1 00:00:11,320 --> 00:00:15,580 Welcome to the How Epidemics and Project based at the University of Oxford. 2 00:00:15,580 --> 00:00:16,990 My name is Erica Charters. 3 00:00:16,990 --> 00:00:25,780 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. 4 00:00:25,780 --> 00:00:35,170 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. 5 00:00:35,170 --> 00:00:41,050 Virginia, you trained as a historian, but you work very specifically on health policy. 6 00:00:41,050 --> 00:00:46,070 Can you explain what you mean by health policy and how you research it? 7 00:00:46,070 --> 00:00:57,890 Yes, well, health policy is not just the formal acts of government or the regulations that they pass, which people sometimes think it is, 8 00:00:57,890 --> 00:01:09,710 but it's much more about how decisions get taken, what sort of decisions get taken by governments and who influences that. 9 00:01:09,710 --> 00:01:18,020 What's the role of politicians, expertise, experts, bureaucrats within government, civil servants? 10 00:01:18,020 --> 00:01:26,480 What sort of networks operate, whether activist groups are involved outside government? 11 00:01:26,480 --> 00:01:35,390 So basically how decisions are taken, why they're taken and how they change over time as well. 12 00:01:35,390 --> 00:01:44,570 And in order to research that, I can use some very traditional historian's source material, 13 00:01:44,570 --> 00:01:49,010 government archives and other archives if they're available. 14 00:01:49,010 --> 00:02:00,050 Although in the case of researching very recent events like HIV, when I first worked on it and swine flu more recently, 15 00:02:00,050 --> 00:02:09,020 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. 16 00:02:09,020 --> 00:02:13,970 So they're mostly not available if you're working on very recent events. 17 00:02:13,970 --> 00:02:18,080 But it's also possible to use printed sources. 18 00:02:18,080 --> 00:02:25,340 For example, the proceedings of Hansard parliamentary proceedings and also great literature is 19 00:02:25,340 --> 00:02:33,200 important reports from organisations which are available obviously increasingly online. 20 00:02:33,200 --> 00:02:37,130 Also in in a kind of informal format. 21 00:02:37,130 --> 00:02:50,580 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. 22 00:02:50,580 --> 00:03:00,030 So you've worked on a variety of health issues in contemporary that in recent British history, typhus, cholera, even the Spanish flu. 23 00:03:00,030 --> 00:03:06,000 But as you mentioned, you also have worked extensively on swine flu and on HIV AIDS. 24 00:03:06,000 --> 00:03:10,890 So can you tell us a little bit about those two recent epidemics? 25 00:03:10,890 --> 00:03:18,510 Yeah, I mean, HIV obviously was and remains a global epidemic, 26 00:03:18,510 --> 00:03:25,590 starting really to be discussed in the U.K. because of what was going on in America or in countries 27 00:03:25,590 --> 00:03:36,750 like Haiti or in African countries in the U.K. it's started to make an impact in the early 1980s. 28 00:03:36,750 --> 00:03:42,270 People started to become concerned around about 1983. 29 00:03:42,270 --> 00:03:50,460 And I think the government reaction came on stream really from 1986, 1987 onwards. 30 00:03:50,460 --> 00:03:59,160 So when I was first working on it as part of something called the AIDS Social History Programme at the London School of Hygiene, 31 00:03:59,160 --> 00:04:04,320 it was very much what people called history in the making, 32 00:04:04,320 --> 00:04:13,470 researching things that really sometimes hadn't happened very long before I was actually researching them. 33 00:04:13,470 --> 00:04:25,290 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. 34 00:04:25,290 --> 00:04:31,950 I think HIV had been very unexpected. People weren't used to epidemics in the early 1980s. 35 00:04:31,950 --> 00:04:40,260 They thought that public health was all about chronic disease rather than epidemic disease by the early 21st century. 36 00:04:40,260 --> 00:04:46,800 I think people are more used to the idea of the might be epidemic disease. 37 00:04:46,800 --> 00:04:52,890 We'd had SARS, we'd had things like BSE, foot and mouth disease and so on. 38 00:04:52,890 --> 00:04:59,100 So the idea of an epidemic was no longer quite so unusual and people were planning for it. 39 00:04:59,100 --> 00:05:09,570 And SARS swine flu first came on the scene in 2009 in in Mexico and then transferred globally. 