No Time to Lose: A Life in Pursuit of Deadly Viruses (24 page)

After the conference ended I took a week off in the Alps with my family and thought about the prospect seriously. I thought about how the new UN agency might work. I weighed the kind of impact it might have. Then I called Hans Moerkerk to tell him I would be a candidate to direct the new body. I added that I wanted to win.

CHAPTER 16

Sharks in the Water

G
ENEVA IS A
small town, and the UN is a big industry there. By mid-September the air was full of rumors about who would be nominated as director of the new AIDS program. Various AIDS constituencies and governments were becoming exasperated by the lack of progress by the cosponsoring agencies, and a consensus had emerged that the process wouldn’t be able to move forward until a leader for this new entity had been identified. Most countries were looking for a political hot shot: a well-known figure, a bankable name.

The selection of this director started accelerating at various levels. The Netherlands and Germany formally announced that I was their candidate, soon followed by Denmark and then my own country. (In other words, I certainly was not promoted by my own country first, as is so often the case with candidates for top UN jobs.) As president of the European Union for the second half of 2004, Germany rallied the European Union behind me. Soon thereafter, and to many people’s surprise my friend Ibrahim Ndoye from Senegal told me his government had officially decided to back me.

Ibrahim also told me that a marabout—a holy man—had slaughtered a bull for my success, just to be sure. And he sent me a special amulet by DHL, a wad of nonwoven cloth, tied up with thread. There’s something inside it, though I have no idea what. As a scientist I’m kind of embarrassed to say this, but I have carried that thing beside a photo of my children in my wallet ever since; it has done a good job so far.

Slowly, but surely, support for my candidacy grew, including from nongovernmental organizations, which had become very vocal in the process. By now, every day brought new rumors about candidates. They destabilized me a little in the beginning, but I decided to keep my head cool and continue with my work at WHO, while quietly lobbying for the new position. I had nothing to lose: deep down I was still hoping that a more competent person than I could be found for what increasingly looked like it was going to be a brutal job. I also still had a job waiting for me back in Antwerp, as the new dean of the Institute of Tropical Medicine. On three occasions I was approached to renounce my candidacy and become the deputy of someone else—as, in the words of one official, they “would need someone to do the work.” I thanked them politely and said that if they wanted me to do the work, I could just as well be the actual boss. At no stage did I feel it worth compromising, just to have a well-paid, prestigious job.

Quite a lot was at stake. It was by no means clear whether the new AIDS program would be a weak secretariat—basically a powerless coordinating administration—or a strong body that would, in effect, lead the whole UN system’s effort against AIDS, with money and political clout. The task force of UN agencies was still paralyzed, still calling it an “entity,” and there continued to be a high degree of animosity about the process. On October 6, a director from UNDP told me that if I were appointed, “UNDP and UNICEF would do everything they could to sabotage me.” I suppose they saw me as a puppet of WHO, a technical guy from the medical establishment. Even if I hardly knew them, mid-level UNDP and UNICEF staff treated me with hostility. I’m still puzzled by their behavior, in which mediocrity was often matched by arrogance.

I began to actively campaign. In October I went to New York, to a meeting of the Economic and Social Committee, ECOSOC, a broad and often weak UN body that oversees economics and social affairs. I had never even heard of ECOSOC before, but it was the body with the mandate to formally establish the new agency. I also went to Washington, to visit the World Bank and see policy makers at the US departments of State and of Health and Human Services. In the eyes of the UN system Washington is kind of a lion’s den because it is the powerhouse of the world and the largest contributor to UN programs, given the size of its economy. Even though some were implying that US support for the AIDS agency would depend on having an American as its director, I knew after my trip to Washington that I could work with the United States and vice versa.

Then, in a surprising turnaround, Dr. Nakajima and his regional directors at WHO said they would nominate me, together with Dr. Kumate from Mexico. Many Ministries of Health, which had been waiting for WHO’s guidance, followed suit. I was then in a very delicate position: I didn’t want in any way to be perceived as a pawn of Nakajima’s; I had a very different vision on what this new program on AIDS should do. But I understood that without WHO’s support no director would be successful.

