Peter Piot: The Crisis Manager

Influence can be evaluated in many ways, but what is rare is a record that demonstrates accomplishment in both the cloistered academies of science and the combative world of policy. Piot, a physician and microbiologist by training, bridges both divides, having built an early record as a researcher in codiscovering the Ebola virus—and hence its containment as a serious public health threat—and then moving to lead a globally integrated approach to managing the HIV pandemic as the founding Director of the UN AIDS Program from 1995 to 2008.

Peter Piot, MD

Today, Piot is continuing that dual role as Director of the London School of Hygiene and Tropical Medicine, where he is busy recasting the school's mission to promote systemwide innovations in public health while applying his deep knowledge of the HIV environment to raise the visibility of non-communicable diseases (NCD) on the global policy agenda. "Science and innovation will only be as good as the institutions and processes responsible for delivering it to those in need," Piot says.

Most industry CEOs acknowledge that it was the work of Piot and other advocates for disenfranchised patients that transformed how drug companies dealt with the AIDS pandemic. According to Piot, a decade ago, the industry had no strategy for examining the AIDS crisis from the necessary global perspective; today, it is both thinking and acting to counter a condition that knows no boundaries. He notes that companies have addressed the access issue through technology transfers, licensing concessions, tiered pricing, and direct donation and funding commitments for first-line anti-retroviral drugs. "It's a sea change compared to what we started with." Another change is the flexibility the industry is now showing on IP rights—while Piot is skeptical about the practical usefulness of patent pooling, approaches like the sharing of compound libraries and other open innovation tools are already bearing fruit.

Piot's principal accomplishment as Director of the UN AIDS Program was to create and execute a coordinated global government response, a strategy that required he move the focus of attention from AIDS as a strictly medical challenge to what amounted to a political campaign. "We knew from the start that no progress could be made in halting the spread of infection if we did not focus on developing countries, particularly in expanding access to these miraculous new classes of HIV-inhibiting drugs. It was audacious at the time, and it took us five years to do it, but as part of my coordinator mandate I did move the debate forward to the top political level at the UN. A special meeting of the UN Security Council in January 2000 and subsequently at the General Assembly engaged finance ministers and leaders in sectors complementary to health, transforming AIDS into a high-profile social progress and development issue rather than one of disease alone. Last month's GA summit on NCDs builds on the precedent we set through UN AIDS."

Piot admits he could never have succeeded without the campaigning of the activist and patient communities, even though the groups made his life difficult at times: "The activists held us accountable." His assessment is that the patient movement is weaker today, a trend partly due to "issue fatigue" founded in part on the erroneous perception that drugs have made AIDS a permanent chronic condition—not a killer—and that spread of the pandemic has been arrested. How to retain interest in the pandemic among the next generation of influentials is something that keeps Piot up at night. Complacency is the virus's best ally.

What leadership lessons does Piot derive from his tenure in the multilateral arena? He outlines three. The first is intense focus. "I always thought about the dimensions of the pandemic first—how to defeat it, with clear goals and targets that are feasible given the resources, mandates, and timelines we had to operate under. The second is to build coalitions—the collaborative approach to making progress. "My assumption is that those who pose a problem must be engaged, as they often are critical to the solution." In that regard, Piot differs from many colleagues in government and academia in insisting that industry be included as a key stakeholder in the debate. The third is taking the long-term view to avoid the confining prison of "in the moment" thinking. "If something is of value in this world, it's unlikely to be accomplished in a day." – William Looney