40 00:05:09,570 --> 00:05:18,660 It came into England that spring. And the there was a high level reaction quite early on, 41 00:05:18,660 --> 00:05:28,400 so rather different to HIV when the possibility of a government reaction took a bit longer to achieve, I think. 42 00:05:28,400 --> 00:05:35,480 So you've you've called these two epidemics, these two recent epidemics, tracer epidemics in your scholarship. 43 00:05:35,480 --> 00:05:40,160 What do you mean by trace epidemics? What do they what are they tracing? 44 00:05:40,160 --> 00:05:48,320 Well, they're tracing their case studies in their own right there of interest to look at how a state responds to epidemic disease, 45 00:05:48,320 --> 00:05:54,350 but by looking at the two in conjunction and comparing them and contrasting them, 46 00:05:54,350 --> 00:06:02,390 you can get some kind of idea about how states respond to epidemics, how, 47 00:06:02,390 --> 00:06:11,300 as Charles Rosenberg said many, many years ago, epidemics throw light on on the workings of of of states, 48 00:06:11,300 --> 00:06:18,710 but also how how that changes over time and how different epidemics produce different responses, 49 00:06:18,710 --> 00:06:25,670 how the state itself has changed and the component parts of what makes policy also have changed over time. 50 00:06:25,670 --> 00:06:30,560 So they're tracing that really so that their individual topics. 51 00:06:30,560 --> 00:06:37,440 But I think they have something broader to say about how we respond to epidemics. 52 00:06:37,440 --> 00:06:46,200 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, 53 00:06:46,200 --> 00:06:53,780 but there's also a political and what's the difference between the two and how do we apply this? 54 00:06:53,780 --> 00:07:05,630 Well, I think that the political end can come sometime before the epidemic actually actually peters out. 55 00:07:05,630 --> 00:07:14,060 I mean, there are always political benefits or benefits to governments from epidemics. 56 00:07:14,060 --> 00:07:27,230 And sometimes, as in the case of HIV, it took some while for to get the politicians within government involved. 57 00:07:27,230 --> 00:07:32,660 The bureaucrats, the medical bureaucrats in particular have been involved for some while. 58 00:07:32,660 --> 00:07:37,280 And activist groups outside government had also been pressing for action. 59 00:07:37,280 --> 00:07:44,630 But government itself, the politicians couldn't see an advantage to this for quite some little while. 60 00:07:44,630 --> 00:07:55,790 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, 61 00:07:55,790 --> 00:08:01,760 came very much centre stage and suddenly government was galvanised into action 62 00:08:01,760 --> 00:08:07,220 and a cabinet committee on HIV was set up and everything was was high level, 63 00:08:07,220 --> 00:08:14,120 very high level emergency. The deputy prime minister, William Whitelaw, was in charge and so on. 64 00:08:14,120 --> 00:08:20,270 But politicians are a very canny and they can use an epidemic for their own purposes. 65 00:08:20,270 --> 00:08:25,430 And so the government used it to get what it wanted in certain areas. 66 00:08:25,430 --> 00:08:29,360 For example, getting rid of the Health Education Council, 67 00:08:29,360 --> 00:08:40,400 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. 68 00:08:40,400 --> 00:08:46,670 And so you see that in other epidemics where governments use them to move, 69 00:08:46,670 --> 00:08:57,290 they move the chairs around in terms of institutions and use the epidemic as a kind of rationale for that. 70 00:08:57,290 --> 00:09:07,100 But that high level political response, I think, in the case of HIV, did not last that long. 71 00:09:07,100 --> 00:09:18,140 By the year after, when the cabinet committee had been set up, there was rather a feeling that the epidemic had been overhyped. 72 00:09:18,140 --> 00:09:24,020 That wasn't going to be this general population devastation. 73 00:09:24,020 --> 00:09:29,120 And the idea that it had all been a gay conspiracy began to take hold. 74 00:09:29,120 --> 00:09:33,050 And that was kind of leaked gently to the media at the time. 75 00:09:33,050 --> 00:09:39,560 And so journalists who were close to government were writing those sort of pieces in the newspapers. 76 00:09:39,560 --> 00:09:51,710 So the government withdrew to a degree. So for the politicians, the epidemic had come to an end as a high level policy issue. 