Latest / South Asian Trailblazers / LIVE: Vas Narasimhan (CEO of Novartis) & Dr. Srishti Gupta Narasimhan (Physician Leader in Health and Education)

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LIVE: Vas Narasimhan (CEO of Novartis) & Dr. Srishti Gupta Narasimhan (Physician Leader in Health and Education) · South Asian Trailblazers

• 0:06
  Simi Shah: Hey everyone, it's Simi Shah, and welcome to trailblazers. On this podcast, I dive deep into the journeys of trailblazing South Asians, sharing the stories of the leaders and dreamers lighting the way across the South Asian diaspora. Welcome, everyone.
• 0:24
  Simi Shah: How's everyone doing tonight?
• 0:34
  Simi Shah: Good are so excited to be here, celebrating South Asian trailblazers, our first ever live podcast in Boston. For those of you who don't know me, I'm Simi Shah. I am the founder and host of South Asian trailblazers, and we are a podcast, as well as a broader media platform and community dedicated to elevating the stories of leading South Asians as well as convening them. And I started this platform almost three years ago exactly to the date, because I'd recently graduated from college and was looking for a way to maintain the connection I'd had to my culture my whole life. And as I was looking around in this new professional chapter of my life, I kept seeing South Asians breaking barriers and making their mark in every possible industry in space I could think of, and I thought, How exciting would it be if we had a space where we could share in their stories in a way that can inform and inspire our own journeys.
• 1:40
  Simi Shah: And so that was the genesis of South Asian trailblazers, and I'm proud to say that today we are celebrating three years, six seasons in over 60 stories tall.
• 2:00
  Simi Shah: Today, marks and especially momentous occasion, because I have the privilege of kicking off season seven, with two of the most extraordinary leaders I know. And honestly, I don't really think they need an introduction, but I'm gonna give you one anyway. Because if you've ever listened to our podcast, you'll know that we're all about diving deep into the journeys of trailblazing South Asians. And so I want to help set the stage before we start.
• 2:26
  Simi Shah: Dr. Srishti Gupta is a physician leader whose career spans the private, public and nonprofit sectors. Today she dedicates her time to board service, serving on the boards of Dorsia pharmaceuticals, the North Skin Foundation, and the backpack Foundation. She also supports steam experiences and scholarships for underserved students, and mentors founders in health and education.
• 2:57
  Simi Shah: Previously, she spent nearly two decades at McKinsey and Company.
• 3:02
  Simi Shah: She was a senior expert in the global health practice, and eventually served as global director for McKinsey alumni and strategy, Director of Global Programs and Director of Diversity and Inclusion.
• 3:13
  Simi Shah: Throughout her career, she has worked as a physician and public health consultant in diverse market contexts from India to Botswana. She holds a BA ma MPP, an MD from Harvard University, because that isn't enough degrees, and a master of philosophy from the University of Cambridge. Now for our next guest, Dr. Voss Narasimhan, is the CEO of Novartis Who could have guessed since becoming and C CEO and 2018, vos has led a strategic and cultural transformation to build a fully focused medicines company. Since first joining the company in 2005. FOSS has held a range of leadership roles, including Global Head of Development for Novartis vaccines, Global Head of drug development, and chief medical officer. He is an elected member of the National Academy of Medicine in the US, and in 2023 he became chair of the Pharmaceutical Research and Manufacturers of America. He holds a BS from the University of Chicago and an MD and MPP from Harvard University. Please join me in welcoming Dr. Voss Narasimhan and Dr. Shashi Gupta Narasimhan.
• 4:40
  Simi Shah: Thank you guys so much for being here today. Thank
• 4:42
  Srishti Gupta Narasimhan: you so much for having us.
• 4:43
  Simi Shah: How does it feel being back in your old stomping grounds?
• 4:46
  Vas Narasimhan: I do a lot of town halls from here.
• 4:49
  Simi Shah: This is familiar territory for you
• 4:51
  Srishti Gupta Narasimhan: so much for me and I know a lot of people have been curious about what is who is the woman behind boss and I'm just super excited to meet everybody today.
• 4:59
  Simi Shah: We're excited to have View. Now both of you have individually built extraordinary careers. And I want to go back to the very beginning. Can each of you talk about your respective upbringings as first generation South Asian Americans? And what initially piqued your interest in medicine and global health? And I know trust me, in your case, your father was a gastroenterologist, did he inspire that early propensity for medicine.
• 5:25
  Srishti Gupta Narasimhan: So my parents moved to the US from India in 1971. They landed in Brooklyn, New York, where I was born, my dad was a medical graduate from India. And they were very excited to have people come from with medical degrees to the US at that point in time.
• 5:39
  Srishti Gupta Narasimhan: I grew up in Brooklyn, and then move it eventually to Long Island. For school and Long Island. There weren't a lot of Indian kids in my, in my school at the time, not a lot of South Asian kids. And so I kind of had this life like a lot of us did, where the weekends were very, you know, you're with your parents, friends, and you're doing lots of things in the community. And then during the week, you're trying to keep your head down, and just try to be a kid and just try to fit in as best as you can. Unfortunately, I had the trifecta of being incredibly unathletic, wearing glasses and being very good at math. That made it very hard to fit in during school. But eventually, things started to smooth out. And all the time growing up, my dad worked in Brooklyn at a hospital and we would go this was back before hospitalist. But my dad would round on all his patients every weekend. And so we would go to the to the city, we would go to Brooklyn, from Long Island where we were, and we would either wait in the hospital or we would I would either sit at the nurse's station or I would go to a park. And then we'd come and we'd page them on the hospital system, which was very cool for us back then. And I think, for me, seeing how incredibly happy he was as a physician really piqued my interest in medicine.
• 6:50
  Srishti Gupta Narasimhan: But I think it was actually my mom, that made me really interested in thinking about a typical ways to do things. She was incredibly supportive of doing things, like trying things out. So one of the things that she had me try out in high school, for example, was taekwondo. And I eventually made it to a black belt and like, I would have never done this and my mom not decided to say, hey, just go for a class so you weren't taking me down. That's a little bit of like, how it was like growing up and why I got interested in my science program at my public school, Long Island was so good. And I really thought science, and we're here at the Novartis institutes for biomedical research. Deep science was kind of the route to understanding human health. And I got super involved in research and science as a high school student. And I majored in Biology and college.
• 7:42
  Simi Shah: asked, Can you paint us a picture of your early childhood? Does it bear any resemblance to hers?
• 7:47
  Vas Narasimhan: I mean, many, many similarities. You know, my my parents, my father first and my mother came to the US in the late 1960s, early 70s. My father first actually, Texas, and then ended up in Pittsburgh. So I was born in Pittsburgh, Pennsylvania, where at the time there was a small Indian community, but not not necessarily a very, very big one. And actually, my parents started a temple there, which ended up being with their friends, a huge, huge part of my upgrading. And most of my evenings and weekends were at the Shri Venkateshwara temple in Penn Hills, Pittsburgh. And I think that also had an impact in other dimensions as well. I mean, my mother was very keen on introducing us to Indian culture, Indian heritage, going to Indian, the temples, summer camps, reading the Bhagavad Gita, reading the MaHA Bara and learning all of those lessons, I still think the Bhagavad Gita is one of the most important leadership texts, one can find in any in any Eastern or Western tradition. So that was that was a big part of my my upbringing, there and like Srishti, also just trying to fit in, put your head down, you're one of the maybe a handful of kids from other ethnicities, non Caucasian kids at your school, just try to figure it out, don't stick out, I was not a black belt, I was much more. Throughout my life, I've been much more mediocre than her. And we've been together since like, we were 21 years old. So a lot of opportunities to prove that. And so that was that was the way I grew up. And I think a lot of my passion to impact public health actually came from my mother again. My mother was somebody who really believed in taking us to India, showing us the way people live and reminding us again and again that we have such opportunities to contribute and serve, and that you have to serve and contributed with the opportunities you've given. Work hard, learn a lot. Be relentlessly curious about the world. She built me a huge curiosity, but figure out how you're going to make a difference for people and I think that kind of stayed stayed with me. Absolutely.
