March 11, 2021
Gary Bisbee 0:05
Healthcare leadership is hard work, but what if you could learn from the most brilliant and influential minds in healthcare and beyond? What would you ask them? Would you ask about politics, policy, or maybe leadership? On The Gary Bisbee Show I’ll do just that. You’ll hear from healthcare’s most successful leaders and those experts who they listen to, as together we’ll explore how the healthcare economy is transforming.
Alex Gorsky is here. Alex is the Chairman and CEO of Johnson & Johnson. We’re all familiar with brands like Band-Aids and Tylenol, of course. These products are found in Johnson & Johnson’s consumer product division, which sits alongside J&J’s pharmaceutical business and medical device business. Of course, J&J made international news 8 days ago with its vaccine as it received emergency use authorization from the FDA. It’s already shipped millions of doses. Alex is only the 7th CEO and J&J’s 135 year history. He’s a West Point graduate and a Wharton MBA, who during his 8 years at the helm, has led J&J to become the most valuable healthcare company in the world, with market capitalization of around $400 billion. Alex, we’re pleased to have you at this microphone for the second time, and congratulations to you and your team for a dramatic accomplishment. Welcome.
Alex Gorsky 1:32
Well, Gary, thank you very much for having me.
Gary Bisbee 1:34
Good to have you for sure. We were joking a little bit before, Alex, I have no idea how many interviews you’ve done in the last 8 days, but we do appreciate your being here with us for sure. Why don’t we dig right in. We’ll cover all the facts on the vaccines and then end up with a bit about your background and leadership. But first, every time you and I chat, you bring up the Johnson & Johnson credo. And I think that it’d be a good place to start here, given the magnitude of the job that you’ve done with vaccines and how you think about the credo and how that plays into the massive job that you’ve done here.
Alex Gorsky 2:13
Gary, thanks, again, for having me. And you’re right, I think it would be hard to cover the topics that you’re talking about whether it be the pandemic, our approach with the vaccine, what we as a company have been doing scientifically, operationally without really starting with our credo. And I have to believe that General Robert Wood Johnson, the son of our founder, who actually wrote our credo more than 75 years ago would be incredibly proud of the way the organization has stepped up at this really important moment to discover, to develop and literally, as we’re speaking, to engineer and distribute vaccines to people all around the world. And look, I think in many ways, it’s the inspiration that all of our colleagues at Johnson & Johnson, let alone the leadership team take from our credo that really provided a catalyst for what we’re doing. And it always starts with patients and consumers, the mothers and the fathers and the doctors and the nurses that depend on our products, in this case, really needing something. Knowing that, my gosh, we’ve never been in a situation where around the world more than 250 million people have been impacted. And unfortunately, more than half a million here in the United States have passed, two and a half million around the world. And so clearly, that kind of unmet need. And it was about taking care of our employees through a time when our employees couldn’t come to work. About 30% of them continue to do that, but how do you take care of them and their families and enable them to work and support them? Certainly for the communities that we live in workaround, many of whom have really been impacted by this, especially communities of color – Black, African American, Hispanic, have been disproportionately hit by this disease in a really significant way. What else can and should we be doing? And so it’s really with that mindset, that purpose, that sense of doing something bigger than ourselves, I think has been incredibly motivational to us as we’ve navigated our way through as we continue to do right to today.
Gary Bisbee 4:14
Well, let’s build on that, Alex. We like to focus on key decisions in this show. And there were a number of them, I’m sure, that you and the team made. But let’s think about research initially. What were the key decisions that you needed to make with the initial decisions around research and how you were going to proceed?
Alex Gorsky 4:34
I’m incredibly proud, not only of our company but of the entire biopharmaceutical industry for the way that we’ve been able to respond at this particular point in time. But had it not been for literally decades of investment, hundreds of billions of dollars in research and development and discovery on many of these platforms, we would never have been able to accomplish what we’ve been able to do. And as I reflect back on it, gosh, the very first time we heard, I think back in late January/early February of 2020 that our scientists had taken some of the genomic sequencing information and within a matter of weeks, they were applying it to a vaccine platform that we had really invested in for more than a decade and some areas had not gone as anticipated, other areas had gone well, for example, in Ebola and HIV in Africa. But it’s so often the case, rather than ask for permission, they decided they would beg for forgiveness and they took their own initiative, took that information, developed about a dozen different, what we called constructs where different versions of this vector vaccine, where we would actually take a common flu or cold virus and then insert a snippet of the COVID-19 and that’s what would stimulate your body to begin producing antibodies to protect itself. And getting the right balance of characteristics on this particular vector that could maximize its safety, its efficacy, its producibility. Also finding just the right dose so that we could do this in a single dose, all those components, and when they selected our final candidate, that’s really when things began in earnest regarding our clinical trial program.
