Albert Bourla: Pfizer CEO | Lex Fridman Podcast #249

1. 0:00 – 3:43

   Introduction

   1. LFLex Fridman0:00

      The following is a conversation with Albert Bourla, CEO of Pfizer. If you would 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 and that the government will hurt you, the company will hurt you, the science, the authorities, the experts, the institutions will hurt you. Both groups have the benevolent and the malevolent, their heroes and their charlatans. And I think the hard truth is that no 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." This is a Lex Fridman podcast, and here's my conversation with Albert Bourla.

2. 3:43 – 19:47

   Clinical trials

   1. LFLex Fridman3:43

      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.

   2. ABAlbert Bourla4:06

      I hope so.

   3. LFLex Fridman4:07

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

   4. ABAlbert Bourla4:14

      We had assembled in a very small office that we are having in Connecticut, very few people. There were five, I think. And, uh, in, in another place, what we call the data monitoring committee, which is a group of experts, independent experts, they aren't Pfizer, we're going to have, uh, the opportunity to unblind the data and then, uh, 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, uh, anxiety to all of us, but came around, I think, two o'clock.

   5. LFLex Fridman4:55

      You're just sitting there waiting? What were you feeling?

   6. ABAlbert Bourla4:57

      Sitting there waiting and teasing one another.

   7. LFLex Fridman5:00

      (laughs) .

   8. ABAlbert Bourla5:00

      Uh, drinking coffee, making jokes.

   9. LFLex Fridman5:04

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

   10. ABAlbert Bourla5:11

       Free. Liberated. Um, happy. Uh, like if a, a huge weight that was, uh, on my shoulders was lifted.

   11. LFLex Fridman5:23

       I heard you, uh, said, "I love you" to the team. (laughs)

   12. ABAlbert Bourla5:27

       (laughs) I did. Um, you know-

   13. LFLex Fridman5:29

       Okay. (laughs)

   14. ABAlbert Bourla5:29

       This is how we speak in, uh, in Mediterranean.

   15. LFLex Fridman5:33

       Li- listen, maybe it's the Russian thing too. I, I, I, I love love, so I appreciate that kind of, uh, 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?

   16. ABAlbert Bourla5:56

       You know, we do a lot of that anyway. This is what we do in our daily work. We are putting, uh, money, we are investing in research which is highly risky. The difference in that case was that we didn't de-risk at all. We put it all in.We put everything in one go so that we don't, uh, lose time. Uh, usually, we'll spend 50 millions and then if that goes well, then we will spend another 50, and then if it goes well, then 100. Here, we put together a little bit more than $2 billion, $2.3 billion, and, uh, it was a significant decision but it was, uh, very easy decision to make in the context of what we were living at that time. It was, uh, pandemic, people were scared, we were scared, we didn't know how tomorrow will look like, uh, we were living unprecedented situations and, uh, we knew that we have capabilities that may help. So there was not a second, uh, question or choice. We go all in.

   17. LFLex Fridman6:59

       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, um, I think you've said a bunch of things, uh, of the kind of saying we need to go all- all in, sort of very boldly diving in.

   18. ABAlbert Bourla7:30

       Mm-hmm.

   19. LFLex Fridman7:31

       Um, how much was that that- that world is, uh, 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?

   20. ABAlbert Bourla7:51

       Yeah. I- 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 on what is the real value driver, and the real dr- 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 company is to be how to help the patient, and that's what the management wants, that's what 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, uh, as always, when you do that, you will have good returns as well.

   21. LFLex Fridman8:53

       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?

   22. ABAlbert Bourla9:08

       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- to lose them. But what you can do is just to change the rules of the game so that you won't lose the money. There are very well-established methodologies that would say with very high precision if your medicine is effective, if your medicine is safe. And those are there for all and they are playing with the same rules.

   23. LFLex Fridman9:59

       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, um, full transparency and immediate access to the data, immediate, you know, on the scale of weeks, not years?

   24. ABAlbert Bourla10:27

       I think the relations with, uh, with regulators, they have been always very transparent and there are a lot of, uh, laws that, uh, they are forcing, um, regulators to- and companies to put out there their interactions and what exactly was discussed. Now, to- to go into specific details of, uh, of some discussions, I don't know what is the reason that FDA wants to take their time and- but I'm sure they have very good reasons.

