Mar 7 2012

Contagion: Movie Screenwriter and Scientific Consultant Chat With NACCHO

file Scott Burns, Ian Lipkin

In the latest podcast from the National Association of County and City Health Officials (NACCHO), Contagion screenwriter Scott Z. Burns answers questions about the fact or fiction of the movie alongside the film's scientific consultant and Director of the Center for Infection & Immunity at Columbia University, Dr. Ian Lipkin. Read an excerpt of the podcast transcript below, and listen to the full podcast on the NACCHO website.

>>Related: Read our earlier Q&A with Barbara Reynolds, Centers for Disease Control and Prevention (CDC) Crisis Communication Senior Advisor in the Office of the Director, about the CDC’s role in the movie and crisis communication.

NACCHO: Scott, you’re an expert story-teller, which is something we can learn a lot from in public health. What was so compelling about this public health story for you?

Scott Burns: The most compelling part of this for me was it was the kind of story that kept presenting us with forks in the road. Ian was amazing for me to work with. At the beginning, he said the one thing we now know about nature is almost anything is possible. It was the kind of story where it kept opening up in new ways and new directions in ways that were almost fractal. Every time you made a choice, you got a whole new set of problems to consider and roads to go down.

NACCHO: Dr. Lipkin, was this the first time you were consulted on this type of project?

Dr. Ian Lipkin: It was the first time I've participated. I've been interested in this genre for a long time. Science movies are enchanting when you’re a kid. When I became involved in infectious diseases, there was one called Warning Sign and then there was Outbreak and then there was I Am Legend. The first question I put to Scott was whether or not he liked these movies and where he wanted to go. So this was the first one I’ve really engaged in, because I think it’s a terrific team and I liked Scott’s vision.

NACCHO: How did you research the science and public health aspects of the movie and who did you work with?

Scott Burns: Obviously I worked with Ian, and early on I also met Dr. Larry Brilliant, who was very helpful. I had seen Larry’s TED talk where he showed the Malthusian charge through the world the virus would have. I also worked with Laurie Garrett on the movie, because she had written this book, The Coming Plague, which was very, very useful to me in sort of teasing out how these things have a medical component, but they also have a social justice component and a political component and all sorts of interesting aspects of human behavior.

It was kind of a process where I would bounce back and forth between Ian and Laurie and my computer to say, “What if this happened? How would the world react?” And then in the midst of writing, about 6 months into development, H1N1 appeared on the scene. There were all these things that started lighting up for me about the economic impact and the social impact. We got to see a lot of the questions we were asking as they played out.

NACCHO: Dr. Lipkin, what was your role in the story development, and what did you find challenging about this role?

Dr. Ian Lipkin: I started very early with Scott. There were a lot of people who contributed—CDC, WHO and others... Scott would bounce ideas off of me and others in his “brain trust” and most of the time we were in accord. My role grew dramatically over the course of production. It began with just a consultation, and then I rapidly moved into helping the set designer in designing the virus, and we had a few days where we had actors come to the lab and spend some time working at the bench, learning how to pipette and look through microscopes and get into gowns and such. And even at the very end, I was working with the sound engineer, recording sound for the movie—lab background and that sort of thing. I did a lot of traveling with the crew. It was like a circus.

NACCHO: The fictional MEV virus, it was a paramyxovirus that affects the lungs and the brain. What real-world virus was MEV based on?

Dr. Ian Lipkin: We settled on that virus within the first half an hour with Laurie and Scott and I, high above Columbus Circle in New York. We threw out a number of possibilities to Scott and he batted them down, and then one came to mind that struck me as the perfect choice, simply because there had been some reports earlier suggesting this virus, which wasn’t readily transmissible, had become readily transmissible to humans—that was Nipah. It also gave Scott and the director and actors an opportunity to do more than just cough and die. They could develop seizures, they could have hallucinations—all sorts of things that were much more interesting than a standard respiratory disease. We settled on that really within the first thirty minutes, and then Scott went back, thought about it and decided it was a good way to run. It doesn’t take much fuel for him to run quite a distance.

Scott Burns: For me, what I wanted was a virus that if it appeared in an emergency room, it could ask a lot of questions and be diagnosed as a number of different things. For me what I was looking for was a virus that could operate under the radar for a week or two, and in that week or two it could spread in such a way that it’s gotten out of control. I was looking for something that was highly transmissible and deadly, but not deadly in a way that made the audience think, "that's ridiculous; there’s no virus that could do that."

NACCHO: I don’t think anybody in the audience felt that way after watching this movie.

Scott Burns: It’s terrifying to think that the headache or symptoms you have could turn into something much more serious than what you anticipate. Depending on the time of year and what else is going on in the world, it’s possible to be sick and not realize how sick you are.

Dr. Ian Lipkin: The other thing I would add to that is that the three major technical advisors on the film have all been in outbreaks. Larry was involved early on with smallpox eradication. Laurie and I were both in Beijing during the 2003 SARS outbreak. So we had a chance to see the social fabric disrupt. [The movie] was so resonant with our memories of this.

NACCHO: Facing potential budget cuts in public health preparedness funding, what kind of impact do you think it would have on the nation were we to face a Contagion-like scenario in 2012 or 2013?

Dr. Ian Lipkin: We have budget cuts in public health preparedness and in science funding. It’s a very short-sighted, very difficult time. One of the things we hoped would come out of this work was to bring home to people the fact that we do need to maintain the integrity of the public health care system. This is not a place to cut.

>>Recommended listening: NACCHO's followers on Twitter sent in a number of questions for Scott Burns and Dr. Lipkin. Listen to the rest of the interview, including responses to Twitter questions, here.

Tags: Emergency preparedness and response, Infectious diseases, Public health agencies, Centers for Disease Control and Prevention, Infectious disease, NACCHO, Preparedness, Q&A, Recommended Reading