José Esparza enjoys the memoir of a long-term veteran of the virus wars.
No Time to Lose: A Life in Pursuit of Deadly Viruses
By Peter Piot
In 1933, Nobel-prizewinning physician Charles Nicolle said that infectious diseases “carry the traits of life that seeks to perpetuate itself, evolving and trying to achieve equilibrium”. But this evolution has a high price for humans. The war between human and microbe is epic and ongoing.
In No Time to Lose, Peter Piot, director of the London School of Hygiene and Tropical Medicine, offers chronicles of two battles from that war: his front-line fights against the Ebola virus, which can trigger a highly lethal haemorrhagic fever, and HIV. The book does not pretend to be a history of those viruses, or a technical manual on infectious diseases generally. It is a memoir — although intertwined with epidemiology, science and politics — and, as such, it is Piot's prerogative to remember and to recognize what he chooses.
We witness Piot's evolution over 35 years, from idealistic young medical scientist in Belgium to skilful United Nations politician and diplomat in Geneva, Switzerland, as director of the Joint United Nations Programme on HIV/AIDS (UNAIDS). Piot is not always diplomatic: he paints a warts-and-all portrait of how science is done and public health protected. And, like many good storytellers, he identifies the good guys and the villains in the threads of his narrative.
Piot's first African adventure was in Zaire, now the Democratic Republic of Congo, in 1976. He was chasing an unusual epidemic caused, he and his colleagues learned, by a previously undiscovered pathogen that came to be known as the Ebola virus. As Piot works towards an understanding of Ebola haemorrhagic fever, the story becomes the stuff of high drama: the writing is so vivid that I felt as if I were beside Piot in the Congolese jungle.
The epidemic Piot witnessed was fast and furious, killing 431 people in Zaire and Sudan in the last four months of 1976. As it raged, Piot began to absorb the realities of research: the tensions between competition and collaboration and the need for priority recognition of scientific discoveries. He also started to learn how to communicate with affected populations, including Belgian nuns in the small village of Yambuku, Zaire, four of whom succumbed to Ebola. Rather than just studying it as a pathological phenomenon, Piot probed the epidemic's human dimension — an essential component of modern epidemiology.
During the epidemic, Piot collaborated and competed with several US scientists. These encounters led him to study sexually transmitted infections with epidemiologist King Holmes in Seattle, Washington. He was at the University of Washington for a little more than a year, but this period was a turning point for Piot, preparing him for his next challenge: the emerging AIDS epidemic. It was to absorb the next 30 years of his life.
Now pursuing HIV, Piot returned to Kinshasa. In 1984, he and his collaborators established Project SIDA, which produced most of the early information on AIDS in Africa. The project was led at first by the epidemiologist Jonathan Mann; in 1986, Mann became the first director of the Global Programme on AIDS of the World Health Organization (WHO).
Piot details the personal differences and changing focus that led to the dissolution of the Global Programme and the launch of UNAIDS. Piot served as its first director from 1996 until 2008 — a period that makes up the bulk of the book. A more definitive overview of these years appears in AIDS at 30 (Potomac, 2012) by Victoria Harden, a historian at the US National Institutes of Health.
Piot resolved that on the research front, UNAIDS would focus on epidemiology. But it also ran many other activities, particularly coordination of the country-level response to AIDS. Piot's main focus was advocacy, community mobilization, political sensitization and fund-raising, and he found success. I am disappointed, however, that as a medical scientist, he does not use his book to discuss the enormous research effort behind the antiretroviral drugs that significantly improved the prognosis of people living with HIV. Nor does he discuss the other biomedical efforts, including vaccines, which I believe will have a key role in stopping the epidemic.
Despite the efforts of virus hunters, neither Ebola nor HIV is under control. These viruses continue to strive for the equilibrium suggested by Nicolle. By May 2011, 28 outbreaks of viruses in the Ebola family had occurred in 11 countries, with a total of 2,288 human cases. And by the end of 2010, an estimated 34 million people worldwide were living with HIV.
This book is not the story of two diseases. Rather, it is a fascinating account of the complex behavioural responses that epidemics trigger among their human hosts.