Newly appointed CEO of one of the world’s largest pharmaceutical companies, he spent twelve hours stranded at Dublin Airport waiting for a Ryanair flight. He still tells the story of that afternoon.
The board meeting was in Dublin. When Vas Narasimhan was told that he would be the next CEO of Novartis, he stepped out to call his wife. She was in a meeting and hung up.
Then he went to the airport.
He had a Ryanair flight. It was delayed. Narasimhan ended up spending twelve hours there, newly appointed chief executive of a global pharmaceutical company and unable to tell many people what had just happened.
He still returns to that story. He likes it because, only a few hours after being given one of the most important jobs in his industry, he was sitting in an airport waiting for a low-cost flight to depart.
Narasimhan grew up a long way from Basel. His first language was Tamil. He was raised in Pittsburgh, when the city was still heavily shaped by the steel industry, and remembers the feeling of knowing perfectly well what something was called in one language but not knowing how to say it in the language spoken by his classmates.
His parents had come from small villages in southern India. His mother worked as a nuclear engineer at Westinghouse while raising three children. His father started at the bottom of an industrial company and eventually reached senior management. Narasimhan remembers him resigning, going back to school, earning another degree and starting again.
His mother had another way of insisting.
When they traveled to India, she would remind him that he had been given opportunities millions of people had never had and ask what he intended to do with them.
Another, much shorter phrase also came from home and is one he still uses: stay in the ring.
He studied medicine at Harvard, and for a while his career seemed headed in a very different direction. He worked with the Red Cross in Gambia, spent time in Kolkata with children living on the streets and in situations involving child labor, and took part in the first HIV treatment program in Botswana.
The trip to Kolkata was also the first one he took with the woman who would later become his wife. They had been dating for only three months.
It was while working in public health that he became interested in management. He saw excellent doctors end up leading teams because they were good at clinical work, even though nobody had ever taught them how to run an organization.
That was when he changed direction.
He spent less than two years at McKinsey. He arrived unable to read a balance sheet. He still describes that period as learning another language.
In 2005, he joined Novartis. Today he leads a company with more than 77,000 employees, operations in roughly 120 countries and medicines that reached more than 300 million patients in 2025. This year, he also joined Anthropic’s board of directors.
None of that was part of a plan.
Narasimhan says he only began imagining himself as a CEO about six months before he was offered the job. When the head of human resources told him he was among the candidates, he thought it was a joke.
He still saw himself as a doctor working on drug development.
One of the decisions that eventually pushed him upward had looked, at the time, like exactly the opposite.
In 2006, he asked to move to the vaccines division Novartis had just acquired. It was losing money and accounted for only about 2 percent of the group’s sales.
It was not where someone went to show that his career was advancing.
Narasimhan stayed for eight years.
In a much smaller unit, he ended up doing several things at once: clinical programs, development and commercial launches. There was less structure, fewer people and much more falling on each individual.
Before turning 32, he was already testifying before the United States Congress.
He was not there to receive an award.
During the H1N1 pandemic, Narasimhan had taken part in the negotiations that made Novartis one of the main vaccine suppliers to the U.S. government. They won the contracts.
Then they failed to meet the initial delivery commitments.
Narasimhan tells the story without trying to soften it. They had promised more than they could produce at that point, and the reputation of the entire company was exposed.
He had to explain it before Congress. He also had to explain it to his own bosses and during a call with the White House chief of staff.
Then he went to the plants.
He spoke with the teams, took part in meetings with operators and kept telling them that they could still deliver.
Eventually, they did.
Years later, when he became CEO, he did not have much time to settle in either.
During his first six months came the contract with Michael Cohen’s consulting firm, signed before Narasimhan took office; an SEC and Department of Justice investigation connected with Greece; and another investigation into business practices in Asia.
In 2019, an FDA investigation followed over manipulated data related to a gene therapy.
His first public reaction was to emphasize that those episodes had begun before he took over.
Today, he acknowledges that this was a mistake.
He had taken responsibility for the company. That included what he had decided himself, but also everything that was already there when he arrived.
Those months also left him with a particular way of handling pressure. He says an important part of the job at the top is preventing every problem from being transmitted intact to the rest of the organization.
If the CEO panics and sends all that anxiety down through the company, he says, the organization starts functioning worse.
During the pandemic, he had to make a much more concrete and considerably more painful decision.
Novartis eliminated more than 10,000 jobs, more than 10 percent of its workforce.
For Narasimhan, it was not an abstract restructuring. He had grown professionally inside the company. He lived in Basel, a city where he even knew parents of his children’s schoolmates who worked for Novartis.
He spent a great deal of time explaining why he believed it had to be done.
The company would focus on innovative medicines, simplify its structure and abandon projects that no longer fit that strategy.
The results that followed ended up supporting the decision.
He avoids saying that this proves he was right. When he made the decision, he says, he did not know how it would turn out.
There is one part of his work he talks about in a much less restrained way.
He cries when a medicine makes it through phase III.
He knows projects that have been inside Novartis for ten years or more. He knows the teams. He knows how many treatments fail long before reaching that point.
So when one succeeds, he finds it difficult to see it simply as another clinical result.
He talks about treatments for breast cancer and prostate cancer. But there is one that affects him differently: the first new malaria medicine in twenty-five years.
Narasimhan once sat in a hospital in Tanzania watching children die from malaria.
Novartis has distributed 1.2 billion doses of its antimalarial treatment.
When he has to decide where to allocate resources, he uses three questions.
The first is whether something fits the company’s mission. The second is whether it is consistent with commitments the company has already made. The third is usually the hardest: whether Novartis is really the right company to do it.
There may be an excellent medicine for a rare cancer that passes the first two tests but not the third.
In a company with around 60 billion dollars in revenue, that project may have better prospects inside a small biotechnology company.
And then someone has to tell that to the scientists who spent years working on it.
Outside the office, Narasimhan has worked with a coach for about fifteen years. He organizes much of his routine around four things: mindset, movement, nutrition and recovery.
He does not present it as a particularly sophisticated formula.
He says the difficult part is repeating the same things for years when almost none of them produces a visible change from one week to the next.
His wife also runs a pharmaceutical company and has four Harvard degrees. Narasimhan suspects they may be the only married couple running two public companies.
When she took on her role, the organization of their home changed and he had to learn to take greater responsibility for their children.
Both are now entering university.
He has far fewer answers about what he will do after Novartis.
He says the job requires giving 200 or 300 percent and that he does not know when the moment will come when he no longer wants to do it that way.
He can talk for hours about mistakes, decisions, vaccines, plants, layoffs and medicines.
When he is asked what comes next, he has no prepared anecdote.
