Contagion

I first of all found Contagion a very entertaining movie. The directors did a great job balancing multiple plot lines while providing their audience with an illuminating account of the fallout from an unprecedented epidemic. Not only that, but the way the movie intertwines the human experience throughout the plot makes the film all the more realistic.

But enough of the film review. What I want to discuss in this blog article is the global severity of potential future epidemics. *Spoiler alert* at the end of the movie, we find out that the virus is caused by a presumably infected bat that flies into a pigs’ den, drops a piece of food that is eaten by a pig, and then that pig is brought to market and the infection spreads from there. Although the movie is just a movie, it doesn’t seem out of the question that diseases that already exist in nature could have the ability to mutate into dangerous microbes that could infect humans. After all, that is essentially what occurred with the H5N1 Avian Bird Flu Virus. According to the CDC, HPAI H5N1 viruses circulating among birds have evolved and are continuing to evolve into different subgroups of viruses, called “clades.” What if a pathogen similar to H5N1 mutated into something much more contagious, effecting many more humans? With the severity of this disease so great, are we prepared to handle such a crisis?

According to Contagion, we are not. The virus easily spread all over the world as the main character and “original case” travelled from Hong Kong to Chicago, then Minnesota, spreading the disease as she went. Because of the interconnectedness of the world, the speed at which the pathogen spread far outpaced the reaction from the Center for Disease Control and World Health Organization. The film also highlighted the inefficiency of government oversight- a private doctor had to go against the CDC’s orders in order to recreate the virus and construct a vaccine. Who knows how long it would have taken if the CDC had effectively kept him from further testing on the virus.

Another potential risk the film describes is the relationship between government and private pharmaceutical companies in this situation. There is an obvious conflict of interests between the government hoping to maintain societal order and private industry pursuing profit, which in this circumstance would be quite large. Jude Law, a self proclaimed conspiracy theorist, is this conflict’s best example. He pretends to be sick in order to show that a drug named Forsynthia helps cure the disease. In the end however, we find out that his plot was mainly to help investors make money as the demand for Forsynthia skyrockets.

The movie also shows that the process of creating and introducing vaccines to the public is quite slow, taking more than three months to complete and costing millions of lives. Because of the government issued quarantines and dearth of essential supplies, the rule of law erodes into nothing, creating anarchy everywhere and leading to looting as well as murder. How does the threat of novel pathogens compare to that of the global problems we have discussed in the first half of this semester? Are there links between these hazards? How can we mitigate against the possibility of future pandemics? Should we be doing more to enhance our infrastructure and safety precautions against novel diseases? — Myles

26 thoughts on “Contagion

  1. I agree with your analysis, Myles. For the most part, I think that “Contagion” was a surprisingly realistic movie. However, one thing I was not convinced by is how the virus managed to be so contagious and so lethal at the same time. The fictional virus kills something like 20% of the people it infects, whereas the Spanish influenza pandemic of the early 20th century had a lethality rate of around 1%. A pathogen that can kill so quickly and efficiently would probably hinder its own ability to spread globally, since infected people wouldn’t have much time to interact with and infect others before dying.

  2. I think novel pathogens are less of a concern, given their rarity and high visibility. As far as bioterrorism goes, it’s a lot easier to just set off a bomb than go to the trouble of procuring a deadly virus or toxin. The best defense against any disease, even a pandemic, is maintaining proper hygiene and making sure government agencies have the proper resources to deal with any sort of outbreak. West Nile, swine flu, and SARS get a lot of media attention, but they kill far fewer people each year than malaria and dysentery – or polio and smallpox before vaccines were developed.

    Speaking of vaccines and conspiracy theorists, I believe these pose a greater threat to general public health and safety. Thanks to the tireless efforts of anti-vaccination agitators and quacks hawking homeopathic “all-natural” “cleanses” and oils, including public figures such as Jenny McCarthy, Jim Carrey and Donald Trump, outbreaks of measles, tuberculosis, and other assorted preventable diseases have been occurring sporadically throughout developed countries. Not only do these people endanger themselves and those foolish enough to follow their advice, but those who do have genuine reasons for not being vaccinated, such as an allergy or autoimmune disorder, are also endangered without the phenomenon known as “herd immunity” to protect them. Unfortunately, this doesn’t confine itself to particular ends of the political spectrum – as recently as Princeton’s meningitis outbreak, I’ve had otherwise intelligent acquaintances and peers try to justify their avoidance of vaccinations with statements such as “I don’t want to put bacteria in my body,” conveniently ignoring the fact that hundreds of trillions of bacteria already live in the human body, or my personal favorite: “they cause brain damage/autism,” referring to a single discredited and withdrawn study from 2005.

