Lex Fridman Albert Bourla Interview

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00:00:00: Lex Fridman The development of the COVID-19 vaccine was one of the greatest accomplishments of science in recent history no matter what that 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.
00:00:23: Albert Bourla I hope so.
00:00:24: Lex Fridman Take me through the day of november 8th 2020 when the fighter team, we're waiting for the results of the phase three clinical trials
00:00:31: Albert Bourla we had assembled in a very small office that we're having in Connecticut. Very few people. There were five I think. And in another place what we call the data monitoring committee which is a group of experts, independent experts, their own fighter. We're going to have the opportunity to um blind the data and then 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 anxiety to all of us. But came around I think two o'clock
00:01:12: Lex Fridman you're just sitting there waiting. What were you feeling?
00:01:14: Albert Bourla Sitting there waiting and teasing one another. Um drinking coffee, making jokes.
00:01:21: Lex Fridman So what how did you feel like when you heard the results, the successful results?
00:01:28: Albert Bourla three liberated happy. uh like if a huge weight that was on my soldiers was lifted.
00:01:40: Lex Fridman I heard you said I love you to the team.
00:01:44: Albert Bourla I did. You know this is how we're speaking Mediterranean.
00:01:50: Lex Fridman Listen maybe it's the Russian thing too. I I love love so I appreciate that kind of celebration. So looking back from that moment to before, how much did it cost to develop the fight sir 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.
00:02:13: Albert Bourla You know, we do a lot of that anyway. This is what we do in our daily work. We're putting money, we are investing in research which is highly risky. The difference in that case was that within the risk category put it all in, we put everything in one goal so that we don't lose time. Usually we will 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 all together A little bit more than $2 billion. 2.3 billion dollars. And it was significant decision but it was very easy decision to make in the context of what we were living at that time. It was a pandemic. People were scared. We were scared. We didn't know how tomorrow will look like we were living unprecedented situations and we knew that we have capabilities that may help. So there was not a second question of choice. We go all in
00:03:16: Lex Fridman 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 the obvious choice um I think you've said a bunch of things of the kind of saying we need to go all in sort of very boldly diving in how much was that that the world is facing uncertainty and fear and 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
00:04:07: Albert Bourla risk. Yeah, I think about it all the time and I know very well, but if you focus too much on making money you will never make, you should focus in what is the real value driver and the real 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 companies to be how to help the pace and that's what the management was that 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 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 as always when you do that, you will have good returns as well
00:05:10: Lex Fridman 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?
00:05:25: Albert Bourla Not at all because the studies are highly regulated. Everybody knows what regulators and when I say regulators F. D. A. European authorities, UK authorities, Israeli authorities, the police 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 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 very high precision if your medicine is effective if your medicine is safe and those are there for all and are playing with the symbols,
00:06:16: Lex Fridman Do you have an intuition about why is the FDA trying to get 75 years To release the fighter data? They're trying to request that we 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 full transparency and immediate access to the data immediate? You know, on the scale of weeks, not years.
00:06:44: Albert Bourla I think the relations with regulators there have been always very transparent and there are a lot of laws that they are forcing regulators to and companies to put out their their interactions and what exactly was discussed now to go into specific details of have some discussions. I don't know what is the reason that FDA wants to take the time and but I'm sure they have very good reasons.
00:07:13: Lex Fridman 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 over 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 that they said it's 75 years is because they set a rate of being able to only review 500 pages of data a day or something like that. And it's a very kind of bureaucratic thing or 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 has the potential to be one of the great institutions of our country. And this is one example that it feels to me like a failure. So when your perspective you're saying, I'm sure they have a good reason. So do you the FDA is this black box that you submit things to once they approve. You know that those are the rules. It's approved. That's it.
00:08:38: Albert Bourla But this is not a black box. We know very well what 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 bridge the FDA. Clearly they have very, very high caliber of science that they are going into a lot of details and also basically everything for a study is really released by law in the specifications of the product but it's a very detailed document that it is issue and has basically the essence of everything was discussed. I don't know about specific documents if take them time to to release. But clearly this is not a black box type of process.
00:09:32: Lex Fridman 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 sometimes it's just in eloquence in communication. It's not that there is a failure of process, it's in eloquence, communication and silence silence in the moment when clearly a lot of people are bothered and have questions. This is when you speak out and you explain exactly why as as opposed to letting the sort of distrust build up and linger because the result is there's a very large percentage of the population that just um I mean it divides people and science suffers I think and also the effectiveness of solutions suffers like the vaccine and so on. I asked a few folks I know if they had challenging questions for you.
