"Contagion" Prompts Discussion of Pandemics, Public Health Responses

In the movie Contagion, an epidemic spreads quickly from continent to continent and leaves a growing number of fatalities in its wake. Public health workers scramble to identify the novel virus and race to develop a vaccine as civil order breaks down and military troops move in to quarantine a panicked citizenry.

Is Contagion just another scary Hollywood horror movie or is it a realistic portrayal of what could happen if—or when—a new and virulent virus spreads to humans?

Members of the Yale School of Public Health watched the film on February 17 in Winslow Auditorium and pondered those questions and others in a follow-up discussion with a panel of Yale and other experts on viruses and epidemics. The panelists agreed that Contagion is a pretty realistic portrayal of what could occur if a particularly lethal virus (such as the one responsible for the 1918 influenza epidemic) took hold.

“A lot like this might happen,” said Matthew L. Cartter, state epidemiologist with the Connecticut Department of Public Health (DOH) and an associate clinical professor at the School of Public Health. “I thought this was pretty much right on.”

Other panelists included Albert Ko, head of the division of Epidemiology of Microbial Diseases; Jamie Childs, a senior research scientist and lecturer in the same division; and Tim Styles, an epidemic intelligence service officer with the DOH. The panel was moderated by Professor Durland Fish, a specialist in Lyme disease and other vector-borne pathogens.

The 2011 movie, featuring a lineup of well-known actors and actresses, tells the story of a virus that is created through contact between a bat and a pig and then passed onto an unwitting American businesswoman in Hong Kong. She spreads the virus to others there and then transports it back to the United States. Within days the woman and her young son are dead, and a growing circle of people are falling ill. In short order the situation becomes a pandemic, moving through large urban areas at a startling pace, passed from person-to-person through contact as casual as a handshake. The death toll becomes staggering. Millions are dying or dead as government and health officials struggle to understand what they are dealing with.

In addition to tracing how a pathogen can originate and the massive public health response that is necessary, the movie deals with a host of other issues that would likely arise in a pandemic—conspiracy theorists alleging that the government is lying, a complete breakdown of civil order, quarantines, questions of who gets the first doses of a new vaccine, transmission rates and even a discussion of “R0” (pronounced R-naught), which is the number of new cases that a single infected person will cause.

Childs, who has researched a range of viruses, including hantaviruses, arenaviruses and rabies, noted that bats are an important host and reservoir for various diseases, included the deadly Ebola virus. He also thought that the movie’s depiction of civil disruption was accurate. Social structures collapsed in Philadelphia in 1918 as the death toll grew from the flu.

The movie also raises important questions about whether government is equipped to handle the next great epidemic, Ko said. In Contagion, daily resources are quickly depleted and people are left to fend for themselves. One scene shows throngs of survivors lining up for ready-to-eat meals, only to have the supply run out. Food becomes increasingly scarce as deliveries are halted.

The movie also deals with the ethical issue of how the first doses of a limited vaccine are distributed, a scenario that puts government in the role of deciding in essence who lives and who dies. “There are going to be the haves and the have-nots,” Ko said.

Fish said he was impressed with the film’s accuracy and noted that a former student, John Brownstein, served as a technical consultant. He also commented on the movie’s portrayal of a government skeptic (in the form of an influential blogger) who achieves the status of a “prophet” among millions of panicked people. Fish said he has seen the same dynamic at play with other diseases.

The panelists noted that Contagion is just the latest movie about epidemics and, while good, it does have shortcomings. For instance, the movie portrays a very limited initial response from the government when in reality it would have been much larger. The movie also condensed the timeline for dramatic purposes, showing the discovery and production of a vaccine in far less time than it would likely take.

For anyone interested in seeing another movie on epidemics, Cartter pointed to Panic in the Streets, a 1950 film set in New Orleans, as one of the best he’s seen.