An Interview with Dr. Peter Piot

| February 1, 2012 | 0 Comments

Interviewed by Ava Carter


Peter Piot, MD, PhD is the Director of the London School of Hygiene & Tropical Medicine and Professor of Global Health. In 2009-2010 he was the Director of the Institute for Global Health at Imperial College, London. He was the founding Executive Director of UNAIDS and Under Secretary-General of the United Nations from 1995 until 2008, and was an Associate Director of the Global Programme on AIDS of the World Health Organization.

Courtesy of Pieter Morlion, Wikipedia

Dr. Piot co-discovered the Ebola virus in Zaire in 1976, and led research on AIDS, women’s health, and public health in Africa. He was a professor of microbiology at the Institute of Tropical Medicine, Antwerp, the Free University of Brussels, and the University of Nairobi, was a Senior Fellow at the University of Washington, a Scholar in Residence at the Ford Foundation, and a Senior Fellow at the Bill and Melinda Gates Foundation. He held the 2009 chair “Knowledge against Poverty” at the College de France in Paris.

He is a member of the Institute of Medicine of the US National Academy of Sciences, of the Académie Nationale de Médicine of France, and of the Royal Academy of Medicine of his native Belgium, and a fellow of the Royal College of Physicians. He is the President of the King Baudouin Foundation, was knighted as a Baron in 1995, and has published over 500 scientific articles and 16 books.

HCGHR: In light of the global recession and the recent problems in the U.S. budget and economy, what problems in the funding of global health do you forsee in the immediate future? Specifically, how do you see a downturn in funding affecting the number of people newly infected with HIV or in need of treatment?

Dr. Piot: First of all, it is not a U.S.-specific phenomenon. Last year, for the first time, UNAIDS reported AIDS funding went down. I mean, there’s been a historic increase since 2001, when the UN general assembly on AIDS said that was a tipping point, and now last year for the first time there’s been a decrease. And the U.S. at this time last year continued to increase, but now nearly all the countries are reducing their AIDS budgets in general as a result of the economic downturn and financial crisis in the West. And the emerging economies like China and India have not come in and have not replaced the western countries that are declining in this kind of funding. And so the first point is that it’s quite a general phenomenon.

Secondly, you know, I am concerned that this is going to get worse but the problem is that it is hard to predict anything and it will depend on how the economy is going to evolve and emerge, and I would say there is a bit of a paradoxical effect in the sense that there are real achievements in terms of AIDS. There are less people dying and less people becoming infected and so some people say, ‘Okay, it’s done,’ but AIDS is not over.

Thirdly, we know that when funding is going to go down, less people will have access to treatment and more people will become infected and we’re seeing that the achievements in AIDS are both a result of increased funding and increased programs and political commitment. So it’s not such an optimistic picture, but on the other hand I think that we need to do two things. One is to do better with the money that we have at the moment. We can save costs, we can be more strategic with what we’re doing and we can be more efficient. And two is to lobby and continue to show that this is still a crisis by any standard.

HCGHR: As the new director of the London School of Hygiene and Tropical Medicine, you have taken on the task of teaching and inspiring the next generation of students interested in making a difference in the field of global health. What changes do you expect and would you like to see in global health education and training both at LSHTM and worldwide?

Dr. Piot: Yes, first of all, I think that one of the drivers of this global health movement are young people and the incredible interest of the Facebook generation and [that] people feel so connected… So that is something that I think is so positive but it’s not something that has always been reflected in the teaching and training programs. And for me there are two quests: global health should not only be taught and should not only be a concern for students in health sciences, in medicine, or in public health. It is something that affects all disciplines so there could be contributions across the university.

I personally think that it should also be part of the undergraduate package and collecting that with practical experience in the U.S. or overseas. But for me I think it is important to make it part of the core curriculum. And lastly, I would say what I mentioned before. To go beyond the health sciences. I mean the business schools and engineers, etc. I think we tend to think of it too much in our box of medical science.

HCGHR: During your time at UNAIDS, you focused a lot on spreading information about how to impact the HIV/AIDS epidemic through social media, such as YouTube and television, to reach youths. How do you think the use of YouTube, Facebook, Twitter, text messaging, and other forms of social media have impacted the prevention and treatment of the disease?

Dr. Piot: I do not know because I do not have the facts or data, but I think it’s playing a major role in the sense of the global interconnectedness that I see. And spreading information has been a major element in the powerful AIDS activism movement globally and this has been key in terms of being effective and impacting the official agenda.

