The Film 'Contagion' Based on Scientific Facts

An Expert Interview With W. Ian Lipkin, MD

Ron Zimmerman

June 08, 2012

June 7, 2012 (San Antonio, Texas) — Editor's note: W. Ian Lipkin, MD, director of the Center for Infection and Immunity at Columbia University in New York City, has a reputation as a hunter of viruses and pathogens. He has seen first-hand the need for speed in diagnosing emerging biologic threats and is proud of his cutting-edge work that has streamlined the investigative process.

According to his biography, he was the first to describe autoimmune neurologic disease in HIV/AIDS, the first to use genetic methods alone to identify an infectious agent (Borna disease virus), and the first to prove that West Nile virus was the cause of the encephalitis epidemic that struck New York City in 1999.

In the past decade, Dr. Lipkin's team has identified at least 400 previously unknown viruses. He discovered a virus implicated in hemorrhagic fever in Zambia and South Africa (the Lujo virus), a virus wreaking havoc in the farmed salmon industry in Norway, and a canine virus that is the closest known relative of hepatitis C. While making these discoveries, he invented molecular tools that cut the time needed to identify previously undiscovered microbes.

In March 2009, Dr. Lipkin signed on as chief medical adviser for Warner Brothers Pictures 2011 film "Contagion." In that capacity, he made suggestions to writer Scott Burns, director Steven Soderbergh, and to actors Kate Winslet, Matt Damon, Gwyneth Paltrow, Jude Law, and Laurence Fishburne. Early on, he suggested that the movie's plot be triggered by an outbreak of a deadly virulent virus that, like the Nipah virus, had migrated from animals such as bats and pigs to people.

At the Association for Professionals in Infection Control and Epidemiology (APIC) 2012 Annual Meeting, held June 4 to 6 in San Antonio, Texas, Dr. Lipkin spoke to Medscape Medical News about how the movie graphically illustrates to the public that international travel can swiftly spread deadly rogue viruses.

Medscape: Was this the first time a Hollywood director asked for your expertise for a feature film?

Dr. Lipkin: No, but it was the first time I accepted.

Medscape: Why is it important to get the science right in a film like Contagion?

Dr. Lipkin: A couple of reasons. Reality is much more exciting than anything we can invent out of whole cloth. Both Scott Burns and Steven Soderbergh were truly committed to that concept.

We were interested in using this film not only as an entertainment vehicle, but as a teaching tool. There's a lot of information in it that is of value. We hoped it would initiate a public discourse that could lead to real changes in the way we make vaccines, in the way we approach surveillance, in our hygiene, and in attracting young people to science and math careers.

Medscape: Is the plot of the film plausible?

Dr. Lipkin: Yes. We took great pains to make certain that was the case. There will always be quibbles about some aspects of the twists of the plot, but the vast majority of the scenes you see come either out of my experiences or those of other technical advisors, such as Larry Brilliant, Laurie Garrett, and Mark Smolinski. We've been in the middle of outbreaks — whether it's smallpox eradication, SARS, or influenza — and immediately seen a breakdown in social fabric.

For example, during the SARS epidemic, vinegar was flying off the shelves in China because of a popular misconception that it had curative powers, very similar to the forsythia scenes that Jude Law drives so well.

You also have issues with who goes first with vaccines. First responders or people with connections? People being people, they find ways to release classified information, drugs, or vaccines to loved ones, which leads to complications, as you saw in the film with Laurence Fishburne's character. And you have the courage that some people show in testing things on themselves. Everything in here is real.

Medscape: Did you have a personal experience with a viral outbreak that mirrored events in the film?

Dr. Lipkin: Yes, I did. I became very ill in 2003 when I came back from China, and I was put into quarantine. I was working on SARS there and they thought I had SARS, but I did not — or else I likely would have died. I just had a very nasty influenza. There's a portion of the film where Matt Damon is put into containment, he's in isolation, and I was able to tell him what that felt like — it's eerie.

Medscape: How accurate was the portrayal of the response by the Centers for Disease Control and Prevention (CDC)?

Dr. Lipkin: For development of plot and character, we needed to have a smaller group. We really wanted to focus on Kate Winslet, and make her look, you know, like the lone voice of reason trying to sort out what was going on. If we'd sent in a large team, you would lose that sense of focus. But in reality, CDC outbreak teams are obviously larger.

There's a lot more truth than fantasy here. The virus itself came from our experience with Nipah, which is a bona fide virus. How it moves from animals to people has been proven in real life. The molecular biology was reasonable. It was a teachable moment, so we could communicate with the audience and get them engaged.

Medscape: What is the public policy value in a movie like Contagion?

Dr. Lipkin: For one thing, the number of people applying for epidemiology positions at the CDC went up as a result of the film. It had an impact on people thinking about funding for public health; not as much as we hoped, but some. It also had an impact on the number of young people thinking that public health would be an interesting field to go into. Like "The Social Network," it encouraged them to think about this field as being cool, that science is exhilarating too, like being a basketball player or a film star.

We do try to emphasize hygiene, and that's why there's that vignette in the film where Laurence Fishburne explains that shaking hands used to be a way to show that you weren't carrying a weapon. But shaking hands isn't necessarily safe anymore.

Medscape: Who played you in the film?

Dr. Lipkin: Elliott Gould. They promised me Matt Damon, but Elliott was great and more age appropriate. During the West Nile virus outbreak in 1999, I didn't do what I was supposed to do because I felt it was more important to do what I needed to do. I talked to Scott Burns about the scene in the film, where [Gould] is told to cook his samples and he doesn't. That scene is faithful to my own experience. Sometimes you have to do what's right, even if it isn't within the rulebook.

Medscape: What are you doing professionally to combat the threat of new viral epidemics?

Dr. Lipkin: I direct a large research and service laboratory and work closely with the World Health Organization, the CDC, and the Department of Defense. I get my funding from the Department of Defense, the National Institutes of Health, and, to some degree, the Gates Foundation. These are all people doing good works in this area.

This film is not about me, but it nicely captures my life's work. The pace at which you can discover a new microbe has dropped dramatically, from years in the 1980s to hours in 2012. It took 7 days to solve the SARS genome, it took us 72 hours to solve Lujo, but the latest novel virus we discovered in 7 hours!

We can't yet go straight from discovery to drugs or vaccine. However, discovery is the first important step — gathering the necessary medical intelligence, knowing what you're confronting.

This is an exciting era in medicine and public health. However, there is enormous uncertainty because the prospects for science and public health in the foreseeable future are dismal. I think this is becoming a larger threat than the pathogens themselves.

Dr. Lipkin has disclosed no relevant financial relationships.

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