Podcast Summary: Novartis CEO Vasant Narasimhan on Transforming a 250-Year-Old Company
Podcast: The a16z Show
Host: Andreessen Horowitz (Jorge, General Partner)
Guest: Vasant Narasimhan, CEO of Novartis
Date: February 16, 2026
Episode Overview
This episode dives deep with Vasant Narasimhan, CEO of Novartis, about the dramatic transformation of the 250-year-old pharma giant into a “pure play” medicines company. Narasimhan discusses the strategic decisions to focus Novartis’s mission, advancements and challenges in platform technologies like cell/gene therapy, RNA medicines, and radioligand therapies, the impact of AI, global competition (especially from China), and the evolving pharmaceutical innovation landscape. The conversation is rich with insights into leadership, business model innovation, healthcare access, and the realities of global biotech.
Key Discussion Points & Insights
1. Novartis: From Conglomerate to Pure Play Medicines Company
- History & Scale: Novartis spans over 250 years, operating in 100+ countries, reaching 300 million patients annually, with ~$55B in sales and a near $300B market cap.
- Transformation: Narasimhan led a strategic transformation by spinning off three public companies and focusing purely on pharmaceuticals (oncology, immunology, neuroscience, cardiorenal).
- “We unlocked almost $180 billion of value. Took this company that was a conglomerate and we turned it into four companies.” (Vasant Narasimhan, 00:00)
- Rationale:
- Core strength is in “discovering and developing novel medicines.”
- Diversification led to “strategic misallocation of capital.”
- Investors prefer companies focus and let them diversify if needed.
“We were often forced to say we have to suboptimize the pharmaceutical business to invest in the other businesses... but it was never really the core of kind of who we are.”
(Vasant Narasimhan, 06:08)
2. Defining Platform Technologies at Novartis (09:20–23:18)
a) Cell & Gene Therapies
- Breakthroughs and Challenges:
- Led in licensed cell and gene therapies (Zolgensma for SMA).
- Successes in B-cell cancers, now pivoting to immunology/autoimmune diseases.
- Notable story: Bedridden autoimmune patient walks again post-cell therapy (12:04).
- Manufacturing Advances:
- Manufacturing times dropping, costs managed.
- Cell therapy impact shifting unexpectedly from cancer to immunology.
“You can rewind a disease or completely, in some cases, almost create a functional cure for patients... This is extraordinary.”
(Vasant Narasimhan, 10:48)
b) RNA Medicines
- siRNA Maturity:
- Small RNA molecules (siRNAs) can silence specific genes.
- Novartis’s PCSK9 siRNA drug enables once-every-six-month dosing for cholesterol (success, especially in China).
- The next frontier: targeting tissues beyond the liver (muscle, CNS, kidney).
- Delivery is Key:
- Advances in “synthetic capsid design,” antibody conjugation, lipid conjugation, critical for targeted delivery.
“I personally think we’re going to be at a place within the next five to seven years where you could get a single injection...”
(Vasant Narasimhan, 15:27)
c) Radioligand Therapies
- Origin: Spinout from CERN; concept is to deliver radioactivity directly to cancer cells.
- Commercial Success: Drugs for prostate cancer ($2B+ sales) and neuroendocrine tumors.
- Supply Chain Complexity: Radioactive drugs have a tight window from factory to patient.
- Potential: Platformized for certain isotopes; could target more cancers as new targets/isotopes are validated.
“Once you actually build that infrastructure...for the given isotope...I think it is platformized.”
(Vasant Narasimhan, 22:29)
3. Patient-Centricity, Modality Choice, and Product Design (24:21–26:55)
- Segmenting patients by preference (e.g., injection vs. oral medications).
- Cultural/geographical differences in adoption (e.g., China’s rapid RNA medicine acceptance).
- Balancing efficacy, safety, and patient experience, especially in cancer treatments.
- “We’ve moved away from an era where it was all about efficacy at all costs... That’s a shift.” (Vasant, 25:15)
4. Artificial Intelligence in Pharma (26:55–36:45)
- 2026: A Tipping Point Year for AI: Pharma is partnering with AI-first startups, moving from promise to practical application.
- Business Model Innovations: Varied partnerships: platforms (e.g., Boltz Bio), pipeline collaborations, model licensing.
- “…we’re trying…to scale it now across the whole company. We have one of the highest numbers of AI licenses for Microsoft Copilot…” (Vasant, 34:41)
- Novartis’s Approach:
- AI as an “enabling technology” across the R&D chain, not (yet) a separate platform.
- Goal: Shorten drug development time, improve probability of success.
- Large-scale deployment via Palantir Foundry, Copilot, and custom agents.
- Real-world automations: prepping financials, drafting company communications in Vasant’s voice, C-suite decision support tools.
“These are all things we did like six years ago…now I have, you know, 3,000 scientists on the Foundry platform…That used to take six months and now it takes minutes.”
