Ebola discoverer Peter Piot on how to respond to the coronavirus

Financial Times


Virologist Peter Piot is a legend in global health. He helped discover Ebola when he was 27, and led the fight against HIV-Aids. Now director of London School of Hygiene & Tropical Medicine, he tells the FT how the world should respond to the coronavirus.

The ‘Mick Jagger of microbes’ on a life of fighting disease — and the severity of the current crisis

FT.COM

Ebola discoverer Peter Piot on how to respond to the coronavirus


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Lunch with the FT Peter Piot Add to myFT Ebola co-discoverer Peter Piot on how to respond to the coronavirus The ‘Mick Jagger of microbes’ on a life of fighting disease — and the severity of the current crisis Share on Twitter (opens new window) Share on Facebook (opens new window) Share on LinkedIn (opens new window) Save David Pilling YESTERDAYPrint this page159 Peter Piot, tall, with grey stubble and a determined gait, sticks out his hand. A microbiologist and one of the world’s most famous “virus hunters” — we later decide “virus detective” is more apt — he evidently deems it safe to shake hands at this moment of coronavirus panic. At 71, Piot is a rock-star virologist, the Mick Jagger of microbes. The man who helped discover Ebola when he was 27 and who led the fight against HIV-Aids is a legend in global health. Charming, rebellious and with little patience for protocol or authority, he has spent a lifetime battling bureaucracy as well as disease. Fortunately for me, the now director of the London School of Hygiene & Tropical Medicine and recipient of numerous awards — including the Order of the Leopard from the former Zaire — is also great company, a wine lover and a foodie. On this blustery London afternoon, he plonks down an espresso-sized plastic cup on the restaurant’s marble dining counter. It contains a black truffle he has purchased from a nearby delicatessen with the intention of asking the chef to prepare something to go with it. This, I predict, is going to be an epic lunch. “I’m in your hands, Peter,” I say, delegating the ordering to him. “That’s really very dangerous,” he replies, a playful look on this face, as we take up our position at his favourite corner spot at the counter of Bocca di Lupo, a superb Italian tapas bar in Soho. Although he is a regular, he scans the menu with the intensity of a doctor examining a medical chart, announcing various items in his Dutch-accented English. “Braised artichokes and potatoes from Rome. Grilled langoustine — but they are so messy. Monk’s beard. I like that. This is the sage leaves that I want. And do you have sea bream carpaccio?” he asks the waiter, who is bouncing from foot to foot in anticipation of our order. “Vitello tonnato I like also,” Piot says. “Let’s see whether Phil is here, the sommelier.” Phil appears to be absent, so Piot takes charge. The FT is paying and I’m happy to see his eyes shift to the bottom half of the wine list. “It’s between a Barolo or a Brunello di Montalcino from Tuscany,” he says, undecided, before settling on a 2011 Elio Grasso. “Barolo is like the Burgundy of Italy.” Kofi Annan called me on a Sunday afternoon. He said, “Peter, you’re a brave man, but nobody has ever won against the People’s Republic of China” The waiter is already planning a post-bottle glass of something bolder for us, to go with the suckling pig coming later. Before that, there’ll be borlotti beans prepared Neapolitan-style with winter tomatoes and basil. And, for the truffle, two pasta dishes: spinach and ricotta ravioli, and some simple spaghetti with oil and garlic. “So, that’s already the most important decision of the day,” Piot says with a wink as the bottle arrives and we take a sip of the beautifully rounded wine. “Cheers. To Africa,” he says, a continent to which he has returned again and again throughout his career. When what turned out to be a sample of the Ebola virus extracted from a Belgian nun arrived in two vials, one smashed, at the lab where he was working as young microbiologist in 1976, he couldn’t wait to get started. He was gripped by what he calls “the rush of adrenalin that comes with a mystery outbreak”. He was wearing no protective suit or mask. “I could’ve died several times,” he says, recounting how, during that epidemic, he refused to board a helicopter after smelling alcohol on the pilot’s breath. It crashed, killing everyone on board, including the man who had taken his seat. “The absence of bad luck in life is the most important thing.” I want to hear his views on the outbreak that is happening right now: coronavirus. I wonder if we are not overreacting. After all, so far it has killed a fraction of those who die from seasonal flu. “I’m not the scaremongering type,” he says. “But I think this is serious in the sense that we can’t afford not to consider it as a serious threat. “It could be that, indeed, it’s going to be over in a few months,” he continues, crunching into a tempura-covered sage leaf. “But just take the counterfactual. We say, ‘OK, it’s fine and we don’t do anything.’ I bet that we would already have had far more cases in Singapore, the UK, Germany. Let’s not forget, we are already well over 1,000 deaths. That’s not a detail.” We are meeting on February 13, since when nearly 1,500 more people have died, and serious outbreaks have occurred in South Korea, Iran and Italy. Japan has announced the closure of all its schools and Saudi Arabia a halt on pilgrimages to Mecca. Stock markets have slumped in anticipation of a further spread of the virus and a disruption of the global economy. “Now, let’s say, the mortality rate is 1 per cent. So, the big question is, how many people will get infected? Are we talking about hundreds of thousands or millions? Now 1 per cent of one million is 10,000; that’s 10,000 people who will die,” he says. “It’s clearly not Sars,” he continues, referring to severe acute respiratory syndrome, which killed nearly one in 10 who contracted it 17 years ago. “That’s the good news. But the bad news is, it spreads much faster. The Sars virus sits deep in your lungs. With this virus, it seems that it’s in your throat and that’s why it’s far more contagious. “Secondly, we have no vaccine. All we have is medieval ways of containment: isolation, quarantine, contact tracing.” Piot remembers hearing about the first cases of a mysterious virus in Los Angeles in 1981. “The first report of HIV was six or seven gay men in California. Cumulatively, now we have, like, 75m people who have been infected. Who would have thought that then? Nobody. I’d rather be accused of overreacting than of not doing my job.” We’re both busy with the food. I’m trying the vitello tonnato — thin slices of veal, something I don’t normally eat. But it’s incredibly tender, accompanied by a yellow tuna-based mayonnaise. Piot is explaining how much he likes the food in Japan, where he collaborates on a PhD programme with Nagasaki University. “Life is too short for bad food and bad wine,” he says, swirling the Barolo around the ample glass. Bocca di Lupo 12 Archer Street, Soho, London W1D 7BB Bottle of 2011 Elio Grasso Barolo £123 Sage leaves filled with anchovy £4 Sea bream carpaccio £8 Vitello tonnato £8 Spinach and ricotta ravioli £7 Spaghetti with oil and garlic £5 Suckling pig porchetta £28 Borlotti beans £7 Glass of Sagrantino x 2 £30 Sparkling water x 2 £8 Almond granita £7 Gelato £4 Americano £3 Total (inc service) £272.25 What’s the worst-case scenario with coronavirus, I ask. “That we’ll have a pandemic,” he replies. “I think it will get much worse in China. And here we will see more and more transmission. That’s my gut feeling. But how big it’s going to be, I honestly don’t know.” He praises the role of the World Health Organization, which he says is nimbler under Tedros Adhanom Ghebreyesus, an Ethiopian and its first African director. Dr Tedros has been criticised for going easy on China, which suppressed information in the early stages of the outbreak. “The dilemma is he could have his five minutes of fame by bashing China. But what happens afterwards? You need to work with them,” he says, scooping up some juicy borlotti beans. “It’s a fine line. I learnt this the hard way,” he says, referring to 2002 when UNAids, the organisation he ran from 1995 to 2008, issued the so-called “Titanic Peril” report, which argued that China had many more cases of HIV than it was admitting. “It’s the only time that my then boss, Kofi Annan, called me on a Sunday afternoon. He said, ‘Peter, you’re a brave man, but nobody has ever won against the People’s Republic of China.’” I think it will get much worse in China. And here we will see more and more transmission. That’s my gut feeling. But how big it’s going to be, I honestly don’t know Piot gritted his teeth and publicly apologised. Still, he remembers a meeting a few years later with Wen Jiabao, then premier, in the Hall of the Purple Light in Zhongnanhai, the communist party’s inner sanctum. “Wen asked me, ‘What’s the situation, what should we do?’ And I thought, you have 10 seconds to think. Am I going to be diplomatic or am I going to say the truth? He must have seen it. He said, ‘Forget who I am. Forget that we’re the Communist party. Tell me what you think and I’ll see what I can do.’ Piot advised Beijing to be more open about the problem and to work with people who were vulnerable, including drug addicts and sex workers, rather than jailing them. China’s policy changed decisively after that encounter. Our pasta has arrived and the waiter grates generous slices of Piot’s truffle onto both dishes. It’s beautifully cooked, and the rapidly vanishing wine is smooth and lovely. How did Piot get into all of this? Growing up in the flat countryside of Flanders — what he thought of then as “the most boring place on Earth” — he wanted to escape. “I wanted adventure and to see the world,” he says, adding that he devoured books from Tintin to Livingstone’s exploration of Africa. “I was dreaming of becoming a discoverer, but what could I discover when the whole world had already been discovered?” At university in Ghent, he studied