Moonshot

Inside Pfizer's Nine-Month Race to Make the Impossible Possible

Dr. Albert Bourla

• Publisher: Harper Business
• Year: 2022
• Print ISBN: 9780063210790
• eBook ISBN: 9780063210820
• Topic: Business
• Subtopic: Historical Biographies
• Index: Business

Wall Street Journal Bestseller

2022 Genesis Prize Laureate

Axiom Award Bronze Medalist for Business Intelligence / Innovation

The exclusive, first-hand, behind-the-scenes story of how Pfizer raced to create the first Covid-19 vaccine, told by Pfizer’s Chairman and CEO Dr. Albert Bourla.

A riveting, fast-paced, inside look at one of the most incredible private sector achievements in history, Moonshot recounts the intensive nine months in 2020 when the scientists at Pfizer, under the visionary leadership of Dr. Albert Bourla, made “the impossible possible”—creating, testing, and manufacturing a safe and effective Covid-19 vaccine that previously would have taken years to develop. 

Dr. Bourla chronicles how the brilliant, dedicated minds at Pfizer, under the enormous strains of the global pandemic, overcame a series of crises that were compounded by social and political unrest, and reveals the doubts, decisions, obstacles, and failures they encountered. As Dr. Bourla makes clear, Pfizer’s success wasn’t due to luck; it was because of preparation driven by four simple values—Courage, Excellence, Equity, and Joy.

Moonshot is a story of leadership under the most unprecedented circumstances—how Dr. Bourla, a Greek immigrant, a child of Holocaust survivors, and a veterinarian, became the head of one of the world’s largest corporations and initiated a dramatic transformation of the organization just before a global health crisis would serve to test the organization, its scientists, and its leader, like never before. Moonshot describes best practices that can be used to address the multiple, unprecedented challenges our world faces, reveals Pfizer’s implementation of scientific breakthroughs at a record-breaking pace, and offers leadership lessons that can help anyone successfully manage their own seemingly unsolvable problems. As Dr. Bourla explains, “I am sharing the story of our moonshot—the challenges we faced, the lessons we learned, and the core values that allowed us to make it happen—in hopes that it might inspire and inform your own moonshot, whatever that may be.”

1

Business NOT as Usual

“What matters is not what happens to you, but how you react to it.”

—Epictetus, AD 50–135

I WAS IN MY FIFTEENTH month as the company’s CEO. The novel coronavirus that had begun as a worrying epidemic in Wuhan, China, was fast becoming a terrifying global pandemic. Our team in China had already been forced to work from home. The first known death in the US had been reported near Seattle, and suddenly cities, sports leagues, and the stock market were in disarray. President Trump sent me an urgent invitation to join other leading pharmaceutical and public health scientists for a meeting to be held on March 2 in the White House Cabinet Room. I was in Europe to deliver a keynote speech at the Delphi Economic Forum, and I had asked our head of research and development, Mikael Dolsten, to attend. A physician and scientist, Mikael was trained in Sweden and has participated in the creation of more than thirty approved drugs. He joined Pfizer in 2009 as the Chief Scientific Officer and head of research and development. We’ve now worked closely together for years. He would play a critical role in our moonshot, despite the personal challenges COVID-19 caused him.

The meeting was to take place Monday, and my phone rang Sunday around noon. Mikael had arrived in Washington, DC, a day early and was wrestling with the message we wanted to land with the Trump administration. Much of our deliberations up to that point had focused on developing therapeutics that would help keep patients alive. But what about a vaccine that would prevent people from getting the virus in the first place? In other words, would we point our resources toward a treatment or a prevention?

In the context of COVID-19, a treatment alone wouldn’t end the pandemic. A vaccine could. A June 2018 paper from Vaccines Europe cites vaccination as “one of the most cost-effective public health interventions ever implemented” and makes the point that childhood vaccination “is one of the greatest medical success stories of the 20th century.” According to the World Health Organization, vaccines prevent 2 to 3 million deaths each year worldwide. Yet every year, around 1.5 million people die from vaccine-preventable diseases around the world, 42,000 in the US alone. Globally, one in five children under five does not have access to lifesaving immunizations. Apart from clean water and sanitation, vaccines have had the most profound impact on public health. This was the reason why when I became CEO I significantly increased the investments in vaccine research.

