Steve Brine: Ministers have seized the chance to finally end the HIV epidemic

4 Dec

Steve Brine is the MP for Winchester, was Public Health Minister 2016-2019 and the Conservative MP on the HIV Commission

The campaign against AIDS, as it then was, was etched in my mind from childhood. I did not need this new pandemic to recall that chilling yet effective tombstone advert from the 1980s.

Norman Fowler is something of a hero of mine. As  Andrew Gimson of the parish reported on earlier this week, when Health Secretary he followed the science when others wanted something far worse. The more I learn about the decisions of those times, the more my respect for him grows.

From 2016-19 I was lucky to serve the party and country as public health minister. I was suddenly in a position to do something to change the modern HIV epidemic. To follow in Fowler’s footsteps.

I engaged, as all good ministers do, with the sector organisations. The Terrence Higgins Trust, National AIDS Trust, and the Elton John AIDS Foundation all lobbied me hard. But not just for retail policies. They had a vision: a country with no new HIV transmissions. They were united in presenting a new scientific possibility: this end to transmissions by 2030. I wanted this for England and took the proposal to my boss, Matt Hancock.

As I told the House of Commons on Tuesday, I was ‘pushing at an open door’. In January 2019, Hancock and I committed England to this ambitious but achievable goal.

On the 32nd World AIDS Day this week, the HIV Commission – on which I subsequently served – issued its final report and recommendations. What followed, for all to see, was the commitment of this Government to that very vision. Conservative minister after Conservative minister reinforced how we wish to see this policy become a practical reality.

Boris Johnson set the tone, becoming the first Prime Minister to pledge to end new transmissions before the end of the decade. Rishi Sunak made the same commitment at the launch of the commission’s recommendations from the floor of the House of Commons putting it in the record in Hansard for perpetuity. At the launch with Elton John, Michael Gove gave a commitment to report annually on progress – one of our key demands.

As if that wasn’t enough, Hancock pledged to work together with the Commission on its ambitious targets – cutting the numbers of people living with undiagnosed HIV by 80 per cent by 2025 – and to increase HIV testing. Lord Bethell, his deputy, told the House of Lords the department would investigate normalising HIV testing. That was all before lunchtime.

Our report had barely been launched for 90 minutes and already recommendation after recommendation was being committed to by my Conservative colleagues. It was a sight to behold. But it turned out the Government was not yet done.

The Speaker kindly granted myself and Wes Streeting, my Labour co-commissioner, an adjournment debate on the HIV Commission’s launch. To everyone’s surprise, the Secretary of State himself took his place at the Despatch Box. He had returned to make yet another commitment: that the HIV Commission would be the basis of a HIV Action Plan, available: “as early next year as is feasible to ensure that the work is high-quality, can be delivered and can set us fair on a credible path to zero new transmissions in 2030.”

He said this was a promise he wanted ‘to make in person’. I was shocked, humbled and filled with pride.

There are many that are cynical about politicians and what we can achieve. Tuesday was not one of those days. A Conservative Government is acting decisively to end an outstanding issue of social injustice in less than a decade is not something to be dismissed.

The work to make it happen starts now. Get this right, my fellow Conservatives, and we could end the five-decade long HIV epidemic ‘on our watch’. Nothing short will now suffice.

What Thatcher’s response to the AIDS crisis teaches us about tackling the present pandemic

1 Dec

“There is now a danger that has become a threat to us all,” the soundtrack begins. “It is a deadly disease and there is no known cure…”

A volcano erupts, a hail of boulders rains down a cliff, and to the sound of wild, funereal music a pneumatic drill and a chisel carve from the solid rock a tombstone bearing the single word AIDS, on which a bunch of lilies is thrown.

This must be one of the most frightening public information films ever made, directed by Nic Roeg, voiced by John Hurt, and intended to strike fear into viewers and get them to read the “Don’t Die Of Ignorance” leaflet which was distributed to 23 million households.

On World AIDS Day, it is worth recalling that in the 1980s another pandemic struck: a lethal and mysterious illness for which there was no cure.

