Former UNAIDS director Peter Piot recounts his role in discovery of Ebola, AIDS

March 14, 2013 — Peter Piot’s “aha moment” came in 1983. That was when he saw firsthand, in a hospital in Kinshasa, Zaire (now Democratic Republic of Congo), the devastating effects of a newly discovered virus that attacked people’s immune systems—AIDS. One ward was full of sick, emaciated young men; another had just as many sick young women.

“When we got out of the hospital, I was nearly breathless,” recalled Piot at a February 27, 2013 talk at Harvard School of Public Health (HSPH). “I had a physical sensation—not the happy, tingling energy of scientific discovery, but the overwhelming feeling that we were facing a truly momentous catastrophe. I suddenly realized that this epidemic would take over my life.”

Piot was the founding executive director of UNAIDS as well as an under secretary-general of the United Nations, serving in both roles from 1995 through 2008. Currently he is director of the London School of Hygiene and Tropical Medicine. He offered highlights of his role in “two of the most extraordinary adventures of our time”—the discovery of the Ebola virus and the AIDS virus—at HSPH’s Dean’s Distinguished Lecture Series Book Presentation, presented with the Department of Global Health and Population. Introducing Piot and his 2012 memoir—No Time to Lose: A Life in Pursuit of Deadly Viruses—HSPH Dean Julio Frenk called Piot “one of the most important and influential public health leaders of the last decades.”

In 1976, Piot co-discovered the Ebola virus in Zaire. In the 1980s, as one of the first scientists to study AIDS, he was involved in a series of collaborative projects in several African countries, including Project SIDA in Kinshasa, which was the first international project on AIDS in Africa and was widely acknowledged as having provided the foundations of understanding HIV infection in Africa.

‘The excitement of discovery’

Originally from a small conservative village in Belgium, Piot told a standing-room-only crowd in Kresge G3 that by age 10 he had one goal in life—“to get out of there.” His deep curiosity about science led him study medicine and microbiology. In 1976, while conducting infectious disease research in Antwerp, Piot and colleagues received a blood sample, in a blue plastic thermos, from a Flemish nun who’d died in Zaire from a mysterious epidemic thought to be yellow fever. But the sample tested negative for that or any other known viruses. Piot jumped at the chance to travel to Zaire to investigate further.

“There were many people who were not available or were too scared to go,” Piot recalled. “But I was 27, therefore being scared was not in my dictionary. I was so excited that I was not afraid of anything. It was the excitement of discovery.”

He described how he and a colleague entered a hut where a husband and wife were both dying from the strange and frightening virus, which caused bleeding from their eyes, noses, mouths, and ears. They drew blood from the wife—they wanted to isolate and confirm the presence of virus—but in the moment they did so, the husband died. Piot and his colleague froze, worried that villagers would think that they, in their “nightmarish outfits” (gowns, gloves, surgical masks, and motorcycle goggles), were somehow responsible for the man’s death, and that the villagers would kill them. They hastily explained that the husband’s death at the moment they drew blood from the wife was a coincidence. Then they instructed the villagers to make sure they wore gloves when burying the bodies.

Over time, after visiting a number of villages struck by the epidemic, Piot and colleagues were able to piece together how it was transmitted—through improperly sterilized needles and the close contact involved in burial rituals. When the team left Zaire, they had blood samples that would later aid in the identification of Ebola.

From research to policy

Five years later, Piot and colleagues began seeing patients—Africans as well as Europeans living in central Africa—with a uniformly fatal disease. Gay men in California were being diagnosed with what appeared to be the same illness, but the patients in Belgium were both men and women. “The dogma at the time was that this was a ‘gay disease,’ ” Piot recalled. “But I simply could never understand why a virus would care about the sexual orientation of its host.”

Piot knew that if there were about 100 sick patients from Africa in Belgium, there were likely thousands more in their country of origin. So he returned to Kinshasa with a team of investigators—and that was where he saw the wards full of sick men and women.

Piot and his team made key discovery: that patients in Zaire had developed AIDS through heterosexual sex, meaning that it wasn’t just a “gay” disease. Piot went on to conduct a number of important epidemiological and clinical studies on AIDS in Zaire and Kenya. But after a while, he said, “I started having existential doubts. I thought, ‘How long can I do research? I want to change the world.’ ”

So he went to work for the World Health Organization in order to influence policy. Shortly thereafter—“to my surprise, like in a movie,” he said—he became the founder of UNAIDS. In that role, he became the chief advocate for worldwide action against AIDS. Sometimes the bureaucracy frustrated him, but his encounters with activists and people living with HIV “would really inspire me and I would know why I was doing this, why I was sitting through endless meetings, or fighting with WHO,” he said.

A high point for Piot came in the mid-1990s, when pharmaceutical company officials—who had initially balked at requests to provide expensive antiretroviral drugs at greatly reduced cost in developing countries—changed their minds. Until that point, Piot said, “the dogma in public health circles was, ‘forget it for those developing countries—too bad, let them die.’ But it was something I could never accept.”

Piot said he has learned that “it’s only when science, politics, and programs on the ground—when these stars are aligned—that we make progress. Sometimes in academia we are focused on just one and forget that we need all three.”

Karen Feldscher