No Time to Lose: A Life in Pursuit of Deadly Viruses (31 page)

CHAPTER 19

The Tipping Point

T
HE CHANGE OF
century brought with it a sharp and sudden shift in the world’s attitude to the epidemic. In the space of a year, it became an urgent, unavoidable subject for world leaders and organizations. I would like to think that this was partly because of our work at UNAIDS in “global health diplomacy” as it is sometimes called today—a mouthful of a term for what was an effort at combining science expertise with the tools of traditional diplomacy, where national and strategic interests are paramount, as well as a new form of transborder activism.

We succeeded in elevating AIDS to levels at which no health issue had ever been discussed before—to where the heavy lifting of international and national politics takes place. The key to this was indeed the UN Security Council, and the key to that was Richard Holbrooke: the tireless, acerbic, larger-than-life American diplomat who was the then the US ambassador to the United Nations. I had met him in a formal meeting at the US mission to the UN and was impressed, so when I learned that he planned to visit the Great Lakes region of Africa in November 1999, I asked his assistant for a detailed schedule.

I asked our staff to write up some short but powerful evaluations of the AIDS situation in Rwanda, Burundi, and Congo, and I made sure that they were in Holbrooke’s background file. Then, in every town he visited, we alerted our UNAIDS country staff and local activist groups and people living with HIV to cross his path, ask him questions, show him the conditions in which they lived. That’s what activists do—they heckle.

When Holbrooke got back to New York he gave a press conference, where he said, roughly, “Yes, the security situation is bad, but what’s really killing people out there now is AIDS and we have to do something about it.” He asked to see me, and when we met he said, “Peter, we’re going to discuss this at the Security Council, because those guys have no clue what’s really going on out there.” Of course I knew that six months before Holbrooke too had not much of a clue, but I kept my mouth shut. Then he added, “To get it on the agenda I know what the hook should be: peacekeepers.”

The Security Council is the locus of power in the UN. Anything discussed there can change lives. But its mandate is not infinite: ECOSOC normally oversees economics and social affairs. The Security Council’s decisions are (in theory, at least) binding, and it makes decisions about war and peacekeeping. But as Holbrooke now knew, UN peacekeepers (currently 120,000 personnel) may catch, or transmit, HIV. His idea was to use this as a starting point to debate the national security implications of AIDS. Furthermore, since the United States would occupy the rotating presidency of the Security Council in January 2000, Holbrooke wanted AIDS in Africa to be the subject of the first Security Council meeting of the new millennium. It was brilliant.

To pull it off in a few weeks around Christmas was quite an effort. I assigned Ulf Kristoffersen, a Swedish former peacekeeper, and my adviser Jim Sherry to the job of working with Holbrooke’s office to collate data and prepare for the meeting. Here went our Christmas break: I got confirmation mid-December that the session was on, we worked very hard when the diplomats at the UN were eating turkey or whatever back in their country, and we took everybody by surprise when they came back. All this was done in close consultation with Louise Frechette, Kofi Annan’s Canadian deputy secretary-general. She was a tough woman who at first seemed to protect Kofi Annan from engaging with what she may have seen as an irresponsible, NGO-type of entity that somehow made it into the UN system. Louise was razor sharp, a former deputy minister of defense with a good sense of humor; but once I had persuaded her that AIDS was not only important but actually had the beginning of a solution, she came on board with vigor, and made sure that I became effective in the minefields and labyrinths of multilateral politics. I owe her a lot.

US Vice President Al Gore chaired the debate on January 10, and said that AIDS was a threat to peace and security. Kofi Annan told the assembled dignitaries that the destructive impact of AIDS on Africa was equal to that of war. AIDS was causing socioeconomic crises that threatened political stability. I tried hard to focus on the speeches, but was somewhat distracted by the enormous painting hanging over Gore and Annan, a somber expressionistic work in dark colors with scenes as from the day of judgment. Very appropriate for the Security Council chamber, I thought, hoping that the country representatives might glance now and then to look at it when making their solemn decision about war.

Then it was my turn to speak, and I am often a nervous wreck before speeches, small and big. I stated the facts, redefining AIDS as a threat to development and stability—thus a new form of security threat—and asking that all peacekeeping operations have an HIV-prevention component (which the council voted in on July 18 as Resolution 1308, thanks to Holbrooke’s tireless efforts).

