In late 1985, Norman Fowler, who was then the health secretary in Margaret Thatcher’s government, sent a letter to the prime minister. He said that there had been 275 people with Aids in the UK that year. Of these, 144 had died. Without action, he added, a further 20,000 people would be infected with HIV by 1988. The UK was on the precipice of a public health emergency. Fowler encountered a lot of scepticism.
“People at the time said that I was entirely taken over by the subject, and that I overexaggerated,” says Lord Fowler, now 83 and speaking via Zoom from his home in Fulham, south-west London. He looks composed, and every bit the lord in recess, wearing a pastel pink shirt underneath a green jumper. Behind him sits a glass cabinet stuffed with weighty texts and political memoirs.
By March 1989, the World Health Organization estimated there were more than 400,000 cases of HIV worldwide. Fowler’s warnings of a crisis were emphatically vindicated. “I don’t think I did overexaggerate it. But I certainly do think that I was taken over by it,” he says.
History has been kind to Fowler and his time as health secretary. He took the post in 1981 (the same year the UK recorded its first death from an Aids-related illness) and is often seen as a rare empathic presence in Thatcher’s government, determined to take whatever action was necessary to tackle the crisis, despite considerable opposition from tabloids, faith leaders and fellow ministers. Although he left the position of health secretary in 1987, he never stopped campaigning on issues around HIV. Last month, he announced he would be standing down as Lord Speaker so that this mission could continue.
The current pandemic has seen a renewed interest in the Aids epidemic. The parallels between the two aren’t lost on Fowler, nor on those who have seen Russell T Davies’s sobering portrayal of that era, It’s a Sin, which follows a group of gay men and their friends from 1981 to 1991 as the crisis devastates their community. For Fowler, watching the television show triggered memories of doctors and nurses working under enormous strain and “the pressure of knowing that there was nothing they could do to save the lives of people who had been afflicted”.
By 1985, Fowler and his team knew that Aids was caused by HIV. They knew several of the ways in which HIV was transmitted, and that there was no cure. They knew they needed to act fast. With no treatment available (the first antiretroviral drugs wouldn’t become available until 1987), Fowler and his team launched one of the country’s largest ever public health drives. Under the slogan “Aids: Don’t Die of Ignorance”, a mailshot campaign was distributed to 23m homes, educating the public with clear facts about HIV transmission. Posters stated that Aids was not prejudiced and could kill anyone, gay or straight. Clean needle exchanges were created for injecting drug users. But the most striking element was the harrowing tombstone and iceberg TV adverts, the former voiced by John Hurt.
A few years into the campaign, Fowler was photographed shaking hands with an Aids patient during a fact-finding trip to San Francisco, which was faring much worse with the epidemic (this was a few months before Princess Diana made headlines for doing the same at Middlesex hospital in London).
Ministers railed against the provision of clean needles as they felt it showed an acceptance of drug-taking. Others believed informing people about unprotected or gay sex would encourage them to experiment. Some thought Fowler should do nothing at all. Outside parliament, there was pressure to mount a campaign not grounded in public health but in morality: preaching good behaviour and abstinence.
“We had people who said that my message – which was deliberately a message of public health – was not right,” says Fowler. “We had the chief rabbi saying: ‘The campaign is telling people not what is right, but how to do wrong and get away with it.’” When Fowler and his team were preparing newspaper adverts with information on the dangers of unprotected sex, Thatcher expressed disproval at their perceived explicitness. “Her only comment was: please don’t use that section on risky sex because it tells people, young people, things that they don’t know. I think she felt that these were practices that she didn’t like, which she didn’t want to see encouraged. She was certainly not unsympathetic to the individuals, but she was very unsympathetic to the campaign.”
On the eve of publication, Thatcher visited Fowler to again express her dissatisfaction at the wording. “What she thought would be sensible was to follow the venereal disease precedent, and have notices in public lavatories and in doctors’ surgeries. Well, I had the ticklish task of saying to her: ‘Actually, communication has moved on a bit since those days.’” The advert was published as Fowler intended.
Thatcher’s resistance was circumvented with the creation of a cabinet subcommittee on Aids; one that allowed Fowler and his team, including his chief medical officer, Sir Donald Acheson, to respond more rapidly to the situation (“very unusual”, notes Fowler). Looking back, he says, he has “absolutely no complaints” about the campaign. “I think the slogan Don’t Die of Ignorance was absolutely correct, and it encapsulated everything that we needed to say. If you got HIV, it was a death sentence. So it’s all very well saying it’s a bit scary, but that was the reality.”
The campaign was effective. A Gallup poll in 1987 showed 98% of the public was aware of how HIV was transmitted, and the vast majority supported Fowler’s campaign. It has since been criticised for its apocalyptic tone, with many arguing that the message of fear and specific focus on gay people stigmatised those living with HIV. “It certainly wasn’t the intention to do that,” says Fowler. “It’s very easy to look at a campaign and say: ‘Couldn’t you have made it a bit softer?’ But we were in an emergency situation. We were working very fast. In everything we said, we were saying ‘gay or straight’. We tried to make it as normal and as accepted as we possibly could.”
Britain’s gay population was under siege for much of the 80s. The Conservative government campaigned on family values and targeted Labour councils supportive of LGBTQ communities. This was the era of section 28, Thatcher’s infamous 1988 law that prohibited councils and schools from “promoting homosexuality”. When the Aids crisis hit, newspapers, such as the Mail on Sunday and News of the World, labelled it a gay plague. Nowhere was society’s palpable lack of empathy more apparent than when the former chief constable of Manchester James Anderton claimed the city’s gay population were “swirling around in a human cesspit of their own making”.