The parallels between AIDS and Covid-19 should not be pushed too far, but are nevertheless illuminating, and in the fulness of time have even become encouraging, for the HIV Commission today publishes its plan for England to become by 2030 the first country in the world to eliminate the transmission of the HIV virus, which causes AIDS.

The Commission’s key recommendation is “test, test, test”, and as one of its members, Steve Brine MP (Con, Winchester), yesterday told ConHome, “in the context of the last nine months, you really get what we’re saying”.

Both pandemics struck during periods of Conservative government, and posed enormous troubles for the Prime Minister of the day.

In August 1975, when there had been 206 confirmed cases of AIDS in the United Kingdom, of whom 114 had died, Margaret Thatcher was told by the Chief Medical Officer, Sir Donald Acheson, that it was likely AIDS could be transmitted heterosexually as well as homosexually.

What message was to be given to the public? In his brilliant account, beginning on page 71 of Herself Alone, the third volume of his life of Thatcher, Charles Moore quotes David Willetts, then a member of Thatcher’s Policy Unit, who told her, “We have to walk a difficult tightrope between being accused of bureaucratic inertia, and being so active as to whip up public hysteria,” and went on:

“We simply don’t know whether everybody with the virus will eventually go down with the symptoms of the disease. So we would be telling people that they may get the clinical disease, but we don’t know; and if they have got it, we can’t cure it. That’s not a very satisfactory message, but seems to be the best course out of several unattractive alternatives.”

The problem was rendered still more difficult by the close association which emerged between AIDS and homosexuality. Some people seized the chance to express the disgust and hatred they felt for homosexuals: as Willetts warned, there was a danger of fomenting public hysteria.

Some Conservatives, and some religious leaders, urged the Prime Minister to preach the virtues of abstinence.

Thatcher declined to treat AIDS as an opportunity for moralising. For her it was a scientific and medical problem. As Moore writes, she was happiest “when she had a concrete and exact point to advance”.

She was a Tory pragmatist: she wanted to solve the problem, not prate about it. Those who have insisted on understanding her in ideological terms have often overlooked how practical she was.

But part of being practical was framing a public message about the dangers of anal sex, and here she took some persuading, which was done by the Health Secretary, Norman Fowler, who in March 1986 told her that the advice to avoid anal intercourse, “which has been linked with 85 per cent of AIDS cases so far”, must remain in advertisements to be placed in the press, or else these would lose all “medical authority and credibility”.

Lord Fowler, who has worked to this day to reduce and at length eradicate HIV, has recalled how difficult things were in the 1980s, and why at the start of 1987 a yet bigger public health campaign, which included the television advertisements, was warranted:

“We had no knowledge of this disease and no drugs with which to treat it. I was reading a note the other day from the Chief Medical Officer at the time and some of the predictions as to what could happen were terrifying – we were talking millions and millions of people becoming infected. That’s why we launched what is still the biggest public health campaign there’s ever been in this country with leaflets sent out to every home.”

In the 1980s, the predictions of the scientists did not always prove accurate. So too today. Nevertheless, Boris Johnson and Matt Hancock prefer to present themselves as following the science, than as adherents of a theory of freedom which would allow them to ignore what the scientists were saying.

They too are Tory pragmatists, most interested in what works, even if that has to be discovered by an agonising process of trial and error.

Thatcher was always worried, and with good reason, that although she and her colleagues insisted “the Health Service is safe in our hands”, the voters would not believe them. Johnson can be seen guarding at every turn against that danger.

Caroline Slocock, the first female private secretary at Number Ten, has described a visit Thatcher eventually undertook to an AIDS hospice, without any press in attendance, partly because she did not wish to seem to be competing with the well-known work already done in this field by Diana, Princess of Wales.

