Episode 2: Prof. Jos van der Meer

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

In this episode Ian Gould interviews Jos van der Meer (Emeritus Professor and former Chairman at the Department of Internal Medicine of the Radboud University Nijmegen Medical Centre in Nijmegen). Jos charts the evolution of modern infectious diseases—from his discovery of the hyper‑IgD syndrome and pioneering work in innate immunity to his early leadership in antimicrobial stewardship and European science policy. He reflects on scientific breakthroughs, the struggle to revive antibiotic development, the lessons of COVID‑19, and his new career as a graphic artist.

Links

Jos Van Der Meer Graphic Art

ISAC website

ISAC Academy

34th ICC 2026 Manila

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 0:07

Hello and welcome to the Living Legends in Infectious Diseases podcast, brought to you by the International Society of Antimicrobial Chemotherapy, shortened to ISAC. My name is Professor Ian Gould, and I'm a recently retired consultant microbiologist at the University of Aberdeen. Each episode features a conversation with a leader whose work has shaped the field of infectious diseases. And I'm delighted today that we have Jos van de Meer, who, for those who have been in the field of antimicrobial stewardship these past 30 years, needs no introduction. Hello, Jos. Do you want to just say a few words of introduction?

Jos van der Meer 0:50

First of all, I'm I'm very honored, let me say that. I don't consider myself as a legend yet because I'm still fully alive and able to correct where things tend to go into fantasy. But anyhow, I think it's a good idea to interview people who have been uh really inside the field and have had an influence on it. And I think in that respect I'm fully willing to talk about that. I'm an emeritus professor of internal medicine in Radboud UMC in Nijmegen, where actually I more or less introduced infectious diseases as a major focus of clinical research, clinical practice, and also in education and training programs. That being said, uh perhaps I should go back to where I came from. I studied medicine at the University in Leiden in the Netherlands, and uh I was trained in internal medicine and infectious diseases in that same place, and I have to mention there that I also did my PhD there. Now, the department in that time was under the leadership of Ralph van Furth, who was one of the pioneers of infectious disease as a subspecialty of internal medicine in the Netherlands. He was not uncontroversial, so to say, because there was kind of a constant tension between the clinical infectious diseases and medical microbiology in those days. But I think nowadays, and say a generation later, those kinds of trouble is over, and uh we can look at good collaborations between the two specialties, and at some places, even fusion of the two specialties. Just a little bit about the time. Uh I was, as I said, I did my PhD in in Ralph van Furth's department, and he was my mentor there, and that was on totally unrelated to uh say antimicrobial chemotherapy, uh, because it was on macrophage biology, um, so cell biology, immunology, uh really lab work. But it was an important training for uh me to become a say clinical researcher.

Ian Gould 3:26

I think van Furth was well known more as an immunologist, was he?

Jos van der Meer 3:31

He was also into say the broad spectrum of infectious diseases from diagnosis until uh antimicrobial therapy, but his basic research was in immunology on say origin, kinetics, and and function of mononuclear phagocytes, macrophages. At that time, I became interested in fever as a clinical uh challenge for some difficult cases with fever, as a challenge for the infectious disease internist. And uh at that time I also discovered a new syndrome Hyperimmunoglobulin D syndrome or hyper IGD syndrome and periodic fever, uh later called HIDS. And over the past 40 years, we have worked on that syndrome which turned out to be an auto-inflammatory disease and for which we we know the genes, we know the pathophysiology now, and we have good treatments. So that's very, very nice. It also was the the reason that I became interested in the cytokines, because endogenous pyrogens, as they were called at those days, turned out to be uh substances like interleukin one. So I stayed in Boston for one short period and a year in 1984 and in 1987 with Charles Dinarello, who was considered and still is considered one of the fathers of cytokine biology and especially of interleukin one. And I still have contact with Charles, and he is uh really my mentor in in that field.

Ian Gould 5:22

And you got your your bean your BTA, as we say, your bean to America, that was uh important in uh the early days of my career, also.

Jos van der Meer 5:32

Yes, and it's a pity that nowadays with the current political climate, it's not the place to be anymore. That's a complete tragedy, and uh this should be restored as soon as possible because otherwise we're losing such an important ground of progress in medicine and also, of course, in infectious diseases of microbiology. Anyhow, that is the current sad situation. Apart from my interest in uh auto inflammatory diseases and immunodeficiency, and later the concept which uh we developed in Nijmegen and uh and myself, the the concept of trained immunity, is my interest in antimicrobial resistance and antibiotic policy or antibiotic stewardship, as we called it at um and actually you were one of the fathers of that term, uh Ian, uh, to get that installed. Uh I think nobody knew what stewardship was until you launched it.

Ian Gould 6:43

Anyhow, I remember you uh being slightly against uh the introduction of a new term, such that the books we uh co-edited um didn't didn't mention that in the title.