   25. LFLex Fridman10:56

       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, um, is there seems to be a bureaucracy that gets in the way of transparency. That's always the challenge with government. So government is very good at setting rules and making sure there's oversight of the companies and people and so on, but they create- they slow things down, which is a feature and a bug. And in this case, they slowed down so much, I think the reason they set it at 75 years is because they set a rate of being o- able to only review 500 pages of data a day or something like that. And that's a very kind of bureaucratic thing, where in reality you could just show the data. And it's not like something is being hidden but in the battle to win people's trust, to inspire them with science, it feels like transparency is one of the most beautiful things, one of the most powerful things that the FDA has. FDA is- has the potential to be one of the great institutions of our country and, uh, this is one example that it feels to me like a failure. So from 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, uh...... you know that those are the rules, it's approved. That's it.

   26. ABAlbert Bourla12:22

       But this is not, um, a black box. We know very well what, uh, 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- the Brits, the FDA clearly, they have very, very high caliber of scientists that they are going into a lot of details. And, uh, also basically everything for a study is really released by law in the specifications of the product, but it's a very detailed document-

   27. LFLex Fridman13:02

       Yeah.

   28. ABAlbert Bourla13:02

       ... that it is issued and has basically the essence of everything was discussed. I don't know, uh, about, uh, specific documents if take them time to- to release, but clearly this is not a black box, uh, type of process.

   29. LFLex Fridman13:16

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

   30. ABAlbert Bourla13:24

       I agree with you.
3. 19:47 – 39:35

   Trust

   1. ABAlbert Bourla19:48

   2. LFLex Fridman19:48

      Still, there's currently a distrust of big pharma in the public. Maybe this is something I'd love to hear your comment on. Um, 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 na- 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?

   3. ABAlbert Bourla20:24

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

   4. LFLex Fridman20:32

      (laughs)

   5. ABAlbert Bourla20:32

      And, uh, once you lost it, uh, 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, uh, 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, uh, very few will disagree that the industry is a very different industry right now. That being said, I truly believe that, uh, if there is one lesson that stands out from the main 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 it given. I'm not make- 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, uh, I hope that we will rise to this occasion and we will do that.

   6. LFLex Fridman22:30

      You've been at Pfizer for 28 years, time flies when you're having fun, and you've become CEO, uh, in 2019. It is the 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, um, on this topic of reputation. In 2009, Pfizer pleaded guilty to the illegal marketing of arthritis drug, Bextra, and agreed to a $2.3 billion settlement. How do you make sense of the fact that this happened to a company you love and that you believe in?

   7. ABAlbert Bourla23:08

      Yes. The Bextra case, uh, in 2009 was related to things that happened in 2003, and the things that happened in 2003 were things that, uh, basically several of our reps did off-label promotion. So they spoke about, with the physicians about off-label use of the product and they shouldn't. And, uh-

   8. LFLex Fridman23:32

      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?

   9. ABAlbert Bourla23:40

      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 they are studies that are happening off-label. And, uh, apparently several of our reps in 2003, they did it, and, uh, we had to, uh, 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 this, the- the fines are if Bextra was a small product, we would get a small fine. Bextra was a very big product and we got a very large fine. Very bad what happened in 2003. I don't think that, uh, these things... happened since then. We have a stellar record from 2009 until now of, uh, complying with every single regulation and rule. We have internal processes to make sure that these are not happening by individuals that may have an interest, for example, to get a promotion, they may try and do things that are not the right things. And, uh, 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, uh, but I believe a lot has changed in the 20 years that followed, or almost 20 years.

   10. LFLex Fridman25:07

       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, um, because there's a lot of lawyers in the world, partially. How do you put that into the calculation of, of how you try to do good in the world, um, that some of the cost is the lawsuits? How, uh, how do you, uh, 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?

   11. ABAlbert Bourla25:49

       No. I, 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.

   12. LFLex Fridman26:02

       Yeah.

   13. ABAlbert Bourla26:03

       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, to sue us. But we believe in the justice system and we believe that, uh, eventually, uh, if you are doing the right thing, you will be on the right side of the history.

   14. LFLex Fridman26:53

       Well, I'm really glad you say that because, um, focusing on doing the right thing, no matter the money, I believe is the best way to make money, just like you said.

   15. ABAlbert Bourla27:04

       It's exactly what I said.

   16. LFLex Fridman27:04

       And also, in another way, in other realms, creating a product that people love is the best way to make money-

   17. ABAlbert Bourla27:11

       Yep.

