As I watched the blockbuster bio-thriller Contagion, I was struck by how realistic it was in many ways. That isn’t surprising, since many epidemiologists, including those from the Centers for Disease Control and Prevention (CDC) in Atlanta, served as advisors. The film was based on a simple premise. What if a new, deadly virus that kills one out of four people it infects were also easily transmissible from human to human?
I knew more about the subject than most people in the audience, because I spent five years researching and writing Inside the Outbreaks, a history of the Epidemic Intelligence Service (EIS). EIS officers have served as the front-line CDC disease detectives since the organization was founded in 1951 in the midst of Cold War fears of bioterrorism. In the film, EIS officer Erin Mears, played by Kate Winslet, is sent to investigate the epidemic in Minneapolis, where she contracts the disease herself and dies a few days later. In reality, only one EIS officer has died in the line of duty, and that was when a terrorist blew up an airplane during the Biafran War in Nigeria. But there have been several close calls, as EIS officers have caught the diseases they were investigating.
Winslet’s portrayal of an EIS officer is essentially accurate, though she would not have been sent alone to handle such a major outbreak. More than half of EIS officers are female nowadays. They usually enter the two-year program in their early thirties, often with a masters in public health. Most are, like the Erin Mears character, compassionate, driven, idealistic, and courageous.
There are four main lessons we can glean from the film.
Lesson 1: We are an invasive species. At the film’s end, a bulldozer dislodges infected fruit bats (the source of the pandemic virus) from tropical trees. It is true that as people invade and disturb habitats, we are more likely to encounter new pathogens. That’s probably how the AIDS epidemic began, with transmission of a simian virus to humans. We are, after all, animals, living in a complex web of other living beings, so it isn’t surprising that zoonoses (diseases that spread from other animals to humans) are so common. And as humans proliferate — there will probably be 10 billion of us swarming the earth by 2050 — we offer a tempting target for infectious diseases.
Lesson 2: Bioterrorism is overrated. In the movie, officials of the Department of Homeland Security tell CDC epidemiologist Ellis Cheever that they suspect the new virus is a bioterror weapon intended to disrupt the Thanksgiving weekend and spread more quickly as people travel to be with their families. Cheever informs them, “Someone doesn’t have to weaponize the bird flu — the birds are already doing that.” Indeed, fears of bioterrorism, which helped to create the Epidemic Intelligence Service in the first place, are overblown. Yes, bioterrorists could spread deadly pathogens such as anthrax, but mad scientists are less likely to create a deadly viral mutation that is easily transmissible between humans. Nature is far better at such achievements. The next pandemic will not be man-made, at least not intentionally.
Lesson 3: People panic. The film is at its strongest in showing how people are likely to react during a pandemic when insufficient drugs or vaccines are available. How will they be distributed? Who decides who will get them first? What kind of looting and violence is likely to ensue? Contagion offers a chillingly plausible scenario. We are woefully unprepared for such panic-driven behavior.
Lesson 4: Rumors on the internet can kill. In Contagion, blogger Alan Krumwiede, played by Jude Law, convinces 12 million frightened internet followers that the government can’t be trusted. The CDC is lying, he writes. Their new vaccine is useless or even harmful. Instead, Krumwiede promotes a homeopathic remedy made from the forsythia plant. He pretends that he has contracted the virus and that he cured himself, thereby making himself wealthy, even as he misleads the public.
These are important lessons, yet Contagion also falls short in a number of ways. While it is far better than most Hollywood biopics, it focuses more on the social consequences of a worst-case scenario than on the science.
For one thing, it doesn’t teach us much about how epidemiologists work, probably because such logical, seemingly plodding methodology doesn’t suit the media. I have some painful personal experience in this regard. When Inside the Outbreaks was published in 2010, it was optioned for a television series, and an experienced Hollywood writer was hired to script a pilot show, in which a platoon of soldiers in basic training dropped like flies. It turned out to result from the intentional poisoning of beef jerky in a vending machine at a bar. The EIS officer in the script figured it out purely by serendipity.
I objected: “What is startlingly missing from the script is the EIS officer asking what they ate. This is very likely to be a foodborne outbreak of some sort. So she is looking for a common food. She should be doing a case-control study, asking the sick men what they ate and where they were, as well as soldiers who didn’t get sick but were as similar as possible in all other ways (i.e., who went on the same march, were in the same barracks, etc). Then when the case-control study pointed to the bar, but not to a particular food, she could have her Eureka moment, seeing the vending machine, finding out what was in it, and going back and redoing the case-control study with the right questions about whether they ate anything from the vending machine, and what it was. One of the vital points of epi is not only to use the right methodologies but to ask the right questions.”
