On the surface, working in pharma and being a soldier may not have a lot in common. But for Court Horncastle, senior vice president and business unit head of the anti-infective and respiratory team at GSK in the U.S., each role has been guided by a clear sense of purpose and communicating that mission with the people he leads.
Of course, moving from one role to the other was a bit of a culture shock. Horncastle’s first job in pharma was as a GSK sales rep in New Orleans. It was a totally different world from the life he left behind in the military.
“I came from leaving the Army as second in command of a rapid deployment tank company, having led soldiers successfully in combat. And now, there were days (of) the sales rep grind (spent) sitting, waiting in the waiting room to be able to get someone to give me a minute of their time to listen to me,” said Horncastle. “That was a juxtaposition.”
That’s putting it mildly.
A different world
Saudi Arabia’s “Empty Quarter” is a harsh desert — a vast sea of sand that stretches 250,000 square miles across the Arabian Peninsula without variation, save for the rippling dunes and gravel plains. In 1990, during the Gulf War, GPS devices barely existed, so Horncastle, then an armor officer leading a tank platoon, navigated the pitiless landscape using only maps and compasses.
“We navigated almost like we were ships at sea because the desert is more analogous to the ocean than to any place else,” he said.
He’d cross paths with Bedouins, nomadic Arab tribes with huge herds of camels, sheep and goats moving across the desert from oasis to oasis, while leading soldiers on reconnaissance missions during ground combat.
“I was leading 30 cavalry scouts,” he said. “Our job was to go out and gain and maintain contact with the enemy.”
At one point, Horncastle was scouting forward of friendly lines and came to a crossroads in the desert where he met two displaced Kuwaitis — a father and son. The boy spoke English and approached Horncastle with a question.
“He said to me, ‘Are you going to help get my school back?’” Horncastle remembered. “At the time, I was … mostly focused on ejecting the Iraqis, but it's now, obviously, one of the most important moments in my life in terms of doing something with purpose.”
A new mission
After leaving the military, it was hard to find that sense of purpose again.
“That type of energy and adrenaline and purpose, I think, is hard to find in the civilian world,” he said. “I've never felt more alive and more purposeful than leading soldiers in combat.”
Once that part of his life was behind him, Horncastle interviewed for a number of sales jobs, but nothing felt right. He needed something more.
“I felt like I could do it. I'd be successful. But it felt unimportant,” he said. “I knew, without really knowing, that I needed to find a career that had a purpose. That still fed doing something noble, doing something important, upholding certain ideals.”
He found that focus and sense of purpose at GSK.
“This is important,” he realized. “This is helping people who are sick.”
Horncastle spent five years working as a sales rep in downtown New Orleans, visiting areas where many other reps wouldn’t go. But the city’s dangerous reputation didn’t deter him. Plus, he saw a place where he could make a difference and show up for people.
“Stepping back into infectious diseases, particularly antibiotics, in an age of antimicrobial resistance is really exciting."
SVP, business unit head of the anti-infective and respiratory team GSK
“I just went everywhere,” he said. “And I realized there are doctors, nurses, pharmacists working in those toughest areas. They were there every day, grinding it out to help people that didn't have access to healthcare that the majority of Americans did.”
Horncastle has now been with GSK for more than 30 years, and he’s still as energized about his work as ever, leading a team of more than 1,000 people who all “have the opportunity to get ahead of disease together.” In particular, he’s focused on helping GSK reenter the antibiotic and antifungal market.
“Stepping back into infectious diseases, particularly antibiotics, in an age of antimicrobial resistance is really exciting,” he said. In fact, the company has said that infectious diseases represent about two-thirds of GSK’s pipeline.
He pointed, for instance, to gepotidacin, which, if approved, would be the first new oral antibiotic treatment for uncomplicated urinary tract infections in more than 20 years. It has proven especially effective in clinical trials for patients who are at risk of treatment failure associated with resistance or recurrence, compared to the existing first-line treatment.
“Unfortunately, about 25% or 30% of women that have recurrent or persistent uncomplicated urinary tract infections or are at risk for successive uncomplicated urinary tract infections. Those women, we know through market research, cycle through round after round after a round of antibiotics that don't solve the problem,” he said. “They certainly could use new alternatives.”
The company said in April that it was planning FDA submission for gepotidacin in Q2 this year.
Although Horncastle is now decades removed from his time in the army, he still applies that sense of purpose to his work at GSK and how he leads — from understanding and carrying out the company’s mission to identifying risks, prioritizing accountability, and tying together strategy and tactics.
“My job as a leader is to make it clear to my team (that) it doesn't matter whether they're medical, financial, legal HR, sales or marketing. We have a single, unified, most-important objective,” he said.
He communicates that by “declaring what's most important and explaining why it's most important,” then allowing each team to determine how to achieve it.
For instance, his team might set a strategic goal for their respiratory medicine which treats asthma or COPD in adults, to help a certain number of people by the end of 2024.
“If you work in (medicine), you should be able to say, ‘In order to do that, we're going have to generate this type of evidence in order for this medicine to be deemed appropriate for this broader patient population,’” Horncastle said. “If I work in market access, that means that I need to work on strategies that continue to have respiratory products widely available in commercial (insurance plans) and Medicare Part D, as opposed to limiting access to a smaller group of patients.”
Communicating intent, planning tactically, and executing a strategy are matters of life or death in the army: Plans are either a “go” or “no go” with no gray area in between.
While decisions in the world of pharma are much less immediate, it’s not as different as it seems. Horncastle still knows that he and his team are responsible for patients’ well-being. In fact, it’s something he thinks about “all the time.”
“I felt like I'm doing important, meaningful work that has the potential to help someone's mom, sister, cousin, friend or neighbor, and that's why I've never lacked motivation for doing this,