    If a global pandemic were to hit the United States, I have no doubt that, as in the movie “Contagion,” the death toll would be exacerbated by a flood of medications of questionable effectiveness, and that once a vaccine was synthesized, a small but statistically significant portion would refuse it, not because Jude Law told them to but because they decided it on their own. At the very least, I think a public education campaign is in order, and perhaps some investigation on how to streamline the research and vaccine development process. I do feel fairly confident in the CDC and WHO’s ability to fight a global pandemic – not only the US would be working on a cure, and given the nature of the problem and the severity of the task at hand, other nations would most likely cooperate – a fact omitted from “Contagion” for reasons of length and plot. Nuclear wars and climate change would be more likely to create conditions favorable for a modern-day plague, but thankfully, no guarantees.

  3. Before I say anything else, here is an interesting Time Magazine article on the movie by a reporter who was in Hong Kong during the SARS outbreak a decade ago: http://content.time.com/time/arts/article/0,8599,2092269,00.html
    It describes among other things how the director, cast, and other members of the production did their homework on the disease.

    As that article touches upon, the symptoms of the movie’s disease are by no means the most graphic symptoms that are (1) possible for real diseases and (2) imaginable by Hollywood writers looking for straight-up shock value. The film instead pursues options that are much more interesting both artistically and with respect to why we are watching it: the human emotions of the afflicted and their loved ones, the death toll, the actions of and interactions between those trying to stop the disease, the dire consequences for normal society, and so on. The film earned its 84% on Rotten Tomatoes.

    Anyway… in response to your conern, Myles, about how we are not prepared, I am inclined to agree. The Time Magazine writer describes how a pandemic poses a greater threat to humanity in the long-run than economic downturns, nuclear war, and meteor strikes. I’m not sure I would go that far, but he is not without some basis. The major problem I see in addressing this problem is twofold.

    First, preparation costs money, and that money has to come from somewhere. Would this be a worthwhile investment / expenditure? Absolutely. Would the costs of such investment be anywhere near the outlays during economic downturns (where the values tossed around have entered the trillions)? Absolutely not. The problem is allocating finite resources to a threat that is by definition unpredictable and unknown. If some terrorist group (in their infinite wisdom) post a video in which they show off their new dirty bomb and declare their intent to use it, I would eat my hat if there wasn’t a substantial response to save thousands or (potentially) millions of lives. In such a case, there is a clear threat (the dirty bomb), a clear foe (the guys in the video), a clear objective (get/destroy the WMD and those who want to use it), and a clear timetable (the threat is here and now). In comparison, investment in disease prevention research involves uncertainty and ambiguity. When will this potentially species-ending disease emerge? We have no idea. What will this disease be? We have some guesses and can work on that, but we can’t say for sure. Where will this disease pop up? Beats us, beyond some well-informed broad guesses. What will success look like? A non-event – the species survives, the disease is either beaten back or prevented from reaching pandemic levels (which isn’t so good for having the president give a “Mission Accomplished” speech). When will this happen? Beats us. We are psychologically predisposed to react to things differently when they are staring us in the face, which is part of why policymakers may choose to spend a dollar on stopping al-Qaeda rather than spending that dollar on fighting a disease that could do more destruction in one day al-Qaeda has throughout their bloody history.

    Second, how much preparation is enough? If, for example, we built a version of Reagan’s SDI and knew we could block (say) 99% of incoming missiles with a high degree of confidence. At that point, we might be justified in sleeping a little easier at night believing that the danger of nuclear attacks have been reduced immensely. What is the analogous situation for fighting diseases? We would be preparing for something that by its very nature is difficult to prepare for as a pandemic strain is likely to resist standard treatment techniques. This is not to sound nihilistic and question the benefit of such research; investment in disease prevention will give us as a species the tools we will need to combat whatever comes our way trying to act out the Book of Revelation. However, such investment is a hard sell when (unlike an SDI-like program countering those loose cannon communists) it cannot offer a high level of confidence against the indeterminate threat it is countering.

  4. I agree with you that this pathogen was a little too deadly to be realistic. Although the movie was very entertaining and quite scary as to the possibilities of such a deadly pathogen all but destroying a first world nation, I feel helpless in providing any recommendations that could stop such a deadly virus. While eliminating the bureaucratic red tape would have speed up the vaccine creation process, I’m not sure at what point regulations would be dropped. As in the Plague Inc. game, the spread of the virus eventually leads nations to remove drug research safeguards.

  5. While the movie was certainly well researched it should be noted that, as it is a hollywood film, this is likely a worst case scenario. In reality the spread of diseases is not quite so perfect – some people have natural immunities, others get lucky in their exposure, etc. Furthermore, as someone else mentioned in their response to your blog post, the relation between fatality rates and contagiousness would represent something of a barrier to catastrophe, as highly fatal viruses and diseases are self-limiting in their contagiousness.

