Almost 3 years ago, soon after I had been elected President of the International Society of Pharmacovigilance (ISoP), the messages of congratulations that landed in my email box were enthusiastic (our society had never had a female President before!) and warm (my ISoP colleagues were over the moon!) but also a little confused. People asked if they should call me Madame President, or perhaps Mrs. President? In my view, both suggestions placed too much emphasis on my gender. ‘Please just call me Mira’, I replied. ‘Or Doctor is fine too’. I am proud of my medical qualification and grateful for the gender anonymity it gives me. The title of doctor also relieves women of having to declare their marital status (even today, using Ms. is considered a feminist statement in some environments), and it allows us to inform others of our professional background in one simple word. I appreciated my colleagues’ excitement—I was delighted too—but I was unsure whether my gender would make much difference to how I carried out my new role. While feminist theory argues girls are not raised to be leaders, with many parents promoting less assertive roles to their daughters, and I had had few female role models in my professional career (I had never been on a board chaired by a woman), I did not consider my gender a barrier to leading an international organization. I was raised by parents who believed girls could do anything, and I hoped the skills I had learned as a mother—supporting, negotiating and caring—would be an asset to supplement my professional experience in pharmacovigilance.

I chaired my first Advisory Board meeting at our annual conference in Bogota in October 2019. The former and new board members gathered in a meeting chaired by the outgoing President, and after a shared dinner, the former members left the room, as is the customary hand-over procedure for ISoP committees. As I moved into my position to chair the next meeting, I heard someone comment, ‘It looks like we are now the Feminist Society of Pharmacovigilance!’ I pretended I had not heard and opened the meeting by welcoming everyone with a small gift from Aotearoa New Zealand (where I live and work) and outlining my ground rules for our new committee. These included expectations that members would attend meetings, or send apologies if unavailable; work in a collaborative, respectful and inclusive way; and read all the papers beforehand. I also requested that in our board’s actions we should be transparent and fair to the ISoP membership who had elected us. To me, these were not specifically feminist ideals, only the expected standards for those leading a democratic professional society.

There was barely time for the newly elected Executive Committee—the sub-group of the ISoP Advisory Board, made up of the President, Vice-President, Secretary General and Treasurer—to adjust to our new roles before the coronavirus disease 2019 (COVID-19) pandemic became the leading agenda item at our monthly teleconferences. In early 2020, we thought the new virus might run its course quickly and that later in the year we would be able to hold our usual face-to-face annual international conference. Looking back, it may have seemed naïve to hope it would all blow over quickly, but it pays to remember we were sailing in completely uncharted waters. Few people had even heard of coronaviruses or Zoom at that time. To the credit of my Executive Committee colleagues, no one suggested ISoP should hunker down until the pandemic passed. Jean-Christophe Delumeau (Treasurer) immediately advised we should buy a professional Zoom license and spent hours setting up virtual meetings and training others how to use the video-conferencing technology. Rebecca Chandler (Vice-President) came up with the idea of regular Pharmacovigilance Journal Club webinars for ISoP members, co-hosted with the editor of Drug Safety. Deirdre McCarthy (Secretary General) worked tirelessly to support the ISoP Secretariat in maintaining ISoP membership during the years when we could not meet in person (prior to the pandemic, most new members joined ISoP at face-to-face conferences or training courses and these meetings were our major source of revenue). We also wanted to ensure ISoP membership was affordable for colleagues in low- and middle-income countries. With the backing of the Advisory Board, we introduced a new fee structure for those on lower incomes and discussed other ways of retaining and growing the ISoP membership during the time of the COVID-19 pandemic.

In Bogota in 2019, I had proudly announced the new Advisory Board was made up of 70% women, representing the proportion of women working in pharmacovigilance worldwide, with broad cultural and geographic diversity (board members came from ten different countries on four continents) and an impressive amount of professional expertise. I cited research that showed more diverse boards make better decisions and build stronger organizations. Almost 3 years later, I remain convinced that our diversity, our respect for each other, and the exceptional hard work of all Advisory Board members has navigated ISoP through arguably the most difficult period in its entire history. Difficult decisions had to be made. We decided to postpone the 2020 annual conference in Oman until the following year and replaced all other ISoP meetings with webinars. It was important to plan in advance and communicate well. As chair of the ISoP Board, I evaluated the evidence and consulted with others before making decisions; then I endeavored to bring everyone along with me. I attribute these skills more to my medical training, research and ethics experience than my gender, but women may lead in a more collaborative, inclusive and supportive manner. In communicating decisions, I tried to simplify often complex information and clarify key messages. There are hundreds of books and magazine articles that debate whether women communicate more effectively than men (and this topic is far beyond the scope of this article), but I would argue that the professional skills I learned as a writer and editor were more important than gender in this aspect of my leadership role.

The support I received during my time as ISoP President was fantastic, especially from Deirdre, Jean-Christophe, Rebecca and ISoP Secretary Sophie Spence. Other Advisory Board members have been extremely diligent and always responded positively to my numerous requests, including the financially risky proposal to host the 2022 annual conference as a face-to-face meeting in Italy. Gianluca Trifirò accepted this challenge at a time of great uncertainty and has expertly led the local organizing committee towards organizing the conference in Verona, with Angela Caro chairing the Scientific Committee in her usual enthusiastic and efficient style. I predict that in September, ISoP 2022 will be hugely successful. At the time of writing, we have over 350 delegates registered, which should not only cover costs, but will result in an annual meeting that is professionally and socially stimulating, after the years when we have been unable to meet in person.