• 9:55
  Simi Shah: It's interesting, the parallel threads with both your mom's and sort of intangible ways in which they impact Did you know both of your paths converge at Harvard Medical School and you preempted my question you guys have been together since you were 21 years old. It's a story that starts right here on Route nine in Boston and ends atop Mount Kilimanjaro not and is cemented atop, clearly continuing. Can you tell us a little bit about how you guys first met?
• 10:21
  Srishti Gupta Narasimhan: Oh, gosh. So before I met boss, I was I kind of said to myself, that is person I definitely don't want to be. I had heard that he was in a fraternity and I there was just a bunch of things I had total misconceptions on. But we actually met in a state where the first conversation we ever had was in a stairwell
• 10:43
  Vas Narasimhan: Vanderbilt Hall,
• 10:46
  Srishti Gupta Narasimhan: dorm for the medical HMS
• 10:47
  Vas Narasimhan: students. And
• 10:49
  Simi Shah: they're all nodding.
• 10:51
  Srishti Gupta Narasimhan: And this was, we just started talking a little bit and I think, well, as you say, Me, I was very active in the South Asian community in college. And I learned very soon that Bas was also active in the South Asian community in college. And we brainstormed this idea and this stairwell to have a pan asian festival for the medical school in order to introduce the different cultures in the Mac for the Mac. I don't even know if it's called the Mac anymore, knotting again, I
• 11:20
  Vas Narasimhan: don't know what it's called now.
• 11:21
  Srishti Gupta Narasimhan: And we decided to throw this thing together. We choreographed as every good Indian story starts with the donde era. We choreographed it on Eros together and we went up and down Route nine to Framingham, because back then, Framingham was sort of the mecca of all things. So we got we went to Home Depot, and we got towels for the Donya, which we cut painted. We went we borrowed we rented those costumes from Monty. Like we did just a ton of things. And we were just driving back and forth on Route nine, and we ate an olive garden and we waited. And Pizza Hut was another place
• 11:56
  Simi Shah: fine dining.
• 11:57
  Srishti Gupta Narasimhan: We were fine dining. We were like living the life. And I we talked all the time. Like all these calls are just conversations back and forth. And then when anything would ever happen, I would pick up the landline I don't know if you guys know landlines.
• 12:10
  Simi Shah: I've seen one of the movies.
• 12:12
  Srishti Gupta Narasimhan: We picked up the landline and we would call each other up and just kind of share with each other. And we just realized we were really we just love being together. But I don't think we actually we weren't I wasn't clear that we'll be clear
• 12:23
  Vas Narasimhan: that the important. One important part she forgets is I did actually ask her out on a date. And then she said Who else is coming?
• 12:28
  Vas Narasimhan: That's real. I wanted to go to an ad but I chose a ridiculous thing to choose. I chose to see psycho at the Brattle street theater. I got
• 12:42
  Srishti Gupta Narasimhan: tired.
• 12:42
  Srishti Gupta Narasimhan: I mean, the medical students here at the people who've done medical school here will will remember this. We were so tired.
• 12:46
  Srishti Gupta Narasimhan: We did it. We went and it got dark. And we sat down and we both fell asleep. Like within two minutes. That was
• 12:57
  Simi Shah: wow, that's American Psycho.
• 13:04
  Vas Narasimhan: I think American Psycho I don't even think it was out. Yeah.
• 13:08
  Simi Shah: So you both meet in medical school. And it's interesting, because I'm curious about the ways in which you also impacted each other's life trajectories. You both made the fairly unconventional decision to pivot into industry after medical school rather than continuing in clinical medicine.
• 13:24
  Simi Shah: And Boston. In your case, you initially started out at the World Health Organization, you did a short stint at McKinsey before being recruited to Novartis. Can you talk us through your decision making process about going straight to industry?
• 13:36
  Vas Narasimhan: Well, I think another part of that whole story is again, what we did together, we didn't mention that after our first year of medical school, we actually went to Calcutta, India, and we work with street children and child laborers. If there's a test ground to see if a relationship is going to work, because you live in a slum in India for three months, which is what we what we did on railway stations. We then later would go to Tanzania and work on on malaria control HIV control. We we also did our thesis together on multi drug resistant tuberculosis in Peru. So all of this kind of built the energy to to think about how could you do something bigger and population health and lead broader organizations. And we were both blessed to have two amazing mentors, Paul Farmer and Jim Kim. We're still both close to Paul, of course, has recently passed away sadly, but they were our thesis advisors, our kind of support network to navigate the whole story. So you know, when the opportunity came up to actually go with Jim, to, to the WHO effort on the antiretroviral treatment, where Jim had this audacity audacious idea to say how could we treat 3 million people with antiretrovirals by 2005 and I had had the opportunity during a previous summer to work on the first antiretroviral treatment program in Botswana. And so It was kind of an opportunity to dive in.
• 15:00
  Vas Narasimhan: And I mean, I look, I think throughout this journey, you're gonna find out we didn't really have a plan, we kind of had a plan, but it was kind of like, let's try this out. But I think the overall spirit was how could you use leadership combined with a deep understanding of medicine and public health to have a bigger impact? And that's kind of what took me to take that bet. And, of course, a lot of counseling from Srishti to ultimately go go in that direction.
• 15:27
  Simi Shah: Firstly, you ended up joining McKinsey, where you spent almost two decades Can you speak a little bit about that decision?
• 15:34
  Srishti Gupta Narasimhan: So decision, in a similar vein, so this was a time we were in med school and 1998 to the early 2000s, I think we were seeing the incredibly negative impact of their inability to address infectious disease at scale in many, many countries around the world and sort of the inequity and how programs were available to populations in Sub Saharan Africa, and in India, and how HIV AIDS especially but TB, malaria, vaccine preventable and illness, like they were just it was just the lifespans were dropping under five mortality was really high. And the traditional routes to do work in this space where you do internal medicine, you do infectious disease as the fellowship, maybe you get lucky, and you get a job with the CDC, and then you go work on this. But at the same time this was happening. The world, I think, also recognize this incredible inequity and global health. And there was a tremendous amount of donor support and country's support to create public private partnerships. And really think about how do we support countries around the world to bring up their health outcomes.
• 16:41
  Srishti Gupta Narasimhan: And so this was the Global Fund for AIDS, TB, malaria, GAVI money was just coming together in a way. And I thought to myself, if I wait to kind of go down the traditional path of kind of, it'll be it was the it felt too urgent, like I was gonna miss it if I didn't start.
• 16:59
  Srishti Gupta Narasimhan: And I had stumbled into the presentation, that before McKinsey had supported the work in Botswana, creating the first national treatment and testing program in an African country.
• 17:09
  Srishti Gupta Narasimhan: They help pilot a private sector program in Uganda. And they had come to campus and done a case study of presenting how they had worked in Uganda with Merck Pharmaceuticals, and the Bill and Melinda Gates Foundation, and the government of Uganda and some payers and Uganda to scale up this program. And I saw how these things were coming together. And I said to myself, if I do that, I can start working on this, too. I can work on this. Now, I don't have to wait for this to happen. I was incredibly uncertain. But if anyone here knows Jim Kim, Jim Kim was like, you might not be competent, but I have enough confidence, but the both of us.
• 17:44
  Srishti Gupta Narasimhan: And so he said, just you know, you can always come back into clinical medicine. But we need people who have a social justice mindset, who were thinking about equity at the tables as we're doing this analysis as we're bringing these programs together. And so that kind of cemented. I mean, there was a couple of stops along the way I delayed graduating, I did the Kennedy School degree so that I would have more time to percolate the decision. But eventually, when I graduated med school, I transitioned to work at McKinsey.
