Elizabeth Pisani is an academic researcher and the director of Ternyata Ltd., a public health consultancy based in London, UK. An epidemiologist by training, her research investigates the ways in which politics, economics and culture influence public health. She currently focuses on the forces that drive the markets for substandard and falsified medicines and has in the past worked extensively on HIV. Together with many academic publications, she is known for her books about Indonesia, and about HIV. , is regularly cited as one of the best books about that country. The Wisdom of Whores: Bureaucrats, Brothels and the Business of AIDS, and her TED Talk "Sex, drugs, and HIV - let's get rational" describe the ways in which politics, religion and culture can outweigh scientific evidence in decision-making about HIV prevention. Pisani is a Visiting Senior Research Fellow at King's College London's Policy Institute, an Honorary Professor in the Department of Population Health at the London School of Hygiene and Tropical Medicine, and a Fellow of the School of Health Policy and Management at Erasmus University, Rotterdam.
Education
She was born in the United States and educated in several European countries. She is fluent in French and Spanish, and has learned Chinese and Indonesian. She graduated from Oxford University with an MA in classical Chinese in 1986. After working as a journalist for many years, Pisani changed professional course, taking an MSc in Medical Demography and later a PhD in Infectious Disease Epidemiology at the London School of Hygiene & Tropical Medicine.
Career
After her first degree, Pisani joined Reuters as a foreign correspondent, working in Hong Kong, India and Indonesia. She also reported at various times for The Economist and the Asia Times from Jakarta, Hanoi, Phnom Penh, Brussels and Nairobi. During her times as a journalist she covered major political events such as the Tiananmen Square demonstrations, and the civil war in Aceh, Indonesia, as well as a wide range of business stories. After retraining as an epidemiologist, Pisani focused on HIV for over a decade, conducting research and worked working as an advisor for the Ministries of Health of China, Indonesia, East Timor and the Philippines, and for organisations such as the UNAIDS, US Centers for Disease Control and Prevention, World Bank, and the World Health Organization. Her work has focused on HIV, sexually transmitted infections and sexual and drug-taking behaviour, and on building robust disease surveillance systems. In the late 2000s, she began working with the Wellcome Trust and other major funders of public health research to increase the sharing of data between scientists so that more knowledge can be squeezed out of expensive field research. She also worked with Wellcome to explore ways of increasing engagement between scientists and society in the countries where they sponsor major research programmes. One outcome of this was the "" exhibition, bringing together art from residencies in research centres in Thailand, Vietnam, Malawi, Kenya, South Africa and the UK. In 2016, Pisani initiated a collaboration with an East London based orchestra, the , which led to "", a jazz show which tried to explore the reasons for bad decision-making in global health through music. Pisani has written a wide variety of research papers and institutional reports on HIV and AIDS, including the first two editions of the biennial global report on AIDS for the United Nations programme on AIDS, technical manuals on disease surveillance, and advocacy papers. In 2008, she published ', which argues that a substantial portion of the funding devoted to HIV and AIDS is wasted on ineffective programming, the result of science and good public health policy being trumped by politics and ideology. It was long-listed for the Samuel Johnson Prize for Non-fiction in 2009. The following year, she gave a TED talk arguing that the "rational" health belief model that underpins many public health campaigns are quite irrational from the point of view of those they target. In late 2011, Pisani took a sabbatical from her day job to explore Indonesia, where she had worked from 1988 – 1991 as a foreign correspondent, and from 2001-2005 in her capacity as an epidemiologist and public health advocate. She blogged about her travels at Portrait Indonesia from late 2011-2013. At the end of 2013, she moved her blog to a new site, Indonesia, Etc. Her travels there form the basis of a book, ', which was published to critical acclaim in June 2014. At the end of 2014 the book was listed among the best non-fiction books of the year by The Economist and by The Wall Street Journal. While working on Indonesia, Etc., Pisani renewed her longstanding interest in political science. She has contributed essays on Indonesian politics to Foreign Affairs, The New York Times, Nikkei Asia Review and others. In seminars from 2014, she began to explore using the tools of epidemiology to look at political "diseases", particularly corruption and conflict. In the mid-2010s, Pisani's interest turned to the quality of medicines. With research grant support from the Wellcome Trust and Erasmus University Rotterdam, she led a four-country study into the political and economic factors driving the market for substandard and falsified medicines, especially in middle income countries, and continues to work in this area.
