Interview with Antoni Plasència, Former Director General of ISGlobal

In his last days as director of ISGlobal, Antoni Plasencia gave us an interview in which he shared his professional experiences.

It is the week before Christmas and Antoni Plasència’s office is dotted with boxes. His time as Director General of ISGlobal, the Barcelona Institute for Global Health, is drawing to a close following his announcement in June that he was stepping down. Despite his busy schedule, Antoni has agreed to meet us for this interview. We’re keen to know how he feels about stepping down and embarking on a new journey, and we’re also interested in his reflections on his time in what he calls the “ISGlobal ecosystem”. It has been 9 intense years at the helm of ISGlobal, as he told us with bright eyes.

-So, the time has finally come. How do you feel?

-Above all, relieved. Relieved that this stage of setting up and consolidating ISGlobal has been a success overall and that I played a role in instigating a rigorous selection process for the new director general. I’m now entering a new chapter of my life, and I’d like to dedicate what is left of my career to what will probably be more focused, scientific-technical projects, as well as supporting some of ISGlobal's most valuable assets.

-Will these projects be with ISGlobal then?

-Yes, they will involve collaboration with other institutions of course. ISGlobal has established a strong reputation and it’s a place where a lot of people would like to work. Its guiding principle is what I like to call “science with a heart”. Among the things I would like to do is contribute to enhancing ISGlobal’s “glocal” capabilities, and in that regard involve my affiliation with Hospital Clínic and the University of Barcelona.

-Was it a difficult decision to step down as Director General?

-What was difficult for me I think was deciding that this, rather than waiting a few more years, was the right moment to propose to the Board of Trustees that they began the process of finding my successor. We all have an expiry date! These years have been very intense, equivalent to two strategic cycles at any organisation. The first cycle involved the merger phase, with all its novelty and complexity. The second was the development, growth and consolidation phase. The decision to step down also meant ensuring a successful succession process. Some people were surprised, because at that time, there were no limits to how long a person could serve as Director General of ISGlobal. But you have to know how and when to pass the baton and let go of your responsibilities. And I’m confident that Quique Bassat will do a better job than me!

Beyond the white coat

-Your career started with a degree in medicine.

-I studied medicine at Hospital Clínic, at the University of Barcelona, and nobody in my family had ever worked in health care. It was a period of massification of higher education, and the political situation at the time didn’t help. During the final years of my degree, I discovered epidemiology and public health through a number of books, mostly written by English-speaking epidemiologists and public health experts. That was when I understood something you’re not taught at medical school: that to understand diseases you have to look at them from the perspective of the population. Health care is more than “white coat” care, it’s shaped by environmental, socioeconomic, lifestyle issues... and epidemiology is key to understanding these and enabling prevention and public health interventions. That was in a sense my most intellectual awakening in relation to health and it's what led me to where I am today. Shortly afterwards, I received a Fullbright grant, one of the first grants awarded by “la Caixa”, and I did a Master’s in Epidemiology and Public Health at Yale University in the United States. That was a life-changing experience.

-Why?

-First, because Yale is a very powerful and intellectually stimulating university and I had excellent lecturers and classmates. The style of teaching was nothing like I had experienced in Barcelona, where the focus had been much more on rote memorisation, leaving little room for critical thinking. In the mid-1980s, the gap between the United States and Spain was much wider than it is today, scientifically speaking too. In Spain, if you were interested in epidemiology and public health, you had no role models, because the few that had existed had practically all disappeared with the civil war and exile. Going to Yale therefore was an important part of my education, but it was also a small yet profound cultural revolution. I will forever be grateful for that opportunity; it opened the doors to the world for me and I continue to relish the experiences it brought my way.

-But you returned to Catalonia.