The meeting had enormous impact. It highlighted the way AIDS swamps a country’s health services; kills the active, productive elements of a population; and creates social and economic crises that can overwhelm and break a nation’s political stability. Moreover, the very fact that it took place at all was in itself a breakthrough for us in terms of access. For years to come, presidents and prime ministers would tell me, “If AIDS was debated in the Security Council, this must a serious problem.” Deep down I found this ridiculous, sure, but I quite literally heard that kind of reaction.

During the Security Council debate, the Ukrainian ambassador to the UN had suggested there be a Special Session of the UN General Assembly devoted exclusively to AIDS. Uniquely within the former Soviet bloc, Ukraine by this time was developing a relatively coherent approach to the epidemic, and I had visited the country twice to meet with its leadership and community groups. It was clearly paying off.

Ukraine’s proposal for a Special Session of the General Assembly took everyone by surprise, and to be honest I had no immediate grasp of what it meant. I learned that to prepare for such an event is ordinarily a two-year project, involving regional preparatory conferences and premeetings that are basically very expensive and time-consuming talk shops. I thought that this would drain our energy and I wanted the shortest possible lead time. The first slot available was June 2001. (Another possibility was mid-September 2001, which would not have happened following the events of 9/11; and that too would have changed the course of the AIDS epidemic, for the Global Fund would probably not have been launched and much else would not have happened.)

A Special Session of the General Assembly would focus the minds of the diplomatic and political decision-makers of the entire planet. It was an opportunity we could not afford to miss: if we failed this, there would be no second chance to get AIDS on top of the world’s agenda. So a few months later I sent UNAIDS Deputy Director Kathleen Cravero to New York full time to start hammering out the preparatory work. I had met New Yorker Kathleen in WHO while she was working with Mike Merson and later as UNICEF’s representative in Uganda, where she was instrumental in the country’s pioneering AIDS efforts. When she was head of the UN in Burundi she was nearly murdered while visiting a refugee camp in the midst of a civil war (two of her colleagues were killed execution style, but she escaped; it is still uncertain whether the assassins were rebels or government troops). Kathleen is a jewel in the crown of the international civil service; you can parachute her anywhere and she will do a superb job. She helped me to bring UNAIDS to another level, and when she felt I was stressed (actually most of the time) would find the joke that brought me back to life. Kathleen was the one who pulled off the Special Session for us. The protocol, the texts under debate—virtually everything was controversial, and nothing could be relied on to function smoothly.

The solemnity of the Security Council debate brought AIDS an entirely new stature in terms of the world’s political agenda. It also startled the heads of our cosponsoring agencies at the UN. And UNAIDS became a subject of study when my daughter Sara told me a year later that she had to study my speech in her MSc class in international relations in London; it was presented as a first event at that level to broaden the concept of security beyond the absence of conflict.

Also, following the Security Council meeting, ministers of finance became far more interested in the economic losses due to AIDS. The media grew more attentive and that brought big corporations on board too. AIDS activists in developed countries started to focus more intently on the need to solve the problem in developing countries. AIDS started to touch a nerve among intelligence agencies, security agencies, religious leaders. The pieces began coming together.

BY 2000, OVER
4.3 million South Africans were living with HIV—the highest number in any country in the world. But because so many of these people had been recently affected, they weren’t necessarily showing up yet as sick—or as fatalities. Still, it was clear to me that would be unavoidable.

Enormous amounts of time were being wasted, at the expense of hundreds of thousands of lives, because the top leadership failed to recognize that AIDS was an exceptional threat to the survival of the nation. South Africa was experiencing one of the fastest-growing epidemics in the world, and yet even after our meeting in Davos in February 1997, President Nelson Mandela didn’t speak about AIDS in his own country until December 1, 1998, World AIDS Day, when I accompanied him to a military base in Kwazulu Natal, where in the presence of Zulu King Goodwill Zwelithini, he addressed the nation in a dramatic live televised address. Mandela said, “We admire the brave . . . who are with us today to say: We are the human face of AIDS—we are breaking the silence!” That day the most admired icon of our time also broke the silence for his nation.

