An epidemiologist explains how science fiction has taught us—and misled us—about pandemics
If you asked a random scientist a question about zombies, they're likely to brush the undead monsters off as pure fantasy. Epidemiologist Tara Smith, however, will take your question seriously—and proceed to thoughtfully explain what the undead can teach us about infectious disease outbreaks and preparing for disasters. In fact, Smith recently taught an entire course on the subject at Kent State University, where she studies emerging infectious diseases.
When an editor at National Geographic asked me to write an article on the science behind popular science fiction films, Smith was on my shortlist of experts to talk to. Before our interview, I asked her to pick a movie or TV show depicting public health that's made a lasting impression on the public. Smith picked three: Outbreak, a 1995 Ebola-inspired action film, Contagion, a 2011 pandemic thriller, and The Last of Us, a post-apocalyptic drama whose first season aired on HBO in 2023. This resulted in a wide-ranging discussion on Hollywood tropes and misconceptions about public health, as well as what the movies sometimes get right. We also discussed what zombies can teach us about disasters, and how pop culture may have primed us to become obsessed with the covid lab leak theory.
Maddie Stone
With covid-19 once again surging alongside other respiratory viruses, it felt like a good time to remind everyone that our perception of public health doesn't emerge in a vacuum: Pop culture plays a big role in shaping it. My full conversation with Smith can be found below, lightly edited and condensed for clarity.
Maddie Stone: When you see Hollywood movies or TV shows centered on public health or a disease outbreak, how well would you say they engage with the science overall? Are there any common tropes or misconceptions?
Tara Smith: It varies so much. Some completely ignore it; just make up their own thing. And sometimes that’s fine—I can suspend disbelief. But it’s nice when they at least try to bring a little bit of science into it.
Some of the common tropes are repeated over and over. It’s often the hero scientist, one person who has a 'Eureka!' moment and does all this stuff by themselves, which is not really how science works.
In the pandemic, certainly, there have been a bunch of people who have been elevated, and been spokespersons, and a couple of times a face of vaccine development. But it’s always a team, it’s always decades of work behind the scenes that you don’t see. So that’s one thing, that it’s often this lone wolf, one person who has this idea.
Often things happen really fast, too, which is understandable. You don’t want people to have to keep up with 5, 10, or 20 years of information for a movie.
I didn’t rewatch Contagion, but I think their timeline from the start of the outbreak in that film to the vaccine that was distributed and basically ended the outbreak was 135 days or something like that. Even in best-case scenario— which we pretty much saw with covid as far as vaccine development—nothing is that fast. So it’s always very compressed.
There’s always this idea that you need serum or blood from a patient, especially the original patient or the original animal, to develop a vaccine. It’s a weird trope because you don’t need that. With covid and things like that, we’ve tried to find the sources of outbreaks, but we don’t need that to develop a treatment or vaccine. That’s more to understand where it came from so we can prevent it in the future. But a lot of shows make it seem like you need that to know all you can about the virus. So that’s something that pops up over and over again that’s a little strange.
Maddie: I was reading the Wikipedia page for Outbreak, and there was a line about developing a cure with the serum from the original patient.
Tara: I think that’s probably one of the worst offenders. And again, a lot of these [tropes] come from a grain of truth. We have used immune serum from people who have antibodies to the virus, and we can give that to someone else to help protect them. We did that in the early days of covid; we’ve done that with Ebola. But that’s different from what the movies are showing. So that’s one of those things that has a little nugget in there, but it’s not really how things work.
Maddie: And then of course there’s the zombie trope.
Tara: Yes, I’ve written a lot on zombies. Zombies are fun to me! Especially the rage zombies like in 28 Days Later, where again, it’s a little more biologically plausible than the completely undead zombies where you have to explain how they’re reanimated and how the brain is still going but not the rest of the digestive system and whatnot. Those are absurd.
It’s often the hero scientist, one person who has a 'Eureka!' moment and does all this stuff by themselves, which is not really how science works.
For me, those are fun tropes. I use them to talk about infectious diseases. I actually just finished teaching a zombie outbreak class. It’s an emergency preparedness class but you do it in the context of a zombie outbreak. It’s a hook to get [students] to learn about being prepared—thinking about having a Bug Out Bag or having a disaster preparedness plan, whether it’s for a pandemic or power outages, blizzards, tornadoes. So really an all-cause disaster plan.
Maddie: Let’s get into these movies and shows you picked. Let’s start with Contagion, which you said does a pretty good job with the science overall. What did you like about about the science of Contagion?
Tara: It’s based on a realistic organism, for one. It’s based essentially on the transmission of Nipah virus, which is a real virus transmitted from bats [to humans], usually with a pig intermediate.
