Pfizer CEO on the COVID-19 vaccine effort and what’s next for the pandemic

The COVID-19 vaccine required an unprecedented effort - and more than just sleepless nights. In a special one-on-one-conversation at the World Economic Forum's Annual Meeting in Davos, Pfizer CEO Albert Bourla talked to founder Klaus Schwab about what the effort really required, including the type of trust and collaboration that could rely on verbal agreements in the short term when there was no time to waste on traditional contracts.

In this talk, Bourla shared his thoughts on what's next for vaccines, mRNA technology and the COVID-19 pandemic. He also shared lessons learned and a new effort that could help bridge equity gaps once and for all.

Read the transcript below.

Klaus Schwab: Good afternoon. I have the great pleasure to start a dialogue with one of the chief executives who was probably most in the news last year. He also made a very groundbreaking announcement today. I have the pleasure to introduce Dr. Albert Bourla, who in 2019, just before the COVID-19 crisis broke out, was nominated chairman and CEO of Pfizer. And what a formidable journey in the last 13 months. You certainly have made a major contribution. So many of us became resistant to the virus. Thank you on behalf of everybody.

I think what is so remarkable is the fact said you went into this venture without asking for public help, as far as I know. You could have probably had access to billions of dollars but you did it to yourself. You did it alone, together with your partner, BioNTech.

Now, I just said you made a major announcement, a ground-breaking announcement, this morning. Can you tell us a little bit more?

Albert Bourla: First of all, thank you for the honour to be here with you. Today, we announced that we will offer all our patent-protected medicines, all vaccines or medicines that currently exist in the US or in Europe, to the 45 poorest countries of the world, at cost. That's a population of 1.2 billion people.

And we also made the commitment that every year, as we discover and bring to the US or to Europe or to the world, new medicines, automatically those new medicines will be inserted into the portfolio we are offering to these countries. I think that it's really the fulfillment of a dream that we had together with my leadership team when we started in 2019. We met in January of 2019 in California to set up the goals for the next five years, and one of them was that by 2023, we would reduce the number of people in the world that cannot afford our medicines by 50%. I think today this dream is becoming reality.

Klaus Schwab: So it's really a purpose-driven company. And if you say 'at cost' -- without margin? Certainly, you must have certain margins for research and development?

Albert Bourla: We will not. We define 'at cost' as strictly what it takes to manufacture and very minimal shipment. We exclude all the research money it took to invent the medicines or the legal input it took to make the contracts or the administrative cost. Everything that sometimes is added to 'non-profit' will not be added in that case. It's going to be strictly the cost to make and ship.

Klaus Schwab: If I think of all the discussions during the last year related to COVID medicine, I think this is such a breakthrough. And if we see how many people are in the developing world, I immediately come in with the question when we talk about the developing world, whom do you help?

Albert Bourla: So we are including all the low-income countries. According to the World Bank definition, there are 27. But because there is always a great line between the income of countries that are not [low-income] anymore (because they improved a little bit), we decided that every country that used to be low-income but they graduated to higher level in the last 10 years will also be included. That will give us 45 countries which are 1.2 billion in population.

Klaus Schwab: 1.2 billion people. And would you help those countries also afterwards to develop their own production line?

Albert Bourla: What we discovered through the pandemic was that supply was not enough to resolve the issues that these countries are having. Right now, for example, there are billions of doses of our vaccine, the vaccine that was used in Europe, in the US., but it is offered to low-income countries for free. And this is supported by the US government mainly, but also by the European Union. But they're doing donations. So the US government bought for us at cost and they donated. They can't use them right now because we discovered that one thing is supply. And the other thing is to have an educated population that believes the vaccines are doing well. You [need to] have doctors or nurses that will administer, to have the infrastructure and logistics [so] you can store it in every place in the country, and not only in the capital of the country. A lot of things are missing.