-I’d need another interview to explain that story! I came back mostly for sentimental reasons and was fortunate enough to connect with an emerging group of epidemiologists and highly dedicated people who had clinical training, but, a little like me, had chosen the path of epidemiology and public health. This group was led by Josep Maria Antó, who had originally trained as a pneumologist. We met at the Municipal Health Institute (now the Barcelona Public Health Agency), which operated under the auspices of Barcelona City Council and was pioneering a novel approach to public health. We were highly motivated, and this was the time of the first “personal” computers (though they weren’t so personal, as in the early days we had to take turns using them!). We were investigating the asthma outbreaks in Barcelona, which were eventually linked to the unloading of soybeans at the port, a real breakthrough. After that, I continued my journey at the Municipal Health Institute as Head of Epidemiology and gradually took on various other responsibilities. One of these, during the 1992 Olympic Games, was overseeing the health and well-being of the “Olympic family” (athletes, officials...) concerning all matters related to epidemiology and public health. That was a new and exciting experience!

Antoni Plasència in 2013, 2016, and 2022. Photos by Glòria Solsona and Aleix Cabrera (ISGlobal).

-In 2004 you became Director General of Public Health at the Catalan Government

-Yes, Marina Geli, who had very recently been appointed Minister of Health for the Catalan Government, asked me if I would be interested in taking on this position, to set up what would later become the Public Health Agency of Catalonia. I jumped at the opportunity. I had never been actively involved in politics; my vision was mostly technical, shaped by my experience with launching the Barcelona Public Health Agency. It was another very exciting time, which lasted just over 8 years. During this time, I worked alongside a team of over 2000 professionals from across the country, managing outbreaks and pandemics and working side by side with the Spanish Government and other autonomous communities. I was able to contribute to Catalonia’s Public Health Law, which was approved in 2009. This law serves as the framework granting Catalonia the powers it needs in matters of health surveillance, prevention, protection and promotion. Unfortunately, and despite the years that have passed and numerous public health crises, the resources available to Catalonia are still clearly inadequate.

A bit of "plumbing and brickwork”

-So then you moved to CRESIB. What prompted that move?

-In my role as Public Health Director, I had been involved in the establishment of CREAL (Centre for Research in Environmental Epidemiology) at the end of 2005, CRESIB (Barcelona Centre for International Health Research) in 2006 and ISGlobal in 2010. I represented the Catalan Health Department on the governing boards of these new centres and was therefore somewhat familiar with their inner workings. I held a deep attachment to these centres, as they were among the first endeavors of the Catalan Government to support research excellence in the fields of epidemiology, public health and global health. When I left the government in 2011, Pedro Alonso, who was the Director of CRESIB at the time, asked me to join them as Deputy Director, taking over from Núria Casamitjana, who was transitioning to the position of Training and Education Director at ISGlobal. ISGlobal was still very much in its early stage at the time (CRESIB was its main research branch). ISGlobal had been established with the aim of bridging the gap between research and impact, also under the leadership of Pedro Alonso and with crucial support from "la Caixa” Foundation and the Government of Spain. Both Pedro and Josep Maria Antó, the Director of CREAL, asked me to explore the possibility of an alliance between the three centres that could eventually culminate in a merger, all with the endorsement of the Catalan Government. At the time—which coincided with the years of the global financial crisis—there were several research institutes, many of which were small yet highly competitive CERCA centres. In order to grow, they had to contemplate alliances or mergers rather than seek new structural resources, as at that time, you had to make do with what was available. The strategy thus was to lay the groundwork for how, when and why to integrate these two research centres into ISGlobal and to do so in a manner that would provide long-term assurances. That was a key part of what I was brought in to do: in sorts a little bit of plumbing and a little bit of brickwork, in close collaboration with the directors of CREAL and CRESIB and their teams.

Antoni Plasència in 2012 and 2022. Photos by Glòria Solsona and Aleix Cabrera (ISGlobal).

-In the early years of this alliance and the merger process, you became Director General of ISGlobal.

