If you are a disease geek, then yes, you will love Contagion, the all-star Oh God Oh God We’re All Going To Die movie that opened last night. Paramyxovirus! R-nought! BSL-4! And, bonus, so many insider references to the CDC that the script could double as an epidemiology drinking game. (Go to the end of this post for my fact-check of CDC references. They’re spoilery and thus hidden on the next page.)
To me, the fascinating thing about Contagion is how seriously it takes its epidemiology, its virology and even its sober sense of how unprepared most Americans are for a mass-casualty disaster (as captured in this April report from the National Biosurveillance Advisory Committee).
To find out where those came from, I asked its chief science advisor: Dr. W. Ian Lipkin, who is the John Snow Professor of Epidemiology, and Director of the Center for Infection and Immunity, at Columbia University’s Mailman School of Public Health, dubbed a “master virus-hunter” by master science-writer Carl Zimmer in the New York Times. Here’s our email Q & A.
Maryn: Given past “science” movies — Outbreak, for instance — I was surprised that the science in this movie is so solid. Was this your doing, and how did you manage it?
Lipkin: Scott Z. Burns and Steven Soderbergh insisted that Contagion be firmly grounded in fact. You won’t see footnotes; nonetheless, choices were carefully researched and vetted. Actors met with people whose work they represented in laboratories and the field. Where feasible we used bona fide equipment in lab scenes. My colleagues and I were on set for critical scenes to address questions from Soderbergh, actors and other artists, or to help with dialogue or makeup on the fly. We want viewers to understand and appreciate what is needed to protect them and their loved ones. Contagion is a work of fiction but it’s based on fact not fantasy.
M: You and your Columbia colleagues designed the viral villain and its syndrome. Why did you choose what you did?
L: [The fictional] MEV-1 is a paramyxovirus that infects the lungs and the brain. It was modeled on Nipah virus because we wanted something more interesting cinematically than an agent that causes only respiratory distress. We do a lot of work on Nipah surveillance in Bangladesh and have produced immunological therapeutics that we hope will be effective in preventing or ameliorating the effects of Nipah encephalitis. I can’t exclude the possibility that influenced my thinking; nonetheless, the choice was perfect in that it gave us a link to bats and pigs as well as an interesting clinical presentation. We considered casting other viruses but this was the best.
M: While MEV-1 is the actual bad actor, the movie has a second villain: the corrupt blogger specifically, and more generally both the Internet and the traditional media. Can you expand on how important it is to address the spread of fear and rumor along with viral spread?
L: People like [Jude Law's character] Alan Krumwiede can be dangerous as well as exploitive. They prey on our fears, consume precious resources and may discourage us from pursuing real solutions. On more than one occasion I’ve heard Steven Soderbergh lament the fact that there is no vaccine against stupidity. Perhaps Contagion is that vaccine. If it is, I expect the studio will remind us of the importance of booster shots at regular intervals.
M: There’s an interesting contrast in the film between what civilian characters say about the epidemic — several times, we hear “You public health people were wrong about H1N1? — and how severe MEV-1 eventually becomes: large-scale quarantine, breakdown of food delivery, mass graves. Did you mean to send a message, that this is what preparedness really looks like?
L: Hope for the best, prepare for the worst. One of the sad facts of public health is that if we do our jobs well no one sees us. How many of us are prepared for an earthquake, fire, or other disaster with water, batteries or even an emergency contact plan for loved ones?
M: Warner Bros. has sold this pretty simply as a horror-thriller. What are the issues you want people to take away from this movie and think about afterward?
L: The Royal Astronomer, Martin Rees, predicts that a serious biological threat will emerge to claim at least one million lives by 2020. Only time will tell whether he’s right or wrong. Nonetheless, I’m appreciative that he has focused the thinking of many influential people on the need for preparedness. Support for science and public health is eroding just when we need it most.
And now: Spoilers! Click through to the next page for a quick run-down on what’s real and what’s fictional in Contagion’s science-studded script.