Marina Pollán: “Talent Is Easier To Attract When You Have A Critical Mass”

Marina Pollán has been a research professor of the Spanish National Epidemiology Centre at the Carlos III Health Institute since 2016, and scientific director of CIBERESP, the Biomedical Research in Epidemiology and Public Health Consortium, since 2017. Last February, she became Director of ISCIII, the Carlos III Health Institute, an institution dependent on the Spanish Ministry of Science, Innovation and Universities. She is the first ISCIII Director to have spent her whole career at the institution, which she joined in 1990. Pollán was head of the Spanish National Epidemiology Centre from February 2019 to October 2022, where she was responsible for coordinating the centre’s work during the COVID-19 pandemic. She was also scientific coordinator of the internationally recognized Seroepidemiological Study on the Prevalence of SARS-CoV-2 in Spain (ENE-COVID). She has participated in coordinating the evaluation of projects both at ANEP, the Spanish National Agency for Evaluation and Prospection, and at FIS, the Spanish health research funding body.
In addition to sitting on numerous national and international scientific committees and panels of experts, since 2021, she has coordinated the Predictive Medicine axis of the IMPaCT (Precision Medicine Infrastructure associated with Science and Technology) project, which aims to create a large primary care-based national cohort with the help of all the Spanish regional public health services, ultimately providing a nationwide research infrastructure.

You took up your position as Director of ISCIII in February 2024, although you have worked at the Carlos III Health Institute for over 30 years. How have these first months been?

First, despite having had a connection with the ISCIII for many years, I’ve realized that there are many more things I didn’t know about it, particularly ones related with the Centre’s external activities. During this short period of time I’ve been able to get to know many people who are connected with this institution, and really interesting projects that I had no idea about. For instance, I didn’t know that Spain has such a prominent place in the international ranking of clinical trials - we are in second place after the USA; I didn’t know that, as a country, we had such a high position in advanced therapies, and I didn’t know the CNIC, the CIEN foundation (the Research Centre for Neurological Diseases) or the CNIO (the Spanish National Cancer Research Centre) very well.

How has having worked at the ISCIII for so many years helped you in this challenge?

I love and value the ISCIII, which I think can be seen in the decisions we are taking. It is a responsibility, but also a little scary, because the ISCIII is very large and my colleagues may have great expectations about how things are going to change quickly, which is not always so easy because changes take time, and we also need more staff and a bigger budget. I believe that changes occur little by little in all organizations and ISCIII will be no different. So the first thing I did when I was appointed was write to all of my colleagues and tell them that I intended to care for the institution and improve it, and they should be patient because I was then aware, but am now even more so, that it is a complicated task. One that is further complicated by the extended budget situation we have in Spain.

Budgets are important because when you want to do new things without setting to one side what already exists, the easiest way is to get more funding

Did you think twice before taking on the responsibility?

I got a call while I was on holiday, and my first reaction was to say no. I thought, I’m not going to get involved in that. But then I began to think it could be an opportunity, and I set myself two strategic objectives. First, to care for the institution, i.e. improve the situation, the research and leadership capacities of the good researchers and technicians we have in ISCIII. The other important objective for me at the time - now I have new objectives because I know the institution better - was to support development of the IMPaCT [Precision Medicine Infrastructure associated with Science and Technology] cohort. I thought it was an opportunity and I had to say yes.

You mentioned the extended budget situation…

Budgets are important because when you want to do new things without setting to one side what already exists, the easiest way is to get more funding. For instance, centres of excellence like CNIC, CNIO or the CIEN Foundation already expected increased funding justified by the activities they undertake. The same situation existed with the CIBER (biomedical research networks) and some other funding initiatives under the auspices of the sub-directorate for evaluation and promotion of research, such as the Fortalece programme aimed at health research institutes, or at the CDTI (Centre for Technological Development and Innovation) to fund joint projects between teams from the National Health System and certain biomedical sciences businesses, which we won’t be able to start due to this year’s national budget which is an extension of last year’s. The same situation exists with the centres themselves: to consolidate their work, strengthen and promote the new objectives we should adopt as the foremost public health institution, we need more staff. The budget dictates a great deal of what can be done, it isn’t everything, but it says a lot.

