EP. 136 — Does Pfizer Have Too Much Power? with Hannah Kuchler

Speaker 1 [00:00:22] Hello and welcome to Factually, I’m Adam Conover. I can’t thank you enough for being here. This is going to be our last new episode of the year. Next week, we’ll take a break and run a rerun. So you’ll have something to listen to, if you need something while you’re puttering around the house with your family. You got nothing to do, you got to do the dishes for the fourth time in a day because you’ve all been cooking and eating so much. We’ll have an episode here for you to listen to, but it’s going to be a rerun of one of our outstanding episodes of the past. I hope, though, that during the next couple of weeks you’re able to take some time off, you’re able to relax and recharge in the way you need to. I hope you’re able to keep your family and your friends safe from the Omicron surge that’s happening now, across the United States and many parts of the world. Please keep those masks on and get your boosters, everybody, if you can. Well, let’s talk about the show this week. Speaking of boosters, we’ve got these incredible, miraculous vaccines, right? They are true marvels of modern science, as we have talked about on this show before. They represent a quantum leap in our understanding of the body and our ability to cure disease, and they only happen because the federal government spent billions of dollars to make them happen. At every step along the way, from developing the basic science to preclinical and clinical trials and then procurement contracts to ensure there’d be a supply here, the federal government was essential. This is the moon landing of medicine. Except if instead of sending a couple of dudes to a lifeless rock, we managed to cure a disease we had just heard about barely a year earlier. It is mind blowing, greatest achievement of humanity level stuff. But despite the integral role that the federal government played (you know, the giant not for profit enterprise that we all pool our money into in order to do things that support the public good – hopefully), we also have a health care system that is based around private companies who are there to make a private profit. We might not like that system, but that is the system that we have. In the context of a global public health emergency where the public good needs to come first, throwing those for private companies in the mix does tend to make things kind of fuckin’ screwy. For example, take Pfizer: the massive pharmaceutical company whose logos you see on the Viagra ads before baseball games? Well, this company partnered with a small German company called BioNTech to earn the contract to manufacture one of the MRNA vaccines. In so doing, they achieved one of the greatest windfalls in all of pharmaceutical history. Because let’s get this straight, Pfizer did not invent the vaccine. They didn’t do the foundational research that led to the vaccine. All that they do now is manufacture the vaccine, and that has given them an incredible amount of power in the world. I mean, sure, they’ve cornered the market and they have saved untold lives by manufacturing the vaccine at scale, but they have also kind of been dicks about it. For instance, they’ve pushed around lower income countries demanding egregious concessions just in order to get this lifesaving vaccine. They have also tried to extract as much money as humanly possible from rich countries like the United States. Basically, they have been playing corporate fucking hardball in the middle of a cataclysmic global emergency. All so they could earn themselves more money. Wouldn’t you guess, there’s actually an even darker side to this. These vaccines are safe and they do work but a lot of people are skeptical of them. A lot of people are questioning. They’re hesitant about the vaccines and the question a lot of them ask is, ‘Hey, hold on a second, why should I trust the drug companies to keep me safe when they’re in it for themselves? Why, exactly, should I believe that they have my best interests at heart?’ Even though once again, these vaccines were (by and large) created by the federal government, by scientists around the world, even though they are safe and they work; when they’re being manufactured and distributed by companies that are looking out for their own profits instead of the public good, it’s a lot harder for us to answer that skepticism with confidence, isn’t it? Muddles the whole issue. This is what happens when we take a public necessity, not even a public good, but a necessity like this and deliver it in a little basket with a bow on it to a private, undemocratic for profit entity and say, ‘Hey, do whatever you want with this.’ On the show today, to talk more about the immense power that Pfizer has been wielding, our guest today is Financial Times Global Pharmaceutical Correspondent: Hannah Kuchler. Hannah is also the author of the fantastic recent piece, ‘The Inside Story of the Pfizer Vaccine: A Once in an Epic Windfall.’ Please welcome Hannah Kuchler. Hannah, thank you so much for being on the show.

Speaker 2 [00:05:21] Thank you for having me.

Speaker 1 [00:05:23] So you’ve written extensively about Pfizer’s role in the pandemic. First of all, how are they situated among all the different companies that are making vaccines? Are they more successful?

Speaker 2 [00:05:35] They are by far more successful, which is why I was so interested in them. So the fact that I think really stand out: Pfizer is due to make $36 billion in revenue this year, which is more than twice as much as the nearest company vaccine maker. That’s Moderna. And in October alone in the big markets where you make money (so the U.S. and Europe), they had 80 percent and 74 percent market share. So while a lot of what I want to talk about is, perhaps, criticisms that could be leveled at other companies, they are so big and so dominant that I think they have to be the focus.

Speaker 1 [00:06:14] So why are they so dominant? At least where I am in L.A., everyone’s like, ‘Oh, did you get Pfizer? Did you get Moderna? Did you get Johnson and Johnson?’ There’s jokes about Johnson and Johnson because of the slightly lower efficacy. I’m triple Moderna myself, and I’m very proud to be because – I don’t know. I don’t really have any allegiance, but these are the kind of conversations people have, right? But we don’t really have this awareness that Pfizer is running away with the game. Why were they able to do that?

