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 two 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 save you. The company will save you. The science, the authorities, the experts, the institutions will save you. The second group too will tell you that only they possess the truth. 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 one in this world can tell you with absolute certainty which is which. You have to use your mind. 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. And then there's the lessons of history. 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 one 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 took two shots of the Pfizer vaccine. This was my decision. 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 one 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. It is not due to pressure or fear. I'm not afraid of anyone. 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.
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This is the Lex Fridman podcast and here is my conversation with Albert Bourla.
The development of the COVID-19 vaccine was one 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. There were five I think and in another place what we call the data monitoring committee which is a group of experts, independent experts, they're not 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. And we were waiting for their call. 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 2:00.
You're just sitting there waiting. What were you feeling?
Sitting there waiting and teasing one another, drinking coffee, making jokes.
So what, how did you feel like when you heard the results, the successful results?
Free, liberated, happy, like if a huge weight that was on my shoulders was lifted.
I heard you said I love you to the team.
I did. You know, this is how we speak in the Mediterranean.
Listen, maybe it's the Russian thing, too. I love that. 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?
You know, we do a lot of that anyway. This is what we do in our daily work. 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 it all in. We put everything in one go so that we don't lose time. Usually we will 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 will 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. We go all in.
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 a 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. If you do that don't worry things will fall into place and also money will follow. But the mentality of the companies 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 we 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 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 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 immediately, 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 the time and but 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. 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 over companies and people and so on, but 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 set 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 it'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 a battle to win people's trust to inspire them with science. It feels like transparency is one of the most beautiful things, one of the most powerful things that the FDA has. FDA has the potential to be one of the great institutions of our country and this is one 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.
But this is not a black box. We know very well what is the process. 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 British, 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. Yeah, that it is issue and has basically the essence of everything was discussed. I don't know about specific documents if they take 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.
I agree with you and sometimes it's just ineloquence in communication. It's not that there's a failure of process, it's ineloquence in 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 distrust build up and linger because the result is there's a very large percentage of the population that just, I mean it divides people and science suffers I think.
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 answer 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. So, one of the folks is Mr. Jordan Peterson. I don't know if you know who that is. He's a psychologist, an intellectual and author. He suggested to me that I raise the concern that there's a close working relationship between Pfizer, FDA, and CDC. So, we talked about FDA. Do you worry that this affects both positive and negative Pfizer's chances of getting drugs approved? The fact that there's people, you know, 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 zero doubts that this is not affecting at all their ability to be unbiased and regulate and in order 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, rightly so. 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 valuation of new technologies to all. They are always as regulators on the conservative side. But always, always they are unbiased and they are trying the best and it's not only one or two people. 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 being 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 agencies by agencies. 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.
It's something I think about. 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. That was the system of the time. Like you get pulled over by a police officer, like obviously you need to bribe them. It was like the way of life. And then 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. But there's still human nature and that worries me a lot here. And again, it goes back to the perception and the communication. When there's people that have worked at Pfizer and FDA, at the CDC, you know, 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?
Okay, I would say that I recognize what you said about what happened in the country that you're coming from. 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 is 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 MHRA 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 you have, they have to be entangled to achieve scale, oversight and to achieve the kind of scale that Pfizer's been able to accomplish. How can Pfizer regain the public trust? 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 and the pharmaceutical industry lost it. It's clear that the reputation of the industry in the last decade was on the lowest that we have seen ever and for 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 one lesson that stands out from the many lessons that we learned during COVID is 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 given. I'm not going to make the mistake that because our reputation is high that will remain so. We need to earn it every day, 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.
You've been in Pfizer for 28 years. Time flies when you're having fun. And you've become CEO in 2019. 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 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?
Yes. 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.
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 with labs. 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 Bextra was a small product we would get a small fine. And Bextra was a very big product and we got a very large fine. Very bad what happened in 2003. 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 try and do things that they 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 tried 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 one way or another. Yeah. 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. We try to find treatments that significantly surpass the current standards of care and we try not only to comply with what regulators are asking us to do. This is what you need to do to prove the safety or the efficacy but exceed them. No matter what we do on that I'm sure that people will find opportunity because as you said there are a lot of lawyers to sue us but we believe in the justice system and we believe that eventually if you are doing the right thing you will be on the right side of the history.
Well, I'm really glad you say that because focusing on doing the right thing no matter the money I believe is the best way to make money.
And also, in other realms, creating a product that people love is the best way to make money. So focusing on the core of the thing that makes people feel good, that brings value to people's lives. So I'm now in Austin, Texas. My good friend Joe Rogan. He's been highlighting to me this aggressive marketing on mainstream media channels by Pfizer. So let me ask a general marketing question. Do you see this as a conflict of interest? Is that might bias the reporting of news that a lot of us, a lot of people me included, look to these mainstream channels of news for kind of authority of like what the heck's going on in the world and if Pfizer is sponsoring many of these shows there's a worry it may be a perception thing but there's also a natural worry that it would influence what they're talking about because they're afraid of losing the sponsorship. It's subtle, but at scale it might have a serious impact. Do you worry about this?
I think people could go one way or another because of multiple reasons. From our perspective, we, I don't think we have aggressive marketing. What do we do? We go on TV and we are having ads about our products and they are highly regulated. I think it is the right of people to know, to learn that if there is a product like that is very clearly that we cannot say things that they are off-label that have not been approved. We need to have every time we go into TV as you know FDA is forcing us to say also all the bad things that can happen for a medicine sometimes that takes more time than the good things. And I don't think that we are doing aggressive marketing. Now people could be influenced and can be biased in the podcasts or in the other type of media activities that they have for multiple different reasons.
Yeah, I know. But it's still it's pressure. It's human nature. I mean one of it is perception. But I worry about it too. I think I have a ton of sponsors for this podcast for example and none of them ever asked me to anything. They're just, you know, I think likely that kind of pressure is not happening for Pfizer but there's implied pressure sometimes and I worry about that a lot because, you know, I look at academia. I look for the good in people. I tend to believe most people are good or have the capacity to be good and the desire to be good. When I came to MIT I was a little bit disappointed, maybe heartbroken, how much pressure, I think unjustified pressure, people felt from financial constraints. Especially at MIT when there's I think a lot of money, people still felt constraints and they weren't, it wasn't bringing out the best in them. They weren't supporting each other. They weren't loving each other, like celebrating each other's successes. I don't want to blame money on everything, money constraints, but when you have sponsors, it just, I personally worry that it doesn't bring the best out of people. And so I feel like I want to put some responsibility on sponsors and great big companies like Pfizer to kind of not get in the way of the best of human nature whether it's sponsoring podcasts, mainstream media, like I don't know athletes, whatever.
You need to know that we are so, so careful with sponsorships. First of all, we have very few, very, very few. We have a team that for every single one, could be $2,000, they will try to see if there is a conflict of interest in the
way we do it. And also, what is the reputation of the persons or the programs that we are sponsoring? So, I don't think our friend I think was from Texas got it right that we do those type of things.
Oh, in terms of manip like having a negative effect on...
Not even having aggressive sponsorships. We have very few. And most of the sponsorships that we have, it is more on patient related organizations, right? Rather than we are very careful not to sponsor other things that can be perceived not even influenced but perceived that we may influence. So we are very very careful on that. This is not the case with us.