    As for your questions, the last one is the most interesting problem of the bunch – what can or should we do to enhance our infrastructure and safety precautions? This is a tough question due mostly to the inherent difficulty in preparing for the unknown. A possible precaution that should be taken, however, would definitely be to establish and optimize lines of communication and protocols for cooperation between various countries’ CDC-equivalents as well as the WHO. Having an effective set of protocols in the face of a new pandemic could produce results before any disease got too far out of hand. By establishing these protocols one could also potentially mitigate the free-rider dilemma – with a diffusion of responsibilities amongst various countries, the final solution would necessitate cooperation by all participating countries.

  6. The possibility of pandemics is an interesting security threat to consider. Given the specific characteristics of the virus in the movie, I felt Contagion does a pretty good job of illustrating the deadly consequences of such an outbreak. IF the fictional MEV-1 did appear in real life, there is very little we can actually do to prevent a global
    catastrophe. The integrated world we live in today makes the containment of the disease extremely hard. However, at the same time, it is perhaps questionable how realistic the emergence of such a virus is. The virus has several
    characteristics that make it particularly difficult to defend against. These include:
    -A long enough incubation period before symptoms appear to allow the rapid spread of the disease
    -An extremely high probability of contamination
    -A high lethality rate
    -Hard to develop a cure/vaccine against
    -Initial symptoms, which are hard to distinguish from other more common diseases
    If one of these characteristics is not met, it becomes significantly harder for the virus to instigate a pandemic.
    For example, the HIV virus has a long incubation period and has no cure. But the fact that it can only be transmitted via the sharing of bodily fluids limits its spread.
    Ebola has a high lethality and also does has not vaccine. Yet its short incubation period and rapid development of symptoms means that it stays local most of the time.
    I believe that the probability of a “worse-case scenario” virus emerging is very low. There is also very little we can do to prepare for such an event. However, what we can do is develop a more effective and instantaneous communication and information sharing. The only real chance other than the development of a cure is to try and catch the virus early and prevent it from spreading to the rest of the world from its point of origin.

  7. Myles, in response to your question about possible connections between the threat of novel pathogens and the global problems we have discussed earlier in the class, I think I strong case can be made for a relationship between the spread of disease and climate change. Phil pointed out in lecture how shifts in weather and temperature patterns are likely to increase the incidence of diseases that we are already aware of, such as malaria. But climate change should also have impacts on novel diseases as well, mainly due to the effects of rising sea levels on population density. As we discussed in class, as sea levels rise populations along the coast become displaced and are forced to move further inland. The squeezing of a greater number of individuals into a smaller area will increase the rate of contact between persons and in turn the rate at which a disease can spread through a population. Therefore, it seems reasonable that even fast-acting and self-limiting pathogens, which many others have discussed in previous posts, would be able to affect a larger part of the population than would be possible under current climate conditions.

    There are other side effects of overcrowding on the spread of disease. Rapid population expansion caused by displacement is likely to lead to the development of low-quality neighborhoods with poor living conditions in the outskirts of towns and cities. These unhealthy environments would be breeding grounds for pathogens and the likelihood that a novel disease would be able to develop under such conditions is high. In addition, the individuals living in these communities would be highly susceptible to the spread of new diseases, as well as to that of traditional illnesses, as a result of unhygienic living conditions. To help mitigate these risks of a disease outbreak, careful planning would need to be put into urban expansion to make sure that population influxes could be accommodated in a healthy way that upholds high standards of living.

  8. One of the recurring themes in the movie that I want to highlight is the tension between the CDC and the government “hiding” information vs. the people. From the CDC and the government’s perspective, it’s definitely not in their best interest to release live, honest updates on the development of the disease. This will not only lead to wide-scale societal panic and disorder (as we saw in the movie), which could then lead to an economic collapse due to bank runs and failing businesses. At the same time, people also have a right to know how deadly and severe the disease is, as this directly affects their lives. In my opinion, the more severe the outbreak, the harder it will be to reconcile and resolve this tension. Developing a successful vaccine will take at least a few months — even then, it’ll take another couple months to produce enough to meet the demand for the vaccine. This means that if the CDC released a live feed of the real fatality rate, the scale of the panic would only increase.

    In response to Myles’ question about whether there are links between this case and the hazards that we’ve discussed in the course, I think the difficulty of resolving this tension is a theme that can be applied to other security threats as well. For example, even though global warming is a threat that is developing at a much slower rate than a disease outbreak, once the threat becomes more imminent and tangible, the government may begin to start holding back information from the public.

