Keynote address: 'No time to lose: of infectious diseases, science, politics and institutions’,...
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No Time to Lose:
Of infectious disease, science, politics and institutions
Peter Piot
ESCAIDE
Stockholm
5.11.2013Improving health worldwide
www.lshtm.ac.uk
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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
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Global HIV prevalence in adults, 1985
UNAIDS/WHO, 2006
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Prevalence of HIV Infection,2012
Piot and Quinn, N Engl J Med 2013; 368:2210
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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
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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
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“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)
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Treatment Action Campaign (TAC)Treatment Action Campaign (TAC)
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Leadership
Former President Fernando HenriqueCardoso of Brazil.
1988 Drugs for opportunistic infections provided
1991 Zidovudine provided
1996 Free and widespread distribution of ARV
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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
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Prices (US$/year) of antiretroviral regimen in Uganda: 1998-2003
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UNITED NATIONSGENERAL ASSEMBLYSPECIAL SESSION ON HIV/AIDS
25 - 27JUNE2001
United Nations
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April 13, 2023UNAIDS 23Source: UNAIDS, 2010
Resources available for HIV in low- and middle-income countries, 1986-2010
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People on ART in low and middle income countries (UNAIDS,2012)
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Source: UNAIDS, 2011
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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!
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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
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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
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HIV incidence and deaths England, 1981-2010 (PHE,2012)
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New HIV infections 2001-2012
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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
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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
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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;
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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
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Emerging infections
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Declan B. Polio risk looms over Europe. Nature 2013; 502: 601
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Europe needs a strong, autonomous Centre for Disease Control and Prevention , working with strong autonomous national Centres, addressing both infectious and chronic diseases
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Science
Politics Services
EmpowermentDevelopment
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