engineering, but switched to medicine. A few years later, when he was working in a junior position in a lab in Antwerp, those vials arrived from what is now the Democratic Republic of Congo, and he boarded a plane for Kinshasa. His passport had expired but, in those more innocent days, he somehow wangled his way on to the plane and through Congolese immigration. Of Kinshasa, he says: “You love it or you hate it. I went straight from Antwerp. Boom. I fell in love within 24 hours. I dove into the water and I swam and I could survive. I embraced it fully.” Yambuku, epicentre of the outbreak, was gripped with fear. He and a handful of more senior colleagues began their detective work, eventually discovering that the virus was being spread by the Belgian nuns who were injecting pregnant mothers with a vitamin shot using reusable needles. “I was the one who told them,” he says, though in his book — No Time to Lose — he recollects that the nuns didn’t fully absorb what he was saying. I recall from the book other madcap incidents. When he was in Congo the first time, he flew in a tiny plane to another suspected outbreak. As I remember it, he looked out of the window to see one of the wings break off. “Not the wing,” he splutters, stabbing a succulent ravioli. “It was an engine. If it was the wing, I wouldn’t have been here for this meal. But I’m really not a risk-taker. I’m scared of skiing downhill and parachuting.” He was initially embarrassed to receive the Order of the Leopard from Mobutu Sese Seko, the kleptocrat then running Congo. Subsequently he found it useful for getting out of scrapes with jittery soldiers. “I’ve lots of funny decorations. Not funny. I have to be very respectful here. The Order of the Lion from Senegal, the Order of the Rising Sun from Japan.” What did he get the Japanese honour for? “I’ve no idea, they don’t tell you. It’s not like here you have this ridiculous, someone becomes ‘Sir so-and-so for services to the food industry’,” he says of Britain’s honours list. In Belgium, where he was made a baron, he had to come up with a crest design. He chose the red HIV ribbon and the motto “Ken uzelf”, or “Know thyself”. Our crispy-tender slices of suckling pig have arrived, together with two glasses of Sagrantino, a more powerful wine from Umbria. As head of UNAids, Piot championed the marginalised, from gay Cubans and Chinese methadone addicts to sex workers in Nepal. Prejudice was the main engine of the Aids epidemic. He has also hobnobbed with a procession of leaders, including Nelson Mandela — who radiated “natural wisdom and authority” — and Fidel Castro, who kept him up till 3am in heated argument and then sent him cigars every Christmas. In recent years, he has been increasingly drawn to Asia, particularly Japan, a country he first visited in 1981. “I left after two days. I thought this was not for me. The taxi driver with white gloves who holds the door open and all that. It was an acquired taste as far as I was concerned.” About a decade ago, he changed his mind. “I decided there’s absolutely no way I will ever understand what the hell is going on. I can’t read, I can’t speak, I don’t understand. It was so liberating.” I ask for an Americano with vanilla ice cream. Piot says no to coffee. “Gives me tachycardia,” he explains, ordering an almond granita. Piot is near the end of a second five-year term as director of the London School of Hygiene & Tropical Medicine, more than half of whose staff is now based in Africa. He’s thinking of prolonging his tenure a few more years, prompting me to tease him that he’s been hanging out with too many dictators for whom two terms is just not enough. No, he says, he is already planning what comes next: mentoring young health workers, and possibly something in biotech. London, where he lives with his second wife, Heidi Larson, a renowned anthropologist, is likely to remain home. Why, incidentally, does he dislike the term “virus hunter”? “Well, it’s not that I’m actively hunting. Things happen. Shit happens. It’s more understanding what’s going on,” he says, comparing what he does to solving a mystery. “So, maybe detective is a better word.” I remind him of Laurie Garrett’s book The Coming Plague. In our arms race with microorganisms, are humans destined to lose? Piot quotes Louis Pasteur: “‘Messieurs’ — because they were all men in those days — ‘microbes will always have the last word.’” Piot thinks differently. “If we do nothing, then that’s the case,” he says, particularly since new viruses — as coronavirus appears to have done — can always jump from animal to human. But these days far more people die of non-communicable diseases than of infectious ones, he says. “Collectively, we’ve done quite a good job. That’s why we need, how to say it, a fire brigade,” he says, of a stronger and better-prepared global health system. “You don’t set up a fire brigade when your house is already on fire.” David Pilling is the FT’s Africa editor Follow @FTLifeArts on Twitter to find out about our latest stories first. 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