   18. LFLex Fridman27:11

       ... so focusing on the, on the core of the thing that makes people f- 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, uh, marketing on mainstream media channels by Pfizer. So let me ask a general marketing question. Do you see this as a conflict of interest? As it 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, uh, 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 'cause they're afraid of losing the sponsorship. It's subtle, but at scale, it might have a serious impact. Do you worry about this?

   19. ABAlbert Bourla28:14

       Uh, I think people, uh, could go one way or another because of multiple reasons. From our perspective, we... I don't think we have, uh, aggressive marketing. What we do, we go on TV and we are having, uh, 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. It's very clearly that we cannot say things, that they are off label, they have not been approved. We need to have... Every time we go on TV, as you know, FDA is forcing us to say also the bad things that can happen. For 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, uh, in, and could be biased in, in the podcasts or in the other type of media activities that they have for multiple different reasons.

   20. LFLex Fridman29:17

       Yeah. I know. But it's still, it's pressure. It's human nature. I mean, I, I... If, uh, one of it is perception, but I, I worry about it too. Like, 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, um, you know, I look at academia. Like, I, I, 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. Uh, when I came to MIT, I, I was a little bit, um, disappointed, maybe heartbroken how much pressure, um, I think unjustified pressure people felt f- from financial constraints, especially at MIT when there's, I think, a lot of money (laughs) . 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 wanna blame money on everything, money constraints, but when you have sponsors, it just, um... I personally worry that it doesn't bring the best out of people.And so I feel like I wanna put some responsibility on sponsors and, and great big companies like Pfizer to, to kind of, um, not get in the way of the best of human nature, whether it's sponsoring, uh, podcasts, mainstream media. Like, I don't know, athletes, whatever.

   21. ABAlbert Bourla31:04

       Yeah. 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, of th- the persons or the programs that we are sponsoring. So I don't think, uh, our friend, I think was from Texas, uh-

   22. LFLex Fridman31:32

       Yes.

   23. ABAlbert Bourla31:32

       Yeah. I don't think-

   24. LFLex Fridman31:34

       Seth Rogen, yes. (laughs)

   25. ABAlbert Bourla31:35

       Yes. I don't think he, he got it right that we do those type of things. We don't.

   26. LFLex Fridman31:41

       Oh, in terms of manipu- like having an e- negative effect on-

   27. ABAlbert Bourla31:44

       Not even having aggressive sponsorships. We have very few.

   28. LFLex Fridman31:48

       Yeah, when you clip 'em all together.

   29. ABAlbert Bourla31:49

       And most of the sponsorships that we have, it is more on patient-related organizations-

   30. LFLex Fridman31:55

       Right.
4. 39:35 – 49:51

   Safety

   1. LFLex Fridman39:36

      (sighs) Let me just kind of linger on the safety. What can you say, there's a lot of people that are concerned that the Pfizer vaccine, by the way, of which I took two shots, no booster yet, is unsafe. What do you say to people that say that?

   2. ABAlbert Bourla40:00

      No, they should not, uh, fear something like that. It's completely wrong. There is no medical product in the history of humanity that have been tested as much as this vaccine, has been administered to hundreds of millions of people. And because of the importance of COVID, they have been scrutinized, those people, constantly. Right now, healthcare authorities are looking for every single signal around the world of people that they got the vaccine and try to see if it is vaccine-related or not. There are electronic medical records that will tell us when and what happened to a person when he did got the vaccine. And we know now more, we have so high certainty that it is so safe, exactly as the data sheet says about this vaccine more than any other product. They should not be afraid of something like that, and they should not listen to information that it is misinformation, that it is spread on purpose.

   3. LFLex Fridman41:10

      Well, I don't like the word misinformation, because, you know, again, back to the Soviet Union, anyone who opposes the state is spreading misinformation. So you can basically call anything misinformation. That's the unfortunate times we live in is you- you can call anyone ... you can basically call anybody a liar and say, "I'm the, uh, sole possessor of the truth." And, uh, just no offense to me, just because you wear a tie doesn't mean you're (laughs) any more likely to be in the possession of the truth than any- anyone else. So-

   4. ABAlbert Bourla41:46

      I wouldn't disagree with that at all.

   5. LFLex Fridman41:48

      (laughs)

   6. ABAlbert Bourla41:48

      I don't think that, uh-

   7. LFLex Fridman41:48

      As somebody who's not wearing a tie. (laughs)

   8. ABAlbert Bourla41:50

      And as- as you can, people can see that I'm not wearing a tie and you are.