I think that it can go either way. It’s wonderful to spread very fast information but it can also be a way of concentrating or spending time on trivial issues that are not going to be changing the world.

HCGHR: The London School of Hygiene and Tropical Medicine in 2010 launched its 10:10 campaign, a campaign to reduce its CO2 emissions, and continues to be committed to combatting global climate change. What do you see as the largest problems that global climate change will cause or exacerbate in global health, both in long-term health and in acute natural disasters?

Dr. Piot: This is a very important question and it’s not well studied. In terms of climate change, it’s studied very well, but in terms of the impact on health it is not so clear and straightforward. While there might be direct impacts such as vector-borne diseases that were limited to tropical regions that now have an effect in countries that traditionally didn’t have these kinds of mosquitoes. For example, in Italy, a few years ago they had quite an epidemic of Chikungunya fever which had never occurred there before. We may see more reimportation of malaria so that’s one thing.

Also extreme climate events, like heat waves are killing people, especially older people. But another thing, I think, it’s a combination of climate change, of further urbanization, of droughts, extreme climate events, [that] could lead to major population pressure. So what we haven’t really looked at carefully. And I think we need to look at it the other way around. I mean how improving health could maybe contribute to alleviating climate change.

For example, we have an epidemic of noncommunicable diseases. There was a study a few weeks ago in The New Yorker in the U.S. drawing attention to it. What they call an obesogenic environment. We eat all this beef and we are not moving and that contributes to CO2 emissions. And if we were to adopt a healthier lifestyle both in terms of healthier foods and moving, using public transportation and cycling on a massive scale that could also contribute to reducing climate change. But there is an enormous need for serious studies and that’s only starting now. We have a new group at the school and two years ago we published this paper but this was based on observation not empirical research which is what we need.

HCGHR: As you know, there are many aspects and necessary steps to combatting the global HIV/AIDS epidemic. The UNAIDS website lists its strategy goals to be reached by 2015, including ending vertical transmission, reducing sexual transmission, preventing HIV among drug users, providing treatment, avoiding TB deaths due to co-infection, supporting women and girls, stopping violence, ending punitive laws, lifting travel restrictions, and protecting the vulnerable. As these goals are complicated and broad, what kinds of organizations do you think are making the strongest effort toward these goals, and how can a small global health program be successful in addressing all of these adequately?

Dr. Piot: First of all, I think that there will never be enough global health programs. You should not say, ‘Oh there are big ones, I cannot contribute.’ So you need to identify a niche. You need to say what are you good at and what can you make a difference in very specifically, and contribute. Global health is not the work of one person or organization. Some people make it all the time to the limelight but it’s the hard and daily work of hundreds of thousands of people and it’s very important to think through what exactly can you achieve. And I think what you are doing is extremely important because it is spreading the message and providing the communication for young people at Harvard and that is going to have a multiplier effect. But I think don’t be overwhelmed by the enormity of the agenda, which is reality, but just go for where you can make a difference. I don’t think that it is that much of a problem in a sense.

HCGHR: As the first director of UNAIDS, from 1995 to 2008, you succeeded in building the organization from its inception. What was the greatest challenge that you faced and what was your greatest success?

Dr. Piot: I think that the greatest challenge was resistance. Not resistance from virus but resistance from institutions and experts in the early days. You know there were people who did not want to accept that AIDS was a problem, who were concerned, for example, with treatment access. It is hard to imagine ten years later but in 2001 there was a majority of donors who were against any mention of ARV treatment access in the declaration of commitment of the UN.

It’s hard to imagine today. The U.S. was against it, the U.K., Japan, even African countries. It was very much influenced by public health specialists and development specialists who said, ‘Oh there are all these obstacles and it is not possible to provide treatment because of how the systems are working.’ All true. But we didn’t accept it. And that was the biggest challenge. And then of course mobilizing the money.

And achievements, I would say putting AIDS on the world’s top agenda, in various countries, globally, regionally, and I think also having negotiated lower prices for ARVs which was essential to make this life-saving treatment available.

In 2000 there were less than 200,000 people on ARV in the developing world, and that was mostly in Brazil because that was the country that was offering it free of charge. And today it’s gone to 7 million. I’m not saying it’s all because of me, but it’s a big achievement and we played a large role.

Category: Interviews, Spring 2011

About the Author ()

Leave a Reply