All ISoP officers—including Executive Committee and Advisory Board members—work as volunteers, donating massive amounts of their time to our society. With this in mind, I have tried to lead by example and always invite my colleagues to help, rather than tell anyone what to do. However, as with the role of mothering, there are times when clear instructions are necessary to get a job done! We have not been short of volunteers and proactive ideas during the last 3 years. Many of ISoP’s regional chapters and Special Interest Groups (SIGs) stepped up to organize virtual gatherings using our new Zoom platform. In September 2020 and 2021, Angela Caro and the Medication Error SIG organized a global marathon of ISoP webinars for World Patient Safety Day, which we offered free to anyone worldwide with an interest in patient safety. This amazing collaborative event is now a regular fixture in the ISoP calendar and reminds us to put patients first in our pharmacovigilance work.

During the COVID-19 pandemic, the annual ISoP General Assembly became an online event. I felt more anxious chairing this meeting from a room in my house (what would happen if a southerly gale-force wind suddenly took out the internet in the middle of the session?) than I had been doing it in person, but the two virtual assemblies in 2020 and 2021 turned out well. More ISoP members than ever before participated, and the chat box was filled with greetings and comments from members on every continent of the world. With Deirdre’s cheerful support from her home in Boston; Jean-Christophe dialing in from Singapore, Sophie in London and Rebecca connecting from Sweden, I managed to chair the General Assemblies without losing either the internet connection or my sanity. I would even say it was fun! It has also been hugely rewarding working with ISoP members outside the Executive Committee; there are many colleagues in our chapters and SIGs (too many to list here) who have been a pleasure to collaborate with on pan-ISoP projects such as communication and specific scientific pharmacovigilance issues during the past 3 years.

It is now time to hand the presidential baton to my successor. The next Advisory Board has recently been elected, and I am delighted to report the two candidates standing for President are Latina women with enormous experience and expertise (Angela Caro and Maribel Salas, President of the North American Chapter of ISoP) who will need little advice from me. The fact that ISoP has come this far in gender equality has led me to reflect on how important or not this aspect of our characters is in determining leadership skills. In writing this article, I have evaluated my personal experiences as ISoP President and considered whether how we define ourselves as women or men, or trans or non-binary, affects how we lead. I wonder if it has as much relevance as I thought it did 3 years ago. Although gender certainly affects our behavior at work, I suggest it should not define us within our professional environments. Collaborating with people from different backgrounds and with varying professional perspectives has always been at the heart of ISoP, and I would say it is more rewarding, interesting and productive than being part of less diverse groups.

Gender is only one factor that affects who we are as leaders. There are many other aspects of our characters that play a part and it would be impossible to detail and discuss them all here. Instead, I will turn to literature and end by quoting my favorite treatise on leadership. This poem by Dr Selina Tusitala Marsh PhD, the first person of Pacific Island descent to become Poet Laureate of Aotearoa New Zealand, perfectly encapsulates my advice to the next President of ISoP.

1 Lead

By Selina Tusitala Marsh

You’re a leader-in-the-making, you’re making history

Redefining this nation’s brown legacy

Poly-saturated activity

It’s Nafanua graduating from university

And now

In tautua, lead our community

Lead through uniqueness, your diversity

Lead through leaning, lead through learning

Lead through others, lead by earning

Your own way in the world.

Lead in alofa, lead in compassion

Lead in fun—lead in your own fashion

Lead by falling forward when you make a mistake

Lead by giving more than what you take

Lead when your strategy is a forward-looking story

Lead when the task in front of you holds no glory

Let your ‘Yes’ be ‘Yes’, let your ‘No’ be ‘No’

Lead and follow in the footsteps of your heroes

Lead by creating out of happy accidents

Lead by taking risks when there’s no precedent

Lead by following the cup-o’-tea trail

Sit, listen, eat and they’ll follow without fail

Lead by digging up diamonds in those around you

Lead when you scale the heights, then plummet to ground zero

Lead with transparency, lead with laughter

Lead in celebration, lead in disaster

Lead with your strengths, lead in honesty

Lead when you see between the lines of policy

And into people’s eyes.

Lead, even in the times you just want to follow

Lead for today, lead for tomorrow

Lead when you want to end all injustice

Lead in the crowd, lead when it’s just us

Lead when you want to revolutionise

When you no longer want to be hypnotised

By what everybody else says is right

Lead when you have your vision in sight

Lead from the front, lead from behind

Lead from the middle, wherever you find

Your standing place.

In the workplace, in the home

Lead when everyone’s watching, and when you’re alone

Lead with an eye on your dream, an eye on the rest

Lead when you can look at yourself and assess

Your weaknesses and strengths with clarity

Remembering humility and charity

Lead when you’re brave enough to ask different questions

And when the answers aren’t good enough, to raise objections

Lead and give yourself permission to fail

Lead and take the less-often-walked trail

Lead and never forget to be kind

Lead with the heart bound up with the mind

Lead with a child’s curiosity

Lead with the end goal of unity

Lead with national excellence and innovation

Lead through intimate conversation

Lead with courage and determination

Even in the face of discrimination—Lead.

Lead with balance, a sense of fair play

Lead to help others lead in this way