Speaker 2 [00:06:44] Yeah, that’s really interesting. I was in the states for the beginning of the pandemic, and I certainly remember there being two big camps. They were able to do it because they are the only big pharma company that is making an MRNA vaccine that is a big vaccine maker before the pandemic. J&J is obviously a huge pharma company. They’re the world’s largest health care company, but they barely had any vaccines. They were just starting to get into vaccines. AstraZeneca, which is big in Europe and not obviously in the U.S. again, pharma company, not a big vaccine maker. Pfizer was a big vaccine maker and it made a big bet. We can thank it for it in many ways because it said, ‘We’re going to spend a lot of money, not even government money, and we’re going to use it to speed up the process, but also (most importantly) expand production.’ So they have taken this vaccine that they didn’t even create – We can talk about that later. But they have expanded production on this massively. So we’re going to get like four billion doses from Pfizer next year. That’s a tricky thing to do. But once you expand production, you’ve got people queuing around the block, countries desperate for these vaccines. Then you become very dominant. Of course, the efficacy rate does have an impact, but it’s quite similar to Moderna.

Speaker 1 [00:08:03] Yeah, first of all, we’re obviously in this position where a big company like this is the only organization that has capacity to make all this. I mean, maybe the U.S. government is large enough that it could have done it all by itself. But I think it probably would have taken longer, simply because they wouldn’t have the infrastructure ready to go in the way a company like Pfizer would. Is that right?

Speaker 2 [00:08:28] Well, yes, certainly, and Pfizer didn’t have the infrastructure completely ready to go. They did have to hire a lot of people, and this is a new type of vaccine, the MRNA. No one had made some of the parts that go into these vaccines at scale before, but they had some expertise. They had a lot of capital ready to deploy. And yes, the US government, you could argue that it’s almost what they did do with Moderna. Moderna was very heavily financed by the US government. But that meant that Moderna is quite dominant in the US, but not in the rest of the world.

Speaker 1 [00:08:58] Hmm. Well, we’ve talked about the vaccines on this show before. We’ve talked about the incredible scientific breakthrough that MRNA vaccines represent. If you want to go back to listen to our episode with Derek Lowe, for folks who are listening and want to hear how they work, why they work so effectively, what one of the great modern miracles of our time (I think) is the invention of these vaccines right when we needed them. So there’s a lot of positive aspects to this story. However, you’ve written a lot that I think one could take as being critical of Pfizer’s, let’s say not the vaccines themselves, but the business practices around the vaccines. And so tell me more of those. Let’s start with, you said they didn’t invent the vaccine. Who did? And why are we all now calling it the Pfizer vaccine if they didn’t?

Speaker 2 [00:09:50] Well, there is a small but growing company in Germany that really wishes that we weren’t calling it the Pfizer vaccine. That’s BioNTech. They were company huge pioneers in MRNA and their founder was one of the early people (like Moderna) to spot the pandemic coming in January 2020 and say, ‘We need to get on this and we have a technology that’s super adaptable and we could test it out on this.’ And so he started making a vaccine. Actually, the first time, he chose Pfizer to approach as a partner because they didn’t have the money to do something like this because they had already got a deal with them on flu. So they hadn’t actually made it yet, but they were working on a flu vaccine since 2018. Then the first time they approached, actually, Pfizer said, ‘No, no, not sure that this is going to be the one that we need to jump on,’ and they continued to finance it themselves. And then in March, they signed this deal with Pfizer (in March 2020, of course) and so they’ve worked together since then. But the research part of it really comes from BioNTech and what Pfizer did, is they put it through the trials and they expanded production.

Speaker 1 [00:11:06] Wow. So, again, it’s almost difficult for me to express how cool MRNA vaccines are as an idea and as a product of research. So this is basically the people who invented this technique, who had it ready to go, who said, ‘Oh my God, there’s a pandemic coming way. We think we have a way to get a vaccine out in record time. It’s going to be far more effective than previous forms of vaccines,’ as has been proven out. They end up being second fiddle to just basically the manufacturing company that is pumping it out.

Speaker 2 [00:11:43] Well, that is obviously how it looks. Putting something through trial is expensive and difficult and scientifically difficult. So is manufacturing. So it’s not like a widget, but it is interesting. They also were splitting the revenue (some people say ‘split the profits’) 50/50, which some people say is unusual for this kind of deal. I think it’s fair enough given the success of the vaccine and how important it was to the world that they get half the profits (and obviously half the profits to a small company the size of BioNTech is a huge deal) and you’ll see that in their share prices, which are massively up. But in terms of reputation and credit, they have a lot of credit in Germany and a little bit in the rest of Europe and basically none in the US.

Speaker 1 [00:12:35] Yeah, Pfizer was already a company that sponsors baseball games here. It’s a well-known company in the U.S. and the fact that it is called the Pfizer vaccine here is like – I mean, you had (I think) a U.S. official quoted in your article saying, ‘This is the biggest marketing coup in the history of pharmaceuticals,’ to the fact that we all call it the Pfizer vaccine when they did not in fact, invent it.

Speaker 2 [00:13:03] Yeah, yeah, it does. I also tried to slip into the piece that some people in the beginning of the vaccine rollout were calling it the ‘hot person vaccine’ but that line got cut.

