Interview: Peter Piot
We talked to Peter Piot about a post-pandemic world, the climate crisis, decolonising global health, and what is in store for him after his 11-year tenure at LSHTM.
Photo credit: Heidi Larson
Peter Piot is looking forward to some change. In July, he will finish his second term as Director of the London School of Hygiene and Tropical Medicine (LSHTM), a post he’s held since 2010. Since he started his career as a virologist in Belgium in the mid-70s, Piot has never stayed at the same job longer than “12 or 13 years” — that’s how he likes it, he says. He has had a prolific career, with each step placing him further to the forefront of the ever-evolving field we now call “global health.” But it wasn’t planned that way.
“I grew up in a small, Catholic town in Flanders. My motivation to go into global health (the word didn't even exist then) was inspired by the liberation movements in Africa… plus a desire for adventure,” said Piot when we spoke to him online from his home in London. After completing medical school, Piot elected to study infectious diseases against the advice of his professors: “they told me there was nothing to study, that they had already discovered all the viruses that exist.”
Since then, Piot has held a number of roles and overseen major global health crises, earning the titles of “Virus Hunter” and even “The Mick Jagger of Microbes”. He is perhaps best known for helping to identify and contain the first recorded Ebola outbreak, and for serving as the founding Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS) and Under Secretary-General of the United Nations from 1995 until 2008.
Piot’s near 50-year career tracks the evolution of the field of global health — from the colonial construct of tropical medicine, to the “post-colonial” construct of international health, to global health now. He credits chance and privilege, rather than expertise, for his first big opportunity in the co-discovery of the Ebola virus while he was a PhD student in 1976, acknowledging how the colonial power dynamics at the time contributed to his early success: “I benefited from the situation,” says Piot. “When we isolated the Ebola virus, that was in Antwerp because in the whole country [then Zaire] there was not a functional virology lab, so they sent the samples abroad. Today that’s different — they do sequencing. I had no experience, wasn't fit for the job [and] the context of the world was different then. Today it wouldn't have been possible.”
“I want to be ahead of the curve”
Notwithstanding the vast changes he’s witnessed, the colonial legacies that pervaded global health when Piot was a young virologist persist today: there are still, broadly speaking, wide inequities in health outcomes between the Global North and low-resource settings in the Global South. Moreover, high-income Western institutions aiming to address these health inequities often deflect the global disease burden on the under-developed South, distancing their involvement in upholding systemic inequity, and maintaining their status and necessity as global health experts.
Piot’s tenure as LSHTM Director coincided with increased scrutiny on the topic of decolonising global health by students and faculty alike, with many demanding to know why the school waited so long to make this a priority.
“It’s true that it was probably a bit late,” says Piot, in regards to the criticism that the school was slow in adopting a decolonising mission statement, “but in practice, I think we were far ahead of anybody else.”
The “practices” that Piot claims put LSHTM ahead of other comparable institutions include the ways in which LSHTM researchers operate worldwide: “As far as I know, no activities and research projects are standalone, that are not [a] part of a local institution."
In response to growing calls to decolonise universities in the UK and globally, Piot commissioned a project on the Colonial Legacies of LSHTM in 2018. And, in reaction to the murder of George Floyd and ensuing international protests against police brutality and racism during the summer of 2020, Piot also issued a statement affirming that Black Lives Matter and committing LSHTM to take “bigger strides” to “ensure racism is eliminated in all that we do”.
For Piot, it is important that the LSHTM model of engaging with institutions and contributing to research globally be one of “equitable partnership” that places “more centres of decision making outside London”. And while he says that progress has been made on this front, Piot believes that there is still a way to go: “The key is that we move further on that trajectory — we've been late, but not later than others. I know, that’s no excuse — I want to be ahead of the curve.”
The critical next step at LSHTM, according to Piot, is decolonising the curriculum. The COVID-19 outbreak has helped and hurt this mission: the digitalisation of teaching during the last year has provided a new opportunity to review and reconsider the curriculum but, at the same time, “not being able to speak to students has made things more difficult.”
“There are parallels [between COVID-19 and AIDS]”
While COVID-19 has disrupted almost every facet of life since the beginning of 2020, the pandemic has also exacerbated and entrenched inequalities within and across countries. Piot — who was briefly hospitalized with COVID-19 in March of last year and says he is “still experiencing the after-effects” — has been advising the European Commission on COVID-19 since May 2020, in addition to serving as Director of LSHTM.
