‘Contagion’ makers discuss the facts in their fiction

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Contagion, the prescient movie by Steven Soderbergh, which ‘foresaw’ the pandemic in uncanny detail, has become stuff of quarantine lore. The 2011 film tells of a deadly infectious disease jumping from bats to slaughtered pigs and finally humans in restaurants in China before spreading to the rest of the world, infecting and killing millions while authorities struggle to contain it.

By virtue perhaps of the uncanny parallels with the current predicament (and perhaps a kind of collective masochism), Contagion has recently risen to become the seventh most popular film on iTunes (from its previous ranking of 270th). In March, as newscasts seemingly reported its storyline for real, it became the most viewed title on HBO and saw a 50-times increase of pirated streams.

Ten years ago the film was pitched to Soderbergh by screenwriter Scott Burns who was adamant it be a plausible telling of a viral pandemic. In the script the pathogen is not a coronavirus but a paramyxovirus and its fatality rate is higher than that of Covid-19. But its origin and transmission are remarkably similar to what is on display today. That is because of Burns’ meticulous research and the advice he got from scientific consultants like virologist Ian Lipkin.

Besides the epidemiology, the film also imagines the social dynamics attendant to a pandemic, including quarantines, run on supplies and rampant disinformation (as purveyed on the internet by a conspiracist blogger played by Jude Law). When the scientists are eventually able to develop a vaccine to abate the fictional virus, Contagion imagines further turmoil connected to  the colossal task of mass producing the vaccine, and prioritizing its distribution to the population — issues that are all too plausible for a time further down the curve we currently find ourselves on.

One thing the film’s authors did not foresee: the nefarious effect of the pre-eminent scientific superpower falling under the sway of a national-populist authoritarian, ignorance-worshipping negationist administration at the exact time when competence and leadership would have been most crucial. And becoming the world’s most virulent hotspot. That, we presume, would have been considered too implausible a science fiction.

Burns and Dr. Lipkin spoke with us about the film and its resonance via remote connection.

What were the origins of Contagion?

Burns: I remember the movie Outbreak from when I was young and I remember seeing it, and something about the end of that movie and the science involved always made me feel uncomfortable, both as a writer and just as a thinker. And so I remember thinking I want to make a pandemic movie but I wanted to be guided by the latest science. And I wanted to be informed now by a world that is committed to globalization and travel and we have great income disparity.

One of the questions that I have been asked quite a bit since the appearance of this virus, is why is the movie so prescient and why is it so accurate. And the response is very simple, which is, when I pitched the movie to Steven Soderbergh, I said I only want to do this if it can be accurate and fact based, because I had some awareness that we are in an age of pandemics. And so I was able to get in touch with Ian, who is the best virologist we have in our country. And he said the same thing to me, which is, I will only help you on the movie if it’s very, very fact based and science based and it isn’t some sort of conspiratorial bullshit about a virus coming from a lab or coming from a cellphone tower. So I think, did I know it was going to happen 10 years later? No. But every expert I spoke to said it wasn’t a matter of if, it was a matter of when.

And of course you were proven correct.

Lipkin: This is not the first pandemic and it’s not going to be the last pandemic. I’m not even sure that it’s going to be the worst. This is something that we need to now anticipate, and as Scott knows, we have been pushing for a long time to develop an international immune system that will allow us to identify these infectious agents while there is still chatter, before they actually move into the human community. If you look at the frequency with which these outbreaks occur, it seems to me to be increasing, it seems to me to be on the order of every three to five years.

If we are successful in controlling an outbreak as we did in South Africa, with something called Lujo, which I doubt that anybody here has ever heard of, which was the most lethal arenavirus ever known, then people take it for granted that they don’t need to worry about it. That’s the problem with public health: if you do your job well, nobody knows and nobody cares, but when everything goes to hell in a handbasket, then it’s a problem. So I am hoping that people will carry forward the lessons of the wild animal markets, data sharing, improvements for platforms of vaccines, so that when the next one comes, we will be in better shape.

But first we have to deal with the current one?

