When Dr. Peter Piot was a young scientist, in 1976, he received a shiny, blue thermos in his Antwerp lab. It was filled with the blood of a Belgium nun who worked in the Democratic Republic of the Congo (then Zaire). The woman had fallen ill with a mysterious sickness, and Piot was asked to screen the blood for yellow fever.



"We didn't even imagine the risk we were taking," Piot, now the director of the London School of Hygiene and Tropical Medicine, wrote in his memoir No Time to Lose. The sample tested negative for yellow fever and a range of other pathogens. But Piot, along with a group of infectious diseases researchers, would later discover that — in that "soup of half-melted ice" and cracked vials — lurked a deadly virus, Ebola.



Just before the discovery, Piot's professors told him that he had no future in infectious diseases. Back then, many people believed that science had solved the problems viruses created in humans with new vaccines and antivirals. Then came Ebola — a disease for which we still have no cure — and later HIV/AIDS in the 1980s.



Piot is now one of the world's foremost infectious diseases experts, and a former under-secretary general of the United Nations. He's been watching the world's largest-ever Ebola epidemic unfold from his post in London, and we spoke with him about his thoughts on the outbreak and how the global community can prevent future tragedies of this scale. This transcript has been edited for length and clarity.

Julia Belluz: You've been working on Ebola since you co-discovered the virus in 1976. For nearly 40 years, this disease has largely been ignored by the international community except for brief flashes of interest, mostly spurred by Hollywood. Now we are seeing unprecedented attention and political galvanization around Ebola. What changed?



Peter Piot: In the 38 years since 1976 until this current outbreak, there have been something like 1,500 people who died in total. So that's less than 50 deaths per year. Up to now, it was not a real public health problem. This year, nearly 3,000 have died. All 24 previous outbreaks were both time and place limited to very confined communities. Even in the worst case, Ebola would kill 300 people. Here it has involved entire countries, and it has been going on for over nine months now.

JB: But the death toll was rising rapidly for months before the international community responded. What do you think finally sparked collective action?



PP: It was the Americans getting Ebola, I'm afraid. Beyond that, I don't know what changed it, really. Early in the second or third week of July, I gave an interview with CNN and I said this crisis requires a state of emergency and a quasi-military operation. After the interview, I thought maybe I exaggerated. But I felt that it was really getting out of hand and it looked like a completely different type of Ebola outbreak than we'd seen before. Then it took another month, so I really don't know.



"It took 1,000 deaths before a public health emergency was declared, and cynically it took two American doctors to become infected."

JB: Before this year, could you have imagined an Ebola outbreak of this size?



PP: I never thought it would get this big. I always thought it was an accident of history where someone becomes infected — from a bat probably — and then an outbreak is contained. Ebola came and went. I really never thought this could happen. But it shows again: when the right, or bad conditions are all combined with each other, then these things will happen again.

JB: We've seen a surge in the number of deaths now for weeks with no sign that the virus is slowing down. Why do you think this outbreak spun so far out of control?

PP: I think this is a result of a perfect storm of a lack of trust in authorities, in western medicine, dysfunctional health services, a belief in witchcraft as cause of disease and not viruses, traditional funeral rites, and a very slow response both nationally and internationally. The longer we wait, the longer there is an insufficient response, the worse it will get, the more difficult it will be to control this epidemic through quarantine and isolation and all the methods that worked in the past.

JB: Most of what you point out here has to do with things that we had no control over — an accident of geography, local beliefs. Can you point to a place where the ball was dropped in this Ebola response, something that should have been done to minimize the suffering in West Africa?



PP: It took more than three months to diagnosis the epidemic. The first case was in December and then they only diagnosed that it was Ebola in March. But then it took far too long before the international community did anything. That goes from the WHO, to the US, and UK governments. It took 1,000 deaths before a public health emergency was declared by the WHO, and cynically it took two American doctors to become infected. I think that's where particularly the local office of the WHO was inadequate, that's for sure. But it's not just WHO. It's the member states of the WHO, the ones who decide about the budget at the WHO.



JB: What do you think will be the lessons learned from this epidemic?



PP: This outbreak has highlighted the fact that we need to make sure we are far better equipped for epidemics in general. There will be others. But the good news is also that experimental therapies and vaccines for Ebola are now being tested for their efficacy so I think that's positive. For the next outbreak, we should have stockpiles of vaccines and therapies.



I also think this outbreak is changing the paradigm that there will be more investment, and accelerated development of drugs for rare diseases. Another impact is that there will be a financially protected team that can deal with outbreaks at the WHO and that there will be massive support to strengthen the health systems and services in these countries.

JB: Strengthening health systems seems to be the thing we need most to make sure all nations can identify and respond to outbreaks like this, but that's also the hardest thing to fix.



PP: I don't think you can fix it. Each country is different. There is an illusion that there is one fix for the three neighboring countries [battling Ebola — e.g. Liberia, Sierra Leone and Guinea]. But they all have different problems. It's important to have a commitment to the long-term view — so when we're talking about global health programs and international development, that there is the long-term view that includes building health systems. That's not a matter of two or five years, that's ten years you need as a horizon.

JB: Those long-term timelines don't exactly square with political agendas, which are short term. What happens when the political will and interest falls away?



PP: We've been there before. After war, we say 'never again.' After Katrina, we say 'we'll do this and that,' and then it gets out of the public eye. I don't know how to do it. I hope that the Ebola epidemic is a wake up call for that if we don't invest more in these health systems, that we are at risk for a repetition of the current Ebola crisis.



JB: What is the biggest public-health threat on the horizon?



PP: The biggest threat remains a flu pandemic. There I think we're better prepared with early alerts and the good news is that China is quite open now. The first cases of flu often come from China. In more recent years — still fortunately small outbreaks — there was open and prompt reporting [to the international community about flu cases]. I think there we have made real progress. But I think it'll come back to the fact that there has to be some central leadership.