  9. I agree with Myles post on every point. As I watched this movie, there was one thing that kept crossing my mind. Certainly a pandemic would be an immensely complex social problem to deal with on a very limited
    time schedule. If it creates this chaotic of an environment within the highly
    organized infrastructure of the United States, what impact would the epidemic
    have on developing or less developed countries? Hotbeds for civil conflict
    would likely implode and whole regions or continents would struggle to keep
    afloat. Just imagine a disease with similar qualities to the Spanish Flu from
    the pandemic of 1918 ravaging the interconnected world we live in today. Even
    here at Princeton we’ve been exposed a deadly disease outbreak, though hardly
    close to a pandemic. I wonder how many more students would have contracted
    meningitis had the vaccine not been ok’d by the CDC. After how many cases would
    we have seen the first death of a student? The most difficult part of
    addressing these issues, especially from a policy perspective, is that the risk
    of pandemic has always been a factor. Since communal living became the norm for
    humans the spread of contagious disease has been a major concern. In my mind, the
    biological nature of disease and its persistence through mutation and contagion
    make it an inevitable risk of being a citizen on this planet.

  10. This is actually the second time that I watched this movie so I was able to pay more attention to the evolution of the virus without worrying about what would happen to the main characters or ultimately mankind. You make a good point, that surprised me as well in both viewings of the movie, about what it takes in terms of time and resources to create and distribute vaccines. When the doctor is explaining to Lawrence Fishbourne’s character that even if they had promising results with the vaccine it would still be months before they could distribute it it really opened my eyes to the scope of the problem. It is not just a race against time in a laboratory desperately trying to solve a scientific problem, it is just as much (if not more) a question of logistics and manpower and resources to distribute that cure. Too often movies of this kind emphasize “the cure” as if it was the key to open a single locked chest. In reality, however, as Contagion does a good job of pointing out, the situation is more analogous to finally being able to create an expensive key that you then need to recreate millions of times for millions of locked chests, some of which are not easy to reach and all of which are running out of time. The question of how we are prepared to deal with these kinds of “worst case” scenarios is a good one, and while the movie obviously has a great deal of Hollywood embellishment and drama, it does not seem to me to be entirely divorced from the truth. Even if the virus was not as extreme or spread as quickly as the one in the film, any sort of virus on a global scale would require a response and coordination from governments around the world and collaboration on a massive scale. Given the trouble that exists currently in getting governing bodies with different ideologies to cooperate on certain issues, one wonders whether this would be a major obstacle in such a scenario.

  11. TJ raises a good point on the response of developing/less developed nations to such an outbreak, one that the movie mainly chose to ignore. I did find the concept of rogue actors taking important people hostage in order to increase their chance of receiving the vaccine. Dr. Leonora Orantes, who went to investigate the origins of the disease, was held hostage in China for quite some time before 100 doses of the vaccine (which she later learned was a placebo) were delivered in order to secure her freedom. And there is mention of hostage-taking in several other countries around the world as well. Thus, this could potentially be one action taken by actors in developing nations (or even developed) for increasing their chance at receiving vaccines (in exchange for the hostage).

    As far as actions of governments in developing nations, it is unlikely they have the scientific expertise, knowledge, and technology that developed nations do. Thus, there is much less chance of them discovering a vaccine and they likely will have to rely on developed nations to import a vaccine. If research on a lethal virus does occur in developing nations, it is unlikely it will occur in a BSL4 as in the movie. As a result, there is a chance of accidental spread of the virus or a mutated form of it because adequate safety precautions were not taken.

  12. I found myself thinking the same thing when the doctor explained how long it would take to find a vaccine, test it and distribute it. While Jude Law’s character was clearly self-centered and profit hungry, I thought he raised one particularly good point when he mentioned the unknown potential side effects of the vaccine. In the movie, the vaccine testing process was sped up in order to deliver the vaccine as fast as possible. While a pandemic of this scale may not be entirely realistic, it does make me think about what would happen if the CDC was blindsided with a new pathogen they had never seen before. In reality, how fast could they produce a vaccine and with time as a limiting factor, how would they be able to adequately measure potential side effects?

  13. From a policy stand point, I found the most troubling theme of Contagion to be the conflict between the pressure exerted on centralized government during crisis (as we saw political systems trending towards anarchy) and its growing importance in a time of crisis (as the disease spread, it became more necessary for a central government to make decisions and resist general panic).

    While I agree that the likelihood of such a terrible epidemic occurring is small, I think choosing an over exaggerated (perhaps) depiction is important at demonstrating this important conflict. On a macro level, to minimize human casualties, an epidemic must be handled by cautious decisions that maintain social order and sanitary/healthy conditions by quarantining patients, rationing supplies, and continuing basic societal resource production and services like street cleaning or police protection. However, this ideal handling of an epidemic is thwarted by the desire of individuals to ensure their own health or their family’s health. We witnessed this conflict first hand in the movie when Dr. Cheever told his wife to leave Chicago and come to Atlanta (breaking the quarantine rule that had just been set in Chicago) because it would put her in the safest position. This decision, as we saw in the movie, multiplied as his wife told her friends, potentially leading to wide spread panic as everyone starts to realize the seriousness of the disease.

