1986–1987: Period Of Wartime Emergency
The governmental reaction until 1986 was primarily at a departmental level. But in 1986 AIDS was recognized as a clear political (in the sense of being a concern for party politicians) priority as well. No longer regarded as a problem for civil servants, volunteers, and medical and scientific experts, AIDS became a political issue—indeed, a national emergency. This reaction was marked in a number of ways, most notably by the formation in October 1986 of an interdepartmental Ministerial Cabinet Committee on AIDS, chaired by William Whitelaw, who was then deputy prime minister. The state of urgency was such that Whitelaw was on the steps of Number 10 Downing Street briefing the press on the (normally secret) meeting before the Cabinet Secretariat had finished typing the minutes.[39]
Peter Hennessy, Whitehall (London: Secker and Warburg, 1989).
The first full-scale debate on AIDS in the Commons was held in November.The health education campaign on AIDS was also enormously upgraded. Until 1985 the Terrence Higgins Trust had been the main source of information and advice on AIDS, but the Department of Health now began to expand its earlier series of leaflets and professional guidance into a public education campaign. In March 1986 a series of full-page advertisements appeared in the national press. These were widely criticized for poor presentation and lack of public impact, but in October, following the creation of the Whitelaw Committee, a public campaign costing twenty million pounds was announced, involving television as well as newspapers and wide distribution of a leaflet to all households in the country. The theme of the campaign—"Don't die of ignorance"—was the potential heterosexual spread of AIDS. This campaign
culminated in an AIDS week in the spring of 1987. There was cooperation, perhaps unparalleled since wartime, between two broadcasting companies, the BBC and ITV. One participant recalled, "If what was known about AIDS was true, then we had to educate the public fast. If it was left, it might be too late." The commitment of the broadcasting companies was wholly exceptional. After the sense of urgency had lessened, however, other considerations became uppermost: "People were beginning to ask, what next? Broadcasters by then had more or less given up editorial rights, were more or less acting as the government's mouthpiece. It made broadcasters reflect on the dangers of giving up editorial freedom and control—not because of AIDS but because of the dangers of being on the slippery slope to government control."[40]
Interview, media worker, January 1989.
In late 1986 the Health Education Council was replaced by a new Health Education Authority, a special health authority under much more direct political control and with specific responsibility for the public education campaign on AIDS. And early in 1987 the Commons Social Services Committee began an extensive series of meetings dealing with problems associated with AIDS. The potential for heterosexual spread of the disease was further underlined by the discovery of the virus among injecting drug users in Edinburgh. In the autumn of 1986 the report of the McClelland Committee on HIV in Scotland declared the prevention of HIV among drug users to be of the highest priority.[41]
HIV infection in Scotland: Report of the Scottish Committee on HIV Infection and Intravenous Drug Misuse (Edinburgh: Scottish Home and Health Department, 1986).
Everywhere, indeed, there was an air of emergency. Norman Fowler, then social services secretary, paid a visit to San Francisco with the chief medical officer early in 1987. Princess Diana's opening of the first purpose-built AIDS ward in the country at the Middlesex received widespread press publicity. The professional guidelines became a flood, and extra funding began to flow. AIDS became a target for increased resources rather than, as previously, a potential drain on existing finance. The £680,000 for AIDS services that had gone to the North East, North West, and South East Thames Regional health Authorities in 1985–86 rose to £2.5 million in 1986–87.[42]
Annual Report of Chief Medical Officer for 1985, p. 46.
The Medical Research Control received a million pounds from the Whitelaw Committee at the end of 1986 for research on AIDS. Early in 1987 a further £17.5 million was approved for AIDS research, £14.5 million of which was to go to a special Directed Programme on AIDS, aimed primarily at developing an AIDS vaccine. In wartime the pharmaceutical industries had collaborated. "It's a war-type coalition where everyone gets their jackets off and mucks in," commented a participant.[43]Interview, MRC research worker, November 1988.
Funding also went to the newly established Global Programme on AIDS, set up by the WorldHealth Organization. In 1987 over £200 million also went from the Overseas Developmental Administration to the European Community's developing program on AIDS.
AIDS was already defined as a problem at the policy community/departmental level before 1986. But how did it become defined as a problem at the political level? How did it become feasible for Conservative politicians to become closely involved in an issue which, in many of its aspects, would appear to have little appeal to the ethos of the Thatcher government? There are a number of possible explanations, none of them mutually exclusive and all warranting further investigation. There is an explanation based on personalities—either the concern of influential public and political figures or the particular involvement of politicians such as Norman Fowler at the DHSS. Fowler was regarded as an astute politician who could use an emergency such as AIDS to attract extra resources to his department. He has also been closely involved in the department's previous continuing activity on drugs, which in some respects—for example, the creation of an interdepartmental Ministerial Cabinet Committee and the development of a mass media campaign—prefigured many of the political responses to AIDS. Lessons from abroad—in particular the danger of heterosexual spread of the disease—also weighed heavily. Dispatches from the British ambassador in Kinshasa had drawn attention to the rapid heterosexual spread in Zaire and the possibility that Britain might share the same fate. The drugs issue in Scotland fueled those concerns. In 1986 the CMO's report pointedly noted that the current sex ratio of the disease in England and Wales was 33:1 (male to female), but in Africa it was 1:1 and in Scotland the ratio was different because of the higher proportion of intravenous drug abusers.[44]
Annual Report of the Chief Medical Officer of the Department of Health and Social Security for 1986 (London: HMSO, 1987), pp. 53-61.
