What Does Contagion (2011) Teach us About Vaccines and Self-experimentation?
By: Aimen Imtiaz
Contagion (2011)
For those of us living in the happy bubble Contagion (2011) created for us in terms of an all to the quick production of vaccine and the heroism of self-experimentation, this is not going to be very fun. However, since my bubble was popped it’s only fair, I help do the same for others. Boohoo!
The fact of the matter is, just like houses aren’t made of chocolate and clouds of marshmallows, vaccines are not THAT easy to produce. In fact, this information is provided and then contradicted within the movie itself when Dr. Hextall (who discovers the vaccine), on a phone call with Dr. Cheever, explains the complexities of creating a vaccine,
“If we even had a viable vaccine right now, we would still have to do human trials that would take weeks. And then we would have to get clearance and approval, figure out manufacturing and distribution. That would take months. And then training survivors to give inoculations. More months, more deaths.” (Contagion, 1:14:53 – 1:15:11)
Not just that, Dr. Hextall’s estimation of the amount of time for human trials is also wrong, for it takes months to conduct human trials which further increases the time for the production of a vaccine.
The process of vaccine development comprises of three stages: research, testing, and manufacturing. The research phase is where scientists explore and experiment with various approaches to design a safe-to-use and replicable vaccine. These vaccines then enter the testing phase where they are evaluated for safety and side-effects across different populations (animals and human trials). Lastly, there is manufacturing, vaccines are produced in masses and delivered to the target population. This process can take 15 to 20 years! Yikes!
However, during a pandemic, efforts are made to move through each stage as quickly as possible. The most flexible of these stages, in this regard, is the research stage which is concerned with finding a safe way to introduce our immune system to the virus (No don’t worry! You won’t die!) so it can create antibodies against it. Antibodies are our body's very own soldiers defending us against harmful intruders such as viruses (see... you are safe).
There is, however, a catch. The most effective and safe designs of vaccines are often the slowest to produce, as with the case of traditionally used attenuated vaccines. Attenuated vaccines – which provide long lasting resilience – rely on weakened strains of the relevant virus. These strains are to be created in non-human tissues over long periods of time.
As pointed out by an epidemiologist, Michael T. Osterholm, “the vaccine [in Contagion] is an intranasal one, suggesting that it's a live attenuated virus, which would probably take even longer to develop.” (“‘Contagion’ Portrays Extreme but Not Impossible Scenario”). Yes, Contagion seems to have wronged all of us.
However, vaccines that can be created quickly, for example, inactivated vaccines (made from viruses that are killed either physically or chemically) and sub-unit vaccines (made of harmless fragments of viral proteins) produce less robust resilience which may not even be long-lived.
Clinical testing, the second stage, itself comprises 3 phases: the first dealing with the intensity of immune response to establish that the vaccine is safe and effective, the second determines the dosage and delivery schedule of the vaccine, and the third phase determines the rare side-effects and negative reactions. I am sure by now we are realizing that it’s going to be a long ride. The complexity of this procedure does not allow its speed-up (TED-Ed).
Once the vaccine is approved by a national regulatory authority, the final process of manufacturing begins. This the stage where we come in, but you see how long the wait is? Certainly not two months after the discovery of the virus.
The last step brings with it its own unique blows so brace yourself. Vaccines are specific and unique, and hence, a specialized manufacturing plant is required for every vaccine. No people, you cannot just start producing vaccines wherever you like. It is for these reasons that “manufacturing plans are designed in parallel to research and testing” (TED-Ed). This requires strict coordination between labs and manufacturers and sometimes even results in a wastage of months of work depending upon the sudden changes in the vaccine design (TED-Ed).
How heroic, no? Dr. Hextall, in the movie, does a heroic act of speeding up the human trials by self-experimenting (testing the vaccine on yourself) with the fifty-seventh batch of vaccine that showed some promising results. Considering the lack of time and the elaborate procedures of getting approval for human trials, conducting them, and then starting manufacturing, Dr. Hextall takes the bold step of testing the vaccine upon herself and then visits her infected father to test it.
How heroic! And it worked too! They distributed vaccines to entire populations of people based on the results of A SINGLE HUMAN TRIAL. No people, this is not something to celebrate.
There is a reason that the testing phase is such an elaborate stage in the development of vaccines. When vaccines are to be distributed to entire populations of people you need to be sure that they will protect not kill or cause unrepairable damage. The testing phase from animals to humans, and then within humans ensures the safety of the vaccine, the adequate dose so as to not overdo it, the correct inoculation (delivery of vaccine) method. Many times, “certain rare side-effects might not surface in the smaller groups of subjects tested earlier” but may come up in the larger diverse groups (“Vaccine Development, Testing, and Regulation | History of Vaccines”).