Speaker 1 [00:13:19] Pfizer, also, I remember a lot of press when the vaccines were first rolling out, about how they were not going to seek to make a big profit off of it. This is the World War Two moment where the pharmaceutical industry realizes that they need to step up and save the world and that would benefit their reputation. But they weren’t going to try to make a whole bunch of money off of it and weren’t going to price it rapaciously or anything like that. Is that actually the case?

Speaker 2 [00:13:49] Well, I mean, one of the things that I did report on is that this price that they offer it to us at now – ish, though it is creeping up. The original price in the US contract was $19.50. That is a lot lower than what you would think of as like a brand new innovative vaccine. They often would come in at about $200. So Pfizer has said many times, ‘Look, this is a pandemic price. After the pandemic it will go up. But for now, what a great offer.’ Except of course, what I’ve reported in the piece is that was not their first offer to the US government. Their first offer $100 a dose. So $200 a course. So much more in line with what we expect of an innovative vaccine.

Speaker 1 [00:14:34] Ten times more

Speaker 2 [00:14:37] Yeah, so much more money. I spoke to Moncef Slaoui, who is the head of Operation Warp Speed, and he said that they said to them, ‘You will look like you are trying to make money off a once in a century pandemic.’ Then the fact that Moderna was coming in much more around that $20 mark meant that they really felt they had to pull back. Now that’s all my reporting. Pfizer will not talk to you openly about its pricing strategy and how it ended up at that price.

Speaker 1 [00:15:09] Wow. So they’re out there in the press saying, ‘Oh, we’re not going to try to make that much money off of it.’ Meanwhile, their first offer was ten times what it ended up being and a more than what Moderna (which largely funded by taxpayer funded or to some large extent, taxpayer funded) was offering. That’s wild. At the very least, that shows a huge amount of hubris, to do that.

Speaker 2 [00:15:34] Yeah, I’m not sure I entirely understand it. I know that Pfizer said, ‘We are not going to be the ones to take government money,’ partly because they wanted the freedom of pricing. So it makes sense, actually, if you think about it. Moderna wasn’t going to have that same freedom, so they came in lower and and Pfizer thought, ‘If we don’t pay the government money, then we can come in higher.’ They have tiered pricing. They’re not charging that for the whole rest of the world. But it is interesting. There’s a lot of little details about how they’re pricing, that I think are interesting. They already raised prices for the more recent contracts, some of the things that (actually didn’t make in the piece) I think they’re interesting, that may be smaller details. Things like the fact that they charge more for delivery in 2020.  That last four weeks (or something) just after the vaccines are approved, in different countries around the world they said, ‘Oh, if you want them straight away, you can pay more.’ Little things like that.

Speaker 1 [00:16:38] Rush pricing, basically. 

Speaker 2 [00:16:45] Yeah, you just think, ‘Oh, really?’.

Speaker 1 [00:16:45] So basically, it’s all these little ways in which you can see that Pfizer is still trying to milk this situation a bit for all its worth. Is that what it’s feeling like? I know you’re a reporter, and that’s a value judgment, but that’s the way I put it. You put it however you want.

Speaker 2 [00:17:07] I mean, I think we can see by the numbers, they made an awful lot of money out of it. I think it’s really interesting that they made a lot of money and have had a reputational win, whereas you have companies like AstraZeneca and J&J doing this on a nonprofit basis for the duration of the pandemic and they seem to have also lost the reputational battle, which I don’t think anyone could have predicted.

Speaker 1 [00:17:29] Yeah. Wait, so you said companies like AstraZeneca and J&J are doing it on a nonprofit basis. Explain to me what is different, because those are still for profit companies. So what is the structural difference in how they’re doing it as opposed to how Pfizer is doing it?

Speaker 2 [00:17:46] Well, so AstraZeneca is the one I know best. So that’s coming in about $4 a dose. So, cheaper.

Speaker 1 [00:17:56] Wow.

Speaker 2 [00:17:58] That was partly because they did this deal with the University of Oxford and the scientists of the University of Oxford say, ‘We’re only going to sign up with a pharma company if they’re not going to make money off it during the pandemic and if they’re not going to make money off low income countries forever.’ So that price means about its cost of goods, plus about 20 percent overhead. So that’s obviously people, time and things. J&J’s was $10, but remember, it’s a single shot. So it was quite similar to AstraZeneca. Again, cost of goods. I don’t know what margin they put for overheads in that. So much cheaper. Pfizer’s vaccine, we don’t know how much it costs. We think that the price they’re offering to low income countries is quite close to cost, and that $6.75.

Speaker 1 [00:18:48] OK, so Pfizer is offering a lower rate to lower income countries, which is good. But is there another side to that? Is there a flipside of that? Is there a way in which – I mean, I’m certainly seeing that the news with the Omicron variant especially, which originated in African countries and then all the countries are closing their borders, and the leaders of those countries are saying, ‘Well, hold on a second. We didn’t get the vaccines that we needed in order to prevent a  new variant from arising, this is why we need more vaccine equity around the world.’ So does Pfizer play a role, at all, in those countries not getting the vaccines that they need?