For this reason, given the lessons that we got, in addition to the initiative that is broad and addresses 45 countries, we selected five of them that the governments are really keen to work on this issue. Those five are: Rwanda, Malawi, Uganda, Ghana and Senegal. So with those five we [already signed] our letters of intent and we will work not only giving them the medicines but on the ground to identify blockages between the medicine [as it] arrives in the country and the medicines as used by a patient.

For example, we have now breast cancer medicines that are very expensive medicines. There are women in Africa who have breast cancer. They're not diagnosed at all. And some say we don't invest in diagnosing breast cancer because we don't have the medicine anyway. Now, you will have the medicine, but you need both.

So we will send also experts from our side. We have a programme that we call Global Fellows. Everyone in Pfizer can raise their hands and say, "I volunteer. I want to go to work with an NGO for six months, for nine months." And we guarantee his position when he goes back. We keep providing the salary and we provide also cost, and accommodation and we network with these organisations. Physicians can go. Engineers can go to help with this. We will do all of that to make sure that it is not [a situation where] "We wash our hands. We send your medicines." We care to make an impact. We care to make a difference.

Klaus Schwab: So you are becoming really a global health provider.

Albert Bourla: I wish to be able to do that. I don't think I would be able to do it alone. So that's why I'm calling everyone that has something to offer in that space -- The World Health Organisation, the Bill & Melinda Gates Foundation, the Carter Foundation. Other organisations, non-governmental -- Doctors Without Borders -- that have the resources. We would like to partner together so they can do diagnosis, we can give them medicines.

Klaus Schwab: Like Gavi.

Albert Bourla: Gavi, for example, has made a huge difference in the world. The biggest product of Gavi, the one that, according to Gavi and Bill Gates, have saved more lives. It is a pneumococcal vaccine that we are providing.

Klaus Schwab: The founder was Bill Gates but it was originated here. Actually GAVI was born here [Davos].

Albert Bourla: He always says that when he speaks. That it was here in Davos. Made in Davos.

Klaus Schwab: It's a Davos charity, if I may say so. And we have many children. You referred to it already. How important is cooperation? I mean, not only do you have to have collaborations with other businesses, but also governments. I feel you you have sometimes to [move forward] also with very little knowledge of the government for such matters like complicated medicines and so on. What is the importance of cooperation? How do you approach it?

Albert Bourla: I think it's very important. I think nothing would have happened during the pandemic, for example, without cooperation, but nothing would have happened when Gavi was founded. And nothing would be happening in the world if the stakeholders, they don't set common goals. Certainly they need to be purpose-driven goals and [they need to] follow through on those goals.

We saw it in all aspects. For example, AstraZeneca partnered with academia, Oxford, to make it happen. We partnered with a small biotech to make it happen. We partnered with FDA or EMA to approve the products. There was a lot of work and help from many so that they would be able to reach that level that we reached.

Klaus Schwab: I have to say, as an observer, when I look at your cooperation with BioNtech in such a setting, you feel that there must be tensions, but you always really acted as twins cooperating. Can you say something about that?

Albert Bourla: I think it is the best partnership we ever had. I think the trust starts from the top. Thank God, we bonded immediately with Ugur Sahin, who is the founder. And it is amazing because I'm Greek and Jewish and he's a Turk and Muslim. And I immigrated to the US and he immigrated to Germany. So there are common paths between the two of us. The first thing that we exchanged when we made the agreement was that it's going to be an oral agreement for the next couple of months because you don't have time to sign contracts. We started the work immediately. We started the work --

Klaus Schwab: In January?

Albert Bourla: We started the work in March and then we signed the contract after two months, which was only the research. The main contract, which was a commercial agreement to define billions basically of dollars, was signed in January 2021 after everything was done. All of that time, we were operating with the trust of our work. It doesn't happen in the corporate world.

Klaus Schwab: Now I come back to a technical question when you produce very complicated medicines. Some people say the knowledge is actually not intellectual property of some product it's the production itself. Could you say something about it?