• 18:12
  Simi Shah: Absolutely. And when you joined McKinsey, you eventually became an expert in the global health practice working on things like vaccines, family planning, HIV and AIDS.
• 18:22
  Simi Shah: Can you speak to any especially impactful projects you worked on? While they're,
• 18:26
  Srishti Gupta Narasimhan: of course, I was going back to your point around the nearly 20 years that McKenzie, I think there was a lot of false starts. So it took me 20 years to figure out how to do just do it, do it well. So I started off, it wasn't going so smoothly. I actually spent my first two years entirely working in pharmaceuticals, because I had no idea you don't learn a lot about how drugs are developed when you go to med school, which is a little bit of a gap, I think and how we think about healthcare. But eventually I did become a senior expert in the global health practice. And there's one project I always look back on. Clearly still an issue and but something that I think is is one of those things that really pulls together, how healthcare is not just health it is all these other factors was the two year work I did on family planning and safe access to family planning around the world. And that involved thinking about, well, why family planning is important is that it's one of the drivers for economic development and with being able to space children allows for economic development allows for women to be able to make choices around how money is spent in the household, on education, on better food on all of these things. And it's hugely transformational thing. But just having safe access to culturally appropriate family planning is can be hugely transformational for countries. And we worked on figuring out how to get 120 million women on contraception of their choice by 2020. And that was multilateral partnerships financing manufacturing of contraception, policy changes How patient behavior physician behavior midwife behavior. How do you actually really think about this at a global level, but global work is really global. And so it was it I was in West Africa, I was in Indonesia, I was, you know, at headquarters that differed in the UK. It was Angola, it was a lot of it was a lot of travel.
• 20:21
  Simi Shah: And it's interesting to me that you say that you got a couple of false starts because you ended up spending 20 years at McKinsey. And in the latter decade, you actually transitioned to doing diversity, inclusion, and global talent development work? What inspired that transition? And how did it impact the longer arc of your career?
• 20:40
  Srishti Gupta Narasimhan: Well, maybe the answer to the why I moved into internal work on talent is sort of as two answers. One is a little less inspiring and more practical.
• 20:48
  Srishti Gupta Narasimhan: And the other is, you know, more driven by McKinsey. As I said, global work is really global.
• 20:53
  Srishti Gupta Narasimhan: And we had two sons at this point. And I was I remember being eight months pregnant, running around Botswana. I remember, you know, leaving the boys was bus, you know, they were like one in three, I think they kind of you know, grew up around the neighbor campus because we used to live right down the street. And it was just, it was a lot. I know, young families to have, you know, just leaving for 10 days at a time. And so I needed I think, something to pivot for me to kind of be more sustainable.
• 21:21
  Srishti Gupta Narasimhan: But when the opportunity came up to work on talent, I said to myself, Mackenzie's only asset is talent, right? Like, it's really people, they don't make anything they don't make. They don't manufacture drugs, they don't make T shirts like shape.
• 21:34
  Srishti Gupta Narasimhan: They make incredible people and so to work on, how do you retain develop, attract incredible people to this company is actually an something an amazing opportunity to work on. And so I worked on a range of things in the talent space, diversity, equity inclusion was a big one.
• 21:50
  Srishti Gupta Narasimhan: I worked on it in Europe, Middle East Africa, which is very different than in the US, do you think about a lot of different topics. And then I worked on talent programs. Kinsey is an incredibly global company, but it was really hard to have it easily have people have experienced in the multi markets, there's McKinsey offices in 60 countries. But it was at the time I took over the program, it was really hard to move between those 60 countries and just get experience on that.
• 22:15
  Srishti Gupta Narasimhan: I worked on alumni, I worked on a lot of issues related to women and on how we retain and develop women. And I think that part came from my own experience as a working mom, and just not having this was pre COVID, where, you know, people didn't have so much insight as to what your home life was like and what you needed to balance. And there was a very high expectation that you would turn up at the office. So there was a very high expectation that you would be able to drop things on a diamond travel. And so for me, it was really saying, we are losing so many people at the manager level, especially women or young parents, how do we figure out how to adapt our way of work so that we can retain these people.
• 22:56
  Srishti Gupta Narasimhan: And now as a board member, I feel like I go back to topics of talent, more than I go to any other topic. It's like compensation, retention. What are our work policies? How do we do pay for performance? How do we bring a go our human capital strategies at the companies that I'm at it is one of the things I feel like was such a gift to be able to work on?
• 23:18
  Simi Shah: Absolutely. I appreciate you, underscoring the fact that this has become a bigger part of the conversation since COVID. The competing demands of work and family that fall on families, not just in the US but around the world.
• 23:30
  Simi Shah: Vasa in your case, you were building your career at Novartis, which has been quite diverse and included many quick pivots, you led vaccines and diagnostics in the US moved to Germany to lead Novartis as biopharmaceuticals division, and then move to Basel, Switzerland, where you both live now to lead global drug development before becoming CEO. How did you navigate all those changes? And did you ever actually envision yourself in the role of CEO
• 23:57
  Vas Narasimhan: I like to always am an accidental CEO, I was never an intention to be the CEO. And every one of those moves was a constellation of factors, a lot of unexpected twists and turns. I would also say that the only way that was all enabled because of Christy's incredible flexibility and ability to keep our family working in the right direction, despite us both having working careers. Yeah, but it was interesting and certainly moving to the vaccine was an interesting first move, and one I would really highlight because vaccines at Novartis at the time was a small nonprofit biteable division almost like a like no one even knew like Novartis had a vaccines business. But for me as a public health physician, somebody really was passionate about public health. It was like sweetspot come here, actually worked on Sydney Street for those of you who lived in Cambridge, longtime my office was above the Asgard I had like a little desk. I later went down to 75 Sydney street I had an office, a desk in a hallway because we couldn't afford any more space. They just gave us best in a hallway. And that was ahead of drug or vaccine development at that point. But it was an incredible time for those eight years to really just work on developing vaccines for children developing vaccines for the world, we will be able to produce things 700 million vaccine and discovering new vaccines, whether it was for meningitis and children. So children in the United States now get the vaccine that we develop, and around the world.
• 25:23
  Vas Narasimhan: Also responding to a pandemic 2009, I led the age one and one swine flu response to the pandemic. So that whole experience of vaccine was really amazing, and galvanizing. But then there was this interview, probably remember, it was crazy year that we had as a as a family. We were living over here on 120 Cherry Street, but those of you know, the brother or two cheeses, just like up the road from there. And we decided after much thought I was I was really convinced Novartis was committed to vaccine, let's buy a house.
• 25:58
  Vas Narasimhan: We went and we bought a house in Brookline, we renovated did all of that stuff. And as soon as we bought the house, Novartis announced are going to sell the vaccines, very predictable, to GSK. Over the next year, we didn't know who they were going to sell it for. And I didn't actually know what my next role at Novartis would be, I had to help lead the process for GSK to for all the companies to evaluate whether they're part of the vaccine business. And we were getting to the month of finally was march towards the end of March, we didn't know what was going to happen, that I need to go like find a job. I started kind of interviewing here in the Kendall Square area.
• 26:35
  Vas Narasimhan: And then our then CEO, Joe demandez, called and said, Look, I've got a great opportunity, you're gonna go to Munich, and you're going to work in generics and biosimilars, right, which was definitely not in the plan, in any way, shape, or form. And we picked up when we went, right. I picked up and finish the school year, you had to finish quickly. So the kids and Christy stayed here, I went back and forth. Finally, we got the kids over in June, be out of place, we had them enrolled in school, I remember we were sitting out it was a sunny day in Munich at the apartment. And we found we found there, I get another call from Japan as and he said, Look, I know we just moved to Munich, we can get all of your stuff to Basel, but I need you to take a different job running drug development for all of Novartis, you need to move to Basel. And so that was a funny day, right? And because we had to figure out how
• 27:27
  Simi Shah: to talk about every move, that was like
• 27:29
  Vas Narasimhan: the third or fourth job that year, and then we got moved to Tibet. And then of course, that that was critical move, because in that year, all of those changes, I ended up running drug development, which then I think led me ultimately become CEO.
