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The Arts and Medicine
April 24, 2020

Infectious Disease Outbreaks, Pandemics, and Hollywood—Hope and Fear Across a Century of Cinema

Author Affiliations
  • 1University of New Mexico School of Medicine, Division of Infectious Diseases, Department of Pediatrics, Albuquerque
JAMA. 2020;323(19):1878-1880. doi:10.1001/jama.2020.7187

Movies are a shared cultural experience that have historically depicted infectious disease outbreaks and pandemics and reflected accompanying hopes, fears, and at times, uncomfortable realism about contagion. To better characterize this phenomenon, a search of IMDb.com (Internet Movie Database, an online database of film and TV information) was conducted in February and March 2020 to update a 2017 search1 using 163 infection-related search terms (eBox in Supplement 1) to identify films with a major focus on infectious diseases (as assessed by review of plot synopses on IMDb, the American Film Institute database, or Wikipedia) through December 31, 2019. The search yielded 373 films released in US theaters (eFigure in Supplement 1). Of these, 142 (38.1%) featured a human infectious disease outbreak (increase in expected cases of an infectious disease in a population) or pandemic (outbreak over multiple countries or continents), as defined by the Centers for Disease Control and Prevention,2 with the outbreak/pandemic (or the threat or aftermath of one) as an important component of the story (eTable in Supplement 2). Eighty films were selected as culturally relevant, defined as having box office earnings of at least $10 million (adjusted to 2019 dollars using a Bureau of Labor Statistics online tool, equating to ≥1 million tickets sold); winning an Academy Award; or having 1 or more long-gap connections, defined as cultural reference to a film (eg, in television or another movie) at least 25 years after release3 (eTable in Supplement 2). All 80 culturally relevant films were viewed and thematically analyzed, and a subset are reviewed here for thematic illustration.

Eight of the 9 earliest outbreak depictions (1914-1957) feature the selfless heroism of medical professionals. In The Green Light (1937), a physician halts a spotted fever outbreak through development of a vaccine (culminating with a test of the vaccine upon himself). In The Painted Veil (1934), a physician’s dedication to fighting cholera nearly costs him his marriage, while in Arrowsmith (1931) and The Rains Came (1939), physicians fight outbreaks of plague while their significant others die from the disease. This theme continued into the early 1950s, with the Oscar-winning Panic in the Streets (1950) presenting the successful resolution of a plague outbreak in New Orleans.

After Sputnik launched the space race in 1957,4 films began depicting the dangers of alien microbes (eg, Space Master X-7 [released in 1957], wherein a deadly alien fungus returns to earth on a satellite, and The Angry Red Planet [1959], in which astronauts return from Mars carrying a dangerous infection). Such alien infections threatened our newfound confidence in antibiotics. Though these fears may seem fantastical now, many forget that until 1970, Apollo astronauts were quarantined for 3 weeks after their return to earth for just such a concern.5 Interestingly, Space Master X-7 presented the first detailed depiction of globalization contributing to a potential pandemic, as an exposed woman is shown boarding a train to Los Angeles followed by a plane bound for Honolulu.

The 1960s and 1970s produced 16 films, and in keeping with the dawning ecological movement of the time, ushered in a darker era of pandemic movies portraying environmental destruction. For the first time, portrayals of postapocalyptic earth were featured (Beyond the Time Barrier [1960], The Last Man on Earth [1964], and The Omega Man [1971]). The 1980s and 1990s featured only a dozen films, of which the most culturally relevant provided the first cinematic depictions of the HIV pandemic. Though Hollywood was slow to address HIV, many cathartic films were eventually produced, including Longtime Companion (1989), Common Threads: Stories from the Quilt (1989), and Philadelphia (1993). Releases after 2000 contributed half of all the movies studied and $2.6 billion in ticket sales. Increasingly bleak cinematic offerings were presented, populated with postapocalyptic landscapes (20 films) and hordes of the undead.

