The life of a chief medical officer

Extremely few doctors have achieved the public profile that Dr Tony Holohan attained over the past few years, owing chiefly to his stalwart work during the Covid-19 pandemic. As a result, Holohan’s memoir, We Need to Talk, was highly anticipated. The book does not disappoint: It is engrossing, readable, and thought-provoking. It embraces both Holohan’s professional work, mainly as Chief Medical Officer (CMO), and aspects of his personal life, including the illness and loss of his wife Dr Emer Feely during the pandemic. The book is essential reading for anyone who is interested in Covid-19 and, in particular, the experience of a medic in the political limelight at a time of national emergency.

Holohan was born in Dublin and raised in Limerick. He attended University College Dublin (UCD) and, during his career in public health, served as CMO for 14 years, most notably during the pandemic. Holohan is now Adjunct Full Professor of Public Health at UCD and a non-executive board member of the Irish Hospice Foundation.

It is worth emphasising that Holohan’s book covers far more than Covid-19: It also embraces his education, his time as Deputy CMO, swine flu, CervicalCheck, and the abortion referendum, as well as his wife’s illness. I suspect that, in time, many of these passages will prove valuable to historians of public health, especially when the current focus on the politics of the pandemic subsides. Public health is not just an emergency matter; a long-term perspective is central to planning and prevention, as is clear from Holohan’s book.

The facts presented by Holohan in his account of the pandemic speak for themselves but, as was the case at the time, it is Holohan’s tone that is pivotal. In the book, his tone is still characterised by patience, logic, humility, and a devotion to evidence-based practice that must have been difficult to maintain during the white heat of the pandemic. And yet, he did.

There is now plentiful evidence that Ireland benefitted substantially from the expertise of Holohan and his colleagues, along with our (mostly) sensible politicians, dedicated health professionals, and well-informed population. To take one example, the Department of Health recently published the Report of the Public Health Reform Expert Advisory Group, chaired by Prof Hugh Brady of Imperial College London. The Group concluded that: “Ireland has performed relatively well in response to Covid‑19 to date. While the cumulative case rate in Ireland was in line with the EU27 average, surges in hospitalisations were of a lower and shorter duration than those experienced by many European countries, with excess mortality amongst the lowest in Europe and globally.”

From an historical perspective, the tone in much of Holohan’s writing is similar to that of one of his predecessors, Dr James Deeny. Deeny was appointed Chief Medical Advisor to the Department of Health in 1944 and served in the post until 1962. In 1989, he published a memoir, To Cure and To Care: Memoirs of a Chief Medical Officer (Glendale Press). Infectious disease loomed large during Deeny’s tenure, too, but it was tuberculosis that preoccupied him. Deeny’s Trojan work on tuberculosis and other matters is well outlined in his book.

Deeny’s trajectory after his time in the role is interesting: “In the spring of 1962, I was telephoned from Geneva and asked would I come for three months, to train the first group of people coming from the USSR to work for the WHO [World Health Organisation]. I was not particularly keen on this, especially because there was a strong political slant [….] I went to see Mr MacEntee [Minister for Health] and told him about it. He said not to turn it down and the next morning sent for me and said that he had spoken to Mr Lemass, the then Taoiseach about it, who said ‘it’s an excellent thing that the Russians are coming to work for the UN at last and an honour that an Irishman should be asked to train them. Tell him to go!’ So I went”.

Deeny’s work with the WHO took him to Leningrad, the Caribbean, Latin America, and elsewhere. His account of this period is fascinating and clearly represented excellent use of his knowledge and skills. In 1967, now past retirement age, Deeny left the WHO, but “coming home was something of an anti-climax. I hoped to find a place in a public health department of a medical school, but they were all fully staffed [….] I was appointed Lecturer in International Health by UCD, but was never asked to give a lecture.”

I hope most sincerely that Holohan’s expertise and skills remain available to health and education systems in Ireland and internationally for many years to come. He has already made significant contributions through his professional work, his example as a doctor of integrity and intelligence operating in a very public arena, and his memoir.

I do have one criticism of the book, however: It does not have an index. If and when a paperback edition appears, it would be enormously helpful to future historians to include an index. It is important to optimise the accessibility and usefulness of this invaluable account of a unique period in Irish public health. Please: An index!