   9. LFLex Fridman41:54

      (laughs)

   10. ABAlbert Bourla41:54

       But, um, it's not about, um, uh, being able, those that they have the power to- to impose on the others the stigma that, uh, you, what you are saying is misinformation. But there are few things that, as society, we have accomplished, and science is one of them. And, uh, data is, and analytics of data is another one. And, uh, to say that, uh, something, uh, which is highly scientific by people that they are not scientists, uh, uh, I- I think that it is not what you're describing, what used to happen in Soviet Union or in any other autocratic, uh, regime in the world right now.

   11. LFLex Fridman42:42

       But I definitely do think that, uh, the scientists, the s- the public science communicators I- I've listened to over COVID have really disappointed me, because they have not...... spoken with empathy. They haven't sufficiently, in my view, have put their ego aside and really listened to people. Yes, people that don't have a PhD, people who have not really, you know, uh, maybe not even taken, like, a biology course in college or something like that. But still, they, they, they have children. They, they worry. They fear. They don't know who to trust. They don't know if they should listen to the CEO of Pfizer who might have other incentives in mind, who might just care about money and nothing else. And so they just use common sense and they ask questions. And I think t- to them, talking down to them as if they're not intelligent and so on is something scientists have done, almost, like, rolled their eyes. And that disappoints me because I think that's kind of what's... is the source of division.

   12. ABAlbert Bourla43:45

       Look, humility is a virtue.

   13. LFLex Fridman43:47

       Yes.

   14. ABAlbert Bourla43:48

       And, uh-

   15. LFLex Fridman43:49

       Yes.

   16. ABAlbert Bourla43:49

       ... the fact that you are educated doesn't mean that you are having either humility or empathy or you have good, uh, human qualities. This was never and will never be a, a, a metric of judging this type of virtues. Um, those that they do this, they're wrong. And actually, they, they are not doing good service to the public health because they're undermining. People aren't stupid. They see if you're not, uh, be respecting them and if you're not respecting their need to learn because that affects their health, the health of the mother or the kids. So I fully agree with you that we should be very patient to explain again and again and again what is happening. And the vast majority of the people that they don't get vaccinations right now is because they're afraid. It's not for any other reason. It's not that they have a... an agenda. What I'm saying, it is there is a small number of people-

   17. LFLex Fridman44:48

       Yeah.

   18. ABAlbert Bourla44:48

       ... that they have make business for them to profit from this anxiety. I'll give you an example. "I have been arrested by FBI." This is what someone wrote.

   19. LFLex Fridman45:03

       Hmm.

   20. ABAlbert Bourla45:03

       I, I read it. I laughed. I mean... (laughs) Okay, this is where they take it. There was a reason why they wrote it that, "The Pfizer CEO was arrested by the FBI," because they want to create doubts in the minds of the people that they're afraid and say, "Look, if the FBI arrested him, likely I will not do the vaccine." But I laughed. A week later, the wife of the Pfizer CEO died.

   21. LFLex Fridman45:29

       Hmm.

   22. ABAlbert Bourla45:29

       There is a picture in the, in this website of my wife. Someone sends to me. Now I'm pissed. I'm not laughing. I try to find my kids to tell them, "If you read something, Mommy's fine. Don't worry." Then I remember that she has very old parents back in Greece. We start calling them to making sure because we know that that will be picked up by Greek newspapers and they will, will publish it, okay? They are... Th- those people that wrote these things, they know very well that my wife didn't die and died because she, she was vaccinated, right? So this is the narratives that they are on purpose forming to profit from, uh, the stress and, uh, um, the anxiety of good people.

   23. LFLex Fridman46:18

       And that's something I have to kind of... People that listen to this that kind of doubt institutions, I do also wanna say that there's quite a few folks who realize they can make money from saying, "The man is lying to you. The government is lying to you. It's all corrupt. It's all a scam. Big Pharma is lying to you. They're manipulating you." I'm surprised at how much money can be made with that.

   24. ABAlbert Bourla46:51

       Mm-hmm.

