For the CEO of a company producing a COVID-19 vaccine, early access to such a hot commodity might be seen as a relatively simple get. That hasn’t proven the case for Pfizer head Dr. Albert Bourla, whose firm produced one of only two vaccines currently available in the U.S.
“I didn’t get it yet. I’m waiting for my turn,” said Bourla.
In explaining his decision to defer receiving the vaccine at a time when many seniors and high-risk individuals have been unable to secure appointments, Bourla added, “I’m 59. I work from the office. I have no underlying conditions. I know many told me ‘You should,’ but it’s challenging when the rest in Pfizer and Moderna are not getting it. Why would I?”
That decision is more than a sign of Bourla’s populist touch. It speaks to both his humility and courage to do the right thing – characteristics that have defined the choices he has made during his second year in the chief executive’s chair.
The remarks came during a wide-ranging fireside chat, held as part of Columbia Business School’s Annual Healthcare Conference Thursday. During it, Bourla shared leadership lessons gleaned in recent months and detailed what the road ahead holds for his company, which has been at the forefront of the biopharma industry’s response to the pandemic.
Pfizer was the first company to secure U.S. emergency use authorization for a COVID-19 vaccine, which was developed in under a year. Its ability to seize the moment, so to speak, stemmed to a large extent from a transformation of its culture, one which began well before Bourla took over the reins.
In the 1990s and 2000s, Pfizer was known more for scooping up competitors, like Pharmacia and Wyeth, than for innovation-scooping its peers. Bourla credited previous CEO Ian Read for his work in revitalizing the company’s culture during the 2010s.
Bourla said that the Pfizer he inherited two years ago was quite different from the one of old. Many key productivity indices – namely, rates of new molecular entities, clinical trial success and breakthrough designations – were dramatically higher.
“I found a very, very good hand to play, so I took that bet to transform the company from a conglomerate of businesses into a singular science company,” Bourla recalled.
He spun off the consumer healthcare business in 2019, spawning a joint venture with GlaxoSmithKline. Then came last November’s spin-off of mature products division Upjohn, which housed such off-patent products as Viagra. Upjohn wound up combining with generics maker Mylan, whose portfolio includes allergic reaction rescue med EpiPen, forming the new entity Viatris.
Bourla also culled the number of therapeutic areas the company focused on from 17 to six, effectively doubling the investment in those fields and enabling Pfizer to attract top-caliber scientists and experts.
As further proof of the turnaround, Bourla cited improvement in the company’s Phase 2 success rate, whose five-year-old rolling average rose from 15% at the end of 2015 to 52% at the end of 2020.
“It’s exactly the job of focus, of liberating scientists, of creating as little bureaucracy as possible,” he explained. “Let them do what they know how to do and what they love to do.”
What also positioned the company well, he added, was being a vibrant part of a “research ecosystem” involving academia and biotechs. Pfizer was no longer simply a company that excelled at financing megamergers, but one that specialized in delivering therapeutic innovation.
When the pandemic hit, mRNA technology got the thumbs-up from Pfizer’s scientists not only owing to its potential to spur a more effective vaccine, but to allow them to arrive at one faster than is possible with any of the traditional approaches. They had been working for the past three years on an mRNA-based flu vaccine with BioNTech and were confident that the platform could – and should – be harnessed for COVID-19, which demanded a highly compressed time frame.
“The only challenge was that if we were successful, that would be the first ever vaccine based on mRNA technology,” Bourla quipped.
Was he surprised by the results? “Hugely,” Bourla responded. He referenced the moment when the data safety monitoring board called to inform him of results from the interim analysis, and that there were four cases in the vaccinated arm of the trial and 90 from the unvaccinated arm.
The magnitude of that benefit almost got lost in translation, Bourla, a Greek native, recalled. “English is not my first language. I said, ‘Nineteen, you said?’ And they said, ‘No, 90.’ And I said, ‘So what is the effectiveness? They told me 95.6%. I couldn’t believe it, really. I couldn’t believe it.”
That same night, Bourla said he placed a call to Dr. Anthony Fauci to share the news. “He said, ‘This is a game-changer.’ And the rest is history.”
As to the critical success factors in going from clinical trials to a EUA in record time, Bourla said, “We didn’t de-risk our study so that our investment will have a better return. We just did all things together, irrespective of how much the cost would be.” That included combining Phases 1 and 2 and starting manufacturing before the vaccine had ultimately proven itself.
But he stressed, “We didn’t cut at all the time. This study was exactly designed the way that any study for a vaccine would be designed. If anything, it was much larger than anything else we were doing because you wanted to get the results very fast.” The intensity of COVID-19 in this country, as well as in Argentina and Brazil, helped Pfizer to see results sooner than if COVID were not demonstrating that level of transmissibility.