Speaker 2 [00:19:34] Well, yeah. I mean, they have vaccines. I think that one of the big themes of my piece is basically that, yes, they have done things like making lower prices, but they have not gotten the vaccines there, clearly. They’re one of the biggest vaccine suppliers in the world, and the low income countries are still only 6% fully vaccinated. That’s compared to like 66& in OECD countries. It’s incredibly stark: as we go around boosting and boosting, there is a huge section of the world where it’s really hard even for the health care workers and their elderly to get vaccines. Of course, that could be laid at government’s door and we could discuss that, and maybe we will. But it’s also very interesting to see how the order books developed. I had a lot of people in my piece who said to me, ‘What the problem is, is that we just don’t understand. We put in these orders, and yet we then see other countries getting them first.’ And we think, ‘Well, if it was just first come, first served, then wouldn’t we be higher up the queue?’ And then there’s some countries that even say, ‘We didn’t get our calls answered by Pfizer,’ which is quite stark. I think there’s a big stark contrast here, because you saw Albert Bourla (who’s the Pfizer CEO) over the summer, really spending quite a lot of time with world leaders. He was at the G7. He was up on stage with Biden, who called him his good friend. He went to this Japanese palace that no corporate leaders ever been entertained in. He went to the Olympics. He was given a big stage because, of course, a lot of countries and a lot of politicians are really grateful to him. But at the same time, you have these low income, and sometimes even middle income countries, that are really finding it hard to get attention and to get orders. The story that I tell at the beginning of the piece, is this and this guy who orders on behalf of the African Union saying that in December 2020, he thought he had agreed and ordered 2 or 3 million doses, which would cover some health care workers across Africa, and that he just waited and waited and tried to get the contract to sign and that he couldn’t get hold of it and no one was responding. In the end, he said, he he wrote to this Pfizer CEO and said – this was actually in, I think, May because the EU had just signed a deal for 1.8 billion doses. Now that’s over a couple of years, into 2023. He wrote to them and he was mad. He was saying, ‘We’re drowning here, you can’t do this. Where are these doses?’ Pfizer will say, ‘Well, we contacted everyone and when they get back to us, we give them orders.’ They didn’t respond to that particular inquiry, but obviously I put it to them.

Speaker 1 [00:22:44] Wow, this is – OK. So the price is not the issue. They’re offering a low price, but they’re literally not returning the calls of people in Africa and people in low income countries that need the vaccine. It’s unconscionable but also not surprising, in a way, because that’s how the entire world is set up: that the people with the most need get the shortest end of the stick. Like, take the bus, for example. A bus ride is real cheap, only cost a dollar to ride the bus, but it only comes once every two hours. And if your bus doesn’t show up, you can try to call, but no one’s going to pick up the phone. It’s that kind of just neglect, where the price is cheap, but because the price is cheap who gives a fuck about you? We’ve only got one person in the call center with an old broken phone you’re on hold for a million hours.

Speaker 2 [00:23:41] Yeah, I love your examples. But if you even think about it in health terms, we don’t spend that much time here thinking, ‘Oh, the cancer drugs we take never get to huge parts of the world.’ But this has been a really stark example, that everyone in the world needed something really fast. Only a couple of companies had control of it. Governments did not coordinate. There was no sense of international prioritization. They were not funding bodies like COVAX, which are meant to procure for internationally, early enough for them to make a real difference. Now what you have, is this hand-me-down vaccine situation where you have countries giving away their spare doses. But they’re often giving them away with really short shelf life left on them. So what you’re doing is giving it to the countries that don’t necessarily have fantastic infrastructure to deliver stuff for fast anyway. Yet they can’t do it in the easy ways that we’ve organized them in the West where we say, ‘Look, we’ve got all these vaccines and we just go down by age brackets five years at a time, or more vulnerable people get first it.’ What they’re getting is dribs and drabs of vaccine, depending on which countries are like, ‘Oh God, these guys have only got a couple of weeks of expiry left on them. We’re not going to use them, so let’s send them abroad.’

Speaker 1 [00:25:03] Yeah, I just saw that like a million doses expired in Nigeria last month. It was a story from yesterday, I think. Part of that must have been what you’re saying; a short shelf life, but also the lack of infrastructure as well. There’s a lot of problems coalescing here all at once that are causing nations like this to not be able to vaccinate their people. A lot of it looks like the extension of every other problem in the world, sort of the same reasons. All those countries have their other problems: neglect from more powerful and richer countries, a history of colonization and resource theft, blah blah blah. The whole big mess, the rich get richer and the poor get poorer. That’s a natural law of the world, except that Pfizer appears to be in a unique position to be able to turn that around, to be able to say, ‘No, we are going to prioritize. We are going to do our duty as we’ve been saying, we are going to do in the press.’ And yet they haven’t been. And it makes me curious about this guy, Bourla, is that his name? The CEO? I mean, how much of this is because he can go to Japan and he can go hug Joe Biden and go to the fancy palaces. And there’s less prestige for him, personally, in doing that if he helps out  Nigeria or another country like that.