The first patient she sees is clearly “very ill and has no hope of recovery”. Slocock goes on:

“I feel out of my depth. I have never been at the bedside of a dying person before and I feel strongly that family and friends should be there at this moment, not us… She [Thatcher] responds by taking a seat by his side, asking questions, expressing sympathy, connecting in a simple and genuine way, to which he responds sweetly. She comes across as more of a mother than a Prime Minister…

“After about ten minutes, we leave him and go into the second room. Inside, sitting in a chair beside his bed, is a young American man, also extremely thin. The virus has attacked his brain too, as it does in the final stages, we are told afterwards, and he is excited and confused. At first he thinks she must be a creation of his own mind, a delusion. But then he begins to believe that she really is Margaret Thatcher, but sent to him miraculously to hear his thoughts and to pass them on to President Bush. He tells her to ring the President. It is imperative that action is taken now to help people like him – that is his message. He is overexcited, it is very difficult to know how to respond, and it is very, very sad.

“I desperately want to get out of the room. I feel responsible for putting them both through this awkward scene. Margaret Thatcher is unfazed and behaves as if she has all the time in the world. She places her hand on his arm, asks him a few questions about his life and listens, in a way that demonstrates that she is real, not a phantom, and is there because she cares and wishes him well. He calms down in response. It is simple, human stuff, but I am in awe of it.

“When we leave them, we ask the staff about their families. It turns out that neither have felt able to tell their parents that they are gay, let alone that they have AIDS, and so they are dying alone.”

For a quite different reason, the need to prevent infection, many sufferers from Covid-19 have lived and died alone.

While reading about the 1980s, it struck me that there was often no correlation between a politician’s views on other questions, and what he or she thought about AIDS.

This elementary point has sometimes been overlooked in coverage of the present pandemic. The urgent need to get things done, in order to avert or relieve suffering, trumps whatever abstract views one may have about the right way to set about this.

In January 2019, when Steve Brine was serving as Public Health Minister, and three charities – The Elton John AIDS Foundation, National AIDS Trust and Terrence Higgins Trust – came to him with proposals for the eradication in England of HIV, he gave the Government’s support and approval to what they wanted to do, as did Matt Hancock, the Health Secretary.

Brine said yesterday:

“We had a policy decision, we had the science that allowed us to approve it. The science of PrEP [Pre-Exposure Prophylaxis], which has been a huge game-changer, now allows us to finish the job.”

A connecting thread of pragmatism links the 1980s to the present day. Lord Lexden, the Conservative Party’s official historian, traces this tradition of unmoralistic pragmatism further back:

“‘Sanitas sanitatum, omnia sanitas’: Disraeli’s famous misquotation from the fourth century Vulgate in the course of his great three-hour speech in Manchester in April 1872 defining modern conservatism rings down the years. He understood that moral censoriousness had no more place in health policy than in private life. In this respect, Boris Johnson, like successful Tory leaders before him, follows in the great Disraelian tradition.”

Elliot Colburn: The nationwide roll out of HIV transmission prevention drug PrEP is a life-changing government policy

15 Oct

Elliot Colburn is the MP for Carshalton and Wallington

While London Assembly member Andrew Boff was finishing his make-up ahead of LGBT+ Conservatives Lip Sync on the eve of our first virtual conference, Jo Churchill, the Public Health Minister, was Tweeting a life-changing government policy.

Not Boris Johnson’s announcement to make the UK world leader in green energy, or Rishi Sunak’s pledge to “protect the public finances”. In fact this might not be even in the same league for the population at large but for the LGBT community in particular – and many others including Black Africans, those of South or Central American heritage and many women across the country – this will be immediate and life changing: the nationwide roll out of the HIV transmission prevention drug PrEP.

On the eve of Conservative conference, Churchill confirmed not only what money would be available to local councillors to create new appointments at sexual health clinics to get people on PrEP – but that the money had been paid and is in their bank accounts. This £11.2 million of ring-fenced grant means already stretched GUM clinics can meet with would-be beneficiaries, run tests and change lives. Welcoming the news, Richard Angell of Terrence Higgins Trust called it a “watershed” moment.

For those who don’t know, pre-exposure prophylaxis, commonly known as PrEP, is a drug taken by HIV-negative people that reduces the risk of contracting HIV. When taken correctly it is nearly 100 per cent effective.