• 27:40
  Vas Narasimhan: But it was all serendipitous things that happened that year because people left and various things that happen. And we ended up having to move to four different houses in a six month or seven month period of time with three little kids. But we figured it out.
• 27:59
  Simi Shah: And did you ever envision yourself in the role of CEO
• 28:02
  Vas Narasimhan: I still remember it was early 2017, when our then beef human resources officer called me up and said, Look, we're starting a new process to evaluate who could be the next CEO of Novartis, we'd like you to be participated. My first reaction was why, like, why would you want me I mean, I'm a running drug development, I'd spent four or five years coming to this building every one once a month, once every two months.
• 28:28
  Vas Narasimhan: Actually, sometimes we before this building was completed, it was also over on the other side, that was very confused, because I'm a non traditional profile. I mean, most biopharmaceutical companies tend to choose people from the commercial side, not the r&d side of things. But in the end, they did a bunch of evaluations and whoever the people are, did evaluations thought that I would be would be good at this. So that's how that's all how it went down. It was certainly not in the plan.
• 28:53
  Srishti Gupta Narasimhan: The meeting was in Dublin, I think it was in a middle seat on air, Dublin. And he had presented and then he got a call on his phone as they were about to take off.
• 29:04
  Srishti Gupta Narasimhan: And they were like, We wanted you to know that we have decided as support that you will be the next CEO. He's in the middle seat. He calls me and I want to call for work. And I'm like, Can I Can I call you back? I'm just not at work. I didn't even know that. He's like, I just got this like no, we he was totally floored.
• 29:23
  Vas Narasimhan: It was easy. It was easy. In the middle seat.
• 29:27
  Vas Narasimhan: I'll never forgot middle seat and Easyjet and you've just been told you're going to become CEO of Novartis. That's one of those and your wife put you on hold my wife put me on hold. She's like, I can't talk to you right now.
• 29:37
  Vas Narasimhan: That was one of those moments.
• 29:40
  Simi Shah: Oh, I love that. So you were appointed CEO in 2018.
• 29:44
  Simi Shah: And over the last five years, you've taken Novartis on quite a journey. Can you speak to your vision for the company on day one and how the company and strategy has changed over that time period?
• 29:54
  Vas Narasimhan: Yeah, and it's been bumpy I have to say because I told me things you can't predict when you when you become I'm the CEO but always division was up did we do what we're best at which is really focused on what this building is all about making fundamental discoveries in science to translate into breakthrough medicines and be focused on medicines at the time. We were a conglomerate.
• 30:12
  Vas Narasimhan: And our history over the past century had largely been to be a conglomerate. So we wanted to disassemble that and really, you know, really get to the core.
• 30:22
  Vas Narasimhan: But that was turned out to be easier said than done, it took.
• 30:25
  Vas Narasimhan: In the end, it's still not done.
• 30:25
  Vas Narasimhan: I hope that the Sandoz spin later this year, will complete the journey. It's over $100 billion of transactions, but we, we spun off the Alcon business, we sold our consumer health business, we exited our row stake now we'll soon spin off Sandoz. And we'll end up being at this core. And I think that that is the right way for Novartis to really have the biggest impact we can, because then it allows us to focus on new technologies that impact human health and things like cell and gene therapies, or RNA therapeutics, and all the great things that that happened here.
• 30:59
  Vas Narasimhan: But I you know, I would also say there's, I mean, the journey of a CEO and there's no way to learn it until you go through it is one of just tremendous perseverance, me of you have huge setback things. I mean, I think the huge success story we've had as a cultural transformation, which I'm really, really proud of. But the business journey, the twists and turns things just don't go your way. And of course, as a CEO, your mistakes are in the spotlight, right? The media, the investors, your board, everything is under a microscope. And so to build a psychological this is like, I think it's as much a physical test, but it's really a psychological test. I mean, can you find enough conviction on the mission of the work you're doing to be able to withstand all of those forces. And I think for many CEOs, it makes them just go into a box, right? You just closed down, like, you don't want to be open. And or you go the route to say, look, it's a complex world, you're going to make mistakes, we're all imperfect, and take more of the humanistic route to be kind to yourself, say, I'm going to learn, I'm going to make a lot of mistakes. But as long as we're heading in the right direction, that's okay. That's okay.
• 32:07
  Simi Shah: I want to come back and spend a second on setbacks and how you both have managed and surmounted those. But I want to spend also a second honestly, your experience in board service, because you also have a unique vantage point, with a different lens, looking in at what it means to be the CEO of a company working with an answering to a board, you've spent time on the board of the North Skin Foundation, which is an ecosystem for impact entrepreneurs, as well as Dorsia pharmaceuticals, a huge biotech company, can you speak to what you've learned about the state of biotech, and also what you've generally learned about corporate governance, broadly speaking,
• 32:47
  Srishti Gupta Narasimhan: biotech, I mean, I think this is one thing we share, though we come at it from very different angles, it is incredibly hard to meet unmet needs for patients.
• 32:57
  Srishti Gupta Narasimhan: And what I mean by that is, is a couple things, I mean, first and first talks really eloquently about this sometimes, and LinkedIn and other places, just unwinding the complexity of cells, that you have a medicine that you can hold in your hand, that is able to do something that affects the human body. So what is clinical success? Right, you have to meet unmet need by having some degree of scientific or clinical success. And that itself is like this giant hurdle that you do. Then there's the second hurdle that you know, for very good reasons. We have regulations around the world that say we we want to know why you think this thing will work.
• 33:31
  Srishti Gupta Narasimhan: Where's the data? How do we know that this is the right thing for mass population, so you have to have a regulatory success to get something to meet an unmet need.
• 33:41
  Srishti Gupta Narasimhan: And then lastly, you have to have people use it patients, physicians, payers, there has to be some sort of market success.
• 33:48
  Srishti Gupta Narasimhan: So we're, somebody's willing to pay for it, people are willing to prescribe it, a patient's willing to put it in their body.
• 33:54
  Srishti Gupta Narasimhan: And that's a whole other layer of context and culturally specific things that need to happen. And as you add on layers and layers of these three levels of success, it is actually incredibly hard to do this. And unlike other industries, this is not a fail fast. And, you know, and cheaply. This is not break things and do like that's one thing on the biotech boards and having people who are in healthcare really understand is that it takes a lot of time to do these things. It takes a lot of money, unfortunately, to do these things. And if you're really committed to going through these levels, to meet an unmet need, you can get there but you know, it there's a lot of drop off along the way as like that happens. And it's some of it is completely out of your control, too. It can just be payers are not interested in having something that does, whatever you've decided is is is interesting, or meets an unmet need. That I think is like the biggest one of the steepest learning curves I've had in the biotech industry is just how incredibly hard it is to make progress on innovation and patient and Then in terms of the governance, I have to say one of the things that's changed a lot since I started serving on boards three years ago is just, you know, the back and forth, you know, why would a board do this? And I'm like, Well, you know, we're actually like supposed to do this
• 35:13
  Vas Narasimhan: is my counselor.
• 35:13
  Vas Narasimhan: Why would they do this?
• 35:16
  Srishti Gupta Narasimhan: So we've had a lot of things to talk about in terms of like, well, how would you feel if we did this, and he's like, that's not manage it. That's management's responsibility to board work is incredibly hard work. I know a lot of people are really excited about it. And I think it's a great, it's, it's a great avenue to have impact. But it's incredibly hard work.
