Watching the new thriller "Contagion" may make you more aware of what you touch and eat and have you reaching for the soap or hand sanitizer — and that's a good thing, according to its writer and the epidemiologist who served as the on-set consultant. "There's a concept called public health, and when there are diseases afoot, you have a responsibility to your fellow person to keep them safe, and that's what keeps all of us safe," says screenwriter Scott Z. Burns, who, guided by his and director Stephen Soderbergh's mandate to keep the film as real as possible, consulted with scientific experts and public officials to ensure that the film was not the typical "Hollywood treatment of these things. The reality is scary enough. You don't have to do a lot of invention," he says, noting, "all of the scientists we talked to said it's not a matter of if, but when."
One of those experts is Dr. Ian Lipkin — professor of epidemiology, neurology and pathology at Mailman School of Public Health and College of Physicians and Surgeons, Columbia University — a researcher with field and quarantine experience who became the film's on-set consultant and had significant input into everything from the design, structure and evolution of the virus to the costumes, makeup, lab sets and equipment (which he helped procure), how the Centers for Disease Control and Prevention and World Health Organization interact with local agencies, and training actors Kate Winslet and Jennifer Ehle to convincingly play epidemiologists. Ehle was a particularly good student. "We went over pronunciation of terms and what they mean — it wasn't just a question of learning the lines. She also became quite adept at using equipment," he notes.
Lipkin had "been interested for a very long time in finding a way to make the public more aware of the risks we face with epidemics of infectious diseases," and agreed to participate because he was confident that Burns and Soderbergh would relay that message accurately. "I wanted people to take this seriously." Initial script input and frequent phone calls once production began segued to 21 days on set "and probably another five traveling with them" for Lipkin, who often helped rewrite scientific dialogue on the fly. "It's not a documentary," he reminds, citing such elements of the film as the "truncated" development of the vaccine, "but the principles are the same. We don't have good ways to rapidly make vaccines, to develop them and manufacture them," he emphasizes. "We need to improve the pathway" from the discovery to the patient, "whether it's a vaccine, a drug or a diagnostic."
While Burns had considered bioterrorism as a cause of the pandemic, and it is indeed speculated about, in the end he opted for what is a convergence of occurrences rooted in human behavior that has impacted the environment. "When scientists talk about where to look for emerging diseases they talk about ecotones, areas that are the margins between civilizations and wild places. And what you see at the end of the movie are bulldozers clearing trees. We're displacing wild animals and those animals are reservoirs for viruses we may not have encountered before."
Deforestation, the consuming of primates in some cultures, and humans coming into contact with rodents and bats — either directly or through domesticated animals — are danger factors, says Lipkin, noting, "Over 75 percent of emerging infectious diseases represent infectious agents that jump from animals to humans." Nevertheless, he's "very concerned about bioterrorism. With synthetic biology on the rise and all these instruments that can be used to create whatever it is you want, it's becoming more of a risk."
So what do we do about these scary scenarios? As co-chair of the National Biosurveillance Advisory Subcommittee, Lipkin prepared "a road map of what we need to do to reduce if not eliminate risk" in a report to Congress and the White House last April that noted, "It is imperative that the federal government develop operating principles for data collection, integration, and sharing that allow for flexibility, expansion and innovation."
Lipkin's recommendations include better diagnostics, standardizing terminology for those diagnostics, a database of digitized patient records, better support for epidemiologists and public health workers, and methods to screen foodstuffs for harmful substances, including infectious agents, and finding ways to stop those agents before they spread. "It's a global world we're living in. Anything can rapidly travel to another place," he reminds. In the meantime, individuals can practice "social distancing" by avoiding shaking hands and washing hands frequently.
Lipkin, who lost colleagues to epidemics, sees "Contagion," in theaters Sept. 9, as a tribute to unsung heroes who work in public health and hopes that it might attract young people to pursue careers in the field. "I know that there are schools that are planning to use this film as a teaching tool," he says. "Not only will this be a blockbuster, I'm convinced of that, but it will have life afterward."
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