Speaker 2 [00:26:44] I don’t know, I mean, I don’t know him, and because he was a Pfizer lifer, he wasn’t one of these people that before the pandemic, had long profiles of or in-depth understanding of his psychology. He is in an interesting position. We don’t normally give this much power to CEOs. The question is, have we given it to him by neglecting global governance where we could have governments step up on everyone looking after their own, in a way? Of course, some things may also be somewhat by accident, that they happen to have one of the most effective vaccines, that they happen to be really good at expanding production. He is a corporate leader. It brings up those big questions about whether companies are only responsible to their shareholders or not. To what extent do we expect them to prioritize their home countries? That’s been a big debate when we talk about domestic production and vaccine nationalism during the pandemic. But I certainly don’t know whether it’s because he likes palaces.

Speaker 1 [00:28:01] But I think you raise a really great point; that when we’ve built a health system that has outsourced the job of developing these really important medications to the private sector – Here in the United States, we have a system where we have the National Institutes of Health which is the largest funder of biomedical research in the world, but it specifically does it in partnership with private companies, a lot of the time. The NIH does the research and the companies produce the drugs. Depending on the drug, it’ll work differently. But certainly, we end up with (because we have a system like that) a situation where company like Pfizer has so much power. When ideally, you’d be like, ‘We want the U.N. to be doing this.’ If somebody has the job of divvying up this incredible lifesaving vaccine between all the different countries of the world, it’s starting to seem like it’s a mistake to leave that to a private corporation that is going to be subject to the incentives and pressures of a private corporation, not those of geopolitical necessity.

Speaker 2 [00:29:08] Yeah, I think it’s really interesting. One of the reasons I wanted to write the piece is because it’s something we need to think about now, because (with Omicron coming, maybe we’re suddenly not feeling like the pandemic is receding) pandemic preparedness efforts around the world are starting to get less attention because people just want this behind them so badly. I think this is the moment where we ask these questions and we say, ‘If we want to prepare for other health emergencies, whose responsibility is it?’ You mentioned the U.N. as if it’s this fantasy idea. I mean, the World Health Organization is an agency of the U.N.. It does exist but it has been definitely underfunded, and not really cooperated with. Partly, that was because Trump actually tried to leave it during this whole process. That was a particularly devastating move that was hard to come back from. But it also was clearly not in that strong of a position, because you have to be in a really strong position to say, ‘Actually your voters, maybe the young healthy ones don’t get a shot or the kids don’t get a shot.’ Or ‘Not as much of the population gets a booster because we need to distribute this to people who are most likely to benefit, who are the most likely to die in other countries.’

Speaker 1 [00:30:42] One of the things that really troubling about your piece, is that with issues of life and death like this, ideally in the ideal of democracy, we want democratically elected leaders and the international representatives at the U.N. who those leaders then appoint at the end of this democratic process to help us make these decisions, right? But instead, you write it in your piece about how Pfizer actually pushed countries to change their laws before they brought vaccines in, which seems like the opposite of that. That is then a private company telling a country – I don’t know the details of what those laws were. But that seemed like a troubling precedent to set. Tell me more about that.

Speaker 2 [00:31:25] Yeah. No, I think it’s a symbol of how powerful they are. Of course, lots of countries did change their laws. Now what they’ve changed them for is liability. The U.S. and the U.K. and some other countries previously had these laws that said, ‘We really want private companies to make these vaccines. But because the vaccine is a product where you put something into a healthy person,  we might need to incentivize them by insuring them against healthy people suing,’ basically. These were laws that do exist in the U.S. and the U.K. but they didn’t exist in many, many countries around the world and often because the government maybe couldn’t always afford to do so. The power imbalance is different between a middle income country and a company vs.  the U.S. and a company. So they said, ‘Put these liability things into your laws.’ Many of them had to pass them through their parliaments. But the other part of it, which I think is quite sad, is that obviously they couldn’t necessarily feel like some government were really solvent enough to be able to do this. So they would get some governments to have specific collateral. They’d say, ‘Oh, well, we need things like sovereign assets.’ So we have the South African government complaining that they were asked for sovereign assets. We know from other people’s reporting  that they included things like embassies and military bases. Then of course, you just jump to the idea that Pfizer is going to own these military bases, which I don’t think is the idea but it is basically that they needed something. They wanted something in the law that said, ‘If this vaccine project goes wrong, the government has enough assets to deal with the consequences.’

Speaker 1 [00:33:20]  So a country like South Africa or a Latin American country goes to Pfizer and says, ‘Hey, we need vaccines to save our people from this deadly pandemic.’ And Pfizer says, ‘OK, but we need you to pawn a military base or two, or just have it as collateral. So if you don’t pay up because we’re a little bit worried about you, oh, I don’t know, what’s your cash flow like?’ They literally are taking out a second mortgage on the old military base. That seems profoundly fucked up to me.

Speaker 2 [00:33:58] What Pfizer will say is, ‘We have these laws elsewhere and we needed to cover and we didn’t need to use them, right?’ Because the vaccine is (and obviously, I want to reiterate this for everyone) very safe. We’ve never had a medical product, probably, tested in more people. Don’t worry about it. But yeah, it is a point of contention. And the other part of it that I think is interesting is that, of course, while they’re having these conversations about willing to change the law to protect us on liability, that’s taking more time. And OK, we don’t know if that means that the country then gets further behind in the queue because we don’t know what the order book is and there’s no transparency. There was a lot of suspicion and fear that basically the longer you take negotiating – We know this is the case in any negotiation, right? That when it’s  drawn out, you can get behind, especially if there’s this imbalance of power when all these countries in the world want this vaccine. I think someone from Transparency International said to me in the piece, ‘It is a case of the more you give up, the faster you get your vaccine.’

