This is not how Reshma Kewalramani envisioned spending her first day as Vertex CEO. The 47-year-old nephrologist should have been in a spacious window office on the 14th floor of the glassy Boston Seaport biotechnology headquarters, three rooms down from the past three years. There should be family photos on the desk, scientists in the labs below, and executives she knew and trusted teaching her about possible cures for sickle cell disease and diabetes.
Instead, on that bonfire day last spring, she sat at a makeshift desk in the dimly lit basement of her house outside of Boston, a bivouac chosen because it was closest to the WiFi router. Her closest companion was Ferris Bueller’s smug face on the wall, and she spent the day jumping from zoom call to zoom call. She was less concerned about producing new drugs than about the safety of her employees and that the global supply chain didn’t leave cystic fibrosis patients without access to the Vertex pills that had changed their lives. It was April 1, 2020.
“This is not what I thought were the top two priorities,” she tells me. “The safety of our people? You take it for granted. “
The pandemic hit Vertex at the worst possible time. For the past decade, CEO Jeffrey Leiden, a cheerful but smart and authoritative figure, had driven the development of these CF drugs and made the most common fatal genetic disease in the US and Europe a treatable condition for 90% of patients. In the process, they had moved from a $ 6 billion company to a $ 60 billion company and had won the rare collective awe of corporations, medical professionals, and patients. “I’m shouting it from the rooftops,” says Bob Coughlin, former CEO of the MassBio industrial group, whose 19-year-old son has CF. “He’s a whole new person, I’m more grateful than I’ve ever been in my whole damned life.”
Just as Leiden passed the torch, the whole world collapsed. It was a devastating process for Kewalramani, who as CEO had already been an unlikely choice. The heads of large biotech companies are almost entirely business people, executives whose main job is to sell the drugs that have already been developed and to find other companies to purchase them. If they have MDs, they also have an MBA or 20 years of sales experience. Historically, they were all men.
Kewalramani was a straightforward, sociable health care professional trained in Boston’s most prestigious hospitals and experimenting with Amgen for 12 years, but with little experience in the biotechnology business. During the last three years while leading Vertex’s medical team, she faced the Executive Committee at key moments explaining the results of studies she designed and conducted in sickle cells and cystic fibrosis.
“It came from the medical side, which was unique, ”said Terry McGuire, founder and general partner of Boston-based biotech VC Polaris Partners. “It speaks for their desire to really focus on what is going on in the clinic and for the patients.” In fact, Vertex had only considered physicians-scientists for the role. They had big plans for the role – for what they called Vertex 3.0. Although they had been known as CF companies for years, Leiden told anyone who wanted to listen that they didn’t just want to transform one disease: he planned to use the wasteful revenue from these pills to cure CF completely and either cure it or deface a hell of a lot of famous diseases: sickle cell disease, diabetes, muscular dystrophy and pain, among others.
It was as ambitious a plan as any biotechnology had ever come up with, spanning medical disciplines from hematology to nephrology and technologies from old-fashioned pills to new forms of CRISPR gene editing, and they needed someone with incontestable scientific skills to carry it out. If Kewalramani and her team can do this, they will change the face of medicine: not just for one rare disease, but for several and some less rare ones. They could also spark the same fierce global debates that followed Vertex’s CF drugs, as the company billed more than many countries thought possible. While less aggressive than its predecessor, Kewalramani is committed to maintaining the same pricing strategy going forward.
“We will do what we did in CF,” says Kewalramani, repeating a promise she repeatedly makes. “Again and again and again.” But first they would have to deal with Covid-19.
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