• 35:33
  Srishti Gupta Narasimhan: Because you're trying to you're not in the day to day, you're at a different level, but you're trying to provide steer, you're trying to see risk you're trying to see around corners, but you don't have the vantage point. So it requires a tremendous number of soft skills to be able to navigate and sort of work on a how do you influence decision making, when you don't have the ability to say I'm in there all the time, you have a lot less information? Do you have to make decisions on a lot less information than maybe you're used to? And it just requires a lot of patience and care. People think, Oh, it's a great job, you meet five times a year, and that's about it. But I mean, you're talking to people constantly and just trying to understand and try to be helpful in a lot of ways in between those conversations. But it's, it is a great way to have impact, but it's actually quite challenging. And it requires a lot of self restraint.
• 36:25
  Srishti Gupta Narasimhan: Sometimes, I can imagine.
• 36:27
  Simi Shah: And to your point, and even the earlier conversation we've had about the work you've done in talent, particularly as it relates to women. Women are historically underrepresented on boards. What advice do you have for women in this space who want to navigate the path toward leadership?
• 36:42
  Srishti Gupta Narasimhan: I have been benefited tremendously.
• 36:45
  Srishti Gupta Narasimhan: There's a handful of resources out there, which I think have been amazing. I think him for her is a great resource. They have a lot of free webinars on just very practical things like how do you write your board bio?
• 36:54
  Srishti Gupta Narasimhan: How do you get feedback on it?
• 36:58
  Srishti Gupta Narasimhan: The National Association of Corporate Directors in the US has taken sort of the idea of board work and said there's a curriculum like you need to know what is the legal basis for board work? Why is there a legal case against board directors?
• 37:09
  Srishti Gupta Narasimhan: What does that look like? What does fiduciary responsibility actually mean? If you're interested in going in direction of board work, I highly recommend just getting started on a lot of those things through a lot of those resources that are available. And then I think the other couple of things are, let people know you're interested in board work, and then find other women or find other people that are also interested in and talk each other up. Right? This is an entirely networked community.
• 37:34
  Srishti Gupta Narasimhan: And if you talk to each other up, and you're kind of this is not a good fit for me, but it could be for you. And it elevates the conversation around each other's brands. And I think that can have a tremendous amount of impact. And if there are women out there who actually are on boards right now, I think one of the biggest routes to having influence is through the nominations committee. So if you're about to join a board, or you have some choices on boards, try to get yourself on the nominations committee, because that is the route by which new members come in board. And if you can bring your perspective and your voice into the nominations committee, I think that is it will do service to the entire group of people who are underrepresented on boards.
• 38:15
  Simi Shah: I'm certainly appreciate you sharing all those resources. Now, it seems like the motif in both your careers to the point of you being able to coach each other in various aspects, even as it relates to board service, is because you have a lot of shared interests and one of the most prominent ones being global health equity.
• 38:30
  Simi Shah: You both have spent a lot of time working in countries around the world on how policy issues medical issues. What do you both see as sort of the key priorities in Global Health Equity today. And I'm curious how your identities as South Asians has impacted that perspective as well.
• 38:49
  Vas Narasimhan: I think I think global health has evolved a lot and will always continue to evolve. But I think when you go back in, you know, the most of the last century, it was really tackling infectious disease at scale. And I think we've done remarkable things on that.
• 39:03
  Vas Narasimhan: Certainly the vaccines industry and the ability to bring so many powerful vaccines to tackle many of the key infectious diseases has been hugely, hugely successful. Our ability and Novartis being one of the real pioneers on this front of having highly effective antimalarials having antiretrovirals that can largely make HIV into a chronic disease treat pregnant women Peri partum to reduce maternal fetal transmission. So many great interventions have slowly brought down I think the infectious disease burden still a lot to do. I think Novartis is great at this or we are Unit here at neighbor that discovers new infectious new medicines for infectious disease. It's truly truly extraordinary. But now I think the chapter turns to chronic disease and how will we bring the next wave of innovations to really tackle chronic disease when we go with our family to see clinics in Tanzania or Rwanda or recent trips to Ghana, one thing that strikes you is that if things continue as they are the burden of hypertension, obesity, diabetes, ultimately leading to the consequences, they normally lead to these how healthcare systems just simply cannot handle it. I mean, it will be crushing. If you just look at little metrics, like the capacity to do renal dialysis or manage strokes, I mean, it's very, very low of the the levels of hypertension you have in these countries. So I think now the next chapter on global health is how do we tackle chronic disease at scale. But what I'm excited about is, some of that is just getting the basics right investment infrastructure. But I personally think we have the power of next generation technologies, again, like what we do here, and one of the ones I'm very excited about and deliver folks know this well who are here in the audience is look with small interfering RNAs, we can give medicines to treat hypertension, or hypercholesterolemia extremely infrequently. So you're no longer asking a patient in rural Tanzania or rural Ghana, to go to the hospital every month to refill their prescriptions, sometimes four or five hours, instead of a single injection would knock down cholesterol or hypertension dramatically. And so that's where it's really interesting to show how you know, the work we do on the cutting edge of biopharmaceutical science, but ultimately have massive public health impact on chronic disease and help us hopefully leapfrog the whole challenge of compliance and diagnosis of chronic diseases. But this is the next challenge. And it just it is coming like a tsunami if we don't if we don't get ahead of it.
• 41:34
  Srishti Gupta Narasimhan: It just to add to that. I mean, ultimately, for us, global health equity has been about challenging the belief that some man lives matter less. And, you know, it's seeing companies that are as committed to making sure that interventions and technologies are available to all populations globally as quickly as possible, instead of saying these are available in the US or Europe or Japan, and then we'll start thinking about other market, like just trying to reduce the time that things take time it takes to get interventions to the broadest set of populations. And then to versus point around things like small interfering RNA, we have this ability to kind of not necessarily go stepwise through how things worked in in the US healthcare system or the European healthcare system, we have this ability to leapfrog.
• 42:24
  Srishti Gupta Narasimhan: And so how do we actually incorporate patient experience, their ability to be and then health centers that may not be that that that close by in order to incorporate that into how we design actual products to use and to have these interventions.
• 42:40
  Srishti Gupta Narasimhan: So as we take this lens into our work, it might work in biotech, or your work and kind of thinking about a large portfolio of products. It's really about saying we have to keep always challenged the belief that some matters lives matter less, because that's that that's how we'll address equity issues.
• 42:56
  Vas Narasimhan: And maybe see me coming back to your question on the South Asian element of this.
• 42:57
  Vas Narasimhan: I mean, one of the striking things is, on the one hand, for instance, at Novartis, we have 10,000 people in the US our second largest center for Novartis as a company in Hyderabad. I mean, it is a huge, huge part of the success of our company. And yet the Indian pharmaceutical market in the Indian healthcare system is still very much a story of low income diseases. It's still very much the challenge of high rates of diseases like malaria. I mean, most of the Novartis donates the global supply of leprosy medicines, most of that goes to India. Interestingly, you know, what do you have a major global effort to tackle sickle cell disease, I didn't know this until we really got into producing the various medicines to give the basics for sickle cell disease, a hydroxyurea antibiotic, the highest number of sickle cell patients in the world is in India. And so there's a lot of things we can do to hopefully move the needle on that front.
• 43:54
  Vas Narasimhan: But certainly a lot to do.
• 43:58
  Simi Shah: I want to double click on that, because you obviously are the CEO of a company that has a presence in 140 countries. And to the point that both of you are making healthcare is very different when you're working in diverse market contexts. What have been your key learnings and takeaways about what it means to lead globally?