Speaker 1 [00:35:12] Yeah. Pfizer is negotiating with a gun held at these countries heads because people are going to get sick and die. They need the vaccine as quickly as possible, so they’re not able to consider things. ‘I don’t know if we should sign over our military base to you.’ ‘Well, alright. You don’t get any vaccine.’ As you say, it’s a striking power imbalance between sovereign nations and a pharmaceutical company that suddenly has all this power. I also just have to say that again, yes, the vaccines are very safe (remarkably safe, given the number of people who have gotten these shots and the very low number of side effects) but for folks who are skeptical; if we’re trying to reduce skepticism about the vaccines, I don’t think requiring countries to pass a law that will protect you from being sued if anything goes wrong, is going to create trust in those vaccines. Seems a little bit counterproductive, if that’s something you’re really concerned about.

Speaker 2 [00:36:17] Yeah, I mean, that’s a very good point. I try my best not to read vaccine misinformation, but I wouldn’t be surprised if that kind of thing comes up. People pick on lots of things. I actually had a real estate agent say to me that they weren’t vaccinated because they’d had that there’d been lots of lawsuits against Pfizer. And of course, as a pharma reporter, I have to be like, ‘Oh, every single drug maker in the world has lots of lawsuits. I wouldn’t worry about it. That’s not a reason.’ But of course, any little thing like that can be picked up. And yeah, trust has to be thought about.

Speaker 1 [00:36:55] Well, I want to ask you about some new news that’s come out, about Pfizer and the Omicron variant, but we have to take a really quick break. We’ll be right back with more Hannah Kuchler. All right, so we’re back with Hannah Kuchler. We’ve been talking about how powerful Pfizer has become, as a result of the pandemic. As well as all of the, perhaps, unwanted side effects of that power (geopolitically) that we might not be happy about. I guess my question is, how should that change how I feel about when I see Pfizer in the news regarding, say, the variants. For instance, Pfizer just announced (this morning, I believe) that their COVID 19 booster shot – this is from the L.A. Times – Pfizer says its COVID 19 booster shot offers protection against the Omicron variant. And it says that (I think more or less) even though the first two doses seem a little bit less effective on Omicron, the booster really increases people’s resistance to it. Normally I’d say, ‘Well, hey, that’s great. Everyone’s worried about Omicron.’ I know the financial markets had a big uptick because of this news. Everyone’s very excited, optimistic about it, except that now that I’m talking to you, I’m thinking, ‘Well, hold on a second. That is what a company that would want to make a lot of money off of booster shots would say.’ First of all, have you covered that new report at all? What’s your feeling on it?

Speaker 2 [00:38:37] Yeah, yeah, so the report is good news to that extent. Actually, if you were going to come with this very cynical mindset that I can see you edging towards, you could also argue that they could say, ‘It didn’t work and that we’re going to make a whole tweaked version and then we’re going to have to sell even more tweaked version because even the people that had the booster already need this new one.’ So I think, there’s always a way that people can make money in this business, and I wouldn’t read it like that. I think that the science is solid and the great thing, as well, is that we have a fantastic scientific community who is reading all this stuff, and they will be pointing out if they’re not solid. And obviously, our governments have scientific advisers who are independent of the companies. I also don’t think is in Pfizer’s interest to go that far and start selling something that doesn’t work because I think we would notice. But I think it is interesting because, again (of course), this means that we end up having to do a whole new round of boosters. That really exacerbates the problem in terms of getting vaccines to the developing world. Way more boosters have been given in the West than there has been first or second doses given to low income countries. So as much as I do think they work (and I will be getting my booster when it becomes my turn in the UK), in an ideal world, there would be some system which meant that actually maybe someone that needed it a little bit more than me got it. So, yeah, Omicron, I think is just going to see what’s happened before, repeat again.

Speaker 1 [00:40:27] Yeah, yeah. I don’t have that cynical mindset. But once you start looking at, ‘Alright, here’s the behavior of the company in terms of how it’s distributing these things and in terms of what it’s charging for them,’ it starts to complicate the picture a little bit. You have to start to really separate out, I think, (as you did really wonderfully in that answer) ‘here’s what we know scientifically: here’s what the scientific community is going to evaluate, and here are the business practices of the company.’ Where we know to say, ‘It’s not the business practices of the company are not getting in the way the science, but they are getting in the way of the equitable distribution of these of these vaccines.’ And yeah, the boosters only intensify that. If we need more shots, then – The fact that it says here that Pfizer is working on a new Omicron specific booster, in case it’s needed. Well, hell, 94 percent of people in a lot of countries haven’t even gotten their first shot yet.

