Monday 27 September 2021
It’s been said often enough: the pandemic has been like a war. Economically, on civil liberties and the deaths it has caused, it’s hard to find a better comparison. And just like a war it places responsibilities on companies that make vital supplies which are different from peacetime – to profit, but not to profiteer
The Arms Race: What next?
We recently held a special ThinkIn on #TheArmsRace, where the campaign’s coalition partners cast their verdict on Biden’s emergency vaccine summit.
Ceri Thomas, narrating: One day, I suppose, we’ll get round to striking campaign medals for conspicuous service or gallantry in the war against Covid. And the people who gave us the only bullets that work – vaccines – will be able to step forward for whatever the equivalent will be of their George Crosses and Medals of Honor, and puff their chests out with pride. And the rest of us – quite rightly – will wipe grateful tears from our eyes and applaud.
It’s been heroic, the vaccine effort. Nothing short of that. And uplifting. That whole army of scientific researchers, small vaccine start-ups and massive global drug companies. In the early days, it seemed, not fighting for scraps of market share but just trying to make a vaccine that worked. Like Christmas in the trenches, it’s tempting to think. Old pharmaceutical rivals – British, Americans, French, Russians, Germans – united. For a time anyway.
Well up to a point.
Even when some clouds started to drift across that heart-warming scene – when we woke up to the fact that the sharing out of vaccines across the whole world was just hideously unequal – it was governments who got it in the neck. The G7. It was their short-sightedness. Their lack of ambition. Their perhaps-understandable greed on behalf of their own people.
And that’s probably the way things are mostly understood right now. The world’s being let down by a terrible failure of global leadership.
And meanwhile, the people who make the vaccines have got their heads down, their white coats on, and they’re just churning out medicines as fast as they can and sending them on their way.
For a few months now, if you’ve had the chance to keep your ear to the ground, there’s been a growing rumble. A sort of murmur of discontent which says that – of course – governments have made the wrong calls about supplying vaccines to developing countries. But don’t fall for the idea that the vaccine manufacturers are blameless. Or that they’re all playing nicely. Or fairly.
I’ve talked to people who are trying to secure vaccine doses for the world. I’ve talked to academics, politicians, vaccine manufacturers, to try to understand what they’re unhappy about. And they all – quietly and carefully, I have to say – point in the same direction.
The first company in the world to license a vaccine against Covid-19; an unbelievably brilliant vaccine. A company which has saved lives which I couldn’t even begin to count.
And this – I promise you – is the most generous thing any of the people I’ve talked to has found it in their heart to say about the way Pfizer has behaved.
“They’re a bunch of shitbags. They’re not the only ones, but they’re cleverer than the rest.”
I’m Ceri Thomas and this is the story of Pfizer’s War.
Ceri, narrating: The story I’m going to tell is about responsibility. In the end, the accusation against Pfizer is that it’s been irresponsible.
And the charge sheet says this.
That a Pfizer board member said things about other vaccines – especially the one made by AstraZeneca – which he should have known – or must surely have known – weren’t true.
In the midst of a pandemic, with a torrent of misinformation rushing round the world and vaccine hesitancy growing, that seemed to some people like a piece of craziness. It led to suspicions that Pfizer was prepared to go to extraordinary lengths to win orders for its vaccine.
But not any orders. Orders at the price rich countries were willing and able to pay. Not at the much lower price they could afford in the developing world.
So a suspicion took hold – very hard to prove – among people who were trying to buy doses of vaccine for some of the poorest and most desperate countries on earth, that Pfizer had an unspoken strategy of stringing them along. Making as much money as possible from the rich folks at the front of the queue before it turned to the poor people at the back.
The drug companies aren’t clones. They’re in the same line of business but there are real cultural and philosophical differences.
AstraZeneca is the British-Swedish company which got into bed with Oxford University. And, famously, agreed to sell its vaccine at cost price for a time, anyway.
Now I’m told it found that culturally quite an easy decision to reach.
But the idea of selling at cost price probably just wouldn’t have computed for the big American companies – like Pfizer and Johnson & Johnson. As someone said to me, that’s because American people – not just drug companies – take the attitude that, “There’s a crisis coming. Let’s make as much money out of it as we can”.
So, there was no real pressure from the public – and certainly none at all from shareholders – to suddenly become a kind of not-for-profit.
And all that means the criticisms of Pfizer are nothing to do with it making money from its vaccine. Everyone always knew it would do that.