(Vasant Narasimhan, 34:41)
5. Global Industry Dynamics: China’s Rising Biotech Power (39:04–44:41)
- China’s biotech industry catches up:
- More/faster clinical trials via nimble regulatory environment (NMPA).
- US/Europe must accelerate trial processes to stay competitive.
- “China had more licensing or exits than US biotech or somewhere close to that.” (Vasant, 39:04)
- US advantage: NIH ecosystem, translational research.
- No visible large-scale response yet from US biotech to China’s rise; sees risk in attempting to block China vs. focusing on competing and innovating.
“Better to actually, you know...use it because it was discovered in Shanghai.”
(Vasant Narasimhan, 43:57)
6. Access, Cost, and Innovative Reimbursement (44:41–49:36)
- Most US prescriptions are generic, keeping costs low post-patent.
- “One-time” (curative) gene therapies challenge payment models—Zolgensma ($2M+) is covered in 38+ countries, justified by cost savings over a lifetime.
- Value-based care and installment reimbursement models still not widely adopted.
- Preventive therapies present even greater system challenges: long trials, uncertain endpoints, large populations to treat—to realize population health gains, systems must evolve (including how trials, endpoints, and payments operate).
7. Leadership & Culture: “Inspired, Curious, Unbossed” (49:36–51:43)
- Culture change has been central: “When your organization is always talking about what is the culture we want to have… the culture kind of naturally improves.”
- Measurable engagement, innovation, and performance gains following cultural evolution.
8. Entrepreneurial Advice and Industry Gaps (51:43–56:42)
- Solvable Friction: Case report forms and trial documentation: enormous, persistent inefficiency in clinical trials due to data silos and outdated processes—a “boring” but high-impact problem for startups to tackle.
- “It sounds so dull, but it affects every single trial…” (Vasant, 52:14)
- Big Need: Early biomarker-based prevention—huge scope for startups/tools to predict and intervene early.
- Startup Advice:
- “Intellectual honesty” on where drugs fit in the treatment landscape
- “Do the killer experiments” to validate targets/ideas preclinically
- Invest early in CMC (Chemical, Manufacturing, and Controls) capabilities—the #1 often-neglected issue that kills deals.
- “Should we just create like a CMC boot camp for biotech startups…so they at least know the right questions to ask?” (Vasant, 55:53)
Notable Quotes and Memorable Moments
| Timestamp | Speaker | Quote | |:----------|:--------|:------| | 00:00 | Vasant Narasimhan | “We unlocked almost $180 billion of value. Took this company that was a conglomerate and we turned it into four companies.” | | 06:08 | Vasant Narasimhan | “We were often forced to say we have to suboptimize the pharmaceutical business to invest in the other businesses...” | | 12:04 | Vasant Narasimhan | “One of our sentinel patients was an individual in bed all the time, not able to walk his children to school. Receives our cell therapy...six months later, no sign of disease.” | | 15:27 | Vasant Narasimhan | “We’re going to be at a place within the next five to seven years where you could get a single injection...” | | 22:29 | Vasant Narasimhan | “Once you actually build that infrastructure...I think it is platformized.” | | 25:15 | Vasant Narasimhan | “We’ve moved away from an era where it was all about efficacy at all costs...That’s a shift.” | | 34:41 | Vasant Narasimhan | “These are all things we did like six years ago…That used to take six months and now it takes minutes.” | | 39:04 | Vasant Narasimhan | “China had more licensing or exits than US biotech or somewhere close to that.” | | 43:57 | Vasant Narasimhan | “Better to actually, you know...use it because it was discovered in Shanghai.” | | 52:14 | Vasant Narasimhan | “It sounds so dull, but it affects every single trial…every time we do a clinical trial, the study nurse has to record…in the clinic 2026, and then has to input that into our source data...” | | 55:53 | Vasant Narasimhan | “Should we just create like a CMC boot camp for biotech startups…so they at least know the right questions to ask?” |
Important Segment Timestamps
- [00:00] – The scale and transformation of Novartis (Vasant’s opening)
- [04:24] – What is “pure play” in pharma—and why Novartis focused
- [10:48] – Cell & gene therapy’s potential and turning points
- [15:27] – RNA medicines: from science fiction to “mature platform”
- [20:24] – Radioligand therapy explained and scaled globally
- [24:21] – How Novartis matches modalities to patient needs
- [26:55] – The AI inflection point in pharma and Novartis’s system-wide deployment
- [39:04] – How China is shifting the global biotech power balance
- [44:41] – Challenges and progress in pharmaceutical pricing and access
- [49:36] – Driving culture change at scale: “inspired, curious, unbossed”
- [52:14] – Major unsolved problems ripe for health tech innovation
- [54:30] – Vasant's practical advice to biopharma entrepreneurs
Conclusion
This episode offers an in-depth look at the inside of a global health giant’s reinvention, the changing tides of drug discovery technology, and the pragmatic realities of running and transforming large organizations in a hyper-competitive, innovation-driven, and globalized industry. It’s a must-listen for anyone interested in the intersection of healthcare, big business, technology, and startup possibility.