Lipkin: Well, I mean we found the virus, we found the virus at the end of December 2019. We have diagnostic tests for it (we don’t have enough of them). Those countries where there’s been success in controlling the pandemic — Germany, Singapore, China believe it or not — have access to these tests and have been using them quite successfully. We in the United States have been behind. The same thing happened in Italy, Spain and elsewhere. We are using old techniques: isolation. This is the sort of thing we used in the Middle Ages to control a plague. Until we have a vaccine or we have drugs that everyone can take that are oral and inexpensive, we are limited in what we have. It’s going to be isolation, testing, tracing, finding people who have come in contact with individuals who are infected, and isolating them.

Burns: I do remember having conversations with Ian about the need to develop at some point a universal coronavirus vaccine. And so am I surprised that we are seeing more and more viruses coming into contact with humans? Not at all. I mean for me this is very connected to larger problems of human beings invading spaces that were occupied by animals. And so we are coming in contact more and more with scientists and zoonotic viruses. Correct me if I am wrong here, and our behavior is behind some of these things, whether it’s the Chinese and their cultural predilection for these wet markets and how they are governed. … And if you really take a look at what we were saying in Contagion, the company that is chopping down those trees that makes the bat go from where it was to another place, is in fact an American company. And so it’s not as easy as saying that we are blaming the third world, because frequently the development of these wild places is done in poor countries, but done under a banner of industrial colonialism.

What happened to the early warning system?

Lipkin: If we go back to the mid-2000s when we had SARS and George Bush set up something called the National Biosurveillance Advisory Committee, that provided specific guidance on how to avoid these particular outbreaks. And then Obama came in and founded yet another one which made a report that no one paid any attention to. There’s nothing here that has surprised me. Our social services are poor, our social center for diseases has less funding than it needs. In contrast to China, where I go frequently, where there is a commitment for a 20 percent increase in the budget for science annually, our budget for science continues to drop, at least in terms of real purchasing power. So it’s not surprising to me when we try to roll out testing kits at the CDC, that there might be a problem. There aren’t enough people, there aren’t enough resources to do what they need to do. So obviously, as I say, the lack of epidemiology, the lack of good tests, the lack of funding for people who are near the poverty line so that they can safely isolate, these are all things that threaten us all, not only as a local culture, but also internationally. And the finger pointing now at China, it doesn’t help. They have been far more transparent with us than they were in 2003, when I was actively involved in SARS.

Is it true in the end, like Dr. Fauci has said, that we will not determine the timeline, the virus will determine the timeline?

Lipkin: Well Tony is a real good friend of mine and I am just going to make a slight twist in what he said. Because in fact we do in part determine the timeline, because we can flatten the curve for isolation, we can improve testing, we can accelerate the advancement of drugs and vaccines. So to some extent, we are the masters of our own destiny. …

If you are asking about the culture as a whole, we will be moving back to those sorts of experiences that are not crowded. Bars, restaurants, theaters, movie theaters, this is going to be more difficult, because until we have a vaccine, it will be very difficult to protect people. But I can see ways in which if you are an office worker, you will be able to go back to your office if you wear a mask. You will be able to go to grocery stores, things of this nature. And we will identify people who have been exposed who are hopefully immune, who can now become first responders in medical teams, fire, police and other activities where they come in contact with large numbers of people. But we are not going to move back to where we were a year ago until we have a vaccine and that vaccine is widely deployed.

And when do you think that might be?

Lipkin: Typically there are three stages in making a vaccine: safety testing, testing for efficacy and then finally testing for long-term safety and efficacy in large numbers of people. Only after you get through the last three phases do you invest in manufacture and distribution, because that’s a billion-dollar proposition. So we are in the process now across the world in collaborations that will allow us to invest in a limited number of vaccines when they begin to show candidacy, some evidence that they are going to be useful, with the understanding that not all of them are going to be promoted, some of them are going to fall out. So this requires partnerships from academia, industry and federal governments across the world.

