Ebola Is Back: Virus Pioneer Peter Piot Explains the Threat

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1:39Bloomberg Audio Studios. Podcasts, radio, news. 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 50 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 are human beings at the end of the day.

2:28From Bloomberg Weekend, this is the Michelle Hussain Show. I'm Michelle Hussain.

2:37Imagine this scene, if you will, from 1976. A group of scientists go to the epicentre 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 2014, because that killed more than 11 ,000 people across six countries, including the United States.

3:40But 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.

4:35Professor Piot, can you hear me? Oh, yes, yes. Hello, Michelle. 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 1976 and the present day, just because you have all of this knowledge and it helps to set us.

5:16We'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 50 years ago. I'm not worried about that. May I begin by asking you to use your 50-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 27 years old, just two years after graduating from medical school, where my professors had told me no future in infectious diseases.

6:07So 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 inject it in mice and so on, and then you wait and then you see something. Today, it's all genetic 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.

6:55Viruses are usually spheres round or square. And here we had like, yeah, I 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 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.

7:58The three other so-called P4 laboratories were all military laboratories preparing for biological warfare in 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, 27. 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 is it transmitted? So that's the moment that's the start of this 50-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.

8:35What was the thinking at that time in the 70s? Yeah, this was when I graduated in 1974. And it was the 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 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.

9:20But 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, these 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 a bat, some kind of bat. And it started actually in an extraordinary way in 1976, 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.

10:18And 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 epidemic, the 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 Bundibugio strain. And as it happens, there is a large colony of fruit bats right outside the town that's considered the epicenter.

11:04The key thing about this strain is that it's different from the one in 2014 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 a family, and there are five different strains. And the most common one is so-called Zaire, after the country where it first happened, and Sudan. And this Budi Boomio 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, yeah, a bit of a curiosum, and we didn't expect that this would give rise to what we see now.

11:49What's very, very important is that the vaccines that we have against Ebola, 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 Bundibugiw 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 as a strain of Ebola. Right. How contagious is it?

12:31Because this is one of the key things that really alarms people, especially when they look at the evidence that there is on fatalities and 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, a child or an adult with Ebola, it's healthcare workers. Let's not forget in 2014, when there was the biggest outbreak that we know in West Africa, it killed 1 ,500 healthcare workers, doctors, nurses, laboratory workers, and so on, because they also have close contact.

13:24And 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 to explosion. But so 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.

14:13So just so I understand that a bit more, if you got off a plane and you discovered 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 very close to zero. But you don't want to take a risk because the what we call case fatality rate, the chance that you die when you have it is pretty high. I mean, in 1976, it was 90 percent, nine out of 10. In the previous outbreaks with Bougie Bougieau was about 30 percent. I mean, we say it's low, but frankly, one out of three tied.

14:56So I think you can't get it on the tube or in a bus in general. 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 with Ebola is that it's really people are contagious when they're symptomatic.

15:39with 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 overkill. And actually, the World Health Organization recommends against it. But I think you do worry about the spread within big cities because 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.

16:27But 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, I mean, 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 on.

17:14But 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, traveled or gone to a funeral or whatever, isolate people. Now, that's not very fun. And as we know from COVID also, that's not something people 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 2024, in Rwanda, they had an outbreak of Marburg virus, a cousin, let's say, from Ebola.

18:05High mortality. They brought it down to about 20%. 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, shuts it down.

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21:24Can 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 is in the headlines. And yet this reporter, Declan Walsh, who 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.

22:08This shocked me because I guess I imagined that help had been sent or sufficient help to an area affected by Ebola to this extent. And yet you read that and realize it's not the case. Yeah, I read the same article and also I've seen it and I literally think every day about the people who live there. their health conditions were 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 there are no decent health facilities. So Ebola is not their only problem. It's malaria that is killing people with HIV, TB, you know.

22:53And just imagine you're a healthcare worker, 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 health care is actually pretty much taught. And that in an area where people are already suffering, not only from poor health care and health conditions, but also because of the violence of all kinds, including enormous sexual violence against women. Today, how far are we, do you think, from a vaccine for this strain of Ebola? Yeah, the first thing is to see whether the available vaccine actually offers at least some protection.

23:43Oh, 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 2014 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 Boongi Boogio strain but that's going to take time I mean let's say six months that's by the end of the year but 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 centres.

24:30And now it's even worse. The security situation is much worse than during the previous outbreak in 2018. How many countries in the region do you think will 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 um maybe at risk but they've done a good job in the past in the in that and burundi i think these are the countries that are the immediate risk.

25:15And one thing that 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 it's tens of thousands.

25:59And 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 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 let's say frontline workers, people who deal with funerals, barioles and so on, 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 you were one of those people at the heart of an outbreak when you went to what was then zaya in 1976 after seeing the virus in the lab in antwerp how much did you think about becoming infected yourself well first i was 27 i was very excited i'd never been to africa i'd never you know investigate 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 virus is transmitted but we found that out in within 48 hours that it must be close contact but what do you do then we were protecting our eyes i i used the motor bike goggles because that they're very close um a mask for mouth and nose and then gloves but nothing like what they use now in terms of um 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 And yeah, we couldn't do much for them.

27:53How did you discover in 48 hours how it was transmitted? Because, I mean, this is 50 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, but 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 did I 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.

28:3411 out of 17 hospital workers had died. Secondly, place. We mapped it out, and we saw that the closer you live 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 makes it very unlikely that this is mosquitoes, insects, or that it's water or so, because why would children be saved? And secondly, we found that there were twice as many women between 18 and 30 who died than men. And since we were a bunch of men, it took us 24 hours to find out what's the difference between men and women.

29:26Of course, women can get pregnant at that age. And then you start to say, ah, okay, were they pregnant? And indeed, 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.

30:09I hadn't really thought about the links between my work and yours, but I see them now. Definitely. No, I hesitated between a journalism or detective or something like this, epidemiology. And I think 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 antenatal clinic, their mortality was very high.