New movie puts public health, infectious disease in spotlight: Behind the scenes of ‘Contagion’
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* Kim Krisberg

Movies about disease outbreaks, with their often-exaggerated portrayals of public health workers, are nothing new. But this month, the movie “Contagion” brings the outbreak theme to the silver screen in a new package.

![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/41/7/1.4/F1.medium.gif)

[Figure1](http://www.thenationshealth.org/content/41/7/1.4/F1)

Actor Matt Damon, who plays a man whose wife is infected during a disease outbreak, in a scene from the movie “Contagion.”

Photo by Claudette Barius, courtesy Warner Bros. Pictures

Directed by Steven Soderbergh, the movie chronicles the rapid worldwide spread of a deadly airborne virus, the public health response to it and the societal disruption that results. The film has been compared to one of Soderbergh’s earlier films “Traffic,” which explored the illegal drug market through separate storylines and from the perspectives of different players in the drug war. For “Contagion,” the movie’s creators worked to strike a balance between entertainment and accuracy, bringing in experts to consult on the complexities of public health response work and visiting the nation’s public health headquarters at the Centers for Disease Control and Prevention. Public health takes such a starring role that W. Ian Lipkin, MD, a scientific consultant to the movie, said that “after watching this film, everyone in public health is going to be a hero…(public health workers) aren’t going to have to explain to their friends and family what it is they do.”

Lipkin, a professor of epidemiology at Columbia University’s Mailman School of Public Health, worked closely with the movie’s screenwriter, Scott Burns, to help develop a plot that was both scientifically believable and entertaining, consulted on set design and dialogue, and helped actors transform into the public health practitioners they play. Lipkin also designed the fictional virus at the center of “Contagion.” To develop a credible storyline, Lipkin turned to zoonotic diseases, which are passed from animals to humans. Such diseases account for more than three-quarters of emerging human diseases and are one of the more likely scenarios for how a pandemic agent would originate.

“The science is really very good,” Lipkin told *The Nation’s Health*. “We took sequences of known viruses and we modeled them and morphed them into this new virus, but everything you see is biologically plausible.”

Movie creators also did research on how society might respond to the virus and the ethical dilemmas public health workers would face in trying to control its spread. Public health author Laurie Garrett, a senior fellow for global health at the Council on Foreign Relations and a scientific consultant to “Contagion,” said that when she first met the movie’s creators, it was “very clear to me that they were dead serious” about making a meaningful film about a disease pandemic — “this wasn’t going to be another movie about evil scientists and people turning into zombies,” she said. Garrett worked with Burns to develop credible public health scenarios as well as the possible policy and political responses to such a pandemic.

For example, Garrett said she advised that the movie not reflect “any illusions of the readiness of industry.” In reality, she noted, a pandemic vaccine won’t be ready overnight and if there is a vaccine, there won’t be enough for all those in need. Garrett said she drew on vaccine development problems related to the avian flu virus, which was lethal to chicken cells and therefore could not be grown in chicken eggs the way typical flu vaccines are created. In the movie, the virus is too lethal to be grown in a lab, slowing down vaccine research and affecting the public health response. On the policy side, Garrett said it was important to her to bring up issues of social justice as well.

“The movie should make audiences think of the equity situation,” she told *The Nation’s Health*. “When we have a disaster, who gets the benefits of science and who makes those decisions?”

Burns, the film’s screenwriter, said the experience has made him “less fearful and more philosophical,” and that he washes his hands more often now. He noted that “Contagion” was not inspired by any particular disease outbreak, but that he has long been fascinated with how diseases move through the world and society’s response. Burns said he wanted to explore the secondary damage that a disease outbreak would cause, such as its effects on air travel, hospitals or truckers trying to cross state lines. Garrett described the film’s societal breakdown as “almost like the scenery in the background,” such as a scene of garbage piling up because trash collection has ceased.

“The whole movie was basically one ‘a-ha’ moment after another for me,” Burns said regarding his experiences learning about disease and public health. “I became acutely aware of how there is a shared health of a society.”

For instance, during the H1N1 flu outbreak, Burns met with Garrett and tried to give her a hug. In true public health fashion, Garrett declined. At that moment, Burns said he realized what “social distancing really meant and how hard it would be to get people to stop shaking hands and how much shared space we really have.”

“To me, the public health people in the movie come across as heroes even though what they’re fighting against is really, really difficult,” Burns told *The Nation’s Health*. “Not only are there viruses in the world that are new and tricky…there’s also things like human fear, politics and prejudice.”

While the film’s creators worked hard to bring accuracy to the storyline, Burns emphasized that “it’s an act of fiction…it’s not ‘this would happen,’ it’s ‘this could happen.’”

Sandra de Castro Buffington, MPH, director of Hollywood, Health & Society, noted that “accuracy and entertainment can go hand in hand…the more realistic the storyline, the more compelling it can be.” A program of the University of Southern California-Annenberg Norman Lear Center with roots at CDC, Hollywood, Health & Society is a resource for writers and producers looking for credible public health information to weave into their storylines. Buffington said that even if education is not the goal of a TV show or film, if the writers work on a storyline’s accuracy, it is likely to leave lessons with the audience.

“I think entertainment has the ability to influence people’s points of view and regardless of whether a piece is accurate or inaccurate, the scientific community can use those pieces of media as teaching tools,” said Rick Loverd, director of development at the National Academy of Sciences’ Science and Entertainment Exchange, which connects entertainment professionals with scientists and engineers.

In fact, many moviegoers may leave “Contagion” recognizing the importance of public health preparedness and wondering if the nation is prepared for such an outbreak. Although the nation has made progress in strengthening public health preparedness capacity, recent funding cuts put that progress in jeopardy, according to health officials.

As of 2010, federal funding for public health preparedness had been cut by 27 percent since fiscal year 2005. Significant losses among the public health workforce due to state budgets means many health departments are struggling to keep up, which could have an impact if a large-scale outbreak occurred. According to Jonathan Links, PhD, director and professor of public health preparedness programs at Johns Hopkins Bloomberg School of Public Health, “there’s no threat for which we’re completely prepared and for which our work is done…there’s also no threat for which we’re completely unprepared.”

Besides workforce and funding issues, research gaps in public health preparedness also remain, Link said, noting that President Barack Obama’s fiscal year 2012 budget proposal would eliminate funding for public health preparedness learning and research centers — “and right now there are no other meaningful sources of funding for (these activities),” he said.

Luckily, much of public health preparedness takes an all-hazards approach, a technique that readies the workforce for a variety of emergencies. The approach is the “only thing saving our bacon these days,” Links said.

“Public health systems aren’t built in a day,” he told *The Nation’s Health*. “Building a public health preparedness system is a long-term effort…that can’t abide a waxing and waning (of attention).”

Both Garrett and Lipkin said they hope “Contagion” audiences take away a new appreciation for public health and preparedness.

“Be concerned and push our leaders for preparedness,” Garrett said. “When an epidemic hits and things begin to deteriorate, lives depend on the ability of the community to care for itself and each other versus isolating individuals out of fear or stigmatizing people. I hope that people come away from (the movie) realizing that if an event like this were to occur…the ability of society to respond properly is going to depend on the notion of ‘are you your brother’s keeper?’”

For more on “Contagion,” which opens Sept. 9, visit [www.contagionmovie.warnerbros.com](http://www.contagionmovie.warnerbros.com/).

*   Copyright The Nation’s Health, American Public Health Association