Interview with Jordi Vila: “If Spain Could Recover All the Brains that Have Gone Elsewhere, We Would Be Leaders in the World of Research"

In this interview, the director of ISGlobal’s Antimicrobial Resistance Initiative shares his views on his research, his life and science in Spain.

Several people have talked to me about the three drawings hanging in the office of Jordi Vila (Gava, 1956): Chopin’s face, a portrait of his grandfather and a drawing depicting a boy standing with his face turned to the wall as a punishment. All three are pencil and Indian ink drawings by Vila himself. He loves to draw. The other day he went to buy art materials because he wants to start drawing again soon. Laughing, he tells me that he doesn’t like the word “retirement “ any more than the term “pre-retirement”. “It’s called a reduction in working hours,” he adds. After thirteen years heading up the Microbiology Service at Hospital Clínic de Barcelona, last April he decided to focus on an area of diagnostics. He could have stayed on as head of the department for another year, but a cyber attack on the hospital made him realise that the management aspects of the job were too much of a headache. Now he works in the lab Monday, Tuesday and Wednesday, and on Thursday and Friday he stays at home and takes advantage of the peace and quiet with no interruptions to write scientific papers.

As well as working at the Hospital Clínic, Vila is Professor of Microbiology in the Faculty of Medicine at the UB and also leads research projects at ISGlobal. He recently received the Amadeo Foz Prize awarded by the Spanish Society of Infectious Disease and Clinical Microbiology (SEIMC) in recognition of his valuable contributions to the field.

- How would you define your career?
- Fortunate and fruitful. I’ve always imagined myself doing research, ever since I was a high school student, and I’ve managed to do just that.

- So you had a clear vocation?
- I was always fascinated by biochemistry. I studied pharmacy and in my fourth year I spent the whole summer in the Department of Biochemistry. I loved it!

- What did that feel like?
- Research is accompanied by two very interesting feelings. The first is the creative impulse—when you are designing an experiment. And this is followed by a keen desire to see the results of what you have done, a feeling of “now let’s see what happens”.

- And were you able to go into research immediately after graduating?
- No, first I had to do my military service. Once I had finished that, I took the FIR (the equivalent test for pharmacists to the MIR taken by doctors). I came 32nd in the country—not bad. But then I had the “bad luck” (or “good luck” in retrospect) that there were no places that year in Barcelona for studying clinical biochemistry. However, three hospitals were offering positions in microbiology. In 1981, I began my residency in the Hospital Clínic in Barcelona, with training in clinical microbiology and parasitology.

The three drawings hanging in the office of Jordi Vila. All three are pen drawings by Vila himself.

Double Shifts, Even on Public Holidays

- What was the Hospital Clínic’s Microbiology Department like at that time?
- It was pretty much like other labs. I learned a lot because we dealt with lots of samples of all kinds. But I still wanted to do biochemistry and I started my doctoral studies at the Faculty of Pharmacy. My thesis was on glycogen synthase, an enzyme involved in the synthesis of glycogen. During that period, I worked at the Clínic from eight thirty in the morning until three in the afternoon. After that I went to the Faculty of Pharmacy and didn’t leave till eight, nine or ten o’clock at night. I worked every Saturday and some Sundays.

The Move to the United States in 1986

- What did you do after you completed your residency at the Hospital Clínic?
- I got a job as a clinical analyst in the Just Oliveres primary care centre in the town of L’Hospitalet close to Barcelona. I worked there for a year during which I defended my thesis and wrote to a number of different research groups in the United States. One of these was a team at the Department of Microbiology in the University of Virginia who were working on viral oncogenesis, that is, viruses that cause cancer. They were interested in me because they knew that cancer was caused by a protein kinase which was a type of enzyme similar to the one I had studied in my doctoral thesis. I managed to get a very meagre grant from the Generalitat de Catalunya, 500 dollars a month, and Michael Weber, the head of the group in Virginia, promised to pay me an additional 500 to bring me up to the 1000-dollar salary earned by postdocs there. I was already married and my son was one year old. So at the end of October 1986, I took a leave of absence from my job here and we moved to the US. To my surprise, from the very first month they paid me double what Mike Weber had promised me because the team had received additional funding. That was how I went to America. I didn’t know whether I was going to stay for a year, for two years or for the rest of my life.