The questions are about how it’s done it. How aggressively. How responsibly. How equitably. And whether it’s been content to stick to promoting its own vaccine, or sometimes set about trashing other people’s.
It’s going to be a common theme of this podcast that Pfizer denies all of that – any suggestion that it’s been too aggressive, irresponsible, or tried to damage the reputation of other vaccines. Pfizer told me their approach from the start has been to deliver breakthroughs that change people’s lives – centred on the principle of collaboration. The only rivals the industry has faced, they told me, are time and the virus itself.
But one of the most eminent figures in the international vaccine effort looked across the landscape for me. Novartis, Merck, Roche, Moderna: companies like that, he said, were “sensible…corporate. They understand their duty to society”.
But Pfizer, he reckoned, was ”an outlier, a blip”. And then he paused for half a second. They’re really “an extreme form of rapacious capitalism.”
Now, just to be clear, the person who said that isn’t a beardy graduate of the Cuban healthcare system. Down the years, some of his own critics might even have called him a rapacious capitalist, or something close to that.
No, actually – this is an argument – and that was criticism – from within the corporate pharma and vaccine family. And a few of the family members have made the obvious point that if you want to understand how Pfizer has operated through the pandemic, you have to understand the sort of shape it was in when it went into it.
The moment which tells you most clearly about the kind of company the modern Pfizer was going to turn into came in the year 2000.
ABC News: Pharmaceutical mega merger has hundreds of workers at Warner Lambert in New Jersey worrying about losing their jobs.
Ceri, narrating: Almost exactly 20 years before the search began for a vaccine against Covid.
ABC News: Warner Lambert has been taken over by Pfizer for 90 billion dollars. The merger creates the second largest drugs company in the world. Job cuts could come as Pfizer tries to save a billion and a half over the next two years.
Ceri, narrating: The merger with Warner Lambert catapulted Pfizer to the top of the tree. Not just the second biggest pharmaceutical company in the world but very quickly the biggest of all.
The game-changer, in a word, was Lipitor. An anti-cholesterol drug which came on board with Warner Lambert and sold by the billion-dollar-bucket-load for the next decade – until it fell out of patent in 2011.
But the most interesting thing about the merger was the pattern it set. In the risky world of pharmaceuticals, Pfizer set about charting a steady course. It focused a lot of time and energy on making drugs which were incremental improvements to ones that were already on the market. Not game-changers.
It reduced the percentage of its revenue that it spent on research and development – a lot of that money ends up going down the drain – and started buying up mid-sized companies which had already developed a successful drug. Safe bets.
It did that with a company called Wyeth and its pneumococcal vaccine in 2009 (and that’s still one of Pfizer’s biggest earners) and with Upjohn which it bought in 2003 along with its drug Sutent. Another billion-dollar-every-year banker.
The strategy meant that, among the analysts who pick stocks and make recommendations to investors, the verdict was that Pfizer had become an ‘underwhelming’ sort of prospect. Solid but unexciting.
In the scientific research crowd and among its commercial rivals, the verdict was slightly tougher.
Pfizer became known for having an eye for an opening rather than both eyes on the biggest medical prizes out there.
Over the decade from 2010 to 2020, Pfizer’s strategy was modestly successful. It trod water.
And maybe ten years of doing that can start to feel more like drowning if your rivals are swimming away from you?
And then along comes a crisis like the pandemic, which is also a lifeline. And if you’re Pfizer and you’ve got a keen eye for an opportunity, what are you going to do?
For a few months, a slide presentation has been doing the rounds. I’ve tried to figure out exactly when it was first shown, but it’s not completely clear. I think it may have found its way first to a person at Johnson & Johnson – that’s what someone told me – and I know people at AstraZeneca have seen it.
It’s from a presentation about vaccines which was given in Canada and it’s got the kind of title that’s always stuck on that sort of thing: “New Horizons In The Global Pandemic”.
The story went around AstraZeneca and Johnson & Johnson that it had been written by Pfizer and presented by one of their sales reps. But it looks as if they got that wrong. Pfizer have told me that they got “numerous requests from Canadian health professionals” for information about vaccines. So they funded the programme which this slide was part of – but they didn’t have any hand in writing it.
The unusual thing about this particular slide and the reason it’s been passed around between other vaccine manufacturers and caught the eye of Astra in particular – is that it doesn’t talk about Pfizer’s vaccine, it talks about the type that AstraZeneca is making.
