Vertex CEO Reshma Kewalramani's rise to top of biotech industry

Sometimes, it’s the littlest things that can help us make the biggest decisions. Though she may not often admit it, Reshma Kewalramani’s journey to become the head of Vertex — Boston’s most valuable biotech — is thanks in part to her fear of mice.

Kewalramani is the daughter of immigrants from India who moved to Long Island, New York, when she was 11. Her father ran a garment and electronics shop in Manhattan, and she often spent time with him behind the counter, working with customers then counting up the cash in the evening.

She was intrigued by the daily happenings at the shop, but her parents wanted more for their high-achieving daughter. Kewalramani followed their urging, enrolling in a seven-year medical program at Boston University, where she envisioned a life for herself as a “triple threat” in the field: seeing patients, teaching, and conducting research.

That’s where the rodents came in.

Kewalramani was working as a transplant nephrologist studying kidney disease, grafting skin from one mouse to another to see if the mouse would reject or tolerate the transplant. For many scientists, working with lab rodents becomes second nature, but for Kewalramani, every encounter was excruciating. “I would stand over the cages sweating,” she recalls. “I devised all kinds of silly ways to get around my fear.”

Even more terrifying: She knew that if her lab experiments advanced, it would be rats, not mice, she’d be working on next.

In some ways, the rodents were a manifestation of a larger issue: Even though she’d become the triple threat she’d once envisioned, Kewalramani wasn’t happy.

She couldn’t articulate it, but now she realizes her work wasn’t fulfilling. “I wanted to make medicines for patients. That’s actually what I wanted to do,” she says. For her, that would mean being part of the drug industry.

Just as she was having second thoughts about her career path, a recruiter came calling from Amgen, a drug developer based outside Los Angeles. He was the son of a department chair at Brigham and Women’s Hospital, where Kewalramani had a fellowship, which made a major career pivot more conceivable. Kewalramani, her husband, and their 6-month-old twins moved to California in 2004. Even now, she’s struck by just how big a leap it was, considering her family and friends mostly lived on the East Coast.

The transplant took. Kewalramani thrived in biotech, advancing quickly through the ranks at Amgen. By 2017, she was vice president and head of the company’s US medical organization when an opportunity to join Vertex — and return to Boston — arose. Drawn to the company’s leadership team, made up of physician-scientists like her, the decision to relocate was much easier this time. In particular, she was attracted to Vertex’s willingness to go all-in when it came to making big decisions.

That mind-set quickly proved important when she arrived.

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At the time, Vertex was working on its next-generation treatment for cystic fibrosis. The company had developed an effective drug that helped about 4 percent of CF patients. Now it was carrying out a rather audacious plan: It intended to take two potential medicines all the way through Phase Three clinical development trials, with the understanding that it would ultimately take the best one to market.

Kewalramani arrived during the Phase Two trials, and learned that one medicine was already a clear front-runner. As the chief medical officer, she could help make the call to pull the resources from the other drug and go full-force into the more promising treatment. But she didn’t.

“I had the strong belief, because of my background as a physician-scientist, that we have to give both medicines equal opportunity to finish the course of the trial,” she says. The company needed to “look at the totality of the evidence, and pick the best one.”

That second medicine they might have abandoned? That ended up being Trikafta, which the FDA called a “breakthrough therapy” when it was approved in 2019. The drug can help save the lives of up to 90 percent of CF patients, and has helped propel Vertex into its current spot as the top-performing biotech in the city.

Kewalramani was just two years into her new role at the Seaport-based company when its former CEO Jeffrey Leiden announced plans to step down. But she didn’t consider herself a potential candidate until Leiden suggested that she apply.

“I just simply never thought about being a CEO. It just never struck me. It wasn’t that I didn’t think I was talented enough, or that I couldn’t do it,” she says. To her, the most significant role she had believed she could play was in research and development.

In 2019, the company announced her promotion to president and chief executive — making her the first female CEO at a top-tier US biotech company. She took the reins the following year, after working alongside Leiden for a time.

Since then, Kewalramani has focused on executing a bold vision they mapped out together. “We don’t do incremental innovation,” she says. “We don’t take medicines that are once a day and make it once a week. We are not serial price increasers. We don’t do direct-to-consumer TV advertising. We are a different company. We have been for many years, and I hope to keep that difference going.”

While Vertex now boasts a market cap of nearly $90 billion and nearly $9 billion in revenues, it’s hardly resting on its laurels. The company is partnering with Moderna to create an mRNA therapy for CF to serve the 10 percent of patients with rare genetic mutations that don’t respond to Trikafta.

It’s also expanding its portfolio beyond CF, embarking on an ambitious mission to release five therapies over the next five years — for sickle cell disease, type 1 diabetes, beta thalassemia, kidney disease, and a non-opioid pain management therapy. (A typical drug takes 15 years to develop.)

And Kewalramani is focused on diversifying the ranks at Vertex, which employs some 4,200 people in the Boston area. She revised job descriptions so 450 positions no longer require a four-year degree and is collaborating with Boston-based nonprofit Year Up to help prepare low-income young people for careers in research, development, and medicine. As of this year, 22 Year Up interns have been offered full-time opportunities at Vertex.

Kewalramani is leading Vertex as the biotech industry faces headwinds. Regulatory challenges, a slowdown in funding, and pushback from both Washington and patients about the high cost of drugs — the annual cost of Trikafta is more than $300,000 — will undoubtedly test Kewalramani’s leadership in the years ahead.

But she says it’s important to lead by example.

“I’m not extraordinary,” she says. But she is clear about who she is: a hard worker, a team player, and someone who happens to be very good at what she does. It just so happens that’s also what it takes to be CEO, even though she never imagined it for herself.

“Had I known that this job existed when I was younger and going through school and medical training, I would have signed up to do this thing. I just didn’t know,” she says with a laugh. “But I feel like I won the lottery to be able to have this opportunity.”

This story has been updated. An earlier version misidentified a recruiter for Amgen, and incorrectly stated Kewalramani’s and Leiden’s roles before she became CEO. The Globe regrets the errors.

How a career pivot catapulted Vertex’s CEO to the top of the biotech world

Reshma Kewalramani never imagined herself leading a company. Now she’s the head of Boston’s top-performing biotech company.

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