Pfizer BioNTech – Reshaping the World

Call it what you may, but COVID has become a hail mary pass for Pfizer. Don’t get us wrong – we don’t mean to imply that Pfizer was failing before. If anything, Pfizer was tracking a more than healthy top and bottom line of $52B and $16B, respectively, in the pre-COVID times of 2019. All in all, great business, as usual! 

However, could anybody have imagined that a doomsday-like pandemic would trigger this great business into becoming a megacorp?  Especially one holding political, economic and healthcare recovery power over large countries of the world? Pfizer today is dominating the world stage through an arsenal of drugs/vaccines against COVID. Whether Pfizer’s role is that of a protagonist or a profiteering antagonist remains to be seen, but as debate gets heated – let’s disengage from the scene and look at the very beginning. A humble Brooklyn beginning in the 1840s. 

Visionary Immigrant Chemists

Brooklyn in 1849 was a different world. It had to be, as the population nearly doubled to 80,000 between 1840-45 and brought in the first major wave of European immigrants. Eventually over the years, Brooklyn came to be known as a quintessential place of immigrants, that 1 in 7 Americans could trace their family roots back to. 

Back then, two German immigrants – Charles Erhart, a confectioner & Charles Pfizer, a chemist founded Charles Pfizer & Company in the Brooklyn borough, financing it via a $2500 loan. Their first product, an almond toffee flavored medicine used to treat intestinal worms became a huge hit. The company continued to grow with a series of successful discoveries – for the U.S Civil war, Pfizer began to develop disinfectants and painkillers. In the late 1800s as Coke, Pepsi, Dr Pepper gained popularity, Pfizer began to manufacture Citric acid, a common ingredient in these beverages. 

Pfizer’s success streak continued well into the 2000s, but really what made Pfizer a household name, or should we say a hit among people struggling in the bedroom was its blockbuster drug, Viagra, an accident discovery. Viagra, aka the little blue pill, was a revolution in the pharma industry – for one, it created awareness / open discussion about erectile dysfunction (ED) and two, it generated annual sales of >$1B  for Pfizer for 17 years, with the highest ever sales of $2.1B in 2012. 

“ Blockbuster drugs are those that generate $1B in annual revenues and are hard to come by, despite a robust pipeline of pharma molecules. 

Drug development in general requires decades and millions of dollars of R&D capital.  Therefore, patents are a way to ensure that the return on investment (ROI) is guaranteed for at least two decades. Once the patent cliff is reached, generics swoop in to eat the market share, which amounts to a huge drop in sales for the company that held the patent (read more about the dynamics of Indian pharma industry here). To Pfizer, similar to other pharma companies, the biggest hurdles have always been patent expiration. 

For Pfizer, the story of a series of discoveries, woes of patent cliff and a business driven by few mega blockbuster drugs driving the majority revenue would have pretty much remained the same for years to come, if not for COVID. Was COVID really pivotal for the business? We will let you be the judge, but how about a mind blowing fact? Cumulative revenue from Viagra sales for 19 years was $32.6 B. In contrast, the revenue from Pfizer’s COVID vaccine in 1 year has been >$36B  and counting.

Pfizer’s Stroke of Luck 

The Pfizer BioNTech COVID vaccine will go down in history as the molecule that changed everything – among other things, it even changed power dynamics between large countries and one single corporate, Pfizer. Albert Bourla, the CEO of Pfizer, has become the most sought after leader. After all, when Pfizer is predicted to bring in $82B in FY21 and top the pharma charts, who wouldn’t be after him? 

So much so that, all the world leaders (at least those that benefited from striking a deal with Pfizer) swear by him. Albert Bourla flew into the G7 Summit in June ‘21, after economies reopened and parked his private jet next to PM Boris Johnson’s plane. Japanese PM Yoshihide Suga rolled out the red carpet and welcomed Albert to the 2020 Olympics – it was the first time ever that Akasaka Palace State Guesthouse hosted a corporate leader (read more about economics behind the Olympics here)! President Biden, now refers to Albert as his ‘good friend’. 

“By email, text or phone, global leaders have pleaded with Bourla for orders, in some cases hoping that it might rescue political careers. The Israeli prime minister Benjamin Netanyahu topped the list, calling Bourla 30 times pleading for vaccines! In spite of which he eventually lost an impending election battle ”

FT

Albert epitomizes the quote that Rome wasn’t built in a day. It took 27 years of grit for this Greek veterinarian/business leader to continuously grow and to get to where he is today. As someone who has lived in 5 countries and taken up numerous demanding functions, we can only imagine how clueless he must have been about what lay ahead, when he took charge of Pfizer in 2018. But boy, was he ready to pounce upon every opportunity! 

In Jan 2020, as COVID swept across the globe, Albert, similar to leaders in other companies, challenged their teams to look for a potential vaccine candidate. At the same time, in an old German port city of Mainz, the husband-wife team of Uğur Şahin and Özlem Türeci at BioNTech, believed that mRNA technology could be the answer for COVID vaccine.

While they gathered all their resources and started looking into it, they approached Pfizer as a financial investor/partner. The world was a witness to what followed next – a historical landmark discovery at an unmatched pace! 

