Just because Wakefield's MMR research has been discredited doesn't mean parents can't question vaccine orthodoxy. Photo: John Moore/Getty Images
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What if not all parents who question vaccines are foolish and anti-science?

It is not completely unreasonable for parents to ask about safety concerns.

For reasons that will become clear, I feel the need to begin this by trying to prove I’m pro-vaccine. Here goes.

To my knowledge, I have always kept my son exactly on the vaccination schedule required by our state of Michigan. Now almost 15 years old, he is fully vaccinated according to public-health recommendations.

I’ve also kept myself on the recommended vaccine schedule and I pester my doctor about whether there are any vaccines I am missing. By some measures, I am actually more vaccinated than “necessary”; the HPV vaccine is not specifically recommended for women in their forties, but I bothered to get it for myself when it became available a few years ago. I did so in part because I thought I would sound more convincing when I urged young people to get it – which I do, all the time, because the HPV vaccine can help prevent cervical cancer, anal cancer, throat cancer and genital warts.

But I suspect all that testimony won’t matter given what else I’m about to say. Because as soon as one questions anything about vaccines – as soon as one expresses any doubt or concern about any vaccine practice – one risks being labelled an “anti-vaxxer”. Or at least represented as a kind of gunrunner to the anti-vax camp.

 

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As American historians of science of the same generation, Mark Largent and I have run into each other professionally for almost two decades. So when he showed up for a bookshop signing of my new book, Galileo’s Middle Finger – about the sometimes fraught relationship between scientists and activists – I thought he was just being collegial. Instead I discovered he wanted to talk about what had happened since he had published Vaccine, a book that tries to unpack why so many parents are resisting vaccinations for their children.

In his work, Largent refuses to take sides with either a) the anti-vaxxers, who think vaccines cause disorders such as autism, or b) the anti-anti-vaxxers – let’s call them the vaccine zealots – who think any parent who resists any vaccination is a dangerous idiot. Even though Largent is easily as “pro-vaccine” and pro-science as I am, among the frenzied zealots his sympathy for resister parents has marked him out as a heretic.

Talking with him over coffee a few days after the signing, I learned that, like other scholars whose misery I trace in my book – who have put forward challenging ideas about gender identity, sexual orientation, the nature of rape and childhood sexual abuse – Largent didn’t wade into his chosen topic naive about the potential for upsetting someone. Nevertheless, like those other scientists, he was caught off-guard by how difficult it has been to make his voice rise above deeply embedded dogma and polarised debates to suggest a different way of thinking about things.

A professor at Michigan State University, Largent tries in his book to do something potentially very useful: to sort out how to think about the “nearly 40 per cent of American parents [who] report that they delay or refuse a recommended vaccine for their children”. Refusing to write off those parents as anti-science, Largent finds in fact that “the percentage of [hardcore] anti-vaccinators in the US has held steady throughout the last 100 years at about 3 per cent of the population”. In this category, he counts people who consistently refuse all vaccinations: some religious groups such as Christian Scientists, some minority groups such as the Amish, and some people who are firmly against modern western medicine. Largent purposely does not include people who resist particular vaccines or who deviate from the mandated schedules.

So, controversially, he chooses not to label as “anti-vaxxers” the likes of the actress Jenny McCarthy, who has suggested that holding all children to the same vaccination schedule might severely harm some of them. McCarthy’s own son was diagnosed with autism after he suffered febrile seizures the night following half a dozen inoculations, and she has publicly speculated that his problems were due in part to the vaccines. Her move has led to a website, jennymccarthybodycount.com – which blames her for over 9,000 infectious disease deaths since June 2007.

Largent also bucks the usual trend among the sometimes self-righteous zealots by refusing to see public-health vaccine recommendations as a purely scientific prescription. In fact, he calls the recommended childhood vaccination schedule “a political artefact” – not a simple blooming of the science but a wrangled set of mandates and recommendations that it is not unreasonable for parents to question.

He prefers to call McCarthy and most other parents who doubt or hesitate “vaccine anxious” rather than anti-vaxxers, and suggests that doctors try to understand why parents might resist jabs for their children. For saying this, some have accused him of being part of the problem of vaccine non-compliance. This is a grave charge; if enough people refuse vaccinations for diseases such as polio, our “herd immunity” will be put at risk, and those children and adults who are too medically fragile to receive vaccines – perhaps because their immune systems have been weakened through illness – will end up at risk of severe disability and even death.

