Novartis CEO Vasant Narasimhan on Transforming a 250-Year-Old Company

What It Covers

Vasant Narasimhan, CEO of Novartis since 2018, details his transformation of the 250-year-old pharmaceutical conglomerate into a focused medicines company. He spun off three public companies, unlocking $180 billion in value, and repositioned Novartis around four disease areas and three platform technologies: cell/gene therapies, RNA medicines, and radioligand therapies.

Key Questions Answered

• •Portfolio transformation strategy: Narasimhan spun off consumer health (GSK joint venture), Alcon eye care, and Sandoz generics as standalone public companies over six years. This radical restructuring unlocked nearly $180 billion in value by eliminating capital misallocation across businesses with vastly different return profiles and allowing pure-play focus on novel medicine discovery where Novartis excels culturally and operationally.
• •Cell therapy renaissance in autoimmunity: Cell therapies initially focused on B-cell cancers with limited commercial success due to high costs. Breakthrough work by Georg Schett in Germany demonstrated these therapies can reset immune systems in autoimmune diseases. One patient went from bedridden to walking children to school within six months, showing near-functional cure potential. Novartis now runs four pivotal autoimmune studies with six early-stage programs.
• •RNA therapeutics as derisked platform: siRNA technology enables silencing specific proteins by targeting mRNA inside cells. Novartis developed PCSK9 siRNA for high cholesterol requiring dosing every six months, performing exceptionally well in China. Within five to seven years, single yearly injections could address multiple cardiovascular pathways simultaneously: HMG CoA reductase, PCSK9, and LP(a), creating transformative public health impact.
• •Radioligand therapy supply chain complexity: Radioligand therapies attach radioactive particles to drugs targeting cancer cells, delivering localized radiation. Novartis products for prostate cancer (PSMA target, over $2 billion sales) and neuroendocrine tumors require delivery within four to five days from factory to patient due to radioactive decay. Building this dedicated global supply chain took seven years but now achieves 99.9% on-time delivery.
• •China biotech competitive pressure: China now matches or exceeds US biotech in licensing deals and exits, driven by NMPA regulatory approval under one month for first-in-human studies versus much longer US timelines. Chinese integrated centers generate proof-of-concept data extremely fast. US biotech must accelerate through regulatory reform, streamlined IRB reviews, common trial contracts, and continued NIH funding to maintain competitive advantage.