I believe changes occur little by little in all organizations, and the ISCIII is no different. So, the first thing I did when I was appointed was write to all of my colleagues and tell them I intended to care for the institution and improve it, and they should be patient because I was then aware, but am now even more so, that it’s a complicated task

In these months of work, what needs have your team identified and how are they going to be tackled?

The management committee have discussed some potential ideas to foster collaboration between the different ISCIII centres. Sometimes, the fact of being located on different sites -the ISCIII has always had its Majadahonda campus and another in Chamartín (Madrid)- means that the potential of joining a research group is not fully appreciated as you don’t work side by side. And now we have a new campus in Moncloa, where the anti-doping laboratories are located. So we want to make an internal call for collaborative projects.

Collaboration is part of my DNA, maybe it’s a needs must, because after having learned a lot of method and wanting to develop cohort studies, which was very difficult in this country, I began to collaborate with clinics, geneticists, etc. I’ve always found it very attractive because it’s stimulating to see what other people know that you don’t. I think that fostering collaboration is going to lead us to better projects.

What other challenges are you facing?

Another challenge is the 100th anniversary of the National School of Public Health. This is our organization’s oldest institution. I myself am an alumna of the National School of Public Health. We have a unit linked with the School to train specialist physicians in preventive medicine and public health. The current Director General of Public Health at the Ministry of Health, Paco Gullón, is an alumnus, as is the Minister of Health herself, and she wants to promote the School. It also represents a strategic area of the ISCIII in supporting the ongoing training of specialists in the National Health System. That is why we need to strengthen the School.

The biggest problem we have, which is probably one shared by all Public Administrations, is the lack of administrative staff and management. We know that General State Administration salaries are not competitive and, compared to autonomous community salaries, are rather low; for years we have been suffering a decapitalization of staff, which is now a serious problem. We can’t solve this problem on our own because the salaries, categories, etc. are set by the civil service. This is a major problem that must be solved.

We are currently in a process of stabilization and offering positions, but what happens is that the lower levels are not attractive, and the vacancies go unfilled. We are working on this issue because we know that to carry out good research, we also need technicians, managers, etc.

Attracting talent. How can the Institute be made more attractive for researchers?

I still don’t know the situation in all of the centres in great depth, but my centre, the Spanish National Epidemiology Centre, has been able to attract talent in recent years. Researchers like to be in an environment where there is a critical mass they can share ideas with. When you have a critical mass it’s easier to attract talent, despite the more competitive salaries of other centres. Many people place more value on an intellectually stimulating workplace than on earning a lot of money. The fact of working with colleagues you can share and learn with is an important part of research.

And the ISCIII is also a known brand. We have talent attraction programmes both in strategic health actions, which is the term for the series of calls we launch from the ISCIII, and in-house. We have specific contracts for the health research institutes to attract talent. But in addition to attracting talent, our objective is to retain it because, for instance, the calls we have for the health research institutes come with the commitment of the Autonomous Community to give stability to the people after the 4 or 5 year contract. And this is a challenge, because to carry out research in a hospital, sometimes we need figures or categories that do not exist in statutory personnel like, for instance, bioinformaticians, biologists, biochemists, etc. These specialists contribute to research in the hospital but the regions experience problems finding solutions to retain them.

You spoke about funding. Is ISCIII considering new funding models with private companies?

When I began working at the ISCIII it wasn’t possible to work with the private sector. Things have changed a lot. In fact, last year we held a call that brought together research groups from the health service and biotech companies to collaborate with each other. The National Health System part was funded by ISCIII, and the Centre for Technological Development and Innovation (CDTI) supported the companies. We also have agreements with the AECC, (the Spanish Association Against Cancer) which is the main non-governmental organization funding cancer research. All funding is welcome. Coordination, for instance, with the AECC to fund major projects has enabled successful outcomes. It’s a win-win, but the role of business has to be limited because we are a public research institution.