Many themes were consistent throughout the 80 films (Table). Infection was frequently used as an explanation for the transformation of the infected into something less than human (eg, zombies) and represented the most common theme (29 movies). This began with Beyond the Time Barrier (1960) and continued into the new millennium (23 films). Loss of one’s humanity was often emphasized in such films, with the transformed frequently portrayed simply as objects to be destroyed (23 movies, 18 over the last 2 decades). The infected often feared the loss of their humanity more than the loss of life, as exemplified by requests to be killed after infection rather than suffer transformation (eg, Day of the Dead [1985]).

Table.  Common Themes in Infectious Disease Outbreak and Pandemic Films
Common Themes in Infectious Disease Outbreak and Pandemic Films

Acts of biowarfare were also commonly featured (28 films), beginning with Counterblast (1948), wherein a former Nazi physician continues with plague experiments after the war. Films with the biowarfare theme have continued to be released in every decade thereafter. Postapocalyptic themes were featured in 27 films, 14 of which depicted a pandemic due to human malfeasance or hubris. Four such films depicted an inability to manage an infectious agent engineered for medical purposes (eg, a vaccine in I Am Legend and a viral-based therapy in 3 Planet of the Apes films). The remaining films portrayed consequences of biowarfare.

A theme of untrustworthy leadership and government was present in 20 films, beginning with The Satan Bug (1965) and featured every decade since. The theme encompassed deceit (eg, The Alpha Incident [1978], wherein citizens infected with a Martian plague are given lethal poison misrepresented as a cure by the government to cover up the outbreak), unethical research (eg, Warning Sign [1985], in which a military bioweapon is secretly tested in a small-town agricultural plant), and orchestrated apocalypses (eg, Resident Evil: the Final Chapter [2016]). The use of unethical methods for outbreak containment was a component of this as well, including draconian quarantine methods (9 films over 4 decades) and outright murder (21 films over 4 decades). In The Cassandra Crossing (1976), soldiers weld metal plates over the windows and doors of a train, trapping people exposed to plague inside. In Doomsday (2008), the border between Scotland and Britain is sealed behind armor-plated 30-foot walls that are welded shut as citizens are desperately trying to escape a viral outbreak. In The Crazies (1973), the president of the United States contemplates exploding a nuclear weapon over a town to contain an outbreak from an accidentally released bioweapon. In the 2010 remake by the same name and in Resident Evil: Apocalypse (2004), such a weapon is detonated. In later films, soldiers are shown shooting indiscriminately into crowds of infected and uninfected citizens to preserve containment (eg, 28 Weeks Later [2007]).

Stigmatization of people who were infected was featured in 19 films dating back to the 1940s (eg, the treatment of peasants with suspected plague in Monsieur Vincent [1947], and blaming women for outbreaks of plague in The Seventh Seal [1957]). Blaming people who were infected was also a prominent feature of films about HIV (Longtime Companion [1989]; Philadelphia [1993]), as well as V for Vendetta (2005), wherein religious extremists are falsely accused of an act of bioterrorism. This theme of stigmatization mirrors the ostracism of the “other” in society during infectious outbreaks, be it HIV-infected individuals,6 the Hopi and Navajo people following the 1993 Hantavirus outbreak in the Four Corners region,7 or contemporary references to COVID-19 as the “Chinese flu.”8

Health disparities and disruption of social class were depicted in 18 films. Fortified castles and city walls portrayed in The Masque of the Red Death (1964), The Pied Piper (1972), and The Season of the Witch (2010) were ultimately unable to keep the plague from the more privileged residents therein, just as the wall built around Jerusalem in World War Z (2013) was ultimately unable to protect its inhabitants from the coming pandemic. However, differential access to medical care was a feature of 9 films, with the more privileged having more ready access. In The Crazies (1973), a preexisting vaccine is available for the military but not the citizens of an affected town, foreshadowing the Resident Evil series, in which a limited supply of antiserum is only available to leaders of the Umbrella Corporation. Dr Reed’s knowledge of a plague outbreak (Panic in the Streets [1950]) led him to change his potentially infected clothes prior to interacting with his wife, while the wife of an exposed café owner was not so fortunate. Similarly, a Centers for Disease Control and Prevention physician in Contagion (2011) shares information not publicly available with his family in order to protect them.

