Maurice Hilleman via Wikipedia
"Contagion," a movie in which a mysterious airborne virus kills Gwyneth Paltrow and thousands of other people, was this weekend's top box office hit, generating $23 million in ticket sales. Many researchers are trying to ride on the movie's coattails to get attention for the risks of an infectious disease epidemic and our lack of preparedness when it comes to dealing with disease outbreaks.
The movie has me thinking about the constant tap dance that infectious disease experts must do to get attention for their field -- scaring the public one moment, calming it the next -- because of the gigantic market failure in our health care system that keeps us from constantly preparing for an infectious disease outbreak. It also has me thinking about one of the greatest industry researchers of the past century: Merck vaccine maven Maurice Hilleman.
Johns Hopkins University issued a press release saying that whatever Contagion director Stephen Soderberg got wrong, the movie "spotlights the fact that hospitals, health care workers and public health agencies will be on the front lines of a major deadly disease outbreak." Through a public relations person, Joseph Kim, the chief executive of a biotechnology company called Inovio that makes antiviral drugs, sent an even scarier missive, writing:
It will be when, and not if, something like this could happen. All flu viruses jump from birds to pigs to humans. The bird flu, H5N1, has the kill rate of over 60% in which 300 out of 500 infections resulted in death. As a comparison, the Spanish flu of 1918, in which 40 million people died, had only about 2-3 % kill-rate. So far, every person who died from H5N1 was infected from birds directly. We have yet to see human-to-human transmission of the virus. But, it is only matter of time, though, as history teaches us.
The virus in Contagion is not H5N1. (See Maryn McKenna's great, spoiler-filled rundown of the science behind the movie.) But H5N1 has been making the disease freakout rounds lately.
On August 29, the Food and Agriculture Organization of the United Nations issued its own warning about the H5N1 bird flu on August 29, urging "heightened awareness and surveillance" of H5N1 because of an uptick of the number of cases in poultry. The virus does not spread easily from birds to humans, and does not seem to spread from person to person. Since 2003, it has infected 565 people and killed 331 of them, worldwide.
The U.S. Centers for Disease Control and Prevention, for its part, has criticized over-hyped news coverage of this season's H5N1 uptick. The reality is that while Contagion presents a worst case scenario – one that it's worth being prepared for – it's also important to remember that a lot of disease outbreaks will also turn out like SARS, which fizzled, or the H1N1 pandemic, which caused many extra cases of flu but which was not so severe as to be a terrible plague.
That brings me to Hilleman. To me, one of the most useful stories for understanding why H5N1 is not worth losing much sleep over right now is the tale of how Hilleman, who created the vaccines for mumps, measles, and hepatitis B, among others diseases. As recounted in Paul Offit's wonderful biography of him, Vaccinated: One Man's Quest to Defeat The World's Deadliest Diseases, Hilleman never believe that H5N1 was a threat.
The H5 in H5N1 stands for hemagglutinin type 5, meaning the fifth known type of hemagglutinin found on the coatings of influenza viruses. Hilleman argued that only viruses with three types of hemagglutinints – H1, H2, and H3 – had ever caused flu pandemics. So far, this has held true. Offit, himself a noted vaccine researcher, says via email that one of the more interesting moments in his life was sitting at a table with Hilleman and Tony Fauci, the head of the National Institute of Allergy and Infectious Disease, when Hilleman "berated" Fauci for fanning fears of H5. Hilleman died that year.
Hilleman wasn't always right; he predicted, based on the patterns of previous flu pandemics, that the next flu pandemic wouldn't come until 2025, and would be caused by an H2 virus; instead, it was H5N1. But his story also shows that alert researchers can be ready for an infectious outbreak. Hilleman was responsible for pushing through bureaucratic and cultural blocks to get a vaccine for the virus that caused the influenza pandemic of 1957 ready in just four months, saving thousands of lives (the pandemic killed 70,000 Americans.)
We do have to keep in mind the worst-case scenario that "Contagion" represents. But we can be prepared for it – and the not-nearly-as-bad outbreaks that are sure to proceed any really bad one. And the tough challenge is this: being prepared requires slowly, methodically, and constantly putting resources into our health infrastructure, something that our current health care market fails to do. The strategy of freaking out every time there is a slightly scary virus on the horizon and then forgetting about it until a scary movie comes out and then forgetting again is not an effective way to guard ourselves against infectious diseases that are always everywhere, always evolving, and usually not that big a threat -- at least, not until they spell real danger.
Update: Michelle Sipics points out this great video of Hilleman recounting the story of the 1957 pandemic.
