Welcome to the How Epidemics and Project based at the University of Oxford.
My name is Erica Charters.
And in these videos I'll be discussing how experts research disease and a variety of ways, as well as how they investigate how epidemics end.
Today, I'm here with Virginia Berridge, who's professor of history and health policy at the London School of Hygiene and Tropical Medicine in the U.K.
Virginia, you trained as a historian, but you work very specifically on health policy.
Can you explain what you mean by health policy and how you research it?
Yes, well, health policy is not just the formal acts of government or the regulations that they pass, which people sometimes think it is,
but it's much more about how decisions get taken, what sort of decisions get taken by governments and who influences that.
What's the role of politicians, expertise, experts, bureaucrats within government, civil servants?
What sort of networks operate, whether activist groups are involved outside government?
So basically how decisions are taken, why they're taken and how they change over time as well.
And in order to research that, I can use some very traditional historian's source material,
government archives and other archives if they're available.
Although in the case of researching very recent events like HIV, when I first worked on it and swine flu more recently,
those archives weren't available because in Britain we have a 20 year rule now that used to be a 30 year old about access to government archives.
So they're mostly not available if you're working on very recent events.
But it's also possible to use printed sources.
For example, the proceedings of Hansard parliamentary proceedings and also great literature is
important reports from organisations which are available obviously increasingly online.
Also in in a kind of informal format.
But as well as that, because I've been working on very recent material, very recent events, then oral history interviews are of great importance.
So you've worked on a variety of health issues in contemporary that in recent British history, typhus, cholera, even the Spanish flu.
But as you mentioned, you also have worked extensively on swine flu and on HIV AIDS.
So can you tell us a little bit about those two recent epidemics?
Yeah, I mean, HIV obviously was and remains a global epidemic,
starting really to be discussed in the U.K. because of what was going on in America or in countries
like Haiti or in African countries in the U.K. it's started to make an impact in the early 1980s.
People started to become concerned around about 1983.
And I think the government reaction came on stream really from 1986, 1987 onwards.
So when I was first working on it as part of something called the AIDS Social History Programme at the London School of Hygiene,
it was very much what people called history in the making,
researching things that really sometimes hadn't happened very long before I was actually researching them.
That's quite an unusual thing for historians to do. As far as swine flu was concerned, swine flu was a rather different kettle of fish.
I think HIV had been very unexpected. People weren't used to epidemics in the early 1980s.
They thought that public health was all about chronic disease rather than epidemic disease by the early 21st century.
I think people are more used to the idea of the might be epidemic disease.
We'd had SARS, we'd had things like BSE, foot and mouth disease and so on.
So the idea of an epidemic was no longer quite so unusual and people were planning for it.
And SARS swine flu first came on the scene in 2009 in in Mexico and then transferred globally.
It came into England that spring. And the there was a high level reaction quite early on,
so rather different to HIV when the possibility of a government reaction took a bit longer to achieve, I think.
So you've you've called these two epidemics, these two recent epidemics, tracer epidemics in your scholarship.
What do you mean by trace epidemics? What do they what are they tracing?
Well, they're tracing their case studies in their own right there of interest to look at how a state responds to epidemic disease,
but by looking at the two in conjunction and comparing them and contrasting them,
you can get some kind of idea about how states respond to epidemics, how,
as Charles Rosenberg said many, many years ago, epidemics throw light on on the workings of of of states,
but also how how that changes over time and how different epidemics produce different responses,
how the state itself has changed and the component parts of what makes policy also have changed over time.
So they're tracing that really so that their individual topics.
But I think they have something broader to say about how we respond to epidemics.
So one of these broader points, the one of the I think, very useful insights you've made is how there's a medical end to to an epidemic,
but there's also a political and what's the difference between the two and how do we apply this?
Well, I think that the political end can come sometime before the epidemic actually actually peters out.
I mean, there are always political benefits or benefits to governments from epidemics.
