Growing up in Bredäng, a suburb south of Stockholm, Annika Östman Wernerson thought being a doctor was far too lofty an ambition. Neither of her parents, a salesman and a preschool teacher, had gone to university, though they did have a lot of respect for education.

She did well in school, but she didn’t see herself as a doctor, a career “for other people, more superhuman than me”, and instead went to nursing school. 

Today, she is still in the Stockholm suburbs – now in Solna on the north side of the city – and in March this year, she became president of the Karolinska Institute (KI), one of the world’s foremost medical universities.

“I feel humble about this big responsibility, but I’ll do my best,” she told ̽����Ƶ from her office on the sixth floor of KI’s looming, modernist conference centre, the Aula Medica.

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Days into her new role, Professor Wernerson said a core goal of her presidency was to create a feeling of “we-ness” at her institution: “We should feel like one KI: that we all work together, that we should feel responsible for doing the best, both in research and education.”

The statement was especially apt in the context of the medical misbehaviour that has dogged the institution in recent years, shaking its research community. The recruitment of the Italian surgeon Paolo Macchiarini in 2010 set in train a scandal that would consume KI for more than a decade. In 2022, he was convicted of causing bodily harm to one of the patients he implanted with experimental windpipes seeded with stem cells but was acquitted of two other charges. Prosecutors have appealed the acquittals, with a trial set for April.

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After multiple investigations, the resignation of many senior staff and a boycott by Nobel Prize committee members, Dr Macchiarini was finally dismissed. But the controversy has raised some difficult questions for the institution, not least how the university’s own procedures cleared the superstar researcher of wrongdoing, even after he was cut off from public funding because of misconduct concerns. 

Professor Wernerson pointed to the many structural and policy changes that had been brought in since then, including in recruitment and ethical review. But for her, preventing another such scandal was a never-ending job: “That is not work we can stop. It should be a living discussion at the university.”

Scientists at KI were now “much more aware” of the risks of fraud and research malpractice, but did that mean she was confident that such problems would never resurface? “I can’t say I’m completely confident. It reduces the risk, but we also have to be all the time on our toes,” she said.

While the greater emphasis on ethics is unlikely to cause much controversy among staff and students, a potentially more divisive issue for a president seeking to create community is working conditions. KI has previously been singled out by SULF, a Swedish trade union for lecturers and researchers, for having the highest proportion of staff on temporary contracts in the country.

Professor Wernerson, like previous KI presidents, blamed the university’s high share of temporary funding from the government and agencies for the dubious honour. But if the volumes of predictable, basic funding for KI rose, would she automatically shift the balance in favour of permanent positions?

“Not necessarily. I mean, we cannot continue just to grow. We need to have good basic funding for those who are on permanent positions also, and we need to have funding for basic research, which is free, curiosity-driven,” she said.

Aside from fluctuating incomes, the other reason she gave for KI’s temporary workforce was a high share of adjunct teachers, many of whom spent more time working in healthcare, employed by the local authority. Factoring in these staff put KI in line with other Swedish universities, she said.

Earlier in her career, Professor Wernerson was herself an adjunct teacher at KI, while her work as a doctor paid the bills. “Of course I think it’s important for people to make their living and...they should feel secure about that,” she said. “I went in and out of these temporary contracts. That wasn’t a problem for me, but as a physician you’re somewhat privileged.”

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She accepted that “maybe” there was a link between a lack of “we-ness” and the share of staff on temporary contracts, but said her solution was to better “take care” of the people in those positions – discuss what they needed to thrive at KI and show them alternative career paths were available – rather than offering permanent roles.

Like universities worldwide, KI grappled with maintaining its sense of campus community during the pandemic. More than 200 staff worked seven days a week in shifts analysing Covid-19 tests, even finding energy for media engagement. 

As academic vice-president for higher education, Professor Wernerson oversaw the shift to online teaching overnight and has since left each KI teaching programme to strike the right online-offline balance, with mixed messages from students. “If you talk to students there is one part that says ‘I love to stay at home and study on my own; that’s the best’, and another part that says ‘I hate this; I want to be at the campus; I want to meet people’. I think ‘how do the students learn?’”

Preparing for the next health crisis means building relationships with other universities, politicians, ministries and agencies – work she said she was just beginning. To help the university and the country keep an eye out, her predecessor set up an interdisciplinary Centre for Health Crises, which included staff from government and policymaking. “They could help us coordinate and see to it that our experts could get ready if there is a crisis coming,” she said.

Ensuring KI is well placed to tackle future pandemics is just one of her priorities in the job. In one of her first days in office, International Women’s Day, Professor Wernerson went to Brussels to receive a European Union Gender Equality Champion award on behalf of the university. Despite the praise, she said, she saw gender equality, like ethical awareness, as a perpetual process. She played down the idea her gender played a role in her own trajectory, particularly her initial decision to pursue nursing rather than a medical degree. 

“In all decisions we make, we need to think of the result connected to equal opportunity and gender equality,” Professor Wernerson said. “Why did we have this result again that the majority of the funding went to male researchers? Maybe that could be explained, but we always have to have that in mind.”

She said it was important to her that promotions were the result of open competition, but also to ensure that both men and women were developed to be top candidates for leadership roles: “When we have a new head of department, there should always be a man and a woman that could be the next head. We should prepare both women and men for such positions.”

Gender diversity, though, is admittedly only part of the bigger picture. In the last decade, one of the strongest influences on Swedish culture and politics has been the role of immigration, particularly of asylum seekers and refugees. KI does some work with schools in Stockholm to help diversify its student intake. Professor Wernerson said it was hard to know how effective that work was, but she was considering getting more involved with it.

“As a person I want to be more connected with that and see what I can do,” she said. “I hope I can be a good role model in that also – that you could come from other backgrounds.”

Perhaps a future KI president will start their own journey far from the Stockholm suburbs.

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ben.upton@timeshighereducation.com

This is part of our “Talking leadership” series with the people running the world’s top universities about how they solve common strategic issues and implement change. Follow the series here.