The role of the media was also clearly important. As John Street has remarked, AIDS is perhaps the first "media disease."[45]
Street, "British Government Policy on AIDS." Obviously, other diseases—such as tuberculosis and influenza—have had considerable media salience. In AIDS, however, the political response was unusually (for Britain) determined by the media representations of the nature of the disease. Politicians derived their definitions of the problem directly from television in particular. See V. Berridge, "AIDS and Media Policy in Britain," Social History of Medicine, 3 no. 1 (1990): 144.
Particular media stories punctuate the early history of the disease—the death of the chaplain in Chelmsford prison in 1985, for example, and the death of Rock Hudson in the same year. Television programs that followed the pattern of the 1983 Horizon broadcast also appear to have made a particular impact—for example, the Panorama news analysis series devoted an entire program to AIDS in 1985. These programs were reacting on a particularly media-conscious government, with a general preference for mass advertising and market research and a reliance on particular media entrepreneurs. Just before the second mass media campaign was announced, there had been a spate of programs dealing with the AIDSissue, Weekend World among them; and there is evidence that these programs fueled the concern of government ministers.
But the pressure for emergency action also came in traditional bureaucratic ways, from the internal workings of the Department of Health and through the role of both medical and generalistic civil servants. For them, too, as one commented, AIDS just "gradually bubbled up."[46]
Interview, senior civil servant, 1988.
The role of Sir Donald Acheson has already been mentioned. AIDS was, in that context, essentially part of a revival of infectious disease since the 1970s, with outbreaks of salmonella and of hepatitis B as well as the arrival of AIDS. It also was part of the apparent revival of public health medicine, which had been severely downgraded in the postwar period. Acheson was chairing a committee on the public health function within the department at the same time that he was chairing the Expert Advisory Group on AIDS. This committee, which reported in January 1988, placed great emphasis on the role of AIDS in legitimating the revival and extension of public health powers. The legacy of Sir John Simon and the nineteenth-century "heroic phase" of public health was again to the fore; this committee's report, too, was remarkable for its historical consciousness. Acheson also appears to have had the support of the policy and generalist side of the Department of Health and of the civil servants in the Cabinet Office. An interdepartmental committee of officials preceded the Cabinet's interdepartmental political committee. In this sense, the period of national emergency conformed to a fairly classic model of bureaucratic policymaking.But the public context of the political reaction should also be recognized. Governmental activity took place against a background of increasing public fear, which should be distinguished from the "moral panic" and anti-gay feeling to which other writers have drawn attention. This kind of panic undoubtedly existed—in particular in the pages of the popular press, with its talk of "gay plague." But there was also a public fear of contagion. A senior London probation officer recalled, "If we had an HIV-positive person in those days, we'd clear the court."[47]
Interview, senior probation officer, 1988.
In the letter pages of the Guardian and the British Medical Journal in the early months of 1987, the safety of kissing was debated by Dr. John Seale, a Harley Street consultant; Sir Donald Acheson; and Dr. Joe Smith, director of the Public Health Laboratory Service. Although the virus had been discovered and scientific knowledge about transmission was proceeding apace, knowledge was not finally constructed and the boundaries with popular knowledge were undefined. A psychologist recalled: "X , consultant at Y hospital, came to see us at the beginning ofthe epidemic. I asked about transmission through sexual intercourse with women. That was seen as no risk then; now it's high risk. There were the arguments about deep kissing and how you'd need a liter of saliva. … Some doctors in Italy think you can and if it is the case, it's very serious. How do you know? There's sloppy talk—and no acknowledgment of doubts. They're full of certainties, and these change."[48]
Interview, hospital psychologist, February 1989.
Scientific and popular perceptions of the disease appeared to have equal credibility; science itself, early on, was only folklore in relation to AIDS. There was in a sense a popular decline in confidence in the authority of science and of official pronouncements about the disease. How far this decline impinged on the emergency policy reaction remains to be investigated. But certainly the vastly expanded health education campaign appears to have achieved an important, if partial, transformation in public knowledge about the virus and its means of transmission.[49]Department of Health and Social Security, AIDS: Monitoring Responses to the Public Education Campaign (London: HMSO, 1987).