A Shadow of Doubt

- Why did you come back?
- After I had been there for a year and a half, I got a phone call from the Hospital Clínic to inform me that there was a vacancy for an assistant position in the Department of Microbiology. I sent in my CV and got the job.

- And have you ever regretted not staying in the US?
- If it had been up to me I would have stayed—in a heartbeat. To be honest, what stopped me was my family. My wife had never been sure about the move to the US even though I had finally convinced her that we would spend Christmas and the summer holidays in Spain. But my mother was also very elderly and I was the only one of her four children working in a medical field. I knew that if she needed me and I couldn’t be there for her that I would be very unhappy. Anyway, I gave the decision a lot of thought and, since I had been offered the job at the Clínic, we came back to Spain in 1987. I don’t know what would have happened if I had stayed on in the US.

Chance Encounter with a Bacterium

- And did the time you spent in the States have an effect on your career?
- Yes, it did! My time there was beneficial in lots of ways, and also because of differences in the way they worked over there. In fact, one problem I had when I came back to Spain was that the Clínic laboratory lacked the infrastructure I needed to continue the very interesting line of research on viral oncogenesis. When I was trying to decide what to do next there was an outbreak in the hospital of a microorganism that was, even then, highly resistant. It was Acinetobacter baumannii, a bacteria that was resistant to almost all antibiotics.

- Your career is closely linked to Acinetobacter baumannii.
- Yes, we have studied it closely, in detail and from different points of view (resistance mechanisms, virulence, etc.).

Three Patented Molecules, One in the Preclinical Stage

- Thanks to your work, Acinetobacter baumannii is better understood, but is it possible to fight it?
- That is another line of research our group started working on about ten years ago. The new antibiotics were ineffective against these microorganisms but we thought that there might be peptides with antibacterial activity, specifically against Acinetobacter baumannii. We started collaborating with Ernest Giralt, an expert in peptides who was working at the Barcelona Science Park. We were looking for peptides with antibacterial capacity that could kill the bacterium and also for peptides that could block its resistance mechanism. This work has resulted in patents for three molecules, one of which is now in the preclinical stage of development. We have another peptide that inhibits the development of bacterial resistance mediated by active efflux pumps. That is another way to fight infections caused by multidrug-resistant bacteria.

Diagnosing Childhood Pneumonia in Under One Hour

- Will your work on Acinetobacter baumannii be your legacy?
- Yes, although in recent years we have been working in another area: the design of rapid diagnostic tools. We are developing a new tool for the rapid diagnosis of paediatric pneumonia suitable for use in low-income countries. It is a low-cost, easy-to-perform test that can detect four viruses and four bacteria (the eight microorganisms that cause the most pneumonia in children) in under one hour. If you can take a sample from an infant and know within an hour whether they have a flu virus or a pneumococcal infection, you can administer the appropriate treatment—antibiotic or not—depending on the case. This will greatly improve the treatment of these pneumonias, which are the leading cause of infant mortality in low-income countries.

- Will the tool be useful in other countries as well?
- Yes, even here in our own primary care system. Rapid diagnosis will reduce overcrowding in hospital emergency rooms during the winter months.

Immediate Action Needed to Combat Antimicrobial Resistance

- Have you also been interested the social implications of research?
- Yes. ISGlobal set up the Antimicrobial Resistance Initiative some time ago to raise awareness about the problem of resistance. It has been estimated that, if nothing is done, ten million people worldwide could die from infections caused by resistant bacteria by 2050, a higher death toll than that associated with either cancer or cardiovascular disease. We have to do something.

- Was that already obvious years ago, when you were starting out?
- No. It has only become apparent over the last two or three decades, as we have witnessed a progressive increase in ever more resistant bacteria. At the time I came back from the US in 1987, when you isolated a bacterium you could treat it with any antibiotic because the microorganism would be sensitive to most of them. That’s why I was so surprised by Acinetobacter baumannii because, even then, it had a tremendous capacity for developing resistance.

Keeping Two or Three Balls in the Air

- Antibiotic resistance, design of new antibiotics, design of rapid diagnostic tools, and more. So many different lines of research!
- But they are all complementary. And I have always tried to work on two or three at a time. That way I wouldn’t get depressed if one didn’t work out so well. I don’t know whether that was a good strategy. Perhaps if I had focussed exclusively on Acinetobacter baumannii I would have published more and I would have gained a greater understanding of that microorganism.