Speaker 2 [00:41:27] No, no. And there have been questions in regard (not just for Pfizer, for other companies as well) to the extent to which we want these executives to be out on TV giving public health advice. I think that this kind of release that you were talking about, which is scientific test that they’re in the best position to do, because they obviously ran the trials. They have all the blood from vaccinated participants that can be tested against these variants, that is very necessary. But there have been questions about CEOs going on TV and making proclamations about when boosters are needed when there wasn’t data out there yet. In particular for Pfizer’s case,  there have been some questions around Scott Gottlieb, who is the former FDA commissioner who you probably know because he’s on US cable TV almost every day. And they do usually mention that he is a board member of Pfizer, but maybe not as prominently as people would like. Certainly, AstraZeneca sent a legal letter to Pfizer at one point to say that they didn’t like him disparaging their vaccine on TV because of course, he’s not just the former FDA commissioner. He is also someone who represents Pfizer’s interests. Pfizer will say he speaks independently of them.

Speaker 1 [00:42:51] How can we, as people who are going to get these boosters, people who are concerned about this, how do we pass out the one from the other? Because certainly, we should be also thankful that we have access (here in the United States and in the U.K., where you are) to these vaccines. They are medical miracles scientific, incredible scientific discoveries. They are safe. They are effective and at the same time, they’re being distributed by these companies where their behavior is not always in the public interest in exactly the way that we would want it to be. As media consumers, when we’re watching these folks speak on cable TV, how do we parse out the one from the other without falling into an unproductive cynicism. Because that’s a real danger here.

Speaker 2 [00:43:47] Yeah, it is, and I think that is partly the job of journalists: to ask, when people make proclamations, where the data is behind them. Not every cable TV channel is doing that. So I guess as media consumers, it’s about making sure you are consuming media where people are asking those questions. Then also, we’ve never had more accessible scientific experts who are completely independent. People like Anthony Fauci in the US. Prioritizing what they’re saying over what a corporate leader is saying and recognizing that a corporate leader never has the full picture and is always got some self-interest. 

Speaker 1 [00:44:30] Well, returning to the question of power, how much power Pfizer has gained as a result of this. Again, power that we should be a little bit concerned about. How do you see the pandemic changing the pharmaceutical industry going forward? I mean, 50 years from now are we going to look at this as a moment that gave Pfizer a huge market advantage that it then continued to have for many years or what? I mean, I’m speculating, but how does it look for you?

Speaker 2 [00:45:00] Oh, no, it’s actually really interesting. I could answer that on like four different fronts. The first is reputationally. Despite some of the issues we’ve been discussing, the reputational surveys show Pfizer having a far better reputation than it ever did. You mentioned that it had been a name that sponsored football matches or whatever, but actually it was either not at all known or it was associated with its previously most famous product, which is Viagra. Or it was disparaged because of the whole industry being tarred by concerns about drug pricing. Mm hmm. It’s really interesting with the drug pricing, investors were quite excited through 2020. They thought the minute that the general public and the politicians see how useful the pharmaceutical industry actually is, they would take the pressure off drug pricing. So stocks for the pharma industry have been lagging, previously, prior to the pandemic. Ever since there was this famous (in this world) tweet from Hillary Clinton in 2015, which just basically suggested she was going to come after them on drug pricing. So stock prices dropped. Everyone was really worried they’re going to try and put in controls around round pricing in the US, which is the world’s largest pharmaceutical market. It’s interesting. So Albert Bourla, Politico reported, sent this video to employees as drug pricing reform started to creep back on the agenda in Congress, saying, ‘Well, I need you to pursue this with the same kind of vigor that you pursued the vaccine and educate yourselves about how damaging these reforms will be.’ Pharmaceutical companies will always say these are really damaging to innovation, but of course, they’re also enabling better access to drugs if they’re cheaper.

Speaker 1 [00:47:05] Yeah, of course. Do you think that there might be more of an attempt to rein in these drug companies? This has been saying that politicians have been trying to do for decades now, but  given what we’ve seen from Pfizer and Moderna and these other companies, do you think that there will be more of an attempt to rein them in and to regulate these prices? Or is this actually going to put wind in their sails?

Speaker 2 [00:47:36] Well, it hasn’t gone away in the way that investors hoped it would last year. There is still interest in drug pricing reform. It’s just really tricky. It’s an unusual thing that both sides of the aisle are united, that there should be some drug pricing reform. But how you do it and how you get the most benefit for the consumer is really tricky. We could probably spend three episodes trying to explore how drugs are actually priced in U.S. because it’s insanely complicated. So that’s one element of how it enables them to dominate. If they do have more political will, then they can curb some of what they think of the are the most dramatic reforms; which are things like negotiating prices on Medicare, which some people would say isn’t dramatic at all. Every other country in the world negotiates when they buy drugs. But then the other thing that’s interesting (n terms of Pfizer, specifically) is that they’ve got obviously a huge amount of money from this right? And this looks like a continuing revenue next year. In October, they said next year they would see at least $29 billion in revenue from this vaccine, which is based only on orders they’ve got up until October, and they’ve actually got loads more since then. Especially after Omicron. They’re going to have huge amount of money. They’re going to have the best balance sheet in the business, which means they can go and spend on other things. They can buy other companies, they can outcompete their rivals. Then in MRNA, it’s really interesting. We started by talking about how this wasn’t their vaccine, but of course, over the process of working with BioNTech, they have developed an expertise in MRNA. They say that they have something now, like 400 scientists working on MRNA. We know that this is a transformative, amazing technology that could be deployed on other things like other vaccines and also in drugs, potentially. So if they got an advantage from that relationship (and perhaps some intellectual property that other companies didn’t get through learning how to produce these vaccines at scale), they could really be the ones that go on and dominate that whole new sector.

