreign students there to learn about tropical diseases. It was also a chance for Philippe to explain more about the work he was doing on HIV treatment and prevention.

This is not just for the benefit of Kenyans, he had told her when they first met. My work is for the good of all Africa. This is a seat of excellence.

Having left France and England to pursue his childhood ambition to return to his roots and work in Africa, Philippe liked talking about work. He also liked to mention the low pay that came with it and was sure that Mara, even as a foreign student on a short-term assignment, earned far more than he did. It was very upsetting.

Philippe had visited Kijabe once before with a group of laboratory technicians and in a mini bus. This time, he was to be alone with Mara and both the driver and the tour guide. Fifty kilometres was no great distance but he hoped it might give Mara a feeling of being on a sort of romantic safari. It would also be quick to return home if things turned out well.

And so, they set off with Philippe nervously small-talking about work in a style that probably was not as exciting as Mara might have hoped for.

I don’t just work in the laboratory, he said. My job is to find more multi-sectoral and multi-disciplinary partners to reduce HIV transmission, to mitigate the impact of HIV and AIDS on vulnerable populations. Mara didn’t react so he added that it was "especially focussed on training and ways to convey information and advice."

Throughout this laborious explanation Philippe even used a few Italian words mixed with English. It was an impressive effort but Mara still seemed more interested in watching the passing scenery through the yellow and cracked plastic window of the old Jeep.

Nearing Kijabe, though, he finally got around to describing where they were actually going. Kijabe, he explained, was Masai for ‘Place of the Wind’. It stood on the edge of the great rift valley and was over two thousand metres above sea level. And it has a railway station, he said glancing at Mara.

When Philippe glanced back, he found he was close to killing a Masai farmer and his cow wandering in the middle of the road, but he swerved and then made amends. Sululu he called out to the farmer in the hope that Mara was also impressed by his Swahili.

At last Mara spoke. Where does the train go, she asked.

Philippe beamed at the sudden show of interest. Uganda one way and Mombasa the other, he replied enthusiastically before remembering a poem he’d read somewhere. What it cost; no words can express. Where it starts from no-one can guess Why it’s there no brain can suppose and where it goes nobody knows.

Mara was still looking through the window but perhaps, Philippe thought, her English wasn’t quite up to the humour.

And there is a mission hospital, he said, hoping that something about hospitals might be more interesting. And a guest house for those who are lost or delayed or decide to stay the night, he added with another sideways glance.

Philippe, though, had not reckoned on there being a problem at Kijabe Station.

A train had arrived but its driver, fifty-six-year-old Samson Omwenga had taken ill. At Kijabe, he had finally given up trying to cope with the utter exhaustion, the sore throat, the dizziness and the dry cough that made his head throb. Samson had almost fallen from his engine, collapsed onto the ground and announced, between more coughing, that he felt so weak he was unable to continue.

When Philippe and Mara arrived to view the historic station, someone had just phoned the hospital for a doctor. Meanwhile, the passengers were standing around discussing the aptness of the train's other name, the Lunatic Express.

Parking the Jeep next to a stretch of red, muddy water, Phillipe jumped out and was immediately approached by someone in a uniform asking if he was the doctor. Being black but with his parent’s Cameroonian features, Philippe felt honoured to be mistaken for a Kenyan medical doctor but his PhD was only in microbiology.

Yes, he said. I am a doctor, but I’m not a medical doctor. I work at the Kenyatta National Hospital. What is the problem?

The stationmaster ushered Philippe towards the station waiting room leaving Mara struggling to leave the Jeep without falling in mud. In the waiting room, a wooden bench had been acquisitioned as a temporary bed for Samson. With Philippe still trying to confirm his non-medical qualifications, the circle of onlookers surrounding the sick driver parted to allow him to approach.

This is senior engine driver Samson Omwenga, said the stationmaster.

Yes, but I'm not... Philippe said as Samson coughed violently. He was sweating profusely, his eyes were red and puffy, his breathing was heavy and Philippe immediately thought of viral pneumonia.

This is the doctor, the stationmaster said to Samson without getting too close.