In offering perspective on our current predicament, Piot reflects back on his experiences as director of UNAIDS. He calls out a slow and disjointed global political response to the pandemic, in addition to inequalities in access to essential medicines, as primary parallels between the two health crises. In his eyes, the inequalities we are witnessing in vaccine access and allocation are unfortunately no surprise — “I don't like it, but I understand that in democracies, leaders are elected by citizens and they have to do the best for them or else not be elected. That's the basis for vaccine nationalism”.
According to Piot, that self-interested imperative can only be outdone by increasing the global supply of vaccines. In contrast to the activists and scholars leading the People’s Vaccine movement — who have called for the suspension of private intellectual property rights on vaccines — Piot doesn’t see patents as a critical issue.
“In the case of HIV, the problem was price, not so much supply. In the case of COVID-19, the issue is not so much money and cost, but supply.” Piot adds, “I was cynical when the US announced a patent break. I’m definitely not against it, but a patent waiver [today] is not going to create a single [extra] vaccine during this year — it was far more important to lift the ban on exports of raw materials.”
When it comes to pandemics, Piot sees urgent action as a matter of global security. “I brought AIDS to the UN Security Council — that still has not happened with COVID, and it’s a big failure of national actors”. He continues, “it's not only a moral imperative of equity and justice [...] as long as there are millions of people infected with this virus [there] will be all these variants coming up, and that will undermine the efforts in countries that have the ability to to vaccinate a population.”
“Climate change is going to affect everything we do”
HIV and COVID-19 were both zoonoses that emerged seemingly “out of the blue”, and Piot has said that we are likely to be entering a new “age of pandemics” as our “failure to live in harmony with nature” increases the risk of emerging infectious diseases being transmitted from animals to humans.
It is this perspective that led him to “realise that [climate change] is not [just] a long term issue, it's an acute issue” with immediate repercussions for global health. “Not addressing climate change will undermine the successes of global health. If we want systemic solutions [...] climate change and planetary health have a lot to do with it.”
Piot feels like a “fish in the water” when he’s discussing topics related to climate change, because of the centrality of civil society and activism driving the global response. He credits activists with putting climate change on the agenda by cutting through “inscrutable science reports'' to communicate the urgency of action to the masses.
“That was true for AIDS, too. People living with HIV and activism [were] big [triggers] for research; and I see that in climate change as well. Even when I was in the UN, my first meeting in every country was always with AIDS activists and people living with HIV, because they were really the ones who knew what was going on,” Piot says. “I think climate change is going to affect everything we do. Without this pandemic […] the big emphasis would’ve been on climate change and planetary health.”
“The global architecture needs to be rethought”
More broadly, Piot believes that a paradigm shift is needed in the operation of global health institutions and their funders. Right now, global public health institutions like the WHO, The Global Fund, GAVI, and PEPFAR are still “very much driven by Western power and values.”
“The global architecture needs to be rethought — these global institutions should become more of a federation of regional entities” says Piot. “One of the biggest changes in Africa in the last 5 years is the establishment of the Africa Centres for Disease Control and Prevention, which did not exist in 2014 during the Ebola outbreak. Now it exists with very strong leadership” including John N. Nkengasong, who was recently inducted as an honorary fellow of LSHTM.
Photo: a screenshot captured during the Zoom interview
Likewise, the foundations responsible for funding and commissioning much of the research and work in global health — the Wellcome Trust, Gates Foundation, and others — are operated out of the English-speaking world. As long as the funding models don’t change, we are unlikely to see fundamental changes in the power dynamics that guide the practice of global health.
“The biggest challenge for all this to change is the funding models. Basically, it comes down to the money, because that determines the power relationship,”.
“I don’t want to be in charge anymore”
With only a few months left in his term at LSHTM, Piot is looking forward to handing over the reins — “I don’t want to be in charge anymore.” He’s planned to maintain his advisory roles at the European Commission and Africa CDC and will remain affiliated with the School as a half-time professor. Alongside traveling to Asia and spending more time with family, Piot will also be working at the University of Washington on a project mapping the global burden of disease, and supporting his wife, Professor Heidi Larson, in her work around vaccine hesitancy: “her field is booming [...] My agenda will be more a function of hers.”
The virologist who “never thought [he] would be a UN diplomat” has some advice for the next generation of global health leaders: “don’t overplan your career.” Navigating the dual crises of climate and infectious diseases in the "age of pandemics" will be a steep task, but he believes we have reason to be optimistic: “On the hope-giving side, capacity and human power [are] there more and more.”
Peter Piot was interviewed on 12th May 2021.