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Norman Fowler, an unlikely hero in the fight against AIDS

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Norman Fowler, the minister of health from 1981 to 1987 in a British conservative government, became a passionate advocate for people with HIV/AIDS()
Norman Fowler, the minister of health from 1981 to 1987 in a British conservative government, became a passionate advocate for people with HIV/AIDS()
Norman Fowler is a passionate advocate for people living with HIV/AIDS, and took a bold approach as Britain's minister of health to confront the epidemic in the 1980s. Mark Dodgson takes a look at some of the lessons from this unlikely icon's fearless political career.
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I never expected to include a cabinet minister from a conservative British government in my pantheon of heroes, a man whom cartoonists lampooned as a chicken.

[Fowler] shows us, at a time of disillusionment if not despair with behaviour in our parliament, what politicians can achieve.

Yet Norman Fowler, who was minister of health in Britain from 1981 to 1987, is an example of a resolute politician determined to push for what is right in the face of fear and prejudice.

He displayed in spades what too many spineless Australian politicians have been unable to do for far too long now. When confronting a crisis, he looked for expert scientific advice, made bold decisions, and then worked tirelessly to get those decisions implemented in the face of bureaucratic inertia on the one hand, and anger and outrage on the other.

He fought direct opposition from then Prime Minister Margaret Thatcher, and in a coalition of science, media and interest groups, led the biggest public education campaign ever staged in Britain.

At first sight, Norman Fowler is an unlikely champion of those suffering from AIDS, but as soon as he learned about the disease he became, and has remained, a passionate advocate for sufferers. He shows us, at a time of disillusionment with, if not despair at, behaviour in our parliament, what politicians can achieve.

His is a story of how politicians make a difference when they effectively marshal evidence, when they push for what ought to be done rather than what is expedient, and when their concerns are for people’s wellbeing, not their lifestyle choices. Fowler reminds us that political leadership is not an oxymoron.

Related: How far have we come on AIDS?

Let's remind ourselves of the scale of the challenge he faced. In addition to reports in the early 1980s of young homosexual men dying in San Francisco, the British Foreign Office was reporting an epidemic hitting Africa, where the strange disease was 'spreading like wildfire'. 

St Mary's hospital in London opened an AIDS clinic in 1982 expecting a few patients. In no time it had over 400, and doctors there were predicting an increase to 20,000.

It was the projections that were so scary, and they were right. Thirty-six million people have died so far of AIDS—a 9/11 disaster every day of the year for over 30 years. Tragically, 17 million children have lost one parent or both their parent to AIDS. Despite the massive improvements in medication and public health advice, there are still two million new cases each year, and 1.5 million deaths.

The scientific community at the time understood the terrifying epidemiology. Suggestions around what to do about it, however, included, in the words of Donald Acheson, the UK's chief medical officer at the time, 'alarm accounting almost to panic'.

There was reference to the 'gay plague'. A member of parliament suggested people with AIDS should be quarantined permanently in a guarded enclosure on the Isle of Wight, a small island off southern England. Gay men were being turned away from restaurants and their lodgings.

The chief constable of Manchester claimed his religion led him to see gay men and intravenous drug abusers as 'scum floating on a sea of corruption'. Lord Monckton, renowned nowadays for his eccentric views on climate change, thundered in The American Spectator in 1987: 'There is only one way to stop AIDS. That is to screen the entire population regularly and to quarantine all carriers of the disease for life.'

Then there was Margaret Thatcher. One of my favourite stories of the time—perhaps apocryphal—was of Mrs Thatcher sitting in a restaurant with her cabinet colleagues. A waiter asked what she'd like to eat. 'A steak,' she replied. The waiter then inquired, 'The vegetables?' Looking around the room with a steely eye, she is reputed to have said, 'They'll have the same.'

True or not, Thatcher's fearful influence over her cabinet is legendary, and she was not happy with Fowler.

Fowler's Health Department began a newspaper campaign informing people about the dangers of AIDS. This was followed by a leaflet, sent to all 23 million households in the country, something that had never been attempted before. Then there was a very effective television campaign. Remember our Grim Reaper advertisements? The British campaign had a tombstone as its motif.

There was continual political opposition to these campaigns, and Thatcher tried to subvert them all. Essentially, the British government was asked to publicly detail sexual practices and drug taking, and promote the use of condoms and clean injection needles.

The attorney general was concerned about the campaigns causing offence, and even creating panic. Treasury, of course, didn’t want to pay for them. The conservative press was sharply critical. Many religious and political leaders felt the issue was not one of public health, but of morality.

Fowler's view was straightforward. It was not a time for delicacy—people were dying. His original draft of the campaign was explicit about the sorts of sexual behaviours that were risky. Thatcher hated it, complaining that telling young people about such unspeakable acts would encourage them to try them.

Her opposition continued on a number of fronts and she used her obsequious political allies, such as the fearsome Norman Tebbit. She had a private word with Fowler at Number 10—'You mustn't become known as just the minister for AIDS'.  She also vetoed a ministerial broadcast on the dangers of AIDS.

