From a modified rabies rage virus to a bloodborne infection that turns people into zombies in seconds, TV and film have a longstanding fascination with infections. Consultant Clinical Scientist and Infection Control Doctor Elaine Cloutman-Green asks which films should have never seen the light of day.
We’ve all been there. We’ve headed off to the cinema or put on the TV to settle in for a night of wonderful escapism only to be hit by the jarring reminder that what we’re watching is a work of fiction and the science is so bad that we can’t remain immersed. Either the character gets their test result in under a minute when it would have taken at least a week or – even more unforgivable to me – they list a whole load of bacteria that everyone keeps referring to as a virus – the kind of science that even a five-minute Wikipedia check would be able to correct.
they are at least wearing masks and gowns, so some precautions are in place, although I would be thinking of using more than droplet precautions at this point!
This kind of science inaccuracy – and might I say laziness – reads differently when we are living through times of such science scepticism. Never has the accurate representation of science and scientists in the media been so important. The question is: “Is it up to fictionalised stories to fulfil this requirement for science representation?” To me, the answer is both “yes” and “no”. Many films and TV series are so far from depicting any kind of true-to-life science that it’s clear that they haven’t engaged with any form of reality. There are others, however, that despite clearly being fictional, hold some elements at their core that relate to scientific fact, even if they are not written to represent real-world scientific knowledge. It is from watching examples of the latter that a book I’m writing, Don’t Open That Door, was born.
From chain of infection to diagnostics
The opening chapters will cover key items, such as the chain of infection (infectious agent, reservoir, portal of exit, mode of transmission, portal of entry and susceptible host), and routes by which infections are spread (zoonotic, contact, droplet, airborne, congenital, blood and bodily fluids). It will then go on to cover interventions, with precautions ranging from personal protective equipment to vaccination. The vital importance of diagnostics and how they are used for detection will also be covered and infectious agents will include viruses, fungi, parasites, bacteria and other causes.
From idea to reality
I’ve watched a lot of films and TV series – 138, to be exact – to find the most interesting examples. These were pulled together from internet searches, blog lists, reaching out for suggestions on social media, and even utilising a scientific paper. The inclusion and exclusion criteria were: Inclusion criteria:
- Best exemplar of a specific infection feature
- Great handling or description of scientific principle
- English language or English language subtitles available
- Infectious agent central to the plot
- Easily available at the time of writing.
Exclusion criteria:
- Documentaries
- Mocumentaries
- COVID related (as linked to non-fiction)
- Infection discussed but not present as the main plot focus
- Based on real life, rather than fiction
- Mystical or other unknown cause of what may be an infectious presentation.
As the camera pans around the lab, we see many of the reasons why this lab would never pass accreditation
Other things that were taken into consideration, but were not truly either inclusion or exclusion criteria, included the production location and year, and quality and popularity. I wanted to reflect possible changes in how society has depicted and commented on infection risk over time, so options were reviewed from 1950 (Panic in the Streets) to a film series the latest instalment of which was released this year: 28 Days Later: The Bone Temple. It surprised me how much infection is represented across genres, and when reduced to 23 examples they cluster into four main groups (horror, outbreak thriller, superhero and science fiction) with causative agents from a modified rabies rage virus to prions making the cut. The final selection of 23 includes three TV series, 20 films, four genres, 63 years of film releases and productions undertaken in 12 countries.
The final selection
Viral Contagion / The Last Ship / World War Z / 28 Days Later / I am Legend / Daybreakers / Outbreak / Rise of the Planet of the Apes / Train to Busan / Death Cure Fungal The Last of Us / The Girl with All the Gifts / Splinter Parasitic The Strain / Alien / The Faculty / Venom / Sea Fever Bacterial/other The Thing / Eighty Thousand Suspects / Andromeda Strain / Zombieland / Warning Sign Following are three examples that are all from the horror genre, but there are plenty that aren’t horror (and don’t have 18 certificates), from Rise of the Planet of the Apes, and Outbreak, to the superhero movie Venom. Please be aware that some unavoidable spoilers follow, so read on with caution…
Alien (18), 1979
Director: Ridley Scott Outbreak stage: Outbreak initiation Route of transmission: Ingestion Organism: Parasite: XX121 or Linguafoeda acheronsis Availability at time of writing: Disney+ Rotten Tomatoes Score: 93% critics, 94% audience
The synopsis
Alien follows the crew of the commercial starship Nostromo who are awakened from stasis by their computer to investigate a distress signal from a desolate moon. Upon landing, they find a derelict spaceship and crew member Kane is attacked by a parasite that attaches to his face. Ignoring quarantine protocols, Kane is brought on board. Later, a "chestburster" erupts from Kane, killing him and escaping into the ship. As the creature grows into an acid-blooded xenomorph, it begins systematically killing the crew. In the end, Ripley is the sole survivor and manages to eject the alien into space.
The science
During outbreak initiation, no one really understands what is happening, information is being gathered in “real time” and safety is based on generic protocols and general risk management. Early on there is a lot of focus on detection and identification of the infectious agent, alongside information gathering. In “outbreak films” detection is often based on symptom presentation rather than laboratory management. In the case of Alien, that is fairly easy as there’s a massive face-hugging parasite. Scientists, when present in films portraying infection, are often attempting to be taken seriously and highlighting challenges ahead. In Alien, this role is held by Ripley, rather than Ash the scientist, who is very much seen as the villain of the piece – a trait also seen in films where scientists are portrayed as careless or having deliberately caused the outbreak. If Alien teaches us anything, it’s that you should listen to the woman who tells you to follow the protocol, whether she’s a scientist or a leader, and then the body count would be much lower.