Gary Bisbee 6:16
So how did you mount the clinical trials so quickly? It seems amazing to me. How many people were in the trial or maybe the trial is still going on? How many people are in the trial, Alex?
Alex Gorsky 6:28
The initial preclinical work, of course, was done in test tubes in animal models. That gave us the confidence based upon the results that we were seeing to go into our phase 1 and 2A trial, which was approximately 1,000 patients. We corroborated a lot of that early evidence. And then it was about in September of this year that we launched our phase 3 trial that was originally projected to take 60,000 patients. But because of the high rate of incidence of the disease and the dynamic that we were observing and experiencing, we ended up closing it at about 45,000 patients. And, you’re right, the trial is still ongoing. We’re still tracking. But all in all, we had 45,000 patients. It was a global trial – about 45% were in the United States, about 40% were in Latin America, and about 15% were in South Africa. And of course, why that’s so important is because not only was this during the time when the virus was spiking in terms of incidence rate which has an impact on your trial, but it was also in the areas where, arguably, the most challenging, the most virulent and persistent mutations and variants were occurring in South Africa and Latin America. It’s a very large, robust data set at a very unique time and in very important regions of the world.
Gary Bisbee 7:44
Well, why don’t we have you profile the J&J vaccine right now. You touched on it in terms of the trial and located in South Africa and Brazil, two of those variants are very challenging. So it’s amazing that the vaccine was highly rated as it is. But why don’t you profile the vaccine for us in terms of safety and efficacy?
Alex Gorsky 8:06
Sure. Well, look, when our database was finally revealed, we saw a few really important things. First, a very safe vaccine. And remember, this has been used in almost 200,000 patients previously with Ebola, with HIV, among young and old patients with significant numbers of comorbidities. And what we saw in this particular COVID-19 database was a very similar profile. I mean, yes, you see some local irritation. You can see about 8 to 9% of the patients experience some type of belays, flu-like symptoms upon administration, but they were generally light and transient and could be addressed by taking ibuprofen or acetaminophen through that period. And we saw very few serious reactions that would give any kind of a signal outside of that expected in broad use vaccines. Next, when it came to efficacy. Here too, we were really pleased to see the results. I think the most important figures are that we saw 80 plus percent effectiveness rates in severe disease, 66% overall, but in severe cases where patients are experiencing multiple symptoms, we saw over an 80% response rate. And very importantly, if you look deeper at the data, what you see is it’s worked 100% of the time thus far in keeping patients out of the hospital or from dying, which of course are the two most significant issues one would ask is, “If I’m going to be exposed, am I going to go to the hospital or am I going to die?” And we could answer that very definitively based upon the data that we’ve been able to gather this far. And remember, and we’re getting that kind of response on a single dose. I mentioned this was also against the South African strain, the first large database against the South African strain, also against the Latin America, that northern Brazilian strain, and even with those factors taken into consideration, you’re seeing very consistent and very continuous results with the data that I just mentioned.
Gary Bisbee 10:05
Alex, is there any way to tell how long the vaccine will be effective before some kind of booster is needed?
Alex Gorsky 10:12
Based upon our previous utilization, we’re cautiously optimistic that this has good durability, good patency over some time. And I believe the trials thus far have gathered information out to about 80 days, 80 plus or minus days. And through that, we’ve seen a nice increase in the level of not only antibodies, but T cell/B cell response, which of course, is the more durable response, which are very important. But we’re going to continue to monitor these for months going forward.
Gary Bisbee 10:40
I mean, it’s a sense that we may be in a situation where we’ll need an annual shot like the flu shot? Is that something that’s being considered?
Alex Gorsky 10:50
I think it’s gonna depend on what happens with the virus. There’s a couple schools of thought out there. One of the schools is that this virus could continue to mutate, which would require a booster shot of sorts, potentially, to provide comprehensive protection going forward, which, by the way, all the companies are already working on boosters. There’s another school of thought that would suggest that perhaps the virus has achieved its fittest form, which would suggest it would not dramatically mutate or if it does mutate, those mutations would not affect the fundamental machinery, such that it would produce an additional threat. And if that’s, in fact, the case, once we vaccinate a high number of patients, you’ll just see the number of cases dropped precipitously. I think only time will tell. I’ve heard scientists describe both counts very thoughtfully, cogently, and based on, upon data. But I think it’s something we’re gonna have to watch, but we’re going to be prepared. Again, we’re already taking a look at, “What if we gave an additional shot?” We’re taking a look at data suggests. Should we be developing a booster for a next variant? We’ve been caught off guard with this virus and we want to do everything so we’re prepared for each different scenario.