And sometimes, as in the case of HIV, it took some while for to get the politicians within government involved.
The bureaucrats, the medical bureaucrats in particular have been involved for some while.
And activist groups outside government had also been pressing for action.
But government itself, the politicians couldn't see an advantage to this for quite some little while.
And then I think the idea that this was going that HIV was going to be a totally overwhelming epidemic, which devastated the whole population,
came very much centre stage and suddenly government was galvanised into action
and a cabinet committee on HIV was set up and everything was was high level,
very high level emergency. The deputy prime minister, William Whitelaw, was in charge and so on.
But politicians are a very canny and they can use an epidemic for their own purposes.
And so the government used it to get what it wanted in certain areas.
For example, getting rid of the Health Education Council,
which had been in charge of public information and replacing it with a body called the Health Education Authority, which was just focussed on HIV.
And so you see that in other epidemics where governments use them to move,
they move the chairs around in terms of institutions and use the epidemic as a kind of rationale for that.
But that high level political response, I think, in the case of HIV, did not last that long.
By the year after, when the cabinet committee had been set up, there was rather a feeling that the epidemic had been overhyped.
That wasn't going to be this general population devastation.
And the idea that it had all been a gay conspiracy began to take hold.
And that was kind of leaked gently to the media at the time.
And so journalists who were close to government were writing those sort of pieces in the newspapers.
So the government withdrew to a degree. So for the politicians, the epidemic had come to an end as a high level policy issue.
Obviously, they continued to be involved in areas like the politics of public information.
Campaigns want what went into those and also in particular in schools, sex education matters,
which had a lot of political intervention, but the sort of high level political intervention was at an end.
So for politicians, HIV was no longer the issue that it had been.
And now if you look at swine flu, there were similar issues.
Politicians were and it was a different government of a different complexion.
In 2009, it was a Labour government, but politicians were still weighing up what advantage the epidemic was to them.
And in that case, the high level response, the policy of containing the epidemic with contact tracing, closing schools,
medication and so on, was popular with the public and the public were concerned that swine flu was going to spread more widely.
And so politicians wanted to continue with that high level response.
So, you know, the contrast with HIV,
but people at the ground level felt and within some of the public health institutions felt that it really wasn't working,
that it couldn't be it couldn't be used for much longer.
It was really kind of creaking at the seams. But they couldn't get that through to politicians.
Politicians were very gung ho for this kind of high level response.
And it was only with a change of politician as the minister of health when Andy Burnham took over and came to see what was going on on the ground,
that that high level response came to an end. So I think there's a contrast between the two epidemics with one politician's.
It came to an end politically quite early on with the other one,
the political benefit was was greater and so politicians wanted to continue beyond perhaps when they should have done.
I think it's a it's a useful insight to think about how there's these different endings within different groups,
and it's pointed out there's obviously a kind of media ending.
There's the medical ending, there's the political ending, but also then the tensions and the clashes between different groups as they
debate and sometimes argue over when it has ended and who who it has ended for.
But I was also really struck by you mentioned at some point this phrase, which probably everyone's heard of now,
how we're not at the end, but perhaps we're at the beginning of the end.
And you've traced this back actually to the HIV AIDS epidemic?
Yes, I think that was something that was used. And I've been trying to track it down because it was used very widely.
And I think it has been used recently in relation to covid as well with the coming of vaccination.
And so I think it was used when AZT started to come on the scene in the States and also subsequently in the UK and elsewhere,
a sense that the the disease was still there, but it was becoming a different sort of disease.
It was becoming a manageable disease and it was becoming less epidemic and perhaps more chronic, something that you would manage with medication.
And people would kind of, in a sense, longing for this to be able to take place.
And they would talk about things like, you know, a disease like diabetes.
And that was the model of what they wanted HIV to become.
Thank you very much, Virginia,
for sharing your expertise and for helping us to think about the difference between policy and political endings and medical endings.
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