The script writer responded: “It is to be assumed she asked what they ate, since she’s also asking deeply idiosyncratic and minute questions. But honestly, ‘What did you eat?’ is very boring and had to be avoided.” The pilot show was never made. Although I wanted my book to be the basis of a TV show, in a way I was relieved.
To his credit, Scott Burns, who wrote the screenplay for Contagion, included some explanation of how the virus was transmitted (by breathing droplets or by touching the same objects as those infected), but the movie did not focus on epidemiology, the methodology of disease detectives. Only at the end of the film do viewers get a quick glimpse of how the virus was transmitted, from fruit bats to pigs to people. Somewhere in the middle of the movie, there is a glimpse of the phrase “Nipah virus” on a CDC document, but otherwise moviegoers would have no idea that this is in fact the real-life virus on which the fictional MEV-1 virus was based. And the film offers no clue as to how anyone figured out its origin or transmission route.
In Inside the Outbreaks, I wrote about the first terrifying Nipah virus epidemic that began in 1998 in Malaysia with pigs who began to twitch, cough, bite at their bars, and lose their footing. Their urine turned bloody. Then they collapsed and died. Pig farmers developed fevers, becoming lethargic and disoriented. Some fell into a coma and died. A desperate farmer advertised on the Internet, selling sick swine on the cheap to farms 50 miles away, where over 200 farmers contracted the disease. When CDC labs found a new virus in spinal fluid from patients, they named it Nipah virus, after a village where the fire sale pigs had been sent, and it was designated a Biosafety Level 4 pathogen, equivalent to Ebola.
“People left their farms, their pigs, everything they owned. Whole villages just fled,” recalled EIS officer Mike Bunning. The outbreak was finally brought under control at the end of May 1999, by which time a million pigs had been sacrificed and 108 out of 280 identified human cases had died. The EIS case-control study indicated that direct contact with sick pigs was a primary risk factor.
The EIS officers suspected that Malaysian bats might serve as the reservoir for Nipah virus and helped to capture a variety of them, including the giant fruit bats known as flying foxes. Sure enough, Nipah antibodies were eventually found in the flying foxes. A dead bat or its feces might have fallen into a feed lot, or bats may have dropped contaminated, partially eaten fruit into pig pens.
In the ensuing years, Nipah virus jumped to Bangladesh and neighboring parts of India, often killing 75 percent or more of its victims, but there was no evidence of person-to-person transmission — it always required contact with a pig. Mike Bunning thought the actual mortality in Malaysia may have been near that figure, since many Chinese laborers who died were buried secretly to avoid the slaughter of their pigs. “If Nipah had been communicable between humans,” Bunning observed, “The world as we know it today would be different.”
I don’t know if anyone involved in Contagion read my book, but Bunning’s final chilling comment summarizes the basic premise of the film. Rather than a 75 percent mortality rate, the movie assumes a 25 percent rate, but that is still appallingly high. The film shows how quickly such a contagion could spread in the jet age.
Yet this doomsday scenario is unlikely to occur, though it is still possible. The most horrific viruses, such as Ebola or Nipah, tend to be dead ends in human beings. They evolved in order to take advantage of other hosts, such as fruit bats. It is a freak of nature that humans happen to succumb so quickly and horribly. If these viruses mutate in order to become easily transmissible between humans, they are also likely to become far less lethal. Why? Darwin told us. Evolution favors survival, and a virus that kills off too many hosts will not survive for long. Still, a lot of people could die before the virus fully adapted to humans.
“Successful” pathogens don’t kill the majority of their victims. They cause communicable diseases such as polio, diphtheria, tetanus, pertussis, influenza, yellow fever, measles, rubella, rabies, hepatitis, meningitis…. the list goes on. All of these bacteria and viruses have something else in common. All have vaccines that can save lives. That is why, to me, the most upsetting part of Contagion was not the virus itself, but the con artist Krumwiede who profits by scaring people away from an effective vaccine.
We don’t need a fictional pandemic to demonstrate this kind of scenario. It has been happening for years, as rumors that vaccines cause rather than cure diseases are rampant on the Internet. Although all vaccines cause adverse reactions in some people, the truth is that they have prevented millions of people (mostly children) from dying. Because of a vaccine, smallpox, an ancient killer, has been eradicated.
Yet paranoia over government-sponsored health programs has prevented many people in the United States and elsewhere from protecting themselves and their children. As long as enough people are immunized, infections are unlikely to spread rapidly, but as a large susceptible population develops, epidemics, illness, and deaths become inevitable.