Boston and Berkeley—Two Highly Productive Interludes

- You have an inquiring mind. During your time working as an associate in the Microbiology Department in the Hospital Clínic, you returned to the US to do research.
- Yes, I spent six months in Boston in 1995 and six months in Berkeley in 2000. I went over on my own around May or early June and started working in the laboratory without any fixed timetable; I could work Saturdays and Sundays. Then my family would come over in July. They took advantage of the trip to travel around and explore while I continued working. They went home in September and I stayed on until the end of October to finish the work I had started. Both these research visits were very interesting. In Boston, at the Center for Genetic Adaptation and Antimicrobial Resistance in Tufts University, I worked with a group led by S. B. Levy that had been studying antibiotic resistance for some time. And at the Department of Cellular and Molecular Biology in the University of California in Berkeley, I did some more basic research on enzymes that were potential target proteins for new antibiotics in a group led by N. Cozzarrelli.

- What did you find stimulating there? What is different about the U.S. system?
- First and foremost, the amount of money they spend on research. In 1986, when the Generalitat gave me a 500 dollar scholarship and Mike Weber decided to pay me 1000 dollars, it was because his team had just received a grant of 1.5 million to cover a three-year period. In other words, paying me 1000 instead of 500 dollars meant very little to him. And the other thing I find stimulating in the U.S. is that there are so many research groups in a single institution. This means that if you have an idea and you want to use a technology that you are not familiar with or haven’t ever used in your group, there will almost certainly be someone else in the same institution who is using that technology and you can simply go over there and learn it in two or three days.

- And here?

- Here, it is more difficult because we don’t have such large departments. The Microbiology Department in the University of Virginia had about 30 research groups when I was there. The Medical Faculty Microbiology service at the University of Barcelona has four.

With the Little We Have, We Do a Lot!

- Have you been able to apply ways of working here that you saw in the US?
Yes. I was lucky and the first project I submitted to the Ministry was granted funding. That project produced good results and many publications and, in a way, it was my door into the system: every three years since then I have been able to renew the grant to fund more research. The problem is that funding for research is limited in Spain. For example, it is very difficult here to get more than 150,000 euros for three years with a grant from FIS (Fondo de Investigación Sanitaria). So, you have to try to supplement this with funding from European projects. We took a lead role in TROCAR, a European project with a 6 million euro budget. But coordinating thirteen groups located in different countries is quite a headache and requires a high level of dedication. We have also taken part in other projects, but as collaborators, which is another important way of obtaining funding.

- Is that is the biggest problem you see for science?
- Yes. The lack of money and, above all, the fact that there is no established career path. I have always had my salary from the Hospital Clínic. I have done the research because that is what I wanted to do. As head of the Microbiology Service, my job was to perform microbiological diagnoses. The problem is that some young people just want to do research. You meet 42-year-old scientists who don’t have a secure job and are still working on the basis of short-term contracts. This is a problem that the government should try to resolve. Because what happens is that when postdoctoral students who go abroad see what is on offer elsewhere (money, infrastructure, work facilities, etc.), they try to stay there. If Spain, and in particular Catalonia, could recover all the brains that have gone elsewhere, by offering the same resources as scientists enjoy elsewhere, we would be leaders in the world of research. Because, in spite of all the difficulties, in my field of microbiology Spain ranks sixth in the world in terms of publications. This means that with the little we have, we do a lot! If we had more resources, we could do much more and our ranking would be even higher.

Cost-Effective Research

- And why is this commitment to science lacking in Spain?
- You’d have to ask the politicians about that! They don’t see the impact that the research can have in terms of innovation and its transfer into practice. If I develop a rapid microbiological diagnostic tool capable of detecting which microorganism is causing a case of pneumonia in less than an hour, that tool will have an impact on public health. And it will probably also have an economic impact, because of the money saved on the antibiotics that are currently prescribed without any evidence that they are necessary. It will also reduce the number of children being hospitalised because, with proper treatment and control, they will be able to go home. What I mean is that, if studies were done, the outcomes would show that a lot of the research carried out is cost-effective once the results are translated into practice.

- To conclude, what would you say has been the biggest disappointment in your career?
- I have been fortunate. I don’t know if I would change anything, but I’ve always wondered what would have happened if I had stayed on in the US.