00:10:29: Albert Bourla I'm sure many of them answer your call.
00:10:33: Lex Fridman Yeah. Yeah. Yeah. You know many friendly folks out there by the way I'm sweating. Not because this is a difficult conversation. It is but it's also hot in here for the record. So one of the folks is mr Jordan Peterson, I don't know if you know who that is. He's a psychologist and intellectual and author. He suggested to me that I raised the concern that there is a close working relationship between Fizer FDA and CDC. So we we talked about F. D. A. Do you worry that this affects both positive and negative? Uh Pfizer's chances of getting drugs approved? The fact that there's people you know that worked at the FDA that not work. A fighter fighter F. D. A. That there's a kind of pipeline. Does this worry you that it affects your ability to do great unbiased work?
00:11:29: Albert Bourla I have zero doubts that this is not affecting at all. Their ability to be unbiased and regulate. And in order to for the system also reinforces that by creating significant time barriers. If someone moves from an industry to F. D. A. He won't be able to deal with topics for a period of time and then for even an enhanced period of time with topics that are related with the company he or she may come from. I think this um regulators, they are really very strict bridal song. If anything, I feel sometimes that maybe they should be a little bit more open minded, particularly when it comes to new technologies rather than trying to judge and implement the same framework of valuation of India crotches to all. They are always as circulators in the conservative side but always always they are unbiased and they are trying the best and it's not only one or two people, they have processes to make sure that they're self checks and balances within the agencies, both in CDC and in the FDA difficult decisions. They bring external experts that they should express easy decisions. There are internal experts that they are debating a lot and if there are disagreements, they elevate them. So I think it's we are lucky to have good regulators. I think I agree with what you said before as with all governmental agencies, there is bureaucracy and the bureaucracy needs to be addressed and by saying, your focus is not relaxing the the bar, the bar needs to remain high, but being uh, focusing on what matters rather than on the, on the detail.
00:13:21: Lex Fridman So, you don't, you know, I've been reading quite a bit about history, you don't worry about human nature and, and corruption that can seep in. You're saying institutionally there's protections against this.
00:13:33: Albert Bourla I think there is always the fear of corruption, particularly when you speak about public servants. But clearly the risk is very different country by country. And speaking about agencies by entrances, I think the regulatory agencies have a very good track record and history of the US of europe of England of very, very good track record of integrity.
00:14:01: Lex Fridman It's something I think about. So I grew up in the soviet union and um, I need to perhaps introspect this a little bit. But when, when I was growing up ethically, there was a sense that bribery is the only way you can get stuff done. That that was the system of the time. Like you get pulled over by a police officer. Like obviously you need to bribe them. It was like the way of life. Um And then so coming to this country was, it was beautiful to see that the rule of law has so much power and ultimately the rule of law when enacted when, when it holds up, it gives people freedom to do the best work of their lives, but they're still human nature. And that that worries me a lot here. And again, it goes back to the perception of the communication when there's people that have worked at Fizer and an FDA at the CDC, you know, you look at the resume, they have those things on their resume. It worries people are these great leaders that we are supposed to see as authorities. Are they playing a game on us?
00:15:11: Albert Bourla I would say that I recognize what you said about what happened in or what I'm sure that what you describe in the country that you're coming from, it was how you experienced it and I know that there are other countries that you need to do these things to do your job. I don't think it's the case uh in in this country, particularly when it comes to those agencies that you mentioned, I think they have a very high track record and also I don't think that there are a lot of people that they are worried about it or doubt, I'm sure like everywhere, there will be a minority. But the vast majority of the americans, the vast majority of the Europeans, the vast majority of the bridge, the vast majority of the Israelis. They trust what F. D. A. Or M. A. Or C. D. C. Or M. S. R. A. I will say
00:16:05: Lex Fridman still there is currently a distrust of big farmer 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 that we've talked about. But you have, they have to be entangled to achieve scale oversight and to achieve the kind of scale that fights has been able to accomplish. How can fighter 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
00:16:41: Albert Bourla reputation is something that you can lose in buckets, but you can end back in drops and um once you lost it, 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 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 very few will disagree that the industry is a very different industry right now that being said, I truly believe. But 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 you didn't have solutions with treatments, solutions with vaccines. And I think that demonstrated very clearly to the world the value thriving life sciences sector, private life sciences sector to society that also affected very positively the reputation both of the sector and a fighter. I'm not going to make the mistake to consider given I'm not making 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 you behave and I hope that will rise to this occasion and we will do that.
