The diplomat


Peter Piot co-discovered the Ebola virus and was the first to make governments sit up and take notice of the unfolding AIDS epidemic.


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PETER PIOT’S FIRST ENCOUNTER with the disease that would later be called AIDS was in 1980, when he was a researcher at the Institute of Tropical Medicine in Antwerp, Belgium. They were taking an increasing number of patients with strange, opportunistic infections – most of the sufferers were young and had a link to central Africa. Around the same time there was talk of a ‘gay plague’ in the United States, following a spate of similar strange infections and deaths among young men in New York and San Francisco.

Piot’s team followed the trail of infection to Kinshasa’s Mama Yemo Hospital, in the Democratic Republic of Congo, where the huge numbers of dying men and women in Kinshasa made Piot realise the implications were much wider than sexual orientation.

“When I saw all these young men and women of my age or younger looking emaciated, I knew this was a disaster … and that this was a heterosexual disease,” Piot said in an interview with medical journal The Lancet Infectious Diseases in 2003.

“I also knew suddenly that it would change my life. I have rarely been right about the future, but this time I was.”

True to his prediction, he devoted almost the next 30 years to battling the disease that has now infected 60 million people and killed 25 million of them – the majority of these in sub-Saharan Africa.

IN 1982, THE WASTING DISEASE was given the name acquired immune deficiency syndrome (AIDS) and soon afterwards the virus responsible was independently discovered by both Robert Gallo in the U.S. and Luc Montagnier in France. It was named human immunodeficiency virus (HIV).

Piot became head of the United Nation’s AIDS agency (UNAIDS) when it was created in 1995 and would steer it through 13 tumultuous years until 2008 when he stepped down to lead the new Institute for Global Health at London’s Imperial College, which is taking lessons learned from the battle against AIDS and applying them to other diseases. The New York Times credits Piot as the “person most responsible for making heads of state understand the political, economic and social ramifications of a pandemic that rivals the worst in history.”

Alvaro Bermejo, Executive Director of the International HIV/AIDS Alliance in Brighton, England, says that in part this was because “Peter understood that health statistics could be powerful. Messages such as … ‘More people killed by AIDS this decade than all natural disasters combined in the last 50 years’ were what got the World Bank and the Red Cross Movement to respond to AIDS. We were inspired by the figures.”

Perhaps Piot’s greatest contribution was to increase the coffers of the war chest at the U.N.’s disposal to battle the great pandemic. When UNAIDS began around US$280 million (A$305 million) was spent on the problem annually, but by the time Piot stepped down in 2008 – after many years of proselytising and bargaining with world leaders – that figure had grown to over US$15 billion (A$16 billion). He also struck deals with multinational pharmaceutical companies to lower what they charged for vital antiretroviral drugs.

Of the many challenges he has faced, the greatest has been negotiating the interface between politics and science. It’s not enough to be right in terms of facts and hard evidence, he says. “That is only part of the story…you also have to be able to sell it politically.”

It’s hard to sell when the people you need to negotiate with are the Pope, former U.S. President George W Bush and former South African President Thabo Mbeki, the latter of whom denied that HIV causes AIDS.

I MEET PIOT, 61, in London on a hot and humid August day. The city is experiencing its greatest heatwave in years. I wander through the leafy streets of South Kensington to get to Imperial College. His office, on the second floor of a townhouse surrounding a grassy square, lacks air conditioning and we make do with a whirring desk fan.

The sounds of laughing and squealing children in a nearby schoolyard drift in through the open window along with the scent of freshly mown grass. Books and papers in several languages are stacked on every shelf, while photos of community projects and African artwork adorn the walls. A plastic figurine of a character from Hergé’s Adventures of Tintin is a clue to Piot’s Belgian heritage.

When I ask him about the perspective that his heritage brought to his work, he tells me that it is no accident that there are many Belgians in intergovernmental organisations – the European Parliament and European Union both have their headquarters in Brussels. “We are a multi-ethnic country with several languages [French, German and Flemish], so we have to look beyond our borders. Though we are not a nation as an ethnicity, we are doomed to live together as a people and have had to find a productive compromise. Perhaps this predisposes us to diplomacy.”

HOWEVER, HIS CAREER COULD have turned out very differently – Piot tells me that after finishing his degree in medicine, at the University of Ghent in 1974, he was warned away from a career in infectious diseases by his professors, who told him there was no future in it. He ignored them and went on to complete a doctorate in microbiology at the University of Antwerp.

