Vas Narasimhan had held down various senior exec roles at Novartis before taking the reins in February 2018. He thought his previous experience had well prepared him for the top job—until he actually started doing it.
“I thought I could just keep doing what I had done in my previous roles and it would be fine,” the Novartis CEO said in an interview with The New York Times. “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.” Prior to CEO, Narasimhan was Novartis’ global head of development—and then also chief medical officer—since 2014.
As CEO, “I’m always in the public spotlight, always the spokesman,” he said. “Even though everyone told me, I still wasn’t prepared for that. I don’t know what prepares you other than doing it.”
And then there’s “the constant crisis,” for which Narasimhan said he was not prepared.
One of those crises hit quickly. Just three months into the CEO job, Narasimhan was hit with the exposé of the now-notorious $1.2 million contract Novartis had previously inked with President Donald Trump’s once-lawyer Michael Cohen. Ongoing bribery scandals in Greece and South Korea didn't help.
Novartis instantly started working to distance Narasimhan from the controversy, and the CEO himself shuffled top staff and put compliance and ethics at the top of his to-do list. In a message sent to colleagues and shared with the media, he acknowledged the Cohen deal was a mistake.
It was not that Narasimhan had not faced an emergency before. During the 2009 H1N1 pandemic, he was the North American head of Novartis Vaccines, which was at that time the largest supplier of H1N1 vaccines to the U.S. government. Novartis, along with other firms, was trying to develop vaccines quickly but was behind.
“It became clear that the only way to get the organization to deliver 150 million doses of vaccines was to inspire people,” he said. “It was such an audacious thing to try to get all of this done.”
So how does Narasimhan, now the face and mastermind of a large pharmaceutical company, deal with that sort of stress? It comes down to four principles: mindset, movement, nutrition and recovery, he said in a recent LinkedIn post.
He sets goals every day, “trying to be clear about what I want to accomplish in the day, right in the morning,” he told the newspaper.
On the physical side, Narasimhan is a big believer in blood-sugar control. Glycemic status affects one's “overall ability to make good decisions, handle stress, all of those things,” he told the paper. A vegetarian, Narasimhan fasts for 15 to 16 hours usually from dinner to lunch, with only coffee and water in between, he said—and when he does eat, he's careful about which foods he eats.
A self-described Peloton addict, Narasimhan combines early-morning exercise with a regular sleep schedule. He’s not one of those leaders who cultivates a rep for performing on just a few hours’ sleep: The Novartis CEO sleeps seven hours a night, and works out for an hour after that, he said.
That day in, day out care is the type of approach Narasimhan says he’s taking to shore up the company's own image.
Amid all the ethical, legal and political controversies, Narasimhan has made strengthening the Swiss drugmaker’s reputation as a priority, which he sees “as a long game,” he told NYT. “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,” he said.
Narasimhan’s Novartis is also facing a big challenge on access and pricing as it rolls out spinal muscular atrophy gene therapy Zolgensma. The one-time treatment’s $2.125 million list price not only made it the most expensive drug ever but also attracted criticism from pricing advocacy groups.
At the time, the CEO again turned to fire extinguisher mode, explaining to investors and the public how the price is “within the range of traditional cost-effectiveness thresholds” used by cost watchdog the Institute for Clinical and Economic Review, and that it’s only around half of the 10-year cost of chronic SMA therapy.
The company touted its outcomes-based and pay-over-time options, as well as a “patient program to support affordability and access.” And Narasimhan has also called for changes to the U.S. drug payment system to make such novel treatments—and proper payments—necessary.