¶ Intro / Opening
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Ebola has let's call it a family and there are five different strains. It's a very dangerous virus, but it's not a very contagious virus. It's not COVID that you can get by sitting on the bus with someone who has it. That's why I'm not concerned that this would become a pandemic.
Peter Piot, who helped identify ebola fifty years ago and has studied viruses ever since. Do you think that when you got COVID yourself and got it badly, did it change something in your own perception?
Yes? Actually I was scared to die. It's a lesson in humility and we're human beings at the end of the day.
From Bloomberg Weekend. This is the Mishal Husain Show. I'm Mishal Husain. Imagine this scene if you will from 1976. A group of scientists go to the epicenter of a mysterious virus in Central Africa, in the country that was then called Zaire. One Peter Piot has already investigated a blood sample at his lab back in Belgium, and he's
seen something strange and as yet unknown. Then at the heart of the outbreak, they work out in days how the virus is going from person to person, and soon it has a name, Ebola, from the nearby Ebola River. Today the country they visited is called the Democratic Republic of Congo, and it's where there is a new outbreak of Ebola, which everyone hopes is not as bad as the one in twenty fourteen, because that killed more than eleven thousand people across six countries, including the United States.
But Ebola is a frightening word, not least because through COVID we all now know what a pandemic is like. So for this episode, I wanted to understand this virus, demystify it, really work out how you get it, how long this outbreak might last, what vaccines there are. But talking to Peter Piot is also a journey into science and discovery in the widest sense. After that pioneering moment on Ebola, he went on to be a leading figure on HIV and now, as he reveals, he worries too
about what he calls an epidemic of misinformation. So I hope you get as much out of this conversation as I did. It began when Peter joined me from his home in Belgium, Professor Piot, can you hear me?
Oh yes, yes, hello Mishal. Nice to see you. Please call me Peter.
Very good to talk to you, Peter. And I'm especially grateful for your time because I know you're just back from a long trip and with many demands on your time given the situation in DRC. So thank you most importantly.
Yes. Well, I arrived home, took a shower, and went into the garden checking on the roses that are flowering. Yeah, it's my mental health program.
At various times, I might go back and forth between nineteen seventy six and the present day, just because you have all of this knowledge and it helps to set us. We're in a time of misunderstanding and alarm, and I think someone like you who can guide us through all of that and separate out the facts, it's really valuable.
Hopefully I can remember everything. Yeah, yeah, fifty years ago.
I'm not worried about that. May I begin by asking you to you to use your fifty year knowledge of this virus that we now know as Ebola, and take us back to the moment that you encountered it for the first time when you saw an image of it in your lab in Antwerp. What went through your mind?
Well, first of all, I was still in training and in virology. I was twenty seven years old, just two years after graduating from medical school, where my professors had told me no future in infectious diseases. So a boy like you should not go into infectious diseases. But I was passionate about it. And the real defining moment was
when we saw a virus under the electron microscope. In these days, virology and isolating viruses was a bit like cooking, which I like a lot, and you put it on cells, you injected in mice and some and then you wait and then you see something. Today it's all genetic, you know, identification and so on, and goes very fast. But the defining moment was really to see it under the electron microscope, and I said, I was part of a team, it's not just me. And what we saw was like a
bit more like spaghetti or worms or so. Viruses are usually spheres around or square, and here we had like, yeah, call it spaghetti, and we needed to think what is this and we needed to look into an atlas. This was before you know, we could go on the internet and see it all. And there was only one other virus that had the same morphology, the same shape, and that is Marburg virus, which had caused a deadly epidemic in the city of Marburg among people who are you know,
producing polio vaccine. And then we got a bit worried because that's high mortality and we couldn't take it further. We got the news from the WHO that we should forward it to the only laboratory in the world, a civil laboratory that was allowed to work with very deadly viruses, and that was at the Centers for Disease Control in Atlanta, Georgia. In the US. The three other so called P4 laboratories were all military laboratories preparing for biological warfare the Soviet
Union in the UK and in the US. It also tells you a bit of a story of the time, you know, But that was very exciting and I was, you know, twenty seven. I said, oh, my goodness, you know, a new virus. But my immediate thought was actually what does it do to people? Yeah, you know, how's it transmitted?