When Thabo Mbeki succeeded him as president in 1999, I had high hopes for his leadership: this was clearly an extremely intelligent and articulate man of great integrity. But in March 2000, our director for southern and eastern Africa, El Hadj As Sy (he had joined me from ENDA Tiers Monde, a Senegalese NGO) alerted me that Mbeki seemed to have adopted some very highly unusual views on the epidemic. Basically, Mbeki had come under the influence of a molecular biologist from Berkeley, California, Peter Duesberg, whose profoundly erroneous theory was that AIDS stemmed from poverty and use of drugs (for recreational or medical purposes), while HIV either did not exist or was a harmless passenger virus. We had no idea to what extent these ideas had taken hold in Mbeki’s mind, and I was sure that if I could only meet with him to discuss it, I could pull him back to reality as he seemed a man of reason.

As Sy obtained a meeting for me with Mbeki on a Saturday evening, March 31, 2000. I was in Nigeria, but because there was no direct flight that time I had to fly all the way back to Zurich to connect to South Africa, so by the time I arrived it was already about 8
P.M.
As Sy drove me straight to State House, where I was greeted by Mbeki’s wife Zanele, whom I knew from a group of African First Ladies against AIDS. She led me into her husband’s study. A fire was burning in the fireplace, and Mbeki was smoking a pipe, with a glass of whisky beside him, wearing a woolly sweater. He was working with his speechwriter on a talk he was planning to give on the need for private investment in Africa at the Africa-Europe Summit in Cairo. It was a very British scene, a chilly autumn evening in these southern latitudes. He looked up and said, “Please have a seat,” but there was no handshake, and kept on writing his speech. So I just sat there and at some point he thanked the speechwriter, who left. Then he passed me a Human Development report that the UN Development Programme publishes every year, and asked me to find some bits of data. Once he’d finished the speech, he looked up again and said, “So. What would you like to discuss.”

I said I had come to find out how UNAIDS could better support South Africa in combating its very serious AIDS epidemic. I remembered his great speech at the conference of people living with HIV in Cape Town in 1995, but there was increasing concern about South Africa’s response to the epidemic. I was coming to him as a scientist who had spent most of my career in Africa and as someone who admired the ANC’s struggle against apartheid. I was up-front: I had heard rumors of alleged policy positions of his government that were in my view counterproductive.

Thabo Mbeki is a very courteous person, who I think probably rarely raises his voice, but he can be cold. His arguments were technical and detailed, but they were partial; there was always a nugget of some truth, possibly outdated, but with some evidence to it, but these nuggets were strung together into a completely skewed approach. He questioned the accuracy of data and the high degree of false positives that came up in HIV tests (this had been true, but was basically eliminated in more recently developed tests). I told him there was very strong evidence that HIV causes AIDS. He repeatedly made the point “But Koch’s postulates have not been fulfilled.” These were criteria that Robert Koch, the German discoverer of the tubercle bacillus in the nineteenth century, had developed to assess whether a microbe causes disease. The microbe must be present in every case of the disease; the disease must be reproduced when pure cultures of the microbe are inoculated into a healthy, susceptible host; and healthy people must not carry the microbe. Actually Koch’s postulates
are
fulfilled with HIV; in any case, they are now obsolete with advances in microbiology and immunology, and the availability of far more sophisticated techniques. (Even in TB you have lots of healthy carriers: I myself test positive for the tubercle bacillus since I acquired an infection while working in the lab in Antwerp because of a dysfunctional protective hood.)

Mbeki continued. He claimed that a lot of so-called AIDS deaths were due in fact to tuberculosis, not HIV. So I explained about opportunistic infections. Then came a discussion about the impact of treatment, and the toxicity of AZT and nevirapin, the medication used to prevent mother-to-child transmission. Yes, indeed, AZT has side effects (so has aspirin; drugs can cause death, it’s true). But there was no balancing intelligence, no weighing of the enormous benefits in lives saved versus mostly controllable side effects. He claimed that no one had actually seen the HIV virus, and I pointed out that I had seen it myself, under an electron microscope; but then he said that those were artifacts, and it’s true that there are lots of artifacts under the electron microscope.