The next thing is, there are ways in which we can fuse different stages of that testing, so we can shorten perhaps the time, the third phase where we test efficacy in large numbers of people and make guesses and speculate, based on what we get in the first two phases. So I think that we are going to get there in a year. People are typically talking about 18 months to two years. I think we are going to get there in a year, which is a significant difference: that’s a 30 percent drop. There are people who I talk to who tell me we are going to be there before the end of the year, but I think that’s overly optimistic. And what does this say politically? The sooner we have a vaccine, the more some of the people who are at risk politically are going to be able to say well look, I succeeded, I came up with this vaccine, when you and I both know that that’s really not the case, right? And I think virologists, we are collaborating, we are sharing data on preprint publications now, in a way that we never did before.

You have been working on plasma therapy?

Lipkin: I have been pushing plasma therapy very hard. I did in China when I was there, the Chinese Government did the first plasma trial. I have a large plasma trial that just kicked off today at New York Presbyterian with 450 patients. And there’s a large national study that is being done as well. People have different protocols for the plasma: some people give one unit of plasma and some people give it three units of plasma. But I anticipate that we will learn, sometime within the next three to four weeks, whether plasma therapy has value in people who are either very sick and whether or not it can prevent disease in healthcare workers and close contacts. Plasma therapy is very, very old.

Contagion also dealt with the issue of disinformation which complicates fighting the pandemic.

Burns: It’s only gotten worse. And it’s not just bloggers. Unfortunately now it’s also people in the federal government. And so I think — and Ian will probably agree — that it’s hard enough fighting the disease and to have to now also fight misinformation, especially misinformation that is relying on xenophobia, that is relying on incredible political divides that have existed in this country before this thing happened, makes the job of someone like Ian incredibly difficult. I don’t understand at all why we would have the need to say “liberate Michigan” when there are a lot of people very sick in Michigan, and I don’t understand why those people have what they would call the right to get sick and endanger the lives of other people, some of whom may have underlying conditions that make this a death sentence.

Your film also imagined other social conflagrations…food riots. Have we not gotten to that part of the film yet?

Burns: My understanding right now is that the supply chain in this country, although it’s certainly stressed, hasn’t broken. And so I don’t think we are at a point now where we have to worry about food. That being said, you are seeing these outbreaks now in meat processing plants and you are seeing some of the companies that run these meat processing plants, may not have been providing appropriate equipment for their workers. I saw a story last night in Iowa, where one company didn’t even want to acknowledge the amount of cases. Now again, it’s a tricky situation because without the testing it’s hard to know what the amount of cases are. So our disease in the movie was much more deadly than this is. And so I think people who are in essential services can perform their jobs right now if they are properly protected and if there are good protocols in place for them. So I think that that probably isn’t a part of this movie, or at least I certainly hope not.

Sadly in this country I think we are seeing … that the schism in this country is going to be affected by this and there are some people who feel like it’s okay for old people and vulnerable people to die for our economy. We have elected officials who said that. And I think as time goes on, unless we can come up with a coordinated approach to this, there are going to be continued problems with that.

I saw something on the news that was really heartbreaking to me, where there is a nurse confronting a bunch of armed protesters in Colorado who are saying that if she wants communism, she should go to China. And it broke my heart that that’s the level of discourse and level of ignorance in this country, that we are threatening the healthcare workers that we need. And I can certainly understand from her position that she doesn’t have a political agenda, she just doesn’t want people to get sick and because she is not protected. So those are the kinds of schisms that if we continue to pull at them, then we are going to have continued escalation and social unrest if we are not going to be very, very careful.

Lipkin: If I can just add in the Indian subcontinent of present, there have been some riots. So we may not have them on the West Coast of the United States or in New York, but there are parts of the world where this does play out.

And another inflection point comes when the vaccine is developed, but the production and distribution is still a challenge.

Burns: It may be a year or two as Ian suggested. The vaccine that is developed in the film, what we tried to do… because no one could really actually answer my question of how it would be distributed… and I know that the obligation is to give it first to first responders, members of our military, people in government, that those people will get the first available batches of any vaccine. Beyond that, I actually made up the idea of there being a lottery. And so do we live in a society that frequently engages in preferential treatment for people who have great wealth or have political allegiances that are currently in favor? Yeah. Will that influence this? I have no idea. I don’t think it’s unthinkable that those kinds of corrupt practices will happen because they happen all over our world. But one would hope that the people who are most at risk would get the vaccines first after we have dealt with first responders.

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