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EPISODE LINKS:
Albert's Twitter: https://twitter.com/AlbertBourla
Pfizer's Website: https://www.pfizer.com/

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OUTLINE:
0:00 - Introduction
3:43 - Clinical trials
19:47 - Trust
39:35 - Safety
49:51 - Booster shots
52:45 - Mandates
59:14 - Antivirals
1:04:13 - Hope for future

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The following is a conversation with Albert Bourla, CEO of Pfizer.

If you'd like to skip ahead to our conversation, the timestamps as always are below.

But if not, please allow me to say a few words about truth and human nature, specifically about 2 groups of people throughout history that seek to lay claim to the truth.

The first group will tell you that only they possess the truth, and that the government will hurt you, the company will hurt you, the science, the authorities, the experts, the institutions will hurt you.

Both groups have the benevolent and the malevolent, their heroes and their charlatans.

And I think the hard truth is that no 1 in this world can tell you with absolute certainty which is which.

This is the burden of being human, of being free.

Don't blindly follow any leader, neither the emperor nor the martyr who points out that the emperor has no clothes.

Vaccines have saved hundreds of millions of lives in the past century.

And in general, the advance of medicine has saved billions of lives.

If you ignore the power of science, you're not being honest with the lessons of history.

And if you ignore the corrupting nature of power and money within institutions, including governments and companies, that led to the suffering and death of hundreds of millions in the past century, you are once again not being honest with the lessons of history.

I announced that I will be having this conversation with Albert Bourla, Pfizer CEO, and a lot of people wrote to me.

I would like to say that I was and am and always will be listening and learning with an open mind from everyone.

My own opinion, worth little as it is, is that the development of the COVID vaccines is 1 of the greatest accomplishments of science in recent history.

For the rest, from safety and efficacy to policy and economics, I stand humbled before a complicated world full of fear and anger.

A small number of malicious people from all walks of life will use that fear and anger to divide us because the division makes them money and gives them power.

I don't ever want to force this on anyone.

And I certainly don't want to dismiss your concerns or worse, you as a person, if you choose not to get vaccinated.

I can assure you 1 thing, in this conversation and in any conversation, the choice of questions I ask and words I say is mine and mine alone.

When my words fall short, as they often do, it is only because of the limitations of my mind and of my speaking ability.

I cannot be bought by anyone, with money, power, or fame.

I hope to prove this to you and to myself in the coming years.

This life is short, and To me, without integrity, it is not worth living.

People sometimes talk down to me, call me naive.

Perhaps they are right, but it is who I am.

I think this life, this world, this, our human civilization is beautiful.

And as Dostoevsky said, beauty will save the world.

This is a Lex Friedman podcast, and here's my conversation with Albert Bourla.

The development of the COVID-19 vaccine was 1 of the greatest accomplishments of science in recent history.

No matter what, this should give people hope for the future.

And yet, it is more of a source of division.

I hope we can discuss both the inspiring and the difficult ideas in this conversation so that we can do our small part in healing this division.

Take me through the day of November 8th, 2020, when the Pfizer team were waiting for the results of the phase 3 clinical trials.

We had assembled in a very small office that we are having in Connecticut, very few people.

And in another place, what we call the Data Monitoring Committee, which is a group of experts, independent experts, they're on Pfizer, we're going to have the opportunity to unblind the data and then tell us if the study needs to continue or if it is successful or if it fails.

So the call came a little bit later than what we expected, which created a lot of anxiety to all of us, but came around, I think, 02:00.

You're just sitting there waiting, what were you feeling?

Sitting there waiting and teasing 1 another, Drinking coffee, making jokes.

So how did you feel like when you heard the results, the successful results?

Like if a huge weight that was on my shoulders was lifted.

You know, this is how we speak in Mediterranean.

Listen, maybe it's the Russian thing too.

I love love, so I appreciate that kind of celebration.

So looking back from that moment to before, how much did it cost to develop the Pfizer-BioNTech vaccine?

What was it like making the decision to make that investment when the risk is very high and you don't know if it's going to be successful?

