by Arthy Santhakumar

Which spreads faster, the deadly virus, or the panic that surrounds it?

What starts with a seemingly innocent cough ends with a sky-high body count and the decay of social order. One victim becomes four, then sixteen, and then millions as the invisible killer marches across the globe. Contagion, directed by Steven Soderbergh (Ocean's 11, Traffic) and written by Scott Z. Burns (The Bourne Ultimatum, An Inconvenient Truth), vividly depicts how the human race might collectively react in the face of a biological disaster.

Contagion is classed as a pandemic thriller, in the vein of 28 Days Later and Outbreak, but unlike its predecessors, it is unique in its careful attention to scientific plausibility. This Hollywood blockbuster, intended to realistically portray unsettling social and scientific reactions to a killer pandemic, doubles up as educational material, having resisted the allure of fantasy and science fiction to deliver a cautionary tale of a very real risk. The film touches on themes such as the enormous personal, societal and economic costs of a major disease catastrophe; the lethal consequences of misinformation; the limitations of an ill-prepared international public health response; and the real challenges of infection control.

The film follows the havoc wreaked by the deadly, indiscriminate mystery virus dubbed MEV-1. After having infected its victims, the virus does not turn them homicidally insane, as seen in the 2002 zombie horror 28 Days Later, but instead produces mundane flu-like symptoms that escalate to encephalitis - leading to death within days. The audience is taken on a nail-biting journey from the initial outbreak, dubbed Day 2, through the various and at times futile attempts to contain it, to the final breakdown of society plagued by a culture rife with suspicion and fear. Kate Winslet's character's phrase, "Don't talk to anyone. Don't touch anything" plays on the public health measure of 'social distancing' to slow down the spread of the virus. It is not until the end that we are whisked back to the very beginning of the story, Day 1, which, like every good old-fashioned whodunit, reveals how it all started.

Fear is a major driver of the story. The camera pans several times onto everyday objects -- a chair, a glass, a door handle -- lingering just long enough to highlight our vulnerability to the pervasiveness of virus transmission, as well as the disturbing ease with which the virus can spread through ordinary daily activities. In an era of Facebook and blogging, Contagion's tag line, "Nothing spreads like fear," emphasises the influence and power of these mediums in propelling a sense of mistrust in the general population. Mass panic spreads faster than the virus and we see a different kind of contagion appearing - one that is harder to control than the virus. What makes the film so frightening, both on an intellectual and visceral level, is the plausibility of this nightmare actually occurring in real life.

Soderbegh and Burns have been praised for their scientifically accurate depiction of a pandemic, achieved through extensive consultation with real life virus hunters and public health experts. The novel and highly transmissible virus MEV-1 was modeled on the real life Nipah virus, which has the capacity to spread from bats to human, and has already claimed the lives of several people in Malaysia and Bangladesh. The strain seen in Malaysia emerged as a result of a combination of events that mixed mutated strains from bats, pigs and humans. In Bangladesh the virus leaped directly to humans from bats after palm tree sap contaminated by a bat carrying the Nipah virus was used to make palm wine.

The series of events and biological factors that trigger the film's pandemic capture the genuine risks that we all face from emerging infectious diseases, and particularly illustrates the complex relationship between human, animal and environmental health. Accounting for nearly 75 percent of all newly identified human diseases since 1945, diseases that originate from animals are becoming more prevalent; modern day history is littered with examples including SARS, bird flu (H5N1) and swine flu (H1N1). It is suggested that we are only aware of around 2000 animal viruses, whilst there are estimated to be a further one million unknown pathogens.

Our vulnerability to such diseases has been significantly heightened due to increased contact among wildlife, livestock and people, as a result of rapid growth in international travel and trade. Intensifying agricultural production, deforestation and urbanisation are continuing to displace wildlife from their natural habitats, bringing them into closer proximity with domesticated animals and humans, increasing the risk of these diseases jumping the species barrier. Veterinary services in developing countries - provided to ensure animals are disease-free within livestock production - are significantly weaker in comparison with Europe and the United States, and as a result their populations often come into contact with animal diseases. This gap in capacity to deal with animal disease is particularly unnerving, given the fact that pathogens do not generally respect geographical boundaries.

Contagion highlights our global vulnerability, illustrating that we are only as strong as our weakest link. In an increasingly globalised world, once a virus crosses the species barrier to humans, it may be difficult to stop its spread. If an outbreak spirals into a pandemic, the costs (both financial and human) around the world are enormous. According to the World Bank, the potential cost of a severe flu pandemic is approximately three trillion dollars and may result in a nearly five percent drop in world domestic product.

We only have to look as far back as 1918 to remember the Spanish Flu pandemic, which claimed between fifty million and one hundred million lives. This unusually brutal and deadly pandemic saw the H1N1 influenza virus sweep from country to country by sea-faring vessels passing through major port cities. With limited capacity for scientific investigation, vaccine development and lack of credible international public health messaging, the mass mortality seen in this pandemic could be argued to be merely a product of its environment. Today, we have a much more conducive and technically advanced environment to manage these sorts of threats. We now see infrastructure in place to help us deal specifically with this type of risk. Whilst there have been significant improvements in science, medicine and communication, these have been accompanied by an increased amount of risk, centered on our ability to travel from continent to continent with such ease and speed. As Contagion illustrates, the modern world brings new challenges, and its capacity to respond has yet to be tested by a severe pandemic.

Whether you now use antibacterial wipes more frequently, or always ensure you move away from the person sneezing on public transport, it is clear that Contagion is a stark reminder that we need to up our game in the war against disease. The question is, are we adequately prepared for what could potentially be just around the corner (or, perhaps already here and yet to show itself)? It is not possible to justify shutting down airports and closing off borders when one person coughs. Nor would it be financially viable to furnish our health systems with sufficient isolation rooms and respiratory equipment to meet the requirements of a large or even medium-sized pandemic. Fortunately, it is feasible to better prevent and control these infections in animals, to arrest their spread and reduce the risk of their emergence as human diseases. As suggested in the film, we could better prepare ourselves in terms of improved cooperation between international laboratories and the transfer of knowledge to facilitate a coordinated response among the numerous agencies responding to a global health disaster. There is a great urgency for investment in bio-surveillance, not only in humans but in animals too, to detect infections before they escalate into pandemics.

It is in the overwhelming interest of us all to help developing countries improve their veterinary capacity and invest in locations that pose the greatest risk of disease emergence. Investing in these measures has a high pay-off, and we should consider it as low-cost insurance for the future - deadly pandemics have happened before and they will happen again. The take home message, apart from don't forget to wash your hands, is that our relationship with viruses will not go away. "It's figuring us out faster than we are figuring it out" - a warning that we must not underestimate the intelligence of viruses in our war against diseases.

The funders of the film, Skoll Global Threats Fund, have funded Chatham House research. No funds were received for this article.

(Arthy Santhakumar is the Centre Coordinator for The Centre on Global Health Security at Chatham House.)



"Global Health: 'Contagion' "