This is not to be confused with PEP, post-exposure prophylaxis, that is to be taken ideally within 24 hours, but no longer than 72 hours after the body has come into contact with HIV. The former is like the pill, the latter the morning after pill. Both prevent harm and heartache, both save individuals, the community and NHS considerable amounts of money. It’s good for the head and the heart.

Churchill’s news is a huge breakthrough – and a team effort. HIV and community groups across the country have highlighted the benefits of PrEP for five years or more – Terrence Higgins Trust, National AIDS Trust, Prepster and iwantPrEPnow deserve special mention.

In 2016 my colleague Mike Freer wrote for ConservativeHome making the case for a trial and eventual roll out (the trial ends this month and the roll out is concurrent) – he also laudably took on the bigotry in the debate at that time. LGBT+ Conservatives has raised this at every level in the party under the leadership of Colm Howard-Lloyd.

But the game changer was Matt Hancock. In January 2019, he told the Elton John AIDS Foundation that the Government would end HIV transmissions by 2030 – a huge commitment and no small challenge. So much had followed since. More places on the PrEP trial, Secretary of State support for the HIV Commission – founded by but independent of Terrence Higgins Trust, NAT and EJAF and due to report on World AIDS Day 2020 – to chart a way to reach this noble ambition. Now this – PrEP on the NHS.

This is something every Conservative can be proud of. Preventing harm – and illnesses – is best for our voters and the public purse. Being responsible for bringing to an end in England a five-decade long epidemic is something worth being in government for. Showing we are here to improve everyone’s lives. Gay and bisexual men arguably have most to gain but so do Black Africans, women and trans people.

Now the roll out will not be overnight – the kind of transformation will take weeks to implement, but there is no reason to not get in touch with your local clinic, just be kind and remember any delays are not their fault. Covid-19 is still stretching the NHS in all kinds of directions.

While this news is a milestone – the job is not completed yet. Not everyone wants to go to a STI clinic – campaigners want GPs, maternity units, gender clinics, even pharmacies to be able to prescribe PrEP. This would be welcome. There will need to be more funds made available to local authorities – Terrence Higgins Trust, NAT and London Councils have called for £16 million per year for the rest of the parliament. The HIV Commission will, I am sure, provide further guidance.

During the unparalleled Covid times, it feels strange to say there are things we can celebrate – our Government rolling out PrEP is definitely one.

Had Boff been Lip Syncing in person at that iconic LGBT+ Conservatives event he would have raised a glass to this massive leap forward. Instead we have to share a socially distanced pat on the back. Politics is ultimately about change not who gets the credit – but know this, it is yet another thing to be proud a Conservative government has achieved.

Bernard Jenkin: The threat of the virus to the NHS hasn’t gone away. How it could overwhelm hospitals – and intensive care.

13 Oct

Bernard Jenkin MP is Chair of the Liaison Committee, and MP for Harwich and North Essex.

The spring lockdown was necessary to avoid the NHS being overwhelmed by hundreds of thousands of seriously ill people. Today, infection rates are rising again.  So again, we must ask the question: what hospital capacity is required to keep pace with rates of infection?

Today, there is far more data, better understanding of the virus, and better treatments, so we no longer need to entertain the most apocalyptic predictions. Nevertheless, the figures are stark.

It is medical consensus that it takes an average of seven to ten days for someone infected with Coronavirus to develop severe symptoms which require hospitalisation. This affects a smaller proportion now, but ONS data suggests it is still significant.

In the week up to the 1st of October, 16,000 people per day were infected with coronavirus in England.  Hospitalisation data for this specific this specific period is still emerging, but already, seven to ten days later, the Government’s daily Coronavirus updates suggest that between 500 and 600 new hospitalisations are taking place daily in England.

This suggests that some three to four per cent of those newly infected with coronavirus will require hospitalisation. This is lower than earlier in the year (which was up to three times higher).

