Last updated: June 9, 2012 12:08 am

Outbreak

The man who led the fight against HIV/Aids offers an insightful memoir of his circuitous career

No Time to Lose: A Life in Pursuit of Deadly Viruses, by Peter Piot, WW Norton RRP£17.99/RRP$28.95, 304 pages

 

Peter Piot winces as he recalls the day in 1976 when, as a young researcher in Antwerp, he opened a cheap plastic thermos just delivered from Kinshasa on his lab bench, using only latex gloves for protection.

It contained a note from a doctor based in the capital of what was then Zaire, now the Democratic Republic of Congo, describing a mysterious and terrifying new epidemic. The handwriting was smudged by ice mixed with a patient’s blood from one of the smashed test tubes inside. Piot’s supervisor would later drop another sample on his shoe.

It is a telling tale from Piot, who in No Time to Lose has written an insightful memoir of his career. An initial interest in infectious diseases in Africa – considered a backwater topic by many of his peers – eventually propelled him to become the founding director of the UN agency on Aids, and now to head the London School of Hygiene and Tropical Medicine.

While his career progression was circuitous, much could be linked to those initial dangerous tests on infected blood, in which he and colleagues successfully identified a new haemorrhagic virus. They named it Ebola, after the river to which they travelled to track down cases in Zaire in the following months.

That mission led directly to his subsequent focus, then unrecognised. Later analysis of Ebola blood samples that he helped collect confirmed that Zaire was already at the epicentre of an HIV/Aids epidemic that would prove far more lethal, affecting 34m people globally today and still infecting nearly 3m a year.

Piot’s time in Africa forged a lifelong commitment to the continent that still bears the greatest burden of HIV/Aids. Over the years he stood up to fellow academics heading down blind alleys because of their focus on North American HIV transmission primarily among gay men; UN bureaucrats “only interested in their own turf”; and donors who used weak health systems and high drug costs to justify refusing support for treatment for Africans.

Piot is generous in crediting others as he explains his tactics in helping broker a deal with pharmaceutical executives to cut prices on their drugs. His sense of fun and taste for good food and drink were important qualities, as he knocks back mojitos and attends a spontaneous late-night banquet with Fidel Castro and bleary-eyed Cuban ministers summoned from their beds for the occasion.

He admits to failures, including the inability to persuade Russia to adopt a more “evidence-based” policy towards drug users as a source of HIV transmission, or to get Thabo Mbeki, the former South African president, to abandon his denialist views on the link of HIV to Aids, which cost hundreds of thousands of lives.

Piot becomes a little less candid as his career advances and those with whom he mixes more powerful. Even so, he expresses frustration at the unfulfilled financial pledges of the French and irritation at the “value for money” demands of the British. He highlights the importance of “almost penitently” confessing to failures in seeking support from the Dutch and Nordic countries; and never doing so in the US, “as that would have been interpreted as weakness”.

Piot could have gone further in addressing his critics, notably over whether UNAids sometimes let “advocacy” figures trump more rigorous and modest subsequent assessments of the burden of HIV/Aids, and its impact on economic development and security.

Some have questioned how far his championing of HIV/Aids drained resources and undermined the provision of broader health services in the developing world; and whether his agency could have pushed harder to ensure money was spent most effectively.

Today, there is also the sensitive issue of how far UNAids, still with a budget of nearly $250m a year, remains necessary. Battles over funding will doubtless be fought in the years ahead. But what is not in question, on the evidence supplied here, is Piot’s own achievement in raising awareness and building an impressive team at an exceptional time.

Andrew Jack is the FT’s pharmaceuticals correspondent

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