   25. LFLex Fridman46:51

       And it's sad. So you have to just as people use their common sense to, uh, be skeptical when listening to politicians and powerful figures, they should be skeptical to also when listening to sort of the, the conspiracy theorists or not even the conspiracy theorists but people who raise questions about institutions. Think, think on your own. Think critically with an open mind that everyone could be manipulating you, but also everybody has the capacity to do good. And I think, uh, science in its pure form, not when entangled with institutions, is a beautiful thing. And in the hands of many companies, it is a beautiful thing at scale. Still, you have a lot of incentive as having created the vaccine at Pfizer, this incredible technology, to, uh, sing it praises. So th- there's a kind of... You know, people are skeptical. Like, how much do we trust how excited, uh, Albert is about this vaccine? So for example, I mean, uh, not, not to do a Shakespearean analysis of your Twitter, but I think you tweeted something about, uh, a study with, uh, 100% efficacy of the vaccine or in stopping a transmission or something like that. Do you regret, uh, sort of being, um... like, overrepresenting the effectiveness of the vaccine? Technically saying correct things, but just kind of, like, highlighting the super positive things that may be misinterpreted? You know, saying 100%?

   26. ABAlbert Bourla48:36

       No, I never said something 100%. Every time I speak, if a number is 100%, I rush to say that in biology there is nothing 100%-

   27. LFLex Fridman48:44

       Right.

   28. ABAlbert Bourla48:44

       ... because always there will be when you go to the millions, okay? There were in the study things that were 100%, for example, deaths, or in South Africa.

   29. LFLex Fridman48:52

       Yeah.

   30. ABAlbert Bourla48:52

       When we tried, there was 100% efficacy.... clearly in small numbers. When the numbers will become much bigger, the 100% will not hold but will be 95, 96. So still, the direction of this is the point. So I'm very, very careful how I- what I tweet and, uh, in addition to how careful I am, I have people that, uh, they're looking it and they're having second or third opinions to make sure that we don't put. Why? Because they know that people are listening to me right now, everything I say.
5. 49:51 – 52:45

   Booster shots

   1. ABAlbert Bourla49:52

   2. LFLex Fridman49:52

      So many felt the vaccine was presented as a cure that wouldn't require regular booster shots. Was that something you believed early on? Did you always believe that many regular shots would be required? And maybe in a bigger picture, how many... Do you think this will, for the Pfizer vaccine, is it something you see that's taking, uh, a booster shot regularly like annually?

   3. ABAlbert Bourla50:15

      Yes. In the beginning when we had the first, uh, months with the vaccine, people would ask me, "Do we need another one?" And I said, "We don't know."

   4. LFLex Fridman50:22

      Yeah.

   5. ABAlbert Bourla50:22

      I was very clear about it. Then around April, May, I started seeing the first data and I made statements that I think we will need a booster around 8 to 12 months after the second dose. And then after that, annual revaccinations. This is what I said, believe is the- one of the most likely scenarios. And it was based on the data that I had, but then Delta came, and because I always making the- the caveat that with absent a new variant with everything we know. With Delta, it pro- was proven that we need the booster to move to the three- to the six months, and this is what, uh, happened. And, uh, I still said, "I think the booster is at six months and then I think it will be an annual revaccination, likely." We have to monitor to see the data but this is the likely scenario. Now, we have Omicron, and Omicron says that the two doses might be challenging. We don't know exactly yet, but three doses work. So clearly a lot of countries already started moving now the third dose, not in six- from six months to three, so that they will reduce the period that people will not be protected with, uh- with, uh, the- the third dose. Uh, I don't know with Omicron if how long this will last. And frankly, I don't know if we will need a new vaccine tailor-made to Omicron based on everything we know so far. We are monitoring and we'll know way more in the weeks to come. If there is a need for a new vaccine, we will have it. And if there is a need for mass production of this new vaccine, I can also feel very comfortable that we will not lose any of our capacity that we have developed. Right now, we are running at one billion almost approximately doses per quarter, four per year. And if we have to switch and have half of that in the new, half of that in the old, we will do still four billion doses. So I think-

   6. LFLex Fridman52:23

      Wow.

   7. ABAlbert Bourla52:23

      ... the world should feel very, very comfortable that if there is a need, we will be ahead of the virus.

   8. LFLex Fridman52:30

      Yeah, you did, uh, you delivered or produced three billion this year-

   9. ABAlbert Bourla52:33

      Yeah.

   10. LFLex Fridman52:33

       ... vaccines and you're on track to do four billion next year.

   11. ABAlbert Bourla52:36

       Yeah.

   12. LFLex Fridman52:37

       I mean, if we had, uh, uh, a lot more time, we would talk about how the heck you achieve that kind of scale. It's- it's truly incredible.

6. 52:45 – 59:14

   Mandates

   1. LFLex Fridman52:45

      Um, let me ask the policy question. W- what are your feelings about vaccine mandates in terms of do you think the most effective way to vaccinate the population is to require it or do you go with the American way and give people the freedom to choose?