Talking to him over that coffee, I got the sense Largent is not sure what is worse: not being heard because he doesn’t fit in easily on either side of the public vaccine debate, or
being positioned as an anti-vaxxer because he dares to try to think deeper about the history and the facts of vaccination campaigns.

 

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To understand Largent’s argument, it’s useful to consider what a child’s vaccine schedule now is. US public-health officials recommend that in the first 18 months of life a child receive no fewer than 25 vaccinations. By the age of six, the appropriately vaccinated American child will have been subject to about three dozen vaccinations. In Britain, the schedule begins at two months with three injections: a pneumococcal vaccine, rotavirus, and a combination jab that protects against diphtheria, tetanus, whooping cough, polio and Hib, a type of bacterial infection. There are three more jabs at three months, another two at four months, and six more before starting school. That’s a lot of interventions for a parent to manage in a short space of time.

The number was similar when my own son was little and, talking to Largent, I remembered with some surprise that I could have reasonably been labelled a “vaccine-anxious parent”. My maternal instinct was riled with every new round of shots and cries and tears: I remembered one particular visit to our paediatrician when my gut instinct had a sharp argument with my brain. I can’t even remember what the vaccine was; I just remember that Gut was yelling, “Enough already! Stand between our baby and that needle!” Trying to stay calm, Brain answered: “Vaccines are safe, and necessary not just for our baby’s health but for the health of those around him, especially children more vulnerable than him . . .”

That one time, I asked the nurse if I could see the written literature on this vaccine. I wanted more information not because I was going to refuse the shot, but because I wanted Brain to shut Gut up. She looked shocked and annoyed and told me testily that there wasn’t any information available. The jab was just compulsory.

No pamphlet in the box, for parents? I asked.

No, she said.

I suddenly regretted even asking. Would I be labelled a “worried” mother, or worse, a  “non-compliant” one?

Fortunately, our doctor came into the room at that moment. He knew that I had a PhD in history of science, and that I am a deep believer in science, in evidence-based medicine, in public health and so also in vaccines. Maybe because of that, or maybe just because he’s a good doctor, he quickly understood the situation. He went to his computer and printed out several pages of information about the vaccine. He gave me time to read, and waited for me to say “OK” before telling the nurse to proceed.

 

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Not everyone is as sympathetic to anxious or resistant parents as our doctor was. ­Writing on a blog under the pen name “Orac”, David Gorski, a surgeon and professor at Wayne State University in Detroit, has lambasted Mark Largent for talking about “vaccine-anxious” parents rather than “anti-vaxxers”. Gorski calls Largent “clueless” and insists that “the concerns of these parents are almost always rooted in pseudoscience, fear-mongering, and outright scientific misinformation”.

He goes on: “What ‘moral concern’ could lead parents to leave their children unprotected against vaccine-preventable diseases, particularly deadly ones?” How dare Largent suggest that paediatricians “address their concerns”, he writes, “as if paediatricians don’t try to do that every time a parent brings her child for a well-child visit and baulks at allowing her child to be vaccinated”?

I wonder if Gorski would have been appalled at my hesitation in my ­paediatrician’s office, like the nurse was. But here’s the thing: I don’t think my anxiety was rooted in pseudoscience, fear-mongering or outright scientific misinformation. While Gorski might want to write me off as a bad and anti-scientific mother, in most clinical encounters a mother asking for data about medical necessity, safety and efficacy before consenting to an offered medical intervention would be seen as a good and scientific mother. So why are vaccines treated in such an exceptional way? Why are they seen as different from most interventions in medicine and public health – requiring old-fashioned paternalism and even heavy-handed legal compulsion?

First off, as every vaccine zealot will (rightly) tell you, vaccines are not your usual sort of medical intervention. To state the obvious, with few exceptions (such as the tetanus vaccine), vaccines don’t just protect the individual being vaccinated; they also help to create “herd immunity”. It is hard not to look at the history of diseases such as polio, diphtheria and smallpox and not feel motivated to sing whatever rousing song will convince everyone to enlist in the army of the vaccinated.