Dr. Hextall could’ve been naturally immune like Matt Damon in the movie, there could be side effects that may surface gradually, there are a number of risks. So, you see, Dr. Hextall’s stunt of self-experimentation and delivery of vaccines based on that ONE human trial is stupid, not heroic.
One of the main reasons, that the practice of self-experimentation is forbidden, is stated in Lawerance K. Altman’s book Who goes first? The story of self-experimentation in medicine; while discussing why doctors don’t participate in their own research it is stated that “their lives as doctors as too valuable to take such risks” (“Who Goes First?”)
This reason applies to all researchers and scientists. As absurd as it may sound, it is argued that their lives as researchers are more important, it is not just their bodies being put at risk but a lot of investment, research work, resources, time, and the intelligence that is being risked if a researcher risks their own life for their research. No one wants to start from scratch.
Those who self-experiment, do so, mostly because they are being doubted, there isn’t enough conclusive research to move to human trials, lack of approval and time, and most importantly the undying curiosity to see the results of their research first-hand and quickly. It is for these reasons, Altman says, that IRB (Institutional Review Board) has “an overwhelming concern to curb a researcher’s overenthusiasm and thus to protect researchers against themselves” (“Who Goes First?”).
Hence, self-experimentation is usually done in secrecy, and if found guilty can result in the researcher being fired, their facility and university being shut-down, and their doctory being terminated.
The other school of thought regarding self-experimentation highlights the biblical saying “do unto others as you would have them do unto yourself,” and states that researchers should have the freedom to explore their curiosities. People from this ideology state celebrate those who self-experiment on the note that “many self-experiments have proved invaluable to the medical community,” for example, Bary Marshal who self-experimented and proved that ulcers were caused by bacteria (Weisse). He was later awarded a Nobel prize for it.
In any case, there is always the risk of death and/or non-fatal health risks when it comes to such experimentations. In that regard, a researcher alive is worth more than dead. Simply put, the rest of us are expendable but the guy looking for a cure is not. Yes, we can all go cry in a corner now.
In conclusion, I would advise that Contagion may not be followed or be dependent upon religiously (in light of the COVID pandemic) because while it is a perfect blockbuster for a movie night, it contains accuracies that are bound to generate false hope and provide wrongful information. At the end of the day, Contagion is a movie is what it is, and that fact speaks for itself.
References:
“Contagion’ Portrays Extreme but Not Impossible Scenario.” CIDRAP, 2011, www.cidrap.umn.edu/news-perspective/2011/09/contagion-portrays-extreme-not-impossible-scenario Accessed 7 Nov. 2020.
Ferris Jabr. “How Realistic Is Contagion? The Movie Doesn’t Skimp on Science.” New Scientist, 2020, www.newscientist.com/article/2239913-how-realistic-is-contagion-the-movie-doesnt-skimp-on-science/ Accessed 7 Nov. 2020.
MODULE 2: Types of Vaccine and Adverse Reactions MODULE 2 Types of Vaccine and Adverse Reactions.
Soderbergh, Steven. Contagion. Warner Bros., 2011.
TED-Ed. “How Fast Can a Vaccine Be Made? - Dan Kwartler.” YouTube, 15 June 2020, www.youtube.com/watch?v=74WQgNa3OsQ Accessed 7 Nov. 2020.
“Vaccine Development, Testing, and Regulation | History of Vaccines.” Historyofvaccines.org, 2010, www.historyofvaccines.org/content/articles/vaccine-development-testing-and-regulation Accessed 7 Nov. 2020.
Weisse, Allen B. “Self-Experimentation and Its Role in Medical Research.” Texas Heart Institute Journal, vol. 39, no. 1, 2012, pp. 51–4, www.ncbi.nlm.nih.gov/pmc/articles/PMC3298919/ Accessed 7 Nov. 2020.
“Who Goes First?” Google Books, 2010, books.google.com.pk/books?hl=en&lr=&id=ybcwDwAAQBAJ&oi=fnd&pg=PR9&dq=self-experimentation+ethics&ots=Kn4-Vbrsoj&sig=yJf_MK15Yj84u-nWAW_omoVYnDE#v=onepage&q&f=false Accessed 7 Nov. 2020.
World Health Organization: WHO. “Vaccines and Immunization.” Who.Int, World Health Organization: WHO, 29 Oct. 2019, www.who.int/health-topics/vaccines-and-immunization?gclid=EAIaIQobChMI__m5rvjv7AIVia3tCh0bQA8bEAAYASAAEgKC4_D_BwE#tab=tab_1 Accessed 7 Nov. 2020.