Pfizer’s Race to the Top

The discovery of COVID vaccine definitely put Pfizer in the race, however, it was actually its ability to quickly scale its manufacturing capabilities that enabled it to run the fastest. As of Oct 2021, Pfizer’s vaccines held 80% and 74% market share in the EU and U.S.A, respectively. 

This was possible only because Pfizer started ramping up its production capacity as early as in July 2020, while the clinical trials were still underway. Since they had never produced mRNA vaccines, Pfizer had to scale up fast and install new equipment. Armed with nine facilities, the largest of them in Michigan and Belgium and ~20 contract manufacturers, Pfizer even built their own ultra cold storage shipping containers. What’s more, to secure dry ice, they built their own dry ice factory. The extent to which they sought to control the supply chain sounds unreal. Expertise and control enabled them to drastically cut down their manufacturing turnaround time for a vaccine vial, from an average of 110 days to 31 days. 

They were already on their way to manufacture 3B doses by the end of 2021. In contrast, AstraZeneca struggled early on to scale up production and failed to deliver 300M doses to the EU, in the first half of 2021, but eventually went on to produce 2B doses by year end. 

Pfizer has been also demonized for its cut throat pricing negotiations and opaque queuing system for vaccine rollout. It would be an understatement to say that the art of pricing for a pandemic vaccine is tricky. Pfizer opened its negotiations with the U.S govt at $200 for 2 doses of vaccine. While many close to the matter believe that it was a profit mongering move, others shared the opinion that this pricing could be justified. For example, Pfizer’s pneumonia vaccine costs $200. If the company used this as a proxy and adjusted for the economic and health impact of COVID, $200 sounds reasonable ! 

However, in an attempt to partially match competition and save face, Pfizer lowered its price for the initial contract with the U.S.A to $19.5/dose. Even then, it was 5x of AstraZeneca’s ($4/dose) and 4x of J&J’s ($5/single dose). 

Despite this many countries around the world continue to secure Pfizer’s COVID vaccine, since unlike other pharma companies, it makes good on its delivery promises. Pfizer being Pfizer is well aware of this – so when the European Union secured an additional 1.8B doses for until 2023, instead of slashing down the prices, it raised it from $17.7 to $22.3. The same was reflected in the subsequent orders for the U.S.A and U.K. 

Middle to low income countries have mostly borne the brunt of opaqueness in vaccine distribution. While supplies ramped up in the later half of 2021, there is still a huge disparity. For example, 70% and more are fully vaccinated in G7 countries but, except a few regions, less than 20% are fully vaccinated in Africa. This is despite well intended initiatives such as COVAX, co-led by WHO, GAVI (Global alliance for vaccines and immunization) and CEPI (Coalition for Epidemic Preparedness Innovations), which, let’s just say, failed spectacularly to reach its lofty goals! 

In response to the backlash Pfizer began to prioritize distribution to these regions as well, but this wasn’t without hiccups. The countries had to jump through a lot of hoops to even get into the order books, had to change national laws to protect Pfizer against lawsuits and there are strong claims that a certain government was asked to put up sovereign assets to cover potential costs. When it was time to release their orders, lack of infrastructure was cited as a reason for not supplying them with vaccines. 

Who’s to blame – the company trying to make hay when the sun is not shining or, the governments of wealthy countries hoarding vaccines or, the vaccine hesitancy in some other countries? Whoever it may, the most alarming danger of inequitable rollout is the emergence of new variants – Omicron, being one of them. 

“No one is safe, until everyone is safe” 

Seth Berkley, Chief Executive of GAVI

All criticisms aside (and we know that there are many), in 2021, Pfizer’s COVID vaccines have been delivered to 161 countries, about 740M doses to middle-low income nations and it has even made boastful promises of delivering >1B doses to them, in 2022.

Covid Vax ARR (Annual Recurring Revenue) 

From Pfizer’s perspective, it is looking to milk COVID for a long time, as it’s likely to become a chief source of annual recurring revenue. COVID pills, vaccines for kids and booster doses are all part of it. Entry of the new oral antiviral pill for COVID, Paxclovid, apparently has a potential to bring in $18B in FY22.  As for booster doses, it appears that they are here to stay! If we are talking numbers, we are looking at closer to $50B from sales of COVID related drugs/vaccines, next year. 

What about beyond 2022? Will the Pfizer COVID bubble burst, after all? 

As things would have it, Pfizer is even planning a clinical study for the 4th dose that could prove the need for annual vaccination. If that doesn’t shock you, we don’t know what could! 

Is it possible that what started out as an acute necessity, will become a vaccine for perpetuity, like Polio? If so, how accessible and affordable will it be? Would it protect us against all the new variants? Would other pharma companies finally catch up with Pfizer? Will Pfizers of the world open up their walled gardens to the public? WE TRULY DON’T KNOW.  

But amidst all the pandemic borne confusion, dread and then desensitization, what hasn’t gained enough attention is the science behind the vaccine. Simply put, the mRNA technology has forever altered the future of medicine. If there ever was a classic example of a network of discoveries that underpin a vaccine, it would have to be COVID vaccine – a network that is complex and beautiful. The twist in the tale is that even if Pfizers of the world claim it as their own, it is actually the brainchild of numerous small academic labs and biotech companies, which were later licensed away to the big guys. 

Surely, “Science will win”, but wouldn’t it be so comforting and relieving to wake up to world sans COVID and science can go back to dealing with the usual menace of human ailments?