THOSE readers with long memories might remember that ‘other’ pandemic that swept the world in the 1980s – that of HIV, and the doomsday scenarios and absolute fear and panic it generated in the population at large.
Michael Bartos certainly does – the Lower Cape Bridgewater resident was at the forefront of the fight against AIDS and the panic, and he sees a lot of similarities in the coronavirus pandemic.
Perhaps unsurprisingly, many world experts around at the time of the early fight against HIV were also pressed into service to battle COVID-19, and the lessons they learned from that time were important.
Some of them you may have seen plenty of on television – the likes of Anthony Fauci, for example, or Deborah Birx, both leading US figures who have served the White House and who Professor Bartos has worked with closely over the years.
Professor Bartos has also been enlisted in the battle, for the World Health Organisation for which he has worked for many years.
Getting started
The road to Cape Bridgewater – and the world – began in Adelaide where Professor Bartos was born, the son of an Immigration Department official.
That job meant a lot of early travel, taking in stints as a child in Italy, then Canberra and Spain.
On return to Canberra he finished his schooling and went to Australian National University where he obtained both Bachelor’s and Master’s degrees, the latter in sociology and education.
Workwise he was initially split between Melbourne, Canberra and Sydney.
Working in education policy he then became a speechwriter for federal Education Minister Susan Ryan in the first and second Hawke governments.
Professor Bartos was a researcher at La Trobe University’s HIV research program – and married to Mary Picard (the couple now live on part of the property where her father Don was once farm manager) – when a job came up at the United Nations as policy adviser and speechwriter for the head of UNAIDS.
The couple, in their late 30s, were looking for different horizons.
“When they advertised for that job I was someone who happened to have speechwriting experience, and I ended up working there for 20 years,” Mr Bartos said.
That also involved stints in locations such as Guatemala and Zimbabwe as country director in the battle against a virus which was still rampant, before returning to Australia in 2017 where he planned to return to academia.
But the coronavirus called and Professor Bartos has been busy since working for the World Health Organisation, writing reports for the G20 during the pandemic as well as the Independent Panel for Pandemic Preparedness and Response, set up by the WHO as an independent inquiry into the pandemic and chaired by former New Zealand Prime Minister Helen Clark and former President of Liberia Ellen Johnson Sirleaf.
So there’s a fair chance that some of what you might have read, heard, or seen about the pandemic from authorities had its origins in a document Professor Bartos co-authored or otherwise helped develop.
These days he’s also an honorary Associate Professor at ANU in its School of Sociology, where researchers look at public health from a critical point of view.
Which brings us to Professor Bartos’ own thoughts on the subject, which provide plenty of food for thought.
The first lessons
And that experience goes back a long way.
In 1982-83 he was part of one of the first organisations that responded to HIV in Australia, looking at the epidemic from a social research perspective – and witnessing the response of politicians and the public to it.
“One of the things that was distinctive about the HIV response, because it was a new disease, people had to find out everything there was to find out about it,” he said.
“With many diseases dominated by very specialised medical knowledge, when a new disease comes along we have to work out what it is all about.
“What I found interesting was that also became characteristic of the COVID response.”
In 1984 one of the first people to die from HIV in Canberra was in complete isolation in a hospital room.
“The fear there was extremely strong and that was part of what the community organisation about HIV was all about, changing that fear to sort of a feeling of solidarity, the whole wearing of red ribbons and all those things where people needed to show they were allies in reducing stigma,” Professor Bartos said.
“Joan Kirner as Premier for example did an enormous amount.
“It was very important that political leaders were prepared to step up and say ‘this is not something I’m afraid of’.
“I think people do forget it looked very different back then – there were a whole lot of social stigmas attached to HIV because of the modes of transmission portraying the only people were gay men, sex workers and drug users.
“It was overwhelmingly gay men but one of the reasons was because of some of the early responses such as needle and syringe exchanges being adopted early in Australia so it didn’t get in drug users as it did in other countries and sex workers were very good about adopting condom use in their work, which became very quickly normalised.
“The whole HIV epidemic is a very clear example of how much the social and medical are clearly intertwined and you can’t understand one without the other.”
Zimbabwe showed Professor Bartos what could be done, during his time there from 2013-16.
At the beginning of that stint about 30 per cent of the total population was infected with HIV.
“It’s remarkable to think over 30 per cent of the population had an infection which at that point would almost certainly kill them,” he said.
While the antiretroviral medicines that have been crucial in getting on top of HIV were first used in about 1996, Zimbabwe wasn’t in the front line of receiving them.
“It took about 10 years to become accessible at all (in the developed world) and 20 years to become accessible in Zimbabwe,” he said.
“The standard view of Zimbabwe is it was a basket case or pariah state – there was a bar in (the capital) Harare called Pariah State, it was a very popular watering hole – but their response to HIV became very effective.
“They halved the size (of the infected population) to 15 per cent and when I was there there was a really rapid scale up of treatment access and most people in Zimbabwe are on treatment.”
Opportunity lost, or not?
Which brings us to the coronavirus, and the lessons learned, or not.
There was the story of vaccines which, like with HIV, became available quickly in rich countries but not poor ones – though in general the experience from HIV allowed a speed up of sorts.