Vaccine zealots also understand vaccines (again, rightly) as being different from other medical interventions because they are subject to higher levels of safety monitoring. They are, as a class, arguably the safest type of medical intervention we have in the world. Any time a vaccine is found to be unsafe or is even perceived as potentially unsafe, public-health campaigns may be put at risk, so most public-health officials are quite vigilant about safety-testing before releasing vaccines into the market and about monitoring them afterwards.

Finally, the history of terrible falsehoods that have been spread about vaccine safety causes in anti-anti-vaxxers the kind of fervour you should expect to find among people who feel their enemies have cheated. In terms of major falsehoods about vaccine safety, best known is the case of Andrew Wakefield in the UK, who claimed to have evidence of a link between the MMR (measles, mumps and rubella) vaccine and autism. In 2003, the investigative journalist Brian Deer began to uncover evidence that Wakefield didn’t just have his data wrong, but had actively misrepresented it. (The Lancet, which had published Wakefield’s work in this area, finally retracted it in 2010.)

In Galileo’s Middle Finger, I write about another major case of falsehoods spread about a measles vaccine. This involved the book Darkness in El Dorado, published in 2000 by the self-styled journalist Patrick Tierney. He suggested that the geneticist James Neel purposely conducted a Nazi-like eugenics experiment on the Yanomami people of the Amazon by giving them a vaccine that caused a measles outbreak. Tierney was wrong: the epidemic started before Neel arrived in Yanomami territory, the vaccine didn’t cause measles, and Neel and his team did everything they could to race ahead of the disease to vaccinate those at risk. But Tierney’s work has fed ­anti-vaxxers and spread false beliefs about vaccines.

Given the Wakefield and Tierney falsehoods, the high safety and efficacy rates of vaccines, and the history of vaccine success worldwide, it is hardly surprising that some public-health advocates see vaccines as the biomedical equivalent of Nelson Mandela.

You can guess what that makes parents who resist.

 

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So why isn’t Largent – and why aren’t I – a vaccine zealot? Well, despite the understandable passion of the vaccine fundamentalists, there are some inconvenient facts that are often overlooked in public debates about vaccines. Noticing them won’t make you an anti-vaxxer but they can make you feel like a vaccine heretic.

First, consider the question of necessity. Not all illnesses for which vaccines exist are as grave as polio or smallpox. Take chickenpox. Some American states have made the chickenpox vaccine mandatory – keeping children out of school unless they get it – ­after a lot of heavy lobbying by its manufacturer. But it is reasonable to ask, as I did, if it wouldn’t be just as safe to let your healthy child catch chickenpox, which is a minor disease for most healthy children, instead of giving them the vaccine. (That is the strategy of the NHS in Britain: it does not routinely offer the jab, claiming “there’s a worry that introducing chickenpox vaccination for all children could increase the risk of chickenpox and shingles in older people”.)

Next, consider safety: all vaccines do carry some risk – even if it is only a very, very small one. Some vaccines, in fact, are not generally given to the public because of concerns about safety. (The anthrax vaccine would be a good example here.) It is not completely unreasonable for parents to ask about safety concerns with vaccines.

Finally, consider the influence of money in the public-health system. Make no mistake: vaccines are a boon to big pharmaceutical companies, and the companies that make and push vaccines are the same kind that have been repeatedly fined for all sorts of bad behaviour where drug marketing is concerned. Moreover, studies consistently show that financial ties to the pharmaceutical industry influence the behaviour of doctors and policymakers – and yet many in those groups maintain such financial ties anyway. I’ve seen British medical journals that are normally vigilant about conflicts of interest “forgive” failure to disclose funding from vaccine-makers by an ethicist who pushes those companies’ vaccines as “necessary” in those journals and in the mainstream press.

Monetary influence on politicians’ decisions about vaccines is even easier to find. One example: there has been huge resistance to the HPV vaccine, which prevents a sexually transmitted disease that causes cervical cancer, because religious groups argue (against the scientific evidence) that it may encourage promiscuity in teenagers. Yet Rick Perry, the then Republican governor of Texas – who might be expected to pander to the Christian right’s abhorrence of the vaccine – suddenly decided to mandate the HPV vaccine for schoolgirls after a series of donations from the vaccine’s maker.