Given that the shot has proven itself with flying colors, Bourla said Pfizer is accelerating plans to develop mRNA shots for flu and other diseases. Also, mRNA holds promise in treating some tumors. Pfizer is leveraging learnings from the experience to speed up clinical trials in its other disease areas. To not do so “would be criminal,” Bourla said.
That’s not the only decision for which the CEO feels vindicated. On Pfizer’s refusal to accept any government money to fund development – some other COVID vaccine makers did – he noted, “When you get money, it always comes with strings attached. They want reports and they want to see, ‘So you’re going to do Phases 1 and 2 together – why? Let’s discuss that; it’s our money.’ I don’t want any of that.”
The second reason for wanting to dodge such an arrangement was the political climate during 2020. “We were living in an insane situation, where wearing a mask or not was becoming a political statement,” he recalled.
Not that Bourla sought to avoid the government altogether. Under terms of its supply deal with the U.S., it will deliver a total of 200 million doses of the shot by the end of May (which, he pointed out, is ahead of schedule), at a price of $19.50 for each jab of the two-dose regimen.
“When you’re successful, success has many fathers,” he noted. “It happens to be that many [governments] stepped up and immediately said, you know, it’s our vaccine that [they] need.”
That’s a good problem to have. Pfizer has projected revenue of $15 billion this year from the shot, although analysts questioned its ability to maintain pole position in the vaccine market over time. Even though its shot looks durable against new variants, competition is expected from entrants like Johnson & Johnson and Novavax.
Still, Bourla paused to imagine what could have been, had the company accepted federal monies to fund development: “I wanted to avoid all of that. And I think I was right.”
The decision afforded its scientists more latitude and the company more freedom on the pricing front. Pfizer sells its shot at a higher price point than some of its fellow vaccine makers, and that price may increase once the pandemic is brought under control.
“We priced this vaccine at what I call a very reasonable price in the developed world,” Bourla said. “For the developing countries – let’s say less middle-income countries – it’s almost half the price. And for the low-income countries, like [ones in] Africa, we give it at cost.”
On mutations of the virus, like those arising from the U.K. and South Africa, Bourla said that thus far, there is no evidence to suggest that the current vaccine is ineffective. Nonetheless, because there is a chance that yet another mutation could elude the protection afforded by the existing vaccines, Pfizer has already started work on developing what he called a new “vaccine construct” with a different RNA sequence to cover any mutant strains.
“One thing I don’t want to do is to develop a vaccine that we don’t need,” he explained. “So we have taken to see how effective the current ones are.”
That’s where the real-world lab comes into play. The company is running a large-scale experiment with Israel, which has already vaccinated close to two million people with both doses, to assess how the variants actually play out.
Should the need arise, Pfizer won’t have to start from scratch but will be able to do the requisite biochemistry and manufacturing to produce a new vaccine quite quickly.
“My goal is to be able to have, in less than 100 days, a vaccine if needed,” Bourla stated.
While Bourla wasn’t asked about the bumpy vaccine rollout, he did have some advice that marketers may want to take to heart, especially when approaching the vaccine-hesitant. “People started getting confused: Is it the Pfizer vaccine or is it a Trump vaccine?” he recalled.
Many Black Americans also remain hesitant due to the trauma which their community suffered after being subjected to inhumane experiments over the years. “But it is not us who can play the biggest role in convincing others, because clearly, if you are vaccine-hesitant, you will make the connection that I have a self-interest to tell you whatever I’m telling you,” he said of the biopharma industry, “It’s very different if Dr. Fauci, a political leader or a journalist speaks on behalf of us.”
The message that needs to prevail, Bourla stressed, is that, “It’s clearly your own right to make decisions about your own health. But when it comes to vaccination, what is at stake is not your own health. It is the health of others. Because if you don’t vaccinate, you’re becoming the weak link that allows this virus to replicate.”
And unfortunately, he continued, “The ones to pay the price are typically the ones that you love the most. So the message should be, ‘Please, think about it. Even if you have a fear. Think that the society needs you now, to overcome this.’”
Bourla, who over his 25-year career at Pfizer touched many of the corporation’s essential functions, couldn’t have possibly anticipated that he was signing onto a crisis like COVID so early in his CEO tenure. “But I knew that I’m signing up to prepare the company to be ready for something like that,” he said. “And it came earlier than what they thought.”
He said he was surprised – but not by the company’s agile response, the groundwork for which had been laid long before. “I was in this position and I had to do what I had to do,” he concluded. “I’m blessed that I made fewer mistakes, made the correct choices, and we ended up where we did.”