Episode 1: Prof. Andreas Voss

Welcome to the first episode of ISAC's Living Legends in Infectious Diseases podcast series, hosted by Professor Ian Gould.

In this episode Ian Gould interviews Andreas Voss (Professor of Infection Control at the University Medical Center of Groningen), tracing his career from early training in Germany to pioneering work in MRSA surveillance, infection prevention & control and global antimicrobial stewardship. Andreas Voss shares key insights from international collaborations, the evolution of clinical microbiology, and the challenges shaping the future of infectious disease practice.

References

1. No Time for Handwashing!? Handwashing Versus Alcoholic Rub Can We Afford 100% Compliance?
2. Methicillin-ResistantStaphylococcus aureus in Europe
3. Methicillin-resistantStaphylococcus aureus in Pig Farming

Links

ISAC website

ISAC Academy

34th ICC 2026 Manila

Infection Control Network Africa

Thanks for joining us on ISAC's Living Legends podcast. You’ll find sources and guest information in the show notes and at the ISAC Academy.

Follow the show for more conversations with leaders in infectious disease.

Transcript

Ian Gould 0:08

Good day. I'm Ian Gould and I'm presenting podcasts on behalf of the International Society for Antimicrobial Chemotherapy, otherwise known as ISAC. It's my honor to interview some of what we're calling the living legends in the field of infectious diseases, really looking at great achievements in people's careers over all aspects of infectious disease, microbiology, infection control, antimicrobial stewardship, and many, many more topics. We wanted to really showcase great achievements over the last 50 or 60 years at least. It's my great pleasure to start off the podcast with a chat with Andreas Voss, distinguished researcher on infection prevention control and antimicrobial resistance. Andreas, we've known each other a long time, and I've certainly got lots of questions for you. But do you want to start the ball rolling by talking about your earliest influences and highlights and inspirations?

Andreas Voss 1:23

Thanks for having me. And yes, I would like to start out then with uh talking about my time in in Germany, where I did my uh schooling and my university times, and then right after university started uh in OBGYN, but due to certain circumstances, landed in clinical microbiology. And the nice thing is that my mentor at that time was Ilya Braveni. And for those being familiar with ESCMID, the European Society of Clinical Microbiology and Infectious Disease, Ilya was one of the co-founders of that society, and he truly took me under his wings and showed me the ropes and sent me to all his friends all about Europe and the US to convince me to leave uh OBGYN behind and take the switch to clinical microbiology, and he did that very successfully. So that's how I ended up uh getting my training in uh clinical microbiology uh at uh the Klinikum Rechts der Ise, which is part of the one of the universities in Munich, Germany, and did my education there with, as I mentioned, lots of travels to all of hSCMID friends around the world.

Ian Gould 2:43

And what were the the main highlights of the these early formative years?

Andreas Voss 2:49

I mean the highlight was really that that I the reason he wanted to keep me actually was to build up infection control. So he sent me to a lot of people who know more about that. And and one of my highlights really was a visit to Steve Sinner in in Boston, where for the first time ever I heard about uh MRSA, only they call it their MERSA. And uh I came back to Munich uh after a few weeks uh at Boston and Providence and uh looked into our department and we didn't even knew MRSA in Germany at that time. So it was all just a staff. So by that, it was it was amazing because now I suddenly started to go into the topic of MRSA, did the German surveillance study, did the the first European surveillance study on MRSA. The first time we showed these nice maps with the green in the north and the red in the south. And and this is how I started my research on MRSA, and I think that was one of the most important things, which was only possible because uh Braveni uh really uh got me in contact with all the people within Europe. So that was one of the best and the nicest things. And the other part was that I really had to learn a little bit of ID service because at that time in Germany, clinical microbiologists was a pure lab-based job. No one actually looked after patients, there were no visits to units, there was nothing like that. And it was great to start that out. And again, I was taught by people like Steven Vinner and others what it actually means to see patients, and I had to work on that regard, which was really good, certainly when you also want to start a program of antimicrobial stewardship. I have to say that I wasn't very successful on that while I was a resident in microbiology, because the head of the ICU, also a surgeon, told me very clearly that I'm not allowed to change all of his patients away from MEPNM because that was the best he could do for his patients, and he does not like any young doctor to mingle with his antibiotic policies, if you want to call it the policy.

Ian Gould 5:04

Well, hopefully that sort of attitude amongst intensivists is is one for the history books. Just to clarify, we're we're talking there what uh early 80s?

Andreas Voss 5:15

Yeah, and we were talking mid-80s, yes. Mid-80s. 86 to 88 in that area, yeah.

Ian Gould 5:20

So, how did that uh early experience influence your um your research?

