Last week, thanks to my college friend Steve Morrison, I got to attend a reception for Peter Piot at the Center for Strategic and International Studies. The event coincided with the 2012 International AIDS Conference, held in Washington, D.C. Piot has just written a memoir, No Time to Lose, about his career as an infectious disease doctor, beginning with his first trip to Africa to investigate a new hemorrhagic fever in Zaire (now the Democratic Republic of Congo), which the team he worked on named Ebola. Although he started with Ebola, however, he has spent most of his career focused on the AIDS pandemic, culminating with his appointment as the first director of UNAIDS in 1996.
Piot’s memoir brings back all the memories of the onset of the pandemic–the terrible wasting away of people with AIDS, the shame attached with the disease, the sense of hopelessness before the development of antiretrovirals, and for most physicians and scientists working on it, the sense of urgency to curtail a virus that hides in the body for years before making itself known, meaning that millions and millions of people became infected before anyone knew there was something to guard against. The main transmission routes added to the misery because society typically recoils from detailed discussions of sex and condemns, well, sex in general, let alone injected drug use; as a result, moral condemnation by society also undermined efforts to alleviate the spread of the disease. To date, according to WHO estimates, nearly 34 million people are now living with AIDS and over 25 million have died from the disease.
What is striking about Piot’s memoir is the role of administrators. I have read a number of books on the pandemic, such as Randy Shilts’ brilliant and moving And the Band Played On to Jacques Pepin’s recent investigation of the onset of the diseases, The Origin of AIDS. Piot touches on some of the areas that earlier books discuss, but he spends half his memoir detailing the efforts of a group of public policy administrators working tirelessly to get the attention of world leaders, to set up prevention, and later treatment, programs, to find the financial means to run these programs, and so forth. He and the others he has worked with understood the devastating consequences of letting the virus ravage the world unchecked. To get world leaders on board, Piot realized that his group needed to show the dire economic consequences of a disease that killed people in their prime productive years, consequences compounded by the millions of orphans left in the wake of these deaths. The economic analysis by UNAIDS helped the world wake up to the need to stop the disease. The memoir reminds us of the importance of organizers and policy wonks. At the same time, Piot also didn’t shy away from mentioning criticisms of him and his work that arose over the years; he has a self-deprecating style at times, and he repeatedly says he wishes he could have done more, sooner.
I was struck by three other points Piot makes, both in his book and in his presentation. First, in both, he absolutely emphasized the collective effort required to fight AIDS. He generously mentioned so many of the people he has worked with over the years–everyone from Kofi Annan and George W. Bush to the doctors and nurses and most importantly the activists–people with AIDS–in the countries he has visited around the world. At first reading, the plethora of names seems too much, but at his book talk, Piot said that he intentionally made the table of contents of the book a list only of people’s names because he wanted to emphasize the importance of all these people working together. He could have spent the book speaking of himself alone, but instead he cites as many people as he can. The second point is he insisted on meeting with and befriending people with AIDS, and he insisted that world leaders and anyone working on the issue needed to do the same because he rightly believes that people with AIDS also need to be at the table.
The third point is that the man must be indefatigable–I was exhausted just reading about the travel schedule he undertook in the past thirty years.
The book event at CSIS ended up feeling like a family reunion–so many of the key people talked about in the book came to see Peter Piot that the Q&A session started at least 30 minutes late as Piot and his friends all hugged and laughed.
Finally, No Time to Lose made me realize that in many ways the defining challenge of our lifetime has been the fight against AIDS. Yes, there are many other issues from poverty and economic upheaval to terrorism and war to the rise of other infectious diseases and so forth. But AIDS cuts across all of them. Without the research, the prevention and treatment programs, the transformation of medical and drug-testing procedure as well as such things as drug-pricing around the world, imagine just how much, much worse the pandemic would be, how much worse condition of humanity, and the changes that the AIDS fight has wrought will help us face new health challenges in the future while also asking us to deal with poverty, disease, bias, violence, etc., now.