The smart science of “Contagion”

By Emma Mustich Salon.com For Dr. Ian Lipkin, working on Steven Soderbergh’s new thriller wasn’t about thrills. It was a chance to educate In Steven Soderbergh’s upcoming disaster film “Contagion,” no one — not even Gwyneth Paltrow — is safe from a pandemic virus that kills quickly and leaves mass frenzy in its wake. We’d all like to hope that the film’s scenario is mere fantasy, calculated to give brave moviegoers a decisive end-of-summer thrill. But as Dr. Ian Lipkin, who balanced a consultative role on the movie with his responsibilities as director of the Center for Infection and Immunity at Columbia and co-chair of the National Biosurveillance Advisory Subcommittee, tells Salon, these things are unpredictable, and “Contagion’s” plot is far from implausible. Indeed, Soderbergh and “Contagion” screenwriter Scott Burns went out of their way to make the movie “ultrarealistic.” In a phone interview, Dr. Lipkin described his own role in the film — and his hopes that the project will ultimately not only entertain, but also inspire, advocate and inform. What follows is an edited and condensed transcript of our conversation. Who approached you about getting involved with this film? And why did you agree? Was there any hesitation at all on your part? I was approached by Scott Burns, the screenwriter, who was representing Steven Soderbergh. And I did have concerns, because I wanted to understand the point of the film, and their understanding of what an outbreak was — what it was they were trying to achieve. There have been a lot of films in this genre that have fallen short of what I think is even acceptable science (let alone good science), and both Steven and Scott convinced me that this was something they really wanted to invest in. They wanted not only to entertain people, but also to educate them. They wanted to get the story right, and that’s why I undertook the project. You’ve said in the past that you want to make sure your field will go from strength to strength over the coming generations — in part by ensuring new people are continually recruited. Did your desire to attract new scientists to your field play a role in the decision to get involved? Yes, very much so. One of the things that’s clear in the film is that the science and public health people are heroes; there’s an effort to really show them in a good light — not as, you know, nerds who are unable to relate to the world at large. Our hope is that this is going to make the field more attractive, so that more young people will go into science and engineering, which I think is really the future of the country (as well as the field itself). In addition, we’re all very concerned right now about the budget. With fire departments and the police, you can see people rushing off to put out fires or respond to violence or theft or what have you; when public-health practitioners do their jobs well, you don’t hear about it. So there isn’t any way you can really appreciate what it is we do on a day-to-day basis. And this film highlights much of that, and it does it, I think, in a very clean way. There are a lot of principles that people will glean from watching this film, including simply the kinds of things that we worry about: How transmissible is an agent? What is a mortality rate? How do we go about tracing individuals who are at risk and trying to make sure that we can mitigate that risk? What’s involved with trying to address a new infectious agent? How do you make a vaccine? How do you distribute a vaccine? How do you deal with issues of civil rights? How do you deal with scarcities — not only of medications and things like this, but also of goods and services and water and food? It’s really a very comprehensive look at what can occur during the course of any sort of a public health event — and I think it will be very instructive. So you would say that it’s a realistic scenario. Yeah. You know, it’s not a documentary. So there will be things with which one can quibble, absolutely. For example, the timeline to deploying a vaccine is a little shorter than it would typically be. But by and large, it is a plausible scenario — and it’s also something in the way of a wake-up call. In addition to the hat I wear right now as a laboratory scientist and director of a center that does this kind of work for the WHO [World Health Organization], I’m also involved with something called the National Biosurveillance Advisory Subcommittee. What we’ve done in the second meeting of that group is to take a survey of all the different risks that face the United States — not just bioterrorism, but things like toxins in foods, radiation, emerging infectious diseases, intoxication of pets, etc. — and determine what it is we need to do to more efficiently deal with these risks and mitigate them. And this group, which is a committee to the White House, issued a report (pdf) that’s now public which describes all the different issues that we need to hit in order to address this in an appropriate fashion — everything from insuring the work force to improving diagnostics to empowering the developing world (because we have different strengths in the Northern Hemisphere than the Southern Hemisphere). All those points are outlined there, and they were quite useful as we were developing the plot for the movie. In terms of your hands-on involvement with the film, how often were you asked to step in? Can you give a few specific examples? It began really with discussions of what would be an appropriate disease to talk about. We tossed around a number of possibilities and came up with one that both Steven and Scott really liked, because it was a virus that spread by the respiratory route, so it was like flu and SARS in its ability to transmit easily from human to human. But instead of being confined to pneumonia, like SARS or influenza, it went to the central nervous system; it went to the brain and caused alteration of consciousness and seizures, so it was cinematically more