The facts listed above might lead you to wonder if all this suspicious behaviour isn’t ultimately as dangerous to public-health vaccine campaigns as someone like Jenny McCarthy is claimed to be – because it breeds cynicism, conspiracy theories and distrust of the medical profession itself.

But as Largent has been learning, you can’t say these things. You have to subscribe to vaccine exceptionalism – vaccines are all necessary, safe and effective and should never be questioned! – or risk being crushed. In the zealots’ eyes, in the battle to vaccinate the world, moderates must be crushed so that children can be saved.

The problem is that the zealots’ approach doesn’t work. Studies show that haranguing people with proof that vaccines are safe doesn’t increase parental compliance. Ironically, if you really take science seriously, you have to admit that beating people over the head with scientific studies generally doesn’t get them to be act in more rational ways, particularly if some important parental psychology is getting in the way.

If you want to understand and reduce vaccination non-compliance, what probably has to happen is what Largent has been trying to do. You have to work to achieve a subtler understanding of parental decision-making, along with a recognition that ­public-health campaigns aren’t Pure Science but are influenced by politics and money (although maybe they shouldn’t be). You have to stop talking about “vaccines” as if they were all one thing, and stop talking about vaccination schedules as if they were simple products of value-free science. You have to stop claiming “we” have science and “they” have stupid.

 

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Mark Largent is working now with public-health officials with the goal of improving vaccination rates by understanding the reasons why a reasonable, well-informed parent might decide to opt out of vaccinations.

Like Largent, I wonder if this more respectful, more generous approach will work. I wonder if it has any hope of even catching on as a public-health approach. Ultimately, given the perceived risk that moderate voices such as Largent’s allegedly present in this matter, the idea of taking vaccine-anxious parents seriously may be declared too heretical to be preached within the church of public health.

Even if Largent is declared a dangerous heretic by those who claim to be the true defenders of vaccine science, he likely won’t end up as badly off as many of the scientists I interviewed for my book. He probably won’t end up accused of genocide, accused of having sex with a research subject, having 20,000 people email his university president calling for his dismissal, or having to fight in court for his right to publish results of his research, as various of the beleaguered scholars I interviewed were.

Moreover, Largent is a big boy with a tough skin. I am not too worried about him. The people I am worried about are the ones who may end up harmed because we couldn’t bring ourselves to think more clearly about what is really going on in vaccination campaigns – because we couldn’t see that it was time to give up on the dogma and bring in the heretics if we want to save more souls.

Alice Dreger is the author of “Galileo’s Middle Finger: Heretics, Activists and the Search for Justice in Science” (Penguin Press)

This article first appeared in the 27 May 2015 issue of the New Statesman, Saying the Unsayable

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Can celluloid lovers like Christopher Nolan stop a digital-only future for film?

Despite proponents like the Dunkirk director, physical film is finding it tough in the modern age. 

“Chris Nolan is one of the few producing and directing films right now who could open that film. He is one of the all-time great filmmakers.”

No prizes for guessing which new release Vue CEO Tim Richards is talking about. Aside from its box office success, aside from its filmmaking craft, aside even from its early reception as an Oscar favourite, Dunkirk sees Nolan doing what Nolan does best: he has used his latest film to reopen the debate about celluloid.

Until relatively recently all film was projected from that old, classic medium of the film reel - a spool of celluloid run in front of a projector bulb throwing images on to a screen. It comes mainly in two forms: 35mm (standard theatrical presentations) or 70mm (larger, more detailed presentations most popular in the 60s and 70s). Fans say it provides a “warmer” colour palette, with more depth and saturation than modern digital formats.

But now it’s hard to even see movies on film to make the comparison. After George Lucas, godfather of the Star Wars franchise, shot Star Wars Episode II: Attack of the Clones entirely in digital rather than on physical film, the rollout of digital progressed with clinical efficacy. Within ten years, film was almost wiped out, deemed to be impractical and irrelevant. Modern cinema, it was argued, could be stored in a hard drive.

