What Contagion missed

It's not often that Hollywood ventures into the realm of epidemics and public health, and when it does, the outcome is usually laughably out of touch with reality -- like Outbreak, the 1995 movie about a deadly Ebola-like virus that infected a city. To prevent the virus from spreading, the military decided to bomb the city to oblivion. Fortunately, a cure was discovered just in the nick of time. Unfortunately, there was no cure for the two hours of my life lost to this film. Outbreak was so bad, I still cringe every time I think about it.

So when Contagion hit the theaters on September 9, I was skeptical but interested (call it professional curiosity) to see Hollywood's latest attempt at showing microbial disaster. This time, director Steven Soderbergh sought help from an actual virus hunter, W. Ian Lipkin, a professor of epidemiology, neurology, and pathology at Columbia University.

Lipkin based Contagion's fictional MEV-1 virus on the Nipah virus, a deadly microbe that appeared more than a decade ago in Malaysia. Although much of the movie was remarkably realistic -- including the unscrupulous blogger promoting a useless cure; the epidemiologic investigation; the use of gymnasiums as makeshift hospitals; the social discord at pharmacies, grocery stores, and neighborhoods; the race for a vaccine (which was unrealistically too fast); and the mass graves -- it barely touched on the key point of the epidemic: why it appeared in the first place. (At the very end, just as the credits were about to roll, the movie spent about a minute demonstrating how the virus emerged into human populations: deforestation led to bats infecting pigs, which in turn infected humans.)

While I'm glad that Soderbergh directed a movie that can be used in classrooms to teach students about public health and disaster preparedness, we still need a movie that educates students and the public about disease emergence and the human health impact of environmental destruction.

I've written a lot about One Health, a concept that promotes the integration of human, animal, and environmental health. This approach would enhance disease surveillance and accelerate the development of new drugs, vaccines, and diagnostics by coordinating medical and veterinary medical research efforts. A One Health approach would also improve the lives of all species and help prevent and mitigate future pandemics.

In practice, this would mean more involvement by field ecologists and veterinarians. We need these people to assess the risks of environmental destruction and other human activities that promote disease emergence. They need to regularly test and monitor wildlife and livestock in order to identify early warning signs of disease transmission before a deadly pandemic emerges. This information must then be integrated with human disease surveillance. I would like to have seen Contagion depict the virus hunters and the animal-disease experts on the ground who investigate these cases and fight these battles every day. We need these dedicated scientists to help ensure that movies like Contagion do not become a reality.

It's important that we prepare for deadly pandemics, but it's just as important to try to prevent them from happening in the first place. After all, prevention is the best medicine.