   2. ABAlbert Bourla53:07

      I think it is, uh, a very difficult, uh, topic and- and a very difficult decision who- whoever needs to make it. And clearly, it's not me. It is the public health officials of every country that they have to make this decision. I have to make the decision for Pfizer employees and I had to- to balance the fear of those that they work, that they want to feel that the others are vaccinated, and the fear of those that they don't want to get the vaccine. And eventually, I came to the decision that we will mandate it at Pfizer. We are flexible, we are giving exceptions, of course for health, maybe some religions, but, uh, we decided to- to mandate it. Now, at Pfizer, we, when we did this decision, we were at 90% vaccination rates when we said we are going to mandate it. And that took it up to 96. It works, right? Uh, this 10% was never going to move, I felt, because no matter what, you have a small number of people that really are scared and they don't feel comfortable to do it, okay? It worked in our case. We- we took it to 96%. I'm happy for those people. A lot will not disease and some will not die of- of the- of those people. But it's not to me to say because the debate, uh, it's serious debate and there are a lot of pros and cons if you need to push people, if you need to give them the freedom. And, uh, it's... Comes with the territory. If you are elected to run a country-

   3. LFLex Fridman54:45

      (laughs)

   4. ABAlbert Bourla54:45

      ... (laughs) you should be ready to make difficult decisions.

   5. LFLex Fridman54:47

      And no matter what decision you make, there will be fake stories written about you as we talked about. (laughs)

   6. ABAlbert Bourla54:51

      Uh, you will not be able to please everyone.

   7. LFLex Fridman54:53

      Yes. Uh, well, let me just say that I think, again, coming from the Soviet Union, I think at the public level, at the federal level, mandates is, um...... is a really bad idea. Even- even if it's good for the health of the populous. Um, there's something about preserving the freedom is really powerful about this country, in- like, doing the hard work of convincing people to get vaccinated, to choose to get vaccinated if they want, but still have the freedom not to. That's a really powerful freedom. To me, it's super lazy to mandate. People should understand the science and want to get vaccinated. (sighs) Do you think children need to get vaccinated?

   8. ABAlbert Bourla55:41

      I do. I do think that they need to get vaccinated.

   9. LFLex Fridman55:44

      So age range is five to 16. There's a lot of parents that, um, that fear for the wellbeing of their children. Can you empathize with those parents? Can you steel man their arguments against the vaccine for their children?

   10. ABAlbert Bourla56:04

       You know, because people know who I am, I had the opportunity to em- em- uh, to interact with parents before that was, uh, let's say, approved, and there were so many, way more, that, uh, I had a lot of empathy because they were afraid for their kids because they didn't have a vaccine, and they were the ones that were speaking at that time. "Bring me vaccine. When are you going to bring me vaccine? I really fear. I feel that this is unfair, that I'm protected, my husband is protected, my old son is protected, and my little sweetheart, because she's below the age is not protected." Now that we have the vaccines, I'm sure that, uh, those that they are afraid of the vaccine, not of the disease, which are smaller number admittedly, also they will have, uh, if they're afraid of them, I'm sure that they will afraid even more about their kids because they love, I would say, more than they love themselves. So it's going to be the situation, and, uh, again, the same. How can you do to demonstrate, to convince people, to win the minds and the hearts of the people that this is the right thing to do?

   11. LFLex Fridman57:15

       What do you think about that calculation? 'Cause the risk for kids is very low. Kids do die. Kids do go to the hospital from COVID-

   12. ABAlbert Bourla57:23

       Yes.

   13. LFLex Fridman57:23

       ... but the rate is very low.

   14. ABAlbert Bourla57:25

       The rate is lower, but kids, they do die, and how can you say that I'm not going to- I'm not going to protect a kid for something that it is likely to happen? And it is not only that. What happens in the school when they stop the education process because a kid got the disease and they don't have vaccines, so that they can control? It is such a big disruption and such a big risk for- for the health of- of the- of the kids that it shouldn't be a debate. Look, how many kids are having polio right now? Way fewer number than those that they're having COVID in- in the hospital, but everybody's getting the vaccine. It's, um...

   15. LFLex Fridman58:14

       Well, polio was deadlier for kids.

   16. ABAlbert Bourla58:17

       But it's not now. So why some- a kid to do it now? Because needs to be protected.

   17. LFLex Fridman58:23

       Well, th- the unique thing about the COVID vaccine, it's a new type of technology too, so there's an extra concern. Choosing to vaccinate a child, you're making a choice that can potentially hurt them. That's the way parents that are hesitant about the vaccine think.

