Interview with Manolis Kogevinas: “As a Scientist, you Must Aim to Do Large Studies that Have an Impact on People’s Lives”

The renowned researcher reflects on his scientific career, social commitment, and how science can generate real change in society.

Emmanouil (Manolis) Kogevinas speaks very good Catalan, which, influenced by his native Greek, sounds rhythmic and musical. In his expressive modulation, you can feel the sun, countless islands, and, letting your imagination fly, the 150 olive trees of Corfu that he tells me he inherited from his family. Manolis is essentially Mediterranean: warm, approachable, passionate.

Research professor at ISGlobal, he has received international awards as an environmental epidemiologist, including the John Goldsmith Prize 2020 and the honorary doctorate from Democritus University of Thrace. He worked at the International Agency for Research on Cancer (IARC), co-directed CREAL, advised the WHO, led the Severo Ochoa distinction at ISGlobal, and presided over the International Society for Environmental Epidemiology (ISEE), among others. He has also led impact studies that helped control dioxins, improve tap water quality, or allow indigenous populations in the Peruvian Amazon to demand government changes in oil extraction. His interests have extended wherever his scientific curiosity has called him: circadian rhythm disruption or, more recently, the ecological effects of wars.

About to conclude his active research career, he welcomes us to his office at the Barcelona Biomedical Research Park.

-We pronounce your name wrong, right?

-In Greek, names are conjugated. My name is Manolis, but if people call me, I’m Manoli: “Manoli, come here!”. Or: “Manoli’s phone”. But since Manoli here is a female name, I am Manolis for everyone, and that’s it.

-Are you from Corfu?

-My family. I was born in Athens, although I spent my early years in Jakarta (Indonesia) due to my father’s work. He died in an accident when I was seven, and my mother took us three children back to Athens. So, I grew up in Athens.

-What a start in life!

-Special.

-Do you remember Jakarta?

-Yes, but it is a traumatic memory, associated with my father’s death.

-Was he a doctor?

-No, no! My father came from one of the good families of Corfu. He spoke English well, which was unusual in Greece at the time, and therefore he interacted with Americans and English settled in the country after World War II. He went to Jakarta for business. My mother also spoke English because my grandmother, anticipating that the Allies would win the war, had her children learn English during the war with the Nazis. My parents met working with the English and Americans. She had studied nursing in England on a scholarship, but once married became a housewife, as was common at the time.

-She seemed interested in health. Where did your desire to study Medicine come from?

-I wanted to help people in disadvantaged countries. I also had an uncle who took good care of us when we returned to Athens and was a doctor. I went with him and watched him operate and make rounds.

The Titanic lesson

-Why did you choose to become an oncologist?

-I started Radiotherapy, but not fully convinced. At that time, after the dictatorship, we were very involved in politics, and at some point I even abandoned my studies to work full-time in a left-wing party. It wasn’t until I went to London that I discovered Public Health, which was not studied in Greece at that time. Another world opened to me. I left my Oncology specialty unfinished and, with a scholarship, went to the London School of Hygiene and Tropical Medicine (LSHTM) to do a master’s. Afterwards, I stayed for the PhD.

It wasn’t until I went to London that I discovered Public Health, which was not studied in Greece at that time. Another world opened to me.

-What is it about Public Health that interests you?

-It takes you out of a purely clinical view focused on the patient, which is important and I like, but opens you to social factors affecting health. Now everyone knows that many more third-class passengers died on the Titanic than first-class, but in the late 1980s, before the movie, we were just discovering it: social factors affect you from fetus to old age. That struck me a lot at that moment when I was so politicized: you can influence population health, not just individual patients. If you want to prevent disease, you have to change society as a whole.

-Recently some students from that 1983-84 course have reunited.

-Yes! In Bilbao. We had exceptional professors. Geoffrey Rose, head of Epidemiology, who had been a cardiologist and had seen that the English population suffered cardiovascular diseases compared to the Kenyan population, which at that time did not have such problems. He was the first to speak of “populations at risk.” We also had Michael Marmot and Valerie Beral. Very, very good people.

-Did all the students pursue a career?

-There were about twenty-five of us, and two or three are more well-known. We hadn’t seen some of them for forty years, but within minutes we reconnected, because for all of us it was a master’s that changed our lives.

Two Mediterraneans in London

-You, moreover, because in London you met your wife, Silvia de Sanjosé.

-Yes. When I was starting my PhD, she came to do the master’s. In student circles, the Mediterraneans gathered, and we connected quickly. Six months later we were living together.

-Shortly after you move to Lyon.

-One Wednesday afternoon I submitted my thesis in London, and the following Monday I was in Lyon leading a small team at IARC. Tremendous stress, because I was not fully prepared. I went from being a PhD student, responsible only for myself, to having a team to supervise. My thesis had been on social inequalities and cancer survival, that is, how being rich or poor affected the chances of surviving cancer in England. And in Lyon I was hired to conduct studies on occupational cancer, basically. The first six months were quite stressful. Later I learned to work in a team.

