Science’s COVID-19 reporting is supported by the Pulitzer Center.
Anton Pozniak attended his first international AIDS conference in 1990, and it changed his life. The English physician was debating whether he should specialize in infectious disease or pulmonology. After the meeting, there was little debate. “I just thought I have got to be a part of this.” Now, Pozniak heads the International AIDS Society (IAS), which runs the mega-biannual meeting, originally scheduled to take place in San Francisco and Oakland, California, next week. Instead, it is going virtual.
AIDS 2020, the 23rd International AIDS Conference, is but one of slews of scientific meetings that have been upended by COVID-19 and gone online. But this gathering of some 20,000 people has no parallel in the world of medicine or science. Researchers, health care workers, pharmaceutical companies, and public health officials from around the world spend 1 week intensely interacting with—and sometimes being harshly criticized by—people from affected communities, which includes villagers from remote parts of Asia and Africa, LGBTQ people, drug users, and sex workers. Speakers have ranged from presidents and royalty to A-list movie stars and musicians. A global village connected to the conference venue offers free admission, creating a festival atmosphere with music, plays, movies, photo exhibits, sculptures, and dance. HIV/AIDS advocates regularly stage boisterous protests that take over streets, city bridges, and the conference stage itself. Media come in droves.
Zoom cannot compete.
Pozniak, who works at Chelsea and Westminster Hospital, says it was clear to him in March that the meeting had to pull the plug on the physical gathering—even though California seemed, at the time, to have the new coronavirus under control. “I feel brokenhearted for Oakland and San Francisco,” he says. Meeting organizers shifted gears to planning a virtual alternative—“Suddenly, IT is everything,” he says—and Pozniak has his chin up about the event, which runs 6–10 July. (A preconference is underway now.) Many talks will report on the intersection of HIV/AIDS and COVID-19. The last day of the meeting will morph into a conference devoted to the newer pandemic, opening with a talk from the head of the World Health Organization, Tedros Adhanom Ghebreyesus, and closing with Bill Gates, whose foundation has long helped in the fight against infectious diseases.
Pozniak responded to questions about the reimagined conference from his London living room, which is where he will “attend” from. This interview has been edited for clarity and brevity.
Q: The International AIDS Conference has made a name for itself because of the extraordinary mingling between diverse groups. How can this work virtually?
A: It won’t have the same feel, of course, but we’ll try and generate the same energy and the same connectivity. And the lack of an audience doesn’t seem to worry a lot of the younger generation that does a lot of connections online. This COVID crisis has converted us from being very, very social and wanting to be next to each other into doing things from a distance to get our thoughts and ideas across. But this is nothing like the meeting I wanted to have.
Q: What was your first AIDS conference like?
A: The first one I went to was in San Francisco in 1990. I was working in Zimbabwe at the time, and my plane was canceled so the trip took 36 hours. I was overwhelmed. People had learned so much. And because I’d been in Africa working for 2 years, the sort of things that had been going on, especially in the United States and in Europe, were to me awe inspiring. My eyes were absolutely popping with how much research was going on. I also thought the activism was fantastic. It just hooked me.
Q: Is there an upside to going virtual?
A: People don’t have to go on airplanes. They don’t have to get visas. They don’t have to stay in expensive hotels and they don’t have to buy food. And we’re doing a lot of stuff virtually to make it a more enjoyable experience: You can visit the virtual global village and walk around. A lot of people who are living in places far away and can’t get to the meeting or can’t afford to go are saying, “Hey, there’s an opportunity for me now to engage in the conference because before I had to wait a couple of weeks for stuff to be posted and to watch a few presentations.”
Q: When you made the decision in March to go virtual, that was relatively early.
A: Europe was hit quite early and badly. I felt this shock of what’s going on very strongly, and all my friends in Italy, Spain, and France were saying, “Hey, it’s all coming to the United Kingdom.” When we talked to people in California, they were saying the numbers are going up—California leaders were the leading lights actually in backing the lockdown and dealing with the epidemic.