Speaker 1 [00:50:01] Wow. It’s almost the postwar economy for them. After they show their expertise and they save everybody, then they’re able to use that to slingshot themselves into a new world of possibility and profitability, perhaps. Let me end with a question. We’ve talked a lot about how the real injustice here is the difficulty that lower income countries have had getting the vaccine. When we’re talking about democratic control, what more could countries like the United States and the EU be doing? What role do they have – When Joe Biden is saying, ‘My good friend here, the CEO of Pfizer.’ We’ve spent this entire podcast talking about Pfizer’s culpability, in that respect. But when we’re talking about, ‘Hey, what can our elected leaders be doing in order to solve this problem?’ What is that, in your view?

Speaker 2 [00:51:11] I think there are things that they could be doing now, and there are things that they could be doing in the future so that we start from a better place in the next pandemic. And there are things that, maybe, they should have done earlier. So the things they could be doing now: Biden is donating an awful lot of Pfizer vaccine now, it’s not getting through the system very quickly. There’s a billion doses promised, but they’re not getting there until mid-2022. We have to remember that, as we know that vaccines save lives, not giving vaccines quick enough means that lives are lost. So I think that trying to accelerate those (and we don’t know because there’s no transparency) whether that’s because Pfizer isn’t giving the administration those vaccines or because of some other reason. We also know that, as I said, these dribbles of vaccine in and out of countries is not very helpful to countries. The best thing that you could also invest in, is improving the infrastructure on the ground. Of course, it would have been better if we’d done that before. But then there are still things you could do to ensure that you’re getting stuff out quickly. Remember, these are cold vaccines which are hard to transport. Anything to help improve that process would be good to do. Looking forward, I called it a one point (quoting someone) a once in a century pandemic. But unfortunately, we have no way of knowing. There’s no pattern to these things. We can’t say that there isn’t going to be a really bad pandemic of some other sorts in five years time, in 10 years time. We should be thinking about, when we write contracts with companies, do we put clauses in that say, ‘Yeah, you deliver me 100 million and low income countries 100 million at the same time.’ That was within countries power and they didn’t do that. We can be thinking about how we do better cooperation through organizations like the WHO or alternatives to the WHO, if people are unhappy with them. Could we at least get to a situation where every health care worker in the world was vaccinated because we know that we really desperately need them to look after other people. Unfortunately, one of the big trends in pandemic preparedness at the moment is everyone tussling for domestic production, which sounds great. But of course, not every country in the world is going to get these big companies to build facilities in their country. So we have to actually be kind of wary of that push and think, ‘Are there other ways that we can put bans on export controls and things to make sure that actually vaccines flow around the world rather than everyone has their own little factory?’

Speaker 1 [00:54:11] Yeah, at the very least, we need to make sure that we are having those conversations in a democratic way and not allowing a small group of people to call the shots on who is getting these vaccines that everybody needs.

Speaker 2 [00:54:27] I think that in some ways, what happens on a micro level in the pandemic: where everyone kind of have their own bad experience. And so we didn’t always look out for each other in the way that we would have swooped and helped our friends, previously. This almost happened on a global level. So many people feel like, how they suffered was either they couldn’t see their family the holidays or they had problems with their work, really legitimate problems. But they  distract us from the fact that huge swathes of the world are still at risk of dying of something that’s now preventable.

Speaker 1 [00:55:09] Yeah. Well, Hannah, I can’t thank you enough for coming on the show to talk to us about it. This has been a pleasure. It’s been a little bit depressing, but it’s been important. It’s been a pleasure for sure.

Speaker 2 [00:55:20] Yeah, I can be a bit depressing. Sorry about it.

Speaker 1 [00:55:23] Where can people follow you? Your reporting is incredible. You’re uncovering details about these stories that no one else is. Where can people find you and keep up with your reporting on this topic?

Speaker 2 [00:55:35] Yeah, yeah. So obviously, I write for the Financial Times, so you can find me on FT.com. I tweet @HannahKuchler. And I’m sure maybe in the show notes.

Speaker 1 [00:55:47] Yeah, awesome. Thank you so much and for coming on the show. Well, thank you once again to Hannah Kuchler for coming on the show, I hope you enjoyed that conversation as much as I did. Once again, I hope you have a happy and healthy rest of your 2021, and I hope you roar into 2022 with some new energy and some new intention to keep learning and keep making the world a better place than it was the day before. I’m making some big plans over here in my world, and I’m hopeful that when we come back, I’m going to have some cool new shit to tell you about. But until then, I want to thank our producers, Sam Roudman and Chelsea Jacobson. Our engineer, Ryan Connor. Andrew W.K. for our theme song, The fine folks at Falcon Northwest for building me the incredible custom gaming PC that I’m recording this very episode for you on. You can find me online at @AdamConover or at adamconover.net. Until next year, thank you so much for listening. We’ll see you next time on Factually.