

Sanofi's board ousted CEO Paul Hudson after six years of one-drug dependence and a shrinking vaccine business. His replacement is Belén Garijo, a former Sanofi veteran turned Merck KGaA chief, and she's walking into one of pharma's biggest turnaround jobs.
Six years, one blockbuster drug, and a stock chart going nowhere. That's the résumé Paul Hudson carried into February 2026, right before Sanofi's board showed him the door.
On February 12, Sanofi announced that Hudson was out as CEO, effective just five days later. No graceful retirement tour. No "spending more time with family" press release. The board simply decided not to renew his mandate, and that was that. His replacement? Belén Garijo, the 65-year-old Spanish physician who just finished running Merck KGaA, and who spent 15 years at Sanofi before that.
Wall Street's reaction was swift and unkind. Shares dropped roughly 5% in pre-market trading.
Paul Hudson wasn't a disaster. Under his watch, Sanofi's total sales climbed to €43.63 billion in 2025, a 9.9% jump year-over-year. That's a number most pharma CEOs would frame and hang on their office wall.
But almost all of that growth came from one drug: Dupixent, the blockbuster asthma and eczema treatment. And Dupixent has a shelf life. Key patents start expiring in the early 2030s, which in pharma time is basically next Tuesday. Hudson's job was to find the next Dupixent. He didn't.
Meanwhile, Sanofi's vaccine business, once a crown jewel, started losing its shine. Vaccine sales declined 2.5% year-over-year, and the company projected they'd dip further in 2026 thanks to anti-vaccine sentiment fueled by US policy shifts under the Trump administration. When your drug pipeline is thin and your vaccine franchise is shrinking, the board starts updating its LinkedIn searches.
Think of it like a restaurant that's famous for one dish. The signature entrée is still selling, but the lease is expiring, the menu hasn't changed in years, and customers are starting to cancel reservations. At some point, the owners look at the chef and say, "We need someone new in the kitchen."
If Hudson was the outsider who couldn't crack Sanofi's code, Garijo is the insider who already knows where the keys are hidden.
She spent 15 years at Sanofi earlier in her career, most notably , the massive biotech acquisition that gave Sanofi its rare disease, immunology, and oncology capabilities. That's not a small line on a résumé. Genzyme was a defining deal for the company, and Garijo was the one who made the pieces fit.

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After leaving Sanofi, she climbed the ranks at Merck KGaA. She became CEO in May 2021, making her the first woman to lead a DAX40 company in Germany. At Merck KGaA, she steered the company through the tail end of the pandemic, executed what the company called a "string-of-pearls" strategy of targeted acquisitions and divestitures, and shifted the healthcare portfolio toward oncology and immunology.
Her track record suggests she's a builder, not a dreamer. Board Chairman Frédéric Oudéa praised her "strategic vision, execution rigor, and transformation skills." Translation: she finishes what she starts.
When she officially takes the helm after Sanofi's Annual General Meeting on April 29, she'll become the company's first female CEO and one of only two women running a major large-cap pharma company globally.
From February 17 until Garijo's official start, Sanofi has an interim CEO: Olivier Charmeil, the company's Executive Vice President of General Medicines and an executive committee member since 2011. It's a caretaker arrangement; keep the lights on, don't redecorate.
But the real question isn't about the transition period. It's about what happens after.
Sanofi's pipeline has over 80 clinical-stage projects, with 34 in Phase 3 or regulatory submission. The rare disease portfolio alone has more than 20 clinical-stage drugs, including treatments for Gaucher disease, Fabry disease, and achondroplasia. That's a deep bench.
The worry is whether Garijo shifts the company's center of gravity. At Merck KGaA, she reorganized R&D, forged global alliances, and expanded into high-growth markets like the US and Japan. She diversified. She went bigger. If she brings that same playbook to Sanofi, it could mean more emphasis on higher-volume diseases (think oncology, immunology, and potentially even obesity) and less focus on the rare disease heritage that defines the company's identity.
There's no announcement yet about an obesity push, and Sanofi's rare disease pipeline looks stable for now. But pipelines change when CEOs change. That's just how pharma works.
Garijo's mandate from the board is clear: boost R&D productivity, tighten governance, and drive innovation. In plain English, that means she needs to find the drugs that will replace Dupixent's revenue before the patent cliff arrives. She has roughly five years to do it.
Sanofi isn't the only pharma giant swapping captains. GSK's Emma Walmsley stepped down after nine years, replaced by Luke Miels in January 2026. CSL ousted its CEO the same month as Sanofi. Even Pfizer faced activist pressure from Starboard Value in 2024, though CEO Albert Bourla kept his job while his chief science officer did not.
The pattern is unmistakable: pharma boards are losing patience faster than ever. Patent cliffs are looming across the industry. Blockbusters are aging out. And shareholders want CEOs who can deliver the next generation of drugs, not just ride the last one's coattails.
Hudson got six years. The generation before him might have gotten ten. Garijo should take note.
Sanofi's board made a calculated bet. They swapped a CEO who grew sales but couldn't diversify the pipeline for one who's already proven she can restructure R&D, integrate acquisitions, and navigate complexity at scale.
Garijo knows Sanofi's DNA — she helped build part of it. She knows rare disease, she knows immunology, and she knows what it takes to transform a sprawling organization. The question is whether she'll preserve what makes Sanofi special or reshape it into something more conventional.
Either way, the clock is ticking. Dupixent's patents won't wait for anyone, not even Sanofi's first female CEO.
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