Albert Bourla: I think that across the board. For example, we don't own, right now, for this vaccine, the intellectual property. It's BioNtech's, right? But we develop the manufacturing process to be able to do it. So all of that are things that count. And in general, I think that the mRNA technology is a very powerful technology. I don't think it's a panacea. I don't think it's the Holy Grail. I don't think that it will treat all diseases in the world. But I do think we have just scratched the surface of what we can see.

Klaus Schwab: How much of the mRNA technology protected by patents?

Albert Bourla: I think it's the Holy Grail. Without the protection, BioNtech would never have the money that they got from their investors to develop it. Without intellectual property. we would never have the money that we have because we everything we do, we do with other people's money. They're called the shareholders. They can tell us, "Put the money in new research" or "Give it back to us for dividends." I think the bloodline of the innovative industry, it is this concept that a property cannot only be bricks and mortar, it can also be intellectual property. And that's exactly what is happening in technology or biology. It's very important.

Klaus Schwab: Now this takes me to the next question: What drives you, actually? Is it scientific curiosity? You excluded all the material reasons. What drives what drives Dr. Bourla?

Albert Bourla: Me, personally?

Klaus Schwab: Yes. You, personally.

Albert Bourla: I like what I do. I like what we do because it's intellectually challenging, but also has the additional benefit that the success brings good to the world. It's very intellectually challenging to make a perfect cell phone, and that brings satisfaction to the world. And anybody should be very proud of being able to do it. But when you are helping to make a breast cancer medicine or lung cancer medicine, you are getting not only the satisfaction of what you want, but the satisfaction that the impact was saving lives. So that's something that in our industry people are feeling every day. It's not the same with the other industries.

Klaus Schwab: It's to some extent like my own 800 colleagues in the Forum, being driven by this feeling of improving the state of the world.

Albert Bourla: It's a very big, driver. And I'm certain that this this sense, this mindset, was what drove people to work day and night. And I'm talking about not 30 or 40 people. I'm talking about a thousand people in vaccine. Because for eight months, a four-digit number of people, they were not sleeping, literally.

Klaus Schwab: When asked to take on COVID-19 to produce your vaccines, it must have meant a major change of the company. I mean, you had traditional successful products and now suddenly you have an overriding objective. How did you manage this?

Albert Bourla: First of all. It was challenging, but COVID-19 drove very different behaviours. Let's remember that at the times that we're trying to develop a solution faster than a smaller biotech, that was a challenge for Pfizer, how to move fast because we are big, right? But these were days of darkness with no hope in the horizon. So people were afraid that the civilisation, the way we know it, could disappear. That was a tremendous weapon in my effort to convince everyone that we need to go about making the impossible possible, because there was a lot at stake. And then, surprise, surprise, they made the impossible possible.

Klaus Schwab: So the company was, before, to a certain extent, driven by the fear that the pipelines are running out. And now suddenly you had such a full pipeline.

Albert Bourla: Yes, but I have to say [this is also] because of the work of my predecessor. It's not that I came and I found a company that was collapsing. I found the company in the best shape one could give to another and I built on it.

Klaus Schwab: Now, if you look more to the future, do we have to expect prolongation of the pandemic, or at least the epidemic? How would you foresee the future? I may immediately ask a second question: Should we be afraid of another virus? And what does it mean to create the necessary resilience personally, nationally, globally?

Albert Bourla: On the first question, I don't think that the virus will disappear. We are not certain about it, but most scientists agree that the virus will be around forever. But the real question that everybody is asking is not this. It is, can we get our lives back? Can we live normal -- normal economic activity, normal social activity -- with the virus present? And the answer is yes. I think we can, absent a variant we have not foreseen right now. (That can happen, but it is not the most likely scenario).

I think we have the means right now -- as the virus mutates -- we have the ability to follow up and -- let's say -- update the vaccines and treatments. With that, people should not die anymore even if we are not following the way that we are following the social measures in the past.