Fowler recalls witnessing “all the antipathy that there was to gay people. People were making judgments, condemning them simply on sexual orientation, which I found simply and totally unfair. I couldn’t understand it then, and I don’t really understand it now. Some said that those with HIV should be kept in isolation. For how long? Perpetually, apparently.”
Did members of the government show a lack of empathy towards those affected by the HIV crisis because it disproportionately affected gay men? “Yes, of course,” he says. “Absolutely, no question at all. My attitude was: ‘People will judge you in future on what you do now.’ But there were others who didn’t take that view. Thatcher was a case in point. She was undoubtedly sympathetic to people who were suffering. But in terms of policy, she was miles away from where I think we wanted to be.” When Thatcher moved him from the post of health secretary in 1987, she told him that he mustn’t be thought of as just the “minister of Aids”.
If he was single-minded, he has no regrets. “I tried to be determined that future generations shouldn’t say: ‘They should have done more.’”
Could they have done more?
“I don’t think there was anything else we could have done actually, no,” he says, his voice solemn.
Fowler was born in Chelmsford in 1938, an only child to Norman Frederick Fowler, an engineer, and Katherine Fowler, a teacher. He took an early interest in politics and by 13 would tell anyone who asked that when he was older he wanted to be an MP. He went from grammar school to Cambridge University – where he chaired the Cambridge University Conservative Association, and went on to work as a reporter for the Times for the best part of a decade.
In 1970, he was elected Conservative MP for Nottingham South. When Thatcher won the general election in 1979, he was made transport secretary; perhaps his lasting legacy in that job was a bill that made seatbelts compulsory, even if Fowler followed the whip to vote against that amendment. “I needed some persuading, to put it mildly, because I thought: ‘This is a law that is not going to be easy to enforce. People are going to ignore it,’” he says. “I was quite wrong about seatbelts. It was self-enforcing. It saved quite a lot of lives.”
After the move from health, he served as employment secretary before resigning from Thatcher’s cabinet in 1990 to spend more time with his family: his wife, Fiona, who he had married in 1979, and his three children. He stood down as an MP in 2001, and entered the House of Lords, where, in 2016 he became Lord Speaker.
Fowler continued campaigning on HIV long after he left the health secretary post. He chaired a parliamentary investigation into HIV in the UK, sits on the board of the Terrence Higgins Trust and is involved with Mildmay Mission hospital, London’s only specialist HIV hospital. In 2014, he published a book, Aids: Don’t Die of Prejudice, the result of nine trips to locations with a high incidence of Aids around the world.
Today, treatments for HIV are highly effective. Most people with the virus can live a healthy life. With PrEP, a drug that prevents HIV transmission, at risk-groups (for example, gay men and sex workers) now have the means to protect themselves from infection. But Fowler laments the complacency that has set in around HIV in the UK, particularly as he feels the country has the means to virtually eliminate it with proper testing and education. “There’s a danger that we look at It’s a Sin as a period piece,” he says. “We’ve got to learn the lessons because each of those scenes is replayed in so many countries, where either homosexuality is a crime, or where there is a vast amount of prejudice and discrimination.”
Building on the research for his book, he wants to continue working in regions where HIV is still prevalent, particularly sub-Saharan Africa, eastern Europe and Russia. “The fact is that around the world, in so many countries, you’re seeing exactly the same thing happening today. So far, we’ve got 35 million people dead from HIV. I think now that figure is beginning to come home in a way that it didn’t before Covid.”
And as a former health secretary, what does he make of the way Matt Hancock has handled the pandemic?
“There is a trade union of health secretaries, you know,” he jokes. “But, to be serious, I think that he’s handled it well, personally. That may not be everybody’s view. But to those who criticise it, I say: ‘You try handling an epidemic or pandemic of this kind.’”
He believes the pandemic, like the HIV epidemic before it, has emphasised the importance of trust in public health officials. “The chief medical officer and his officials may not be right on every individual point, but it is far more likely that they are right than any politician,” he says. “A politician who goes against the advice of his public health officials and the CMO [chief medical officer], I think, slightly takes his life in his hands.”
His parliamentary career is not without regret, chief among them section 28, which Fowler voted for, but now describes as “a terrible mistake”. “Like the whole party, I was guilty of going along with that. It was the Local Government bill; it sounded very undramatic if you just looked at it as that. It just slipped through. But it’s a matter of shame for us.”
Though Fowler is now unequivocal in his support for the LGBTQ community, his voting record as an MP is mixed. In 1998, he voted against reducing the age of consent for gay people from 18 to 16. “I apologise for that,” says Fowler without hesitating. “I don’t make any secret of the fact that my views have evolved. My views of 40 years ago, or 50 years ago, are not my views today. Even [those of] 20 years ago.”
Fowler has called for the number of Lords to be reduced and was frustrated by Boris Johnson’s decision to increase their number by 50 to 830. But he remains adamant the chamber still has value in British politics. “Although the Lords gets a hell of a lot of mud thrown at it, the people – not all – that I’ve met there have been some of the best and wisest people that I’ve met in half a century in politics,” he says. “There is a place still for experience and, if it’s not too old-fashioned a term, wisdom.”
Despite growing cynicism about politics, Fowler believes it is still a career in which you can produce worthwhile, meaningful change. “There’s no question that you can,” he says. “Any politician has within him the power to change things for the better. Even now – with the domination of the whips, and the party machines – you can find MPs who, through their own single-handed efforts, managed to get bills through and changes through.”
In Fowler’s case, his has been a parliamentary career that has almost certainly saved lives. It is, he says, “the most important thing a minister can do”.