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Weighing the Risk of a Real-Life 'Contagion'

While Steven Soderbergh’s popular thriller “Contagion” is a fictional account of a mysterious virus that wreaks global havoc, the film is based on real science and outbreaks of disease.

“Is there an agent right now that has the capacity to spread in this fashion and cause this level of disease? No. But that doesn’t mean it couldn’t or wouldn’t happen, or that we shouldn’t be concerned about the potential that it could happen,” says Dr. W. Ian Lipkin, an epidemiology professor, and director of the Center for Infection and Immunity at Columbia University’s Mailman School of Public Health.

The success of “Contagion” comes as real-world health threats are in the spotlight.

It’s the 10th anniversary of the anthrax incidents, following the September 11 attacks, and health officials are battling a Listeria outbreak tied to cantaloupes from Colorado.

Between frames of attractive doctors struggling to save the world, the film poses legitimate questions about the preparedness of the actual global health infrastructure. Are international organizations ready to battle modern-day, borderless epidemics?

What’s the impact of reduced city and state public healthbudgets?

“We wanted this to be a wake-up call to people that there is this risk and that we need to take this seriously,” says Lipkin, who served as the film’s senior technical advisor.

He worked with screenwriter Scott Burns and actors including Gwyneth Paltrow to ensure an outbreak was represented authentically on film.

Casting a Deadly Virus

The film tracks a virus that travels on a flight to Chicago from Hong Kong. The pathogen spreads quickly, and the race is on to get a vaccine to market.

Lipkin and his Columbia colleagues helped cast the lethal MEV-1 virus in the movie. The fictional MEV-1 was based on a real-life Nipah pathogenthat’s linked to bats and pigs.

The film explores the emergence of new diseases passed from animals to humans. Changes in modern land use patterns and animal and livestock populations have triggered hot spots for diseases including, for example, the foot-and-mouth outbreakin the United Kingdom in 2001.

Some have criticized the quick pace in which a vaccine is manufactured and brought to market in the movie. In the spring of 2009, a new strain of swine flu, H1N1, spread and created a vaccine shortage.

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“The H1N1 vaccine rate was unacceptable. … We should have it on the street in three months or less because we’re going to need to do this,” Lipkin said.

As social disruption ensues, the film uncorks more thorny, ethical questions related to epidemics. For example, many vaccines are manufactured outside the United States. So when a country makes a vaccine, how much will be sold outside its borders?

Who gets access to vaccines first? In 2009, Wall Street banks faced criticism when they received early shipmentsof the scarce H1N1 vaccines.

The film “really portrays some of the issues we want to make sure people started to think about,” says Mark Smolinski, another technical advisor for “Contagion,” and director of global health threats for the Skoll Global Threats Fund in Palo Alto, Calif.

The Fund began in 2009 with a $100 million donation from Jeff Skoll, founding president of eBay, to tackle global threats including pandemics, water shortages, and the Middle East conflict. Skoll’s film company, Participant Media, has helped finance“Contagion” and other socially-minded films including “The Help.”

Scenes, Characters Based on Reality

Recent health scares inspired many scenes and story lines in “Contagion.” Empty city streets reflect Beijing in 2003 during the SARS outbreak. Fictitious squabbles among health officials echo the story of Andrew Wakefield, a British medical researcher who expressed concerns in 1998 about the measles-mumps-rubella vaccine and its relationship to autism.

The movie also touches on how quickly health information, misinformation, and fear can travel. Jude Law plays a corrupt blogger, who reports on the crisis in “Contagion.” In fact, health practitioners are only beginning to explore the possible ways online communities and technology might shape epidemics and healthcare information.

“This movie has gotten a boost out of being truthful,” says Jamie Heywood, co-founder of PatientsLikeMe, a Cambridge, Mass.-based website that aggregates patient data to gauge the effectiveness of treatments, bypassing clinical trials. “There are efficiency gains in allowing the right people to see the right data,” Heywood says.

PatientsLikeMe

So how well prepared is America to detect and respond to a mass-casualty disaster? It’s a big question health experts and epidemiologists are addressing.

In April this year, the National Biosurveillance Advisory Subcommittee released a report on America’s ability to detect and respondto modern health threats, which include bioterrorism, radiation, infectious diseases, and intoxication of pets. The report cited insufficient staffing, complexity and overlap among stakeholders, and inconsistent biosurveillance data-collecting methods and metrics.

“There is no question we’re not prepared,” says Lipkin, who co-chaired the subcommittee. “Were we to have an outbreak, let alone a pandemic, we would not be able to handle it and that’s just the way it is. People are beginning to use this report as a way to guide some of their thinking and investment."

A separate report on biological threats will be released Oct. 12 by the WMD (Weapons of Mass Destruction) Terrorism Research Center in Washington, D.C.

Lack of preparedness for a massive health threat partially reflects health budgets that have been slashed.

“The best defense for any bioterrorism event is to have a robust public health system,” says Smolinski of the Skoll Global Threats Fund.

Meanwhile, the healthcare debate broadly has been focused on chronic diseases including obesity in recent years, not epidemics. “We’re not especially visible like police or firemen. If we do your work well, you don’t hear about it until something goes very bad,” says Lipkin.

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