00:18:46: Lex Fridman You've been a fighter for 28 years, time flies when you're having fun and you become Ceo 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 On this topic of reputation. In 2009, fighter pleaded guilty to the illegal marketing of Arthritis drug Bextra and agreed to $2.3 billion dollar settlement. How do you make sense of the fact that this happened to accompany you love and then you believe in?
00:19:24: Albert Bourla Yes. The Baxter case in 2009 was related to things that happened in 2003. And the things that happened in 2003 were things that 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. Can you
00:19:49: Lex Fridman 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,
00:19:57: Albert Bourla 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 our studies that are happening of labor and apparently several of our reps in 2003 they did it and we had to 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 the fines are if Baxter was a small product, we would get a small fine. Baxter was a very big product and we've got a very large fine, very bad. What happened in 2003? I don't think that these things happened since then. We have a stellar record from 2009 until now of 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 the promotion. They may try and do things that they are not the right things. And 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, But I believe a lot has changed in the 20 years that followed For almost 20 years.
00:21:24: Lex Fridman 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 tried to do good in the world? Um that's some of the cost of the lawsuits. How do you uh not fall victim to thinking that is just the cost of doing business and then some of the losses might actually represent real pain that people are going through.
00:22:06: Albert Bourla No, 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 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 tried 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 eventually, if you're doing the right thing, you will be on the right side of the history.
00:23:10: Lex Fridman 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. And also in another way in other realms creating a product that people love is the best way to make money. So focusing on the on the core of the thing that makes people 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 marketing on mainstream media channels by Fizer. So let me ask the 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. The kind of authority of like what the heck is going on in the world and if Pfizer's sponsoring 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 because they're afraid of losing the sponsorship. It's subtle but at scale it might have a serious impact. Do you worry about this?
00:24:31: Albert Bourla I think people could go one way or another because of multiple reasons. From our perspective. We I don't think we have aggressive marketing, what do we do? We go on tv and we are having 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 there are off label that have not been approved. We need to have every time we go into v as you know, FDA is forcing as 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. No, people could be influenced uh in and can be biased in in the podcast or in the other type of media activities that they have for multiple different reasons.
00:25:34: Lex Fridman Yeah, I know. But it's still it's pressure, it's human nature. I mean I was one of its perception but I worry about to I think 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 Fizer, but there's implied pressure sometimes and I worry about that a lot because, you know, I look at academia, like I look for the good in people attentively, most people are good or have the capacity to be good and desire to be good. When I came to M I. T. I. I was a little bit um disappointed. Maybe heartbroken. How much pressure? Um I think unjustified pressure people felt from financial constraints, especially at M. I. T. When there's I think a lot of money 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 want to blame money on everything money constraints. But when you have sponsors, it just um I personally worry that doesn't bring the best out of people. And so I feel like I want to put some responsibility on sponsors and and great big companies like Fizer to to kind of not get in the way of the best of human nature, whether it's sponsoring podcasts, mainstream media, like I don't know, athletes,
00:27:21: Albert Bourla whatever 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 the persons or the programs that we are sponsoring? So I don't think our friend I think was from texas. Yes. Yeah, I don't yes, yes. I don't think he, he got it right that we do those type of things
00:27:58: Lex Fridman we don't know in terms of manipulate like having a negative effect on
00:28:01: Albert Bourla not even having aggressive sponsorships. We have very few.
00:28:04: Lex Fridman Yeah. When you clip them altogether and
00:28:06: Albert Bourla most of the sponsorship that you have, it is more on patient related organizations rather than we are very careful not to sponsor other things that can be perceived not even influence but perceived that we may influence. So we are very, very careful on that. This is not the case with us.
00:28:24: Lex Fridman So with the incredibly fast development of vaccine, could you tell me the story from the engineering to the science to the human story of how you could do it so fast by november even had the ambition to do by october It was in the initial days.