Gary Bisbee 11:57
Yeah, that’s really a key point. So with the apparatus that you’ve put together to do the research and the trials and so on, if we come up with another virus, is it likely that you’ll be able to be more responsive more quickly, or perhaps at less cost?
Alex Gorsky 12:16
I think we will. We’re learning a lot about these platforms. We’re already working with regulators to be able to take an appropriate yet accelerated pathway for the booster and for new mutations. And of course, we will have built up the manufacturing capacity in a much more significant way. The fact that all of the companies are at the point now where we’re producing hundreds of millions of vaccines, Gary, that’s never been done in history before. It’s one thing to discover and to develop and to do the clinical trials on these vaccines, but in parallel, to be ramping up production. And you have to remember, this is fundamental biology and chemistry and engineering where you’re literally growing these proteins in these cells and then you’re having to put them into vials in a very sterile environment. And to be doing that at the rate and pace I don’t think has ever been done in history before. So it’s a comprehensive, it’s a, frankly, a remarkable undertaking.
Gary Bisbee 13:13
I’ve heard you talk about the fact that you have a manufacturing plant that was a parking lot, 9 or 10 months ago, is that true?
Alex Gorsky 13:20
That’s true. We’ve developed a very extensive, globally integrated network of more than 10 different hubs. And one of them in the United States, in particular, was literally a parking lot 11 months ago. And today, it’s one of the most advanced, high throughput biopharmaceutical manufacturing facilities in the world. And it’s taking a tremendous amount of dedication, good thinking, hard work, planning, execution. We’re really pleased, just this past couple of weeks to announce a partnership with Sanofi in Europe, that’s going to help us do some production, recently with Merck, that we’ve worked on with the United States government that we’re very excited about. And look, the overall level of partnership and collaboration that I’ve seen with our industry, again, has been another source of pride. Where, yes, we’re competitors, but in this case, there’s been information sharing, database sharing, real-time to do everything we can to accelerate and increase the insights, let alone the production of these vaccines. I’ve also seen similar levels of partnering with regulators, with other government stakeholders. And look, I hope some of these things we can actually continue in a post COVID environment, but it certainly gives me optimism about some of the ways we may work together in the future.
Gary Bisbee 14:39
Yeah, that would be terrific. There was a letter that Johnson & Johnson and other companies signed to address the vaccine distribution that it be global, that it be equal. What was the motivation behind that letter, Alex?
Alex Gorsky 14:54
There’s been a few issues that we’ve tried to address collectively as an industry giving the very unique challenge that this presents to the world. I think one early on was around data transparency and the rigor and the review of the regulatory process that all of us were committed to following. And unfortunately, we live in a very politicized world where every comment, every aspect, and look, I can understand. When we’re talking about developing a vaccine in an abbreviated period of time that could be administered to billions of people around the world, there should be a level of transparency and expectations around our data. But I was proud of the fact that we, again, collectively signed on to this commitment. And we’ve done the same thing when it comes to distribution. This is a global pandemic. And until we find a way to vaccinate, to treat people around the world, we run the risk of this virus continuing to be able to mutate and change, and in some ways, we’re only as strong as our weakest link. So getting strong global access to this and making sure, not only in terms of capacity but also in terms of the cost to the system. Then that’s why, again, we’re trying to do this on a not-for-profit basis so that price is not an obstacle, is not a roadblock to people around the world getting access to these important vaccines.
Gary Bisbee 16:19
Well, you’re to be commended on that point, Alex. Vaccine hesitancy is a long-standing issue for some. I’ve seen statistics on the flu vaccine that 50 or 60% of the people take it and I’ve also seen statistics even less than that. Any way to gauge what the percentage of people will take the J&J COVID vaccine and the other vaccines?
