By Margaret P. Battin – Leslie P. Francis – Jay A. Jacobson, MD – Charles B. Smith, MD
Contagion, the extraordinary film portraying the outbreak of lethal virus that spreads rapidly around the world, may seem eerily familiar: from the medieval plague to the Spanish flu of 1918-19 to more recent fears of avian influenza, SARS, and H1N1 “swine flu”, contagions have long characterized the human condition.
The film captures almost perfectly what a contemporary worst-case scenario might look like, and is eerily familiar because it trades on realistic fears. Contagion, the transmission of communicable infectious disease from one person to another (either by direct contact, as in this film — sneezing or coughing or touching one’s nose or mouth, then a surface like a tabletop or doorknob that someone else then touches — or transmission through an intermediate vector like the mosquito or the rabid bat) is among the oldest fears of humankind, and yet also among the most contemporary as our world has become so much more interconnected by air travel. The scenario depicted in this terrifying film is entirely realistic.
Furthermore, “Contagion” is impressively accurate in portraying its doomsday scenario. The epidemiology, including the source, the index patient, and the possibility of natural immunity are all spot-on. The modes of transmission of an airborne virus are deftly portrayed. Various scenarios of pandemic planning, including quarantine and isolation, mandatory social distancing, vaccine research, and prioritization for access to treatment and prevention are all accurately depicted. And so, chillingly, is the human potential for fear and self-interest. We see misinformation, deception, crime in the pursuit of self-protection, and the governments of countries trying to evade economically devastating publicity by hiding the facts. But we also see what looks like heroism: the scientist who works desperately towards the development of a vaccine in defiance of explicit orders to leave an unsafe lab; nuns who treat patients when nurses are on strike; and the person of greatest privilege and authority who gives his own dose of vaccine, when it is eventually developed, to the son of the janitor in his building, an act of selfless justice in trying to distribute the vaccine in an equitable way.
How, ethically, should we think about issues raised in the movie? Those issues include: whether to tell loved ones information that others don’t know; to what to do about profiteers from pseudoscience (like the promoter of the herbal remedy forsythia); to whether leaving an unsafe lab is putting other lab members or the general public at risk or, instead a genuinely heroic act (or both); to whether to distribute scarce vaccines based on randomized dates of birth. The movie poses all of these questions and more, and leaves us to wonder whether there are fundamental ethical principles that we can use to analyze such horrific circumstances.
These are not just questions dreamed up by a thriller movie. The ethical problems associated with a global epidemic like that portrayed by the movie also arise with many more familiar cases of transmissible infectious disease, from seasonal influenza (actually a real killer, especially of vulnerable people) to sexually transmitted diseases, including HIV/AIDS, a global killer already tragically familiar in the real world. Ethical problems associated with infectious disease are everywhere, even those of smaller scale — problems that may be just as interesting but possibly more amenable to solutions. Contagion depicts a worst-case scenario, but that does not mean we should not pay attention to less dramatic but still challenging real-life scenarios involving any disease that passes from one human being to another.
At bottom, we are all in this together. We are victims of contagious disease; at one and the same time, we are also vectors of contagious disease, threatened by others but also threats to others. Thus we must recognize ethically that we cannot go it alone. We cannot develop policies that seek to protect only ourselves, or assume that we know whether we will be in privileged positions to help ourselves, if a global outbreak of the terrifying contagiousness and lethality portrayed in Contagion ever does occur.
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