Toni Vidal-Puig – Leading with Empathy Through the Covid-19 Pandemic

Professor Antonio Vidal-Puig is Professor of Molecular Nutrition and Metabolism at the University of Cambridge. Reflecting on the Covid-19 pandemic and its impact on the research landscape, in this month’s Alumni Story, Toni tells us about fundraising for PPE, testing the strength of global networks, and what we can learn from the crisis.

Tell us a little about your current research and clinical work.

Our research focuses on understanding why obesity is associated with cardiometabolic complications. There is evidence that some obese patients are resilient to developing these complications. In contrast, other patients, many of them Asians, show severe cardiovascular complications at a moderate degree of obesity. We believe that defects in the adipose tissue may account for these apparently paradoxical phenotypes.

We have built a programme of research investigating how defects in adipose tissue expandability result in peripheral lipotoxicity. This concept refers to the toxic effects of lipids when accumulated outside the adipose tissue in metabolically relevant organs such as muscle, liver, myocardium or macrophages. We are trying to prevent or reverse lipotoxicity by improving how adipose tissue works. Our BHF programme aims to elucidate how macrophage lipotoxicity in obesity contributes to the inflammatory changes, typically associated with cardiovascular outcomes.

The BHF has been supportive of our research since I opened my lab in 2000 and has been fundamental in establishing the cardiometabolic programme as one of the essential four areas of the BHF Centre of Research Excellence in Cambridge. The programme is unique in bringing together Cambridge research strengths in obesity, metabolism and diabetes, atherosclerosis and vascular biology. The cardiometabolic programme would have been impossible without the sustained support of the BHF.

How has the Covid-19 Pandemic affected your work and life?

The pandemic has disrupted our work at the bench and animal facilities. Most importantly, it has changed the way we socialise and communicate. Face to face communication is essential in capturing unique clues for understanding what is going on in the laboratory. It is important to communicate with empathy in order to be a supportive PI and extract the maximum value from the team. Adapting to the new challenge has required flexibility, new channels of communication, extra effort to introduce new behaviours and generosity. 

My personal life has massively changed but going to the hospital and being busy has helped me to deal with the pressure. I sent the lab home and I have spent more time in my office in the laboratory than under normal circumstances for several logistic reasons. The lab is a safe space with only three PIs and some administrators. So, it was the best option for remote clinical consultations by phone. With my colleague Professor Sadaf Farooqi, I have been busy running a charity programme we created to raise funds for PPE in collaboration with the Cambridge University Nanjing Centre of Technology and Innovation (CUNJC), so the lab has been a great place to coordinate our efforts in this front.

Professor Toni Vidal-Puig and a colleague at the Cambridge University Nanjing
Centre of Technology and Innovation, currently in construction, Nanjing, China

What lessons are there for Research in general, and your own working life in particular, that can be learned from the pandemic?

I have realised how problematic and critical is decision making and execution during a crisis. You cannot apply the standard operating procedures that work well in stable, predictable situations. The pandemic requires leadership able to make quick decisions, with incomplete information, and being flexible and confident enough to change direction as you learn. It helps if you accept that mistakes will be made, and resist entering into blaming exercises. The alternative to this flexible approach is paralysis, waiting for someone higher up in the chain to give direction - a direction that may never come in the context of multiple demands and different priorities. You need to trust your people and empower them to make decisions. This type of leadership is essential for most organisations.

How has working with your network supported you and your work during the crisis?

Over the years we have developed an excellent global network based on trust and reciprocity. Despite the challenges of communication and travel limitations, I have been surprised by how the pandemic has strengthened these networks. It is because our networks in Europe and in China are genuine that we have been resilient to this sort of acute "acid test" of a pandemic. When Covid-19 was hitting China, we were obviously worried about our colleagues there. We supported them to the best of our capabilities and beyond the pure transactional interest of our work together. In these extreme moments you see the character and integrity of the individuals involved. If the relationship does not collapse, the network becomes more robust. So, the question is not only how the network has supported us, it is rather if we have worked for each other in moments of need. In this respect, I know our network will help us to revamp quickly and healthily.