28 Days later (15), 2005
Director: Danny Boyle Outbreak stage: Early outbreak Route of transmission: Bloodborne Organism category: Virus: Rage virus (modified rabies virus) Availability at time of writing: Amazon Prime Rotten Tomatoes score: 87% critics, 85% audience
The synopsis
Animal rights activists release chimpanzees infected with a rage virus from a Cambridge research lab. Twenty-eight days later, Jim wakes from a coma in a deserted London hospital to find society has collapsed and the population turned into blood-crazed, fast-moving "infected". Jim is rescued by survivors Selena and Mark and they navigate the ruins of Britain, eventually teaming up with Frank and his daughter, Hannah. They travel to a Manchester military blockade, hoping for safety, where they encounter a group of soldiers who plan to use the women for sexual slavery to "repopulate" society. Jim fights back and utilises the infected to overcome the soldiers. He finds refuge with the survivors as the infection dies out.
The science
In some respects, the actions near the start of the film are typical of the phases of an early outbreak. More information is being made available, but the risks are not truly understood. In the case of the Rage virus, detection doesn’t rely on the laboratory; however, as the change from uninfected to symptomatic occurs in less than 20 seconds, there is a tiny window for action to limit spread – it also means that the virus is likely to burn through susceptible populations quickly. Like most early outbreaks, it is acknowledged that the infection is out and spreading within specific populations or locations, and the emphasis is on trying to limit further spread. This phase includes the beginning of implementation of more specific protocols, such as wide-scale quarantine. When Jim encounters Selena and Mark, they are also wearing full PPE, including limb and face coverings, to help protect them from transmission through bites. The virus in the 28 series is based on the rabies virus (Rabies lyssavirus), which does alter behaviour and make those infected more likely to bite others. There is, however, no virus with an incubation period of seconds – usually the shortest is thought to be one day, and the incubation period for rabies is generally three to 12 weeks, although it can be years. This shift from undead to infected does allow for some scientific grounding, in both the transmission and response of society to a new-onset rapidly spreading virus, much of which has featured in previous pandemic flu plans. If only the scientists could stop playing with the viruses in the first place, this film would never have happened.
the Girl with all the gifts (18), 2016
Director: Colm McCarthy Outbreak stage: Late outbreak Route of transmission: Blood and bodily fluid Organism: Fungus: Ophiocordyceps unilateralis Availability at time of writing: Prime Rotten Tomatoes Score: 86% critics, 67% audience
The synopsis
Set in a dystopian future where most of humanity has been wiped out by a fungal infection, turning victims into flesh-eating "hungries". In a military base, a group of second-generation infected children (who retain their cognitive abilities but crave human flesh) are studied, including the highly intelligent Melanie. When the base is overrun by hungries, Melanie escapes along with teacher Helen Justineau, scientist Dr Caroline Caldwell, and sergeant Eddie Parks. Travelling through Britain, the group faces challenges to survive while Dr Caldwell tries to create a cure. Melanie must choose between her attachment to humans and her nature as a new breed of predator, deciding the future of humanity.
The science
As a later-stage outbreak, where the infection is established and acknowledged as either an epidemic or pandemic, outbreak management options are different. During this phase, a lot is usually understood about key characteristics of the infectious agent. Dr Caldwell knows about, and has researched, the infection and understands key components, such as transmission, diagnostics and precautions. The focus is on moving beyond knowledge acquisition and containment, to being able to regain control. This is the phase when people are looking to develop vaccination programmes, or have decided to quarantine entire areas if vaccination is not an option. It is also the phase when there are issues to consider that would not necessarily be present in earlier phases, such as congenital infection, as seen in the children, and how world changes are impacting subsequent generations. The worldbuilding in these settings is often very different to that seen in stories that focus on outbreak initiation or early-stage outbreaks, as it is usually acknowledged that the world has changed – sometimes forever. As vaccination is the only route this world has to return to a previous normal, the big question posed is what would you do, and who would you sacrifice, in order to save humanity?
Milestones in the movies
A selection of films about infections
1971
Andromeda Strain
1979
Alien
1982
The Thing
1995
Outbreak
1998
The Faculty
2002
28 Days Later
2007
I am Legend
2010
Daybreakers
2011
Contagion
2013
World War Z
2016
The Girl with All the Gifts
2023-25
The Last of Us
How can you get involved?
If this topic speaks to you, there are a number of ways to participate. There are two chapters at the end of the book – Hall of Fame, for films and series that almost made the cut, and Hall of Shame, for those that lack scientific or artistic merit.
If you’d like to nominate a film, please do get in touch. There is also the possibility of including two more chapters, so if any of your suggestions cover science I’ve missed, they may end up being a whole new chapter – especially if they cover fungal infections. Finally, please submit your suggestions for science in films that infuriated you to add to my “Science House of Horrors” list.
Illustrations: The Red Dress / Début Art All movie stills: moviestillsdb.com