Alex Gorsky 16:45
I’m hopeful that, some of the current surveys that would suggest that there’s perhaps about 10% of the population that’s saying that they would never take a vaccine and perhaps another 10 to 20% of the population that wants to wait and see, to ensure that they’re as safe as their said, and and then you see usually somewhere about about 50 to 60% of the population saying that they would be willing to either take one right away or certainly they’re very open minded to it. And I think that population, that 20% of wait and see, I think, are the ones that we can likely influence. And look, that takes, as I mentioned earlier, transparency. Absolutely sharing the data, the information, with the public, with healthcare systems, with everyone. Two, it requires a lot of education and then making sure people understand all the research that’s gone behind these. And while, yes, it’s been accelerated, we haven’t compromised, we haven’t taken shortcuts when it comes to safety and efficacy. Next, I think in some ways, it will depend on getting people vaccinated. I think the more people see others vaccinated – their friends, their family members, they’re going to, I think, better understand the relationship between vaccinations and getting our lives back. And I think people can’t wait to hug their parents, they can’t wait to go see that game or go to the concert or just go out to eat and do those rituals of daily life that we took for granted. And again, I’d like to think optimistically that the more people see that, and the more and more people get vaccinated. The more vaccines we have available, the fewer guardrails that we’ll need to have in place regarding restrictions on age and other factors. I think we can get that number up when you combine that with the underlying infection rate. I think we then start making a major difference as we go through the second quarter and into the summer, particularly here in the United States and other parts of the developing world. I think beyond that, it will take longer, simply because, you know, getting vaccines out to the rest of the world. But I think that that starts here and now and educating, sharing, transparency.
Gary Bisbee 18:54
Well, you know, I spend a lot of time with the large health system CEOs and to a health system, they are really focused on education, so hopefully that’ll expand beyond just their own employees and medical staff. How did you work, Alex, with the health systems in the trial and distribution?
Alex Gorsky 19:15
Well, we wouldn’t be where we are if we didn’t have great partnerships with healthcare systems. And by the way, let me start by just giving a shout out to the tremendous job our healthcare systems have done. As someone who’s been in this industry and my wife’s a nurse, a sister, a niece who’s actually a nurse in one of the largest systems and was helping to direct traffic in and out, literally, during the very height of the pandemic. And the challenges that our hospital system faced at that time were daunting. And when you think about the way that our doctors and nurses and healthcare systems responded, and if you look at the improvement in morbidity and mortality that developed over months and protocols and the processes that were put in place, it was just a remarkable job. And while any single life being lost is one too many, the number of lives that were saved by the men and the women and the first responders in the hospital systems are listening to this, this was truly God’s work, and I just want to say thank you. Regarding the partnership, we’ve tried to partner all along. Early on, we were, in many cases, just trying to help get more masks, get more PPE out from some of our facilities or from some of our networks. We worked on ventilator splitters, very early on, when the numbers were particularly concerning on the number of ventilators that would be needed. We immediately began working on our library of existing therapeutics to say, “Look could some of our antivirals or other areas work on patients as a therapeutic?” And then of course, with our vaccines, we quickly partnered with them regarding our clinical trials. And that’s the only way we were able to get our trials done in the kind of timeframe that we’re talking about. It was because of the quality, the efficiency, the comprehensive approach that some of these centers, and of course, now we’re partnering with the United States government who ultimately distributes into these systems so the vaccines can actually be administered.
Gary Bisbee 21:10
Well, this has been a terrific review. Thank you, Alex. Let’s turn to your life a bit. What was your life like growing up?
Alex Gorsky 21:18
Well, Gary, it was pretty simple, but it was very fortunate. I was one of six children in a very middle class family, originally born in Kansas, in the Midwest and later moved to Michigan, my father’s job moved. And when I was growing up in Michigan, it was a town of only about 3500 people, kind of a small, rural community where people looked out after each other and supported one another. I went to a very small, public high school and was fortunate enough to be inspired along the way, much of it based upon my father was a Korean War veteran and continued to serve in the Army Reserve. And I was always very inspired about the possibility of going to West Point. And when I was in high school, I prepared for that and that had remained my goal. And I was fortunate to be able to attend and then went into the Army.
Gary Bisbee 22:06
Well, after your 6 years of service, did you join J&J at that point or was it a later point?
Alex Gorsky 22:13
Yes I did. I’d served my 6 years. I spent time in Europe as well as in the United States and trained in other places in the world. And when I got out, I went to work directly for Johnson & Johnson as a sales representative.
Gary Bisbee 22:24
Was that because of healthcare or just because Johnson & was a terrific company?
Alex Gorsky 22:29
All the above. I was really inspired by the company, by the credo, by a purpose driven company. At that point in time, I’d really only worked for the United States government in the Army and had that kind of duty on our country, esprit, so joining a company that I felt had a purpose and a set of principles was very important to me. I was really attracted to healthcare. Earlier on I had reflected on the possibility of med school in the future, ended up taking a different path, but that was an area that I was attracted to intuitively, but also was inspired by some of the technology, as well as the idea of actually being able to help patients and consumers. And clearly being able to join a company like Johnson & Johnson. They had such a great track record of hiring and training and development and career opportunities. You know, all those things made it a very enticing career choice for me.