You mentioned the IMPaCT project as one of the factors that encouraged you to take on the position of ISCIII director.

IMPaCT is an initiative started in 2020 by the ISCIII to promote research in precision medicine; it has an element of genomic medicine and another of data science. Its foundations are the IMPaCT Cohort, which consists of generating an infrastructure of a cohort with at least 200,000 people whose data, extracted from questionnaires, imaging tests, biological samples, etc. is available to the scientific community. The model that we followed, in common with most developed countries, is the UK Biobank. When I was director of the Epidemiology and Public Health Networking Biomedical Research Centre, I had already convinced Raquel Yotti, then director of the ISCIII, that Spain, as a large country within the European Union, deserved to have its own cohort.

Because, although many researchers use the UK Biobank data, it does not represent us well: not our lifestyle nor our genetics because we have a genetic structure with a large influence from the Arabs who were here for 8 centuries. In fact, we have seen that polygenic risk score (PRS) models don’t work as well here as they do for the populations of the Anglosphere. I’m not just saying this for the sake of it: it’s so that we have our own infrastructure that allows us to obtain results which are applicable to our context.

One of the novelties the IMPaCT Cohort includes, which was stipulated in the call, is that it is generated within the primary care system of each autonomous community. That makes it more difficult to start up because primary care has its own problems, but at the same time it involves a higher participation rate, which in turn means a cohort that is more representative of our country’s population.

So, while the UK Biobank has 5% participation, ours is over 30%, which is unusual. To date, none of the cohorts of this type have such high participation.

When we talk about population cohorts, the Scandinavian model always comes up.

Scandinavian countries represent the gold standard. But extrapolating that model here is difficult. They are small countries with a single data collection system, whereas we have 17 Autonomous Communities. So we are like a federal country and the Scandinavian model cannot be automatically transferred here.

It is a great model, because you have all of the information collected ad hoc for you to exploit and use, what is called Real World Data. The IMPaCT Cohort is different because the general population does not usually undergo so many tests. Having more in-depth information and biological samples of people who do not necessarily come into the system for a health problem, but rather are recruited by sampling based on their health card, allows us access to information before disease appears. For instance, CNIC has projects like that, like the PESA cohort, which serve as a model for all of us.

It is an attempt to anticipate disease, as Valentín Fuster [CNIC’s Director General] says, a vision that will become increasingly generalized. The ageing population, the sophistication of treatments, etc. in most developed countries has shown that investing in prevention is generally more efficient than investing in treatment. Postponing disease may be a key aspect that allows the health system to continue functioning, apart from improving the population’s health. The problem with prevention is that, unlike treatment, the future patient does not always understand that in their case the disease has been avoided or postponed.

Yet again we come up against the problem of funding that is only short-term...

A long-term vision is more complicated. It’s about convincing the funding bodies that what we are doing in the IMPaCT cohort is going to have results in 10 to 20 years’ time. We know that the UK Biobank began to produce a large volume of publications 10 years after recruitment.

At ISCIII, we want to accelerate the process. We have a 3-year, maximum 4-year, funding structure for projects, which makes it difficult to conduct a cohort because they require more time. We hope that when we complete implementation in all of the Autonomous Communities, and the rules about how to use the information are established, the Spanish scientific community will take advantage of this resource to show it is useful and can produce interesting outcomes because if not, I don’t think it can be maintained over time.

Also, bearing in mind current funding, we have designed a cohort for which we collect a lot of information at the baseline visit so that, if it cannot be maintained over time, we have enough data to conduct a follow-up using the medical history, which would be enough to at least take advantage of the effort.

How do you see the ISCIIII in 10 years?

I would like the Institute to continue to be a reference institution in biomedical research, both from an in-house and an external perspective. What’s more, I would like the existing inequalities to have been reduced thanks to ISCIII research into the health of the populations of different Autonomous Communities, and I would hope that there will not be first and second-class Communities in terms of research. Research is a driving force. And, of course, I hope that the IMPaCT Cohort continues to exist in 10 years and has produced articles and information that is important for the public health of our country.