On that call, Mikael and I agreed that this virus was different, and we warmed to the idea of pursuing a vaccine first. One aspect that distinguishes Pfizer’s vaccine-making capabilities is that we are highly integrated, end to end, from early research to late-stage trials and clinical development. We also had one of the world’s premier vaccinology teams, led by a tough, courageous German scientist, Kathrin Jansen, and as a result we had an ace up our sleeve. With a career that spanned breakthroughs at Wyeth, Merck, and GlaxoSmithKline, Kathrin came from an East German family that fled just before the building of the Berlin Wall. Trained as a microbiologist in Germany, she did her postdoctoral research at Cornell University, and today she leads a team of globally recognized scientists who work in Pfizer’s laboratories in a small New York town called Pearl River. The director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, Paul Offit, told a reporter at Stat: “She’s exactly who you want in that position. She fights for the vaccines she thinks are important. People who think pharmaceutical companies are evil should spend time with people like Kathrin Jansen.”

I remember telling Mikael, “If not us, then who? Tell the White House that we are all in for a vaccine.” I could hear the excitement in his voice.

The next day in the White House Cabinet Room, the president was flanked by Vice President Mike Pence and Health and Human Services Secretary Alex Azar, the National Institutes of Health’s Dr. Tony Fauci, leaders from the Centers for Disease Control (CDC), and our colleagues from the pharmaceutical industry. There was a lot of discussion about treatments. When it came to his turn to speak, Mikael told the president, “It’s not just one solution. I think we should offer multiple approaches, therapeutics and vaccines.” He said that Pfizer was already advancing a therapeutic option and dedicating all resources necessary to pursue a vaccine at the same time, with a thirty-thousand-person team across the company to design clinical studies and manufacture both therapeutics and vaccines. He stated that Pfizer had started mobilizing our vaccine experts at sites around the world to prepare for this second approach against COVID-19 and that we would share with everyone around that table what we were learning, act as one team, and move swiftly given the urgency of the situation. “That’s fantastic,” the president replied. “Thank you very much. That’s, really, very exciting.”

Mikael called me later that day to report on the meeting. He told me that most of the discussion was about treatments, not prevention. “Tony Fauci seemed to be getting excited when I said we will go for a vaccine as well,” Mikael said.

In the meantime, the world started to change as the virus spread. The forum I had been invited to speak at, the Delphi Economic Forum, was suddenly and urgently postponed. For me this triggered a major alarm, and I decided to return home early. On the plane, I kept thinking about the emerging situation with this coronavirus and what the Pfizer priorities should be in response to it.

Coronaviruses are a large family of viruses named for the crown-like protein spikes on their outer surface. This was not the first time we’d had to worry about them. In 2003, the outbreak of severe acute respiratory syndrome (SARS) caused worldwide concern, with its swift global spread resulting in thousands of infections, and approximately 10 percent mortality. Laboratories in Hong Kong and Germany, and the US CDC, confirmed the root cause to be a novel coronavirus. The disease was controlled within months. A few years later, in 2012, another novel coronavirus, which may have transferred to humans from infected dromedary camels, became the cause of another respiratory syndrome, the Middle East respiratory syndrome (MERS-CoV). However, now the situation with COVID-19 was looking different. For example, in China we had to shut down our facilities to protect the safety of our people from COVID-19. This was not something we’d had to do with SARS or MERS. Would we have to do the same with our facilities around the world? I also knew from China that in the first weeks of COVID-19 the hospitals in the affected areas were overwhelmed. Could that happen in other parts of the world? And if yes, would these hospitals have enough medical supplies to treat the patients who would storm their intensive care units (ICUs)? For us at Pfizer, this question was translated into, Would we be able to supply them with enough quantities of the medicines they need? I started imagining dark scenarios where the global demand for hospital medicines was growing exponentially and at the same time our manufacturing sites were shutting down because of the disease and were unable to supply enough treatments.

Finally, I kept asking two questions: What if the medicines that physicians had currently in their hands were not effective enough against this virus, as seemed to be the case in China? And could Pfizer do something about it? I knew that in 2012 we had tested some molecules against MERS that seemed to have good antiviral activity. Maybe we could test them against this virus as well.

