Walter Holland

Memories of the IEA Presidency

My first IEA encounter was the 1961 international meeting in Korcula. This epitomised the ethos of the IEA. The meeting was held on an island, the weather was warm, the food was fair and the wine plentiful. For a young researcher it was a wonderful opportunity to mix with the great and experienced in the field. It was also remarkable in that many of those present were eminent professors of medicine, e.g. Sir George Pickering of Oxford, Professors Ustvedt of Norway and Frøm Hansen from Denmark. The scientific papers were read in the morning and late afternoon, and at least half the day was spent in informal activities on the beach! Many lasting friendships resulted.

Following the 1964 Princeton meeting, I served on the Council and Executive for a number of years, first as editor of the Bulletin, then as secretary and finally as Editor of the IJE. After my periods of office I continued to attend most international meetings. All were good – but by the mid-80’s the Association had grown so large that the informal atmosphere and customs had been replaced with much more formality. Whereas in the early years most members knew each other well, this could not continue.

In the early years many comparative or parallel epidemiological studies were first conceived and nurtured through contact, at the ISM, e.g. the comparative health service studies by White, Logan and others. I do not wish to give the illusion that all that went on was sweetness and light, there were often fierce arguments and controversy. There was great rivalry between different groups-and even disdain by the chronic disease epidemiologists of those still concerned with infectious disease. Perhaps one of our major errors was our neglect of communicable disease, and inability to grasp the links between the two. A missed opportunity was an outbreak of gastro-intestinal disease among participants in one of the meetings in Primosten – no one, not even the epidemiologists present from CDC bothered to investigate it. The early years of our Association were dominated by such “greats” as Cruickshank, Pemberton, Doll, Fletcher, Breslow, Langmuir, White, Kass, Hetzel, Newell, Raska, Kostrezewski, Pradsad. It is salutary to remember that the IEA often provided them with the forum to try Out their ideas and it was at our meetings that they received the necessary stimuli for some of their work. The original aim to exchange information on teaching was soon replaced by the concentration on research. But throughout we gave great priority to the development and spread of the subject throughout the world.

My role in the Association affairs was revived in 1987. Until then most elections were not very serious affairs. Usually there was only one candidate for each officer post, only in 1978 had there been two contenders for the post of President – the nominating committee, of which I was chairman, had nominated Jan Kostrezewski of Poland, while the Council nominated Basil Hetzel of Australia. They felt that the former would be too isolated to be able to cope. The membership did not agree with Council. In 1987 the nominating committee as usual, put up only one candidate, the late Willy Eylenbosch from Belgium. The President, Johannes Mosbech and some other members of Council felt uncomfortable with having only one candidate. I was approached by Johannes, over a glass of beer in Nyhavn, while visiting Copenhagen, as to whether I would agree to stand for election as well. I agreed on the condition that Willy Eylenbosch agreed. He, of course, did, immediately. But the Presidency was the only post where there were two competing nominees. As a result of that experience it has since been our custom always to have at least 2 candidates for every officer’s post. Thus “democracy” took a long time to arrive in the IEA.

When I rejoined the Council and Executive Committee after 9 years’ absence I found that our problems were largely unchanged, but the complexities of running the organization were much greater. Meetings of the EC and Council were almost always pleasant affairs. Members of the EC and Council were hardworking and generous with their time and help to the Association. The major change I noted were the size of the meetings and the far greater bureaucracy this involved. Elected “cold” after an absence meant that I had to learn a lot very quickly, and the EC had an ignorant President. This was particularly true at the first meeting in Helsinki, immediately after the ISM, when we all had planes to catch.

The Regional meetings in my time, Pattaya, China, Zimbabwe and Spain were all enjoyable. I soon learnt that to keep the Past- President happy and working regular bottles of Danish beer had to be supplied – much to the Treasurers chagrin. One problem that I had was always the inauguration of these meetings with senior officials, often Ministers. The way that I learned to cope with these, was to obtain briefing from the UK Department of Health on the health problems etc. of the host country. Our hosts were impressed by my apparent depth of knowledge!! The biggest problem was in China – the airline (British Airways) had lost my luggage – and I had no suit. It arrived 5 minutes before I was due to meet the Minister – and I did the inexcusable and kept him waiting in order to be able to respond to his welcome in a suit and tie – which were “de riguer”.

The most difficult problem that I faced was right at the start of my term. The Council, under Johannes Mosbech’s Presidency, had chosen Los Angeles as the venue for the XIIth ISM. However, during the second general meeting in Helsinki a very attractive Thai member greeted every delegate with an orchid and showed a most inviting video of facilities in Bangkok. She linked this with an invitation for the meeting to be held there. The membership was very taken with this invitation, but, as no precise commitments on costs were available, it was decided to defer a decision about the XIIth ISM venue for 8 weeks to enable Thailand to provide the required details and a decision was then to be made by the EC. No adequate commitment were forthcoming and so the meeting, and a very successful one, was held in Los Angeles.

The meeting in Pattaya was some consolation, and our hosts, demonstrated great efficiency in holding an international meeting jointly with a number of other international organisations.

The meetings in China and Zimbabwe demonstrated the strength of epidemiology in relatively less affluent parts of the world. There were many very good researchers doing good work – but they had few resources to join the IEA – and we had no resources to enable them to play a major role in our activities.

At the beginning I tried very hard to forge closer links between the IEA and WHO (Geneva). I spent a day with the Director-General, Dr. Mahler, and his Chief-of-Staff, Dr. Cohen. The former admitted that one of his mistakes during his period as Director- General had been neglect of our subject and thus a lack of emphasis on the importance of epidemiology in improving health world-wide. As a result of our discussions WHO(Geneva) commissioned a consultation, which was undertaken by Professors Gordis and Noah and is described above.

As I have already stated, in spite of goodwill and concern by successive Directors-General, Mahler and Nakajima, insufficient progress has been made in Geneva and some of the other WHO Regions.

Another major issue during my period of office was the decision to hold a Regional meeting in Israel. Invitations from this country had been frequent and Israeli members played a prominent part in the Association. There had always been a reluctance to hold meetings in Israel because of our fear of offending members in neighbouring countries. We have always had a rule that no meeting could be held in any country which forbade entry to nationals of any other country. Johannes Mosbech had visited Israel to assure Council that it was safe to hold a meeting there and received the necessary guarantees of entry for any member, including Palestinians living and working on the West-Bank. As a result, Council agreed to such a meeting, which was successfully held in 1993, with the participation of several West Bank epidemiologists. Although several participants arrived at the meeting place with guns – these were all parked in the cloakroom!

My period in office 1987-1993 are perhaps best summarised by the following:-

  • The friendships which developed between members of the Executive Council.
  • The willingness and ability of the members of the EC to give their time and resources to the IEA. Although the IEA pays for secretarial help to each member of the EC certainly during my “time” the payments made could not have met more than a fraction of the costs of secretaries, postage, telephone etc. We were fortunate that our institutions were willing to turn a “blind eye”.
  • The enthusiasm of workers in epidemiology in all parts of the world for our subject and their hunger for help, expertise and advice. My greatest regret is the lack of time we had to give this, particularly while on visits to less affluent regions.
  • The need to maintain standards and improve the quality of our work – as well as the need for better and easier implementation of findings.
  • The desire to host meetings. While I was in the EC we were inundated with invitations. We had great problems in deciding the criteria which a country had to fulfil to host either an ISM or Regional meetings and when we had made a decision based on the competing bids I was surprised by the depth of disappointment in some of the unsuccessful bidders.

But, all in all, it was a stimulating and rewarding time.