Now, on the second question, sadly, we are afraid of a new and very different virus with the monkey pox. I don't think we should be afraid, but I think we should be prepared. And if we are prepared, I think science will win.

Klaus Schwab: Now, some people may argue, "why should I get vaccinated if there's a treatment." How would you respond?

Albert Bourla: Because I think the goal is not for you to get sick and then treat you. The goal is to prevent the sickness. And that will maximise your chances to do well and that will maximise the chances of people that you love not to get infected. You vaccinate not only for yourself. You vaccinate also to protect society and particularly to protect those that you love the most.

Klaus Schwab: In Switzerland, for those who do not know, there are no restrictions anymore. So we set a standard that we will require vaccination [for the Annual Meeting]. But what vaccinations [do we need in the future]?

Albert Bourla: That's a very good question. I think we will need vaccinations in the future. But also I'm concerned the compliance of the population with the recommendations of the experts will not be very high. Most people did the first dose and then less of the second and then a lesser the third and the fourth. And so for that reason, we need to find the solution that makes it easy for people to get. And I think the number one priority is to have a vaccine that lasts a year. So once people know that "once a year - I do it every autumn," for example, I think that will improve the amount of people that are getting the vaccine.

Klaus Schwab: There are also certain attempts to combine it with an anti-flu.

Albert Bourla: That is another good way to improve compliance. If someone thinks that I'm going to go to the doctor or to the pharmacy, but at least I will get two, that also will increase the number. It's very difficult to improve the efficacy right now. It's very, very high. But what you can improve it is how convenient it is and how can last the efficacy for longer periods of time.

Klaus Schwab: It's a question which I ask now as the audience is maybe not fair, but despite, let's say, no restrictions in Switzerland, we insisted on being vaccinated, being tested twice, and this may become a standard for future meetings anyway. I mean, if we are not getting rid of the virus. I can share with you that we had many internal discussions. Now the process to get approval, it's a very cumbersome process. Can you tell us: Do you feel governments understood your needs and reacted positively to your needs? Or would you recommend for the future any change in public private cooperation if you are confronted again with such a situation?

Albert Bourla: There are a lot of good examples, great examples. And there are examples that maybe we can improve for future situations. Always, the intention was very good. Now you ask about regulators. I think both EMA and FDA and most regulators, the UK regulators as well, I think they belong in that category that they did extremely well. I think they understood the situation. They sacrificed themselves also a lot. I know that preparing the final report, maybe 30 of our people couldn't sleep for five days and they would send and they would go to bed. And then the next day the FDA would start. 30 FDA people would not sleep for five days to review the data.

Klaus Schwab: Yeah.

Albert Bourla: Because usually it takes six months and now they were doing it in one week. So this was crucial for our success. We wouldn't be able to do what we did without this collaboration. There are some other examples -- in countries where there are multiple centres of of scientific authority, where they don't coordinate very well. And some happen also in the US., sometimes between NIH and CDC. And there was not, let's say, the most smooth collaboration. They are the first ones to recognise that this is happening. And I think they already announced that they are trying to find a way so that they can be better.

Klaus Schwab: When you get their conditional approval or preliminary approval, who is actually carrying the risk and liability?

Albert Bourla: Most countries -- they indemnified them. In the US and in Europe, was always clearly indemnified, so they are taking the liability, if there are lawsuits, for example, against that.

Klaus Schwab: So the government is taking the liability.

Albert Bourla: It is. There was some issue with the US and Europe were ready for that already. With a vaccine, we knew that there was a very fanatic group of anti-vaxxers that will go after us no matter what. They will claim that the sun didn't go up because people were vaccinated and that created issues with the crop. 'So I'm suing you.' And it is one thing to sue you in the US, another thing is to sue in a country where the legal system is not up to that standard. So I think that's behind us...and now I think we can move on.