Christopher Nolan set out to change all that. He championed film as a medium against the industry trend, producing (The Dark Knight, The Dark Knight Rises, Interstellar) in super-detailed, super-sized IMAX 70mm. With Dunkirk, Nolan has taken that further by screening the film in 35mm, 70mm and IMAX 70mm.

Nolan is not the medium's only poster boy – it is symbolic that the new Star Wars trilogy, 15 years on from Attack’s groundbreaking digital filming, is now being shot on film once more. This summer, Dunkirk may well be seeing the biggest rollout of a 70mm presentation in cinemas for 25 years, but in 2015 Quentin Tarantino’s The Hateful Eight saw chains and independent cinemas having to retrofit 21st Century cinemas for a 20th Century presentation style. It was a difficult process, with only a handful of screens able to show the film as Tarantino intended – but it was a start.

Today, celluloid is, ostensibly, looking healthier. A recent deal struck between Hollywood big wigs and Kodak has helped. Kodak will now supply celluloid to Twentieth Century Fox, Disney, Warner Bros., Universal, Paramount and Sony. It’s a deal which is not only helping keep Kodak afloat, but also film alive.

Kodak has also gone a step further, launching an app to help audiences find 35mm screenings in local cinemas. Called ‘Reel Film’, it endeavours to back Nolan and co in ensuring that celluloid is still a viable method of film projection in the 21st century.

Even so, whether Nolan’s film fightback has actually had any impact is unclear. Independent cinemas still screen in film, and certainly Vue and Odeon both have film projectors in some of their flagship screens, but digital dominates. Meanwhile, key creatives are pushing hard for a digital future: Peter Jackson, James Cameron and the creative teams at Marvel are all pioneering in digital fields. Whether or not film can survive after over a decade of effacement is a difficult – and surpisingly emotionally charged – question.

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Paul Vickery, Head of Programming at the Prince Charles Cinema in London, is the kind of person you might expect to talk all about how physical film is a beautiful medium, key for preserving the history of cinema. History, he tells me, is important to the Prince Charles, but it's a surprise when he saysfilm is actually more practical for their operation. Because not every film they screen has been digitised, access to old reels is essential for their business.

“If you completely remove film as an option for presentation as a cinema that shows older films,” he says, “you effectively cut 75 per cent of the films that you could possibly show out of your options, and you can only focus on those that have been digitised.”

Vickery says the debate around film and digital often neglects the practicality of film. “It's always focusing on the idea of the romance of seeing films on film, but as much as it is that, it's also to have more options, to present more films. You need to be able to show them from all formats.”

That’s a key part of what makes the Prince Charles Cinema special. Sitting in London's movie-premier hub Leicester Square, the Prince Charles is renowned for its celluloid presentations of older films and has made a successful business out of its 35mm and 70mm screenings of both classics and niche films.

“If there is the option to show film and digital, we tend to take film as the option because it's also something you can't replicate at home,” he explains. “It's also just the nature of how film is seen on screen: its image clarity, its colour palette, the sound is just something that's very different to digital, and I think that's something that's very worth saving.

“Not many people have 35mm projectors at home. If you have it on Blu-Ray or DVD, to see it on film is a way of dragging someone out from their house to come and see it at the cinema.”

Currently screening is Stanley Kubrick’s 1968 epic 2001: A Space Odyssey in 70mm. It’s an incredible presentation of what Vickery says is a seven or eight year-old print struck from the film’s original negatives: the colour of the picture is far richer, while the fine detail in some close-up shots is on par with modern movies. Even more impressive, though, is that the screening is packed. “Fifteen years ago, there would be cinemas where that would be almost on a circuit,” laments Vickery. “We've just stayed the course, and that's something that's just fallen away and we're one of the last, along with the BFI, to show films from film.

“There’s still a bit kicking around, but as we do more and more of it, we seem to be pulling out those people who are looking for that and they seem to be coming back again and again. The repertory side of our programme is more popular than ever.”

That popularity is seemingly reflected in its audiences’ passion for celluloid. Vickery tells me that the PCC’s suggestions board and social media are always filled with requests for film screenings, with specific questions about the way it’s being projected.