Andreas Voss 5:26

I was lucky enough to meet a lot of colleagues all over all over Europe so early on while still being a fellow and still being in training, uh, because Barveni sent me anywhere. I remember his his famous word that I can't do a lot, but I can talk pretty well and give talks. So he sent me to give his talks all over Europe because he wasn't so keen on traveling. And thereby I had my own network, I was able to do studies, I got to know people, I was able to see uh what they do in their in their labs and in their hospitals. And uh I think it was for me, I got a clear idea about uh clinical microbiology, it's not a lab-based, uh it might be lab-based, but it does not really work if you not go out, see your clinical colleagues, uh, work on the intensive care unit, work uh with them on the hematology units and other risk units. So uh that was important, and also he brought me in contact with other of his friends who have a nice uh grant to give away. It was uh Franz Daschner, one of the most famous infection control people in Germany, and I was able to, via the uh Walter Margett Foundation, which they had built for their mentor, to go to the US. And all this was made possible really by my uh educator, uh Ilya Praveny, and so he made sure that I would be able to go to the yes to Dick Wenzel, who at that time was kind of the Pope in infection control.

Ian Gould 7:04

And Dick Wenzel uh was based where, and who else did you meet in the States?

Andreas Voss 7:09

In 1992, 1993, he was based in in Iowa City, so it's in the middle of nowhere, you could say, but a great hospital, uh, with uh amazing people working there. And due to his uh uh to the fact that he was that famous, we were like about 16 fellows from around the world that came there together there and and and learned from Dick Wenzel. Uh, and he was an amazing teacher, and not only contents-wise, but also showing us how you can actually treat your fellows or people working with you. So he was making sure we got a bike, he was making sure we had a bed to sleep, he was inviting us for barbecues and to his home. And he was an altogether an extremely pleasant man who really taught you from uh you do not have to act like a general and giving commands, but you can convince people by just showing them what you know and and treating them well. So uh that was for me a true eye-opener, uh, because that was not within the German hierarchical system. Uh, because like at the beginning of this interview, I was talking about Ilya, I would have never dared to do that. For the man, I worked at least 12 hours a day, six days a week, uh, because he was for all the time Professor Braveni, because that was the only way I would have talked to him. So uh they're very different in the US.

Ian Gould 8:41

Indeed. In those uh late 80s, early 90s, my recollections too would have been that uh the US was the center of the earth in terms of the the leading research in the fields that you and I are interested in. Do you agree with that? And how did uh Europe gain uh in the ascendancy in the following 20 years?

Andreas Voss 9:04

Uh yeah, it's true. At that time, the most important title you could have uh uh was not the professor or the doctor, but was the AIG, which is a German translation for in was in America. So if you could say I was in America, you have obviously done something well. And I would say that they were really leading. They they had the most research, they had the most famous researchers at that time, too. They were sharing that really well on all the big meetings. The Society of Healthcare Epidemiology of America, SHEA, was the leading society, and their journal uh was certainly the leading journal in infection control. So uh what happened is that a lot of Europeans came there. Dick Wensell was able to bring them all together and to keep them together. So we started with a team called the Friends of Iowa. People I worked with a lot, like uh Andreas Widmer and Didier Pité, were just there before me with a little overlap, and and that really became a tight group of friends and colleagues who worked together and had this kind of American way of working, namely hard and a lot, and publish and work together. Uh, and I think that helped to change the world or of infection control at least, and bring Europe forward. Like I stole the idea of the SHEA hospital epidemiology course. They had this course in hospital epidemiology hold in five-star hotels, at least for the faculty. The faculty flew in for give the lecture, flew out. But we thought we'd do it differently, more European-based. We do it low-key, with all the faculty staying together for five days with the with the uh people who came to the course. And I think we built an extremely successful course that way that ran for 20 years before it gave it over to younger people. And then things in Europe changed. Infection control became more sexy because when I started out with it, no one wanted to do it, but it became far more sexy over the years, people got far more engaged, and and we saw how important it is for healthcare. So I think that was the main reason how Europe suddenly ended up in uh coming into infection control and having more interest for it.

Ian Gould 11:32

And how uh much of a role did um ISAC, previously known as ISC and and uh ESCMID, have, of course, ISAC being uh a much older organization than ESCMID.

Andreas Voss 11:46

True, ISAC is in this far older, and and later on they also joined this uh ESCMID SHEA course. I have to admit that in the very beginning, with regard to infection control, ESCMID was a little bit more proactive, or the working groups were very active. I was part of uh a small group together with Emilio Bouza from Spain, who reactivated the European Study Group on Nosocomial infections from ESCMID, uh and we did that very successfully. And and and by combining all that, uh it really helped. On top of that, with those friends of Iowa, we started later on the uh the meeting, which now is one of the top meetings in infection control, ICPIC, which is uh in Geneva. And we also started a journal, which I was the founding editor and editor-in-chief for several years, uh, which now is a top journal also within infection control. So I believe at that time it was mainly activity from friends, not supported by societies. But uh, you see it now. ESCMID started with EUCIC, pouring a lot of money into that, and ISAC has now a very active uh working group on infection control too, which I also happened to lead for some time. And I'm very happy to see that we're now also working together. There's so much to offer. So, like the the the webinars we now to do, ISAC is now doing with ESCMID together, it's they're really great, and I believe it really uh helps not to offer more and more and more, but to bring the best from all societies together and then have just excellent webinars.