    As a result, at the exact time that centralized decision making becomes crucial to the maximum survival of human life, human nature withers it down dramatically. I am not sure how this conflict is resolved, but I do think that choosing such a dramatic epidemic in Contagion did a good job of exhibiting this aspect of health policy. Is the implication of this policy problem that there are just certain aspects of epidemics that we can never prepare for? I’m not sure, but it’s certainly an interesting thought.

  14. I felt the movie highlighted for me the unpreparedness that we as society may have in response to a pandemic, especially in maintaining social order and ensuring things like food supply and continuation of business. What I thought was interesting was that properly taking care of oneself, i.e. continually washing hands, living in isolation, avoiding contact with others, was an effective means of protection against infection (as we saw from Matt Damon’s daughter). On the other hand, there was considerable difficulty in maintaining societal order or stopping the existing methods and means of life from eroding. This particular insight was something I largely overlooked when previously thinking about what a real outbreak would mean for policy decisions.

    That is, while we may be able to avoid overrun by disease in the long-run by changing behavior and through preventative methods, that change in lifestyle has implications for society overall as well. There was considerable difficulty in maintaining rule of law, and an announcement over radio claimed absenteeism of the police force in the order of 25%, further there was difficulty distributing and rationing food. Overall, if people are isolating themselves and avoiding contact and business, what will that mean for the economy, food production, and functioning of services like national defense for the nation? Also how much should a nation like the United States help or aid less developed nations in the event of wide spread disruptive events like these? And do we have policies to deal with these issues should they arise? The movie highlighted for me the importance of not only having a plan for combatting the pandemic, but also a means to control the population and ensure continual safe living conditions as people adjust to a new lifestyle to prevent the disease from spreading.

  15. Hi Myles,
    One thing that you highlight from the movie, which may have more practical implications than is initially apparent, is the point of origin of the pandemic detailed in this movie. Although it may seem implausible, the idea of a pig being the point of origin for a huge outbreak is not outside of the realm of reason. About a month ago, I was fortunate to get to attend a lecture by Dr. Julie Gerberding, the ex-director of the CDC. She described that one of the biggest issues facing our time is the rapid spread of diseases on a global scale. The planet is getting smaller due to increased human mobility, and diseases are spreading faster than they ever have before. Dr. Gerberding described many different disease outbreaks during the last decade that she has helped to quell. One of the most striking examples was the case of the SARs outbreak in 2003. Dr. Gerberding explained that the CDC was able to track the spread of SARs back to one pet distributor in China. She then showed us a graphic that illustrated the spread of SARs around the world via different pet shops and travelers visiting China. This one pet distributor ended up infecting thousands of people around the world. This shows us that a pandemic originating from a pig is much more of a reality than we may want to believe.

  16. In watching Contagion, there were two things about the potential effects of a pandemic that particularly struck me. The first is probably the most evident theme in the movie: the societal distress and pressure on our institutions that a widespread disease may have. Though in the context of the movie, this may have been slightly played up for dramatic effect, it was something I had not previously considered. If one attempts to aggregate the effects a pandemic can have on the world, you can not only consider those directly affected by the disease. In fact, the destructive effects it may have on society could potentially outweigh those of of the disease itself. We saw this in all the looting and general anarchy that emerged at the peak of the pandemic. This effect serves to make a pandemic a far more significant global threat, as you have to weigh the negative externalities and their longterm effects on society.

    The second thing that struck me was the importance of individual people in solving and countering the pandemic. Again, the film may have dramatized this for audience appeal – it serves as a good way to develop individual characters – but it illuminated a key insight: We do not have exact protocols and systems in place to deal with such a threat. Instead, when we counter a disease outbreak like this, it is the culmination of the efforts of individual people. This proves especially significant and dangerous when you consider the possibility of one of these key people contracting the disease. If, for example, Morpheus had gotten sick, we would not have had someone in charge of the counter-disease effort; as they stated in the movie, there was no one in line to replace him. In this sense, egalitarianism may not be the right approach; in times of crisis, we actually do need to protect certain people more than others to ensure the longterm survival of our species.

  17. The thought of a lethal pathogen causing a pandemic is different than some other hazards we have discussed in terms of panic and fear. With a deadly bacteria or virus (especially if the incubation period takes time), we may never know with full certainty where the disease will appear next. Furthermore, in a worst-case scenario, a superbug could mutate more quickly than we have the capacity to inoculate ourselves (or come up with new methods to fight a newly-mutated bug). While other security hazards we have discussed have their own fear factors, disease is unique—it can spread and transform unknown to society until the first victims show symptoms, and by then, the bug may have spread to a much wider audience.