Q: Is IAS losing money?
A: IAS is not into making money for conferences. We have 2000 scholarship recipients, and this one cost us less money because we’re not flying them in, buying them visas, hotels, and everything else. So there’s a lot of stuff that’s being saved. And we’re not having to fund a lot of things that happen when people meet personally. We cut the registration fee in half.
Q: In the past, the conference’s geographical location has given a focus to a lot of the talks. The world was changed by South Africa’s Nelson Mandela speaking in 2000 at the meeting—it’s one of the most powerful gatherings of humans I’ve ever participated in. I felt like I was at Woodstock. There were thousands of people in a hall singing “Nelson Mandela, Nelson Mandela.” Whether it’s world leaders giving talks, activists pouring fake blood on researchers, celebrities, all of that has had power. It can’t possibly work on the same level, in a virtual sense.
A: I’ve been so motivated sitting in front of people who have said things that have changed the way I think. But we have to react to a world where doing that is dangerous for everybody. If I could wave a magic wand, I’d have the meeting in Oakland and San Francisco tomorrow. But it’s not possible.
Q: Should we even hold virtual conferences? Now that there is a flood of preprints, it’s like we are constantly walking through the massive poster exhibitions at a conference. Are we just holding on to horses and buggies in their carriage houses when there are automobiles driving around?
A: You may well be right. Last year, before COVID, we sat down and began asking, “What is the future of conferences, with all this technology and people having trouble traveling and visas?” One of the reasons I think conferences still can be held is if they have a peer-review function. With COVID, I have seen a huge erosion in the quality of science in just a few months. Conferences can say, “OK, journals are supposed to do [peer review], but we’re going to also do it on a really big scale. We’re going to peer review abstracts, and then things are going to be presented that you guys can look at and comment on. And if you think it’s a load of rubbish, and you want to criticize it, you just go online and do it.”
[IAS typically rejects about 70% of submitted abstracts and the ones deemed most important are given oral presentations as opposed to poster slots.]
Q: There’s an overlap between scientists studying COVID-19 science and HIV/AIDS, and in the United States, several of the scientific leaders in the COVID-19 response are HIV/AIDS researchers. How do you see the blending of these two worlds?
A: Outside of Asia, the last big pandemic we had was HIV. So HIV has grown up a large number of people who have responded to a pandemic. People from the HIV field understand what it means to think about developing treatments, vaccines, and mobilizing people. They understand what it’s like to try and mobilize science toward a goal. The problem for me now is trying to mobilize a community when it is absolutely every member of the planet, which it is for COVID. It’s been a struggle. The leadership for COVID has been political leadership. The leadership for HIV came from science and community working together, and then trying to convince global leaders that’s the right thing to do.
Q: You’re an infectious disease doctor. Have you treated COVID-19 patients yourself?
A: We’ve got very few now, but a few weeks ago when it was bad, I was on the ward for 3 weeks. It was a very worrying experience, very frightening. It reminded me of the old days with AIDS when there were people who were dying and relatives didn’t visit. When I started in ’83, there were these young men who had broken with their parents and their brothers and sisters because they happened to be gay. Then they got this illness and people weren’t visiting. It was lonely, and we were trying to be supportive of people. It’s bringing tears to my eyes. And that was the end of a short life. It was great when Princess Di came and sat on the bed, shook people’s hands and said, “Look, these guys are normal, right?” It was hard to do that with COVID [because it is transmitted more easily than HIV]. You can’t sit on beds and you can’t give people hugs.
Q: Is there mission creep for the International AIDS Conference?
A: The circumstances are just so extraordinary and we have the platform and the convening ability to do something. I felt very strongly that we should have something on COVID, whereby we can distill the ideas of the science and the community aspects of COVID into something that wasn’t just online abstracts, or published in journals. We’re probably not going to live through anything like this again. We reached out to many people and they all say, “Fantastic idea, it’s just what you need to do.” Whether it’s going to be the same in the future, I’m not sure.