The pieces exist. The partnerships are ready. What is missing is the decision to move forward.
On an archipelago that has quietly assembled the building blocks of a serious medical research ecosystem, the University of the Azores finds itself in a familiar human predicament: the infrastructure is ready, the vision is clear, but the institutional will to act remains suspended in deliberation. Rector Susana Mira Leal has been pressing the Regional Government since 2022 to formalize a Clinical Academic Center — a structure that would unite the islands' hospitals, research units, and academic programs into something greater than their sum. Her appeal is not merely administrative; it is a question of whether a small, peripheral region will choose to invest in its own capacity to understand and treat the diseases that most afflict its people.
- A working group promised in 2022 has never been convened, leaving the Clinical Academic Center stranded between political intention and institutional inaction.
- The rector's frustration is palpable — she is no longer asking for a plan, only for names: who will actually sit at the table and do the work.
- The Azores already operates medical training, three hospitals, and specialized research centers in genetics, epidemiology, and oncology, making the absence of a coordinating structure increasingly difficult to justify.
- A parallel project — the veterinary hospital on Terceira, required for accreditation of the veterinary master's program — is also stalled, with funding unsecured and construction not yet begun.
- The ultimate prize, a university teaching hospital on São Miguel, remains a distant but coherent ambition, contingent on the smaller steps that the region has so far declined to take.
Susana Mira Leal, rector of the University of the Azores, has been making the same argument for years: the islands have what it takes to build a Clinical Academic Center, and the moment to act has long since arrived. Speaking to the Association of Seniors of São Miguel, she returned to the theme with visible impatience. The working group that should have formed in 2022 still does not exist, delayed by what she diplomatically calls contingencies. Her request is now stripped to its essentials — she needs the government to name who will participate.
The case for the center is grounded in what already exists. The university trains medical students through its Basic Cycle program, with clinical rotations running at the Hospital of the Divine Holy Spirit. Doctoral-level physicians and nurses have been joining the faculty. Researchers across the institution collaborate with hospitals and partners from mainland Portugal and abroad. Three hospitals serve the archipelago, alongside specialized units in genetics, molecular pathology, epidemiology, and oncology. Two health-focused consortia have been secured under the Recovery and Resilience Plan, and health research is a named priority in the region's 2022-2027 innovation strategy.
Leal's longer horizon includes a university teaching hospital on São Miguel — the only island where the medical program operates — though she is careful to sequence her ambitions. She draws a direct parallel to the veterinary hospital planned for Terceira, which will be built there because the veterinary program is there. That project, too, is moving slowly: funding is not secured, the management model is still being studied, and the accreditation agency has made construction a condition for approving the veterinary master's program.
What her remarks reveal is a region with genuine capacity held back by institutional hesitation. The research infrastructure is in place. The academic partnerships are ready. What is absent is the decision — the names on a working group, the commitment to build. Until the government acts, the Clinical Academic Center remains what it has been since 2022: a priority that lives only in conversation.
Susana Mira Leal, rector of the University of the Azores, has spent years making the same argument to the regional government: the islands have everything needed to build a Clinical Academic Center, and the time to stop talking about it has long passed. Speaking on a Tuesday afternoon to the Association of Seniors of São Miguel, she returned to the theme with visible frustration—the working group that should have formed back in 2022 still hasn't materialized, held up by what she diplomatically calls "various reasons and contingencies." What she wants now is simple: names. The government needs to tell her who will sit at the table.
The center itself is not a luxury. Leal frames it as both strategic and unavoidable for a region that has been building health education infrastructure for two decades. The University of the Azores already trains students in medicine through its Basic Cycle program, which has been running clinical rotations at the Hospital of the Divine Holy Spirit since its inception. The university recently hired a doctorate holder in Biomedicine and is recruiting two more doctoral-level physicians. Four new doctoral-level nurses and specialists joined the faculty recently, with two more positions being filled. Across the institution, researchers are working in health-related fields, many in partnership with hospitals and specialists from mainland Portugal and abroad.
The region's healthcare system itself offers the infrastructure a clinical academic center would need. Three hospitals and island-based health units exist across the archipelago. Three separate research structures already operate in health: the Unit of Genetics and Molecular Pathology at one hospital, the Specialized Service of Epidemiology and Molecular Biology at another, and the Azores Oncology Center. The university has also secured two consortia under the Recovery and Resilience Plan specifically aimed at advancing health education and modernizing medical teaching. Health research is already designated a priority in the region's 2022-2027 innovation strategy, particularly around diseases with high incidence rates—cancer, diabetes, hypertension, obesity—that demand sustained investigation.
Leal's vision extends beyond the academic center itself. She sees it as a stepping stone toward a university hospital, though she is precise about where such a facility would need to be located. A university hospital in the Azores makes sense only on São Miguel, where the medical program actually operates. The hospital's function would be to provide continuous, regular clinical training for medical students—work that has already begun at the Divine Holy Spirit Hospital. She draws a parallel to the planned veterinary hospital on Terceira, which will be built there because that island hosts the veterinary medicine program. The logic is straightforward: you cannot offer a complete medical degree program without a teaching hospital in the same location.
The veterinary hospital project itself is moving slowly. It will be situated at the Agricultural Development Service on Terceira, positioned deliberately next to the Regional Veterinary Laboratory, which Leal describes as a fundamental partner in the training effort. But the project faces obstacles. The Higher Education Evaluation and Accreditation Agency has made the start of construction a condition for approving the veterinary medicine master's program, which was supposed to launch next year. Funding is not yet secured, and the operational and management model is still under study. Leal acknowledges the urgency—work must accelerate—but the timeline remains uncertain.
What emerges from her remarks is a portrait of a region with genuine capacity but institutional paralysis. The pieces exist. The partnerships are ready. The research infrastructure is in place. What is missing is the decision to move forward, the names on a working group, the commitment to build something that could transform how the Azores trains health professionals and conducts medical research. Until the regional government acts, the Clinical Academic Center remains what it has been since 2022: a strategic priority that exists only in conversation.
Citas Notables
It is fundamental to create this working group, which has been delayed since 2022 for various reasons and contingencies.— Susana Mira Leal, rector of the University of the Azores
The creation of a Clinical Academic Center is a demanding project, an inter-institutional project, and therefore requires bringing partners to the table to discuss and evaluate the specific conditions we have for a project of this nature.— Susana Mira Leal
La Conversación del Hearth Otra perspectiva de la historia
Why has this working group been stalled since 2022? What's actually blocking it?
The rector doesn't say explicitly, but the language suggests it's not a technical problem. She calls them "various reasons and contingencies." It sounds like political will, or perhaps disagreement about structure and funding between the university and the regional government.
The region seems to have all the pieces already—hospitals, research centers, trained people. So what exactly would a Clinical Academic Center add?
It would formalize and coordinate what's happening in fragments. Right now you have a medical program here, a research unit there, a hospital doing some teaching. A center would bind them together deliberately, with shared governance and a unified strategy. It's about coherence.
She mentions this could lead to a university hospital. How realistic is that?
She's careful about it. She says it's possible, but only if the Clinical Academic Center is built first and only on São Miguel. It's not a near-term prospect. It's a long-term vision that depends on funding and political commitment she doesn't yet have.
What about the veterinary hospital on Terceira? Is that moving faster?
No. It's actually a prerequisite for approving the veterinary medicine program, which was supposed to start next year. But the funding isn't secured and the operational model is still being designed. She's frustrated about the pace.
So the real issue is money and political decision-making, not capacity.
Exactly. The region has the infrastructure, the expertise, the research centers. What it lacks is the government saying yes and putting resources behind it. That's what she's waiting for.