As you probably know by now, Pfizer’s is an mRNA vaccine. AstraZeneca uses an established, older technology called viral vector. And this slide is all about the pros and cons of viral vectors.
It’s got a column labelled ‘Advantages’ with two entries. It credits the long track record of viral vector vaccines and the fact they can create a strong antibody response. Which is fair on both counts.
But in the ‘Disadvantages’ column there are six entries. The language is technical, but the message is tough.
What it says, among other things, is that vaccines like AstraZeneca’s are really difficult to manufacture at scale; they work patchily (they have what’s known as ‘variable immunogenicity’); they can cause ‘inflammatory adverse events’; they aren’t suitable for people with compromised immune systems. There’s even a risk of ‘oncogenesis’ – the process that turns healthy cells into cancer cells.
For people at AstraZeneca who saw this slide, this wasn’t just a glass-half-empty view of their jab, it was a bucket of half-truths and lies.
I asked someone who’s pretty eminent in vaccine development about the Pfizer slide, and if any of the claims on it was particularly beyond the pale.
“Actually they’re all pretty outrageous”, he said. There’s no risk to people with compromised immune systems; no evidence of variable immunogenicity.
But when I twisted his arm he did have a winner. The oncogenesis idea. That shows a complete misunderstanding of viral infections, he said. It might even beat the crazy piece of Russian disinformation that the Astra vaccine could turn people into monkeys.
It says something about how relationships between the vaccine manufacturers were going that people involved in more than one of them saw that slide presentation and assumed Pfizer had written it. And it was one of a growing number of incidents that made Astra hyper-sensitive to the sound of every snapped twig and catcall in the jungle where it began to feel it was operating.
And with their ears pricked up, Astra could hardly miss a man with a megaphone on a big US TV channel.
Montage of news clips: Joining us right now for more on this is Dr Scott Gottlieb… Dr Gollieb… Scott Gottlieb former FDA commissioner… welcome back Dr Gottlieb good to have you…
Montage of Scott Gottlieb speaking: Well look, Pfizer could be in a position to file very quickly… We could be in a situation within a couple of months where’s there’s going to be ample supply of vaccines… Pfizer, the company I’m on the board of, is studying this right now… so far the data is looking very encouraging… AstraZeneca’s been very particular over how they’ve wanted to present their data I know their CEO has been as well so I’m going to reserve commenting…
Ceri, narrating: All those clips came from one US business channel – CNBC. When the pandemic struck, they gave Scott Gottlieb a sort of bully pulpit. He was on – literally – every day.
CNBC: He’s been with us almost every morning for the last year.
Ceri, narrating: He’s got a great calling card as an expert on vaccines – until a couple of years ago he was in charge of the massive regulator the Food And Drug Administration, which licences vaccines in the United States. He’s still young; he’s not even 50 yet. He’s got slicked-back black hair like an extra in a Scorsese film. And a sort of machine-gun delivery of killer facts.
He’s also – as, to be fair to them, CNBC have mentioned every time I’ve watched Scott Gottlieb on the channel – a non-executive member of Pfizer’s main board. He gets paid by them, not in the millions but in the hundreds of thousands of dollars a year.
For months, through those TV appearances and by tweeting as if it was going out of fashion, Scott Gottlieb did to AstraZeneca what those Covid test swabs have done to the rest of us.
He got right up their nose.
He was taking potshots at AstraZeneca, someone told me. He was doing things you’re just not allowed to do as a board member of a rival company; saying things about the Astra vaccine that they said, “just aren’t acceptable”.
And then – on 14 February this year – this happened. Breaking point.
Margaret Brennan, CBS: You heard the British prime minister stand by his decision to continue vaccinating his population with AstraZeneca’s vaccine even though it has shown itself to not be as effective in early trials against the South African variant, the WHO sticking with it too, is that a mistake?
Scott Gottlieb: Well I think if we’re going to do that we need a plan B. I understand why they want to do this, they’ve manufactured a lot of this vaccine, it’s cheap, it’s accessible, it can be put into low and middle income countries because of the handling requirements, it doesn’t require complicated cold chain storage, but if you’re putting a vaccine into those markets that we know does not cover B1351, the South African variant very well if at all, you have the risk that you could select for that variant in those markets and so you need a plan B on what vaccine you’re going to deploy to those regions, if in fact B1351 becomes prevalent in those regions after you vaccinate with the AstraZeneca vaccine.