Substandard and falsified medicines
While working in an HIV prevention programme in Indonesia in 2004, Pisani and her colleagues discovered that the medicines they were giving female sex workers to cure sexually transmitted infections were not working. There were three possible reasons for this: the women were not taking their medicines correctly; the pathogens were resistant to the medicines; or, the medicines were of poor quality. It turned out to be the second of these, but it took fully four years to change national guidelines and to start treating women with medicines that did work, largely because of the economic interests of government-owned pharmaceutical companies. In a presentation to the first Conference on Medicine Quality and Public Health, held in Oxford in September 2018, Pisani explained that this incident sparked an interest in the relationship between medicine quality and antimicrobial resistance, as well as in the political drivers of pharmaceutical policy. In 2016, the UK government's Review on Antimicrobial Resistance asked Pisani to review evidence for the links between poor quality medicine and the development and spread of drug resistant infections. The full report was summarised in an interim paper published by the AMR Review. With funding from Wellcome Trust, Pisani led a study looking at the political and economic factors that incentivise pharmaceutical companies to produce substandard medicines, and the factors that create market opportunities for criminals to make and sell falsified drugs. The research team looked closely at medicine markets in Indonesia, Romania and Turkey, as well as at producers of active ingredients in China. They concluded that substandard medicines are most common where oversight of production standards is lax and procurement systems push prices so low that companies are incentivised to cut corners. Falsified medicines, on the other hand, appear where there is an unmet demand from patients, and where patients or health care providers are incentivised to step outside of the regular supply chain, to cut costs or to maximise profits.
HIV and AIDS
Pisani discussed a presentation given at the Merseyside Skeptics Society 2014 QED Conference with Eran Segev of the Skeptic Zone Podcast. They discussed AIDS and HIV with Pisani describing how HIV is now invisible because AIDS is not typically occurring anymore so people are not as afraid of HIV and are not as concerned about sharing their status with their partners. The private cost of HIV is not high but the public cost is significant due to costs of medications paid for by insurance and public benefits Pisani stated. This creates a public message problem about how and why to avoid HIV. Pisani detailed how HIV transmission is dependent on the amount of free virus in your system and the most likely time to transmit the virus is during the active time when they are between stable partners which makes the common wisdom about transmission rates using average numbers of partners out of date.. The interview wrapped up with a discussion of how Circumcision reduces the likelihood that you will contract HIV by 60% in heterosexual populations. Pisani stated that she received a lot of grief over her support of circumcision.
AIDS prevention
Pisani has been a vocal advocate of the harm reduction approach to addressing HIV/AIDS, supporting needle exchange programmes, making condoms widely available, and giving aid to countries that have policies of legalized prostitution. She outlined these views in her book, subsequent articles, interviews, and her 2010 TED Talk. She strongly criticized the regulations imposed by USAID ambassador Randall Tobias, in particular, those forbidding aid recipients from accepting, tolerating, or legalizing prostitution, or promothing anything but abstinence, arguing that organizations of prostitutes are effective at educating those most at risk, and that abstinence-only sex education has been demonstrated to fail in rigorous scientific studies. In addition, she criticized the Catholic Church's prohibition on condom use as a means to prevent the spread of HIV. In an interview with The Guardian, she said "I don't think it's evil to have anal sex with 16 people in a weekend without condoms. I just think if you do that there's a high likelihood you're going to get infected. That's all. It's cause and effect. And I think if we can prevent a fatal disease, we should. I don't get how it's OK to keep someone alive once they're sick - but not OK to stop them getting sick. I just don't get that." In an article for The Guardian the following year, she asked "hy can't we extend our compassion to those who are not yet infected, and provide them with all the information and tools they need to stay uninfected? Whether the pope likes it or not, those tools include condoms. In her TED Talk, she called the position "clearly irrational" In addition, she elaborated her position on needle-exchange programmes, citing several studies that supported their effectiveness, and noting that Margaret Thatcher was the first major public figure to lend support to it. She concluded her talk by saying that the audience there, and anyone viewing the talk on the web, "has a duty to demand of their politicians that we make policy based on scientific evidence, and on common sense."
Religious views
In The Wisdom of Whores, Pisani wrote, "I went to Sunday School as a child, and I still go to church every now and then. But I am unable to understand religious convictions or religious ideologies that stand in the way of saving hundreds of thousands of lives."