For Vickery, it’s a mark of pride. “It sounds like inflated ego almost,” he begins, as if providing a disclaimer, “but it's why I think the work we do and the BFI do and any cinema that shows films from film is about history. By us continuing to show film on film, studios will continue to make their film print available and keep them going out. If people stop showing films on film, they'd just get rid of them.

“Once they're all gone, they only way we're ever gonna be able to see them is if they're taking these films and digitising them, which as you imagine, is always going to be the classic set of films, and then there'll be very select ones will get picked, but it's not gonna be every film.

“You have to keep showing films from film to keep the history of cinema alive in cinemas.”

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History is something that the BFI is committed to preserving. 40 per cent of their annual programming is projected on celluloid, and they loan around 200 prints to venues each year. Their new “BFI 2022” initiative will produce 100 new film prints in the next five years.

Most recently they have focussed on safeguarding their archive, the BFI’s creative director Heather Stewart tells me when we meet her in her office in the BFI’s artsy offices just off Tottenham Court Road.

“We got money from the government to renew our storage which was a big deal because the national collection really wasn't safe,” she says  “There was work at risk because it was warm and humid and we have bought a fantastic, sub-zero state of the art storage facility in Warwickshire in our big site there and our negatives are there. So our master materials are all in there safe - all the nitrate negatives and all that. In 200 years, people will be able to come back and make materials from those, whether digitising or analogue.”

Stewart tells me that it’s important to do both: “Do we at the BFI think that audiences need to see films in the way the filmmaker intended? Yes. That's not going away - that's what we're here for. Do we want as many audiences as possible to see the film? Yes. So of course we're interested in digital.”

The restoration and printing project is attracting lots of “international interest” according to Stewart: just one example is that the BFI are looking into partnering with Warner Bros in their labs in Burbank, California.

“We're becoming the only place left that actually loans film prints around the world so that you can see the films the way they were intended,” she says. “So if you don't have any kind of renewal programme, you'll eventually just have blanked out, scratchy old prints and you can't see them."

They're getting financial support too, she says: “There are people like Christopher Nolan, Quentin Tarantino, Paul Thomas Anderson [director of Oscar-winner There Will Be Blood whose 2012 film The Master was shot and screened in 70mm], a lot of people who are very committed to film, and so there's conversations going on elsewhere and with the film foundation about bringing other investments in so we can really go for it and have a fantastic collection of great great 35mm prints for audiences to look at.”

As a fan of the film reel, Stewart is passionate about this. I put to her the common suggestion that lay audiences can’t tell the difference between screening on film, and digital. “I don't agree with that", she says. "If you sit with people and look at it, they feel something that you might not be able to articulate.

“It's the realism the film gives you - that organic thing, the light going through the film is not the same as the binary of 0s and 1s. It's a different sensation. Which isn't to say that digital is 'lesser than', but it's a different effect. People know. They feel it in their bodies, the excitement becomes more real. There's that pleasure of film, of course but I don't want to be too geeky about it.”

Yet not every film print available is in good condition. “There's a live discussion,” says Stewart. “Is it better to show a scratched 35mm print of some great film, or a really excellent digital transfer?”

There’s no neat answer.

But Stewart is certainly driven by the idea of presenting films as closely as possible to the filmmakers’ true vision. “If you're interested in the artwork,” she explains, “that's what the artwork has to look like, and digital will be an approximation of that. If you spend a lot of money, and I mean really a lot of money, it can be an excellent approximation of that. But lots of digital transfers are not great - they're cheap. They're fine, but they're never going to be like the original.”

The process of restoration doesn’t end with digitisation. Keeping film copies in order to have originals is hugely important given how quickly digital media change. Film is a constant form of storage which does not alter. As Stewart defiantly puts it, “all archives worldwide are on the same page and the plan is to continue looking after analogue, so it ain't going anywhere.”

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The BFI were kind enough put on a display of how film projection works in practice. Tina McFarling, Media Advisor, and Dominic Simmons, Head of Technical, provide a tour of two screens at BFI Southbank. Chatting in the projection room above the screen which hosted the 70mm première of Dunkirk, their passion for celluloid was on display.