And the problem is you may foreclose the one vaccine that’s the most likely candidate in those markets which is the J&J vaccine because it has very similar storage requirements, you would want to use that vaccine. But in fact the AstraZeneca vaccine is very immunogenic against the vaccine effectors so what they’re using to deliver the Covid gene sequence is a chimpanzee adenovirus and it turns out that that adenovirus that they’re using is very immunogenic it creates antibodies that can attack other adenoviruses including perhaps, and we don’t know this for sure but perhaps the J&J vaccine.
So you might foreclose the opportunity to use that vaccine in these markets which means you need another plan B which might be the mRNA vaccines like the vaccine that Pfizer produces, the company I’m on the board of, but those vaccines are harder to handle in those markets because they require more complicated cold chain storage. So we need to work this out right now.
Margaret Brennan, CBS:That’s a pretty big warning.
Ceri, narrating: Some of what Scott Gottlieb said might have seemed quite technical. But – as you’ll have noticed – it wasn’t so technical that the presenter of the programme missed it. She was right. It was “a pretty big warning”. And it went off like a bomb in AstraZeneca’s headquarters.
If you pick the bones out of Scott Gottlieb’s argument, what he said was that AstraZeneca’s vaccine didn’t work very well – “if at all” – against the South African variant, which was the great global worry back in those days before Delta came along.
“We know that,” he said.
Scott Gottlieb also speculated that if Astra’s vaccine got overrun by the South African variant, you might not be able to turn to the Johnson & Johnson vaccine instead. Because the Astra vaccine might actually have turned people’s immune systems against it.
So you had to have a Plan B. And what was Plan B? Well it was Pfizer’s vaccine – the one made by the company, as Dr Gottlieb said, whose board he sat on.
Three days after Scott Gottlieb’s TV appearance – on 17 February – a letter went out. From AstraZeneca’s general counsel Jeff Pott (their in-house legal adviser) to his opposite number at Pfizer, Doug Lankler. Here’s some of what it said:
Letter extract: “Dr Scott Gottlieb who was an FDA Commissioner, currently on the board of Pfizer, appeared on Face The Nation on CBS News on 14/2/21
During a nationally televised interview, Dr Gottlieb made false, misleading, speculative and derogatory statements about the AstraZeneca vaccine. They are unsupported by evidence and misrepresent data from the studies.
As a director of the Pfizer board, Dr Gottlieb’s statements are directly attributable to Pfizer, and Pfizer is responsible for harm caused by his statements. His inaccurate and unsupported comments have caused harm to AstraZeneca. They have also caused confusion and misimpressions that pose a serious public health threat around the world.”
Ceri, narrating: It’s not a particularly hard letter to grasp. And it’s a stand-out
It’s not every day that one of the world’s great Covid vaccine manufacturers accuses a board member of another of posing a serious public health threat around the world – in the midst of a global pandemic.
The gloves were off.
I asked Pfizer, of course, how they’d responded to the serious charges that AstraZeneca had put to them. The charge that, because Scott Gottlieb is a Pfizer board member, what he said was directly attributable to them – and that it posed a public health threat around the world.
They didn’t have a great deal to say except they wanted me to note that Dr Gottlieb is what they called an experienced scientist and public health official. He retains his independence in his public engagements, Pfizer told me, “including the example provided”.
We’re in a world where it’s hard to draw direct lines between the kind of things Scott Gottlieb said about AstraZeneca’s vaccine and the way the world reacted. But he threw his penny’s worth in at a particular time – when countries were beginning to turn against Astra’s jab.
A couple of weeks before Scott Gottlieb went on Face The Nation, Germany had stopped giving AstraZeneca vaccines to people over 65. Just a day after that, President Macron of France said it was “quasi-ineffective” in that age group. Misinformation was racing through the corridors of power.
As if to emphasise how all over the place the authorities were, six weeks after Germany banned the Astra jab for over-65s, they flipped. Now they said it could only be used for over-60s.
By mid-March, news was starting to emerge that AstraZeneca’s vaccine caused – very rare – blood clots. For a time, the list of countries which stopped using it altogether read like this:
Austria, Norway, Denmark, Thailand, Iceland, Romania, the Democratic Republic of Congo, Bulgaria, Indonesia, Ireland, The Netherlands, Slovenia, Portugal, Sweden, Latvia, France, Germany, Cyprus, Luxembourg, Italy, Spain.
I want to stand back from all this for a moment or two. Because it’s a cliche – or maybe it’s a truism – of British journalism that, as night follows day, we build people up to knock them down again.