In some countries, they’ve started putting fruit orchards, especially apples, in close proximity to pig farms, to make better use of the land. Bats are attracted to the fruits, they eat parts of the fruits, they drop parts on the ground, pigs eat them, can get infected with these viruses and pass them on to people.
So that was kind of the origin of, in the movie it was called the MEV-1 virus. So that was pretty realistic. And that was in part because the writers did consult a lot of scientists and had characters in the movies taken to represent particular scientists.
One thing I think was really spot on: Jude Law plays a character in the movie who is selling a bogus treatment and basically undermining all of the public health authorities, saying they’re lying, his treatment works and protects people. We have seen that before [the pandemic] with vaccine denial, and that’s what they modeled that on. But seeing people with their alternative treatments for covid, it was just a little too accurate. And again, they had talked to people who said 'You could expect that if this was to happen again, we’ve seen it in previous pandemics.'
Maddie: And what was less plausible about this film? What would you have liked to see it do better?
Tara: I think the response in the public [to the pandemic] was kinda panicked. People left their jobs; garbage was accumulating everywhere. It was a little of what happened in real life [during covid], but of course, it’s a drama. It was super magnified. Roads were shut down; people couldn’t leave some geographic areas. Again, that happened in China. In the United States, we had our lockdowns but they weren’t really that serious. So it was dramatized, of course.
And then of course, once the vaccine was there, everything was just fine again. One day everything was back to normal, and obviously that’s not really what has happened in any pandemic. But it wrapped up the story very nicely.
Maddie: Let’s talk about Outbreak. What was your overall reaction to this movie?
Tara: It was just really horrible. There was almost nothing accurate about it.
It starts out with a flashback to 1967 in Zaire, and there’s a [disease] outbreak with US soldiers. They're dying horribly, and this virus is identified as basically a cousin of Ebola. Of course, in 1967, we didn’t know about Ebola, but in this alternative history, that’s what we find.
And instead of trying to do anything about it, the army just bombs the village. The solution is to just kill everybody, including the American soldiers, which is a great way to develop these conspiracy theories we saw circulating in the pandemic.
Seeing people with their alternative treatments for covid, it was just a little too accurate.
So that was terrible, to start off. And then, 30 or 40 years later, there’s this monkey that ends up in the United States as a pet and apparently starts the outbreak. And it’s horrible, it’s basically like a super Ebola. And then it goes airborne. Ebola is a blood-borne infection, and this one is in the air ducts, spread by coughing, and things like that.
Which again, you don’t really have that rapid change of transmission for a virus. When you have a blood-borne pathogen, it would be very rare for that to suddenly be spread by coughing.
Maddie: It would need a large population to mutate in, right? And probably a lot of time?
Tara: Right. And I can’t think of any human infections that have gone [airborne]…we don’t have airborne HIV, or HepB or HepC, or any of the common blood-borne types of viruses. So there was that.
And then again, there’s all this secrecy and this fight between general physicians and the army, again which wants to keep this hidden. And their idea, again, is to bomb the town to stop the spread. And at the last minute, Dustin Hoffman, who was portraying this heroic doctor, lone wolf scientist, he finds the cure, and everything is saved.
So it’s absurd from start to finish. And I think that was one of the movies that kept getting cited with the West African Ebola outbreak [of 2014-2016]. So I think it put this in the mind of the general public that this was gonna happen. There were op-eds about airborne ebola. So I think that had some, whether direct or indirect, influence on public understanding of Ebola viruses that was completely wrong.
Maddie: Sounds like it was basically just a lemon.
Tara: It was pretty terrible. There were some lab scenes where it was okay. They had some pictures where you could see in real-time the virus infecting some of the cells. Except, it all seems to be under a light microscope rather than an electron microscope which you’d need to see the virus. So they even messed it up there, which was probably the most accurate part.
Maddie: Let’s move on to The Last Of Us. This is a show I’ve been wanting to see. You said it [the science] was better than you expected. What did this show get right or do a good job depicting?
Tara: One, and I was surprised by this, it has kind of a cold opening. Where you’re watching a show from the late 60s, or early 70s, kind of a talk show with scientists. And they’re talking about global warming and the potential for emerging infections. And the scientists talk on there about what are they most scared of. They talk about bacteria and viruses, and it’s pretty scientifically accurate. And one scientist says the thing he’s most scared of is an emerging fungus.
He explains it’s because fungi don’t tend to hurt people unless they’re immunocompromised, but as the Earth warms and more fungi get adapted to warming climates, they could potentially cause more harm to people at body temperature. I used that in my infectious disease epidemiology class last year to talk about climate change and emerging disease.