You are known for your global approach to research and networks forging strong links with China – how will this be affected in the post-crisis situation?

Our work in China has become even more critical now than I had anticipated. The time invested in developing trust through our current collaborations and the closeness amongst scientists brought about by the difficulties of the pandemic have helped to advance our research plans and strengthen our partnership through the CUNJC. For instance, despite all these challenges, our new building in Nanjing is being built at full speed, reflecting our confidence in the future.

One of my 'other' interests is learning about transcultural approaches to business, which I find relevant to understanding and succeeding in building scientific networks in China.

What ‘green shoots’ can you see for research and clinical practice and what does the future look like?

Before Covid-19: Christmas celebrations with the lab in Cambridge, UK

There is a lot of uncertainty, which precludes building up the confidence required to be entrepreneurial and taking ambitious risks in science. The incentive to work in Covid-19 research is decreasing the visibility of other vital areas of research. I have been trying to resist the urgency and the temptation of additional or redeployed funding. Covid-19 is a crucial problem, but I think science should be done by those with the right expertise to make the most from the budget by doing competitive research. In our case, our expertise is obesity, metabolism and diabetes, and these seem to be risk factors for the severity of the infection. We are happy to contribute our knowledge and experience to address this problem by working with experts in virology. We have, however, decided to remain focused on cardiometabolic research because it is important, and we feel this is the area we can make a significant contribution towards. I may have been influenced in this view by the experience of my Chinese colleagues. Many groups jumped into Covid-19 research incentivised by investments in clinical research projects that have now stopped because they do not have enough patients.

I feel the pandemic is changing the way we see demographics and the contribution and potential stigmatisation of the elderly population. The current scarcity of resources will become scarcer still and likely hit the funding of science. However, the pandemic has reinforced the perception that expertise/science is essential to overcome our problems, even though the prestige of science has, it seems to me, been misused to justify policy and political action.

One of the few positive aspects for science during the pandemic is that it has promoted transparency, collaboration and quick dissemination of data, although given the urgency there is the caveat of its heterogeneous quality. The crisis has accelerated technological development in many different domains. This is positive as many of these innovations are highly transferable and will contribute to changing business models and operations in different areas. 

The future Cambridge University Nanjing Centre of Technology and Innovation,
Nanjing, China

This pandemic is also bringing critical ethical challenges. The way we have dealt with the patients of the pandemic will need to be scrutinised, raising questions about the use of deontological or utilitarian ethics to determine the value of a human life. There is also an ethical dimension in the perceived choice between security and privacy enabled by technology. The development of systems of continued surveillance to guarantee our safety, for example, in the form of testing and tracing, raises issues of confidentiality determined by the prospect of using information beyond their original purpose. The pandemic is accelerating socio-technological changes, which I feel are potentially beneficial but that we need to be able to control to protect our free will and autonomy.

What role would you like to see funders playing in preparing for the post-crisis?

The funders will need to adapt. They will probably need to be innovative to adapt their business models to the "new reality" to be able to fulfil their missions and resurrect the post-Covid-19 science by supporting critical health problems currently neglected. They may need to determine whether their model is still viable or requires a disruptive innovation to support science. This may require finding alternative sources of value, enabling new types of partnerships. Funders will not be wrong if they continue to support the best science and the best people at a moment when resources will be more limited. Also, showing an understanding of the challenges the scientist are going through to deliver results in a predetermined timely way, may help to retain and rescue talent that otherwise may get lost. It will be essential to reassure the scientists and the public that the funding is allocated strategically through transparent, fair processes, which will help to increase trust and commitment.

Editor's note: Please note that all photographs in this article were taken prior to the introduction of social distancing measures. 

Find out more

Professor Antonio Vidal-Puig, University of Cambridge

BHF Centre for Research Excellence, University of Cambridge

Professor Sadaf Farooqi, University of Cambridge

Cambridge University Nanjing Centre of Technology and Innovation (CUNJC)

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