I’m conscious of at least trying not to fall into that trap about the vaccine effort and Pfizer. You could count on the fingers of one hand – maybe on one finger of one hand – the number of human endeavours which have ever been so astonishing and so consequential.
So when – and this is what happened at Tortoise – you start to hear grumbles about one of the companies involved, it feels like the right thing to do to ignore the noise for as long as you can.
But what happened, over time, was unmistakable. The grumbles about Pfizer got louder – and they started coming from everywhere.
Yes, from some of Pfizer’s commercial competitors – so, take those with a pinch of salt. But from UN agencies, too. And from the public-private partnership trying to get vaccines to poor countries. From Switzerland, London, New York and the African Union, from academics and public health workers.
Often, they were coming from people who were actually frightened of Pfizer. Frightened of damaging their relationship (which is not a good relationship or they wouldn’t be speaking out) with a company that holds in its hands the power to do so much good. That’s why you haven’t heard – and you won’t hear – any Pfizer critics quoted directly in this podcast.
In the end it all got too loud to ignore. So I’m trying to find a way here to measure the volume of the complaints against the astonishing, consequential success that Pfizer’s been part of.
From the moment they struck a deal with the German company BioNtech to take their technology and create not just a Covid vaccine but a type of vaccine the world had never seen before, their track record has been amazing.
The brilliance of the technology has given us a vaccine which is more effective against Covid-19 than anyone dared to dream – one of the very best there is. The manufacturing of it has, mostly, been a piece of genius, carried out with a level of commercial skill and energy which is close to awe-inspiring.
If you run a company which holds one of the keys – one of the really big ones – to ending a pandemic, what does that do to the balance of your responsibilities?
If it’s not a straightforward commercial game because humanity – all of it – needs the medicine you’ve made, does it place you under an obligation to re-do that calculation between the bottom line and the common good?
That’s where we are with Pfizer. That’s the question.
That question about the common good – well, after a bumpy start when a lot of European countries weren’t getting the supplies they wanted – that’s really come down to the share of vaccines that’s going to the developing world.
And, obviously, that was always going to be tricky. Vaccine doses were about the most precious thing on the planet. For a long time there weren’t nearly enough of them to go round. And developing countries couldn’t afford to pay full whack.
So in the spring of 2020 Covax was set up, with parents that included big UN agencies like the World Health Organisation and UNICEF, and other groups like GAVI and CEPI that had been lobbying for vaccines for poorer countries and trying to get the world ready to face the next pandemic, whatever and whenever it was.
Covax had one job, which was to give poorer countries the best chance of getting safe and effective vaccines as quickly as possible. It pays for vaccines, but at a heavy discount against the price in the US or the UK, for example. What’s known as ‘tiered pricing’. Everyone is understandably cagey about saying how big the discount is, but it might go as high as 75 percent.
At first – in the afterglow of the moment when Pfizer published the test results which proved that its vaccine worked so brilliantly, and got it licensed – Covax felt showered with warm words and good intentions.
Albert Bourla speaking on CNBC: “We are, of course, in discussions with Covax facility and offer to the Covax facility to provide our vaccine to the low income countries – these are the poorest countries of the world – at the non-for-profit base.
Ceri, narrating: That’s Pfizer’s chief executive, Albert Bourla, in early November 2020. About a month before the first Pfizer/BioNtech jabs were going into people’s arms.
So it’s quite a journey – isn’t it? – from that apparent warmth and generosity to “shitbags”.
At first, as you can imagine, Albert Bourla’s words were greeted with real excitement at Covax: “Of course we wanted to work with them,” they told me.
There was a dash of realism in the mix, too, because Pfizer’s vaccine has to be stored at ultra-cold temperatures. So Covax, which wanted to buy on behalf of low-income countries, was never going to rush to sign billions of doses for countries where ultra-cold chain capacity would be difficult.
But there was real promise in the air.
It didn’t feel like that for long.
Now, to be fair, Covax has had scratchy dealings with a lot of vaccine manufacturers. Maybe all of them.
Most often, the road to Covax’s little corner of hell has been paved with good intentions. Over-promises and under-deliveries.
And in an odd way, the pattern of over-promising-and-under-delivering means there’s a sort of grudging, back-handed respect for Pfizer’s bluntness. As someone in the global vaccine effort said to me, “They’ve always been scrupulous in telling us how little we’d get from them.”