Fowler's frustration with the Thatcher government of which he was a part grew. As a political issue, he notes dryly in a recent book, AIDS promised few rewards. He certainly didn't dither, though. In his autobiography, Donald Acheson remembers seeking a meeting with Fowler to talk to him about AIDS for the first time.

'Norman's reaction was one of deep concern, and for the rest of my time in Whitehall, with his unfailing encouragement and support, I was able to give the AIDS epidemic a place close to the top of my priorities,' he recalls.

Fowler visited San Francisco in 1987 and his diary tells of being photographed shaking hands with personable young men with AIDS who would be dead in a couple of months.

He visited New York and looked at the babies of intelligent and articulate drug-using mothers who would shortly die. He was deeply moved and harrowed by what he saw, and was taken aback that despite the bigger problem in the United States, less was being done.

'At a Federal level, from Ronald Reagan down, there was a state of complete psychological denial even seemingly to the very existence of the HIV/AIDS epidemic,' Acheson says of the visit. 'The word AIDS hadn't crossed Reagan's lips.'

Related: AIDS 2014

Fowler's approach emerged, in his own words, because he 'didn't have any alternative but to do it that way'.

'Disease was disease, suffering was suffering and we had a moral and human obligation to treat sexual disease just like any other.'

How did Fowler progress his agenda in the face of such opposition? For one thing he encouraged a bipartisan approach. The first parliamentary debate on AIDS was held on 21 November 1986. Hansard records an incredibly ordered and informed debate.

Fowler opened the debate with these words: 'I welcome the opportunity … to set out the facts about the disease, the serious threat it poses to public health, and how the government proposes to meet that threat.'

He explained that the disease was fatal and incurable, and estimated it affected 30,000 people in the UK. He asked for as much common ground amongst the political parties as possible.

Apart from the occasional reference to the need to curtail promiscuity, the five hour debate was essentially non-partisan. There were lengthy and well-informed contributions from members of both major parties, with general consensus that the key issues were public education, research and treatment.

Fowler then cleverly circumvented Mrs Thatcher by encouraging the establishment of a special cabinet committee to deal with AIDS. He saw that progress was always going to be blocked in full cabinet, where too many diverse and unknowledgeable interests would have intermingled to create gridlock.

Mrs Thatcher would have usually expected to chair any such committee, but on this occasion Willie Whitelaw took the chair—an inspired choice. Whitelaw knew how things worked; he was deputy prime minister and had been home secretary.

The committee managed to get all the policies through in the space of a couple of months.

Donald Acheson says that Whitelaw's chairing of these meetings included the best example of managing meeting outcomes he experienced in his entire career. Whitelaw was a decorated World War Two tank commander, and appreciated the need for action. What is more, he had been responsible for the sexual health of his men when overseas, and understood the need for blunt advice and condoms.

Another element in Fowler's strategy was dealing with the media and he found a lot of support from television companies. However, he was very concerned about the opinions of religious leaders, and before launching a campaign he asked his chief medical officer to embark on what Acheson describes as one of the most memorable experiences of his career.

His task was 'to gain, at least the acquiescence, if not the approval of ... the archbishop of Canterbury, the cardinal of Westminster, the moderator of the Free Churches and the chief rabbi'. All were concerned with the unfolding tragedy and despite the fact that Acheson's message promoted the use of condoms; he received no criticism about the government's intentions.

Although Fowler was initially apprehensive about it, he had a secret weapon in the campaign against AIDS: Princess Diana. Fowler and Acheson are full of praise for Diana, with the latter saying the 'fearless example of this largely untutored young woman, by allowing herself to be photographed embracing people of all ages infected by HIV … probably had more influence in dispelling irrational fears ... than all the government’s leaflets and advertisements put together'.

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Fowler has recently written a book called AIDS: Don’t die of ignorance, in which he reflects on his campaigns and also the current state of the disease in a number of countries, including Australia.

He argues that his information campaigns were successful, and Gallup polling showed 94 per cent of the public thought the government did the right thing. He believes the most successful part of the campaign was introducing clean needles. The UK has hardly been touched by transmissions through intravenous drug use.

Today, Fowler continues his work on AIDS in a number of organisations. He has been highly influential in making condoms available in prisons and in giving asylum seekers and other non-British citizens free HIV treatment. As his book reveals, he continues to be shocked by the persistent official and personal prejudice towards people with AIDS around the world.

We have so many issues in Australia crying out for political leadership—climate change, asylum policies and declining productivity. Wouldn't it be nice to see some of Fowler’s virtues pursued instead of partisanship, opportunism and the 24-hour news cycle?

I’ll leave the last word on Fowler to the astute journalist and commentator Matthew Parris from The Times

'[Fowler] took this country down the track of an energetic, expensive, positive, honest, generous response to the AIDS crisis ... And he's still here, still "boring", still the last man on Earth to want to be a gay icon, or any kind of icon, still patiently engaging with the machinery of public administration, still showing how government can matter and how politics can be worthwhile.'

Ockham’s Razor is a soap box for all things scientific, with short talks about research, industry and policy from people with something thoughtful to say about science.

Professor Mark Dodgson is the Director of the Technology and Innovation Management Centre at the University of Queensland.

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Philosophy, Health Policy, Men's Health, Sexual Health, Health, Community Education, Aids and HIV, Government and Politics