Used with permission from Warner Bros Entertainment.

Interestingly, within one month of the first case of COVID-19,9 Contagion (2011) was back among iTunes’ top 10 most-downloaded movies.10 Many may remember the development of a successful vaccine at the end of the movie. Perhaps, as we collectively enter an uncertain future wrought by COVID-19, some of these films will help us share not only a moment of communal reminiscence but of hope as well.

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Article Information

Corresponding Author: Walter Dehority, MD, MSc, Division of Infectious Diseases, Department of Pediatrics, The University of New Mexico, MSC10 5590, 1 University of New Mexico, Albuquerque, NM 87131-0001 (wdehority@salud.unm.edu).

Published Online: April 24, 2020. doi:10.1001/jama.2020.7187

Conflict of Interest Disclosures: None reported.

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    4 Comments for this article
    EXPAND ALL
    Zombie Movies
    Douglas Davidson, Master of Library Science |
    In movies featuring zombies, the point is not to "dehumanize" disease victims, but to use disease as an excuse for a zombie movie. The zombies are already dead; that is, they're no longer disease victims but monsters at the time they become dangerous.

    Also worth noting is that three of these films, "Last Man on Earth," "Omega Man," and "I Am Legend" are based on the same novel. Matheson's novel, also, is not about disease as such, but is a science-fictional attempt to envision an (admittedly strained) scientific explanation for vampirism. Although the movies vary in how they interpret
    the novel's themes, in the original work, the vampires, like in zombie films, are animated corpses.

    Seems remarkable to get through an essay on this subject with no mention of "Night of the Living Dead" or "12 Monkeys."
    CONFLICT OF INTEREST: None Reported
    READ MORE
    "The Andromeda strain" (Robert Wise, 1971)
    Marta Crespo Barrio, M.D, Ph.D. | Hospital del Mar
    This is clearly a very timely article. We all lived the begining of this nightmare feeling that we suddenly were moved into a movie. Reality looked more like cinema than like reality.

    Though this is a thorough review, we miss a reference to “The Andromeda strain”, directed by Robert Wise in 1971, based upon the novel written by Michael Crichton (https://www.imdb.com/title/tt0066769/). It is one of the most relevant movies of the 70’s. A disturbing film thanks to the containment of expressive resources, which contrasts with the narrative noise of other films of the genre at the same
    time. Not only does the deadly virus portrayed in the novel and the film connect with the current Covid pandemic, but also the vision of scientists as leading professionals who must take control of the situation.

    Marta Crespo, M.D. & Daniel Esteban, Video creator
    CONFLICT OF INTEREST: None Reported
    READ MORE
    See the Lead Book on this Topic
    Victoria Sutton, PhD, JD, MPA | Texas Tech University School of Law
    The author overlooked the lead book on the topic, "The Things That Keep Us Up At Night--Reel Biohorror," published in 2014 (1). 

    Unlike most movie analysts and critics, I actually watched all 48 movies in my book, beginning with Nosferatu, identified as the first of this genre. The book is full of legal and public health analysis, and useful for interdisciplinary humanities, law and science discussions.

    REFERENCE

    1. https://www.google.com/books/edition/The_Things_that_Keep_Us_Up_at_Night/NKV4oAEACAAJ?hl=en.
    CONFLICT OF INTEREST: I am the author of the book I am discussing.
    What About the Classic Biopics of Famous Microbiologists?
    Manuel Sanchez Angulo, Ph.D. | Universidad Miguel Hernández - Spain
    Good article, but I miss some references to movies like "Dr. Ehrlich's Magic Bullet" (1940) and "The Story of Louis Pasteur" (1936). Even the Germans made one dedicated to Koch ("Robert Koch, der Bekämpfer des Todes" 1939).
    CONFLICT OF INTEREST: None Reported
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