The negotiations between Covax and Pfizer that began after Albert Bourla fired the starting gun in November dragged on for months. Until late January with Covax. And the middle of February with UNICEF who were going to take care of the ultra-cold chain.
And after all those months – and an uneasy feeling at Covax sometimes that they were being deliberately messed around with long, long gaps while they waited for Pfizer’s next move in a negotiation – that kind of thing – there was a number to announce.
Pfizer was going to supply Covax with 40 million doses of its vaccine. It was – as someone involved said to me – “a paltry amount”. A fraction of one percent of the number of doses the developing world needs.
And even getting to that paltry figure, the persistent feeling at Covax – the feeling which took hold in those early negotiations and never went away – is that Pfizer deliberately stalls.
Someone put it to me like this, “Racking up the deals with the rich countries at a higher price, and using the fact that they were giving us a lower price to ratchet up the tiered pricing for wealthier countries. That was our strong suspicion. Still is our strong suspicion. The whole pattern is kicking the can down the road.”
Now stalling is a hard thing to prove. Maybe there’s a memo somewhere which says that was Pfizer’s strategy – but if it was the strategy it wouldn’t be a very clever thing to write down, so I doubt it. And I certainly haven’t seen it.
What I do know is that Pfizer vehemently deny dragging their heels. They say their vaccine has reached more than 130 countries and territories in every region of the world, and they’ve promised to send two billion doses to low and middle income countries by the end of next year.
But inside Covax, inside the World Health Organisation, in other manufacturers, they’re just as vehement. Everything they’ve seen happen at all with Pfizer – every negotiation, every delivery – has happened slower than made any sense. And they’ve run out of ways to explain it.
If stalling is a hard thing to prove, some others – fortunately – are easier. Like how many doses of vaccine are in every vial of it that jostles its way off a production line.
In January this year, Pfizer sprang a small surprise on the world. A good one.
Scott Gottlieb on CNBC: The bottom line here is that this is a very scarce resource. We need to make sure that every dose gets used. The only way to do that is to market this as a vial that has six doses and provide the proper equipment to extract that six dose which, in fact, Pfizer is doing.
Ceri, narrating: Pfizer may have known for months that it could squeeze six doses out of every little bottle of vaccine, but it had been negotiating with Covax on the basis of five.
And to Covax’s astonishment, when the news came through that, actually, it was six, Pfizer upped the price. They told me that’s in line with their existing agreements: they’re all based on the number of doses not vials.
But for Covax, the new price caused two problems. The money one, obviously. But it also set the procurement negotiations back – and some people in the organisation thought that was as much of an issue as the cost.
Like anyone else who’s never been involved in complicated negotiations to buy doses of vaccine for the world, there are moments like this when I find it hard to figure out what’s normal.
Should I expect a big pharmaceutical company to ask the world’s poorest countries to pay more for what, of course, is the same amount of liquid in a bottle once they’d figured out that it could deliver extra doses? Cost-per-dose is exactly how we normally figure out the price of a vaccine – so maybe that’s OK.
So I rang someone who has done those kinds of negotiations before – or something similar, anyway – and told him what had happened.
I can still hear him belly-laughing at how terrible – how not normal – he thought Pfizer’s decision had been.
Nearly everyone I’ve talked to about Pfizer at the UN or in that effort to get vaccines to low-income countries has started the conversation in the same way.
First they go off the deep end about Pfizer. And then they apologise. I’ve lost count of the number of people who’ve said they’re really sorry – they don’t have a smoking gun.
What they have – as you’ve heard – is an uneasy feeling that things are happening which are hard to explain.
Some of their suspicions about what Pfizer – and actually other companies – have been up to behind the scenes are misplaced, I’m sure. There’s really nothing like a pandemic to make people a bit paranoid.
And the sense of powerlessness that some of the agencies feel, up against the might of multi-billion dollar corporations – well, perhaps it feeds a belief that there are hidden powers at work.
Which is a challenge to reporting, of course. Lord knows, if you want suspicion, paranoia, and hidden hands, you’re well catered-for on the internet these days.
There’s a way of doing PR which, recently, people have started calling pitch-rolling. From cricket: where you can prepare the pitch in a way that suits your batting or bowling and gives you a better chance of winning.
Same in PR. You prepare public opinion ahead of time so your argument is half-won before you even make it. That’s what people who are trying to get vaccines for low-income countries think is happening – about whether or not those countries can handle vaccines that need ultra-cold-chain storage: Moderna and Pfizer.