It was a long flight to come back home, and I ruminated for hours and wrote thoughts in a Pfizer board of directors notebook that I had pulled from my bag. Before landing, I cleared my notes by consolidating a few bullets and deleting those that didn’t seem important enough for the moment. I took a new piece of paper and I wrote on it what I thought would be the top three priorities for Pfizer:

Albert Bourla’s handwritten note, written on the plane returning home from Greece as he contemplated the company’s priorities in the early days of the COVID-19 pandemic, March 2020

Image courtesy of Pfizer Inc.

The next day I opened the door to our executive leadership team (ELT) meeting room at Pfizer’s headquarters near the United Nations building in New York City. We had named this room the “Purpose Circle.” When I’d taken over, I had removed the conference room table so that we could all sit together in comfortable chairs arranged in a circle. At first not everyone took to this arrangement, preferring the traditional setup. One element that warmed even the naysayers to the concept was a wall that prominently featured our purpose, “Breakthroughs that change patients’ lives.” On the other wall, each of our executives had hung photographs of patients who had inspired them personally to remember the importance of the decisions we make to the people who matter the most, the patients. It was their personal reminder to put patients first. Some hung a picture of a parent, some a picture of a friend, and one had a picture of their neighbor’s kid who was sick. I had hung a picture of my daughter, Selise. Selise, like her twin brother, Mois, was born prematurely in a hospital in Warsaw, where my wife and I were living while I worked for Pfizer Poland. However, unlike her brother, Selise suffered from hypoxia for a few minutes at her birth, which was enough to destroy some cells in an area of her brain near the cerebral ventricles. That caused her cerebral palsy, a condition that affected her mobility. My wife, Myriam, had devoted her life to making sure that Selise would not be defined by her condition, and that Selise could become an independent and thriving adult. She spent all her time taking Selise from one doctor to another and from physical therapy to myofascial therapy. She refused to accept “fate” and kept telling me and others that one day Selise would be a dancer and could run marathons. Setting bold goals runs in the family. Myriam spent hours every day searching the Internet for new medicines under development, like cell therapies, that, if successful, could help Selise rebuild some of the destroyed cells in the area of her brain that was affected by the few minutes of hypoxia. Thanks to Myriam’s sacrifices, Selise today is a bright student at Barnard College and lives an independent and full life in the college dorms. Her degree plan (at the time of this writing) is urban studies because she cares a lot about building more equitable cities. Her aim is to serve others in ways that will help people become happier and healthier. Unfortunately, those new medicines didn’t come in time to help Selise rebuild her cells and dance or run, or even walk without a cane. But I knew that one day they could come in time to help other kids and us at Pfizer to do something about it, so this day might come sooner than later. Selise’s picture on the wall of our executive team meeting room was my reminder to always put patients first. That day, in that room, many important decisions related to the three priorities I wrote on the plane had to be made.

But originally COVID-19 was not supposed to be the topic of discussion that day. We were supposed to continue our discussions for our ongoing major reorganization efforts. Not surprisingly, the decision we’d made in 2019 to increase our investments in R&D and digital capabilities, coupled with the need to reduce our cost base in marketing and administration, had created a lot of anxiety and tension. COVID-19 was not yet the central focus it would become. Leaders were still figuring out where they stood in the re-org. A CEO must have a spider sense for tension within the leadership team. I was sensing in early March 2020 that our effort to reimagine Pfizer’s organizational structure was causing emotions to boil over. To let off some steam, I planned a dinner with my executive team for that night at the aptly named Break Bar on Ninth Avenue in New York. “The Break Bar is everything you’d expect from any other bar with a BIG TWIST (OR SMASH). Here, when you are done with your shot, pint or wine . . . you smash the glass” is how it advertises itself. You can book a Rage Room at varying levels of intensity—“Anger Problems” or “RAMPAGE,” for example. I felt it was a creative way to let my team know that I understood how they felt. The dinner never happened, though. The COVID-19 lockdown canceled all plans. At our weekly executive leadership team roundtable in mid-March, the day we were supposed to go to the Break Bar, COVID-19 was the main concern in the air. I made it clear that it was time to rise to the occasion. I discussed with them the priorities I had set on my flight back: The safety and well-being of employees. Maintaining supply of critical medicines. And developing new medical solutions against COVID-19. We started making decisions.

One of the first and most difficult at the time was to close all our office facilities around the world and work remotely. We debated this question before the city and state of New York issued lockdown orders. When I asked to go around the room to hear from each person, it was clear there were differing views. After hearing them all, I had to make a decision. I decided to do it. “We have to close all offices and start working remotely.” I turned to Lidia Fonseca, our Chief Digital Officer, and told her, “You must make this work. There is a lot at stake here.”