   18. ABAlbert Bourla58:41

       I think choosing to vaccinate children makes a choice so that something could not potentially hurt them, which is the disease. That's why we are doing vaccinations since ever. I know that, uh, there are people that they're concerned for themselves and for- for their kids. What I know, it is that I'm a scientist and I'm a parent, and I am telling you that vaccines is a very good thing for kids, and thank God we were able to develop.

   19. LFLex Fridman59:12

       (sighs)

7. 59:14 – 1:04:13

   Antivirals

   1. LFLex Fridman59:14

      So we've talked quite a bit about the vaccine, but there's an incredible new technology that Pfizer's developing with, uh, Paxlovid, uh, antiviral for COVID. Where does that stand? How does that work? Um, and how were you able to develop i- in four months, uh, like you said, and all of that in just a few minutes? (laughs)

   2. ABAlbert Bourla59:37

      First of all, what this is about, this is a real game changer. This is a course of treatment that you get only if you get the disease, you get COVID. Then what happens is that you will take for five days pills day and night and twice a day for five days, and instead of 10 people from those that this is to go to hospital, only one will go. This is an end with all the caveats that the numbers are small, no one died. It was 100% efficacy on deaths. Of course, I'm sure that, uh, in, uh, real world when the numbers are getting very high, we may have, uh, 99 instead of 100, but, uh, these are spectacular results for something that you can take home and stay home. The biggest problem right now in Europe, in the US when we have surges, every time that we have a surge of, uh, of COVID, it is that the ICUs are full. The hospitals are paralyzed. They have to postpone elective surgeries. They have to postpone other operations because they don't have the capacity because of that. Keeping people out of the hospitals, home, keeping people, uh, without dying, uh, it is something that we didn't have before, uh, and this is a significant, significant game changer.

   3. LFLex Fridman1:01:03

      I have to ask a controversial, difficult question. What- what are your thoughts about ivermectin?... has it sufficiently been studied? Has Pfizer considered it in its, like I said, incredible development of the antiviral, um, as, like, as a comparator, that kind of thing? Just in- investigate it in general. The reason I bring it up, 'cause I've read quite a few criticisms of people. There's been some comparisons to Paxlovid and ivermectin, and I think people should look up, there is Dr. John Campbell that describes that comparison and makes that claim, and there's quite a lot of people that debunk or argue against that. You can do your own research. But there is a lot of people that kinda see this free drug without patents on it and say, "This could be the savior." So, can you just speak to that comparison and-

   4. ABAlbert Bourla1:01:57

      It's not the first time. If you remember, there were other compounds that were claimed that they are the- the- the s- the solution to COVID, and, uh, clearly they were proven that they are not. Uh, there are compounds that they are solutions and compounds that they are not. I, as a scientist, and I discuss with our scientists, they don't see any reason why a medicine like ivermectin, which is a parasiticide, to be able to act on COVID, and so they don't think that there's any connection, and they haven't seen any paper that describes someone that used it that had any results. I'm sure that there will be some people that will claim, because people are claiming anything, but, uh, I don't think that, uh, there was any paper in any peer review magazine, I mean, any reliable scientific magazine, to- to support this claim. So, we are focusing on saving people's lives. We are not focusing on, uh- on, uh, (laughs) craziness.

   5. LFLex Fridman1:03:02

      Well, th- to push back, there is quite a lot of papers, but the studies are small, so th- so there's no conclusive evidence, and that's the point.

   6. ABAlbert Bourla1:03:10

      I haven't seen any that it is reliable.

   7. LFLex Fridman1:03:12

      Right.

   8. ABAlbert Bourla1:03:12

      I don't know where are these... Small or big, reliable. I haven't seen any.

   9. LFLex Fridman1:03:18

      Right. Well, some of the big ones have been retracted, which means they weren't legitimate.

   10. ABAlbert Bourla1:03:24

       Good point.

   11. LFLex Fridman1:03:24

       Yes.

   12. ABAlbert Bourla1:03:24

       Yeah. So?

   13. LFLex Fridman1:03:25

       Uh, you know, so this is definitely something that people need to look into, the people that kinda question of the effectiveness of ivermectin, definitely, uh, something to think about. And I think is the reason that Paxlovid-

   14. ABAlbert Bourla1:03:37

       It was chloroquinoline before.

   15. LFLex Fridman1:03:39

       Yes.

   16. ABAlbert Bourla1:03:40

       For God's sake.