• 44:19
  Vas Narasimhan: I think, well, one, one of the first things you learn early on as a CEO is you control a lot less than people think you control. You know, you can set a direction, you can set a context so you can hopefully inspire. But man some of the things I've learned. It's I mean, I think these are basic principles that leaders have to always remember the number one job of a leader is to multiply the energy of your people. And you have to have the energy to give energy and the idea is can through your presence or the ideas you convey. And you multiply the energy of the people by making them extremely tied to the mission. Being a man I think you have to ultimately answer the question, why do we do the work over and over again?
• 45:04
  Vas Narasimhan: In generally that answer is across cultures, right?
• 45:08
  Vas Narasimhan: reimagining medicine to extend and improve patients lives, which is our Novartis story and a single sentence, that that motivates somebody from Australia, to South Africa, to Argentina to the US. And so you have to be able to articulate that vision, get people energized, and multiply the energy of the people. I think the second thing I learned about right leaning in such a big global organization is the consistency of the message, have simple, consistent messages. So I've learned like, we're not going to change the words, we're just going to keep saying the same thing. Because to get through 105,000 people in 140 countries takes years. And if you start getting bored and say, You know what, maybe, you know, maybe we switch from reimagined to reignite or whatever, then the whole company loses the plot, right? So I think I think you have to really stay consistent, simple messages consistently, over time. And then I mean, I think in the end, you have to pay a lot of attention to culture. And in the human element, I mean, we think about trying to get a humanistic culture at Novartis. In the end, Novartis is just a word, right?
• 46:15
  Vas Narasimhan: We're 100,000 people trying to do something good for the world.
• 46:18
  Vas Narasimhan: And you have to bind people together by a common set of beliefs and norms and values that hopefully carries the organization forward.
• 46:27
  Simi Shah: I love that. And I love the piece where for you semantics is not really semantics, it goes a long way.
• 46:34
  Simi Shah: Both of you, as we talked about earlier, have based your share of setbacks in your careers, and I'm curious what you've done to be able to cope with them and surmount them, and what practices you have, even on a daily basis that have helped push you through even the toughest of time.
• 46:50
  Srishti Gupta Narasimhan: I think a big one for me is I think I said it earlier, it's understanding what you actually control and what you don't control of, and doing a lot of yoga, and mindfulness, I have a daily yoga practice twice a day.
• 47:06
  Srishti Gupta Narasimhan: i It's like one of those, it's like a coping mechanism. It's a reminder of equanimity, like you want to approach things as they are, not as they should be, or as you want them to be. And when you can sort of step back and see things as they are, you really can appreciate, you know, your ability to control that, you know, you can't control the outcome. But what you can control is the energy you put in or the passion you put in for the curiosity, you approach that with the kindness that you approach that with. And I think that has been a big one for me over the years and really understanding you know, when things go well, and things don't go well, it's it's really just appreciating that you don't actually control the outcome at all.
• 47:45
  Vas Narasimhan: So I have a whole whole spiel on this. I want to take you through all of it. But you know that I really believe daily practices are super, super, super important. I learned from a coach long ago, and I continue to practice and continue to work with that coach, mindset, movement, nutrition and recovery. Mindset is stories, you tell yourself, so and you really, as Christie said, Get really outstanding at looking at your own thoughts and emotions and understanding how you can reframe whether that's meditation, whether that's yoga, whether that's breathing practices, but I think you can control your thoughts. And you can control how you perceive the world, if you can become the Get get that sort of awareness.
• 48:27
  Vas Narasimhan: Nutrition clearly has a huge impact on performance, energy.
• 48:31
  Vas Narasimhan: Movement, literally exercise is one of the highest correlations with happiness, no matter which study you look at in the long run. And then recovery. I'm a big believer in sleep, I think you have to sleep seven, eight hours, people have to take their vacations. Because in the end, your ability to have that energy to make the right decisions. All of those those those little things matter. And so I think that's that's a big part of it.
• 48:54
  Vas Narasimhan: I think the other thing we don't talk enough about is just asking for help. I mean, I have two coaches, and Srishti, who's my lead coach, I've had three coaches, right? Even my son, sigh, he's also a coach, right?
• 49:04
  Vas Narasimhan: If you need you need, you need to be able to ask for help.
• 49:08
  Vas Narasimhan: Because these are these are tough things that all of us have to go through. And I think when people go through those things alone, it's just so much so much harder. And I think humans are social beings are apes. We want to actually convey talk and work through those emotions. And I think that's something we can really encourage people to do a lot more of. Absolutely. I
• 49:30
  Simi Shah: love that. And I think what's interesting is it's clear the ways in which you both have helped each other through the course of your careers. And I'm curious, I mean, both of you have been rising and hustling for the better part of 25 years, but I imagine it hasn't been easy supporting each other through moves across the world career changes, while also building a family and supporting each other's individual aspirations. Can you speak a little bit about how you've done that, especially in a world where I think there's a bigger conversation Shouldn't that's about how can we do it all.
• 50:04
  Srishti Gupta Narasimhan: When I was in the first grade, my parents went to this like parent teacher conference, they went to school and they sat at my desk.
• 50:09
  Srishti Gupta Narasimhan: And then the next day, I remember like going to my desk and I opened up my desk, this wooden desk, and I had this note from my dad. And he's like, I'm so proud of how organized you are, I still I think I still have it. And I honestly like organization is one of those things that's helped us navigate, like, I'm hyper organized. We have a whiteboard in our kitchen, it feels like a team room for like McKinsey. So I am very hyper, it's like project management is like my superpower, which I think coupled with one of us is super powers, which is being able to say what's important and what's not important, because like, he can cut off half a list of things like when all of a sudden he's like, trivial. That's like that's not relevant right now.
• 50:49
  Srishti Gupta Narasimhan: It's helped us navigate a lot of this, like, sort of logistical complexity. And I mean, we talk a lot like we have we just anytime like something comes up, we just are like, we just talk it out, like we, you know, we're like we have to, we have to be in two different cities. And the kids have to be in another third city, like, what are we supposed to do? How do we work this out?
• 51:07
  Srishti Gupta Narasimhan: We kind of do that. I think the one thing I would say is, none of this was pre planned to, like we didn't know, like, this is how we were going to navigate any of this. Like we didn't even know the complexity our lives were gonna take at the time we got together. So I wouldn't get bogged down and kind of, you know, analysis paralysis of sort of saying, Okay, this is how we're going to prepare for these things. I think, for me, it's just been if you make a good decision, and your partner, and you can just trust that you'll be able to work it out, like every single time something comes up, because you're never going to prepare for every scenario.
• 51:39
  Vas Narasimhan: You know, things I would add is, look, I mean, I married my best friend. So that actually helps helps a lot, right to actually work through all all of all of these different topics. I also think we added a lot of shared shared values, I mean, that our parents and grandparents ultimately instilled in us that kids are paramount. So for Sian Kabir, we drop everything, whatever it is that we're doing. So that's our top always family top top top priority. Trustee says family Novartis, Novartis is usually sometimes said she doesn't like it when it's Novartis and of artists family sometimes. So she rightfully calls that out. But I think that that that that belief is really, really important, I think a common belief that it's about impact we're having on the world, what are the right things to do? Not a materialism or a kind of a attachment to material things. I mean, like we still live in that same house that I told you, we told you about earlier in the story. And we still like eat at the same like Anna's taqueria and like the has no fancy restaurants, the furnitures the same, everything is exactly the same. Except the desk isn't in the hallway.
• 52:48
  Vas Narasimhan: Exactly. The desk is not in the hallway anymore. Yeah, so I think staying grounded and having a belief that being grounded is ultimately the right thing to do. I think a lot of those values are important to have a common understanding of and then you can navigate all the ups and downs, twists and turns. But
• 53:05
  Simi Shah: I love that. I have one last question for you both.
• 53:08
  Simi Shah: But before I ask it, I'm going to turn it over to our audience for an audience q&a. So feel free to raise your hand if you have a question. We have one back there.