¶ "No future in infectious diseases"
So that's the moment that's the start of this fifty year journey. But I want to ask one more thing before we come to the present outbreak, and that is why had your professor said to you that there was no future in infectious diseases? What was the thinking at that time in the seventies.
Yeah, this was when I graduated in nineteen hundred and seventy four, and it was a prevailing wisdom. Don't we have antibiotics, don't we have vaccines, Don't we have hygiene, clean water and all that, so it's all under control? And today we know, of course that that's not the case. Two years later, new virus. There was a lot of
optimism about that, infectious diseases were on, were gone. But not only was there ebola, which was actually, frankly a small outbreak, but then came HIV, which has killed more people than even COVID, you know, in the meantime.
And which I think is your second life changing moment. Yeah, but I want to take you right to the present day because there's so much about this outbreak that we are learning, and there's a lot of distrust, there's a lot of misunderstanding. So help us to understand it. First of all, this particular strain, where do you think it emerged from.
Well, what we know is that most of these, if not all, the so called emerging infections, they're what we call zoonosis. In other words, they come from other animals
and they live happily with animals. In this case, we assume it's you know, it's about some kind of bat And it started actually in an extraordinary way in nineteen seventy six, because there were two outbreaks of Ebola independently, one in what was then called Zaire the Equator now the Democratic Republic of Congo, and another one in South Sudan,
independent from each other. And today we know that that's the Sudan strain and the Zaire strain, and both came from an animal that infected a human being and then transmitted. And the same is actually true for HIV. It came from chimpanzees. And when we have this deadly influenza epidemics, flu comes from animals. So that's why I think we will always see it unless we want to eradicate all
bats in the world. What we can prevent, though, is that they give rise to a big outbreak and a big epidemic, and that's what's happening now, and.
This particular strain is the Bundibugyo strain, and as it happens that there is a large colony of fruit bats right outside the town that's considered the epicenter. The key thing about this strain is that it's different from the one in twenty fourteen that caused thousands of deaths and for which there are vaccines and there are treatments approved.
Yeah, so Ebola has like it's nearly let's call it the family. And there are five different strains and the most common one is so called Zaire after the country that first happened and Sudan. And this Bundibugyo has only caused two fairly small outbreaks. It's actually a town in Uganda on the border with the Democratic Republic of Congo, and so it is a bit of a curiosum and we didn't expect that this would give rise to what
we see now. What's very very important is that the vaccines that we have against ebola is they're only active against Zaire because that's the most prevailing one. There's some therapies that were developed, but there was really not a strong reason to develop a vaccine specifically for this Bundibugyo
that then suddenly appeared. And that's also one of the reasons that it took quite a long time to identify and to diagnose that this was ebola, because the diagnostic tests also don't work against this new strain.
Yeah, two months I think before it was actually identified
¶ How contagious is Ebola?
as a strain of ebola.
Right.
How contagious is it? Because this is one of the key things that really alarms people, especially when they look at the evidence that there is on fatalities, in the number of fatalities per cases.
It's a very dangerous virus, but it's not a very contagious virus. But this is not corona. This is not COVID that you can get by sitting on the bus with someone who has it. You really need close contact and you need to be exposed to body fluids. That is why it's household contacts, often the women who care for someone or a child or an adult with ebola. It's
healthcare workers. Let's not forget. In twenty fourteen when there was the biggest outbreak that we know in West Africa, it killed fifteen hundred healthcare workers, doctors, nurses, laboratory workers and some because they also have a close contact and then and that's more cultural. In Central Africa, funerals are also a very dangerous moment because people say goodbye adieu to their loved ones by touching them, by hugging them before they're kind of buried, and that also gives rise
¶ "I'm not concerned that this will become a pandemic"
to explosion. But so it's you need close contact. That's why I'm not concerned that this would become a pandemic, you know, because that's reserved for you know, for respiratory transmission or for sexual transmission, as we see with HIV.
Interesting, it's so useful for you to separate out dangerous but not contagious or not so contagious, because to many people those two things are just inextricably linked. So just so I understand that a bit more. If you got off a plane and you discover that the person you'd been sitting next to on that plane had ebola, how frightened would you be?