-In 2014, Pedro Alonso was appointed Director of the World Health Organization's Malaria Programme, and my name was put forward as a possible replacement. I was officially appointed Director General by ISGlobal’s Board of Trustees at the end of October in the same year and tasked with continuing the work already underway. When things had progressed to a relatively advanced stage, we executed the merger in two phases: integrating CRESIB in 2015 and CREAL in 2016. This pioneering endeavour, with all its organisational and legal complexities, was successfully executed through excellent teamwork, with Josep Maria Antó, Scientific Director, and Gonzalo Vicente, General Manager, both playing a pivotal role. This merger marked the birth of a new, or you could say, renewed ISGlobal in 2017. We were extremely lucky that the Trustees of the former institutes were willing to come on board with their commitment and resources and join ISGlobal’s new board, which has, to date, remained largely unchanged. I cannot emphasize enough the significance of this privilege, as these were very distinct institutions, with diverse missions and visions, but each of them recognised the added value of research and its translation into impact. They understood the importance of putting research at the service of equity in health at a “glocal”, that is a local and global level. And remember, this was before the pandemic, which among other things, helped further the understanding that health knows no boundaries, whether geographic or political.

Managing identities

-Did the merger work?

-I believe it did, particularly if you consider that very few mergers have been carried out in the field of research. The results speak for themselves: we have grown in terms of science, knowledge translation, people, projects, budget and reputation. In short, and generally speaking, the operation was successful, and my role was primarily as a facilitator. I always say that my main responsibility was to ensure smooth communication, both internally and externally, and to maintain a state of equilibrium or homeostasis, as we say in medicine; the goal was to prevent major mismatches between expectations from our surroundings and our response as a human, professional team. But it was the people who work at, for and with ISGlobal who made the merger possible.

-Was this the main challenge you faced in your role as Director General?

-Essentially there were two main challenges: facilitating the merger and ensuring its subsequent development and consolidation. Merging similarly sized institutions that are highly competitive and have well-defined goals is always complicated, and there is an understandable risk that initially some people will want to leave things as they are (“if it’s not broken, don’t fix it”). I believe that this is no longer the case, especially among the newer generations, but perhaps the greatest challenge was to manage the fear of losing one’s identity. Some people were of the opinion that we should focus on communicable diseases in developing countries, while others believed in highlighting the impact of the environment and climate on health. The key to success, therefore, was to merge and multiply these identities, not to lose them. My message has always echoed what Amartya Sen said: people don’t have a single identity; they have several identities and these exist at multiple levels. The existence of multifaceted identities represents an added value for any institution operating in a complex, ever-changing world. Monolithic identitarianism leads to polarisation, sectarian division and conflict. I therefore believe that we have to continue emphasising the distinct value of unity in diversity, as this makes us stronger and more relevant. Dialogue and empathy also have a key role here. Global health institutions with a long history, such as the London School of Hygiene and Tropical Institute and the Swiss Tropical and Public Health Institute have understood and applied this concept well.

Antoni Plasència jokes with Quique Bassat, staging the handover of the ISGlobal leadership during the Christmas toast of 2023 at the Faculty of Medicine of the University of Barcelona.

ISGlobal is not a hotel

-You said that we all have different identities. What are yours?

-My identities are primarily manifested through my values, which I strive to uphold in my everyday life, to the best of my knowledge and ability. Although it may sound a little pompous, I consider myself, above all, an institutional builder, that has been the main focus of my professional energy: building and transforming institutions, collectives of people working together in organisations striving to effectively fulfill their missions. That's why I’ve always stressed the value of collective intelligence and the concept of "we", applied, in our case, to an academic and scientific environment where individual identities are necessarily very strong and unique and need support and recognition. From the outset, and drawing from the philosophy of Ubuntu, I wanted to convey the message "I am because we are", that anyone who makes a contribution does so through and with the institute, that is, through and with its people. I’ve always maintained that ISGlobal wasn’t and shouldn’t be a hotel (for researchers, creators and innovators). Above all else, it should function as an organisation of cooperative intelligence, which is precisely one of our distinguishing attributes.

-You’ve led a lot of people. Would you like to have fewer people under your charge going forward?

-Absolutely. I’m not looking for a quiet life, I’m looking for a little more focus, something that I can concentrate on, hone in on. Less managerial responsibility, but with the hope of being able to leverage everything I’ve learnt over the years in global public health, from knowledge and knowledge transfer to organisational development. I also intend to remain available to help with anything where I can be of service. That’s what I hope to gain personally in this new phase of my journey.

