Pfizer CEO Albert Bourla on equity, booster shots, and doubling production of COVID vaccines

Fortune spoke with Pfizer CEO Albert Bourla last week about the state of the global vaccine rollout and Pfizer’s role in it. The transcript has been lightly edited for length and clarity.

Fortune: Pfizer had one of the world’s first available COVID vaccines. There must have been a lot of demand from governments around the world, while you had only so much supply. Can you talk about how the dealmaking process worked?

Bourla: I was avoiding doing deals myself—we had a process for it. We established a tiered pricing policy. It depends if you’re a high-income country, there was a price, more or less as we see here in the U.S., Europe, and Japan—that was set at the cost of a meal. If you were a middle-income country, it was approximately half that, and if you were a low-income country, it was not-for-profit. All of that we made clear to all governments in May or June [2020], and then those that were interested started engaging in discussions.

I intervened early only for countries that didn’t place orders because I was highly concerned. I sent letters to some of the countries because I could see the doses were going predominantly to high-income countries. That was the only involvement I had. Later, after the vaccine was approved in December and after everybody was able to see the efficacy of the vaccine, and after some of the other companies had issues, this is when people who hadn’t placed their orders soon enough, they were trying to get better volumes now and they were trying to call me. I was not really negotiating unless there was a special reason, but I’d take all the calls and I tried to be polite and explain the situation.

What were these calls like?

Believe it or not, some of them, they just called to say thank-you. I truly appreciated that. They were all very polite, but some of them were also asking, “Is it possible to get more doses in our country because we have a high disease burden?” Or if they didn’t have orders at all, “We made a mistake, we thought we were going with another option but that didn’t work. I know it was our fault. But can we do something about that?” 

How did Pfizer prioritize these orders, and how did you think about who got what when?

We had supply agreements with a lot of countries. For example, the first agreement that we signed, I think, was with the U.K., then the U.S. and then the EU. Those agreements were coming with a schedule—so I want to buy from you that many doses, and saying how much will be in the first quarter, the second quarter, the third quarter. The doses had all been allocated to those who placed orders.

Thank God, we started producing more and more and more—more than we thought we’d be able to—and so more quantities were becoming available, and then we were able to serve new contracts. Someone would negotiate with us a schedule, and we’d allocate the doses to them.  

Can you talk about how you’ve managed to increase vaccine production?

It is a combination of multiple things, but they all went very well. It’s a combination of investments, of [finding a] very smart way of building new capacity fast. For example, instead of building new formulation suites, which would take more than a year, we used precut, pre-built modules. We transferred them from Texas [to Kalamazoo]—we had to have police block the roads because they were huge. These are things we don’t typically do. 

Another thing, our scientists worked a lot to improve the manufacturing process, the yield. We were able, from 110 days—that was the cycle of manufacturing, from start to finish—to reduce that to 60, so by almost 50%. That means we’re doubling the output from the same infrastructure. 

Pretty soon the bottleneck was not the infrastructure that we built, but raw materials. Pretty much up until now, raw materials are the bottleneck for why, for example, this month we can’t do more, and next month we will do more.

Why has it been so difficult to find these materials?

Most raw materials are highly, highly specialized ingredients. There were very few companies manufacturing them; for some, there were two or three manufacturers in the world. Now for some we’re in the double-digit number of suppliers. All of that is because we explained to them what we want; we gave them capital—because usually they aren’t big companies—to expand. We gave them know-how on how to help build their materials, so we worked with them a lot. 

Because we couldn’t find enough suppliers to ramp up manufacturing, we started manufacturing some of these materials ourselves. We don’t do raw materials, but formulations. 

Can you give a few examples of the raw materials that have been especially hard to get?

[The vaccines use] 186 raw materials, from specialized vials to particular ingredients. There are A LOT. Some of the most challenging ones are highly specialized lipids that are required to make lipid nanoparticles, which are an important part of our vaccine formulation. We really needed more and more and more; it was very challenging. [Pfizer started producing lipids at its Kalamazoo facility to meet demand.]

Right now, we have a situation where many more people are vaccinated in rich countries than in low- and middle-income countries. How have you been thinking about the issue of equity and the global vaccine rollout? Is there anything you think could have been done differently to address the issue?

I was worried about it very early. That’s why I sent the letters to some of these leaders. I don’t want to blame anyone, because at that time, who knew which vaccine would be the successful one, right? Some [governments] didn’t place orders for our vaccine because they were promised local manufacturing; that was a very big deal for a lot of them. This didn’t work, technically it was not successful, and most of these efforts faced significant problems. 

Some preferred another vaccine because mRNA was not a tested technology at the time. We were offering it to all [countries] at different prices, and if they were placing orders, we were ready. We were actually bothering them, “Come sign the contract, come sign the contract.”

When [mRNA] basically became the main technology and we became the main company able to produce volumes, countries that originally did not place orders started to come back. I believe eventually everybody will get [a vaccine] because we are going to make 3 billion doses this year. The first half [of the year] we’ll make 1 billion doses—and these doses are significantly skewed toward the developed countries—but in the next few months, there will be way more going to developing countries than to developed because the developed already got their doses. The 2 billion that we are going to make in the second half of this year will go mostly to middle- and low-income countries.