   17. LFLex Fridman1:03:41

       And that's why Paxlovid-

   18. ABAlbert Bourla1:03:42

       How many people died because of that?

   19. LFLex Fridman1:03:45

       Yeah, this is th- th- this is- this is the dangerous thing. This is the sad thing.

   20. ABAlbert Bourla1:03:50

       Yeah.

   21. LFLex Fridman1:03:51

       So-

   22. ABAlbert Bourla1:03:51

       Paxlovid has been studied in thousands of people and will be under the scrutiny not only of, uh, regulators, but, uh, as we will go into the implementation as it happened in many countries, they will monitor to see what happen with... L- let's say that whatever we do. Once it is out there, within few weeks, they will know, all hospitals, if it works or not, because they will see the statistics.

8. 1:04:13 – 1:07:58

   Hope for future

   1. LFLex Fridman1:04:13

      We've gone through, uh, one of the more difficult periods in recent human history over the past two years, like as a society. What gives you-

   2. ABAlbert Bourla1:04:24

      Mm-hmm.

   3. LFLex Fridman1:04:24

      What gives you hope about the future for our human civilization? You look into the next few years.

   4. ABAlbert Bourla1:04:31

      I think the human ingenuity. I think although there- there is, uh, the world always is progressing. Although there are a lot of things that, uh, need to be fixed in the society of 2020, society of 2020 is better at large than things 50 years back, 100 years back, in all different aspects. From poverty, for human rights, from, uh- from, uh, science, from quality of life, from any aspect. I am positive that, uh, humans, uh, can create and always create a better future, and will continue doing so.

   5. LFLex Fridman1:05:14

      You have helped save the lives of millions of people, help improve the quality of their lives, but you yourself are just one biological organism with an expiration date. Do you ponder your mortality? Do you, uh, think about your death? Are you afraid of death?

   6. ABAlbert Bourla1:05:32

      I- I'll tell... That's a very interesting question. I- I was discussing with a lot of people that I was fearless of death, I couldn't care less when I was young. The first thing that... The first time that, uh, I started feeling that I want to be around was when I had kids, and then I started feeling that, "Oh gosh, is it... I hope I will be around to see their wedding. I hope they will be around to see their- their children." So, if there is something that scares me, it's the possibility that I will not be part of their lives anymore and I will not be watching. I hope there is life upstairs-

   7. LFLex Fridman1:06:08

      Yeah.

   8. ABAlbert Bourla1:06:09

      ... so I will be able to watch them from there.

   9. LFLex Fridman1:06:11

      (laughs) From upstairs, get a nice overview. Uh, let me ask the big ridiculous question, and you only have two minutes or less to answer it. What is the meaning of life? What's the meaning of this whole thing? You said ingenuity is the thing that gives you hope. We seem to be all busy trying to help each other, trying to build a better world. Why are we doing that?

   10. ABAlbert Bourla1:06:34

       I- I- I would repeat something that, uh, uh, Steve Jobs has said, "Death is life's biggest invention. Uh, it eliminates the old and gives place to the new." Uh, life is all about moving forward. Life is all about, uh, creating new things. Um, maybe everyone is a contributor, but no one is the owner.

   11. LFLex Fridman1:07:03

       And always creating something new.

   12. ABAlbert Bourla1:07:05

       Always.

   13. LFLex Fridman1:07:06

       Adding something beautiful into the world, maybe a little bit of love.

   14. ABAlbert Bourla1:07:10

       Hopefully.

   15. LFLex Fridman1:07:11

       Albert, thank you so much. It's a huge honor that, uh, you would go through some of these difficult questions with me today, th- and that you give your extremely valuable time for this conversation. Thank you so much for talking today.

   16. ABAlbert Bourla1:07:23

       Thank you for your interest, and I'm happy, as I was telling you before, that, uh, I can, uh, brag with my kids that- that I was in your podcast because you are their hero.

   17. LFLex Fridman1:07:33

       You made it. (laughs)

   18. ABAlbert Bourla1:07:34

       I made it. (laughs)

   19. LFLex Fridman1:07:35

       (laughs) Thank you.

   20. ABAlbert Bourla1:07:36

       Thank you.

   21. LFLex Fridman1:07:37

       Thanks for listening to this conversation with Albert Bourla. To support this podcast, please check out our sponsors in the description. And now, let me leave you with some words from Oscar Wilde, "The truth is rarely pure and never simple." Thank you for listening, and hope to see you next time.

Episode duration: 1:08:03