Gary Bisbee 23:21
Now you’re quite a fitness buff. I’ve talked to you many times about that. And you’re a proponent among CEOs and executives for equating fitness and leadership. How do you view that, Alex? Why is it so important that good leaders be fit?
Alex Gorsky 23:39
I just think it’s incumbent upon all of us to take care of this great gift that we have in our health. And the healthier we can be in taking care of ourselves, the best we can be in showing up regardless of whatever it is that we’re doing. If you just look at the things that impact us long term and our health, so much of them are influenced by the way we live our lives, our daily rituals. And so by just taking a few moments every day and acting and reflecting about, how do we keep moving? How do we, how do we better manage our diets? How do we better manage our sleep? How do we think about stress? How do we limit other activities – drinking, smoking that can have a significant impact? And when we achieve the right balance in all those things, it’s not just about running a marathon or doing extraordinary physical feats, but I think it’s a holistic combination of those things that can make a huge difference in our overall health. And I’m just convinced, and I think the data shows that when we’re healthy, we can go and take care of ourselves, we can be our best not only for us, but for our families, for our careers, for our lives.
Gary Bisbee 24:48
We’ve all been in a crisis situation over the last year or so. How do you think about characteristics of a leader in a crisis, Alex? What are the most important characteristics of a leader in a crisis?
Alex Gorsky 25:01
Well, Gary, a few things. I’ve always tried to take the approach as a leader is that when things are going really, really fast, you have to kind of slow things down. And if things are really going really, really slow, sometimes you need to speed them up. And what I’ve found in a crisis is making sure, one, that you remain focused on the data and the facts that are occurring. And that can be really difficult when things are hitting you real time. I think number two, have a diverse team around you, because we can all get tunnel vision. And if you don’t have people that bring different perspectives, that aren’t afraid to challenge, that are going to look at things in a different way, you can quickly find yourself going down the wrong path and so having, again, a diverse group of leaders around you, and making sure you’re setting a culture where they can challenge openly and disagree with you is very, very important. And last but not least, I think it’s about making sure that you deal with the really challenging reality at hand, but you also create a vision where there is light at the end of the tunnel, and you actually put together a plan then that’s going to work towards that. And you support, you empower, you do what is necessary for your team to keep them aligned until, you know, you’re ultimately willing to accomplish that goal and get through those periods. And there’s always going to be ups and downs. You know, these things are rarely a linear shot, there are twists and turns and things that come up that have been unanticipated. But I think when you create a culture of trust, of competence, of belief, of purpose, above and beyond, I think those are the kinds of things that can get you through even the most challenging of periods.
Gary Bisbee 26:40
Alex, this has been a terrific interview. We appreciate your time. I have one other question if I could ask it. And that is, Johnson & Johnson is a true diversified business model with your three pillars. Can you share with us how that fits in with a crisis like this and all the work that you did to develop the vaccine? Why is it important to have a diversified business model?
Alex Gorsky 27:04
At a time like this, I mean, ultimately, the world needs a comprehensive approach to get through it. And I think by having an understanding, our pharmaceutical business, our medical device and technology business, our consumer business, it gives us a really unique vantage point and aperture through which to look at not only the problem, the challenge, but also potential solutions. And so look, we remain committed to that kind of diverse, holistic approach. We think that it not only uniquely positions us today, but even more importantly for tomorrow, where we may see sciences and technologies come together in very unique, common tutorial ways. So whether it’s strategically from a technology standpoint, the financial stability that it provides, having that kind of broad based diversified approach has been a major reason for our success through decades and generations.
Gary Bisbee 27:56
Alex, thanks again for your time. We all appreciate what you and Johnson & Johnson have done for not only the United States, but the world. And all of us in health care for sure, so thanks again. Keep up the great work. We appreciate it.
Alex Gorsky 28:11
Gary, thank you very much and stay safe, stay healthy, and look, by doing the right thing here, by getting vaccinated, keeping our guard up over these coming weeks and months, we’ll get through this and be stronger on the other side. Thank you, everybody.
Gary Bisbee 28:24
New episodes will debut every Thursday. Join me in conversations to gain advice and wisdom from CEOs, presidents, and experts. Healthcare leadership is hard work, but it becomes more manageable as we learn from the remarkable lives and careers of our guests. I’ll see you there.