In 1976, Piot was working at the Institute of Tropical Medicine in Antwerp when he received tissue from a Flemish nun who had died from a gruesome tropical illness that was wiping out the villages near the Ebola River Valley in what was then Zaire. The disease was characterised by a week of fever and diarrhoea before it erupted in a scabby rash and caused mass bleeding, the breakdown of all major organs and, finally, a fitful death. The cause of the outbreak, his team discovered, was an unknown virus that they named ‘ebola’.

Zaire ebola virus still kills around 90% of the people it infects and is among the most lethal and infectious pathogens known.

This discovery led to Piot’s first trip to sub-Saharan Africa to map the epidemic. He says this was his first experience dealing with an international team of researchers and public health officials and all their associated rivalries – an experience which would come in very useful in his later work.

Recounting his career, Piot is dressed casually but neatly in a loose, short-sleeved shirt. He has a close-clipped salt and pepper beard and contemporary spectacles. I find him remarkably modest, approachable and relaxed for a man who at one point was tipped to head the World Health Organisation (WHO), mixes with some of the world’s wealthiest and most powerful people, and who has authored 16 books and over 500 papers.

Piot was ennobled by King Albert II of Belgium in 1995, making him one of very few people who have the title “Professor Baron” on their business cards.

But it is the projected sense of approachable calmness and good-natured honesty that has perhaps made Piot such a successful diplomat and negotiator. “Although he heads the only U.N. agency dedicated to a single disease, it seems precisely because Piot is not a stuffy bureaucrat that he has been a key player in putting HIV/AIDS on the agenda,” the British Medical Journal (BMJ) notes.

Despite the calm exterior, anger over inequality has been a driving force for Piot. In the late ’80s and early ’90s he held various professorships at institutes including the Free University of Brussels and the University of Nairobi in Kenya, while also becoming increasingly involved in governmental and non-governmental AIDS organisations. He says he felt more and more frustrated as the epidemic turned into a pandemic and the world failed to respond: “Anger became a part of my drive.”

THIS DISTASTE FOR INEQUALITY fuelled his first forays into politics as a student activist in the 1970s, when he participated in demonstrations against the Vietnam War and the closing of Belgium’s coal mines.

“I am from a generation where we were discovering the world. It was a time of the liberation movements – the beginning of gay liberation and the beginning of widespread feminist movements,” Piot says. “This appealed to me, coming from a Catholic and conservative background. I wanted to escape from that.”

He channelled his efforts into creating a community health centre for migrants at the university, which still exists today. And it was at this time that he first developed a principle which he has stuck by ever since: “nothing for the people without the people”.

The health centre was set up to help first generation immigrants from North Africa and Turkey. “They had no clue what was going on and didn’t speak the local language, so we hired Turkish nurses … This wasn’t rocket science, but nobody had thought of it.”

In 1992, Piot joined the WHO’s Global Programme on AIDS. As the pandemic continued to spread and the challenge grew, AIDS got its own agency and UNAIDS was born.

PIOT BECAME THE EXECUTIVE DIRECTOR and Under-Secretary General of the U.N. He then “set about rallying politicians, religious groups, scientists, activists and businesses to fight AIDS,” according to the BMJ.

“Peter grasped before most that we had to build on the power of mobilised civil society,” comments Bermejo. “He knew where the energy, the creativity and the pressure to defeat this [AIDS] epidemic would have to come from, and he tried to build UNAIDS in a way that acknowledged this and supported it.”

Michel Sidibé, Piot’s replacement at UNAIDS, describes him as a visionary. Prior to Piot taking the helm of UNAIDS “few people grasped the sweeping political, economic and social significance of AIDS,” he says. “Now, the epidemic is universally recognised as one of the most significant development and human rights issues of our generation.”

Working at the community level to educate people about safe sex and prevent them from contracting HIV has been a major focus of UNAIDS. With that in mind I ask Piot how he found dealing with both former U.S. President George W Bush and the Pope, who argued that abstinence should be preached over safe sex. The Vatican has gone as far as saying that condoms are not an effective way to prevent the spread of HIV, even though that goes against all evidence.

Both cases “demonstrate that evidence is not enough to develop policy. Beliefs come in a big way,” Piot argues. “This is particularly true when it’s about sex, gender and drugs. We have to accept that there are other dimensions of cognitive behaviour that are not based on facts. This is hard for scientists to understand.”