But I'm not… Philippe repeated and Samson’s eyes opened as if it was his last breath. Philippe stared down at him. It was obvious the man was running a very high temperature and Philippe who had seen patients with AIDS saw the look of fear in his eyes. He needs to go to hospital, sir, he said.

Do you not have some medicine for him? The train is late.

Sir, said Philippe. This man is very sick. He can hardly breath. He has a very high temperature. Just look at him. He has no strength – certainly not enough to drive the train to Nairobi let alone onwards to Mombasa. He needs a proper doctor. But I am only a...

Can you take him to the hospital, sir? We have too many passengers here and they all think he will be OK soon. And we do not have a qualified replacement. If you take him away, they will see that the train will be delayed.

Mara finally arrived. This is Mara, said Philippe. She is a nurse from Italy. I will ask her what she thinks."

Minutes later, Philippe had abandoned his well laid plans and was driving back to Nairobi with Mara still staring silently out of the window and train driver Samson coughing, shaking and groaning on the back seat.

Philippe called the hospital later that evening to enquire about Samson Omwenga.

He was in intensive care, said the nurse in charge,

Was? Philippe asked.

Yessah. He died two hours ago.

CHAPTER 3

Larry Brown could trace his morbid interest in infectious diseases back to a video he watched as a boy.

While his younger sister played with plastic stethoscopes, plastic thermometers and a plastic doll as her patient, Larry watched and re-watched a video about leprosy, Chagas disease, yellow fever and leptospirosis.

While his sister became a lawyer, Larry became a doctor but the childhood fascination with infection and tropical disease had never waned. It was one reason why, once he’d qualified and practiced for a short while, he left New York to travel.

He worked in Chile and Peru and then Kenya. It was in Nairobi that he met Philippe Fournier and where he was asked by someone from the US Embassy if he was interested in looking at the Nigerian health system with a view to - as it eventually explained in his new job description - assist American companies understand how best to win contracts in the provision of management services and medical equipment.

Larry accepted, was seconded to the American Embassy commercial team in Lagos, Nigeria and started work by travelling around the country.

His first stop was the northern state capital of Kano. The reason was obvious to Larry. The smaller city of Jos in neighbouring Plateau State was, according to Larry's calculations, only about 150 miles away and as the Evangel Hospital in Jos had always held top spot in Larry's list of places with especially interesting diseases, the chance for a quick visit was too good to miss.

In 1969, before Larry was born, the Evangel Hospital had been the first centre in west Africa to identify the haemorrhagic, flesh-eating, Lassa Fever virus that still causes around five thousand deaths a year across Africa. Two missionary nurses at the hospital died of the virus and a third fell ill and was flown to the USA. It was there that the virus was isolated and named. A year later, the medical director at the hospital, a missionary surgeon, also caught Lassa Fever after she accidentally cut herself during an autopsy. She was dead within two days.

Some viruses are like that and there’s no vaccine for the Lassa virus. COVID-19 was an amiable pussy cat in comparison.

After his visit and hoping that diplomatic relations between the US and Nigeria had been enhanced by his short and unannounced intrusion, Larry began to consider what he himself had discovered the day before during his few hours in Kano. The more he thought about it the more he was convinced that he might have discovered another new fever.

This one had none of the characteristics of Lassa Fever but if the estimated death toll in Kano of at least one hundred men was accurate then someone needed to sit up and take notice. But no-one yet had.

Larry's official visit to Kano had been at the request of his Embassy superiors in Abuja, the Nigerian capital. The line was that it would be useful diplomacy if an American, especially a black one who could trace his roots back to West Africa, was seen to be doing something useful for the ordinary people. All the better if it was handled in a way that could not possibly be interpreted as remotely political or designed to inflame ongoing tensions with the northern Moslem community.

Someone had organised a debate for two schools in Kano. The topic of discussion was to be, Who is more important to society, the teacher or the doctor? and it was designed to encourage students to speak good and correct American English using appropriate American expressions. Who better to run the debate, then, then a real live doctor fresh out of New York?

But Larry had never been a man who did his job and then went home. He met the students as required, learned far more from them than they did from him, went back to his hotel and then, with time on his hands changed out of his suit, put on a pair of jeans and headed out to explore Kano.