Ian Gould 13:33

We mentioned uh your experiences in in America and Europe, but of course there's a whole wide world out there, another four inhabited continents. Do you think the world of in infection and antimicrobial resistance and stewardship has um uh dealt fairly with these other continents?

Andreas Voss 13:52

Fairly is is it's difficult to say. I have been also for a short time on the African Board for Infection Control, ICAN, on that society, which was a pleasure to work with, and which by the way has way better connections with uh ISAC than with ESCMID. So that I think that was one of the strong points of ISIC, of course, was the fact that uh they had great connections in Africa, great connections all over Asia, uh, which is also extremely important. And I have uh traveled to a lot of the Asian countries during my ISAC time, obviously, and giving talks on infection control and talking to leaders in the field there, and uh opening a completely different view on the subject. So uh, yes, I believe that it's a world we we did not look at for a long time, but I have to say that the advancement within infection control, maybe with the difference with the exception of Hong Kong and Singapore, uh, was in most Asian countries in Africa, of course, very, very different to what was going on in the US and in Europe at that time.

Ian Gould 15:04

And looking back on a distinguished research career, what are your main uh papers that you're you're proudest of?

Andreas Voss 15:12

Yeah, one I already mentioned that was the MRSA survey, because that was done way before there was any uh European surveillance system or any surveillance system around the globe. Um, another one I did together with uh Andreas Widmer, and as every great idea came during a meeting at night in a bar after a few beers, when we decided uh which good arguments could we have to show people that hand washing is literally impossible and they should all switch to hand rubbing with bedside alcohol. So the paper No Time for Hand Washington, uh, while it's not a major research because it was very, very easy, a simple idea, but is a very impactful idea. To stay with MRSA, I believe that our detection of livestock associated MRSA, SD398, and everything that follows from there, because also it was not only uh MRSA within uh livestock, but also other multidrug resistant organisms. And uh I think those were very important too. I would say that thus my top three papers are around that.

Ian Gould 16:23

You you've mentioned in glowing terms the uh benefits of going to international congresses in terms of contacts and the liaising and bringing home good ideas. What what uh are your your best memories in particular of Isaac uh meetings, but also of other international conference highlights?

Andreas Voss 16:45

Yeah, number one I should say I'm a big defender of face-to-face meetings because I believe uh there's a lot of things you can do online, but to really get to know your colleagues and become friends and really have good exchange, you also need the social contact during those meetings. Uh, if I think about top meetings, uh number one, I would mention uh the joint uh ISAC uh uh ICAAC meeting, uh, which obviously was uh a great success uh and was wonderful to be part of it and being uh being actively engaged while being there and in the preparation of the meeting. Um I should say that I I like the ESCMID as a former ESCMID in Munich, where I happened to be the program director, which was for me personal, as it was my hometown kind of a very exciting meeting. And um, maybe during a decennial meeting in Atlanta when when all the infection control people come once in the in the 10 years come together. I had the year in infection control with Bob Weinstein, and I think we had at least seven, eight of those together uh in the US. But during that meeting were so good that people in the end commented if they if the organizers had hired actors and comedians to give this uh one-hour presentation. So we had an amazing time, and I think Bob Weinstein enjoyed it very much too. Uh, in opposite to the first time we did it together, he even created a disclaimer slide to say that he had no influence over my slides, and there's nothing to do with it. But uh that changed over the years and we really became a great team.

Ian Gould 18:29

You practiced medicine through the latter part of what we often call the golden age of antimicrobial chemotherapy. What are your uh most notable memories of that? And do you think we can ever achieve another golden age?