The appointment was due to take place on December 12, 1994, at a meeting in New York of the executive heads of the Committee of Cosponsoring Organizations. A task force cochaired by Nils Arne Kastberg, a Swedish diplomat, Bernadette Olowo-Freers, a Ugandan diplomat, and El Hadj As Sy, a Senegalese NGO leader organized the process. They sent out what they called a “straw poll” to all governments and well over a hundred NGOs, asking them who they would like to see as director. (This was unprecedented, as far as I know, in UN history.) On December 2, I had lunch with Helene Gayle, and she said she was giving up her candidacy for personal reasons, and would support me. On December 5, the results of the poll came in and I was flabbergasted to see my name so prevalent among them. I did not know a soul in many countries nominating me. In the meantime, at an AIDS summit hosted by the French government, several countries said they supported my candidacy.

On the morning of December 12 I was drinking tea at the Belgian Permanent Mission across the street from the UN headquarters in New York when I got a call asking me to come immediately to the meeting of the Committee of Cosponsoring Organizations, which was deliberating on the new appointment. I had no idea this would be part of the process, but the principals of all six agencies—WHO, World Bank, UNDP, UNICEF, UNFPA, and UNESCO—wanted to interview me. I had never even set foot at the UN headquarters, and I didn’t think to ask for the number of the meeting room. When I got to the building, the security guards wouldn’t let me in, and I literally just ran past them. (This was before September 11!)

But then I had no idea where the meeting was. So I asked someone what floor the secretary-general’s office was on; I thought a meeting that important, creating a new UN agency, must be on his floor, the 38th. Finally someone told me it was taking place in the basement—a bad level, I thought, to start a new career. I arrived half an hour late, a nervous wreck. I was asked a number of tricky questions, as each agency wanted to test me on their area of interest, sometimes in conflict with the viewpoint of another agency. The atmosphere was not pleasant. This antipathy had more to do with institutional territory than with my person as such. As individuals these were mostly decent and competent people, but the whole process of creating this new agency—whose mission was, let’s not forget, to help people—was in fact driven by the urge for control and power.

I waited in a corridor for about 15 minutes and then someone came out and said I had been chosen. I went back in, everybody congratulated me, and then they promptly moved to the next item on the agenda. Although I was still digesting what had just happened to me, I realized that the discussions were basically aiming at undermining the position of the newly elected director—me. Dr. Jim Sherry, who represented UNICEF (the director, Jim Grant, was by now terminally ill), passed me a very small piece of paper with five words on it: “Peter. Congratulations, you poor bastard.” Friendly and cynical at the same time—at least he was honest! I decided on the spot that I wanted to hire him.

Around noon Nakajima took me up to meet UN Secretary-General Boutros Boutros-Ghali, who formally appointed me. We shook hands for a photo; I never saw him again. We then went straight to a press conference where the first question was, “What is the position of this new UN program on masturbation?”

Another trick question. A few days before, President Bill Clinton had fired US Surgeon General Joycelyn Elders because, when asked whether it would be appropriate to promote masturbation as a means of preventing young people from engaging in unsafe sex, she replied, “I think that it is part of human sexuality, and perhaps it should be taught.” Outrage ensued. Such a trivial episode; so surreal, that something like that could end a fine career. But I knew about it, and realized that the wrong answer could be the swift demise of my own, ultrashort career at the UN. So I responded to the reporter’s question very blandly: “To a scientist it’s very clear you need two to transmit the virus. Next question, please.” I dodged the bullet—my political skills were already improving.

Then CNN asked me for a live interview for the world news, strung me up with some equipment, and the world was told about my existence and that of this new program that would stop the AIDS epidemic. So began the media whirlwind that would last for 14 years. There was no return possible, and I knew that. I went back to my hotel and wrote in my notebook: “I feel very lonely, with an impossible task.”