• 53:19
  Audience Member: truly inspirational speech today. So thank you so much for it. I wanted to ask you, it seems like in the world at large, at least in the United States, there are a lot of Indian CEOs that are there. And every time I hear many of them speak, it certainly appears that their grounding in the Bhagavad Gita comes up a lot. And their grounding in their traditions comes up a lot.
• 53:42
  Audience Member: So what advice would you have for youngsters, young Indian Americans growing up? How could they keep in touch with their culture? And should they as they go along? And that was one question. I'll ask a second one.
• 53:55
  Audience Member: I work for a nonprofit called Akel, which works when very rural, remote areas in India.
• 53:59
  Audience Member: I'm hearing that diabetes is becoming the next big thing in South Asia, I heard hypertension you're talking about? So again, in my own villages, I'm seeing it. I didn't know if you have suggestions on how we might go about tackling that. Thank you so much.
• 54:16
  Vas Narasimhan: Yeah, absolutely. So you know, the first question was the young people, oh, the young people. So yeah, you know, I think one of the things that's interesting about this day and age with all of the technology social media is, of course, it's harder to sometimes make, I think ancient bot and religion relevant. But if I if I really were to ask myself, what really helped me ground in whether it's in leadership or ways of thinking, it's mostly ancient texts, I mean, the books leadership, my two favorite leadership books are the Bhagavad Gita. And the doubt a Ching, I think are the two best leadership books. And they're both basically odes to servant leadership, which is well all we talk about now. At Harvard Business School's servant leadership, these books talked about it 3000 years ago, I think there is value in reading these stories, I think the hard part is we just have to as an AI need to do it better for my own sons is is to make it relevant for today's world? And what are you learning that's going to be very relevant for today's world, because there isn't necessarily that same connection to go into a temple every like, you know, the way I was raised. But I think it's so powerful. Still, the stories, the lessons are the same, it's just hard as human beings to follow them. I don't think the lessons have drifted. So I think it's just making that relevant, I would encourage people to read these books. And you can certainly quote that I think most of the leaders I know, who are of Indian origin, at the tops of these companies also are deeply grounded in these stories. I think on the on the diabetes front, this is a minute clearly a global challenge. And there's not an easy, easy solution, though, of course, be more and more therapeutics we can offer and now there's a new wave coming that also has a powerful impact on on obesity.
• 56:06
  Vas Narasimhan: But this is still grounded fundamentally in habits, you know, the the approach to food, the abundance now of food for a species that actually as a species, we were designed for scarcity. And now we're surrounded by abundance. And fundamentally, our metabolisms don't know what to do. And so of course, that leads to insulin resistance and all the consequences. I don't think there's an easy solution to this. I think what's clear, though, is early diagnosis and early intervention, no matter which disease, we talked about a hypertension, diabetes, lung cancer, breast cancer, we we have to just figure out how to diagnose earlier and intervene earlier because past a certain point, it's very, very cool.
• 56:52
  Audience Member 2: Thank you guys, for very riveting talk.
• 56:56
  Audience Member 2: This question is for either of you guys, given that both of you have different perspectives on global health and global equity.
• 57:03
  Audience Member 2: As someone who's currently in med school right now, I feel like a lot of the education we get is often US centric focused on the sort of modalities and diagnostic and therapeutic capabilities that we have here in the US. And we're very lucky to have you know, impressive biotech engines based here in the US. But we're in places where there's disease burden, like you mentioned, sickle cell in India, and a lot of the innovation is often resource intensive, or really cutting edge like biologics or gene therapies. How do you ensure that those populations get those treatments? And what do you think is the first step in sort of developing that infrastructure in areas of disease burden developing nations,
• 57:48
  Srishti Gupta Narasimhan: I mean, one of the things I would just start with is even in the United States, or even in Europe, 70% of health outcomes are structural in society, or social determinants. So whether you work with the pollution and your access to food or access to safe spaces to exercise your jobs, to I think even in the United States, we're struggling in medical education, to help students understand or medical professionals to understand what is the breadth of actual intervention required to achieve health outcomes in your, in your, in your local patient populations. And a lot of people are is very divided discussion.
• 58:24
  Srishti Gupta Narasimhan: A lot of people say you go to med school for four years you do a residency, you're not there to make sure your patient has heat that needs to be somebody else.
• 58:34
  Srishti Gupta Narasimhan: But without that heat, or without access to food, your patients are not going to get better even if you give them the best drugs in the world. And so this is only amplified as we move into more resource poor settings outside of the United States and outside of Europe, I think we have to figure out ways that we're structurally addressing these fundamental drivers of access to food, socio economic status, what is the GDP per capita in a country? These are the things that I think are going to elevate communities, but then instilling the right behaviors, I think around activity around consumption, are going to be really important. I know you guys have done Bernardus has done a lot on thinking about shortening the timeline for interventions.
• 59:17
  Vas Narasimhan: And the way I think the way we think about it is on the one hand, to your to your question, how do we reduce the costs and the barriers to getting the most technologically advanced therapeutics, but at the same time, how do we just keep raising the base of kind of just the basics that are in place? So let me use sickle cell as an example. We're actually here at number on alongside the monoclonal antibody, we have programs looking at CRISPR based therapeutics to tackle sickle cell disease as well as fetal hemoglobin based technologies.
• 59:50
  Vas Narasimhan: And do we wanted to do something to tackle sickle cell in Africa five, six years ago, actually, when I first started as CEO, then when we went on the ground, we realized for First, that there isn't good newborn screening in place like the newborn screening is just non existent, despite there being millions of children with sickle cell disease on the continent.
• 1:00:10
  Vas Narasimhan: So we started with newborn screening, we got newborn screening up in Ghana. Now we've got newborn screening up across six different countries. And interestingly, nobody else was working on it. We had to sit there and just go country by country on newborn screening.
• 1:00:21
  Vas Narasimhan: Then we said, okay, very interesting. We have monoclonal antibodies and cell therapies.
• 1:00:27
  Vas Narasimhan: But what's the next step for these patients, it's access to antibiotics. We have Sandoz the largest antibiotics producer in the world. So we started to supply antibiotic. And the next therapy is hydroxyurea, it's not any of the fancy stuff, we actually made an agreement with a company in Italy to produce hydroxyurea at large scale at low costs. And then we made it available to all these countries, step by several raising this and at the same time, we have a partnership with the Gates Foundation to figure out how can you make CRISPR based cell therapies in vivo and extremely cheap? I don't know, John, if you're working on that project, or others, but it's a it's an interesting model to say, how can you take a cell therapy that normally requires huge infrastructure? And can you actually condense that down to actually make it inside of a person. And in each one of these cases, that's what we have to do, whether it's cancer, whether it's sickle cell disease, raise the bar on the basics, while still driving down the complexity of the high end. And hopefully, at some point in the next decades, we meet in the middle,
• 1:01:32
  Audience Member 3: back there.
• 1:01:32
  Audience Member 3: Thank you, both so much for a very inspiring conversation are for my cell phone, my wife, as we both raise two young kids, it's inspirational to see how how the both of you do it. So thank you for that. My question is, for us, particularly on how do you see the impact of the inflation Reduction Act impacting what Novartis is doing with this pipeline moving forward? And or do you see changes coming to that particular act? That might also impact what Novartis is doing in terms of medicinal development?
• 1:02:11
  Audience Member 3: Again, thank you both.
