‘Our Chief Focus for Future Investments will be on
Increasing R&D Footprint Here’
We continue to
focus on product development... What we have done is design clinical trials in
India, which is a shift from where we were a year ago
Earlier this year, Vasant ‘Vas’ Narasimhan (42) was
named CEO of Novartis, the $50-billion Swiss pharmaceutical behemoth. An
American of Indian origin, Narasimhan is a Harvard Medical School-educated
physician and has deep experience in the development of breakthrough medicines.
Kymriah is one such cell-based therapy that recently
received the USFDA approval where Vas was closely involved. On a short trip to
Hyderabad, Narasimhan spoke to Vikas
Dandekar & CR Sukumar and covered a wide spectrum of issues — from
India’s ambitious healthcare programme to the direction of the US drug pricing
debate amid a firm pushback from President Donald Trump. Edited excerpts:
India is giving shape to the
largest health protection scheme with coverage for ten million families. How
does Novartis see this development?
We are trying to understand how all this will work
from the hospital settings and the outpatients setting. Overall, we continue to
invest and expand our sites here. On the new health insurance schemes, most of
the times we have seen that they increase patient access. That is good for
public health and also helps companies like ours. The biggest topic for us is
the role for innovative medicines and access to innovative medicines. How will
such a system evolve? For the population, it will be great to have preventive
care and care in the hospitals. There are questions but I am quite hopeful that
this will lead to an expansion of opportunities for companies like us.
Will you look at driving R&D
in India?
We have 8,000 associates in multiple locations in
India. Our chief focus for future investments will be on increasing our R&D
footprint here over time. Second is data and digital. I believe immensely in
data and digital. There is an explosion in terms of opportunities in data and
digital and there is a lot happening here in healthcare in data and digital. We
certainly would like to build capacity to leverage that opportunity in the
future. Third, we continue to see opportunities in business services in India,
which remains our hub.
In R&D, what exactly will
you look at doing?
We continue to focus on product development and that
includes running our operations for clinical trials. Now, what we have done is
actually design clinical trials here in India, which is a shift from where we
were about a year ago. We have teams here that are designing clinical trials
for our global programmes and for novel medicines in malaria and other major
diseases. We continue to focus on chemistry work and chemical capabilities.
What about doing full-fledged
drug discovery in India?
At some point, we would like to start looking at drug
discovery and there we are very cautious. We have scaled operations here — from
the drug development standpoint, India is our second largest centre in the
world.
What are your needs for the
discovery research centre?
Most of the times it has to be a cluster development
where we see universities, start-ups coming together with big companies and in
most places that we invest, we see a sustainable research cluster. We are still
waiting to see that fully evolve. The ecosystem is evolving very rapidly but
may be not at the same level as other countries in basic science and medicine.
Kymriah, the pioneering
cell-based therapy for cancer treatment, is being much talked about. Where do
things go from here for Novartis? The initial uptake of Kymriah is below the
expectations of analysts.
We are really looking at Kymriah as a five-year
journey. This is an extraordinary medicine and one-of-its-type approved in
children and provides patients who have no other option of treatment. It is a
science to take the cells out of the body and reprogramming them is really
remarkable; but it is also so new that it will take time for the hospitals to
be ready to take this on and manage such a complex therapy. From our side, we
need to scale up the operations. Overall, it is in line with the expectations
and we always knew that this will be a long-term strategy for cell therapy.
The important thing is as we go global, and we have
announced the addition of a manufacturing site in France, we will build the
infrastructure that also links us to all of these hospitals. We are focusing on
three areas — one is to invest in manufacturing and make it very efficient and
scale up; second, we are looking at expanding to more cancer types and we would
think of covering all B-cell cancers. My hope as a physician is to live in a
world where no patient should die from B-cell cancer. We believe there is a new
science emerging that will allow us to create new cell therapies with different
targets that cell therapies can attack, which we hope can apply to areas like
solid tumors and that could possibly be the next breakthrough.
Our mindset is for the long term, of a five-year
journey to get this to a blockbuster enterprise and that’s our overall goal.
Our aspiration is that this could be a significant part of the Novartis
portfolio.
The US has been at the centre of
most healthcare debates and lately President Trump has been giving a strong
pushback to price increases. How does Novartis see the future of drug pricing?
We as a company are very supportive to try and find a
sustainable approach for the US healthcare system. We have to find ways to
improve patient affordability and get the innovations to have a broad access. I
would like to think that we need value-based pricing and have things like
cost-effective research and have sustainable prices. We are watching very
carefully and discussing solutions with the US government and we have to see
how the coming months evolve as initiatives roll out.
Overall, the directions taken by the health
department is right and in many areas they are targeting different elements of
the system and seeing how we think of different classes of drugs and how we see
biosimilars and reduce patient costs at the pharmacy counter. All of these are
elements that are going to be important for a sustainable solution and I am
optimistic that will be seen in the coming months.
Prices of newly approved drugs
are moving steeply. Where does the value-based performance or
pay-for-performance debate go?
We have to keep in mind whether it is for a chronic
therapy or a one-time therapy. In the case of Kymriah, it is a one-time therapy
and it becomes cost effective…The second thing to see is how efficacious is the
therapy. In the case of Kymriah again, it has a 90% response rate, which is
very high. It is important for us to explain to patients and society that some
of these cell and gene therapies have an extraordinary level of efficacy — a
single infusion — and the patient does not need to be treated again. So that
will have a different price point than something that is chronically given
every single month or every single day for thirty years.
ET 21AUG18
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