I would be worried, of course, But unless you touch the person and all that, you know, the risk is is very close to zero. But you don't want to take a risk because the what we call case vitality rated chance that you die when you have, it is pretty high. I mean, in nineteen seventy six it was ninety percent, nine out of ten. In the previous outbreaks with Bundibugyo was about thirty percent. I mean, we say
it's low, but frankly one out of three tight. So I think you as you can't get it on the duke or in the bus in general.
¶ Are travel restrictions necessary?
So what do you think of travel restrictions which are starting to come in, notably by the United States, well not only in.
The United States. I think travel restrictions, let's put it this way, it depends how you're applying it. I mean, I think that what makes sense is to test people for fever, and if you're in a neighboring country, like if you're in Uganda, then people who come from the area with plenty of cases. Yeah, you would screen everybody for fever because another thing that ebola is that it's really people are stages when they are symptomatic, with some exceptions later on. So I would say you have to
be careful. I would indeed do screening for fever and all that from everybody who's coming. But a complete restriction I think is really overkilled. And actually the World Health Organization recommends against.
It, but I think you do worry about the spread within big cities because yes, human beings living close together, there's just much more potential for contamination exactly.
I mean, let's not forget the area where this is happening is very densely populated, even by African standards, and then you know people are very poor, so they live with many in the same room. But the worst case scenario for me is that it's in an area with extremely high insecurity, with armed struggle, with a lot of violence, which means that people will get close to each other.
You know, you can't move as you want, and that means also that controlling it through contact tracing and all that is difficult because what do you do in terms of ebola one. You try to identify to isolate as soon as possible someone who's infected, so from the moment
that they're having fever, headache and so on. It starts like a bit like a flu, you know, nothing specific, and although it's a hemorrhagic fever at the end you can start bleeding from your nose and so, but so, identify someone who you know has it and immediately isolate that person and then also isolate all the contacts of that person in a household or if they are you know, I've traveled or gone to a funeral or whatever. Isolate people.
Now that's not very fun, and as we know from COVID also it's not something people you know, appreciate, but it is really as primitive as that. And then you try to offer the best possible treatment, supportive treatment to someone with ebola, and we know that if you can provide good therapy, mortality will go down. In twenty twenty four, in Rwanda they had an outbreak of Marburg virus, a cousin let's say, from ebola high mortality. They brought it
down to about twenty percent. And we say only, I shouldn't say only, but it's a major decrease because in Rwanda they could provide intensive care and so on, but that is not available in where we have ebola. Now. It's such a poor area with very poor health facilities, and ebola just paralyzes the healthcare system, shut since down.
Can I tell you the moment Peter in the last few days that I think really brought home to me the inequality and the indignity that is an aspect of this. It's when I read a piece in the New York Times and Ebola's in the headlines, and yet this reporter, Declan Walsh went to the epicenter of this outbreak. Describes going to a hospital seeing a body covered by a thin sheet, highly contagious, yet hardly anyone in the ward was protected. He writes, in the next ward lay the
hospital's laboratory technician also sick. Seven other hospital workers already died from suspected ebola. The most rudimentary equipment was in dangerously short supply, tests, protective suits, goggles, masks, even drinking water. This shocked me because I guess I imagined that help had been sent, or sufficient help to an area affected by a bola to this extent, you read that and
¶ "Ebola is not their only problem"
realize it's not the case.
Yeah, I read the same article, and also I've seen it, and I really literally think every day about the people who live there. There are health conditions who are already
the basis is really is already pretty awful. You know, just when you think of women giving birth, the level of maternal mortality is enormous because around no decent health facilities, So ebola is not their only problem is malaria that is killing people, HIV TB you know, and just imagine you're a healthcare worker, you know, and you have ebola patients in your hospital. That means that anybody you touch
can mean for you the death sentence. And so that means that all regular healthcare is actually pretty much stocked. And that in an area where people are already suffering not only from poor health scare and health conditions, but also because of the violence of all kinds, including enormous
¶ How far are we from a vaccine for this Ebola strain?
sexual violence against women.
Today, how far are we, do you think, from a vaccine for this strain of a bowler.