Klaus Schwab: I think we were we were both targets of the anti-vaccine movements and conspiracy. People are claiming that I had "triple COVID." I wonder what it means, "triple COVID."

Albert Bourla: Mm hmm.

Klaus Schwab: I think it got hundreds of thousands of clicks and so on. I know you were also a target.

Albert Bourla: I read one day that I was arrested by FBI.

Klaus Schwab: Yeah, same happened to me.

Albert Bourla: And there are pictures. Pictures of me and FBI officers... The surprising thing is that the same publication I found out had published that the previous one who was arrested was the Pope -- by the FBI. So ridiculous.

Klaus Schwab: We are in good company.

Albert Bourla: Yes, at least I was in good company.

Klaus Schwab: With such a success with mRNA technology, how confident can we be that this technology will help in other diseases (such as cancer, particularly malaria)?

Albert Bourla: I think we will see a lot of advancements with mRNA. And the good thing after the success of the COVID vaccine is that right now we have a substantial wave of companies, biotechs and big pharma, that are working on mRNA. A lot. And they are working on multiple applications for mRNA. The first thing that I'm hopeful to see is other vaccines other than COVID: A flu vaccine with mRNA; A shingles vaccine with mRNA; And other vaccines with mRNA.

The second wave I think that we could see is cancer. There is a lot of research that has been happening for many years now trying to use your immune system to attack your cancer cells, to train your immune system as the vaccine that kills your cancer cells.

Then the third horizon in which the technology will be used is gene editing. If people are born with an untreatable and deadly genetic disease, we have some hope that maybe this technology also can work. So we will see a lot of advancements because so many people are working. We are working with that as well, on all of them, but there are also many others that it increases the chances that something will come out.

Klaus Schwab: You had to observe the COVID restrictions yourself. So how did you manage with so much to undertake such a great effort?

Albert Bourla: Yeah, actually, it's a very good point. And you need to know that we have some other heroes in Pfizer, but they didn't become so famous. They are the people that are working on all our injectable and hospital products. We are the largest supplier of injectable products in the world. And suddenly with COVID, we saw that demand was growing for some medicines that were needed in ICUs, from 50 to 500 times. And we had to manage this uptick in supply while we had to operate the manufacturing sites under COVID conditions. So very strict: Who goes in, who goes out? I'm very proud of what they were able to do.

Klaus Schwab: Did you have a problem with one part of the company engaged in such an exciting exercise and then another more traditional part? There have been a cultural tension between the two parts. How did you manage it?

Albert Bourla: I'm trying to teach the others that you have your moment and your concert theme. You saw what the vaccines team did. So now is your time to shine. Bring us the cure. And they do. Vaccines were one of six business units of Pfizer. And the other five were watching them doing their thing. And they were also wanting to have their moment. And the second one was the infectious disease unit that did the treatment, and I'm sure the other are working on that as well.

Klaus Schwab: If you're taking all your experience now - and you see many CEOs sitting in the room - what would be your message to them based on your personal experience?

Albert Bourla: I think the biggest lesson for me was that people -- they don't know what they can and cannot do in their lives. And if you set the bar high, if you give them very high, ambitious goals, and trust in the resources, you will be surprised how much they deliver.

Klaus Schwab: Now I add a question. You must have had some doubts yourself because it's such a public expectation level. How did you manage this tension over such a long time?

Albert Bourla: It was tension for all. And the truth is that the CEO is in a lonely position because there's no one to stop you if you make a mistake. This means the buck stops with you there and you are responsible for everything, right? But I felt that what really gave me drive was that we didn't have any option here. What was the option -- not to do it? And then why have the world die? If Pfizer didn't engage full speed in something like that, with all hands on deck, when the world was needing something like this, who would do it? So it was very clear: That's what we have to do. When you understand what is at stake, you know that if you lose three billion, it would be painful, but it's not going to be the end of the world. But if we don't find the solution, it's going to be very painful for all.

This interview was edited for clarity.