DON’T RELY ON MOVIES!
Contagion (2011)For those of us living in the happy bubble Contagion (2011) created for us in terms of an all to the quick production of vaccine and the heroism of self-experimentation, this is not going to be very fun. However, since my bubble was popped it’s only fair, I help do the same for others. Boohoo!
Virus Outbreak occurs and Viola! You have a vaccine! Really? Is it that simple?
In the movie, we see how a vaccine is created and is being delivered to the population within approximately two months of identification of the MEV-1 virus. This really makes me wonder if the doctors and researchers have become a little slower since the movie was released. I mean, it is almost a year now, since the COVID virus was identified and we’re still waiting for a vaccine. Have we not been good this year for our Santas (doctors/researchers) to grant us our wishes? Not really.Virus outbreak, waiting for a vaccine?
“If we even had a viable vaccine right now, we would still have to do human trials that would take weeks. And then we would have to get clearance and approval, figure out manufacturing and distribution. That would take months. And then training survivors to give inoculations. More months, more deaths.” (Contagion, 1:14:53 – 1:15:11)
Not just that, Dr. Hextall’s estimation of the amount of time for human trials is also wrong, for it takes months to conduct human trials which further increases the time for the production of a vaccine.
How About a Little Reality Check?
When you really understand all the complex and time-consuming processes behind the production of a vaccine you realize it is not as hunky-dunky-dory as Contagion made it out to be. Vaccines do not just fall out of the sky and even if they did, discovering a vaccine is just the first step.The process of vaccine development comprises of three stages: research, testing, and manufacturing. The research phase is where scientists explore and experiment with various approaches to design a safe-to-use and replicable vaccine. These vaccines then enter the testing phase where they are evaluated for safety and side-effects across different populations (animals and human trials). Lastly, there is manufacturing, vaccines are produced in masses and delivered to the target population. This process can take 15 to 20 years! Yikes!
15 to 20 years for a vaccine ?!
There is, however, a catch. The most effective and safe designs of vaccines are often the slowest to produce, as with the case of traditionally used attenuated vaccines. Attenuated vaccines – which provide long lasting resilience – rely on weakened strains of the relevant virus. These strains are to be created in non-human tissues over long periods of time.
As pointed out by an epidemiologist, Michael T. Osterholm, “the vaccine [in Contagion] is an intranasal one, suggesting that it's a live attenuated virus, which would probably take even longer to develop.” (“‘Contagion’ Portrays Extreme but Not Impossible Scenario”). Yes, Contagion seems to have wronged all of us.
However, vaccines that can be created quickly, for example, inactivated vaccines (made from viruses that are killed either physically or chemically) and sub-unit vaccines (made of harmless fragments of viral proteins) produce less robust resilience which may not even be long-lived.
Clinical testing, the second stage, itself comprises 3 phases: the first dealing with the intensity of immune response to establish that the vaccine is safe and effective, the second determines the dosage and delivery schedule of the vaccine, and the third phase determines the rare side-effects and negative reactions. I am sure by now we are realizing that it’s going to be a long ride. The complexity of this procedure does not allow its speed-up (TED-Ed).
Once the vaccine is approved by a national regulatory authority, the final process of manufacturing begins. This the stage where we come in, but you see how long the wait is? Certainly not two months after the discovery of the virus.
Approved vaccines lead to manufacturing.
The last step brings with it its own unique blows so brace yourself. Vaccines are specific and unique, and hence, a specialized manufacturing plant is required for every vaccine. No people, you cannot just start producing vaccines wherever you like. It is for these reasons that “manufacturing plans are designed in parallel to research and testing” (TED-Ed). This requires strict coordination between labs and manufacturers and sometimes even results in a wastage of months of work depending upon the sudden changes in the vaccine design (TED-Ed).
So, Wait For The Vaccine OR Self-experiment And Get It Over With?
Just imagine! Eliminating the longest phase (clinical testing) of the process is bound to speed-up production, right? I mean, Dr. Hextall did it.Dr. Hextall’s decisive moment of self-experimentation.
How heroic! And it worked too! They distributed vaccines to entire populations of people based on the results of A SINGLE HUMAN TRIAL. No people, this is not something to celebrate.
There is a reason that the testing phase is such an elaborate stage in the development of vaccines. When vaccines are to be distributed to entire populations of people you need to be sure that they will protect not kill or cause unrepairable damage. The testing phase from animals to humans, and then within humans ensures the safety of the vaccine, the adequate dose so as to not overdo it, the correct inoculation (delivery of vaccine) method. Many times, “certain rare side-effects might not surface in the smaller groups of subjects tested earlier” but may come up in the larger diverse groups (“Vaccine Development, Testing, and Regulation | History of Vaccines”).
