Peter Piot: Ebola’s foe | By Clive Cookson and Andrew Jack

When the lethal Ebola virus began terrorising Africa, Peter Piot watched in frustration as international experts dithered over how serious the crisis was and how it should be tackled.

It was 1977, the year after a Belgian medical team led by the young microbiologist helped discover the virus behind a mystery illness that was killing hundreds of people in what was then Zaire. Some argued for a decisive international effort to diagnose patients and co-ordinate the kind of systematic response that could stop the disease in its tracks. Nearly four decades later, Prof Piot recalls sadly: “None of the recommendations were ever implemented. We have to avoid making the same mistake this time.”

History has caught up with Prof Piot, a simultaneously soft-spoken and outspoken virologist turned UN administrator. An influential figure who enjoys public attention, he is now director of the London School of Hygiene and Tropical Medicine, where those frustrating early arguments took place.

Ebola is not an especially contagious virus. Prof Piot has said that he “wouldn’t be worried” to sit next to an infected person on the London Underground, “as long as they don’t vomit on you or something”. But the disease exacts a deadly toll. The current Ebola epidemic in west Africa, by far the worst ever recorded, has infected more than 7,000 people. Patients suffer severe internal bleeding, which has been fatal in about half the cases so far.

Experimental drugs are being readied for use, but for now the only treatment is to keep patients well hydrated.

The collapsing health systems of Liberia, Sierra Leone and Guinea mean that many cases probably go unrecorded; the real toll could be far higher. Even the least alarming projections suggest there will be more than 20,000 cases by early next month. Looking further ahead, the worst-case scenario from the US Centres for Disease Control foresees 1.4m cases in west Africa by late January. Prof Piot says that while such dire predictions must be treated with caution – “like the ones in the 1990s that had everyone in Britain coming down with the human form of mad cow disease” – he is frightened. “There is a very real danger of a complete breakdown” in parts of west African society, he says.

Like many a cook or scientist Prof Piot – a gastronome with a penchant for fine wine – began by washing up. Growing up in Keerbergen, a small Flemish-speaking town near the Dutch border, he recalls the culinary excellence of the women in his family and the serious drinking of some of the men.

As a junior researcher at the Prince Leopold Institute of Tropical Medicine in Antwerp, he spent his first months washing laboratory glassware and sterilising pipettes. Then, as was natural for a young Belgian setting out in tropical medicine, he went to the former Belgian Congo. There he would discover that the first known Ebola outbreak, in 1976, had been spread unwittingly by Flemish nuns using unsterilised needles in a missionary hospital in the northern village of Yambuku.

The legacy of Africa remains deeply rooted in Prof Piot, not least in his taste for African music. Early this year he celebrated his 65th birthday by returning to Yambuku, a trip he described vividly in the FT Weekend Magazine. In the 1980s he turned his attention to the Aids epidemic beginning to devastate Africa. From his base in Kinshasa he laid the scientific foundation for understanding the transmission of HIV through unprotected sex. Reflecting on the importance of patience after years of cancelled flights and delayed meetings, he says: “You learn to wait”.

He also learnt diplomacy, pragmatism and the need for ugly compromise – including the occasion when he felt he could not refuse the honour, offered by Zaire’s despotic leader Mobutu Sese Seko, of becoming an Officer of the Order of the Leopard.

Such skills would prove invaluable in his career as founding director of UNAids. Many believed that organisation had been founded as part of an American bid to quieten demands for western help in treating HIV in poor countries. In fact, Prof Piot injected its work with a campaigning zeal, brokering deals with drug companies to make antiretroviral therapies widely accessible. This was “the first time people in low income countries gained affordable access to new medicines that were still under patent,” he says. It was during his 13 years at UNAids that he met his wife Heidi Larson, a medical anthropologist who teaches at the London School and researchers public trust in vaccines.

He hopes the Ebola crisis will trigger another change in western attitudes to African health. A serious effort to develop drugs and vaccines to counter tropical disease would mean that “after this epidemic is finished, we’ll have supplies to fight the future outbreaks which will undoubtedly occur”. And western support could bolster African health services, enabling future outbreaks to be spotted early, and contained.

Prof Piot says he “became very scared” in late June, when he realised the seriousness of the current outbreak. But he is helping to cure the lethargic dysfunction that undermined Ebola relief efforts in the 1970s. “When there’s an emergency I can’t just say my schedule is full,” he says, voicing pride at the task force the London School has sent to help in west Africa. In the four decades of his rise, Prof Piot has learnt to wait. But he has also taught others to act.

The writers are, respectively, the FT’s science editor and head of aggregation

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