Crying wolf? Contagion is a real threat!


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If you accept my 5 cents of wisdom, you should rush to see the new movie “Contagion.” It is a well done, spooky public health mystery, with great acting. Why you may ask? Simply because it is a timely reminder about the public health risks but also the potential benefits of a globalized world.

Watching the movie brought back vivid memories of passionate discussions we had in the fall of 2005 when we—a Europe and Central Asia and East Asia and the Pacific agriculture and public health team—prepared in a few days what became the $500 million Global Program for Avian Influenza and Human Pandemic Preparedness and Response. Some colleagues argued with merit that we were “crying wolf” and that it was going to be a waste of precious resources. Our counter argument was “this is a wonderful opportunity to shine a light and revamp health surveillance systems, basic public health laboratory networks, and update the epidemiological intelligence capacity as these basic public health services and functions usually tend to be the most deteriorated, underfunded, and often underdeveloped, elements of a health system.” Ditto in the veterinary sector.

The movie clearly portrays the interconnection of the animal and human health dimensions of communicable diseases, and how in the new phase of globalization—large-scale movements of people, goods, and services, and shortened geographical distances due to the dramatic growth and improvement of air transportation—the rapid spread of viruses and bacteria is a clear and present danger. The movie also shows that to be vigilant and to be able to mount a rapid and effective response, both locally and globally, countries need to have well-developed, adequately staffed and funded public health agencies such as the U.S. Centers for Disease Control and Prevention (a big role in the movie) to serve as the “intelligence centers” that guide multisectoral responses by collecting, analyzing, and disseminating data and information for decision-making, communicating, and educating the general population, and sharing evidence across countries.

And, as the movie also shows, strong public health infrastructures and networks are needed to galvanize the power of evidence and scientific knowledge to come up with tools (e.g., vaccines or drugs) to control the spread of infectious pathogens that cause disease. In doing so, the movie brings to the fore with great cinematic eloquence one of the main benefits of globalization: the sharing of knowledge and expertise to deal collectively with common public health threats that do not need passports to move with impunity across national borders and cause havoc.

In retrospect, while the avian influenza and human pandemic of the mid-2000s did not become another global disaster as the 1918-1919 Spanish flu pandemic that caused millions of deaths worldwide, it alerted us, just as the movie does, that strong public health structures and essential functions are critical to help member countries build resilience and respond to crises in an ever more interconnected and integrated global village.


Patricio V. Marquez

Senior Associate, Johns Hopkins University Bloomberg School of Public Health

September 27, 2011

The Contagion film is very good, indeed. It has so many livesaving messages that it's hard to know where to start. Yes, agree that everyone should go and see it and think why things are happening as portrayed.

Looking at the last scene of the film, where it's shown why the horrible pandemic started at all, one can begin to see the solutions, how the horrendous costs can be prevented or mitigated. In short, it's a man-made problem (no women in eviddence, but that's not the point).

If it's man-made, it can be solved, especially if the returns are so high. Veterinary standards have to be dramatically improved if we want to keep the globalized economy we have. The diseases that span animals and humans can end up in no-man's land, nobody's responsibility. One Health approach would have helped prevent the pandemic in the movie by controlling the infection at the animal source instead of letting it get out of hand in the human population. It's possible, maybe not 100% but far better than the 0% we are living with now.

Tomorrow is world rabies day. This unnecessary epidemic is another example where One Health approaches can help avoid unnecessary deaths and costs. Also very educational, like the film:

Patricio V. Marquez
September 27, 2011

Indeed Olga you are right on the mark. The last scene is critical to understand the movie: from multinational corporation bulldozer destroying a habitat to vector-to-animal-to-human transmission and then human-to-human through a simple handshake with "contaminated hands" to human-to-human via casual contacts and facilitated by modern transportation (jet-set viruses!). The movie should be require "watching" for those working in development to help better convey and understand the multisectoral interconnectedness underlying the outbreak and the subsequent viral spread.

September 28, 2011

Patricio, yes, I agree that everyone interested in development should see this film. As a further recommendation, here is the link to the review in the New Yorker:…

The New Yorker review is entitled "Call the Doctor". This does not really capture the desired response, however. It is actually helpful to "Call the Vets".

Controlling the disease in animals is far cheaper and more effective. If that piggery in Quangdong (that supplied a pig for the party at the glitzy casino where Gwyneth Paltrow celebrated the business deal) had been told it had to have higher biosecurity standards, the bats would not have been allowed near the pigs. A health inspection before the pigs left the enterprise could have identified the diseased pig. Raising animal health standards in developing countries is urgent, especially with the rapidly growing livestock production there, and will yield huge "global public good" benefits.

As the film shows, once the disease is spreading in the human population, there is relatively little that even a well-resourced medical system can do before there is a vaccine. This will take many months ... and it will be even longer before a vaccine is available in sufficient quantities (maybe never) and distributed.