It is impossible to prove a negative, so one cannot prove that vaccines do not cause autism or other ailments. Epidemiology is a science of probability, not proof. But an overwhelming array of epidemiological studies provides evidence that vaccines do not cause autism or the other ailments that fear-mongers claim. So let me end this essay with a plea for support for vaccinations. Anti-vaccine misinformation on the Internet is more prevalent and powerful than the staid official policy presented on the CDC website. But there are other well-informed websites about current dangers from vaccine-preventable diseases, such as Meningitis Angels (meningitis-angels.org), Parents of Kids with Infectious Diseases (pkids.org), and Families Fighting Flu (familiesfightingflu.org) In addition, Voices for Vaccines (voicesforvaccines.org) provides science-based information. Also, check out the well-researched, informative books by pediatrician and vaccine specialist Paul Offit. The fact that Dr. Offit has received hate mail and death threats for telling the truth and trying to save lives is evidence of the passionate misinformation out there.
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This is my second blog about Japan’s current energy situation and its future, about which I wrote in my short book, Japan’s Tipping Point: Crucial Choices in the Post-Fukushima World. In my first post, I explained how I came to Japan to study Eco-Model Cities and renewable energy policy two months after the earthquake/tsunami/Fukushima meltdown. I asserted that Japan is a kind of “canary in the coal mine” for the rest of the world, since it is facing the same issues that we all face, only sooner and more starkly. Japan has no fossil fuel, and it has scrapped plans to build more nuclear power plants. It therefore must ramp up renewable energy efforts, energy efficiency, and lifestyle changes.
The comments that my first blog inspired turned into a vituperative argument over the benefits and perils of nuclear power, with interpersonal attacks that added much heat but little light. So let me address the nuclear power issue briefly: The subtitle of my book referred to the “post-Fukushima world” because nuclear policy in Japan and other parts of the world has undergone a seismic shift following the meltdown, with a subsequent surge in interest in renewable options. I did not intend, however, to focus on nuclear power in my book, and I don’t want to focus on it in my blogs, either. My underlying assumption is that nuclear power in Japan will not be a viable alternative in the future. Even pro-nuclear Japanese experts such as Takao Kashiwagi, a professor at the Tokyo Institute of Technology, admit that Japan will not build any more nuclear plants for at least two decades.
Particularly in Japan, nuclear power plants are hazardous since the country sits on top of fault lines that make earthquakes and tsunamis a constant danger. All of Japan’s nuclear plants are located on the ocean’s edge for access to water as a coolant. I am not a fan of nuclear power for many reasons. Human beings who run nuclear power plants make mistakes, and in Japan there is a long history of cover-ups of such mistakes. Etc. But really, can we move on from this issue? For the purposes of discussion, I would simply like to assume that nuclear power is not a viable option for Japan’s future. In the book, and in my blogs, I want to focus on renewable energy. I propose to deal with each form of renewable energy one at a time in future blogs — geothermal, solar photovoltaic, solar hot water, wind, biomass, hydro/tidal — as well as food, energy efficiency, and lifestyle.
In this blog, I’ll talk about Tetsunari Iida and Tokyo’s Institute of Sustainable Energy Policies (ISEP) that he founded and continues to lead. A trim, short, self-assured man of 52, Tetsunari Iida seems to lack all pretension despite his current celebrity. He doesn’t appear to be a radical, even though his opponents think he is. He told me with pride how in the late 1990s he had criticized TEPCO, the Tokyo Electric Power Company, about its nuclear plants, while simultaneously working with the utility as a partner on a wind turbine project in Hokkaido. “I believe in dialogue,” he said, “not confrontation.” He comes across as a mild-mannered man with a sense of humor and a large dose of common sense.
Iida grew up on a farm in western Japan. His octogenarian father still sends him a package of home-grown vegetables every month. He heats his home, just to the north of Tokyo, with a wood stove. Iida started his career as a nuclear engineer. I asked him what led him to quit in 1992, expecting him to cite the Chernobyl meltdown, but he said he wasn’t really worried about safety issues in those days. He hated the groupthink atmosphere in which it wasn’t permissible to question any aspect of nuclear energy policy. All of his papers were censored. “It was a kind of soft fascism,” he said. He fled to Sweden, where he studied renewable energy. After shuttling back and forth to Japan, he returned to his native country in 1998 and founded ISEP two years later.
Since then, he has become the chief Japanese gadfly of nuclear power, while advocating strenuously for renewable energy. He has helped to found several green mutual funds, offering a small return to idealistic investors who want to support wind and micro-hydro. But until 3/11, he was mostly a voice crying in the wilderness, largely ignored by bureaucrats, governing politicians, and the mainstream media.
Now that has changed. “All of a sudden our voice is taken up more centrally,” he told me. He is constantly in demand for interviews on TV, radio, and in print. “Within the last month, ISEP has become one of the most well-known organizations in Japan. I now have deep connections in the cabinet and with both political parties.”