For me this decision didn’t come easy. I am an extrovert. I gain energy by interacting with people. It’s important to look someone in the eye, read body language, walk down the hall with someone after a difficult conversation. How could I work from home? I was surprised to find, once we started working remotely, how easy the change came for me. Walk through the kitchen, turn left and you find the laundry, turn right and you find my home office. It is a relatively small room, suitable for no more than four people. But the size would no longer matter. In the next eighteen months, I could fit dozens of people on my new computer screen. I could still look them in the eye and read their body language, at least from the parts you could see on the screen.

Once this decision was made, someone asked, “What will happen to the people that are working in our buildings but are not our own employees?” As is typical with many large organizations, many people working in the mailroom, security, cafeteria services, and sanitation are employees of other companies that have contracts with us to provide their services. We work with these people daily, and everyone thinks about them like members of the family. In fact, one of my first thoughts was, What would happen to Luis? Luis Perdomo is a barista in our cafe, and he is a bit of a legend at Pfizer. He is also the epitome of joy. His smile lights up the room, and for many of us who drink coffee, he is the first person we see when we come to the office. Though his life has not always been easy—he tragically lost his teenage son to cancer a few years ago—you can always count on Luis for a smile, a kind word, and, if you’re really lucky, a morning hug. He is a true gem, so much so that we forgive him for his undying love of the Boston Red Sox!

The concern we were all feeling was that if we closed the offices and discontinued some of these services for a prolonged period, Luis and many other wonderful service providers would likely lose their jobs. “Let’s maintain regular payments to all these contractors under the condition that they keep the people working for us regularly employed, even though they won’t provide their services to us,” I said. Everyone felt good about it. Our procurement team took the responsibility to make this happen, working with each of the businesses within the company to keep contractors paid wherever possible. These early decisions took care of the first priority I had written on my flight back home, “Safety and well-being of employees.” I was happy because, like other CEOs, I felt tremendous responsibility for the health and welfare of the ninety thousand Pfizer employees around the world. But I also felt we had additional responsibilities as a healthcare company in the middle of a health crisis. Our people discover, develop, and produce medicines for hundreds of millions of patients globally, people who rely on us each and every day—people suffering with cancer, heart disease, or arthritis. Our research centers and manufacturing plants around the world would have to remain open. My immediate fear was expressed in the second priority I had set for us, “Supply of critical medicines.” COVID-19 or not, people had to receive their medicines. I was concerned with potential shortages of needed medicines—stockouts, as we call the situation. I was particularly concerned with hospitals. They were expected to get overcrowded, and Pfizer is one of the largest suppliers of injectable hospital medicines in the world. I discussed this concern with Frank D’Amelio, our long-standing and highly regarded Chief Financial Officer, who likes to roll up his sleeves and problem-solve. Frank, who also has the responsibility of overseeing manufacturing, warned me that stockouts would be inevitable. The demand for these medicines could be ten to fifty times higher, and at the same time it would be difficult to ramp up production under COVID-19 restrictions. I rallied our team, imploring that we must deliver in the middle of a health crisis. Failure was not an option. They acknowledged the challenge and immediately jumped to a wartime footing. We already had in place a crisis management plan that was developed years ago with situations like this in mind. The management of manufacturing had already activated this plan, and our manufacturing sites were operating under “preparedness level ...

Table of contents

• Cover
• Title Page
• Dedication
• Contents
• Foreword by President Jimmy Carter
• Preface: Luck Never Comes to the Unprepared
• 1. Business NOT as Usual
• 2. What Is Obvious Is Not Always Right
• 3. Thinking Big Makes the Impossible Possible
• 4. Lightspeed
• 5. The Ultimate Joy
• 6. Past, Present, Future
• 7. Manufacturing, the Second Miracle
• 8. Equity: Easier Said Than Done
• 9. Navigating a Political Minefield
• 10. A Beacon of Hope
• 11. The Science of Trust
• 12. A Pro-Patient, Pro-Innovation Agenda
• Epilogue
• Acknowledgments
• Appendix: Albert Bourla’s “We Stand With Science” Open Letter to Colleagues
• Bibliography
• Photo Section
• About the Author
• Copyright
• About the Publisher