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New
York Times, July 21, 1998
"Battle-Scarred
Veteran is General in Global War on AIDS"
By
LAWRENCE K. ALTMAN, M.D.
GENEVA
-- It was November 1983, and Dr. Peter Piot, who had done pioneering work on the
Ebola virus in Africa the previous decade, was returning to Zaire to get his
first look at an emerging disease, AIDS. The scene of his return to Mama Yemo
Hospital in Kinshasa "is branded in my brain," Dr. Piot recalled last
week. "I walked into the hospital and saw all these emaciated men and
women."
Dr.
Piot's team quickly showed that the Zairian patients had developed AIDS through
heterosexual sex -- a finding that was initially met with disbelief by medical
experts. But Dr. Piot (pronouced PEA-ott) knew his work was important. "I
realized AIDS would take on immense dimensions in Africa and would change my
life because here was something so complex -- sex, Africa and the politics of
AIDS," he said. "But I did not realize in what sense it would change
it."
Today,
Dr. Piot, a 49-year-old Belgian, is executive director of the United Nations
AIDS Program, the chief coordinator of the global war on AIDS. It is a position
to which he brings scientific expertise, an avid interest in history and a
political will that once led him to march against NATO headquarters to protest
Belgium's possible entry into the Vietnam War.
In
his frequent meetings with heads of state, the bearded, Flemish doctor tackles
diplomacy with the directness of a scientist, particularly when leaders scoff at
the monstrous public health threat they face in H.I.V., the virus that causes
AIDS.
An
African leader, for example, asserted that his country was well prepared to
handle AIDS and took pride in reporting recent tests showing he was not H.I.V.
infected. Dr. Piot then asked what the leader would do if, injured in an
accident, he needed a blood transfusion. The leader, whom Dr. Piot declined to
name, contended that his country's blood supply was safe. But Dr. Piot, fresh
from a visit to a blood bank, knew better because the bank had no laboratory
kits to screen blood before transfusions.
The
skeptical leader called the blood bank and learned that the blood was in fact
dangerous. The leader then summoned his health minister and ordered him to adopt
the United Nations AIDS Program's recommendations. That country's program now
works well, Dr. Piot said.
The
doctor who can sway a head of state's views about AIDS was a member of an
unusually diverse class at the University of Ghent Medical School in Belgium.
More than a dozen of his classmates are now diplomats, government officials and
drug company executives. As for Dr. Piot, he nearly dropped out of medical
school because, he said, he was so appalled by the curriculum's disregard for
public health. He stayed principally because of the fun he derived from
lampooning the faculty in a newsletter.
In
1976, when he had been out of medical school two years and was researching
tropical diseases in Antwerp, Belgium, Dr. Piot and his colleagues discovered a
mysterious virus that was causing a deadly epidemic of hemorrhagic fever in
Zaire. It was later named Ebola, the horrifyingly quick virus that in 1995
caused a widely publicized outbreak in Kikwit, Zaire.
Last
week, this reporter shared a Flemish dish, "water zooi," that Dr.
Piot's wife, Greta, a psychologist, made from chicken and vegetables that Dr.
Piot grew in the garden of their French countryside home near Geneva. The Piots
recalled how their lives unexpectedly changed directions when, at a scientific
meeting in Paris in 1976, a notice was flashed on a screen asking Dr. Piot to
make an emergency call to Belgian officials.
"Go
to Zaire tonight," Dr. Piot was told. Earlier, the same Belgian officials
had opposed sending a team to investigate the epidemic in Yambuku, Zaire, from
which Dr. Piot's team in Antwerp had isolated the new virus. Suddenly, Dr.
Piot's presence in Zaire was needed because American, French and South African
scientists were there and the Belgians did not want to be embarrassed by not
being represented. Dr. Piot's wife was two months pregnant, and the trip was
supposed to last no longer than 10 days. So Dr. Piot asked "Tomorrow?"
The Belgian officials agreed.
Rushing
to Antwerp, Dr. Piot found that his passport had expired and his picture was
missing because he had used it for an application.
Even
so, Dr. Piot, wearing his wedding suit (his only one), boarded the flight. A
cooperative Belgian diplomat told Dr. Piot to cling to his coattails when they
arrived in Kinshasa, and Dr. Piot entered Zaire through a V.I.P. lounge.
The
rest of the trip had little diplomatic glamour. Dr. Piot proceeded to a
missionary hospital in Yambuku, a village in a jungle where the Ebola virus was
killing more than 300 people.
Although
Dr. Piot's team escaped Ebola infection, one member became so seriously ill that
he had to be taken to South Africa. His illness could not be diagnosed.
At
one point, Dr. Piot was ordered to fly to a meeting to report on the
investigation. A helicopter landed in Yambuku to whisk him away. In chatting
with the pilots, he found their breath reeked of alcohol, and Dr. Piot refused
to board. An hour or so later, the helicopter crashed, killing the two pilots
and a passenger who had taken Dr. Piot's place.
A
few days later, Zairian officials ordered Dr. Piot to retrieve the rotting
bodies from the jungle, saying it was his moral duty to do so because by
refusing to board the helicopter he indicated he "knew" it would
crash.