In his talks, Iida shows a slide in which Japanese nuclear power and fossil fuel use gradually dwindle to nothing by 2050, while renewable energy increases to account for 50 percent of current use. The other 50 percent will supposedly be covered by energy savings and efficiencies. By 2020, ISEP proposes that renewables will contribute 30 percent of Japan’s power supply and energy efficiency 20 percent, with coal and oil at 15 percent, liquid natural gas 25 percent, and nuclear power 10 percent. That scenario assumes no new nuclear reactors and a 40-year life for existing nuclear power plants, which will slowly be phased out. Iida would prefer to see all nuclear plants closed by 2020, however, with their energy share replaced temporarily by natural gas.
The ISEP plans for renewable electric generation capacity are fairly specific. Hydro currently supplies eight percent and is to be brought up to 14 percent by 2050. Wind will blow up from 0.4 percent to eight percent, solar from 0.3 percent to 14 percent, geothermal from 0.3 percent to eight percent, and biomass from 1.1 percent to six percent. While those are ambitious goals, they are perhaps feasible. But how is the other 50 percent in energy savings and efficiency going to be achieved? Iida is vague about that. He talks about switching to LED lights and installing better house insulation. He seems to think that the Japanese can drastically reduce their energy consumption without significantly modifying their lifestyles. I don’t see how that is possible.
Nonetheless, of all the people I interviewed in Japan, Tetsunari Iida was among those who impressed me the most, and I hope that his sudden rise to celebrity means that his message will be heeded. He tries to remain optimistic even as he observes that the Japanese energy policy has relied on a kind of “political delusion without rationality or evidence.” He believes that 3/11 marks the third drastic turning point in modern Japanese history. The first was the Meiji Restoration of 1868, in which Japan opened its doors to the outside world. The second was the defeat that ended World War II. Iida says that a mass delusion and blind faith in military might and the emperor led to the disastrous war, and no one was allowed to question it. “But after the war, everyone questioned it.” The same kind of unquestioning allegiance to nuclear power drove him to oppose it, and now, in the post-3/11 world, he hopes that Japan will throw itself into a massive energy shift.
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In 2010, I published a book on public health (Inside the Outbreaks), and as a follow-up, I concluded that the overarching threat to the world’s public health that we face in the coming decades is climate change/peak oil.
In researching that story, I got an Abe Fellowship for Journalists that allowed me to go to Japan to study renewable energy and specifically to visit several so-called Eco-Model Cities in Japan. I already had my plane reservations when the earthquake/tsunami hit. I nearly didn’t go, but things had calmed down by May 11, which is when I showed up.
I have just completed and published a short ebook as a result of the trip, called Japan’s Tipping Point: Crucial Choices in the Post-Fukushima World. It is a small book on a huge topic. In the post-Fukushima era, Japan is the “canary in the coal mine” for the rest of the world. Can Japan radically shift its energy policy, become greener, more self-sufficient, and avoid catastrophic impacts on the climate?
Japan is at a crucial tipping point and I discovered that I had been naive in thinking that the country was ready to make a massive change. The Japanese boast of their eco-services for eco-products in eco-cities and yet they rely primarily on imported fossil fuel and nuclear power, live in energy-wasteful homes, and import 60% of their food. That may be changing in the wake of the Fukushima nuclear disaster. Maybe. But as I documented, Japan lags far behind Europe, the United States, and even (in some respects) China in terms of renewable energy efforts. And Japan is mired in bureaucracy, political in-fighting, indecision, puffery, public apathy, and cultural attitudes that make rapid change difficult.
Yet Japan is also one of the most beautiful countries in the world, with friendly, resilient people who can, when motivated, pull together to accomplish incredible things. As an island nation, Japan offers a microcosmic look at the problems facing the rest of the globe. And as Japan tips, so may the world.
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Thursday, Dec. 16, 1 p.m., Foege Auditorium, University of Washington, Seattle, WA. Mark Pendergrast will speak about the history of the CDC’s Epidemic Intelligence Service and its impact on public health, based on his book, Inside the Outbreaks. EIS officers are the front-line disease detectives of the CDC, and EIS graduates are among the leaders of the world of public health (including Bill Foege, for whom the auditorium is named). The presentation is free and open to the public. Located in the Foege Building, southeast corner of Pacific Street and 15th Ave NE in Seattle.
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Tuesday, Dec. 14, 2010, 7 p.m., Starbucks Olive Way store, 1600 East Olive Way, Seattle, WA. Mark Pendergrast will be speaking about his book, Uncommon Grounds, which has just come out in a revised, updated edition. The presentation is free and open to the public. 206-568-5185.
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