00:28:45: Albert Bourla How do you Eight days later
00:28:48: Lex Fridman in that time. How do you show that the vaccine is safe and effective. Um, given that I think previous vaccines have taken years to do that.
00:28:58: Albert Bourla The vaccines take years to do that and the time what it takes. It is basically The vast majority of the time to conduct the final Phase three study, what is the confirmatory study? And you do that because the Phase two study cost a lot of money in our case cost almost a billion. So you don't want to go and risk a billion in blindly data. Normally before you do a lot of experiments to make sure that the product that you're putting in the Phase three is the right one. We didn't have the time. So we risk all the money. So we went into we condensed all the time towards this phase three but the phase three study had to follow all the rules that any study follows. When you do this trial,
00:29:48: Lex Fridman could you just briefly describe the basics of what is phase one, what is phase two, what is phase
00:29:54: Albert Bourla 3? Let's say that there are so many phases. When you try first of all to find what is the right vaccine. We tried from 20 different vaccines, we nailed down to four and for those four we selected eventually too and then eventually won. Once you have those selections, what is the dose you're going to use And then we tried multiple different doses to see which one we think is the best
00:30:19: Lex Fridman what is trying entail in those early days
00:30:22: Albert Bourla you go first of all with smaller doses in humans and then after you have done a lot of experiments in animals so that you can feel that it is safe enough to go to humans and then go with very low dose and then you gradually increase the dose and then you monitor those humans to make sure that there are not any, let's say react to genesis to what you're giving them at the same time, you start to measure what is doing in terms of immune responses. So you do that with multiple vaccines and you do that with multiple doses and you do that with multiple ages of people, young people, old people and eventually From the 20 vaccines to multiple doses to multiple schedules. Is it after three weeks, the second dose or is it after four weeks or after six months? All of that will inform you. But I think this is the vaccine, this is the dose, This is the scheme that I believe Will give me the best results. And when you have that, then you go to do what we call the Phase three. This is a very big study. Thousands of people Where you use the vaccine that you think is the right one and a placebo. The placebo and the vaccine they look identical. Nobody knows if he's injected a placebo vaccine, the physician that makes the injection, the doctor doesn't know if he's injecting placebo or vaccine he knows a barcode only the computer knows in order to go into this computer. There are keys and there are at least two people that needs to put their kids so that someone can see the data. And there's those people, they have legal obligations never to do that. Right? So before a certain point. So all of that is blinded. The idea is that when you go into this study, you need to make sure that you are going with the right one. That's why it takes so many, so much time. But the study is the study. You need to have a significant number of people that will give the two and then you let them live their lives. And then you see how many of them will get the disease. And then you see if there are differences in percentage of infections for the vaccinated compared to non vaccinated at the same time, you're monitoring all of them to see if there are differences in the safety profile. If those that they go to placebo have the same, let's say Heart attacks with us that they didn't, they got the vaccine. Because heart attacks will happen if you have 50,000 people because it's part of life. These are the all these processes are very, very, very well established. And since years, what we did, the last one was exactly the same as we did. Always. We just didn't lose time. We didn't we were not careful with money Instead of recruiting 50,000 people over a year. Because we had, let's say 30 hospitals doing the recruitment, We went with 150 hospitals doing the recruitment that cost a lot of money. But instead of recruiting them in a year, we recruited them in 34 months. So I did this type of things by taking a return on investment, taking costs out of the equation and we're able to achieve this result. But it's not the process. Believe me, it is the heart of the people. People don't know what they can and what they cannot do. And if anything, they have a serious tendency to underestimate what they can do. And always when you ask them something that is seemingly impossible, they will think out of the box to be able to deliver. We discussed about the time instead of eight years. We didn't ask them to do it in six, we asked them to do it in eight months. Our normal manufacturing Yearly production fights was 200 million doses of vaccines every year. That was we are doing in the last 10 years. We didn't ask them to make $300 million three billion doses for a new vaccine. The discovery phase of a new molecule like the treatment that we have another appeal against. Covid text four years. We didn't ask them to do it in three. We asked them to do it in four months, which is what they did when you're setting this type of goals, They know immediately they cannot just think within the box And immediately this is where the human ingenuity and the heart comes and this is how they surprised all of us.
00:34:54: Lex Fridman So there is incredible science and engineering going on here. This
00:34:58: Albert Bourla is an incredible,
00:35:00: Lex Fridman this is what's bothering me that the conversation in the public is often not about that.
