J. Stephen Morrison
Senior Vice President, CSIS & Director, Global Health Policy Center at CSIS
Peter Piot – the iconic, much admired Belgian figure who spearheaded UNAIDS between 1996-2008, and now heads the London School of Hygiene and Tropical Medicine – begins his richly insightful memoirs, No Time to Lose: A Life in Pursuit of Deadly Viruses (W.W. Norton & Co.; 2012), by describing how he became captive, as a young boy in a rural Flemish village, to Tintin's romantic adventures, science and math's power, and Africa's pull. These key ingredients of his childhood propelled him forward through many 'incarnations' in his life.
As a young doctor and researcher, his experiences in the late 1970s investigating an Ebola outbreak in Yambuku, Zaire (now Congo) were profoundly formative. He witnesses firsthand the villagers' trauma and terror; the struggles of well-meaning Flemish missionaries, who inadvertenly contributed to the crisis through their use of contaminated syringes; and the 'fiscal feudalism' of the Mobutu era. He also comes to understand the powerful synergy among science, anthropology ("qualitative research"), politics, data ("facts can be subversive") and collaborative international networks with critical links to the US Centers for Disease Control and Prevention (CDC), the National Institutes of Health, and major research universities. These revelations become all the more important when he returns to Kinshasa in the early 1980s to partner with US researchers in the groundbreaking project, Operation SIDA.
Despite his innate modesty, Piot inexorably reveals the mix of personal traits that undergird his rapid evolution into such an impactful leader. Early in his career, he recognized a recurrent fear, shyness, self-doubt, 'semi-outsider' identity, and tendency to become 'frantic' and do too much when he habitually swings into overdrive. He regularly turned to intense internal reflection, at the same time that he systematically rallied the advice of mentors and colleagues and built enduring alliances with leading American personalities such as Dr. Tony Fauci, Ambassador Richard Holbrooke, and Dr. King Holmes; then UN Secretary-General Kofi Annan; the heads of state of Uganda, Thailand, Senegal; and many others. His obsession with constructing small, highly competent, dedicated teams made it possible for UNAIDS – freshly minted in 1996 amid considerable skepticism – to quickly become, in his words, a "taut little mammal in a world of brontosauruses."
In a charmingly understated voice, Piot recounts the rapid sequence of major achievements to which he contributed substantially while at the helm of UNAIDS. He assembles much improved data on the pandemic, and moves debate into high political circles, centering it upon a hopeful vision of what could be achieved in Africa and other settings. He and his talented staff create the detailed framework for expanded global action, which was launched at the pivotal June 2001 UN meeting, that called for upwards of $10 billion per annum to be put toward treatment, care, and prevention programs. He concentrates upon, and succeeds, in changing China's outlook. He gives voice to persons living with HIV and civil organizations, and elevates human rights as fundamental to effective action. He becomes obsessed with driving the prices down for antiretroviral drugs and establishing a new norm of universal access to treatment. In combination, these actions generate the essential momentum that made possible the creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria in 2002 and soon thereafter the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), which in turn suddenly made it possible to imagine that resources could begin to be commensurate with need.
Beyond his successes, Piot recounts utterly haunting experiences such as his ultimately unsuccessful efforts to coax then South African President Thabo Mbeki's into the mainstream and away from the tragic course Mbeki had set for his country.
There are also amusing vignettes. Zaire President Mobutu confers upon him the Order of the Leopard, helpful later in smuggling cash into Zaire in his underwear. Cuban President Fidel Castro engages him in extended, at times bizarre nocturnal exchanges – even after Piot bluntly admonishes him to desist from anti-capitalist cant. Fortuitously, CDC and NIH elevate the junior Belgian to be the manager of Operation SIDA as a quick fix to their interagency rivalry.
He began as, and has remained, one very stubborn, independent individual. He went against the professional grain when he made the early strategic decision to pursue infectious diseases. He has adhered to a fierce pragmatism and adaptability, what he disparagingly refers to as "my inner chameleon." His animus against extremist, utopian, polarizing positions – "nuts and obsessives" – made him the target of considerable scorn and heat from diverse directions, although that only seems to have hardened his core toughness.
Peter Piot's style and form of leadership fit – and steadily drove forward – the surprising era of heady expansion and remarkable achievement that unfolded over the past decade. For that we owe him a debt of gratitude. One question his memoir leaves before us is what innovative new dynamic leadership now comes forward, in the present era that oddly mixes rising optimism – that an 'AIDS free generation' is within reach – with considerable angst that resources and high level political may fall far short of what is required to sustain success.
Peter Piot was a member of the CSIS Task Force on HIV/AIDs, launched in November, 2001, as well as the CSIS Commission on Smart Global Health Policy, 2009-2010.