The catch-phrase for the idea that poor countries can’t deal properly with those vaccines has become “absorptive capacity”. How capable they are of ‘absorbing’ vaccines that need to be kept really cold.
If you talk to people in and around Covax – in spite of the difficulties – they say they’re building that capacity really well. Since the US government promised, back in June, to supply 500 million doses of Pfizer, a massive effort has gone in. It’s been the fastest roll-out of ultra-cold-chain technology in history. And after all, the ebola vaccine needed the same handling in some of the most difficult terrain on earth, and that went OK.
And then the phone rings, and it’s someone who’s had a tip-off and wants to know why Covax is “really far behind on its cold chain.”
Pitch-rolling, they think in Covax. Massaging public opinion to create a belief that it’s not worth big companies selling precious vaccines to poor countries – at much lower prices than in advanced economies, by the way – because they wouldn’t be able to look after them properly.
It’s quite obvious whose interests it would be in for that idea to take root. But that’s no help at all in figuring out if the pitch is really being rolled – or who might be rolling it.
Let’s head back to solid ground. Covid has taken us into a world of hard numbers. Death tolls, infection rates. All the grinding, daily evidence of a pandemic.
Vaccine numbers can be less straight-up-and-down because they’re often a mish-mash of what’s been delivered, what’s been fully agreed, and what’s been promised.
And the promises are sometimes extravagant and a long way off – right up to the end of next year.
So it’s that first category which interests me. What proportion of all the vaccine doses actually delivered around the world has Pfizer been responsible for? And what proportion of the ones that have gone to Covax?
The difference between the two might be telling. And there is a difference.
Roughly speaking, so far, Pfizer has delivered about a quarter of all the vaccine shots around the world. And about one in seven of the ones that have gone through Covax to poorer countries.
In the world of promises rather than deliveries, Pfizer have told me things are beginning to change. They said they expect their supplies to tilt in favour of low and middle income countries in the second half of 2021.
But Pfizer’s relative under-delivery to Covax so far is an interesting contrast with Moderna which is the other vaccine which needs to be kept ultra-cold.
Relatively speaking they’ve delivered a higher percentage of doses to Covax – to poorer countries – than they have to the wealthy people of the world.
It can be done.
The interesting thing about making this podcast now is that, suddenly – literally in the last few days – there’s real optimism that something big may be on the horizon. For whatever reason – perhaps it is the pressure from all the people I’ve talked to – they hope that Pfizer might be about to turn up to the party.
On top of the half a billion Pfizer doses that Joe Biden announced at the vaccine summit last week, there’s talk of something perhaps even bigger. And maybe direct from Pfizer itself, rather than through an intermediary like the US government. Either way, we’ll know soon.
If Pfizer does turn up, it’ll be able to afford to arrive in style. Because the other numbers which are worth watching are what the vaccine has done to Pfizer’s financial prospects.
Last year, Pfizer’s turnover was about $50 billion. It’s expected to make in excess of $60 billion this year and next from the vaccine alone. In each of those years its revenues from the vaccine will be greater than the entire turnover of AstraZeneca.
It’s a shot in the arm for Pfizer just like it’s been for us – and one that wears off. The consensus is that the Covid vaccine isn’t going to be like Lipitor. It’s not going to lay golden eggs every year for decades to come. If they want to make the most of it from a financial perspective, it’s the first two years that matter.
When activists and lobbyists put the word Big in front of an industry we know what they mean. They mean Bad.
And for Big Pharma, there was a strong whiff of redemption in the air when the world realised its only route out of the coronavirus pandemic – without untold millions of deaths and unbearable economic damage – was a vaccine programme delivered at a speed we’d never seen before.
The smell isn’t quite so sweet now. More like a battlefield than a perfume factory, for all the wonderful successes.
Pfizer has battled hard. It’s won its war on behalf of its shareholders. But if it wanted to burnish its reputation, more than its finances, then it feels like it’s lost. It’s shot itself in the foot.
In the world of vaccine-makers, among the logistics experts and activists and health specialists in the global vaccine effort, north and south, Pfizer has won an unenviable standing. As a company with a beady eye on the bottom line and a blind-spot for the common good.
This is a statement sent from Pfizer in response
When Pfizer rolled out its five-point plan in March 2020, it was built with our values and purpose in mind – to deliver breakthroughs that change people’s lives – and it centred on the principle of collaboration.