00:35:09: Albert Bourla It's about politics. Unfortunately,
00:35:10: Lex Fridman politics. So I spent the day with y'all musk yesterday. He works with rockets. Ah, similar situation is with visor in the sense that there's Nasa and then there's this private company and that's a source of incredible inspiration to people. No politics. Very little politics. Um, so this is part of the thing. I'm trying to I'm hoping to do our little part in this conversation. Help untangle a little bit. Just reveal the beauty and the power of the thing that was done here, especially with the vaccine. But other things that are being done with the, with the antiviral drug, 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? Let's say that
00:36:16: Albert Bourla No, they should not fear something like that. It's completely wrong. There is no medical products in the history of humanity that have been tested as much as this vaccine has been a minister 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 sit 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. But it is misinformation but it is spread on purpose.
00:37:27: Lex Fridman 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 can call anyone, you can basically call anybody a liar and say I'm the user sole possessor of the truth. And just no offense to me. Just because you wear a tie, it doesn't mean you're any more likely to be in the possession of the truth and anyone else. So
00:38:03: Albert Bourla I wouldn't disagree with that at all. I don't think that somebody who's not wearing a tie. And as you can people can see that I'm not wearing a tie and you are but it's not about uh huh being able though that they have the power two to impose on the others the stigma that you what you're saying is missing formation. But there are few things that the society we have accomplished and science is one of them. And data Is an analytics of data is another one. And to say that something which is highly scientific by people that they are not scientists. I think that it is not what you're describing, what used to happen in the soviet union or in any other autocratic regime in the world right now.
00:38:59: Lex Fridman But I definitely do think that uh the scientists and the public science communicators have listened to over covid has really disappointed me because they have not spoken with empathy. They haven't sufficiently, in my view have put their ego aside and really listen to people. Yes. People that don't have a PhD people have not really, you know, maybe you're not even taken like a biology course in college or something like that but still they have Children. They they worry they fear they don't know who to trust. They don't you know if they should listen to the ceo of fight sir 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 to them talking down to them as if they're not intelligent so on is something scientists have done almost like rolled their eyes and that disappoints me because I think that's kind of what is the source of division
00:40:02: Albert Bourla humility is a virtue. Yes and yes, the fact that you are educated doesn't mean that you are having either humility or empathy or you have good human qualities. This was never and will never be a metric of judging this type of virtues. Um those that they do this, they're wrong and actually they are not doing good service to the public health because they're undermining people aren't stupid. They see if you are not be respecting them and if you're not respecting their need to learn because that affects their health. The health of the mother of 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 an agenda. What I'm saying is there is a small number of people that they have made business for them two profit from this anxiety. I'll give you an example. I have been arrested by FBI. This is what someone wrote. I I read it. I laughed. I mean, okay, this is where they take, there was a reason why they wrote it down the fighter Ceo was arrest FBI because they want to create doubts in the minds of the people that they are afraid and say, look if FBI arrested him, likely I will not do the vaccine. But they left a week later. The wife of the Pfizer Ceo diet. 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 tried to find my kids to tell them if you read something, mom is fine. Don't worry. Then I remember that she has very old parents back in Greece. We started calling them to making sure because we know that that will be picked up by correct newspapers and they will publish it. Okay. They are those people that throw these things, they know very well, but my wife didn't die and died because she was vaccinated. Right? So this is the narratives that they are on purpose forming to profit from the stress and the anxiety of good people.
00:42:35: Lex Fridman And that's something I have to kind of people that listen to this, that kind of doubt institutions. I do also want to 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 farmer is lying to you. They're manipulating you. I'm surprised at how much money can be made with that. And it's sad. So you have to just as people use their common sense to be skeptical when listening to politicians and powerful figures. They should be skeptical to also when listening to sort of the conspiracy theorists are 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 science in this pure form, not when entangled 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 adviser, this incredible technology to ah sing your praises. So 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 not not to do a Shakespearean analysis of your twitter, but I think you tweeted something about a study with 100% efficacy or the vaccine or in stopping the transmission or something like that. Do you regret sort of being um like over representing 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%,,
00:44:53: Albert Bourla no, I never said something 100% and every time I speak if a number is 100%. I rushed to say that in biology there is nothing 100% because always there will be when you go to the millions. Okay. They were in the study things that were 100% for example deaths or in South Africa. When we tried there was 100 Africa's Clearly 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 in addition to how careful I am, I have people that they are looking at and they're having 2nd and 3rd opinions to make sure that we don't put why? Because I know that people are listening to me right now. Everything I say and I want to make sure that they continue not only not only being clear as to what I want to say. So there are no misunderstandings but also I maintained the trust of the people. I don't think that someone who only sell picks information and only emphasizes because the things, it's someone that it is the one to be trusted and I want me and fighter to be trusted.