Jos van der Meer 6:58

You know, they were called uh antibiotic policies. But anyhow, so um when I moved to Nijmegen I became a professor and became say an important player in internal medicine. I felt that I had to develop infectious diseases as a subspecialty and as an expertise in uh in that place. And one of the things that we hadn't done uh wasn't done so uh scientifically in Leiden was the basis of our antibiotic prescribing decisions. Why do we prescribe antibiotics this or that way? And and how good is the quality of antimicrobial prescribing? How how well do doctors do? What's their behavior when they're alone in their office prescribing drugs? Can we peek into their heads and see what's happening? Those kind of questions started to come, and I was able to get money for this kind of research from the the hospital at the University Hospital at that time, and I was able to get Inge Gyssens to Nijmegen to start this research really from scratch. And I think in the early days, Inge did beautiful studies, but it was very hard to get those papers published. The Americans were not interested in antibiotic stewardship. Papers were always, if you submitted a paper to ICAC or to Infectious Diseases Society of America, um you would always end in the post-session and never have an oral. That was better in Europe, uh I must say, but it was also in the beginning a hard uh area to get into and to get appreciation of especially the infectious diseases community.

Ian Gould 8:54

I remember some resistance in some of the societies, including uh not least ESCMID to the concept, but through your good offices we managed to uh to start the uh European study group on on antibiotic policies.

Jos van der Meer 9:10

Yeah, there was actually uh an idea which came from the the fact that in uh 95, I think, 1996, we founded the SWAB, the uh the a foundation in in the Netherlands on antimicrobial stewardship, which was paid by the ministry. Actually, we got quite a chunk of money uh yearly to get that developed, and I have to mention uh Henry Verbrugge and Orop Janken Echt, a medical microbiologist and hospital pharmacist, uh, with whom together we founded this uh SWAB and that became the kind of model for ESGAP and I remember quite well that we were sitting drinking a beer, you uh Henry Verbrugge and I, where we said we should have a European working group to actually try and influence this gradient over Europe in say liberal and uh parsimonious prescribing of antimicrobial drugs, which seemed to also actually be connected to say religion. So the the Catholic countries were much more liberal than in their prescribing and than the parsimonious uh Nordic Protestant countries, and now this this is of course not causality, but it's a nice association.

Ian Gould 10:42

Just uh one thing I I might um argue with you there. You said that um when you started out there it was difficult to get anyone in America interested in antimicrobial policies and stewardship, but of course there was uh APUA formed by the great Stuart Levy, and and I remember Calvin Kunin and Bill Bill Craig was uh on that on that area.

Jos van der Meer 11:13

So there were there were a few were yeah, but if you were doing this uh in a more say uh precise way, do you were doing really the daily practice and you investigated the daily practice and try to do interventions to change that? There was not a big interest of the uh say the juries in the US. Of course, uh they all became good friends, uh, especially um uh Stuart did a great job, and uh it's a great pity that he died a couple of years ago.

Ian Gould 11:48

Yeah, indeed. What do you consider your best publications on your main research themes, whether it be uh chronic fatigue syndrome or interleukin disease associated disease or antimicrobial resistance?

Jos van der Meer 12:04

Scientifically, my best papers are in the field of uh innate immunity uh and and the auto-inflammatory diseases, no doubt. They have the highest impact and so on. But that doesn't say that it wasn't fun to do these antimicrobial stewardship papers, and uh also to ask questions: what is uh really moving doctors to prescribe as they do, and what are barriers and and and those kinds of things? And we have a paper in in The Lancet, uh, which is more a review-like paper on how to prescribe antibiotics and what happens in real life with Richard Groll and uh Malies Hölscher, which I think is still a very valid paper that gives directions to the way to go.

Ian Gould 12:58

You became uh vice president of the Dutch Academy of Medical Sciences, I believe.

Jos van der Meer 13:04

No, the the the idea of the Royal Netherlands Academy of Arts and Sciences. So the the the broader thing. I became a vice president, yes.

Ian Gould 13:12

Correct me if I I'm wrong and don't be too modest, that uh was a great distinction for you.

Jos van der Meer 13:19

Yes, that was a great and becoming a member is already, of course, a great distinction. And then to be asked to uh become a vice president was uh a very nice final part of my professional uh career in Nijmegen. And uh afterwards I was able also to, because of my role in the academy, to become a president of ESEC of the European Academy's Science Advisory Council. And in in that context, we we had a whole infectious disease program, which uh it was actually actually we have we there were there are a series of good reports on on infectious diseases and microbial resistance and so on. And I remember that we also had a very nice meeting in H errenhausen in uh Hanover, the old palace there. About can we try and get the antibiotic development, the stagnant development of the antibiotics? Can we can we change the pace with which that's being done? Can we, as academia, contribute to that? And still, this has hasn't had much of an impact because industry is still not greatly interested, let's face it. And and and the real new uh antimicrobial development is still not taken off.

Ian Gould 14:51

How are we going to uh solve this important dilemma?

Jos van der Meer 14:55

Yeah, we we were at at this meeting in Herrenhausen, we we will were actually dreaming about a kind of Manhattan project where you get the the smartest people you can get on the same spot on on the earth for say a couple of months and see how you by cross-fertilization get this field moving again.