THAT NIGHT I
couldn’t sleep: hundreds of thoughts tumbled through my head at once. Eighteen million adults and over a million children were estimated to be living with HIV already, and the curve was rising steeply. In the following 12 months, over 3 million more people became infected worldwide. China began reporting fragments of data in what was soon recognized as an epidemic of at least 30,000 to 50,000 people who had been infected when selling their blood in the central Henan province, through criminally careless medical practice. No country in the world could be called “safe” from AIDS, and it was absolutely unclear whether HIV would start spreading as fast through Asia as it was already doing in Africa—we simply did not have the information. There was no treatment. The lives of people with HIV could be prolonged, but they could not be saved. And there was not even the beginning of a real vaccine.

We needed a massive, very profound behavioral shift. People around the world had to learn to use condoms at every sexual encounter except confirmed monogamy—whether they be acts of prostitution, of homosexuality, or casual encounters of any kind. Injunctions to “just say no” whether to curb epidemics of syphilis, smoking, gambling, or heroin use—were ineffective.

Community-based programs like TASO (The AIDS Support Organization) in Uganda, on the other hand, showed evidence of real success. Noerine Kaleeba, a physiotherapist whose husband Christopher had died from AIDS, founded TASO with the help of 12 others. Noerine was a superlative communicator and organizer, with a vitality that her country badly needed; Uganda had just emerged from years of civil war, only to be confronted with deaths from another man-made disaster, AIDS. Like the White Ravens support group whose board I had worked on in Antwerp, these programs helped individuals in small and large ways, through acts of human solidarity and compassion and they provided the street-level intelligence that I knew was crucial to any kind of program for social change. They supported each other, helped each other to endure the sorrow of illness and the mourning of loss.

Noerine’s TASO organizers were also fun, joyful people, who understood their society. For example, Noerine understood how difficult it was for people to even say that they were infected with HIV, and developed the idea that you should select one safe person—perhaps even a stranger within the TASO network—and share with that person until you were more at ease with the words necessary to informing your partner. TASO also launched a very moving project of “Memory Books,” where parents with HIV would write down their lives in a book, so that their children, once orphaned, would carry the fullest possible memories of their parents. I will never forget witnessing a conversation between a woman with HIV and her daughter, with the mother recounting her life and discussing her unavoidable death with striking calm and dignity. It was human strength at its best. I thought then—not for the first time—that AIDS not only brings out the worst in people, with rejection and discrimination, but also the best.

TASO grew and grew, and at last tally, had provided treatment and support to 200,000 Ugandans with HIV and their families. Groups like these are the unsung heroes of the AIDS epidemic, and I very much wanted to sing them. In fact, I wanted to tie in community organizations like TASO to all the work we did, globally as well as within countries. People needed to realize that AIDS was different. In the worst-affected countries, AIDS transmission was a matter of national emergency, because it was clearly set to grow exponentially, and its long-term and ripple effects on society were exceptional. In contrast to most diseases that affect primarily children and the elderly, AIDS affects young adults, the productive and reproductive elements in society; their children are orphaned or infected, and grandparents then have to take care of them. Even if we could stop AIDS today—stop it cold—in terms of new transmissions, it would still have a massive impact on generations to come. The economic losses and social damage may go far beyond anything that we have seen with an epidemic in modern times, and nobody’s going to resuscitate the parents of the 14 million orphans.

So we needed to get world leaders on board. All the UN agencies needed to pull together into a joint approach to AIDS programs, with much less duplication and far less back-biting. We needed to have more powerful responses to AIDS in every country. We needed to develop policy guidelines for HIV prevention and treatment: people were hungry for examples of policies with concrete results on the ground. I also wanted us to develop a more solid epidemiological data base. I didn’t want us to actually
run
programs on the ground, as I felt strongly that this should be done by local governments, NGOs, and businesses, rather than by expensive international civil servants who may actually undermine local capacity by doing work that locals could do. But I felt we could have real value added in terms of coordination, evaluation, and policy guidance, because the supranational nature of the UN meant we could have a better view of what worked than anybody in only one country and that we should become the world’s advocate for AIDS, mobilizing desperately needed resources. As I saw it, we might be small but we should be smart and powerful—a catalyst for support to developing countries.