Dr Mark Toshner is “evangelical about research”, although he admits that it’s often “not enormously glamorous”. He’s been involved in major ground-breaking clinical trials throughout the ongoing Covid-19 crisis, helping to collect data on the first Covid-19 patients that arrived in Cambridge and working as a principal investigator for the Oxford/AstraZeneca vaccine study.

Toshner, a consultant physician and Cambridge lecturer, currently spends most of his time working on a project called HEAL-COVID — one of the first studies aiming to reduce the frequency of longer-term complications of Covid-19. Pre-pandemic, he worked primarily on experimental and translational medicine — seeking to “translate” models of disease and large-scale data into “workable therapies” — with his major focus lying on a rare lung condition known as pulmonary hypertension.

Our interview is one of Toshner’s many back-to-back Zoom meetings today. Although he’s friendly and eager to chat about science, it’s clear he’d much rather be in a laboratory.

As Covid-19 swept the world in early 2020, Toshner found himself “dragged into a number of pandemic studies”. “Just because I’ve got generic clinical trial skills that can be repurposed towards different things, I ended up sort of by accident doing a lot of work on things that wouldn’t normally be my area.”

The daily life of a principal investigator – a role Toshner held in the Cambridge branch of the Oxford/AstraZeneca vaccine study, as well as for the ongoing HEAL-COVID research project — “is not enormously glamorous.” Compared with his previous research work, Toshner tells me: “I spend a lot more time in meetings than I ever did.” The paperwork, too, is extensive. “There’s a lot of paperwork involved in trying to make sure that the governance of this type of study is absolutely rock solid.” This includes detailed documentation on everything from staff training to data-input and ethical compliance. Despite this, being part of such significant trials has been “phenomenally exciting”, not least because “the sort of resources we had were a once in a lifetime opportunity.”

“There was a lot of manic work” at the beginning of the pandemic, Toshner says, especially when it came to setting up the vaccine trials: “We were trying to set up a study within a time frame of days or weeks when we would normally have years”.

Accomplishing this “extraordinary” feat required “the sort of Herculean effort and the sort of infrastructural focus that, by definition, very few studies are ever going to have”. To put this into context, Toshner tells me that, at one point, 88 people were working together to set up the Oxford vaccine trials. A normal clinical trial, he says, would have just “two, maybe three” people doing this work.

It’s hard to overstate the scale of the achievement. The research community went from having no understanding of the disease, to analysing its genetics, understanding its basic biology and developing workable therapies and vaccines all within the space of just 18 months. This, Toshner says, is “the equivalent of setting up the moon landing and nailing it within just a few weeks”.

He is keen to stress that such progress would have been impossible without large-scale international collaboration: “It was an astonishing human achievement that involved an amazing cast of characters from all around the world pulling in one direction.”

Throughout the pandemic, Toshner’s research has involved both great highs and terrible lows, from the joys of the vaccine success to the stress and trauma of treating extremely sick and dying patients. He very clearly remembers the anxiety he felt upon recruiting the first infected Covid-19 trial patient in Cambridge, back in early 2020.

This research was stressful because, not only were the investigators navigating the suffering of very sick patients, but they also had to intentionally expose themselves to Covid-19 for an interaction that wasn’t clinically necessary: “Although you could see that there would be a downstream benefit, what you actually had to do was to open a door and go into a room with a patient who had Covid.”

Nevertheless, Toshner says he feels “very privileged” to have been part of these “crucial” studies. “At a time when most people felt powerless, we genuinely felt that what we were doing might be important. To have been able to contribute to that is something that I’ll always treasure.”

Asked about the outlook for future health crises, Toshner is cautiously optimistic. Although he emphasises that the speed and intensity of the Covid-19 trials was a “real one-off”, he’s optimistic that “some of the tangential side effects might change how we do things in other areas”, making us better-prepared to take on future threats.

In particular, he says, the regulatory authorities — who are responsible for approving medical research and treatments to ensure safety, efficacy and quality — “have done an astonishing job of changing some of their processes to be faster without compromising their safety”. This has involved “better and more open dialogue” between regulatory authorities and researchers, both equally motivated to streamline trials and ensure comprehensive ethical compliance and scientific integrity.

According to Toshner, “the regulators are the unsung heroes of the pandemic”. On various occasions, he notes, the UK was one of the first nations to license new Covid-19 therapies, and very rarely did British regulators “put a single foot wrong”. UK regulators avoided licensing controversial therapies such as hydroxychloroquine but streamlined the acceptance of those treatments that met the necessary ethical and scientific standards.

Although his heavy workload left little time for learning a new language or baking sourdough, Toshner tells me that he did manage to learn personal, as well as scientific, lessons from the pandemic. Covid-19 offered “the best excuse to just take the leash off of my workaholic tendencies”, Toshner says, “and there was a little part of me that was delighted by that”.

“My main takeaway from this is that I need to actively and constantly be careful to ensure that I make time for the people that are important in my life”. He keeps a whiteboard in his office, listing his most important tasks in order of priority. For the last for the last year, that whiteboard has just displayed the words: “go home and see your kids”.

Overall, Toshner is positive — both about our eventual route out of this pandemic and about the future of scientific research. “I really hope I haven’t presented a negative view of research”, he tells me. “The wonderful thing about research is that you can ask a question nobody knows the answer to, design a study to try to answer it, and along the way you might — if you’re lucky — improve people’s lives.”