• 1:02:14
  Vas Narasimhan: I was gonna try to give it to you, but she's not gonna let me Yes, I live, obviously, a lot of the US public policy topics. And I mean, certainly the the inflation Reduction Act is going to have an impact on innovation as it currently stands. And that largely relates to how the price setting provisions in the act or are structured. But I mean, taking a step back and sort of thinking about what what is fair and right and appropriate in a biotech ecosystem. When you go back to the hatch Waxman act from the mid 1980s. And you look at the broad set of data. On average, biopharmaceutical companies have had between 13 and 15 years of exclusivity on a new invention, it roughly makes sense. If you think that we make a discovery, we wait a few years before we patented, then we have 20 years, and then it takes us seven years from that point in time of the patent to ultimately develop it, then you have 13 years left for a exclusivity on your invention, then it goes generic. So the provisions in the act where they say that after 13 years for biologics, we're gonna have some sort of generic cessation event is really meant to, I think, curb some of the abuses that have happened in the system. And I mean, while we don't love it, it's hard to argue with the logic there. The challenges on the small molecule provisions in the act where you reduce that down to nine years, it's just simply too short of time for us to be able to fully develop small molecules in areas of cancer or cardiovascular disease that are predominantly in the elderly. So what that incentive shift does, and I don't think that the the, there was enough of a discussion or understanding of how markets work, when you put in something like that systems like this quickly shift, right, we deprioritize products that will be within the crosshairs of those nine year provisions. And we prioritize things that will put us in the 13 year provision, right. That's just the nature of this. So I'm hopeful that in the next five years, we can get that nine to 13 directed. The sad part is in the meantime, I think many good medicines will get delayed or deprioritize. In the absence of having certainty on how this this whole thing evolves.
• 1:04:26
  Simi Shah: Maybe someone on the bleachers.
• 1:04:28
  Audience Member 4: Thank you so much for an inspiring talk. And as an Novartis employee, I'm very honored to be part of a company that really reimagined medicine. And I'm very excited to know that we're having therapeutics be more accessible to these communities. At the same time, there's also a lot of mistrust with communities that don't understand the science, although new innovation of the technologies and platforms and modalities of this new therapeutics, so how do we bridge the new up and coming technologies to really make more accessible at the same time, make sure it's safe and effective this community They might not understand the exact science of this.
• 1:05:04
  Srishti Gupta Narasimhan: Yeah, I mean, it's such a good question. And I think one of the things, even moving back into therapeutic availability is clinical trial diversity. And we really see mistrust in communities when it comes to participation in clinical trials. And not all that some of that is just is mistrust. But there's actually very pragmatic aspects to clinical trial, the lack of diversity in clinical trials, patient populations, there's data that shows that patients are actually not in touch with a physician who's close enough to a clinical trial, and especially in underrepresented in patients of color. Their physicians, they often go to physicians of color, and those physicians are not actually close enough to clinical trials to enroll their patients into clinical trials.
• 1:05:47
  Srishti Gupta Narasimhan: So this, it starts a chain of events where you kind of perpetuate mistrust in certain communities, because they're not part of the innovation of it.
• 1:05:57
  Srishti Gupta Narasimhan: They're they're not knowledgeable about, you know, why this product? Or why this thing? Or where's this going? Or why is this different? And that even goes back to physicians, diversity in medical schools, I think is going to help a lot. I think there's a lot of initiatives on thinking about how do we, how do we ensure that there we have diversity in schools, and that we actually talk about clinical child participation with with with physicians, regardless of you know, who or what they're graduating with, or what they're doing, and then trying to increase the amount of community involvement and trial design and trial participation, I think we'll start to start the level of of increasing some of the trust so that therapeutics can be available. But maybe you want to add that,
• 1:06:37
  Vas Narasimhan: I would just build it on what she said and add from a bigger picture kind of narrative of what we're seeing in the loss of trust in science and how it's so important that we tackle that.
• 1:06:47
  Vas Narasimhan: Well, I mean, one of my favorite books is a book called enlightenment now by Steven Pinker, which really talks about how over centuries, we dramatically improve human life on this planet, on almost every dimension based on science and science based innovations across the full range of human life.
• 1:07:05
  Vas Narasimhan: And actually, this moment in time is the best moment in time to ever be alive in the history of the species. But when you read the papers, or you hear our politicians, you wouldn't believe that right? You have this whole, you know, kind of bizarro world that's been created, that the world is ending and all these things and, and, of course, there's huge challenges, but the only way we're going to overcome them is by trust in science and trust in and knowledge, creation and curiosity. And so I think all of us have to just keep trying to fight for hopefully, the voice of scientists, the voice of science, I often sit in meetings, right? I just cannot believe the things that senior politicians say about vaccines.
• 1:07:45
  Vas Narasimhan: I mean, vaccines are simply the greatest public health intervention that humanity has ever created. Barnatan, maybe one of the greatest inventions we've ever created. And yet, they're talked about, like, there's some sort of evil conspiracy. And so we need to, we need to tackle this, I don't have a magic solution. But I think we just have to keep, as all of us in whatever communities are in, you know, building more trust in science and in scientists.
• 1:08:14
  Simi Shah: I think that's a great place to end our audience q&a. And as I said, I have one last question for you guys. You both started a momentous moment in your journeys, a stone's throw away from here at Vanderbilt Hall. And looking back at that younger version of yourselves. I'm curious. I mean, in some ways you guys are every Indian parents dream your Harvard educated physicians. And in other ways you've charted completely unconventional paths in health and education and beyond. Looking back at your younger selves, looking at your son, sigh who's here today? What advice would you give to that version of yourselves? I think
• 1:08:54
  Srishti Gupta Narasimhan: one big theme for me is careers tend to make sense in retrospect, they don't necessarily make sense forward looking. And so don't beat yourself up too much.
• 1:09:05
  Srishti Gupta Narasimhan: If you can't sort of connect the dots in the moment, they wind up connecting somehow, in some way.
• 1:09:08
  Srishti Gupta Narasimhan: Oh, that would be that would be my piece of advice.
• 1:09:16
  Vas Narasimhan: Yeah, I would look back I'm still the same advice sigh keeps giving me is to have more fun on this whole journey. Right. And, and it's, it's easy to get so caught up in in, you know, what you're going to do next, and the roles and the titles and the and all of the things and in the end, right, it's this this moment that matters. And the more you can live in that moment, and be happy in that moment, the more fulfilled you'll be. It's really hard to do that really, really hard to do that. But psych always calls me out on it, which I'm always grateful for. And, but that would be the advice, you know, have a lot more fun on the journey. For sure. It sounds
• 1:09:50
  Simi Shah: like you guys both have a lead coach in the house.
• 1:09:53
  Simi Shah: Honestly, I think I could dedicate an hour or two each of you. Thank you both so much for taking the time to share your wisdom Have an insights can we give them a round of applause?
• 1:10:12
  Simi Shah: Now, before we wrap up for the evening, there are a couple of people who I'd like to think who were instrumental in making today possible. Starting with the Novartis team, who's hosted us and put on this beautiful event, Vinny, who's been there walking alongside me helping make this event happen and come to life. To Kathleen Patrick Conrad, Chris Ihar. John, Daniel, thank you all so much.
• 1:10:38
  Simi Shah: This literally event would not have happened without all of you. And I'm so grateful to have met you through this process.
• 1:10:44
  Simi Shah: And I think it speaks to the talent you guys are cultivating here. To all the friends family who've come from a far side so awesome to be joined by your son and I know we're missing could beer. My dad also flew in for this event, which is really exciting, but to all the familiar faces and new ones, we're so happy to have you here.
• 1:11:08
  Simi Shah: And last but certainly not least, to shoot the in boss, for giving us the privilege to share your story and for the enthusiasm you've shown for South Asian trailblazers. Your journeys individually and together are incredible and so grateful to have the opportunity to share it with our community.
• 1:11:25
  Srishti Gupta Narasimhan: Thank you for inviting us. It's Thank you.
• 1:11:27
  Srishti Gupta Narasimhan: amazing what you're doing.
• 1:11:33
  Simi Shah: Thanks for joining us for today's episode. If you want to get new episodes great to your inbox, subscribe to our newsletter at SouthAsianTrailblazers.com And follow us at South Asian Trailblazers on Instagram, Facebook and LinkedIn.