The recent and popular film ‘Contagion’, directed by Steven Soderberg, paints a pretty bleak and horrific picture of a deadly virus’s spread around the globe in a matter of days. But how close to reality is such a scenario?
In a recent NY Times op-ed, epidemiologist W. Ian Lipkin (a technical consultant on the film) weighs in on the authenticity of the threat depicted in the film, factors contributing to the rise of global contagions, and describes current plans and policies to deal with a major, contagious disease outbreak.
Dr. Lipkin commences by using an historical example: his recollection as a youth of the Sputnik satellite launch by the U.S.S.R., which drove an urgent awareness that the U.S. was falling behind in the space race. This historical event he likens to the current state of global preparedness for a deadly microbe strain, implying that we are not fully prepared, even “falling behind”.
In the op-ed (The Real Threat of ‘Contagion’, the good doctor ponders “Could a movie like ‘Contagion’ be an effective vehicle for sounding the alarm?”
Showing a keen understanding of the inter-relatedness of ecology and epidemiology, Lipkin offers this general summary of the risks presented in the film:
“Those risks are very real — and are increasing drastically. More than three-quarters of all emerging infectious diseases originate when microbes jump from wildlife to humans. Our vulnerability to such diseases has been heightened by the growth in international travel and the globalization of food production. In addition, deforestation and urbanization continue to displace wildlife, increasing the probability that wild creatures will come in contact with domesticated animals and humans.”
In his consulting role for the film, Dr, Lipkin began working with a team of scientists at the Center for Infection and Immunity at Columbia University’s Mailman School of Public Health. The team devised a fictitious virus, modeled on a very real one known as a Nipah virus, which appeared in Malaysia in the 1990’s (and again in Bangledesh from 2001 – 2008, via human to human contagion). That particular virus evolved by jumping from fruit bats to pigs to humans and caused respiratory disease and encephalitis resulting in the deaths of over one hundred people.
Though the Nipah virus was contained (in Malaysia), it could have been much worse; its manner of evolution, spread, and deadly physiologic effects made it the “ideal” model candidate for the film’s vector of contagion.
Additionally, in 2003, Lipkin was summoned to China to advise on the SARS epidemic. His recollections of that crisis — the deserted streets, political instability, and wide-spread food and medical supply shortages — also found there way into Soderberg’s film.
‘ I hope the public and our lawmakers will see the movie as a cautionary tale. Pandemics have happened before. And they will happen again.’ — W. Ian Lipkin, professor of Epidemiology, Columbia University
So, how prepared are we for such a ‘contagion’?
The Lipkin op-ed notes that the National Biosurveillance Advisory Subcommittee, at the Centers for Disease Control and Prevention, was established in 2007 (by presidential directive), to assess our “biosurveillance capabilities and make recommendations for improving detection, prevention and management of biohazards.” Lipkin himself serves as the subcommittee’s chairman. To date, the subcommittee has issued several reports that “provide a road map for steps we have to take to protect our future.”
Amongst these steps, the professor notes two key ones (quoted):
1] “we need to recognize that our public health system is under-financed and overwhelmed. We must invest in sensitive, inexpensive diagnostic tests and better ways of manufacturing and distributing drugs and vaccines. Although new technology now allows us to design many vaccines in days, manufacturing strategies for influenza vaccines have not changed in decades.
2] [we need] “more and better coordination is needed among many local, federal and international agencies. Joint effort is required to monitor human, animal and environmental health, optimize electronic health records, mine nontraditional data sources like the Internet for early signs of outbreaks and invest in a state-of-the-art work force.”
Author Note: Although the recent avian flu (H5N1) pandemic (see top photo) was ultimately stopped in North America (though over two hundred died, and it continues to appear in Europe, the Middle East, and most recently, Africa), vaccine shortages due to production time requirements had started to become an issue. This is a major concern of epidemiologist the world over, some of whose host nations lack the degree of vaccine manufacturing infrastructure that we have in place here in the U.S., however much it is in need of modernization.
W. Ian Lipkin is a professor of epidemiology and a professor of neurology and pathology at Columbia University.
Photo: (bat) Raul654 ; CC – By – SA 3.0