00:46:08: Lex Fridman 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 that something you see that's taking a booster shot regularly. Like annually.
00:46:32: Albert Bourla Yes. In the beginning when we had the first months of the vaccine, people would ask me do we need another one? And I said we don't know 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 8-12 months after the second dose and then after that annually vaccinations. This is what I said, I believe is one of the most likely scenarios and it was based on the data about the head. But then Delta came and because I always making the the caveat that with absent and you very in with everything we know with delta it was proven that we need the booster to move to the three to the six months. And this is what happened. And I still said I think the booster is a six months and then I think it will be an annual re vaccination. Like we have to monitor to see the data. But this is the likely scenario. Now we have a microphone And the immigrant says that 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 3rd dose 196 from six months to three so that they will reduce the period that people will not be protected with with the third dose. Uh, I don't know with immigrant 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 will no 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're running At one billion almost approximately doses per quarter four per year. And if you have two streets And have half of that in the new half of that in the old we will do still $4 billion. So I think the world should feel very, very comfortable. But if there is a need we will be ahead of the virus.
00:48:46: Lex Fridman Yeah you did. You delivered or produced three billion this year vaccines and you're on track to do four billion next year. And if we had a lot more time we will talk about how the heck you achieve that kind of scale is truly incredible. Um, let me ask the policy question. 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?
00:49:24: Albert Bourla I think it is a very difficult um topic in 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 fights 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 and fight. We are flexible. We are giving exceptions of course for health, maybe some religions, but we decided to mandate it now Advisor We when we did this decision, we were at 90% vaccination rates. When we said we're going to mandate it And that took it up to 96. It works Right. 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 took it to 96%. I'm happy for those people. A lot were not disease and some will not die of the obvious people, but it's not me to say because the debate, 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 uh and uh it comes with the territory. If you're elected to run a country, you should be ready to make difficult decisions
00:51:04: Lex Fridman and no matter what decision you make, there will be fake stories written about you as we talked
00:51:08: Albert Bourla about. You will not be able to please everyone.
00:51:10: Lex Fridman Yes. Um 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 it is a really bad idea even even if it's good for the health of the populace. Um, there's something about preserving the freedom is really powerful about this country. 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. Do you think Children need to get vaccinated?
00:51:58: Albert Bourla I do I do think that they need to get vaccinated.
00:52:01: Lex Fridman So age range is 5 - 16. There's a lot of parents that that fear for the well being of their Children. Can you empathize with those parents. Can you still man their arguments against the vaccine for their Children.
00:52:21: Albert Bourla You know because people know who I am. I had the opportunity to um to to interact with parents before that was let's say approved. And there were so many way more that 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 the vaccine? I really fear. I feel that this is unfair. But I'm protected. My husband is protected. My old son is protected and my little sweetheart because he's below the AIDS is not protected. Now that we have the vaccines, I'm sure that those that they are afraid of the vaccine, not of the disease, which are smaller numbers, admittedly also they will have if they are afraid of them. I'm sure that they were 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 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?
00:53:32: Lex Fridman What do you think about that calculation? Because the risk for kids is very low. Kids do die. Kids do go to the hospital from covid, but the rate is very low,
00:53:42: Albert Bourla 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 stopped 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. Well, fewer number than those that they're having Covid in in the hospital. But everybody is getting the vaccine. It's um,
00:54:31: Lex Fridman well, polio was deadlier for kids,
00:54:34: Albert Bourla but it's not now. So why some kid to do it now because it needs to be protected?
00:54:40: Lex Fridman Well, the unique thing about the Covid vaccine is 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,
00:54:58: Albert Bourla I think choosing to vaccinate Children makes its toys so that something could not potentially hurt them. Which is the disease. That's why we are doing vaccinations since ever. I know that there are people that they are concerned for themselves and for for their kids. What I know it is, but 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.