It’s not 100% accurate, but it’s a pretty good introduction. Overall, I think the idea of pairing climate change with the emergence of some of these new infections was pretty good.
And they do try to explain a little bit about where the fungus came from. That’s an issue with all these zombie movies: where does it come from and how is everyone suddenly infected all at once? If you have everyone biting each other, it takes a while. You can’t really explain it with water sources because people have so many different water sources. It’s hard to get something to happen globally, all at once.
So their explanation, which is kind of inferred by looking at patients early in the infection, is that this comes in through flour. So presumably the crops would be infected at some point, and brought into a big flour mill. The one they talk about is in Indonesia. And they go to that country and have some of the early patients examined by a mycologist. It’s not perfect—you have to figure out if the exposure is just from eating all of these flour materials, and [if so] wouldn’t the fungus be killed by stomach acids? Or maybe it’s exposure to flour you’re baking with, and you aerosolize the fungus? But I think it was pretty well done. That’s something that could be transported all around the world.
And they talk about contact tracing; a little bit of the principles of general epidemiology. So I think that part of it was done pretty well.
Maddie: Have we seen an example of a serious disease outbreak stemming from fungi?
Tara: Not in people. This is based on an insect model where they can get sick from these infections. In that case, it does cause them to have fruiting bodies that sprout out of their heads and things like that. [Editor's note: The fungal infection in The Last of Us was inspired by Ophiocordyceps unilateralis, also known as the zombie ant fungus. The fungus takes over insect bodies and turns them into factories for fungal spores, which burst forth from the insect horror movie-style.]
If that’s what always happens in the movies, why wouldn’t that happen in real life as well?
But our culture changed because of fungal infections in the things we eat. Like the potato blight in Ireland. That’s a fungal infection that led to a lot of our ancestors coming to the United States and other places. It's been suggested that some of the behaviors of people acting strangely during the witch trials could have been due to ingestion of fungal-contaminated food that produces mycotoxins.
So not exactly the same as what’s portrayed in The Last of Us. But certainly, fungi have affected other areas of our history.
Maddie: Of the three, The Last of Us is the only one that was produced during the pandemic. Do you think that informed some of the science in it?
Tara: Good question. I can’t think of anything that was probably informed by the pandemic. You don’t see them masking or anything like that, or distancing. But again, it happens very quickly once it happens, so you don’t have time for that. It is kinda like Outbreak in that it’s all a military operation—all of a sudden people are getting shot because they are getting infected. So that’s again a not-so-accurate aspect, but it is what it is for the tale. So I’m not sure that had much of an effect on the storyline.
Maddie: What's it like looking back on the older movies [Outbreak and Contagion] with the hindsight of the pandemic? Do they feel more dated? Would some things have been changed if they were made today?
Tara: With Outbreak, again, science was kind of out the window, so I don’t know that that would have made a difference at all. Maybe with Contagion, because they did value the scientific accuracy more.
Maybe they would have brought in something like long covid. None of that—any potential lingering events—ever show up [in movies]. And the timeline was so compressed with the vaccine, I'm not sure if they were remaking that post-covid if they would bring in any long-term effects of infection, or the pandemic on society. It’s a movie; clean endings are nice.
There haven't been a lot of movies or shows I've seen that have really addressed the pandemic. Glass Onion has a few moments where they’re wearing masks, and then we see a super shot of whatever it is rich people use to ward off the virus. But I don’t know if we’re really going see a lot of infectious disease dramas that deal with the pandemic—that deal with things in a more realistic way. We’ve been through that; no one wants to watch that. When you watch these shows, you kind of want to get away from your life for a few minutes. A more realistic thing might just be too traumatizing, at least for a while.
Maddie: Overall, do you think these sorts of films are a net positive or negative for your field, in terms of public understanding of the science?
Tara: I would have to be wishy-washy. I initially got interested in infectious diseases by reading things like The Hot Zone. So not necessarily movies, but fictionalized books that are supposed to be nonfiction but really aren’t. And I’m not the only one who got interested in this by popular media, in some way or another.
And with the zombie class I teach, students are interested in that because they’ve seen zombie movies. So that brings people to public health.
But I am concerned that a lot of [movies] do provide these misleading ideas. Again, outbreaks that are here and gone very quickly and easily. Again, the misinformation about Ebola that could drive conspiracy theories.
Even the lab leak idea, which has gained a lot of steam with covid. So many movies have that as one of their tropes. Like 28 Days Later, where people broke into a lab to free these animals that are being experimented on. There are a lot of examples like that, where scientists are doing this thing, and it either accidentally gets out or is purposely released. So, I wonder how much the idea of this lab leak comes from that. If that’s what always happens in the movies, why wouldn’t that happen in real life as well?