Via The Guardian, a must-read article by health editor Sarah Boseley: Peter Piot: the veteran scientist who helped to raise the alarm over Ebola. Excerpt:
Peter Piot was one of the scientists who discovered the Ebola virus in what is now the Democratic Republic of the Congo (DRC) in 1976, but as he watched the latest outbreak develop in west Africa this summer, he began to think with alarm of the early years of Aids.
“The worst possible fears were confirmed in June or July that this was very different from ’76,” he said. “Context is extremely important. There had been civil war, a lack of trust, breakdown of health services because of civil war and dictatorship in Guinea. Most professionals had left the country. In Liberia there were 51 registered medical doctors and four of those worked for the ministry of health, so 47 for a population of 4.5 million. These are countries in reconstruction after civil war, still very fragile politically and with traditional beliefs in the causation of disease – it’s not pathogens but witchcraft.
“But all that exists in DRC. The main difference, I think, has been denial and the lack of response. It reminds me of the beginning of Aids.” The same attitude prevailed, he said. “Just – no, it is not us, it does not exist. Precious time was wasted.”
Past outbreaks have been halted through prompt action to trace every contact of anyone who falls ill. Isolation and quarantine are medieval techniques, said Piot, by comparison with modern medicine, but they have stopped about 25 small outbreaks since that first one. This time the response was too slow.
As with Aids, there was denial. In March, when the first official lab confirmation of Ebola in Guinea was made, others beside Médecins sans Frontières (which has done a heroic job, according to Piot) should have reacted. “But WHO was silent. Governments denied it. All that meant that it got out of control.”
Piot understands the parallel with Aids better than most. He helped set up the UN agency on HIV, called UNAIDS, and ran it as executive director from its launch in 1996 until he left in 2008. Under his leadership, UNAIDS became the driving force of the global response to the HIV epidemic.
By June, Piot was getting alarmed. He had heard MSF’s warnings, to which the World Health Organisation had not paid attention. Ebola outbreaks begin in rural areas, when one person gets infected by handling or eating a forest creature, probably a fruit bat, with the virus. But by the summer there was a case in Conakry, Guinea’s crowded capital city, where infection could spread so much more rapidly, along with cases in Liberia and Sierra Leone.
Acting as much on gut instinct as evidence, said Piot, he gave an interview to CNN on 2 July. “I said this is out of control and then I surprised myself and said we need a quasi-military operation,” he said. “Afterwards I thought, oh my God, what did I say? I’m Flemish by culture. We don’t exaggerate. We use understatement if anything. But unfortunately I was right.”
After that he got very frustrated, he said, asking why the WHO and the US were not doing more. “MSF can’t carry the weight of a nationwide response in three countries,” he said. “It may also be because of my Aids background. I always felt if we had acted much earlier and had the resources we have now for HIV, it wouldn’t have got out of hand.”
In 1996, antiretroviral drugs became available for people with HIV, but it took about 10 years before they were on the agenda for Africa. “It became a bit of an obsession for me to bring down the price. It took a good five years before the money was coming in. So the way I look at it is very coloured by my Aids experience.”