Standing next to two mammoth 70mm projectors, Simmons talks through the real-terms use of film, and the technical expertise behind it. “It's a lot more labour intensive than sticking digital prints on, but it's something we want to do,” he says.

One of the projection booths at the BFI

During the visit, the team are prepping a rare 35mm screening of the documentary I Am Cuba to be shown that afternoon. Simmons says that operating a celluloid projector is a “more complex operation” than digital. Looking at the endless labyrinth of film and sprockets, it's easy to believe.

“If you're screening from film in a cinema,” he says, “then you need engineers, technicians who are capable of doing it, whereas a lot of multiplexes have deskilled their operation.”

Simmons says that, while larger chains have one engineer to oversee every screen with the actual process of running the films centralised with a centre loading playlists, the BFI has twenty-two technicians, each closely overseeing the projection of a film when on duty.

“There's so much about the different elements of the presentation that you need to know that all comes together with the sound, the lighting and the rest of it.

“When you're starting a film, it's more of a manual operation. Someone needs to be there to press the buttons at the right time, manage the sound, operate the curtains, and attach the trailers to the feature.”

Having skilled operators is all very well, but of course you need to have the equipment to operate in the first place. “We have to make sure that the equipment is kept and utilised as well as making sure the prints are available, and then the skills will follow”, he says.

Simmons says many are likening the film fight back to vinyl’s resurrection, but has a rueful smile when he talks about film being described as “hipsterish” and “boutiquey”.

He also points out that the quaint touches that make film attractive to this new, younger audience – blemishes, the occasional scratch – are a headache for projectionists. “For me,” he says, “that's quite difficult because a bad print of a film is never a good thing, but if it's a bad print of a film that can't be seen any other way...” He trails off sadly.

The threat of damage to film prints is constant, he says. “Every time you run a film print through a projector there is some element of damage done to it. You're running it over sprockets at loads of feet per second.”

He switches a nearby projector on – it’s loud, quick and, after leaning in to look more closely, it’s easy to see that it’s violent. “It's a really physical process,” Simmons continues. “The film is starting and stopping 24 times a second.”

The idea that shooting on film, for which the very raw material is in short and ever-decreasing supply, is endangered is a tragic one. “There's a finite amount,” Simmons says. “People aren't striking new prints, so if you damage a print, the damage is there forever.”

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The Prince Charles and the BFI are in a privileged position to protect endangered film stock. A friendly partnership between them, which sees the BFI lending reels to the Prince Charles, as well as benefitting from the business of London’s rabidly cinephile audience, allow them to prioritise screening on film the majority of the time. Not every cinema is so lucky.

While the historic Ultimate Picture Palace in Oxford does have a 35mm projector, owner Becky Hallsmith says that it’s mainly the digital projector in use “for all sorts of logistic reasons”.

Though Dunkirk’s push for film projection was a welcome one, it still didn’t make sense for the UPP to screen it. “Certainly we thought about it, but I felt that if you're going to see it on celluloid, you probably want to see it on 70mm, so we decided not to get it on 35mm.”

Economic factors come into effect here too – the UPP, based just out of the city centre in Cowley, vies for Oxford’s filmgoers’ love with the Phoenix Picturehouse in nearby Jericho. While they do have slightly different markets, Hallsmith was aware that the Picturehouse was already set to screen Dunkirk in 35mm, leading her to decide not to.

 “It's not like I'm saying we never do it” she clarifies. “But there are reasons I haven't this time.”

Hallsmith was also aware that not all of her projectionists are trained in screening film, saying that, by screening Dunkirk in digital, she was “taking that little headache out of the equation”.

For the UPP, practicality of this kind trumps sentiment, given the cinema’s small operation. “I'd love it if I had the time to work out what films had beautiful 35mm prints and programme accordingly,” she says, “but I just don't have the time to put that amount of thought into details of programming. We're tiny. I'm doing all sorts of different jobs around the cinema as well. The programming is by no means the least important - it's the most important part of the job - but there is a limit to how much one can do and how much research one can do.”

Despite the practical issues related to 35mm, Hallsmith is still glad to have the option available, saying that when the digital projector was installed in 2012, there was enough room for the installation to account for the 35mm one – and to revamp it.