Ian Gould 15:20

Have you seen any uh evidence of that sort of sincerity exists or that ambition?

Jos van der Meer 15:27

Actually, we we we tried in Herrenhausen to get people from different directions and to get those new ideas, but uh two days is just too short to get to know each other enough and to get enough wild ideas, and you have you have too little spare time to walk uh together, to sit together, to drink together, and uh and try and and explore new new ways of development. But there were a couple of interesting ideas. One of the things, though, and we have published this in uh nature reviews of drug development, I think the the the name of the nature journal is, in which we showed that almost any step in the whole process of development has inbuilt barriers, and and there is no swift way to get from an idea to a product. And all the steps, say the the the basic chemistry, the medicinal medicinal chemistry, is more or less dead. Uh animal experimentation is is is is limited and often at different places. The toxicology is is old-fashioned and doesn't work, and then the first in man studies are very, very difficult. And big pharma is not interested in this first phase. They don't care until you come with a product that has been trialed already. Do you think AI may uh help for the future? Yeah, but still you have to do the wet work as well. So the wet laboratory is uh still to be there, of course. But indeed can help you to, of course, to to predict uh, say the 3D structures to help you to tell the pharmacology, to it can help you to tell which side chain uh chains um should be put onto a molecule and things like that. So those kind of things are are being facilitated. But I think there should be more uh uh European collaboration on such a project. And now with the Americans uh that start lagging behind, it's a great chance to to try and develop that in Europe.

Ian Gould 17:51

Do you think the there's a political will still? There's it seemed to be uh it seemed to gather momentum maybe a decade ago, but uh probably quite naturally it seems to have lost steam.

Jos van der Meer 18:04

The tragedy is we had such a big warning by COVID, and and the whole world was in a kind of alarm phase and tried to do uh a lot of things to combat this new kid on the block, this coronavirus. And it it should have been an alarm also for antimicrobial resistance. And one of the things, of course, that was a by product was that the bacterial infections really went down because of the hygienic measures that were taken, and that was of course an important message. But on the other hand, also it could have been a good starting point for thinking about vaccines, the using the new vaccine, uh the RNA vaccine technology to say can't we do these kind of things for bacteria? Starting, for instance, with the Gonococcus.

Ian Gould 19:03

Indeed, Jos, it's been absolutely fascinating. Just perhaps a couple of issues to reflect on. Uh one is your best memories of the golden age of antimicrobial chemotherapy and and uh particularly any major conference highlights. And uh then we mustn't forget your new career as an artist.

Jos van der Meer 19:24

So best memories first. I still have great memories uh at the time that we were able to organize a yearly conference in the Kurhaus in Scheveningen in the Netherlands. Uh, Marc Michele and I and Kees van Boven, the three of us were facilitated in in the most generous way by uh Glaxo originally by Beecham, Smith Kline Beecham, and then Glaxo Smith-Klein to have a free hand in inviting people. You were there, I think, also at one of these meetings, and even your father was there at I remember at one of the meetings.

Ian Gould 20:08

Uh yeah, you're really going back in history.

Jos van der Meer 20:11

But it was the place where new ideas really came to bloom, and we we covered all kinds of important topics in in the different years. Uh, and there were small booklets made of it uh that would be used for promotion, but it's the the whole meeting they stayed really uninvolved and just facilitated.

Ian Gould 20:39

Yeah, I mean the relationship with the pharmaceutical industry is often criticized, but uh in the halcyon days, as well as the excesses, there were were, as you say, very useful interactions with the likes of Beecham, laterally, Smith Kline Beacham. Um, these were great, great days indeed. And they had great scientists on board themselves. Oh, indeed.

Jos van der Meer 21:04

Broken park. That's right. They were giants in microbiology and and in drug development.

Ian Gould 21:12

Now uh laterally you've moved in a major way into uh more artistic endeavors. You do you want to just finish with some uh optimistic reflections on that?

Jos van der Meer 21:23

I have a lot of fun still doing my graphic art. I'm quite productive right now, so I'm I have an Instagram page and a very nice website, and uh there's a lot of interest in my art also worldwide, so it's it's nice.

Ian Gould 21:40

Excuse my ignorance, but you seem to be concentrated rather much on birds or fellow friends.

Jos van der Meer 21:46

Fellow friends, yes, because they're fellow friends. No, they I think they're they're so anthropomorphic, and uh you can actually reflect on human behavior, watching birds. I'm not a bird watcher who is going on his belly through the field with a large camera? So I rather sit at home and look at photos which I try to combine. And I take a lot of liberties in that area. But it's fun because I they express emotions and they express thoughts. And they yeah, that's that's it.

Ian Gould 22:26

It's been great fun, Jos, and uh I hope you've enjoyed these rather brief reflections on a fantastic career. And on behalf of uh ISAC, I want to thank you very much for giving us uh your time. It was my pleasure.

Jos van der Meer 22:41

Thank you very much, and it was great meeting you again.