No Time to Lose:
Of infectious disease, science, politics and institutions
Peter Piot
ESCAIDE
Stockholm
5.11.2013Improving health worldwide
www.lshtm.ac.uk
My lessons from Ebola, 1976
• Time , place, person!• Poverty driving disease• The power and challenges of international
collaboration• EIS : US field epidemiology • Good intentions can be dangerous
Global HIV prevalence in adults, 1985
UNAIDS/WHO, 2006
Prevalence of HIV Infection,2012
Piot and Quinn, N Engl J Med 2013; 368:2210
Lessons from STD and HIV research
• The power of combining epidemiology with clinical and laboratory sciences
• Pre-eminence of social determinants, economics, politics and human rights
• Opportunities and challenges of international collaboration
• Europe needs a CDC• Weak EU support for global health research
Non-viral resistance
• Experts: in public health and health services, essential medicines, international development
• Institutions: development agencies, World Bank, European Commission, WHO, Unicef
• Politicians: Ministers of Health and of Finance• Denial about HIV : e.g. President Mbeki• Lack of ambition
“the brutal fact was that those who could pay for Africa’s AIDS therapy - the pharmaceutical industry by way of price cuts, and rich-country tax payers by way of foreign aid – are very unlikely ... to do so”
(W McGreevy, World Bank,1998)
Treatment Action Campaign (TAC)Treatment Action Campaign (TAC)
Leadership
Former President Fernando HenriqueCardoso of Brazil.
1988 Drugs for opportunistic infections provided
1991 Zidovudine provided
1996 Free and widespread distribution of ARV
UN Secretary-General Kofi Annan,Al Gore, Vice Presidentof the USA, chaired thefirst debate on AIDS as amajor security issue at theUN Security Council inJanuary 2000.UN Photo
Prices (US$/year) of antiretroviral regimen in Uganda: 1998-2003
UNITED NATIONSGENERAL ASSEMBLYSPECIAL SESSION ON HIV/AIDS
25 - 27JUNE2001
United Nations
April 13, 2023UNAIDS 23Source: UNAIDS, 2010
Resources available for HIV in low- and middle-income countries, 1986-2010
People on ART in low and middle income countries (UNAIDS,2012)
Source: UNAIDS, 2011
Lessons from the AIDS response
• Evidence: both size of the problem and of solutions • Human rights as driver• Unified strategy • Political strategy • Bring solutions• A brilliant coalition • Activism by people affected
• Never take no for an answer!
Lessons from the chameleon
• Focus on your goal• Be flexible, while sticking to goal• Constantly process intelligence• One step at a time• Timing is everything
How AIDS invented Global Health (A.Brandt, NEJM 2013)
• Disrupted divide between prevention and treatment
• New forms of disease advocacy and activism• New global funding• Changed the cost of essential medicines • Recognised basic human rights • Major boost for global health research and
academic interest
HIV incidence and deaths England, 1981-2010 (PHE,2012)
New HIV infections 2001-2012
In some countries the entire AIDS treatment budget comes from international sources
Percentage of care and treatment expenditure from international sources
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
AlgeriaSeychelles
EgyptCongo
BotswanaLesotho
MoroccoAngola
ChadGabonBenin
SenegalSwazilandCameroon
UgandaBurundi
GhanaTogo
KenyaBurkina FasoSierra Leone
NigeriaCote d'Ivoire
MaliGuinea
MozambiqueGuinea-Bissau
MalawiEritrea
NigerCentral African Republic
RwandaDemocratic Republic of the Congo
0% 10 20 30 40 50 60 70 80 90 100%
Partners PrEP FTC/TDFPartners PrEP TDF
73% (49; 85)
39% (6; 60) CAPRISA 004 TNF gel
iPrEx FTC/TDF 42% (15; 63)
TDF-2 FTC/TDF 63% (22; 83)
FEM PrEP FTC/TDF 0% (-69; 41)
Efficacy of primary and secondary ARV-based prevention studies
62% (34; 78)
VOICE TDF
96% (77; 99)HPTN 052
HIV-diagnosed
Linked to care
Retained in care/Eligible for ART
On ARTAdherent to ART
0102030405060708090
100
United StatesMozambique
Perc
ent
The HIV Treatment Cascade Piot and Quinn, NEJM 2013;
How well equipped is Europe for the next challenges?
• New health challenges will emerge• Many countries have weak institutional capacity • Financial crisis has weakened Europe’s public
health and response capacity• Challenges beyond infectious diseases • Use regional funds to strengthen public health
institutions • Need to expand mandate of ECDC
Emerging infections
Declan B. Polio risk looms over Europe. Nature 2013; 502: 601
Europe needs a strong, autonomous Centre for Disease Control and Prevention , working with strong autonomous national Centres, addressing both infectious and chronic diseases
Science
Politics Services
EmpowermentDevelopment
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