However, the epidemic is currently most prevalent among young adults.  They are far less likely to require hospitalisation.  This is the case in my own county, Essex, but low case rates are now doubling every ten days, as the virus spreads up the age range.  So rising case rates will lead to rising hospitalisations.

Intensive care units will also come under pressure.  Estimates from the spring suggest that up to 17 per cent of those in hospital with cthe Coronavirus required a move to the ICU.  Perhaps that will be lower too.  Let’s assume it will be only 10 per cent (and that optimism makes the sums easier).

The length of hospital stays also matters.  Those infected with Coronavirus can expect a length of stay in hospital of between five and 15 days, depending upon from where the data is drawn.

Here, a consensus has yet to emerge.  (The paucity of studies from outside China and the pandemic’s continuation means that medics are still feeling their way.)  In his presentation on Monday, Jonathan Van Tam, the Deputy Chief Medical Officer, showed a graphic with a range of nine to nineteen days: taking the middle point of that gives an average stay of 14 days. Similar evidence suggests that eight days is also the approximate length of stay for patients in ICU beds.

England has approximately 140,000 hospital beds, and 4,100 adult ICU beds. For this part of the year, we would expect around 85 per cent of beds to be full, which gives ‘spare’ capacity in England of around 20,000 hospital beds.

So what do all this statistical estimates mean, when asking how much hospital capacity will be needed if there is serious Coronavirus spread throughout the UK?

Let’s assume that we let the virus spread, so that, over the next three months, an additional quarter of the population of England becomes infected with coronavirus – an additional 14 million people. This is equivalent to just under five million infections per month, or 156,000 infections per day. 3.5 per cent of five million would become sick enough require hospitalisation.  That is equivalent to 5,500 daily hospitalisations.

We have to date ignored two factors which make things seem better than they would be. First, there would not be a flat rate of infections at 156,000 per day over three months. Instead, the daily infection rate would follow the familiar (and far more disastrous) bell-curve.

Second, we are assuming that the population which falls sick is relatively young and healthy, as now, and that we can protect the vulnerable.  Experience in this second wave already suggests this is most unlikely.

But let’s look again at what would be necessary to manage 5,500 daily hospitalisations. We know that hospitalisations last, on average, for 14 days. This means that we would need 77,000 extra beds on top of what we now have. So in addition to the 20,000 spare hospital beds that we currently have, we would need to find another 57,000 – equivalent to just over 16 new London-sized Nightingale hospitals.

In this (flat) scenario, these hospitals, as well as every hospital in the country, would have to be run at 100 per cent capacity, each and every single day for three months.

We have also assumed that we can perfectly match hospital capacity to the location of infection hotspots, which is not the experience.  Images we have seen of packed hospital corridors in Lombardy or New York demonstrate this task is very difficult, if not impossible.

For ICU capacity, the numbers are even more stark. If one in ten of those requiring hospitalisation require being moved to the ICU, then 5,500 daily hospitalisations becomes 550 daily ICU admissions. At an average length of stay of eight days, England alone would require 4,400 ICU beds, more than the entire capacity of ICU beds in the country.

And if the epidemic spreads to older and more vulnerable people, this shortage would become yet more acute.  In Essex, the NHS is not planning to stop doing anything but Coronavirus.  The aim is to keep the NHS open for as much normal business as possible, but there would be no possibility of achieving that in the scenario above.

This is the maths which is driving the conversation in government around the need for new Covid restrictions. If test and trace was working better, perhaps we would have been better able to keep the number of cases down.

But absent massive test and trace capacity, the Government has no option but to consider the second round of Covid restrictions to get us through this winter.

The reality of this virus is that it is not like ‘flu; something you get once and gives you immunity.  It is also very hard, perhaps impossible, to find a permanent vaccine.  There never was a vaccine for AIDS or for SARS (another coronavirus).

Time and science will improve the resilience of people, society and the economy.  We certainly should not plan to have varying degrees of lockdown every six or twelve months.  The Government should set up a long term strategic group, away from the daily pressures of Whitehall, to draft a strategic White Paper, Living with Coronavirus, which sets out how we can best manage Covid-19 while keeping the economy open.