One Wednesday afternoon I submitted my thesis in London, and the following Monday I was in Lyon leading a small team at IARC. Tremendous stress, because I was not fully prepared.

-And you liked it.

-I learned a lot. There I connected with many people, because IARC was then one of the few centers conducting large international studies. It had a status, being part of WHO. And I learned a lot, a lot, a lot. For example, we knew dioxins were very toxic but had no evidence they were carcinogenic in humans. We provided it, with a very large and innovative study. I learned to do impactful studies, studies that lead to change.

Carcinogenic dioxins

-Where are dioxins found?

-We are all exposed, but at very low levels. They were in the herbicides used by the Americans in Vietnam to clear the forests where the North Vietnamese army was hiding. And, in large amounts, in the Baltic Sea, where the paper industry discharged dioxins generated in the chlorine bleaching of paper.

-Is the Baltic still so contaminated?

-Yes, because they are persistent. Pollution has been controlled for some time, but in the 1990s, when studies were done with people eating Baltic fish, it was clear that those who ate more fish had more dioxins in their bodies. Very clear.

We knew dioxins were very toxic but had no evidence they were carcinogenic in humans. We provided it, with a very large and innovative study.

-And more cancer?

-Indeed. We conducted studies with workers who had very high levels of dioxins. Occupational studies have an advantage over general population studies: they allow you to see what happens with very high exposure.

-And how are we exposed to dioxins now?

-Mostly by eating meat, cheese… anything fatty, because dioxins are lipophilic and have an affinity for fat. And they come from incinerators, industry, etc. Now there is much more control, and this is a great success. In 1997 they were classified as carcinogenic, largely thanks to the studies I coordinated with others, and many measures were taken in the US, Europe, and other places. Filters were added to incinerators, for example. However, many are still produced in many places, and they are found even in surprising amounts in isolated populations such as the Inuit, who have no industry but eat fatty animals. This can only be explained by wind transmission. There is global contamination.

The broad view of the exposome: everything is connected

-I imagine that, as a scientist, the more you study, the more you see the complexity of life.

-From this arises the concept of the exposome. From the need to evaluate more globally everything that affects us. Around 2005, Chris Wild, director of IARC, said that much money had been spent studying the genome, but we knew little about how external exposure affected internal balance. The idea resonated widely, and studies began assuming that our exposures are complex and everything matters because everything is connected: how we sleep, how we eat, whether we exercise…

Chris Wild, director of IARC, said that much money had been spent studying the genome, but we knew little about how external exposure affected internal balance. The idea resonated widely, and studies began assuming that our exposures are complex and everything matters because everything is connected: how we sleep, how we eat, whether we exercise…

-So it is a fairly recent concept.

-Since the late 1990s, molecular epidemiology was discussed, which now forms part of the exposome. When I was at IARC, molecular biology evolved rapidly and gave us tools to evaluate carcinogens and other toxic agents. We conducted studies to demonstrate their effects on the body before clinical disease appeared. For example, there were animal studies showing ethylene oxide was carcinogenic, but at that time studies were conducted with nurses using it to sterilize medical tools, and it was observed to cause DNA changes.

IMIM running group in the mid-1990s: Joan Soriano, Manolis Kogevinas, Jordi Sunyer and Rosa Lamarca.

Barcelona 1994

-How many years did you spend in Lyon?

-Five and a half years. Quite a few, because WHO is very special as an organization. Very interesting, but very bureaucratic. However, the main reason we left was personal. Silvia and I had good salaries and were conducting good studies, but we had our first child, Niko: I spoke to him in Greek, she spoke to him in Catalan, and between the two of us we spoke English at that time, and he went to a French school. It was like having the United Nations at home! In 1994 we moved to Barcelona. Silvia got a job at the Catalan Institute of Oncology (ICO) and I had a European fellowship. After one or two years, I joined IMIM. It was fantastic, with Josep María Antó and Jordi Sunyer. We were a small team of ten people.

We had our first child, Niko: I spoke to him in Greek, Silvia in Catalan, and between the two of us we spoke English at that time, and he went to a French school. It was like having the United Nations at home!

-They were already well-known.

-Yes. They had shown that the asthma epidemics of the 1980s in Barcelona were due to inhalation of soybean dust lifted during ship unloading at the port. And I knew a lot about occupational epidemiology. So I joined them working on asthma. It was very interesting to research a disease other than cancer.

Manoli Kogevinas, Josep Maria Antó and Jordi Sunyer, 2016. Photo: Glòria Solsona.

-All three of you got along very well.

-We agreed a lot, we talked a lot! And that’s how CREAL (Center for Research in Environmental Epidemiology) was born. Initially, we were just the three of us. Later, fantastic people joined: Mark Nieuwenhuijsen, Elisabeth Cardis and many more. We expanded the core, but have maintained this friends’ connection.

Nature Briefing forever

-Now the three of you are nearing the end of your professional career. How do you experience it?

