It's the end of 'easy solutions' in global health, Peter Piot says

SAN FRANCISCO — Peter Piot is a world renowned microbiologist, but only so much progress can be made within the laboratory, the former UNAIDS executive director told Devex. In 1976, a patient died of a mysterious illness at Yambuku Mission Hospital in Zaire, now known as the Democratic Republic of the Congo. A month after patient zero was hospitalized, and after several dozen patients developed hemorrhagic fevers, blood samples from a nun who died were sent to the Institute of Tropical Medicine in Antwerp, Belgium. “The easy solutions are over in global health.” --— Peter Piot, director, London School of Hygiene & Tropical Medicine Piot, then a 27-year-old junior researcher, was part of a larger team of scientists that would go on to discover that this was a new virus: Ebola. Piot, now the director at the London School of Hygiene & Tropical Medicine, went from helping to discover Ebola to pioneering research on HIV/AIDS to working as a leader in global health policy. But despite his impressive credentials, the author of “No Time to Lose: A Life in Pursuit of Deadly Viruses” would be the first to say that scientists do not have all the answers when it comes to ending pandemics and epidemics. What links his work on Ebola and AIDS — and what will be critical elements of global health work moving forward — is the role of behavior, the importance of listening to communities, and the challenge of distrust, Piot told Devex. “The easy solutions are over in global health,” Piot said. “It used to be — you have an infection, you make a vaccine, and you wipe it out. That’s what happened with measles. But it’s coming back.” The value of social science Piot has spent his career moving between research in the lab, projects in the field, and high-profile positions in global health. In the ‘90s, he was president of the International AIDS Society, then assistant director of the World Health Organization’s Global Programme on HIV/AIDS, then founding executive director of the Joint United Nations Programme on HIV/AIDS, or UNAIDS. In each of these roles, Piot tried to make the case for listening to people who are affected, understanding their concerns, and asking what they think will work to solve the problem. “When he got to the U.N., he felt as if he had to become a bureaucrat, and that didn’t fit him,” said Ben Plumley, who worked for Piot as director of the executive office at UNAIDS. “He’s really one of the few physicians who understands how you interact and communicate is possibly more important than how well you know the science,” Plumley added. Piot guided the team at UNAIDS by saying: “Not only do we listen, but we use voices of people affected by this virus to guide us,” Plumley said. In April, Piot joined Plumley for a conversation in San Francisco, at an event called: “Are we ready for the next epidemic? Lessons from Ebola, Zika and HIV.” There, Plumley interviewed Piot and his wife Heidi Larson, who is an anthropologist, a professor at LSHTM, and director of The Vaccine Confidence Project. Plumley calls the pair “the power couple of global health.” Piot and Larson prefer to keep their personal and professional lives separate, although they also recognize the value of their partnership. “Not everyone who has his background appreciates the value of social science, community engagement, and the people’s voice,” Larson told Devex. What HIV/AIDS denialism, distrust in vaccines, and the recent Ebola outbreak in the DRC have in common is the power of belief, she said. “The people who believe these things, they are absolutely convinced they’re right,” Larson explained. “You don’t deal with belief in the same way you deal with someone who has misinformation or has misinterpreted something. It’s a whole different thing.” Bringing disciplines together Piot and Larson met through their work on HIV/AIDS, and have also worked together on Ebola vaccine trials in West Africa, where he focused on the clinical side, and she led a grant focused on vaccine deployment, acceptance, and compliance Both Piot and Larson said they value the way LSHTM values a range of perspectives and disciplines in global health. “People are united around the problem, not a discipline or department,” Piot said at the event in San Francisco. When Piot sent an email to all staff at LSHTM in August 2014 to encourage them to volunteer in response to the Ebola epidemic in West Africa, nearly a third of the staff volunteered. Ultimately, the response team included not just scientists, but people from all kinds of backgrounds — critically, people with expertise in human resources or management. “In an epidemic, it is often more about communications, logistics, and coordination,” Piot told Devex. “The medical technical part is in a sense the easier part.” Since the Ebola outbreak in West Africa, two Ebola vaccines have been developed. WHO and other NGOs are working to vaccinate people in the Democratic Republic of Congo, but militia interference and rampant misinformation are fueling distrust and hampering the overall response. “It reveals in a very spectacular way that global health is not just a technical issue. It requires peace and a society where there is no structural violence or acute violence. That is the general message, and Ebola is a symptom of it,” Piot said. Over the course of his career, Piot has seen more recognition from the global health community of the importance of not just developing vaccines but also understanding the social and cultural context where those drugs will be introduced. “The data clearly shows science is not in a silo.” --— Imran Khan, head of public engagement, Wellcome Trust For example, last month, the Wellcome Trust, a foundation based in London, United Kingdom, released the world’s largest study on how people think and feel about global health challenges. “The data clearly shows science is not in a silo,” said Imran Khan, head of public engagement at the Wellcome Trust. “We need participation by communities. If we don’t do that work, we’ll end up in some cases disappointed or in other cases taking a step backwards, as we’ve seen with vaccine hesitancy.” ‘We need to look at where the vulnerabilities are’ Piot said collaboration between sectors will become all the more critical in the face of rising global health challenges like chronic disease and mental health. “There is no vaccine for diabetes,” he noted. Piot is leading a number of changes at LSHTM to reflect this new reality. For example, LSHTM’s new Center on Climate and Planetary Health is an effort to engage the global health community in the fight against climate change by asking: “How does climate change impact health and what can we do about it?” Another problem that is high on his “intellectual and managerial agenda” is how to deal with people who feel “left behind by globalization,” he said. A year from now, Piot will travel to San Francisco for the International AIDS conference, the largest conference on any global health or international development issue, hosted by the organization he once led. When San Francisco hosted AIDS 1990, it was at the epicenter of a crisis. But while the city still has one of the largest HIV positive populations in the United States, infection rates have plummeted. Meanwhile, just across the Bay Bridge in Oakland, new infections are on the rise, particularly among racial and ethnic minorities. These health disparities make the Bay Area an example of the global inequities in the HIV burden, and the event will be an important forum for conversations on how to end the epidemic, Piot said. “We have these super optimistic messages of the end is in sight, we know what to do, and so on,” Piot told Devex. While there have been amazing gains, not everyone has benefited, and progress is uneven, even just across the bridge from San Francisco to Oakland: “We need to look at where the vulnerabilities are, what we need to do more and better, and take into account the perspectives of communities,” Piot said.