Yeah, the first thing we is to see whether the available vaccine actually offers at least some protection.
Oh, the one for the other strain, for the other strain.
Yes, it's a vaccine made against the so called Zaire strain and we know that works, So we're lucky. And that's only you know, since the West Africa outbreak in twenty fourteen that we know that that works. That's the first thing to do. But then there is now a race going on to develop new vaccines against the Bundibugyo strain. But that's going to take time. I mean, let's say
six months. That's by the end of the year. And I'm not a pessimist at all, but I'm afraid that this outbreak will go on for quite a while, probably beyond the end of this year. And the reason is we've seen it before in that region also with a lot of violence, with attacks of care centers, and now it's even worse. The security situation is much worse than during the previous outbreak in twenty eighteen.
How many countries in the region do you think we'll be engulfed by this by the end of the year.
Well, I think that definitely. Uganda has already some cases, but they've been doing a good job in isolation and so on. I'm the most concerned about, of course DRC, the Congo, Uganda and South Sudan, which also has a lot of insecurity, very poor health conditions, very poor people. Rwanda, I think they're maybe at risk, but they've done a good job in the past in the debt and Burundi. I think these are the countries that are the immediate risk.
And one thing that is I think we should not underestimate is that there are no really outstanding world class teams in Africa who can deal with it, and that's something that did not exist before. So the capacity is there, but the means are not there. We need to really support them.
And the fact that you think it's worth trying the vaccines for the other strain to try and give people some protection. What are stocks of that? Like, how much of a challenge would it be to mass vaccinate the key region in the DRC for starters.
GAVI the Vaccine Alliance has quite a big stock of I don't know the numbers, but its tens of thousands. And the way to deal with this is not to vaccinate everybody, but what we call ring vaccination. So what does it mean. It's I have it ebola, so everybody around me will be vaccinated because these are the people at high risk. And so what they're starting to do is to vaccinate all healthcare workers and say frontline workers, people who deal with funerals, bearer burials and so and
then the family members and so on. So that's a matter of logistics now. Frankly, this is the biggest challenge getting the supplies there also the protective equipment.
¶ Tackling Ebola in 1976
You were one of those people at the heart of an outbreak when you went to what was then zire in nineteen seventy six after seeing the virus in the lab in Antwerp. How much did you think about becoming infected yourself?
Well, first, I was twenty seven. I was very excited. I'd never been to Africa, I'd never investigated an outbreak. And the first challenge we had is that this is a new virus, completely unknown, and we had no clue how this is transmitted. Is it mosquitoes, which was my biggest worry, because how do you protect yourself? Is it water? Is it food? Is it touching someone? Is it blood? Is it sex? I mean all the ways that viruses transmit it. But we found that out and within forty
eight hours that it must be close contact. But what do you do? Then? We were protecting our eyes. I used their motorbike goggles because they're very close, a mask for mouth and nose, and gloves, but nothing like what they use now in terms of, you know, so called protective equipment. It just wasn't there. But we were careful. But on the other hand, I drew blood, I touched patients and yeah, we couldn't do much for them.
How did you discover in forty eight hours how it was transmitted because I mean, this is fifty years ago in a really challenged part of the world, even more challenged than it is today.
Oh yeah, there was definitely no AI to tell us what it would be, not even mobile phones. So what
¶ Tracking the virus
you ask yourself three questions when you're in front of an epidemic, and that is time, place, and person. In this case, we said, when they they die, and then you see and it goes up and up and up it's an epidemic. And then we saw it was going down. Okay, very interesting. Then you ask, okay, when did it go down? And then it turned out that that's when the hospital
was basically closed. Eleven out of seventeen hospital workers had died. Secondly, place, we mapped it out, and we saw that the closer you lived to the hospital, the more likely that you have it. And thirdly, most important, who person? And so you map it out by age and sex. It's as simple as that. And what did we see? One? Very
few children died and were infected. So that's we said, okay, that it makes it very unlikely that this is mosquitoes insects, or that it's water or so why because why would children be saved? And secondly, we found that there were twice as many women between eighteen and thirty who died than men. And since we were a bunch of men, it took us twenty four hours to find out what's the difference between men and women. Of course, women can get pregnant at that age, and then you start, you say, okay,
were they pregnant? And indeed were the excess of women were pregnant women or women who had just delivered, and they had been at the hospital, so everything pointed to the hospital. It's not really rocket science. And then you use your brain and you talk to people. I also asked in the villages, how do you think that it's transmitted? And you know, it's more like journalism, a bit of detective story, and it's only afterwards that you prove it scientifically.