We are putting money, we are investing in research, which is highly risky.

The difference in that case was that we didn't risk at all.

We put everything in 1 go so that we don't lose time.

Usually we'll spend 50 millions, and then if that goes well, then we will spend another 50, and then if it goes well, then 100.

Here we put all together a little bit more than $2 billion, $2.3 billion.

And It was a significant decision, but it was a very easy decision to make in the context of what we were living at that time.

It was a pandemic, people were scared, we were scared.

We didn't know how tomorrow would look like.

We were living unprecedented situations and we knew that we have capabilities that may help.

So there was not a second question or choice.

When you make decisions like that, you're the CEO of a company that needs to make money and that hopes to do a lot of good in the world.

How much of both of those things are part of the calculation?

So when you said it was an obvious choice, I think you've said a bunch of things of the kind of saying we need to go all in, sort of very boldly diving in.

How much was that, that the world is facing uncertainty and fear and potentially destructive pandemic in the early days, just when you're seeing the full uncertainty before us, don't know how it's going to unroll.

And how much of it is, this may also be a good financial decision to take this risk?

Yeah, I think about it all the time and I know very well that if you focus too much on making money, you will never make.

You should focus in what is the real value driver.

And the real value driver, it is to make breakthroughs that change patients' lives.

If you don't do that, you will never make money.

Things will fall into place and also money will follow.

But the mentality of the company is to be how to help the patient.

And that's what the management was that the shareholders want, because that's the only way that we can create value.

In this particular case, we're not thinking at all about what are we going to make when we sell it or if not sell it, because what we were focusing 100% was how to bring a solution to the world that will help all of us change the way, the fear that was bring hope to the world.

And as always, when you do that, you will have good returns as well.

On a philosophical level, on a human level, do you ever worry that the pressure to cover the costs that were invested to develop a new drug, to develop this vaccine, harms your ability to conduct unbiased studies.

Ah, not at all, because the studies are highly regulated.

Everybody knows what regulators, And when I say regulators, FDA, European authorities, UK authorities, Israeli authorities, Japanese authorities, Canadian authorities, want to see how the study needs to be conducted and what exactly they need to see to approve it or not.

So clearly everybody takes into consideration how much money I'm going to invest and what is the chances that I'm going to lose them.

But what you can do is just to change the rules of the game so that you won't lose the money.

There are very well-established methodologies that would say with very high precision, if your medicine is effective, if your medicine is safe.

And those are there for all and all playing with the same rules.

Do you have an intuition about why is the FDA trying to get 75 years to release the Pfizer data?

They're trying to request that it will not be released for 75 years.

And then maybe the broader version of that question is, do you think people should have sort of full transparency and immediate access to the data?

Immediate, you know, on the scale of weeks, not years.

I think the relations with regulators, they have been always very transparent.

And there are a lot of laws that they are forcing regulators and companies to put out there, their interactions and what exactly was discussed.

Now to go into specific details of some discussions.

I don't know what is the reason that FDA wants to take that time, and I'm sure they have very good reasons.

Well, let me just say my side of it, It doesn't look like a good reason.

It looks like maybe it's because I come from the Soviet Union.

Now, this is not you saying this, this is me saying this, is there seems to be a bureaucracy that gets in the way of transparency.

That's always the challenge with government.

So government is very good at setting rules and making sure there's oversight of a companies and people and so on.

But they create, they slow things down, which is a feature and a bug.

And in this case, they slowed down so much.

I think the reason they said it at 75 years is because they set a rate of being able to only review 500 pages of data a day or something like that.

And that's a very kind of bureaucratic thing where in reality you could just show the data And it's not like something is being hidden, but in the battle to win people's trust, to inspire them with science, it feels like transparency is 1 of the most beautiful things, 1 of the most powerful things that the FDA has.

FDA has the potential to be 1 of the great institutions of our country.

And this is 1 example that it feels to me like a failure.

So in your perspective, you're saying, I'm sure they have a good reason.

So to you, the FDA is this black box that you submit things to, once they approve, you know that those are the rules, it's approved, that's it.

Everybody knows very well what are the processes.

