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Sir Gustav Nossal: improving health equity for all

Across a long and storied career, immunologist Sir Gustav Nossal has broken new ground and collected numerous accolades. But it was through his work on public health projects with the World Health Organization, the Bill and Melinda Gates Foundation, and VicHealth, that ‘Sir Gus’ improved the lives of millions worldwide. As VicHealth celebrates its 30th Anniversary, we catch up with our inaugural Chair.

Renowned immunologist, the first chair of VicHealth, former deputy chairman of the Council for Aboriginal Reconciliation, friend of Bill and Melinda Gates and former World Health Organization (WHO) luminary, Emeritus Professor Sir Gustav Nossal is in a reflective mood.

Now 86, still spry, incisive and charming, Sir Gus is on a large couch in his Melbourne loungeroom, pondering the question, wondering about a particular moment, maybe an epiphany, when his focus shifted from the medical predicaments of the individual to the broader concerns of health equity, a topic integral to Sir Gus’s role in health in Australia and abroad.

“Oh, definitely when I was young, I was much more into the individual and individual problems,” Sir Gus says. “But now I’m much more interested in the public health aspects… just think what environmental sanitation has done!”

Sir Gus is known for his work as a medical researcher. Arriving in Australia as a schoolboy with his Austrian family in 1939, the young Gus always wanted to be a doctor. He started medicine at the University of Sydney months before turning 17. His work in immunology in general and monoclonal antibodies in particular was groundbreaking. He later described his work as “studying the white cells of little rats and mice, trying to figure out how those white cells make the precious antibody molecules that keep you free of disease.” His discovery that individual cells in the immune system only ever manufacture one specific antibody changed the way that diseases were researched and treated. It also led to numerous honours, including a knighthood in 1977.

Later in his career he became increasingly involved in initiatives that addressed the social and environmental factors affecting the health of the population. Thirty years ago, he was approached by the late Dr Nigel Gray, renowned advocate for tobacco control and long-time director of the Cancer Council Victoria, to get involved with VicHealth, known then as the Victorian Health Promotion Foundation. Sir Gus recalls that he was intrigued by the proposal to buy out tobacco sponsorship with strong health promotion messages and was won over.

“I thought it was a pretty natty idea,” he says of the initiative that is about to mark its 30th birthday, adding “and VicHealth became part of the landscape”.

His growing interest in issues of health equity crossed over with his work as an immunologist in the early 1990s when he was appointed chairman of the Vaccines and Biologicals Program run by the World Health Organization (WHO). The connection with WHO started with his great mentor Sir Frank Macfarlane Burnet, the gifted Australian virologist and Nobel Prize laureate who served on Expert Advisory Panels on Virus Diseases as early as the 1950s. It was those WHO meetings in Geneva, talking to international experts and seeing the massive health inequalities on the ground, that shaped Sir Gus’s view that there was a pressing need to redress the balance, and help ensure the developing world’s health outcomes improved. Narrowing the health gap between the world’s haves and have-nots became a marker of his career.

The most precious thing of my professional life is the research.

In the late 1990s, Sir Gus was appointed the founding chairman of the Bill and Melinda Gates Foundation Children’s Vaccine Program. Sir Gus was chairman of WHO’s Strategic Advisory Group of Experts at the time he was introduced to Bill Gates’ father and then the Microsoft co-founder and his wife. The more the Gates learned about immunology and the developing world, the more money they committed to a program that sought to improve access to vaccines for children in developing countries. The current program, which helps not only improve vaccine delivery in the developing world but also makes available the newer and more expensive vaccines, remains a source of great pride to Sir Gus. “The most precious thing of my professional life is the research,” he says, adding “…[of] the extra-curricular things, this work with WHO and the Gates Foundation occupies the highest space.”

But Sir Gus’ contribution to public health was certainly not restricted to matters of immunology, vaccination and disease control. Through his later involvement with the Council for Aboriginal Reconciliation and ongoing association with VicHealth, he has continued to explore the social determinants of health in Australia. He is wary of giving the nation unchecked endorsement on equity grounds, but does point to the positives: “Australia’s far from perfect but a hell of a lot better than many other countries,” he says. “Yes, there is health inequity, but the life-saving elements such as access to vaccines and access to acute care are equitably distributed through the public health system.”

In 2009, Sir Gus contributed a foreword to the publication of the Brumby Government’s Building on our strengths policy guidelines, arguing that modern medicine provides only a “partial solution” to the health challenges now facing the Australian community and that work must be done to identify and address the broader environmental factors, “many of which can be prevented”.

Speaking now, he admits that the broader equity focus is still underappreciated and under-researched. There is more work to be done, but he acknowledges that it will more than likely be done by those who follow him. “I’m 86 years old. I’m not likely to pick up the pipette and the test tube again,” he says.

Sir Gus may be a little less busy these days, but his leadership remains strong and his message is as pertinent now as it was in 2009 when he wrote: “Making our communities and organisations welcoming and fair for all is not just the right thing to do. It is fundamental to our survival as a peaceful and prosperous society.”