Despite many 35mm projectors being sent to an unceremonious death in skips, some projectors that are replaced for digital successors are cannibalised for parts. Hallsmith was a beneficiary. “Most of the bits on our 35mm projector are quite new,” she explains, “because they had all this stuff that they were taking out of other cinemas, so they upgraded our 35mm for us because they had all the parts to do it with.”

But Hallsmith is grounded when I ask her if having both projectors in operation is important. “It's important for me,” she laughs. “One of my real pleasures in life is to sit at the back near the projection room and to hear the film going through the sprocket. It's one of the most magical sounds in the world and always will be for me.

“But I know that for a lot of our customers, it is neither here nor there, so I have mixed feelings about it. It's not like I think everything should be on 35mm. I love it, but I can see the practicalities.”

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It is certainly practicality that’s governing cinema chains. Cineworld, Odeon and Vue have all seen huge expansions in recent years. Vue chief Tim Richards, says celluloid is a “niche product”, but the admission is tinged with sadness.

“The problem that we had,” he says about the 70mm screenings of Dunkirk, “with the conversion to digital that happened globally, there are literally no projectors left anywhere, and it's very, very hard to get one. We managed to find a projector and then we couldn't find anybody who actually knew how to run it. There are very real practical issues with the medium.

“To reinforce that we have a new look and feel to our head office, and I really wanted to have an old analogue 35mm projector in our reception and we couldn't find one. We had thousands of these things, and we had none left. We couldn't even get one for our reception!”

Even with a working projector and a trained projectionist, Richards says the format has “very obvious issues” with mass consumption. Again on the subject of Dunkirk, this time in 35mm, he says, “One of the prints that arrived was scratched. It's something that's been in the industry for a long time. If you have a big scratch, you simply can't screen it. You've got to get another print, especially when it will run through part of the film.”

It’s something that saddens Richards, who still says that projecting on film forms part of the “philosophy” of Vue. “We’re all big supporters [of film] and we love it. We've all been in the industry for between 25 and 30 years, the whole senior team. We genuinely love what we do, we genuinely love movies.”

That said, Richards, who is a governor of the BFI, is firmly committed to refining digital, more practical for Vue’s multiplexes. “If you go down and look at what we opened up in Leicester Square, our new flagship site, it's a 100 year old building where we shoehorned in new technology so it's not perfect, but it gives you an idea of what we're doing."

The new site has two Sony Finity 4K resolution projectors working in tandem – as well as the brand new Dolby Atmos sound system. The dual projection gives the screen a brighter, deeper hue. From a digital perspective, it is bleeding edge, and the set up is being rolled out across the UK and Germany, with 44 sites and counting. Richards is, as you would expect, enamoured with the results, claiming “that screen stands up to anything in the world”. What might be more surprising are the reactions he claims that it has elicited from celluloid devotees.

“There were a lot of old hardcore film fans there who were pleasantly surprised at the quality” he says. “People think of digital as being that new, TV-at-home which has got that clinical feel to it, and they don't feel it's got that warmth and colour saturation. This [Finity presentation] has that warmth of an old 35mm or 70mm, so I don't think the future is going back.”

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For Richards and Vue, the future appears to be as bright as that 4K Sony Finity screen in Leicester Square - for celluloid, not so much. While the appetite for watching movies on film might be growing at a promising rate for indie exhibitors, the list of technical and logistical problems is still insurmountable for many smaller venues - saying nothing of the race against time to preserve easily-damaged prints.

The main concern is an ephemeral one: the preservation of the knowledge needed to run a film projection. When the BFI’s Dominic Simmons speaks about the skills of his team and the need to pass those skills on, it evokes near forgotten skills such as thatching and forging. If the BFI and the PCC have anything to say about it, those projection skills will live on, but it’s unclear how far their voices can carry in a digital multiplex age.

As for the voice of celluloid-lover-supreme Christopher Nolan, even he too is shouting down what seems to be an unstoppable march towards a convenient digital future. But in a groundswell of growing interest and passion for the film reel, it seems that a director so obsessed with playing with time in his films seems to have bought exactly that for celluloid. Time is running out on the film reel, but there might be more of it left than we thought.

This article first appeared in the 27 May 2015 issue of the New Statesman, Saying the Unsayable