00:55:31: Lex Fridman So we've talked quite a bit about the vaccine. But there's an incredible new technology that fighters developing with Paxil Covid? Uh, antiviral for Covid? Where does that stand? How does that work? Um, and how are you able to develop in four months like you said and all of that in just a few minutes
00:55:54: Albert Bourla 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 disease 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 in the real world when the numbers are getting very high, we may have 99 100. But 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 search of, 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. It is something that I didn't have before. Uh, and this is a significant, significant game changer.
00:57:20: Lex Fridman I have to ask a controversial, difficult question. What what are your thoughts about Ivan martin? Has it sufficiently been studied as far as it considered it? And it's, like I said, incredible development of the antiviral um, as like as a comparator, that kind of thing just investigated in general. The reason I bring it up because I've read quite a few criticisms of people, There's been some comparisons of Paxil over to the 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's a lot of people that kind of see this free drug without patents on it and say this could be the savior. So can you just speak to that comparison? And it's not the first
00:58:14: Albert Bourla time if you remember there were other compounds that were claimed that they are being the solution to Covid. And clearly they were proven that they're not, there are compounds that their solutions and compounds that they're not. I as a scientist and I discussed with our scientists, they don't see any the reason why a medicine like I have a market in which the policy decide to be able to act on Covid? And so they don't think that present connection. And they haven't seen any paper that describes someone that used it, that it had any results. I'm sure that there will be some people that will claim because people are claiming anything. But I don't think that there was any paper in any peer review magazine and a reliable scientific magazine to to support this claim. So we are focusing on saving people's lives. We're not focusing on on uh, craziness.
00:59:18: Lex Fridman Well to push back, there is quite a lot of papers but the studies are small so that, so there's no conclusive evidence and
00:59:27: Albert Bourla I haven't seen any that it is reliable. Right? I don't know where are these smaller, big reliable. I haven't seen any.
00:59:35: Lex Fridman Right. Well, some of the big ones have been retracted, which means they weren't legitimate. Yes. You know, so this is definitely something that people need to look at the people that kind of question or the effectiveness I've ever met and definitely um something to think about. And I think is the reason that chloroquine
00:59:55: Albert Bourla before. Yes, for God's sake. That's why I packed how many people died because of that.
01:00:02: Lex Fridman Yeah, this is the, this is this is the dangerous thing. This is the sad thing
01:00:08: Albert Bourla but has been studying thousands of people and will be under the scrutiny. Not only of regulators, but as we will go into the implementation, as it happened in many countries, they will monitor to see what's happened with, let's say that whatever we do once it is out there within a few weeks, they will know all hospitals if it works or not because they will see the statistics.
01:00:30: Lex Fridman We've gone through one of the more difficult periods in recent human history over the past two years. Like as a society. What gives you, what gives you hope about the
01:00:42: Albert Bourla future for
01:00:43: Lex Fridman human civilization? You look into the next few
01:00:47: Albert Bourla years I think the human ingenuity I think although there there is um the world always is progressing. Although there are a lot of things that need to be fixed In the society of 2020 Beside of 2020 is better at large Than Things. 50 years back 100 years back in all different aspects from poverty for human rights from, from science, from quality of life from any aspect I am positive that humans can create and always create a better future and we'll continue doing so
01:01:31: Lex Fridman 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 think about your death? Are you afraid of death?
01:01:49: Albert Bourla 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 the first time that 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, the possibility that will not be part of their lives anymore and I will not be watching, I hope there is life upstairs, so I will be able to watch them from there
01:02:28: Lex Fridman from upstairs and get a nice overview. Um, 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? He 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?
01:02:51: Albert Bourla I would repeat something that steve jobs has said, death is life's biggest invention. It eliminates the old and gives place to the new life is all about moving forward. Life is all about creating new things. Maybe everyone is a contributor, But no one is the owner
01:03:19: Lex Fridman and always creating something new, always adding something beautiful into the world. Maybe a little bit of love. Hopefully Albert thank you so much. It's a huge honor that uh, you will go through some of these difficult questions with me today and and then you will give your extremely valuable time for this conversation, Thank you so much for talking today.
01:03:39: Albert Bourla Thank you for your interest and I'm happy as I was telling you before, but I can brag with my kids that I was in your podcast because you're their hero. I made it. Thank you. Thank you.
01:03:54: Lex Fridman 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.