As president and CEO of Terumo Blood and Cell Technologies, Antoinette Gawin leads a company involved in some of the most essential and fast-evolving areas of medicine: blood collection, therapeutic apheresis, and the systems helping to bring advanced cell therapies to patients around the world.
In this conversation, she discusses the practical experiences that shaped her leadership style, the emerging promise of blood filtration and cell-based therapies, and why expanding access to advanced medicine will require smarter regulation, stronger ecosystems, and a culture that empowers people to act.
What first drew you to medical technology?
My professional career began with GE, which at the time had a big healthcare division. I was good at translating technology into reality, and I always wanted to understand how to change systems. Healthcare is one of the most complicated systems out there, and MedTech was an opportunity to get closer to this purpose-driven environment without training as a doctor or clinician. It plays a big role in spreading established science and novel innovation around the world.
What experiences shaped your leadership philosophy?
I grew up in a rural area – a town of about 400 people with lots of farmers and immigrants. In that environment, if something is broken, you fix it. If someone is in trouble, you help. You don't wait to be asked, because often, people don't ask. That upbringing taught me to lead with empathy and understand the world by walking in someone else’s shoes.
Growing up, we never had quite enough of anything, so if there was a way to do something faster and cheaper, you had to find it. We worked smart and hard, and this turned me into a Lean Six Sigma fanatic. To name one example, earlier in my career at GE, I audited payroll for 380,000 people – before everything was computerized. I reviewed thousands of timecards. This didn’t make sense because too many employees were exempt and not paid by the hour. I wound up on a personal crusade to eliminate timecards for all exempt people in the company. I thought to myself, this is nuts, but it went all the way to the top of the company, and I was 23 years old.
Another part of my upbringing that shaped my leadership philosophy was learning the value of division of labor. When I was 12, I picked berries with migrant workers and I babysat. But the guys who baled hay earned more, so I wanted to bale hay. The problem? The hay bales were about my height, and I physically couldn't keep up. I couldn't reach the pedals of the tractor. At the end of the day, I was best suited for picking berries or babysitting.
You use everyone's capabilities to the best of their abilities. That's how I think about organizations. We need to focus on how to get the best out of people, which means leveraging their strengths as much as addressing their weaknesses.
How do you balance immediate business demands with a long-term vision for blood and cell technologies?
In my opinion, the two are intrinsically connected. The short term is simply the next step toward the long-term vision.
There’s always something flying at you. But when your strategy and operating philosophy are clear, the day-to-day decisions become much easier. My view is that we must be tightly aligned strategically and loosely coupled operationally. Everyone understands where we’re headed, but teams have the freedom to move quickly and make decisions without constantly moving through the hierarchy.
For example, when COVID hit, our priorities were clear: employee safety first; second, ensure products reached the patients who needed them; and third, support our cash flow. The guidance was simple: if what you're doing moves us closer to those priorities, go. Even though we weren’t the biggest company – and didn’t have the most directly connected products – we became the first to receive FDA Emergency Use Authorization for a device to treat COVID in the ICU. We went from idea to approval in just six weeks. That kind of speed is only possible when people understand the mission, and trust that leadership is behind them.
What emerging approaches are most exciting to you in blood and cell-based therapies?
First, I believe innovation happens at the intersections where biology, engineering, data, and clinical practice meet. Today, we understand far more about the biological makeup of the body than we did even a decade ago. We know the roles of proteins and antigens, and we understand how a single mis-wired cell or genetic marker can drive disease.
This deeper biological understanding is opening doors to entirely new therapeutic approaches, including the ability to potentially filter out more harmful components that drive disease. As we learn more, these approaches have the potential to move us closer to more permanent cures – within our lifetime.
The COVID example I used is a good illustration. When a virus like COVID enters the body, the immune system triggers inflammation by releasing cytokines to fight it. But for some patients, that response becomes extreme – a cytokine storm can become more dangerous than the virus itself. Our insight was that if we could filter those cytokines out, then you have a chance of surviving the storm: it worked. Filtering the cytokines allowed the patient’s immune system to respond and win the fight. Those dangerous cytokine storms emerge in other diseases, even in response to advanced therapies like cell therapies or stem cell transplants.
There are already a number of rare diseases treated with blood filtration therapies, such as sickle cell disease, not as rare as one might think. Historically, 95 percent of children born with sickle cell disease died before they were five years old. Today, with our treatment to replace a “sickle” cell with a healthy red blood cell, we can turn sickle cell into a chronic disease rather than a death sentence.