But we needed an answer very very fast, and we found it with a high level certainty.
I hadn't really thought about the links between my work and yours, but I see.
Them now definitely. No. Yeah, I hesitated between a journalism or detective or some like this epidemiology, and I.
Think the one of the sad moments when you wrote about it in your book, you realized that these very well meaning nuns who had seen fellow nuns die from this mystery virus. You were the one who, you and your team who realized that inadvertently, through the syringes they were using in that hospital, they were inadvertently spreading the virus and passing it from one woman to another.
What we found is that these pregnant women who had gone to an anti natal clinic, the mortality was very high. But then it took a while to find out that there were only three syringes and that they were not sterilized only at the end of the day. And this is the most effective way of transmitting a virus, you injected directly into you all another person. Yeah, and that was yeah, the women. I'm Flemish, so I could speak in Flemish dialect and too the and then it was tragic.
Yeah, we live in an age of vaccine hesitancy and distrust sometimes in conventional medicine. Those local people back then who started to fear the hospital in that particular context, they were right.
They were absolutely right. And that's what they told me when I went into the villages and talked to people, and they said, they said, there's something wrong at that hospital. That's when we stopped going there. But you mentioned something that is now extremely important and is added to violence in the region, and that is the lack of trust amplified by social media conspiracy theories. In the last epidemic in the region, they already burned several care facilities already
too have been burned also now. And so on the one hand, I understand it. I mean, you know, just imagine you're Ebola. You were put in isolation, and you die in isolation, and then all your family sees is a plastic bag. And particularly in a culture where ancestors are so important, where saying farewell to the ancestors is really extremely important as part of life. And then that's
amplified that the mistrust by social media. We did not exist, you know, certainly not fifty years ago, and that's why today is far more complicated than before. We have better tools, hopefully we'll have a vaccine, we have maybe treatment, but we also have the epidemic of misinformation, and that means that when we deal with epidemic, we also have to invest in social media in the influences. Before we would talk to the traditional leaders, religious leaders and people would
listen to them. That's still the case, but not with the young people.
There are people, pull companies, universities working on a vaccine right now. But I wonder if you have a message to the pharmaceutical industry more widely, given that today it's clear how much money there is to be made from weight loss drugs, and there was a study out the other day that said that obesity drugs have displaced oncology drugs is the largest contributor to the industry's pipeline value. That's happened for the first time in more than a decade.
What's your message to the industry not to forget these needs.
Well, my message is not only to the industry but also to governments and public authorities. We really need to invest in vaccines, but also drugs against viruses, antiviral drugs that we will need when there's the next epidemic, because what we now see is this cycle of Okay, there's a new virus or a new epidemic, panic, and then we scramble in and there's money, and we will have quite optimistic vaccines, and then we forget, you know, think
of COVID. We've forgotten and I psychologically I understand you don't want to remember all the time all the bad things that happened. But as a public authority, we can't do that. So we need to continue to invest in preparedness and that needs industry and you know, there is what we could call there's no market incentives. Who are making a vaccine against the Bundibugyo virus. I mean that requires public money. Fortunately for vaccines, we have SEPI Collision
for Epidemic Preparedness Innovation and that's working. And like in the European Union, now we have here are there are now mechanisms which we did not have before. But keeping that on the political agenda is quite a challenge. It's really bad that we wait when there's another crisis to wake up again and then you know, and then we all joined forces as we did for COVID, But we need to continue to invest in this absolutely.
I have been thinking about the link to COVID and the experience of COVID and how people perceive an outbreak of a bowler like this, because clearly science has moved on and the progress made during COVID is playing a role right now. AI is playing a role in the discovery of therapeutics but also people are triggered by COVID.
If they think lockdowns were an overreaction or there was misinformation, then they, you know, revert to those perceptions, and that's the lens through which they see something like this.