    In terms of government response, it is clear that with something on the scale of a superbug, extraordinary measures may need to be taken to protect public health. For instance, the CDC has contingency plans in place should there ever again be a smallpox outbreak (for which we do not currently have immunity), including stockpiling enough vaccines for every person in the United States, working with local and state health officials to vaccinate members of the public (voluntary, of course—no forced vaccination), and working with local authorities to quarantine individuals with smallpox (or those who may have come into contact with somebody who has smallpox): http://www.bt.cdc.gov/agent/smallpox/basics/outbreak.asp

    While these may seem extraordinary, let’s remember that at Princeton, we recently underwent a mass vaccination campaign against meningitis serotype B (with high turnout among the eligible population).

    [Something that is quite worrisome: The CDC states that “credible concern exists that the virus was made into a weapon by some countries and that terrorists may have obtained it.”]

  18. In my mind, the most chilling aspect of “Contagion” is that it followed existing and very real concerns to their most extreme possibilities and implications. At Princeton, the presence of ample P-Safe officers at the meningitis vaccination site hinted at the security implications of vaccination provision. In Canada, a handful of famous NHL players used their fame to gain early access to flu vaccinations when concerns of swine flu broke out. While the case in context seems nothing more than arrogant and a little funny, it too hints somberly at real concerns about being “front of the line”.

    On the matter of transmission vectors, I found the plot of wealthy Macau casino patrons coughing and touching on video camera a little contrived. The scrutiny of a casino allowed the investigators to pinpoint exact transmission vectors, but in reality, knowing the details of such transmissions would be near impossible. While this point may seem a bit trite and could be forgiven in the name of dramatic effect, the transmission vectors in the movie “Contagion” obscure actual observed transmission vectors in previous epidemics that are much more alarming. The idea that only wealthy businessmen are interconnected enough to cause global transmission betrays a conception of globalization as old as the nineties. SARS, on a per capita basis, was most devastating in places like Hong Kong and Toronto because they are centers for the movement of lower-income remittance workers and traders. In fact, in Hong Kong, one building, Chungking Mansions, is the global epicenter of this kind of globalization. Similarly, it’s ironic to think that the movie depicts Canada as a safe haven hoarding body bags when the U.S.-Canada border is relatively porous, and even in absolute terms, had more SARS cases than any other country outside of Asia, mostly due to the numerous familial ties between recent Canadian immigrants and their families in Asia. The global ramifications of such an outbreak are even greater than the movie depicts if one considers that labor mobility under globalization results in regular travel across the distinctions of rural/urban and developed/developing.

    I agree that the movie underscores a lack of preparedness for such an event. It is interesting to consider that Hong Kong still maintains many of its precautions, such as covering elevator buttons with replaceable disposable plastic screens, disinfecting escalator handrails hourly in public spaces, requiring students at boarding schools to take their temperature daily, and by social convention, requiring the ill to wear masks in public, despite the fact that the threat of an immediate epidemic has already passed. Whether a locale has to suffer such a high number of deaths (as HK did during SARS) in order to take these concerns seriously is an open question. As the movie highlights, this kind of government activism could be considered overreach in the U.S.. Is there a way to nudge the public towards safer practices without infringing on rights when no immediate threat is present?

    I also have questions about international cooperation in such a situation. If states believe the epidemic may be of malevolent intent, would they be suspicious of cooperating on scientific findings and producing a vaccination? The movie mostly focused on the interaction of public and private actors in a crisis, but cooperation over international borders is likely more fraught.

  19. I agree with your comment @sstrauss:disqus. Contagion did not strike me as being particularly realistic. Consider the SARS outbreak of 2003, during which around 8,000 people were infected and 774 people died (a fatality rate of 8%). The SARS outbreak occurred in much the same conditions as the disease in Contagion: a highly populous city, transmission through “close contact”, highly reactive public. However, SARS did not spread at nearly the level of the disease presented in the movie. I understand that Contagion needs a disease that is much more deadly than SARS in order to entertain audiences, but in my opinion we should not be discussing the features of the disease in Contagion or the response of the fictional government apparatuses as informative because the scenarios are hyperbolic–meant to illustrate the beyond-worst-case. Of course our governments are not prepared for a virus that has a 20% fatality rate and that spreads all over the globe in just a few months. As @sstrauss points out, that type of virus would likely hinder its own progress.

    The film does a good job of depicting response infrastructure and by defining some of the key vocabulary used by the CDC. However, I do not believe that it is useful to consider this movie as anything more than a basic illustration of these features of disease response because it relied on a wildly imaginative pandemic scenario to entertain rather than to inform. The movie itself is reminiscent of the conspiracy theories that the character played by Jude Law is asserting, especially considering the unrealistic scenario in which a single professor is sent a sample of the incredibly deadly disease and is able to sequence it by himself.