He tells me that under the former Pope (John Paul II), UNAIDS negotiated an informal pact, the gist of which said: “I understand that according to the teachings of the Catholic church you can only have sex within marriage, therefore I can’t expect that you would say use a condom, but don’t make statements that condoms are spreading HIV because that is not scientifically correct.” This was respected for many years and the senior leadership in the Vatican didn’t make any speeches against condoms. Piot says he was “upset and shocked” by statements made by Pope Benedict XVI over the past year, which reneged on the gentlemen’s agreement and has “endangered lives”.

WHEN IT COMES TO George W Bush, Piot is pragmatic about the former U.S. President’s contribution. He acknowledges that Bush helped the cause – despite the fact that a third of money pledged by his administration had to be spent on abstinence-only programs, which countless studies show don’t stop the spread of HIV.

“I think Bush actually has a very positive legacy in terms of AIDS. It’s not perfect, but in 2003 he used his State of the Union address to ask for US$50 billion [A$55 billion]. This completely changed the landscape and what we could do.

“The discussion moved from … millions to billions,” he says. “Overall, the president’s emergency plan for AIDS has saved literally millions of lives. I’ve always spoken up in support of it. But I’ve also said that money for abstinence-only programs should be used for something that we know works.”

Money is key to fighting the pandemic, says Piot: for prevention, for antiretroviral medication to treat the infected and for the hunt for a vaccine. Increasingly, though, this money is coming from unusual sources.

Piot himself has worked with the Bill and Melinda Gates Foundation, which in 2006 gave US$500 million (A$550 million) to the Global Fund to Fight AIDS, Tuberculosis and Malaria. In separate donations it has put $287 million (A$315 million) towards vaccine research.

PHILANTHROPY IS PARTICULARLY USEFUL for encouraging innovative projects, says Piot. “A government must be accountable to the taxpayer for how it spends its resources… But as a foundation you can try out new things.”

For example, the Gates Foundation’s ‘Grand Challenges in Global Health’ initiative awards grants for “unique and largely untested” ideas. “A normal research funding process is based on peer review and this brings you down to the consensus, which is the lowest common denominator,” says Piot. “There is not so much space for the crazy things – and sometimes progress is because of innovative ideas.”

Despite Piot’s unquestionable success, not everyone agrees that UNAIDS’s record is unblemished. Helen Epstein, a public health consultant based in New York City, says that, “although UNAIDS can be proud of its success in getting most governments around the world to face up to AIDS, it must also face up to its failure to help the most severely affected communities understand the causes of the epidemic.” In an article in the BMJ in 2008 she says that UNAIDS has contributed to confusion by promoting a complicated picture of the pandemic.

The problem may lie in the agency’s mandate, she suggests. “UNAIDS is both the most trusted source of scientific information on the global epidemic and an adviser to governments about how to tackle it. Unfortunately, these two goals are seldom compatible.”

Piot is the first to agree that negotiating the boundary between politics and science is difficult. “A lot of science gets lost in translation,” he says.

“This interface is really difficult … and to make progress the stars have to be aligned. Science and politics have to be right.” Teaching graduates the skills necessary to walk this fine line is something he is now working on in a new course at Imperial College London.

In addition to this challenge, Piot lists peace, the linked problems of climate change and population, and greed as the top challenges facing humanity.

“CONFLICTS ARE STILL UNDERMINING development,” he says. “Greed is as big a problem to the future of the world as climate change. When you look at the figures, inequality is getting worse in most countries. The gap between rich and poor has grown.”

Fixing the problem of climate change he likens to “rowing in a boat with a big hole in it. If we are attempting to reduce our carbon dioxide emissions, but our populations continue to grow the net effect may still be to increase our emissions.”

This is a problem related to greed, he says – many people and nations hope that someone else will do the work of reducing emissions for them. Piot says that he now cycles, walks and uses public transport, which he hopes will be good for his health as well as the environment.

Despite the challenges, our triumph over chaos stands out as the “incredible achievement” of humanity, he says.

“I’m always flabbergasted that we are still alive and that things function – when you consider the body or society. The complexity of both is enormous and we only understand pieces of it. The fact that we are able to function as a species with six billion people … is the result of something unique that distinguishes us from other animals.”

John Pickrell is a Sydney-based science writer and the author of Weird Dinosaurs and Flying Dinosaurs.
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