Vas Narasimhan of Novartis: ‘We Are Not at All Prepared for a Pandemic’


Vas Narasimhan was drawn to work in public health. He pursued degrees in medicine, worked to combat disease in India and Africa and studied with Paul Farmer, the renowned physician.

But after a brief stint at the World Health Organization, he became disillusioned with public-sector bureaucracy. “I found there to be a dearth of real leaders,” Mr. Narasimhan said. “There wasn’t a mind-set of: How do you create great leaders and how do you lead large organizations?”

Instead, Mr. Narasimhan went into the private sector. He worked at McKinsey for a short time, then joined Novartis, the giant drugmaker, in 2005. He has held various roles since then: head of U.S. vaccines, head of the company’s Sandoz biopharmaceuticals development unit and head of global drug development and chief medical officer. When he became chief executive last year, he was just 41.

Mr. Narasimhan is on a relentless quest for self-improvement, working with an executive coach, using meditation apps, exercising daily and practicing intermittent fasting. At the same time, he is hoping to improve the damaged reputation of the pharmaceuticals business.

This interview, which was condensed and edited for clarity, was conducted in New York.

What was your childhood like?

My grandparents were from villages in India. Both of my grandmothers only had first- or second-grade educations. Both married as young teenagers. My grandfather was the first person in his family to leave the village and go to college. Then my parents, similarly, were the first in our family to come to the United States.

My father is a physical chemist who moved into the business world and was the head of research and development for a chemicals company. My mother is a nuclear engineer. It was really kind of an immigrant childhood. I learned to speak Tamil before I learned to speak English. My parents started a temple in Pittsburgh, which is still there to this day. And despite living in the United States, I really spent my time growing up trying to recreate kind of the Indian atmosphere.

What did you study in school?

I went to the University of Chicago and did pre-med. Then for my junior year of college I went to Gambia where I worked with the Red Cross in malaria control. That was my first exposure to public health.

I came back and decided to study the great books program. So I read Aristotle’s “Ethics,” Plato’s “The Republic.” I took a whole course just reading one book, Tolstoy’s “War and Peace.” I was sort of a closet philosopher, I guess. Then I decided to go to medical school, and I got into Harvard.

Did you have any sense of what you wanted to do in the field of health?

I wanted to be in public health. I went to Calcutta, India, after my first year of medical school, and then I went to Africa a few other times. And I really began to think about how to impact public health on a large scale. Somewhere in the journey, I decided that I did not want to impact health by working with individual patients. I wanted to have a bigger impact on populations. The question was: Do you do that through public health? Do you do that through private business?

So you decided to join McKinsey. What happened?

I promptly got put on M&A projects. That’s what happens. And I had an aptitude for translating medicine into valuation models. It was a skill set that I still use today. Frankly, the fact that I can build my own model is something useful in a job like this. I don’t want to criticize McKinsey. It’s often portrayed that I was at McKinsey for an extended period of time. I was there for about 18 months.

You’ve had a variety of roles at Novartis. Which were the most formative?

The real trial by fire for me was leading our response to the H1N1 pandemic in 2009. Novartis had become the largest supplier of H1N1 vaccines to the U.S. government. We were behind, as were all companies, because we were trying to develop these vaccines in, like, six months, something that usually takes about six years. We were far enough behind that I was on calls with Kathleen Sebelius, the health secretary, and the White House, under huge amounts of pressure to figure out how to make this all happen.

It became clear that the only way to get the organization to deliver 150 million doses of vaccines was to inspire people. It was such an audacious thing to try to get all of this done. And in the end we did pretty well. We were only a couple of months later that we needed to be to get the full supply in.

Did that experience leave you hopeful or concerned about our ability to respond to a pandemic?

I remain deeply concerned. In that instance we were incredibly fortunate that the virus was not deadlier. But I think we are not at all prepared for a pandemic.

There are a couple of challenges. One is that the industry cannot make it financially sustainable to have the capacity to be ready for a pandemic., because it just sits idle. But the governments lose interest, right? So you have to invest in the long run from a public sector standpoint. If there are no pandemics for a while, then people don’t want to invest in this. So I think that remains a challenge, whether it’s pandemic influenza, Ebola, Lassa fever, Zika. We are ill prepared, and are just dodging bullets.

You’re relatively young to be the C.E.O. of such a large company. How did you prepare for the role?

I spoke quite a bit with other C.E.O.s and former C.E.O.s. I remember one of them telling me that the larger organizations will fight change through all of their inherent systems. Whether they realize it or not, organizations will resist really fundamental change. Another one said, “Be careful. Everyone’s going to try to kill your dreams.”

You’d already been a senior executive at the company. Was being C.E.O. really that different?

I thought I could just keep doing what I had done in my previous roles and it would be fine. It took me probably six to nine months to realize that I’ve got to adjust because it’s an all-consuming role, mentally more than anything. Everyone told me that the job is harder and it takes a huge toll. But I think until I experienced it, I wouldn’t have known.

And then there are things you can’t be prepared for. I was not prepared for the constant crisis. I’m always in the public spotlight, always the spokesman. Even though everyone told me, I still wasn’t prepared for that. I don’t know what prepares you other than doing it.

How do you deal with all these stressors?

I’ve been working with a coach on four principles: mind-set, movement, nutrition and recovery. On mind-set, I set intentions every day. I find that trying to be clear about what I want to accomplish in the day, right in the morning, is very important. What’s the impact I want to have?

Nutrition is, Am I eating for performance, or am I eating to enjoy? I’m convinced that your glycemic status impacts your overall ability to make good decisions, handle stress, all of those things.

Movement: I’m a Peloton addict.

And then recovery. I try to sleep seven or eight hours a night. I take all my vacations with my family. I go on walks with my wife, who’s like my life coach, and professional coach, and all of everything in between.

How do you make time for all that and still do your job?

There’s a feedback loop. If I build those four areas into my daily schedule, I have a bigger impact. So I don’t see it as making time. I just build it in. I try to sleep from 10 p.m. to 5 a.m. I work out from 5 a.m. to 6 a.m., and somewhere in there I try to do my meditation. Then I get to the office, and I try to take breaks during the day. I try to be super careful about what I eat all the time. I fast for 14 to 16 hours as well. I generally do from 7 p.m. or 8 p.m. to noon, with only coffee and water in between. I find that all of this helps. It’s just a matter of doing it for enough times in a row that it just becomes a part of your normal way of being.

What’s your view on the reputational problems facing your industry?

One of the five priorities I’ve set up for our company is building trust with society, which I see as a long game. This is not going to be fast. It’s about consistency, whether it’s on access and pricing, tackling public health problems like malaria and leprosy, or being a responsible actor on social problems, human rights, gender equality. I believe I have an opportunity to do something unique in this because of my background in developing vaccines and working in public health.

If you look over the last 100 years, the gains in life expectancy have been tremendous. And if you look at some of the philosophers like Steven Pinker, they would say that these are some of the greatest achievements of mankind. And it’s even happening in sub-Saharan Africa, Tanzania, East Africa. You have these life-expectancy gains, and it’s because of the advent of modern medicine. That gives me tremendous determination to stay the course. But people don’t think about that huge story. They think about what happened recently. And recently our industry has not behaved in the best way.