Andreas Voss 18:44

I were really amazing times. And it could not only because uh uh a lot of new antibiotics and later on anti-mycotics and others came to the market, a lot of opportunities for research. It was new drugs, whereas now I have the feeling it's a lot of it's it's more like a Me Too product than a totally new class. Um infectious diseases were hot, people really liked it, whereas at the present time and and COVID might not help. COVID showed for a short time that we are needed, uh, infectious diseases and infection control, but uh people are now uh yeah, they don't like to see us anymore, in my opinion. A lot of things change now. So I don't think the golden era is over. We can tell all the politicians that there is a silent pandemic of antimicrobial resistance, and they will repeat it during their G8 and G6 and whatever meetings they have, but they are not, in my opinion, not really acting on it. So I think that all those in our beloved field having way more difficult over the future. And um I believe it in the future it is will still always be needed. There will always be people needed who know about infectious disease, who know about good ways of treating it, and who to diagnose it and to prevent it. So that's a skill set that will not be replaced by AI or anything else. We need good communicators who are able to get in contact with their clinical colleagues or who were clinical in part themselves. And so it will always be needed. But the golden ages, where there was tons of money from the industry flowing our way, and tons of grants, I mean, those are over a bit more a fight to do what is needed.

Speaker 1 20:43

You don't think that AI uh might help in that a new era of antimicrobial discovery?

Andreas Voss 20:50

They already are the first drugs under development uh that are uh detected or that were composed, I should say, using AI. So we know about that. They are in clinical phase studies already, at least one I know of, not in for infectious diseases, but for heart disease. So it will help in the drug discovery, but we also know how extremely expensive it became to develop new drugs. And why would you use an antibiotic? Then you have people like me who are telling everyone, you know, put it somewhere away and use it when there's really nothing else to be used. And so we put them away in a safe while the company can't earn the money they invested in it, and when we finally use them, they probably can be produced by others too. So it's not a very attractive drug to produce. If you're lucky, you can treat someone for three to six months. Uh, but that is an absolute maximum, and usually it's a few days. I believe that uh yes, there will be new drugs. We will be winning or stay winning the race against antimicrobial resistance, the golden ages. Where there was one new antibiotic after the other, and we could test them and we could do clinical studies, and we were traveling all over the world on costs of pharma industry. And I believe that's a good thing that that is over. But uh it was certainly fun, but uh it will not be the same anymore as it used to be in the 80s and the early 90s.

Ian Gould 22:23

Intensive care physicians of your uh youth that you mentioned who were addicted to imipenum prescribing, you and I believe that they do not exist anymore in in uh Europe, perhaps, uh or in some excellent centers worldwide. But I still have my suspicions that in the darkest uh areas of practice around the world, these um habits die very slowly, if at all.

Andreas Voss 22:51

Oh, I I I I know for sure, because I remember that I uh gave a talk in a in a not mentioned here Eastern European country on antimicrobial uh stewardship, and people told me later on it was very interesting, but completely stupid, because uh, I mean, they of course gave the newest and most expensive drugs for antimicrobial prophylaxis because they sold it to their patients, and that was the highest and best income they had. So uh, no, but uh in usually, like in the Netherlands, we know for in the Netherlands, Germany, and most of the European countries, luckily uh intensivists are very, very different. And in my opinion, I'm sitting here in Nijmegen, where Jeroen Schouten is probably one of the most active and and also excellent people in antimicrobial stewardship. And he's an intensivist, a very good one. So, no, things changed luckily. A lot of our clinical colleagues now know the value of good uh uh clinical microbiology, so good diagnostics, good prevention, and good treatment.

Ian Gould 23:56

Just to finish, final thoughts on some aspect of MRSA, which I was intrigued, appeared on a website uh chat uh only yesterday with a well-known microbiologist in the UK pontificating whether we shouldn't just forget that MRSA is different from ordinary staff or is MSSA and just treat them as the same in the future. Kind of the argument that uh people like Richard Lacy had back in the 1970s. Any final thoughts to go through?

Andreas Voss 24:35

I think this is this is a very dangerous idea. Um, we know it's not the same. Vancomycin and flucloxacillin. or or or a good cephalosporin, uh, Cefazolin have do not have the same effect against MRSA. So vancomycin is far less active in in treating the patients, has far more side effects. So the idea of letting it go, and thereby we know it's increasing, is not a good idea. We also know from old UK data that MRSA is not only a replacement, but frequently in addition to the existing uh susceptible Steph aureus. So there's a nice paper from Bonton and Clyde Mons and others who reported those. And yeah, I think it's a very bad idea. We did this a little bit with uh um amoxicillin resistance or with uh amoxicillin resistance in enterococci and uh and let go, and now it's a problem that you cannot uh get rid of anymore. So uh no, I don't like it. If you know it is a multidrug-resistant organism, you should fight it as long as you can. You can obviously go ahead and ask how far do you need to go? What is the most efficient way to fight it? But to just let go, as long as I have any influence on infection control, I will fight it. I wouldn't say to my death, but to my to the end of my active uh involvement uh in clinical micro and infection control.

Ian Gould 26:08

Indeed. One can never turn one's back. Immediately you do uh things uh revert to previous bad behavior of our colleagues. Andreas Voss, it's been a great pleasure to speak to you and thank you very much for pleasure time.

Andreas Voss 26:25

Have a great day.