Countries like the U.S. have been criticized for vaccinating low-risk individuals like teenagers before many countries even had vaccines. What’s your perspective on that? Do you think there’s any role for manufacturers to play in addressing those inequities?

From my perspective, I want to be able not to say who is right to have it or not, I want to be in a position where everybody can have it. This is where I’m focused, and this is why I make so much. Pretty soon—the doses are increasing so dramatically—everybody will be getting it. That is what I can affect. I cannot affect the vaccination policies of a country. What I can do is make sure that I give it at a price that everybody can afford and by making enough for all. 

The tiered pricing system that you’ve been using—selling the vaccine for about the price of a takeaway meal to wealthy countries, for half of that in middle-income countries, and at a not-for-profit price to low-income countries—have you done that with other products, or was that a new approach with COVID?

We do have tiered pricing for several products, but not to this extent. We do not have, for example, not-for-profit prices. We do donations, and maybe some products we give not-for-profit, but it is not something that we do broadly, but we did with the COVID vaccine.

You recently announced a big deal with the U.S. government to provide 500 million doses that it will donate to COVAX, the global vaccine distribution effort supported by Gavi and the WHO. Can you talk about how that came about? Were the terms the same as if you had sold the vaccines to COVAX directly?

Correct. COVAX immediately placed a lot of orders for another vaccine. We have a 40 million doses contract with COVAX. They didn’t order more. Unfortunately, things didn’t work well with the other vaccine; they didn’t produce as many quantities and also India blocked the exports. So suddenly, the 40 million that we gave is one of the biggest contributions to COVAX right now. We were trying to give them more, but the U.S. wanted to step up their game so we made this commitment. The deal with the U.S is 500 million doses—200 million this year, and 300 million in the first six months of next year. The condition is only that they should go to the poorest countries of the world, either the countries of the African Union or a fraction of COVAX countries with really low incomes.

Keep in mind that [Pfizer] made also a commitment that from the doses that we are producing this year, 1 billion will go to middle- and low-income countries. The 200 million is part of that.

Are you also selling to some of the COVAX countries directly?

Absolutely. COVAX has a lot of countries. Most of the middle-income and some of the low-income countries, they buy also directly from us. They could also get vaccines through COVAX, but mostly our vaccines go directly to them.

There’s been a lot of talk that booster shots will be necessary. What do we know at this point, and how do booster shots complicate the picture of equitable distribution? Will people be getting booster shots in the U.S. before people in poorer countries even get vaccinated?

There are trials that we are running to make sure that we know exactly what needs to be done and when [regarding booster shots]. Those studies will be done this summer, let’s say by the end of August. I made a public prediction based on a whole bunch of different data points that likely we will need a third booster between eight and 12 months for our vaccine to maintain a high level of efficacy. 

Keep in mind that now we are using two doses, and when it comes to the booster shot next year it would be one dose only. So that makes the availability of the vaccines quite different. To us, the fact that in the past six months, we made 1 billion doses, the fact that we are going to make in the next 1.5 years, 6 billion doses—2 billion [more] this year and 4 billion next year, and that this is only one of many companies [producing COVID vaccines] around the world—I believe there will be enough doses for all for the end of [next] year. 

Some people argue that the most sustainable way to ensure adequate supply of COVID vaccines for the world is through technology transfers and by waiving IP rights. That’s something you’re not in favor of. Can you talk about why you feel that way, and what you think would be a better solution?

The better solution is what we are doing, which is offering [the vaccine] at prices that everybody can buy. And we are building enough manufacturing capacity for all. Right now, the bottlenecks for anyone to produce, including us, is not IP; it’s that there are no raw materials. That would not change with an IP waiver or any type of tech transfer. These are very complicated manufacturing operations, and right now I would say Pfizer has the dream operation, in being able to convert those raw materials into lifesaving doses with remarkable efficiency. There is not a single gram that is spoiled right now.

The only thing that would get in the way between us and our ability to make 6 billion doses in the next 18 months is if we don’t have raw materials. If suddenly some company in South Africa or India started putting raw materials in their warehouse. 

I think it’s politically motivated, all these discussions.

We’re just about out of time. Is there anything you’d add on this topic of equity and the global rollout?

The important thing here is to appreciate how lucky we were to be able to produce safe and effective vaccines—that they have this level of real-world performance. It’s not always easy, particularly for respiratory diseases. I think the key lesson for me and for everyone who plans for the next pandemic is thank God we had the vibrant life sciences sector that was able to step in and produce the miracle that everybody’s discussing in this miraculous timeline. It’s extremely important, for everybody who thinks about how can we be better prepared for the next pandemic, for us to have the conditions that will maintain this situation so it’ll be an even more vibrant life sciences sector that will be able to use science as a tool and weapon against the next pandemic. I think sometimes, we are missing this point. [Without that], we’d still be looking at very dark days, right now.