We recognised that no one company could combat this virus successfully alone; that it would take the combined resources and expertise of us all to bring this public health crisis to an end.
We continue to recognise that while companies may have pursued separate paths to significant scientific discoveries, all these efforts have been important in combatting this devastating disease – the only rivals the industry has faced are ‘time’ and the virus itself.
We refute any suggestion that Pfizer has sought to undermine others’ scientific endeavours. Our priority has always been getting high-quality, well-tolerated and effective vaccines to patients all over the world as quickly as possible and to help put an end to this deadly pandemic.
Regarding Dr Gottlieb, a non-executive member of Pfizer’s Board of Directors, it should be noted that Dr Gottlieb is recognised as an experienced scientist and public health official. He retains his independence in his public engagements, including the example provided.
You reference a presentation that we believe has been wrongly attributed to Pfizer. Following the authorisation in Canada of the Pfizer-BioNTech COVID-19 mRNA Vaccine (BNT162b2) (December 9th, 2020), Pfizer received numerous requests from Canadian health professionals for information. To help address this need Pfizer provided financial support to a third-party agency to create an “Other Learning Activities” (OLA) programme for health professionals. The programme, including the presentation you reference, was designed with support from an external independent scientific committee and programme reviewers. Beyond the funding, Pfizer was not involved in the creation of the programme and did not influence programme content or delivery.
Fair and equitable distribution was our North Star from day one. Pfizer-BioNTech have been transparent about the tiered pricing structure in place for high, middle, and low/lower-middle-income countries. High and middle-income countries will pay more than low-income countries, but at a value that is significantly discounted from our normal benchmarks, during the pandemic. Low and lower-middle-income countries pay a not-for-profit price.
As explained by our CEO in an open letter published May 7, 2021, when we developed our tiered vaccine pricing policy in 2020, we reached out to all nations asking them to place orders so we could allocate doses for them. Some countries decided to place initial orders with other vaccine makers. Several of the countries that did not choose us initially have reopened conversations and we have started signing supply agreements with them.
Pfizer did not delay conversations with COVAX. We signed an agreement with COVAX for the supply of 40 million doses through 2021 on January 22 and have subsequently taken further steps to expand access. We have pledged to provide 2 billion doses of our COVID-19 vaccine to low/lower- and middle-income countries in 2021 and 2022 – 1 billion doses each year. As part of this pledge, Pfizer and BioNTech will provide 1 billion doses at the not-for-profit price – deliveries of the initial 500 million doses began in August 2021, with the second 500 million expected to be delivered by the end of September 2022 – to the U.S. Government to support multilateral efforts to address the surge of infection in many parts of the world. The Government will, in turn, donate the doses to the 92 COVAX Advanced Market Commitment (AMC) countries as well as the member states of the African Union that are not already part of the AMC 92.
To date, our vaccines have reached more than 130 countries and territories in every region of the world.
We have remained open about the challenges associated with managing this global vaccination effort. As we work to ensure equitable distribution, and countries become better prepared to receive, distribute and administer the vaccine, we expect the supply balance to weigh in favour of low/lower-middle income countries in the second half of 2021.
We have also continued to advise regulatory authorities, public health bodies and governments on additional data supporting our vaccine and its use. For example, our initial regulatory submissions proposed five doses per vial and did not specify the type of syringe and/or needle (low dead space (LDS) or standard) that should be used. We subsequently submitted the appropriate information to regulators to support the label changes with use of LDS syringes and/or needles. Obtaining six doses from the current multi-dose vial by administering with LDS syringes and/or needles can help minimise vaccine wastage and enable the most efficient use of the vaccine. This enabled countries to vaccinate more of the eligible population each month and complete vaccinations in a shorter period.
Throughout we have fulfilled our supply commitments in line with our existing agreements – which are based on delivery of doses, not vials – and in accordance with locally approved labeling.
In conclusion, Pfizer and our collaborator, BioNTech, achieved our goal of creating the first COVID-19 vaccine to receive Emergency Use Authorization from the U.S. Food and Drug Administration (FDA) in December 2020 – and we were thrilled when other companies’ vaccines were subsequently authorised as well. Together with our industry peers and the cooperation of the broader global health community, we’ve helped protect more than 2 billion lives around the world and counting. With more than 1.5 billion doses delivered to date, our vaccine has saved millions of lives worldwide and allowed countless numbers of people to avoid the devastating experience of being hospitalised for COVID-19 – an accomplishment that continues to make us all immensely proud.