77 00:09:51,710 --> 00:09:58,040 Obviously, they continued to be involved in areas like the politics of public information. 78 00:09:58,040 --> 00:10:05,960 Campaigns want what went into those and also in particular in schools, sex education matters, 79 00:10:05,960 --> 00:10:14,750 which had a lot of political intervention, but the sort of high level political intervention was at an end. 80 00:10:14,750 --> 00:10:20,330 So for politicians, HIV was no longer the issue that it had been. 81 00:10:20,330 --> 00:10:25,160 And now if you look at swine flu, there were similar issues. 82 00:10:25,160 --> 00:10:29,750 Politicians were and it was a different government of a different complexion. 83 00:10:29,750 --> 00:10:40,460 In 2009, it was a Labour government, but politicians were still weighing up what advantage the epidemic was to them. 84 00:10:40,460 --> 00:10:51,980 And in that case, the high level response, the policy of containing the epidemic with contact tracing, closing schools, 85 00:10:51,980 --> 00:11:02,090 medication and so on, was popular with the public and the public were concerned that swine flu was going to spread more widely. 86 00:11:02,090 --> 00:11:06,410 And so politicians wanted to continue with that high level response. 87 00:11:06,410 --> 00:11:09,920 So, you know, the contrast with HIV, 88 00:11:09,920 --> 00:11:17,690 but people at the ground level felt and within some of the public health institutions felt that it really wasn't working, 89 00:11:17,690 --> 00:11:22,070 that it couldn't be it couldn't be used for much longer. 90 00:11:22,070 --> 00:11:28,580 It was really kind of creaking at the seams. But they couldn't get that through to politicians. 91 00:11:28,580 --> 00:11:33,140 Politicians were very gung ho for this kind of high level response. 92 00:11:33,140 --> 00:11:45,050 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, 93 00:11:45,050 --> 00:11:53,310 that that high level response came to an end. So I think there's a contrast between the two epidemics with one politician's. 94 00:11:53,310 --> 00:11:59,250 It came to an end politically quite early on with the other one, 95 00:11:59,250 --> 00:12:08,420 the political benefit was was greater and so politicians wanted to continue beyond perhaps when they should have done. 96 00:12:08,420 --> 00:12:13,670 I think it's a it's a useful insight to think about how there's these different endings within different groups, 97 00:12:13,670 --> 00:12:17,600 and it's pointed out there's obviously a kind of media ending. 98 00:12:17,600 --> 00:12:24,290 There's the medical ending, there's the political ending, but also then the tensions and the clashes between different groups as they 99 00:12:24,290 --> 00:12:31,730 debate and sometimes argue over when it has ended and who who it has ended for. 100 00:12:31,730 --> 00:12:37,050 But I was also really struck by you mentioned at some point this phrase, which probably everyone's heard of now, 101 00:12:37,050 --> 00:12:41,150 how we're not at the end, but perhaps we're at the beginning of the end. 102 00:12:41,150 --> 00:12:45,530 And you've traced this back actually to the HIV AIDS epidemic? 103 00:12:45,530 --> 00:12:51,620 Yes, I think that was something that was used. And I've been trying to track it down because it was used very widely. 104 00:12:51,620 --> 00:12:57,840 And I think it has been used recently in relation to covid as well with the coming of vaccination. 105 00:12:57,840 --> 00:13:10,940 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, 106 00:13:10,940 --> 00:13:18,650 a sense that the the disease was still there, but it was becoming a different sort of disease. 107 00:13:18,650 --> 00:13:29,510 It was becoming a manageable disease and it was becoming less epidemic and perhaps more chronic, something that you would manage with medication. 108 00:13:29,510 --> 00:13:35,270 And people would kind of, in a sense, longing for this to be able to take place. 109 00:13:35,270 --> 00:13:40,640 And they would talk about things like, you know, a disease like diabetes. 110 00:13:40,640 --> 00:13:46,450 And that was the model of what they wanted HIV to become. 111 00:13:46,450 --> 00:13:47,710 Thank you very much, Virginia, 112 00:13:47,710 --> 00:13:54,820 for sharing your expertise and for helping us to think about the difference between policy and political endings and medical endings. 113 00:13:54,820 --> 00:13:59,170 And thank you all very much for watching the videos. 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