There are also studies exploring the use of filtration to remove circulating proteins related to Alzheimer's disease, doctors are filtering the blood for cholesterol, and devices for filtering tumor-protecting cytokines.
So, the idea that we can filter out harmful components to treat disease is well-established and rapidly expanding. The more we learn about these diseases and about our own genetics, the more partners come to us with ideas for what else we might be able to filter for. AI will spur discovery of these connections.
What are the biggest barriers to global access to blood and advanced cell therapies?
Blood and cell therapies run counter to the traditional pharmaceutical model where a patient moves from illness to diagnosis to taking a pill. When we talk about things like “access,” people probably aren’t thinking about the cost or infrastructure behind a blood transfusion. Blood isn’t something you pick up at a pharmacy; it’s embedded in a hospital bill. That can lead to taking it for granted and underestimating its value.
In many mature healthcare systems – the US, Japan, parts of Western Europe – we assume safe blood will be available when we need it. But blood supplies are fragile, most people just don’t realize it. Even in the U.S., we routinely see severe shortages in the winter months, and it only takes a bad flu season or a major storm to strain the system.
Globally, the challenges are even more profound. There are still so many people who die because they lack access to safe blood or because cultural beliefs make donation taboo. In some countries, patients must purchase blood in advance – and even present proof of having secured it – before they can undergo a procedure. That’s impossible if you're in a car accident. Sometimes, you need to bring your whole family to the hospital hoping someone will be a match because there’s no reliable donor pool or national blood system.
With cell therapies, the field is so new that implementing best practices remains a challenge. For example, we’ve been working with developers to help them understand how to better control collections – the source material – to make their therapies more viable.
When each player focuses on their own niche, they tend to miss out on the kind of systemic learnings that improve the entire field. We’ve begun implementing a cell therapy ecosystem blueprint in the Asia region to address this, drawing on insights we’ve learned from collaborations with thought leaders in every part of the cell therapy value chain. When the ecosystem evolves, you’ll see more therapies reach more patients and faster.
How do you create a culture where people across a global company feel empowered to contribute?
For me, it starts with respect – respect for all voices and all sources of ideas.
We hold town halls all over the world, so I hear ideas from every corner of the company. My job is to value each one equally, regardless of someone’s level, function, or location.
When people see their input reflected in decisions or solutions, it creates a virtuous cycle. They feel heard, speak up more, and start solving problems proactively because they know their contribution matters.
One of the most powerful leadership tools is simply saying: “That’s a great idea – go do it. I trust you.” That level of empowerment changes how people approach their work.
Too often, organizations assume innovation only comes from technical functions. But sometimes the best ideas come from the people actually using a product, or someone who simply notices something others missed.
I believe decisions should be made by the person closest to the action. The person on the front line should feel empowered to stop the line if they see a quality issue or invent something if there's a need.
For example, we have a platform for cell expansion, and our customers highlighted the need to integrate multiple cell therapy manufacturing steps. Our field team developed protocols for a “3-in-1 workflow” – enabling CAR-T activation, transduction, and expansion on the single platform. It’s faster, simpler, and more cost effective – a new standard. We’ve published those results and received great feedback from partners.
What role should regulation play in enabling innovation in blood and cell technologies?
I represent AdvaMed – a medtech trade association – on the Technology and Regulatory Affairs committee working with the FDA. I firmly believe regulation should be an enabler. But by design, regulation is often structured to prevent yesterday’s mistakes rather than accommodate today’s technologies or tomorrow’s solutions.
Regulation must absolutely keep patients safe – that's non-negotiable. But over time, we've layered on so many legacy requirements that some of them no longer reflect how modern technologies function, especially in a world increasingly driven by AI-powered insights and connected data.
We also still face situations where long-established technologies take decades to move from one regulatory environment to another. A good example is our whole-blood processing automation platform, which had been in standard use globally for more than a decade before it received approval in the United States. That kind of timeline shows how regulatory systems can lag behind innovation, even when the underlying technology is well understood.
What advice would you give to the next generation entering this field?
Stay as broad as you can for as long as you can.
There’s a strong incentive today for people to hyper-specialize early but doing that too soon can limit your exposure to new ideas and reduce your ability to make a meaningful impact.
Second, constantly challenge your own perspectives. Make it a habit to connect with others who see the world differently. Healthcare is an incredibly complex ecosystem involving providers, clinicians, policymakers, patients, and payers. No single viewpoint is representative of the whole.
The more diverse your experiences are, the more valuable you’ll be in solving healthcare problems. A broad, multidimensional background will make you more adaptable, more relevant, and ultimately more effective in shaping the future of this field. Who knows how many lives you can impact?
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