By
the time Dr. Piot returned to Belgium, his wife was six months pregnant, and he
had a new professional focus. Excited by the field epidemiology he had just
completed, he went to the Centers for Disease Control and Prevention in Atlanta,
which had a maximum security laboratory that was better equipped for work on the
Ebola virus than the Institute of Tropical Medicine in Antwerp.
But
Dr. Piot found that he was not cut out for the discipline required in a high
security laboratory. He forgot things, and had to undress and shower before
leaving the lab to retrieve them. Then he had to go through the time consuming
ritual needed to reenter. In addition, the man who relished the freedom of
working in the African jungle was extremely uncomfortable in the confining
environment of the C.D.C.'s headquarters.
After
two months, Dr. Piot and his family left for the University of Washington in
Seattle, where he specialized in sexually transmitted diseases. In Zaire, Dr.
Piot had been struck by the large number of women who had suffered pain and had
become infertile because of pelvic inflammatory disease, a condition resulting
from infections transmitted in sexual intercourse.
In
one of life's strange twists, a fellowship from NATO, the very organization that
Dr. Piot had protested, paid for his stay in Seattle, where he worked with Dr.
King Holmes, widely considered the leading expert in sexually transmitted
diseases, and Dr. Stanley Falkow, an internationally recognized expert in
microbiology, who now works at Stanford University. Of his decision to pursue a
fellowship from an organization he once marched against, he said "I loved
the irony of it, and I highly appreciated it. That's democracy."
Dr.
Piot was astonished at differences between the European and American educational
systems. In Belgium, he said, students were taught to regurgitate what the
faculty members said without challenging their views. In the United States,
faculty members asked students their opinions and expected answers. When so
challenged, "my first reaction was they must have mistaken me for someone
else," Dr. Piot recalled after sipping wine from a bottle provided by his
brother-in-law, Yves Catulle, a sommelier and wine merchant in Brussels.
"If I had not trained in the United States, I probably would have left
medicine,"
Dr.
Piot said. He returned to Belgium and earned a doctorate in microbiology at the
University of Antwerp in 1981. On learning about AIDS later that year, Dr. Piot
recalled the case of a Greek fisherman who lived in Zaire and who died in 1978
of what Dr. Piot realized in hindsight was AIDS.
Itching
to return to Africa to study the new disease, Dr. Piot gained support from the
National Institutes of Health in Bethesda, Md., and went in November 1983. After
research at the Kinshasha hospital, Dr. Piot's team submitted a paper on the
transmission of AIDS through heterosexual sex to the editors of The New England
Journal of Medicine. The editors rejected the paper, citing one expert who said
"it is a well known fact that AIDS cannot be transmitted from women to
men." In 1984, The Lancet published the paper.
Now,
just weeks after speaking at the 12th International AIDS conference in Geneva,
Dr. Piot said he never dreamed that AIDS would become "the runaway
epidemic" that it is today in much of the world. Overshadowing the
conference were new statistics showing that one of every four adults in two
African countries, Zimbabwe and Botswana, were infected with HIV.
"I
am angry that the international community and all countries have not done their
jobs," he said. "I am angry that we heavily underestimated what was
possible and how the epidemic would evolve."
Until
1996, the World Health Organization ran the global AIDS program. But then Dr.
Hiroshi Nakajima, WHO's director-general, was harshly criticized as being
ineffective. (Dr. Nakajima left WHO on Monday after 10 years in the position.)
In 1996, the United Nations created its AIDS Program, a coordinated effort among
five United Nations agencies and the World Bank.
Dr.
Piot, who is also assistant secretary-general of the United Nations, was chosen
because "he and his group have contributed as much or more than any to a
rigorous scientific base for sound
AIDS
prevention and care policy in developing countries, always linked to
humanitarian concerns for affected populations," Dr. Holmes, the Seattle
expert, said. "His political abilities are bonuses."
A
budget of $60 million a year and a staff of 150 limit the options of the United
Nations for defeating a virus that has infected 34 million people. Dr. Piot's
main weapons are influence, moral suasion and the leverage of expertise. He has
negotiated with industry to develop vaginal microbicides as new preventions and
helped arrange a $300 million World Bank loan to India to combat AIDS.
Dr.
Piot said he left the AIDS meeting in Vancouver two years ago determined to find
ways to get the new, expensive combination drug therapies to underdeveloped
nations. Staff members thought of something the United Nations had never done --
negotiating with industry to lower the price of certain drugs in those areas.
Dr. Piot said he was skeptical but let them proceed. Now some AIDS drugs are
available in some countries at one-half to one-third of their cost in the United
States.
Dr.
Piot also has urged government, industry, researchers and developing countries
to expedite testing of experimental H.I.V. vaccines, particularly in areas where
they are needed most.
In
1995, Dr. Piot was made a baron, one of Belgium's highest honors, and had to
create a coat of arms. It centers on the disease that has become his life's
work. Birds, representing freedom, surround hands clasped for solidarity and the
red ribbon that is the symbol for the fight against AIDS.
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