Perhaps he was naturally drawn to clinics and old mission hospitals but as he wandered down the Kofar Wambai Road watching, listening, smelling and generally taking in local Kano life he took off down one of the side streets. He had hardly walked fifty yards when he found himself looking up at a cardboard sign hanging from a single nail above a doorway. Behind the door was a single story, concrete building with rusting bars fronting dusty, unwashed windows. Perhaps it was because a red cross is never upside down, but it made him stop and, by twisting his head. he read the rest of the faded writing. Kofi Clinic, Doctor A. Mustafa, it said.

Interest sparked, he pushed open the unlocked, wooden door and found himself in a dark and dusty hallway that might, had the electricity been turned on, have been lit by a single bare light bulb that still hung from the ceiling. At the far end was another door.

It is closed, sir. The voice from behind was that of an elderly woman Larry had seen sitting and sewing in the shade outside. She was now standing behind him holding an old shirt with the needle and thread hanging from the corner of her mouth. Dressed in a long, colourful dress and an ornate head-dress that Larry had recently learned was known, at least in Lagos, as a gele. Despite the dust, the trash and the rubble around her feet, the woman looked and sounded educated. Larry introduced himself. Was it a private clinic? he asked.

Yes, sir. Doctor Mustafa.

Did he have many patients? Larry asked peering down the hallway at a grey metal filing cabinet lying on its side with empty drawers hanging out.

No sir.

Where has he gone?

She shrugged so Larry tried the door at the end, found it locked, wiped his dusty hand on his jeans and returned outside. Do you live nearby? he asked. She pointed across the road to a concrete block house with a corrugated tin roof and open doorway. Did you see patients arrive here?

Yes sir.

Did Doctor Mustafa have many patients?

No sir.

Why did it close?

His patients died?

"Died? All of them?

Yes, sir. They were taken away in a truck.

CHAPTER 4

Kevin Parker had just finished another week at the Bristol University School of Sociology, Politics and International Studies. There would be no Friday night drinking to oblivion with fellow lecturers and other hangers-on tonight, though. Kevin had an appointment.

He’d spent most of the day in the library rather than teaching, so he was even more casually dressed that normal.

With six years of trying to teach British Economic and Social History to students with mixed results and very little self-satisfaction behind him, Kevin's weekends, most evenings and any other spare time was spent on his real interest - moderating the website of the International Malthus Society.

Dedicated to exploring the ideas of Thomas Malthus on a theoretical and a practical level was the somewhat uninspiring strap line of Kevin's website. But it opened the doors for all sorts of comment, opinion, political lobbying or action linked to Thomas Malthus' dire, eighteenth century warnings of the effects of overpopulation.

The power of population is indefinitely greater than the power in the earth to produce subsistence for man, he’d written. "The increase of population is limited by the means of subsistence."

Kevin had personal experience of overcrowding. As the oldest sibling of eleven brought up on a poor housing estate in Liverpool he had seen and felt the consequences. His father had left soon after Kevin was born and his ten brothers and sisters had ten different fathers but he still felt proud to be called a Liverpudlian.

Kevin, in his usual day-time wear of crumpled brown corduroy trousers, a green, open-necked shirt and bright red sweater that said Liverpool FC on the front was on his way by train to London to give what he thought was a talk to Malthus Society members and any other enthusiasts interested in human population control. He was an expert on the subject. He lectured on it so had all the facts and figures at his fingertips. He also tried hard to temper his lectures to conceal his own views and, even more so, his radical solutions. After all, he told some in private, he was not there to brainwash students like some radical cleric in an Islamic mosque. Nevertheless, he often felt comfortable enough to expound on his wish to see direct action to radically reduce the world population so that the quality of life for those remaining improved. Kevin liked giving talks to gatherings of like-minded folk.

But this invitation had come as a surprise to Kevin. It had been a phone call from someone he hadn't even heard of, an Arab if the man’s accent and name of El Badry was anything to go by. He also seemed to be an Arab with money as the flat Kevin had been invited to was overlooking Chelsea Embankment. It would certainly be large enough to hold several other members of the Malthus Society if that was what the caller intended.

On the train, he took out his notes and a yellow marker to set about highlighting the points he would make. But then he put it down again. The fact was he was tired of giving straight talks with facts and