Yeah, it's true that COVID was collectively a quite traumatic experience. I had it myself. I was even in intensive care and so so for once the virus got me also, but fortunately I'm well. Collectively, I think, on the one hand, you can say it's a triumph of science to know that we had a vaccine so fast and that saved millions and millions of life. On the other hand, there's a group of people that believe that all this was
a conspiracy, that it didn't happen. And this is I would say, a relatively new phenomenon because it can be accelerated by social media AI will make it even more effective.
¶ Vaccine disinformation
And for me, the big lesson is that we need to listen really to people. We need to communicate. It's not as many scientists think a matter of give more information. It's often about something else because I don't trust the state, and that's where we need. Also. The signs of misinformation and developed not only vaccines against viruses, but maybe vaccines against this misinformation, if I may use that term A plus,
we should not be naive. Also some of these misinformation you know, campaigns, and so they can be you know, organized by foreign powers and all that. So it is a world that we're in that where we need to take these things very seriously because they are there to undermine our societal resilience and cohesion. And without that you
¶ "Long Covid really exists"
can't deal with epidemics.
You had long COVID. I think it lasted quite a few months. There are doctors today who don't really believe that such a thing exists.
Well, they can call me no, no, the long COVID really exists. I mean I could not cross the street who's living then in London and we were living in one of these houses. The bedroom was on the third floor, so I slept downstairs. I could not make no. No, you're it is. It's very well documented. Now. I'm lucky that I can run ten kilometers no problem, but some people for years they're suffering. And fortunately there's quite some research going on now, but I still haven't found exactly
how to treat it. It may be a mixture of other things, but I'm optimistic that thanks to the investments in dealing with long COVID, we will also hopefully find treatments and a way to, you know, to manage people who have this kind of chronic fatigue syndrome due to
¶ "I was scared to die"
other viruses.
Do you think that when you got COVID yourself and got it badly, did it change something in your own perception of our relationship with viruses after so many years of having been in contact with pathogens.
Yes, actually one. I was at some point scared to die, that's one thing. But it made me realize that, you know, we're all vulnerable. It can happen to anybody. And it made me also more to say interest not only in the virus, but also in the people. And certainly I mean, I'm privileged because we were living in London and the healthcare is there and so but going back to where we have ebola, there is no safety net. It's a lesson in humility and we're human beings at the end of the day.
And having done detective work on more than one virus, what is left for you to solve? Do you still have a burning scientific desire or another problem that you're just longing to get to grips with fully.
I'm seventy seven, so I, you know, supporting young people to take it on new ideas, they come up with the digital stuff and AI and so that can make it all more efficient and faster to solve problems. I'm now particularly interested in the societal aspects, but I'm not looking for another vir I mean, when you look at it, serendipity has been a major element in my life. You know it all right? Did we isolated ball in and to up in Belgium Because in these days in Zaire
it was not possible to isolate a virus. Today they can do sequencing. They do it in you know, in no time, and that gives me also a lot of satisfaction that there is progress. Although sometimes you wonder in the world, but on the field of pandemic control and some we remade fantastic progress.
Professor Peter Piot, thank you very much.
Thank you, Mishal, good to talk.
I like the idea that you came back and went to check on your roses. That's that's that's very close to my heart.
Do you have a garden, yes, and.
Well a very recently planted rose garden. So I too go and inspect my roses most mornings.
And when you come to Brussels, let me know I'll come.
And see your rose garden. Yeah, thank you so much, Peter, take care, thank you, And that's it for this week. Apart from Peter's own book, which is called No Time to Lose, there was so much I read and we read as a team for this episode. So on the show page, which is Bloomberg dot com forward slash Michelle, you'll find the written version of this with links to that material and my notes, and also photos of Peter at work in Zaire as it then was. The show's
producers are Jessica Beck and Chris Martlew. Guest booking is by Elan Bird. Video producers this week Andy Hayward and Maria Grechaninova. Social media is by Alex Morgan. Our music is by Bart Warshaw. The executive producer is Louisa Lewis at Bloomberg Weekend. Our thanks to Brendan Francis Newnam and our executive editor Katherine Bell. Finally, please do subscribe to follow episodes as they come every Friday, and until next time, goodbye,