The review process also, it is very detailed.

They have scientists of very, very high caliber.

Not every regulator in the world, but the Europeans, the Brits, the FDA clearly, they have very, very high caliber of scientists, that they are going into a lot of details.

And also, basically everything for a study is really released by law in the specifications of the product.

But it's a very detailed document that it is issued and has basically the essence of everything was discussed.

I don't know about specific documents if take them time to release, but clearly this is not a black box type of process.

A lot of this stuff is how do you effectively communicate to the world about the incredible science that's been done, about the processes that were followed.

And sometimes it's just ineloquence in communication.

It's not that there's a failure of process, it's ineloquence of communication and silence.

Silence in the moment when clearly a lot of people are bothered and have questions.

This is when you speak out and you explain exactly why, as opposed to letting the sort of distrust build up and linger.

Because the result is there's a very large percent of the population that just, I mean, it divides people.

And also the effectiveness of solutions suffers, like the vaccine and so on.

I asked a few folks I know if they had challenging questions for you.

I'm sure many of them answered your call.

Well, Yeah, yeah, you know, many friendly folks out there.

By the way, I'm sweating, not because this is a difficult conversation, it is, but it's also hot in here, for the record.

He's a psychologist and intellectual and author.

He suggested to me that I raise the concern that there's a close working relationship between Pfizer, FDA and CDC.

Do you worry that this affects both positive and negative, Pfizer's chances of getting drugs approved?

The fact that there's people that worked at the FDA that now work at Pfizer, Pfizer FDA, that there's a kind of pipeline.

Does this worry you that it affects your ability to do great unbiased work?

I have 0 doubts that this is not affecting at all their ability to be unbiased and regulate.

And in order to, for the system also reinforces that by creating significant time barriers.

If someone moves from an industry to FDA, he won't be able to deal with topics for a period of time and then for even an enhanced period of time with topics that are related with a company he or she may come from.

I think these regulators, they are really very strict.

If anything, I feel sometimes that maybe they should be a little bit more open-minded, particularly when it comes to new technologies, rather than trying to judge and implement the same framework of variation of new technologies to all.

They are always, as regulators, in the conservative side.

But always, always, they are unbiased and they are trying the best.

They have processes to make sure that there are self-checks and balances within the agencies, both in CDC and in the FDA.

Difficult decisions, they bring external experts that they should express.

Easy decisions, they are internal experts that they are debating a lot.

And if there are disagreements, they elevate them.

So I think it's, we are lucky to have good regulators.

I think I agree with what you said before, as with all governmental agencies, there is bureaucracy and the bureaucracy needs to be addressed.

And by saying bureaucracy is not relaxing the bar, the bar needs to remain high, but focusing on what matters rather than on the detail.

So you don't, you know, I've been reading quite a bit about history.

You don't worry about human nature and corruption that can seep in.

You're saying institutionally there's protections against this.

I think there is always the fear of corruption, particularly when you speak about public servants, but clearly the risk is very different country by country.

And speaking about an agency by agency, I think the regulatory agencies have a very good track record and history of the US, of Europe, of England, of very, very good track record of integrity.

So I grew up in the Soviet Union and I need to perhaps introspect this a little bit, but when I was growing up, ethically, there was a sense that bribery is the only way you can get stuff done.

Like you get pulled over by a police officer, like obviously you need to bribe them.

And then so coming to this country, it was beautiful to see that the rule of law has so much power.

And ultimately the rule of law, when enacted, when it holds up, it gives people freedom to do the best work of their lives.

And again, it goes back to the perception and the communication when there's people that have worked at Pfizer and at FDA, at the CDC, you look at their resume, they have those things on their resume, it worries people.

Are these great leaders that we are supposed to see as authorities, are they playing a game on us?

I would say that I recognize what you said about what happened or what I'm sure that what you describe in the country that you're coming from, it was how you experienced it.

And I know that there are other countries that you need to do these things to do your job.

I don't think it's the case in this country, particularly when it comes to those agencies that you mentioned, I think they have a very high track record.

And also, I don't think that there are a lot of people that they are worried about it or doubt it.

