Peter Piot: Two moments that scared me

If you’re looking for a page turner, Peter Piot’s chronicle of a career spent chasing down the Ebola virus and combating HIV and AIDS on a global scale might do the trick. In No Time to Lose, Piot describes his first brushes in the field with the two then-mysterious diseases.

Now director of the London School of Hygiene and Tropical Medicine, Piot was also the founding director of the Joint U.N. Program on HIV/AIDS, which he led for 13 years. The New York Times credited him as the person most responsible for making heads of state pay attention to the AIDS pandemic and contribute funds to stop it. Under Piot, developing countries went from spending about $250 million on AIDS annually to $10 billion.

The global fight against AIDS has been one of the most spectacular achievements in international development, Piot told Devex in a recent interview. With more than 2 million new infections each year, though, “AIDS is not over,” he was quick to point out.

We asked Piot about some of the gripping moments of his career, what he had to learn to become successful, and why he finds disease so fascinating.

What’s the scariest moment you experienced while working on public health?

The scariest moment I think, which I describe in my book “No Time to Lose,” was when we were drawing blood, my colleague and myself, off a patient with Ebola literally in a hut in the middle of Zaire, and while we were doing that, her husband died from Ebola also. That was scary because on the one hand, we were still at the phase where we had no clue how the virus was transmitted, how we could protect ourselves, how to stop the epidemic. But then also just drawing blood was quite dangerous. And then had we started taking blood from the other person and she would have died that would have been really bad. But the scary part is that also at some point I got diarrhea and a fever and I thought, OK, I’ve got it. But fortunately, it was only 24 hours and it was over.

But there are different types of scary. For example, when we organized the special session of the U.N. general assembly on AIDS in 2001, which was a tipping point in the global response to AIDS. By the last night, we still didn’t have an agreement with over 40 prime ministers and presidents there. You know, everything was blocked because of hang-ups with a few words like men who have sex with men, sex workers, the whole issue of reproductive rights. I thought, if the member states of the U.N. can’t even agree on something like how to fight AIDS … That was also scary, even if it’s a completely different type of scared.

A lot of your work involved convincing national leaders to pay attention to the HIV and AIDS pandemic. How did you get through to some of those who were reluctant to put resources into AIDS?

I always try to analyze the situation very carefully of each leader, each country, not only the AIDS situation but the issues from a political perspective, religious perspective. What would make that leader tick? Often it has to do with the economy or development.

I started in this as a scientist and I thought if we have the evidence and the facts, then action will follow. It’s obviously very naïve. So after a while, my conclusion was that at the end of the day, there are only two things that really matter in international politics, and that’s the economy and security, and the rest can only be dealt with if money is left for it. So I try to put myself in their shoes and build a case on that.

Also, it’s important to talk to the handlers, the people who prepare the notes, the speechwriters, and to convince them that this is an issue so they can help also with shaping the message.

And then, certainly, never give up. It’s not because the first time doesn’t work then it’s a failure. I think in advocacy and in today’s world, we all want quick results and that’s not how things go.

For example, in China, it was not until June 2005 when I had a meeting with Premier Wen Jiabao when policies in China changed dramatically and they adopted a progressive policy on AIDS. But that didn’t happen in one day.

But then there are other places still where it hasn’t changed; for example Russia and the former Soviet Union are among the few regions in the world where HIV continues to increase. There are more and more cases whereas in Africa, it’s going down; in Asia, it’s going down. And it’s because the governments don’t want to change its policies, particularly in regards to injecting drug users, and they’re still choosing a pure repression approach to drug use instead of providing clean needles and methadone; so that’s clearly a failure.

Also, in South Africa, when Thabo Mbeki was head of state, we had to wait basically until he had left before the current AIDS response, which is now very good could really change things.

I think I managed to convince quite a few people to take on AIDS, but there were also a number of failures.

Another important element is that it’s kind of peer pressure. For example, in April 2001, President Olusegun Obasanjo from Nigeria convened a special summit of what was then still called the Organization of African Unity, to talk about AIDS. And here it was, all heads of state from Africa were there, and one after another broke the silence. But that was kind of peer pressure.

You need to use many different approaches. The media obviously are very important. But it depends on the country. Like in China, it’s not the media that’s going to change policy, you go through the Communist Party; so I addressed the Central Party School of the Communist Party of China. But in India, it’s the media, it’s the NGOs, it’s the members of parliament.

What do you find most fascinating about disease, or health?

I’m fascinated how microbes spread in populations. It has as much to do with the microbe — it can be HIV, or Ebola or the flu — as with the behavior of societies and people. So it’s both the biology and also the interactions of people.

Just think of it with HIV: It started with a report on I think eight gay men who came down with a mysterious disease in California and then more, and [since then], about 60 million have become infected with HIV: They’re all connected with each other because HIV can only be transmitted because they had sex with each other, a blood transfusion from each other, or they shared needles, or their mother had it. That I found really fascinating. It tells a story about human behavior that no other research has actually captured up until now.

What I’m fascinated by also and what I think is one of biggest issues for the future is chronic diseases: obesity, diabetes and so on. They’re spreading like wildfire. That’s not so much fascination as much as really wondering what exactly we can do.

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