-Will you miss the office?

-No. The most emotional part was the decision to make this change and then follow through with it from a position of responsibility. Now, my goal is to ensure that this new chapter in my life will be as or even more exciting for me on a personal level. As I mentioned earlier, you need to know when and how to let go of your responsibilities, but also how to embrace new ones. My personal expectations lie in this direction. As long as the gods of health don’t throw me a curve ball, I hope to be able to continue growing professionally and contributing to new projects.

-Do you have any sayings or phrases that have guided you during your time at ISGlobal?

-One saying you may have heard from me more than once is that "the shortest distance between two dots is never a straight line." Things are always more complex and less obvious than they seem. "Simplexity" is the challenge, trying to make things simpler and easier. I also really like a saying by Rita Levi-Montalcini, a Nobel Prize winner in Medicine in the 1980s. She said something like "Don't be afraid of life’s difficult times, the best comes out of them." Everything that is worthwhile is difficult, and everything that is difficult is worthwhile. And perhaps a third guiding concept has been that resolving problems (I say problems but you could also say challenges) is part of our paycheck. So, if someone is stressed or distressed by problems at work, they are not doing what is expected of them. A problem can be a scientific question, a question about how to manage people or any other matter. Throughout these years I have tried to inspire people to seek solutions to problems, and not problems to solutions, and to do this with composure and mutual respect.

COVID-19... was it unexpected?

-Were there any major surprises or events that caught you off guard while you were at ISGlobal? Were you that surprised by the COVID-19 pandemic?

-On paper, those of us who work in epidemiology and public health knew that something like that could very well happen sooner or later. What nobody foresaw, however, was that countries would for the most part be so ill prepared and that their responses would be so ineffective and insufficient, especially during the early months of the pandemic. What is more concerning though, and an area that I am interested in working on in this new phase of my life, is the sense that we have already moved on, that other issues have taken precedence, and that we have left the task of dealing with the next pandemic for a future generation. We need to break these cycles of panic and neglect, and do everything in our power to ensure prevention and preparedness for future global health crises. Otherwise, these will become increasingly numerous and disruptive to health, the economy and society as a whole.

-How did you experience the pandemic, as Director General of ISGlobal?

-With a certain sense of bewilderment, with “bated breath”, but I also saw it as an opportunity, one we managed to seize successfully. Many researchers put their projects on hold to contribute to addressing some of the most pressing questions that were emerging. We also responded to the pandemic through innovation, training, communication... I think that, as a whole, the pandemic strengthened the credibility and societal recognition of ISGlobal's mission, and positioned us as an institute of scientific excellence formed by deeply committed individuals.

Trust, an emotional asset

-The world when you assumed leadership at ISGlobal is quite different to the world today.

-Yes. The pandemic acted as an accelerant in many ways. The world now (and we only have one!) is much more complex and interconnected, meaning that it is also stronger yet more fragile. And we can only move forward through effective dialogue and collaboration. Either we all do this or nobody will be able to, although not everybody is quite on board with this...

-And you, have you changed?

-I’ve come to place a higher value on trust. Trust is probably the most important asset in leadership, something that has to be nurtured in any organisation, big or small. It’s almost like an intangible, emotional asset: you invest your trust in someone or something without really knowing what lies ahead. Our lives are rife with uncertainties, and trust is a crucial part of interpersonal functioning. Trust is difficult to build and very easy to lose! Tintin is one of my role models, he embodies the importance of trust as he goes through life.

-Have you become the Tintin you dreamed of once becoming as a child?

-Well it’s not as if he was my hero 24 hours a day! But deep down, and over time, I’ve come to realise that he is a global hero, albeit with his personal and cultural biases of the time. And I've re-encountered him time and time again in ISGlobal. At times, like him, we've sweated it out, alone in the middle of a desert, and at other times, we’ve hopped on a rocket aiming for the moon. We’ve faced some tough moments, but above all, we’ve shared exciting adventures that are open to the world. In a way, that’s been my “Tintin” experience. Now a new adventure awaits me. Do check back with me to see how that unfolds, but give me some time!