I'm sure, like everywhere, there will be a minority, but the vast majority of the Americans, the vast majority of the Europeans, the vast majority of the Brits, the vast majority of the Israelis, they trust what FDA or EMA or CDC or NHRA will say.

Still, there's currently a distrust of big pharma in the public.

Maybe this is something I'd love to hear your comment on.

There's distrust of science when it's tangled up with corporations and government institutions like we've talked about.

But they have to be entangled to achieve scale, well, oversight and to achieve the kind of scale that Pfizer has been able to accomplish.

How can you regain the public trust, do you think?

Not regain, but sort of take steps to increase the public trust.

Reputation is something that you can lose in buckets, but you can earn it back in drops.

And once you lost it, you are going to take a lot of effort to bring it back.

It's clear that the reputation of the industry in the last decade was on the lowest that we have seen ever.

And there are many reasons for that, but clearly there are reasons that are related also with the behavior of the industry.

That needed to change, and I'm hopeful that very few will disagree that the industry is a very different industry right now.

That being said, I truly believe that if there is 1 lesson that stands out from the many lessons that we learned during COVID, it's the power of science in the hands of the private sector.

I think It was the private sector that came with solutions with diagnostic tests, when we didn't have, solutions with respirators, when we didn't have, solutions with treatments, solutions with vaccines.

And I think that demonstrated very clearly to the world the value of a thriving life sciences sector, private life sciences sector to society.

That also affected very positively the reputation, both of the sector and of Pfizer.

I'm not going to make the mistake to consider it given.

I'm not to make the mistake that because our reputation is high, that will remain so.

Every day with everything we do, with everything we say, with the way we behave.

And I hope that we'll rise to this occasion and we will do that.

It is a company you love, a company you believe in.

It's a company that has developed drugs that has helped millions of people.

So let me ask yet another hard question on this topic of reputation.

In 2009, Pfizer pleaded guilty to the illegal marketing of arthritis drug Bextra and agreed to a $2.3 billion settlement.

How do you make sense of the fact that this happened to a company you love and that you believe in?

The Bextra case in 2009 was related to things that happened in 2003.

And the things that happened in 2003 were things that basically several of our reps did off-label promotion.

So they spoke about, with the physicians, about off-label use of the product, and they shouldn't.

And- Can you clarify, so off-label are things that the FDA didn't approve, extra stuff.

You basically say this drug does extra stuff that the FDA never approved.

Correct, and this is something that it is allowed when physicians are speaking to physicians, but it is not allowed for the pharmaceutical companies to refer to these studies, because usually are studies that are happening of labor.

And apparently several of our reps in 2003, they did it.

And we had to settle in 2009, and we paid a very big fine, as you said.

The fine was related not to the severity of the conduct, but the size of the revenues.

So the fines are, if Bexster was a small product, we would get a small fine.

Bexster was a very big product, and we got a very large fine.

I don't think that these things happened since then.

We have a stellar record from 2009 until now of complying with every single regulation and rule.

We have internal processes to make sure that these are not happening by individuals that may have an interest.

For example, to get a promotion, they may try and do things that are not the right things.

And we have, more importantly, a culture in this company that really sets aside people that they think differently.

So I didn't like what happened in 2003, But I believe a lot has changed in the 20 years that followed, or almost 20 years.

So you're developing drugs, you're developing solutions to help millions of people, but there's risk involved.

And so there would be lawsuits heading back your way because there's a lot of lawyers in the world, partially.

How do you put that into the calculation of how you try to do good in the world, that some of the cost is the lawsuits.

How do you not fall victim to thinking that it's just the cost of doing business and that some of the lawsuits might actually represent real pain that people are going through.

No, I think that we try always to do the right thing.

And that's, as I said, very well embedded into our culture.

If you don't do the right thing, sooner or later you will pay for it, 1 way or another.

And right now, for us doing the right thing, it is being able to find innovations to issues that are real, diseases that they do not have good coverage, good treatments right now.

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Albert Bourla: Pfizer CEO | Lex Fridman Podcast #249