In the 1980s, as news of a dangerous virus now known as HIV was coming to the fore, Mary Horgan was studying medicine in university.
Its emergence sparked the professor’s almost four decade-long career in the field of infectious diseases.
“My career really has paralleled that of HIV,” Prof Horgan says.
The first HIV/Aids cases were discovered in 1981 and the bug that caused it was identified in 1983, she recalls.
“The really gloom and doom days of the next decade were certainly when I was in the [United] States, where it was the commonest cause of death in men between 20-45.”
Prof Horgan says living in a world where treatment is widely available, as is medication to prevent transmission, shows the “complete change” that can occur in a relatively short period.
“That’s amazing. To have had the experience to live through that scientific discovery that makes people have normal, healthy lives,” she says.
Last August, Prof Horgan swapped out her scrubs for more corporate attire when she was appointed interim chief medical officer (CMO) by then minister for health Stephen Donnelly.
In her first interview since her appointment, Prof Horgan says at times she misses the patient contact of her previous roles, but she believes she is still helping people, just in a different way.
“Coming in here really allows me the opportunity to do it at a population level and really impact positively on people’s lives in Ireland,” she says.
The role of the CMO became a much more public position during the Covid-19 pandemic, when Dr Tony Holohan became an all-too-familiar face speaking to the nation at almost daily televised press conferences.
Since those days of crisis, things have returned to how they were before, with much of the CMO’s work going on behind closed doors in the Department of Health on Dublin’s Baggot Street.
One aspect of Prof Horgan’s job is ensuring the country is as ready as possible for the next pandemic, which she says “will come at some stage but hopefully no time soon”.
There are “definitely lessons to learn” from the Covid-19 experience, she says, ahead of the commencement of a review into the State’s handling of the crisis. But overall she believes Ireland did “very well”.
“I think it’s important that it’s never just a health issue. It’s much wider than that and that cross-sector, cross-government approach to it is really, really important.”
But preparing for the next one is difficult, Prof Horgan says, due to the fact that so much about any pandemic is unknown until it happens: Who will it affect most? What sort of disease will it cause? What is required to suppress it?
A “critical” part of preparedness is global surveillance and early warning signs, she says, and this is why she believes organisations such as the European Centre for Disease Prevention and Control (ECDC) and Centers for Disease Control and Prevention (CDC) in the US are so important.
“I suppose there’s a concern about the ability to have robust surveillance in the US given the reduction in funding for things like CDC,” Prof Horgan says.
“The US has always been very strong when it comes to surveillance but also research, innovation, clinical trials and we need all of that to ensure that we are absolutely prepared.”
US president Donald Trump’s complicated relationship with the World Health Organisation (WHO) is a concern. He has indicated the US will pull out of the WHO next year, which will have widespread ramifications, Prof Horgan says.
“The US was one of the biggest funders of the WHO and [the] WHO not only support us through a lot of surveillance in Europe, but also in resource-poor settings. I think morally we have an onus to continue that,” Prof Horgan says.
She says a funding decrease from the US will “have an impact”, but it should make “Europe be stronger in supporting that and our surveillance network”.
Prof Horgan’s predecessor as CMO, Prof Breda Smyth, resigned from the role after 18 months. Before her resignation, she highlighted issues around staffing in the department, with a number of deputy CMO roles remaining vacant for months. Prof Smyth described this at the time as unsustainable as she felt it created a clinical risk.
Prof Horgan says those deputy roles have now been filled, with the individuals seconded to the positions having expertise in the areas of mental health, children’s health and public health.
Prof Horgan believes the right people have been attracted to the roles and says they are doing a great job.
Vaccination has always been a particular passion for Prof Horgan, who was the first person in Cork to receive the Covid jab. Her support of this public health measure is more acute now, particularly given the recent increase in incidences of measles and TB.
There is growing hesitance and fatigue around vaccination, she accepts, saying the reasons behind it are “complex”.
“If you look at measles, you have some vaccine hesitancy resulting either from misinformation or disinformation around the connection of autism and measles, which has been absolutely disproved. People often forget how bad infections were; our memories sometimes are short,” Prof Horgan says.
“And particularly during the pandemic, I think it’s probably a bit of fatigue. Everyone really wanted to get the vaccine and then they just got tired of doing it.”
Previously, when she served as president of the Royal College Physicians Ireland, Prof Horgan called for mandatory flu vaccinations for healthcare workers in high-risk areas such as intensive care, cancer wards and emergency departments.
This winter season, Colm Henry, the HSE chief clinical officer, described the uptake of the flu vaccine among those working in the sector as disappointing, with just one-third of healthcare workers receiving a jab.
Is mandatory vaccination something Prof Horgan will be advocating for in her current role?
She says it would be her “last port of call”.
“Healthcare workers do have an onus to not only protect themselves, but to protect their patients,” she says. “I would prefer if it wasn’t mandatory … I think with highly educated healthcare professionals we should understand why they may not want to get it and how we can change that attitude.”
It is not just pandemics about which Prof Horgan is concerned. She also has a focus on areas including mental health, smoking cessation, obesity and alcohol consumption, including the introduction of alcohol warning labels.
Minister for Finance Paschal Donohoe recently said the introduction of warning labels on alcohol products would need to be “carefully examined again” by the Government in light of increased pressure on the drinks industry due to the prospect of US tariffs.
The warnings, messages placed on alcoholic beverage containers or packaging to inform about the potential health risks of drinking, are due to be introduced under the Public Health Alcohol Act.
“I understand Minister [Paschal] Donohue’s perspective in that he’s probably looking at it from a different perspective, but … we’ve done a lot of work and research in the area,” Prof Horgan says.
“All I can talk about is the public health message about alcohol, and labelling is important to get that across.”
While there are many illnesses associated with alcohol, another “priority topic” is preventing skin cancer, the most commonly diagnosed cancer in Ireland.
Last summer, Taoiseach Micheál Martin said he was in favour of banning sunbeds, making comparisons with them to passive smoking and asbestos. Prof Horgan says this is something she would support and work is ongoing in the area.
“Developing the policy, we have to go through a particular way of doing it as we do with all public health interventions. That is something we have started working on gathering the evidence and looking at what’s there and what the best way forward is in protecting us from skin cancers.”
But Prof Horgan is aware that some of the health challenges are a direct consequence of inequities between class and geographical areas.
Recent research from Pobal, a State-sponsored organisation with the aim of achieving social inclusion and development, found people living in “deprived” areas are four-times more likely to report not having good health than those in better off communities.
Consequently, there is a focus on more deprived communities and health support structures are being put in place to help with this, such as increasing healthy food options or supports for people to stop smoking.
Overall, Prof Horgan’s main goal for her time as CMO is quite simple: to improve the health of the nation at every stage of life, from childhood to beyond retirement.
“What I really would like is we live that lifespan as healthy as possible for as long as possible.”