interesting for them, and of course that’s helpful, because they need to sell seats — if nobody sees the movie, it’s not much good to public health or anyone, including Warner Bros. Then, as Scott developed a script, we talked about the individual characters and I tried to provide him either with insights of my own or outside contacts. I was reviewing scripts with him initially, I would say, once every week or once every couple of weeks — but it rapidly became clear that I could be more helpful if I was involved more frequently, so I started talking with them almost daily at one point (and in addition talking with the producers, and the set designers, and so on). All in all, I think I spent 21 days on-set, and another week traveling with them to various locations around the United States and organizing for them to meet people at WHO and CDC [Centers for Disease Control] and so on — and then we had actors who trained in the laboratory. We taught them how to work in a laboratory safely. I’m also a doctor, a neurologist, so I was helpful to Gwyneth Paltrow when she was wondering, “What does a seizure look like?” Many times [in films], people have these very exotic, very exaggerated concepts of what seizures look like, so I was able to help her with that. I was able to help Jennifer Ehle with her self-vaccination scene; I was helpful in terms of showing Elliott Gould how to pull samples in and out of liquid nitrogen, how to pipette these sorts of things. There were so many places where I would correct dialogue, or blocking, or something of that nature, that I frankly lost count. But when I was on-set I was fairly active. Soderbergh is a very secure director, and he wants to be able to change things on the fly. He likes having his screenwriter there, he likes having his consultants there; if he decides that a scene would be more effective done differently, he’ll say, “How else can I do this?” And so he’ll have to rewrite, or reblock the scene. It sounds like a major commitment for you! Yeah, but you know, it was a lot of fun. I’ve never been on other movie sets, so I don’t know what they’re like, but people tell me that on many sets, you move at a glacial pace. That’s not the way a Soderbergh movie runs. He’s not sitting in a chair telling somebody else to take shots; he’s behind the camera, directing, editing, shooting, all at the same time — and he shoots five pages a day, which is three or four times as much as many other people do. He’s very efficient. I felt that I could make a very large contribution by ensuring that the film got made well. Very few scientists ever have an opportunity to represent our field in this way, so I felt it was a responsibility to the field to do this. I have been very, very fortunate in my career — in being successful and having a lot of people who have been very kind to me as I’ve moved up — and this is my way to try to buttress support for the mission of science in the United States. And of course, I’m hoping that a lot of people who are involved with gridlock right now in D.C. — who are cutting budgets and so forth — will look at this and appreciate the significance of the risk. I hope they’ll say, “We can’t cut the budget for science as much as we’re planning.” I’ve heard truly draconian cuts are in the offing, so I’m hoping that this will reduce the probability that that will occur. But who knows. My last question is about the hyping and over-hyping of viruses — which is not all that different, sometimes, from the hyping of other potential disasters. It’s not health-related, of course, but the most recent near-catastrophe that springs to mind is Hurricane Irene; we were told it could wreak an enormous amount of havoc on New York City and the surrounding area, and by and large, it didn’t. Is it still important to prepare for the worst — even if people start to panic? We don’t have crystal balls that allow us to tell you whether a virus is going to be pandemic, with high pathogenicity, or not. We do know the following: We know that we dodged a bullet on SARS, because SARS actually came through the United States, but it didn’t get established here. We know that thousands of people died in China — and I was in China; I saw the havoc it wreaked there. It was profound. And we know that if we were to have some sort of an outbreak — or pandemic, worse yet — in the United States, we don’t at present have the tools that are required to rapidly ramp up some sort of a strategy for making vaccines and distributing them. Those are just the cold, hard facts. We make influenza vaccines in chicken eggs right now, right? Which means we need, what, 300 million eggs, fertile eggs in order to make vaccines? That’s insane! We have to change the way we do these things. Furthermore, much of the vaccine manufacturing has moved out of the United States, so when we needed lots of vaccine in 2009, there were people who ran out and couldn’t make it for us. Do you remember that? We had contaminations of various facilities. That was a situation where that particular virus was not a major threat to humankind. But the next one may be. The problem, of course, is that, if this happens two or three years in a row — it happens with SARS, and it happens with H1N1, and it happens with H5N1 and so forth — people say, “OK, every time we have a new flu season, you guys tell us the sky is falling, and then the sky doesn’t fall.” And at some point they also say: “All right, we’re done with this hype.” My argument is that if we actually make generic improvements to all these different platforms — recognition of risk, response to risk — then whatever it is, whether it’s tuberculosis or SARS or flu or whatever, we’ll be in a better position to deal with it. We’re not trying to scare people. (Well, Warner Bros. obviously is trying to market this as a horror movie.) What we are doing is trying to highlight vulnerabilities and solutions. http://www.salon.com/entertainment/movies/contagion/?story=/ent/movies/feature/2011/09/03/lipkin_contagion