-Look, I decided this a long time ago, which is why in the last two years I haven’t applied for any grants. It’s a huge psychological change because I am very interested in research and science. I open Nature Briefing every day and will continue to do so, because it’s the most interesting thing: reading about black holes, crocodiles, or viruses from four thousand years ago. I will never lose interest in science, but I don’t want to continue with active research, grants, and all that. I must accept that I have many study ideas I will never do. Let others do them! I’m entering another phase.

I open Nature Briefing every day and will continue to do so, because it’s the most interesting thing: reading about black holes, crocodiles, or viruses from four thousand years ago.

-And is it hard?

-Of course. At seventy, it’s difficult to start another career in a different field.

-You would do it!

-I would, I would! But I have few years left; I should have stopped working at sixty. The thing is that then I would have missed everything we did in these last ten productive years (and difficult, with COVID-19). They have been wonderful years of work, with ISGlobal studies in the Amazon, long COVID, the Severo Ochoa award, and so many other things done with my group.

The disaster, also ecological, of wars

-What would you study now?

-Something artistic. I have been doing ceramics for a long time, and I used to paint as well. I will never be a very famous ceramist, but it doesn’t matter—I'll make hundreds of bowls and high-quality pieces! I really enjoy it. And I also have to read quite a bit. Regarding work, I am interested in continuing to study how armed conflicts affect the environment and environmental health, and how they interact with climate change: because climate change causes wars, but wars also significantly affect climate change. They probably emit 5% of CO₂. But this is neither measured nor considered in any international agreements. I chair, with a U.S. epidemiologist, a committee of the International Society of Environmental Epidemiology and we are trying to work on this. For example, to see what can be done in Gaza, with all the waste everywhere. What happens there, besides being a war crime, is an ecological disaster that will last many years.

I am interested in continuing to study how armed conflicts affect the environment and environmental health, and how they interact with climate change: because climate change causes wars, but wars also significantly affect climate change.

-Will you be able to go there to take samples?

-Now it is impossible. Colleagues of Arab origin have managed to extract water samples from the occupied part of Palestine, although clandestinely. But there are other places where we can do it: Congo or Ukraine. This is the only organized activity I will maintain. And it connects with my political past.

-Your science has this connection with society.

-It’s one of the important things at ISGlobal. Besides being open to the world and not closed to Europe, it has all the translational and policy aspects much more developed than CREAL. I really appreciate that ISGlobal cares so much about the impact of research.

Peruvian amazon 2016 study with Cristina O'Callaghan.

Dinner alone at eight or accompanied at ten?

-Have the results of your studies changed anything in your daily life?

-The problem is that everything I find in my circadian cycle studies I cannot apply at home, partly because Silvia works with America and has an afternoon schedule. My studies say you should have an early dinner and not go to sleep immediately. We have dinner at ten at night, you know? Life is like that. You have to make decisions, and for me it would be much worse to have dinner alone at eight.

My studies say you should have an early dinner and not go to sleep immediately. Silvia and I have dinner at ten at night, you know? Partly because she works with America and has an afternoon schedule. Life is like that. You have to make decisions, and for me it would be much worse to have dinner alone at eight.

-Are you happy with your professional career? Did you expect it to be so fruitful and stimulating?

-You never know. You do studies and some turn out well and others don’t. I have done some big ones, also with WHO, that didn’t work out: too much effort for few findings. And other studies have been fantastic: the one on water with Cristina Villanueva, for example. We changed knowledge, the way chemical contamination studies in water are conducted. We were the most powerful team in the world in this area! In occupational asthma, we also made important findings. And in the circadian cycle. That was what I wanted: studies that change knowledge or have an impact on the way we live. Later, there are other studies that could have been better published but were important, like the one we did with Cristina O’Callaghan in the Amazon, which gave tools to indigenous populations in Peru to request improvements in their horrible living conditions. We achieved it, and that is an important impact.

We changed knowledge, the way chemical contamination studies in water are conducted. We were the most powerful team in the world in this area! In occupational asthma, we also made important findings. And in the circadian cycle. That was what I wanted: studies that change knowledge or have an impact on the way we live.

-Is this the most rewarding part of your work?

-There are many things: sitting with a good PhD student and seeing what we find, interpreting the data, trying to summarize it in a table, that is very rewarding, very much! Young researchers come with a clear mind, have new ideas, and we, as mentors, have the experience to guide them. That’s what happened with Cristina Villanueva: she had an idea, and we worked a lot together, but it was her idea. We changed all the water and chemical contamination studies.

-And policies too.

-Of course. Here, until the early 2000s, chemical levels were higher than those established by European legislation. Now it has improved a lot.

-How would you summarize what you have learned as a scientist?

-To do well-conducted studies and be very demanding in everything. In Epidemiology, you have to do large studies and have good funding. And I have learned to do studies that have an impact, even if before conducting them you cannot always evaluate the impact they will have. But you must want to do big things that change people’s lives. And work a lot in a team.