Dr. Hextall could’ve been naturally immune like Matt Damon in the movie, there could be side effects that may surface gradually, there are a number of risks. So, you see, Dr. Hextall’s stunt of self-experimentation and delivery of vaccines based on that ONE human trial is stupid, not heroic.
But Is Self-Experimentation All Bad? Two Schools Of Thought
What is so wrong with this practice? Why is self-experimentation frowned upon, you must think? If some human eventually is going to be experimented upon, why can it not be the researcher /doctor/ scientist or whoever themselves? There are two distinct ideologies, one in favor of it and the other against it.Is it so bad?
This reason applies to all researchers and scientists. As absurd as it may sound, it is argued that their lives as researchers are more important, it is not just their bodies being put at risk but a lot of investment, research work, resources, time, and the intelligence that is being risked if a researcher risks their own life for their research. No one wants to start from scratch.
Those who self-experiment, do so, mostly because they are being doubted, there isn’t enough conclusive research to move to human trials, lack of approval and time, and most importantly the undying curiosity to see the results of their research first-hand and quickly. It is for these reasons, Altman says, that IRB (Institutional Review Board) has “an overwhelming concern to curb a researcher’s overenthusiasm and thus to protect researchers against themselves” (“Who Goes First?”).
Hence, self-experimentation is usually done in secrecy, and if found guilty can result in the researcher being fired, their facility and university being shut-down, and their doctory being terminated.
The other school of thought regarding self-experimentation highlights the biblical saying “do unto others as you would have them do unto yourself,” and states that researchers should have the freedom to explore their curiosities. People from this ideology state celebrate those who self-experiment on the note that “many self-experiments have proved invaluable to the medical community,” for example, Bary Marshal who self-experimented and proved that ulcers were caused by bacteria (Weisse). He was later awarded a Nobel prize for it.
In any case, there is always the risk of death and/or non-fatal health risks when it comes to such experimentations. In that regard, a researcher alive is worth more than dead. Simply put, the rest of us are expendable but the guy looking for a cure is not. Yes, we can all go cry in a corner now.
In conclusion, I would advise that Contagion may not be followed or be dependent upon religiously (in light of the COVID pandemic) because while it is a perfect blockbuster for a movie night, it contains accuracies that are bound to generate false hope and provide wrongful information. At the end of the day, Contagion is a movie is what it is, and that fact speaks for itself.
References:
“Contagion’ Portrays Extreme but Not Impossible Scenario.” CIDRAP, 2011, www.cidrap.umn.edu/news-perspective/2011/09/contagion-portrays-extreme-not-impossible-scenario Accessed 7 Nov. 2020.
Ferris Jabr. “How Realistic Is Contagion? The Movie Doesn’t Skimp on Science.” New Scientist, 2020, www.newscientist.com/article/2239913-how-realistic-is-contagion-the-movie-doesnt-skimp-on-science/ Accessed 7 Nov. 2020.
MODULE 2: Types of Vaccine and Adverse Reactions MODULE 2 Types of Vaccine and Adverse Reactions.
Soderbergh, Steven. Contagion. Warner Bros., 2011.
TED-Ed. “How Fast Can a Vaccine Be Made? - Dan Kwartler.” YouTube, 15 June 2020, www.youtube.com/watch?v=74WQgNa3OsQ Accessed 7 Nov. 2020.
“Vaccine Development, Testing, and Regulation | History of Vaccines.” Historyofvaccines.org, 2010, www.historyofvaccines.org/content/articles/vaccine-development-testing-and-regulation Accessed 7 Nov. 2020.
Weisse, Allen B. “Self-Experimentation and Its Role in Medical Research.” Texas Heart Institute Journal, vol. 39, no. 1, 2012, pp. 51–4, www.ncbi.nlm.nih.gov/pmc/articles/PMC3298919/ Accessed 7 Nov. 2020.
“Who Goes First?” Google Books, 2010, books.google.com.pk/books?hl=en&lr=&id=ybcwDwAAQBAJ&oi=fnd&pg=PR9&dq=self-experimentation+ethics&ots=Kn4-Vbrsoj&sig=yJf_MK15Yj84u-nWAW_omoVYnDE#v=onepage&q&f=false Accessed 7 Nov. 2020.
World Health Organization: WHO. “Vaccines and Immunization.” Who.Int, World Health Organization: WHO, 29 Oct. 2019, www.who.int/health-topics/vaccines-and-immunization?gclid=EAIaIQobChMI__m5rvjv7AIVia3tCh0bQA8bEAAYASAAEgKC4_D_BwE#tab=tab_1 Accessed 7 Nov. 2020.
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