“I kind of think of it as things which took a couple of decades with HIV took a couple of years with COVID,” Professor Bartos said.
“That’s in fact what I’m going to be working on now, a book on the comparison between HIV and COVID.
“One would hope that there would be more lessons learned than mistakes repeated – I like a line from a senior person in the WHO who said ‘I don’t mind if people make mistakes but I want them to be new mistakes.
“What I think is slightly disappointing about the COVID response is I think in some ways some of those fundamental lessons haven’t been taken to heart enough.
“The response of public health authorities throughout the pandemic has in some ways not been nuanced enough.
“I was one of the authors of a paper which found all or nothing responses were actually very harmful to the response.
“The fact that Australia moved from complete lockdown to no one needs to bother about wearing masks – more could have been done and still needs to be done and will need to be done.
“For example mask wearing – there needs to be a sensible way in which community norms about mask wearing evolve.
“For some people mask wearing seems to be a symbol of being under the thumb of health authorities and not wearing a mask is a sign of freedom.
“To me that seems to be complete nonsense.
“You’d hope that when people are sneezing a bit or have a sore throat that they would see wearing a mask is a sensible thing to do.”
That also extended to the social response from governments – the need for people in part time or “precarious” work to have sick leave entitlements so that going into isolation would not come with an unaffordable financial penalty.
“The idea is if you’re sick you should not go into the workplace,” Professor Bartos said.
“Politicians need to see that. I’m also disappointed about when for a brief period free childcare was on the table but that was quickly kiboshed.
“Really we need to rethink the care economy – we expect that professional levels of care are available but we’re not prepared to pay for them. That needs to be addressed.
“The reality is COVID is going to be endemic and it’s still possible that there will be new variants which will be much more deadly.
“Some of those longer-term discussions about how we want to set up both health and care are still to be had.”
Finding a healthier way
Having discussions is a starting point, but how?
“We still don’t have very good ways of engaging people with health issues,” Professor Bartos said.
“There are some major rethinks that are needed in the way people address health.
“To some extent we tend to have the notion that health is either something where we have an acute health problem and you go into the health system and it fixes you or you don’t need to worry at all.”
Professor Bartos said he has been working on a report for the WHO on social determinants of health equity – things such as the quality of road networks which might mean people are more likely to be involved in crashes or if young men are raised so that risk-taking is part of their identity and other factors that are key to good health in the first place.
“All of these factors are key to health,” he said.
“But in a sense we want a completely medicalised health system to take care of it.
“We were kind of realising that and COVID underlined it, that health isn’t something that you can just hand over to the medical system.
‘It’s perfectly obvious that prevention is better than cure but it’s also perfectly obvious that our system is skewed to the other end.
“Part of the question is why is it the case – of course one of the answers to that is we have a whole set of interest groups and we set things up so there’s a set of interest groups for who it’s important that money goes into those sorts of services.
“What is much harder to generate is the type of interest group who might say social inclusion is more important.
“The WHO definition of health is not the absence of diseases but wellbeing for everyone.”
Local solutions to global problems
And then there’s Portland – Professor Bartos was on the Portland District Health board before resigning in July for reasons which were well covered in the Observer then, but he has some thought-provoking views about the wider health system as it applies locally.
“The real questions here are about how do you provide the health services that are needed that basically gives everyone the right sort of access,” he said.
“For example for acute medical care but in a population of a small city, why you can’t expect to have a vast tertiary level hospital in place providing every service.
“How many GPS there ought to be in town is another question, but there’s also a different question – what should GPs’ time be used for in Portland and the fact that an awful lot of what GPs do is provide a certain level of reassurance and prescribing.
“In NSW they say a pharmacist should be able to do a certain level of prescribing but we’ve had a reaction against that from the (Australian Medical Association).
“But actually the real question is is that a good use of their (GPs) training and time, when all sorts of things should become routine.
“We became very used to self-testing for COVID but there was a lot of resistance to that initially.
“It took 15 years for HIV self-testing to be normal, it was resisted all the way, including by medical professionals.
“It’s a useful thing – the reason it was done (for the coronavirus) is because the medical system would’ve been completely overwhelmed.
“Imagine if now you had to make a doctor’s appointment to see if you were possibly infected by COVID.”
Professor Bartos said there was a “whole lot of diagnosis stuff” that doctors did at present that was better able to be done by technology.
“I think in the next 5-10 years we’ll start to see those systems take over or change in a major way how health happens.”
But even there, there had to be caution.
“We saw the other way – at the start of the pandemic everyone thought you could install a COVID-Safe app on your phones and it would tell you everything, so we have to be careful about the hype of (artificial intelligence).
“It’s probably a mistake for people to think that their health is something they hand over to the suitable health professional.
“In fact no one is more interested in their health than themselves.
“If people can engage more in their own health, that’s the way things ought to go.”
And there were some good things to come out of the coronavirus pandemic, Professor Bartos said.
“People realised they had to work out what to do,” he said.
“It was not something they could hand over to other people.
“Conspiracy stuff almost comes with the territory, people realise it’s not something there’s a fixed manual about and the fact that it became something that people were involved with having to work out I think that’s a good thing, not a bad thing.”