  20. The past several posts have led me to wonder about how our government would maintain order should a pandemic spread across America. As Carter pointed out, the pandemic in the film caused utter panic among the affected citizens. Their desperation to protect themselves led them to behave selfishly and immorally, to the point that it put others in danger. But just as the CDC has emergency measures in place for certain outbreaks, like smallpox, should our local or federal governments have concrete emergency protocols as well?

    This is to say, is the danger of pandemic credible enough that the government ought to educate its citizens now about what they ought to do? In the film this pandemic spreads incredibly rapidly, which seems to be a dramatic device rather than an accurate depiction of reality. However, if a pandemic were to actually spread this quickly, there would be no time to properly educate citizens on how to behave in this situation before chaos ensued. Is this something that we ought to be taught now, before a pandemic actually occurs? Or is a pandemic like that depicted in the film so unlikely that there is no true cause for concern? If there were to be a public education campaign – telling people to stay in their homes, not to congregate in public areas, and not to trust shady Internet figures like Krumwiede in the film.

    It seems most likely that a public education campaign like this, at a time when there is no actual threat of pandemic, would likely do more harm than good. But it is still worth developing such a campaign so that the next time a highly contagious disease does begin to spread, people will know what they should and should not do.

  21. Carter, I agree with your point about the importance of individual people that was highlighted in the movie. However, I do think that they did a good job of intertwining the different stories. One thing that struck me about the individual people was how public policy and government protocols can so easily be thwarted by human error and unforseen decisions of individuals. Luckily in the movie all of those actions (the scientist continuing to work, the doctor injecting herself, Marion Cotillard being taken hostage, etc.) all had positive or negligible effects. However, there could easily have been negative effects to these actions. For example, what if the scientist who had kept working in unsafe lab conditions exposed more of the world to the virus? This just shows how, no matter how much public policy there is, we cannot account for everything.

    Additionally, I was also struck by how the spread of people affected is so much different from what we examined with nuclear weapons. The analysts in the movie were trying to figure out where the virus had originated and where it could possibly go next. With nuclear weapons the damage stays in one area, and there is not this type of concern.

  22. Hi Julia –
    You raise many good points, and the point you mention at the end of your comment is particularly valid and is actually something outlined by Guillemin in last week’s readings. She explains that it’s difficult to find a balance between information that a government SHOULD or should NOT provide, regarding biological warfare or disease outbreak. For example, it’s difficult to warn a population of potential disease and fund/promote widespread immunization and preventative tactics without increasing anxiety levels tenfold. Civilians begin expecting imminent danger if they see such a high amount of resources poured into prevention techniques. On the other hand, failing to communicate can lead to the chaos and lack of public preparedness observed in “Contagion,” an equally, if not more, undesirable result.
    What Rosebury and Kabat advocated for in 1942 – that remains valid today – is that public institutions and individuals need to (i) establish a reliable infrastructure for dealing with disease outbreak, concretely in the form of hospitals and clinics that are always ready and institutions prepared to conduct the necessary research and develop the technology necessary for an outbreak, (ii) practice general sanitation, hygiene, and avoid risky behavior (think Princeton meningitis advice posters), and (iii) promote public development of widespread sanitation methods that could potentially stop or at least slow the spread of a hypothetical disease.

  23. Yeah, I suppose the key irony here is that the best time to prepare the public for a situation is when there is little to no danger of that situation. The measures taken in the film, such as the quarantining of several entire states, while effective, are actually quiet chilling in their cold calculation. Large amounts of the population are essentially sacrificed in order to save the many. In this situation, I can see that it would be very easy to panic and disregard the rule of law. As to your question of developing a campaign that does less harm it would need to be subtle and enacted through innocuous means. Perhaps through… a feature length film? The conspiracist in me wonders…

    At the very least, we have existing protocols from the swine and avian bird flu outbreaks that we could quickly and easily enact to stop the spread and to prevent disease. But of course, as highlighted in the film, the panic is equally, if not more destructive. I was actually surprised at how early the characters in the film were examining individuals deaths in places as varied as Hong Kong, Minnesota, and Japan, and assuming they were all linked together.

  24. I think this post brings up a number of important concerns, although I may disagree a bit with the final paragraph. In terms of vaccine distribution, I think the film did a good job showing a likely method for distributing vaccines. In such a case, the government would have to treat all citizens equally and a randomized way of assigning vaccine dates is the only way to do so.

    I do think that international cooperation would come with relative ease in the event of a global pandemic. Biological warfare is far from most peoples’ as a likely event, and I don’t see people assuming that as a cause without very specific and persuasive evidence. China, for example, didn’t blame Japan or the United States over the H5N1 outbreak, and it seems unlikely that they would jump to such a conclusion without substantial evidence in the future.

    In terms of nudging the public towards safer practices — perhaps educating children about the real dangers associated with poor hygiene at a young age (kindergarden?) might lead them to live with more healthy habits. They could also be taught to take all doses of an anti-biotic to avoid creating bacteria resistant germs as well.

  25. Myles,

    In response to your questions at the end of your post, the threat that novel infectious pathogens seems to me to be much greater than many of the global problems discussed in the first half of this semester (referencing this blog post: http://nuclearfutures.princeton.edu/blackboards-of-risks/). Many of the global hazards we face would occur due direct and deliberate human action meant to bring about these hazards (ie, nuclear war, space weapons, cyberterrorism). However, in the case of a novel pathogen, there is no such corresponding individual or group that could potentially be responsible for creating such a hazard, which makes prevention of this type of disaster significantly more difficult. As we have discussed previously, there are steps that can and are taken to mitigate some of these risks (ie, nuclear deterrence, arms control, etc). However, beyond basic global health initiatives (promoting hygiene, access to clean water, etc), there is little action that can be directly taken to counteract the potential impact of a novel pathogen simply because it is exactly that, novel. As was shown in the film, the disease traveled so quickly that it was able to penetrate a variety of populations before symptoms were detected, which was itself long before government action was taken to contain the spread of the disease. At this point, such action was already too late as the disease had already spread to a large percentage of the population. Based on the film’s portrayal, the only true way that I see that the disease could have been contained is to have completely restricted travel regardless of the knowledge of the existence of such a disease. If, for example, patient zero had been somehow tested for disease or studied by a doctor before leaving Hong Kong, the disease would have never spread to the rest of the world, thus preventing a global pandemic. However, this recommendation is completely unrealistic, both in terms of a restriction of individual’s privacy and freedom of movement, but also in terms of costs and logistics of implementation. Therefore, because a novel pathogen is by definition, there is little action that I see can be taken to specifically target mitigating the possibility of such an event.

  26. This movie has certainly made me think more about the extent of the effect of bioterrorism. Despite its rather exaggerated portrayal of means of transmission for dramatic effect, it was indeed a powerful visual aid for the general public to feel the gravity of such small everyday human interactions upon introduction of a new disease. Not only that, but it was fascinating to see the dichotomy in the public and the government. While the people in CDC were working intensely under immense pressure and risks to produce vaccine in order to save people and restore public order, the public were discontent with what they view as inefficiency (mistrust added by the CDC censoring the current progress and magnitude of the danger in order to maintain public order). I noticed the notion of “us and them” play much larger role in the public, with clear mistrust and anger towards the government which they saw as corrupt and inefficient, resulting in a mass panic and disorder. Whether the movie provide accurate presentation of what goes on in CDC during emergency crisis such as this or not, it is still a good movie for the public, to raise awareness of the danger, actions taken by the government behind the scene, and suggest implication of such highly contagious disease on the world today.

    The effect of bioterrorism is very different from nuclear attack. First of all, the biggest difference is the impact of these attacks on the civilians. When a city is attacked by a nuclear attack, it is easier to create a public narratives of “us and them”, to unite the nation together and support the government to retaliate. It is much easier for the government to frame itself to look more like a savior – even if it is very inefficient at providing aid and restoring infrastructure, the solidarity formed under nationalism gives justification for people to endure through hardships and losses. upon bioterrorism, however, it is much harder for the government to control the public. As the movie shows, even though the disease derived from Hong Kong, and seemed to be not related to any terrorist attack, it created hostility and mistrust among the public against the government. The “us and them” notion is turned into the unprivileged public vs. privileged elites in the government. Not only that, but the aid and cure for bio-related attack is much harder to develop and distribute whereas aid and rebuilding post nuclear attack is quite controlled and mechanical. In addition, bioterrorism seem to create additional harm due to the ongoing threats of spread through human interaction. This movie shows that the threat seems to create mass panic resulting in economic and infrastructural shutdown and potentially social disorder. Since people feel endanger by the risk of transmission, it will make people avoid human interaction, which translates into low supply of volunteers and communal support and even discourage economic activity despite the potential profit from high demand for goods and services. High demand compared to low supply of labors and goods will result in mass shortage, further encouraging social disorder. Upon nuclear attack, those affected are contained within the targeted region. Although the whole economic activities are shut down and create mass casualties and trauma, it will boost the demand for goods and services, possibly propping up the economy. Economic incentives will most likely help the victims to get assistance they need.

    As many pointed out, the chance of epidemics to have such dramatic effect is very low. However, I couldn’t help but question the possibility of combined use of bioterrorism and nuclear attack. What if a terrorist group or another state was able to successfully launch bioterrorism in the United States to create at least a sense of insecurity, panic, and mistrust among the public, creating pressure for the government to put unconventional control over the public which result in political tension and economic disruption, and then launch a nuclear attack on a major metropolitan city?

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