Breakthroughs Run on Speed. Trust Runs on Patience.

Fridman opens with a warning he will come back to at the end. One group of people, he says, tells you that only they possess the truth, and that government, companies, science, authorities, experts, and institutions will save you. A second group tells you that only they possess the truth, and that those same forces will hurt you. Both groups have the benevolent and the malevolent, heroes and charlatans. The hard fact is that no one can tell you with absolute certainty which is which. You have to use your mind. That is the burden of being free.

He also refuses to flatten history. Vaccines have saved hundreds of millions of lives in the past century; medicine has saved billions. Ignore the power of science and you are dishonest about that record. Ignore the corrupting nature of power and money inside institutions, including governments and companies that led to the suffering of hundreds of millions, and you are dishonest again. He took two shots of the Pfizer vaccine. That was his decision. He does not want to force it on anyone, or dismiss people who choose otherwise.

Then he asks Bourla for the day that still sits at the center of the story. On November 8, 2020, a handful of people — Bourla thinks five — assembled in a very small Pfizer office in Connecticut. Somewhere else sat the data monitoring committee, independent experts, not Pfizer, who would unblind the Phase 3 data and say whether the study should continue, had succeeded, or had failed. The call came later than expected. They sat there teasing one another, drinking coffee, making jokes, anxiety rising. Around two o’clock the phone rang.

Successful results. Bourla’s words are simple: free, liberated, happy, as if a huge weight had been lifted from his shoulders. Fridman has heard that he told the team “I love you.” Bourla does not deny it. That is how people speak in the Mediterranean, he says, and maybe it is a Russian thing too. Fridman, who loves love, appreciates that kind of celebration. The rest of the hour is what that phone call could not settle: money, speed, regulators, rumors, and whether a company that had just done something historic could still be believed.

Looking back from that afternoon, Fridman asks what the Pfizer-BioNTech vaccine cost, and what it was like to make the bet when failure was still on the table. Bourla says this is the daily work — investing in research that is highly risky — with one difference. Usually they spend $50 million, and if that goes well another $50 million, and if that goes well $100 million. This time they put it all in at once so they would not lose time: a little more than $2 billion, $2.3 billion. In the fear of early 2020, with no one sure what tomorrow looked like and capabilities that might help, he calls it a significant decision and an easy one. There was not a second choice. They went all in.

Fridman pushes the question many listeners have: the CEO of a company that needs to make money, in a pandemic that might also be a financial opportunity — how much of each was in the calculation? Bourla’s answer is the industry’s oldest commercial logic dressed as a motto. If you focus too much on making money, he says, you will never make it. The real value driver is breakthroughs that change patients’ lives. Skip that and you never make money; do it and the money follows. In this case he says they were not thinking about what they would make when they sold the shot. They were focused on bringing a solution and hope. Good returns, he adds, come when you do that.

Does the pressure to cover those costs harm the ability to run unbiased studies? Bourla says not at all. The studies are highly regulated. FDA, European, UK, Israeli, Japanese, and Canadian authorities all specify how a trial must be run and what they need to see. You can decide how much money to risk. You cannot change the rules of the game so that you will not lose it. The methodologies that say, with high precision, whether a medicine is effective and safe are the same for everyone playing.

Fridman’s first hard question is about the FDA. The agency was seeking on the order of 75 years to release Pfizer data, apparently because an internal rate of a few hundred pages a day would stretch that far. Should people have full transparency on a scale of weeks, not years? Bourla says relations with regulators have always been transparent, and laws force both sides to put their interactions into the open. He does not know why the FDA wants that much time. He is sure they have very good reasons.

Fridman will not leave it there. The 75-year clock does not look like a good reason to him. It looks like bureaucracy getting in the way of transparency — a feature and a bug of government, which is good at setting rules and slow at showing the work. In the battle to win trust and inspire people with science, transparency is one of the most powerful tools the FDA has. The agency has the potential to be one of the great institutions of the country. This example, to him, feels like a failure. Silence, when a lot of people are bothered and have questions, is when you speak. Letting distrust linger divides people, and science suffers, and the vaccine’s effectiveness suffers with it.

Bourla’s reply is technically about process. This is not a black box, he says. Everyone knows the review steps. High-caliber scientists at FDA, in Europe, in Britain go into a lot of detail. By law the essence of a study is released in the product’s specifications, a very detailed document. He does not know about specific files taking time. Fridman is asking a different question: when the public is uneasy, why the quiet? Process can be fine and communication still fail. That gap — I have a question, and nobody answers it — is how distrust fills in.

Jordan Peterson had asked Fridman to raise the revolving door. People move between Pfizer, FDA, and CDC. Does that pipeline worry Bourla? He has zero doubts that it does not affect unbiased regulation. The system builds in time barriers: someone arriving from industry cannot handle related topics for a period, longer still if the topics involve the company they came from. Hard decisions bring in outside experts; easier ones are debated internally and elevated if people disagree. If anything, he sometimes wishes regulators were more open-minded about new technologies rather than forcing every novelty through the same conservative frame. He thinks Americans, Europeans, Brits, and Israelis, in the vast majority, trust FDA, EMA, CDC, and MHRA.

Even if the agencies are trusted, Fridman notes, the public still distrusts big pharma, and science when it is tangled with corporations and government. How does Pfizer take steps to increase that trust? Bourla’s best line of the hour is a proverb. Reputation is something you can lose in buckets and earn back in drops. Once you have lost it, bringing it back takes a lot of effort. The pharmaceutical industry lost it. Over the last decade its standing was as low as he has ever seen, for many reasons, including the industry’s own behavior, which needed to change. He hopes few would disagree that the industry is different now.

The lesson he wants taken from COVID is the power of science in private hands: diagnostics when there were none, respirators, treatments, vaccines. That demonstration, he thinks, helped the sector and helped Pfizer. He will not make the mistake of treating high reputation as a given. It has to be earned every day, in everything they do and say. He has been at Pfizer 28 years and became CEO in 2019. Fridman then names Bextra. In 2009 Pfizer pleaded guilty to the illegal marketing of an arthritis drug and agreed to a $2.3 billion settlement — coincidentally the same number as the vaccine bet.

Bourla does not dodge the timeline. The 2009 case was about 2003. Several sales reps did off-label promotion: they talked with physicians about uses the FDA had not approved. Doctors may discuss those studies with doctors; companies may not pitch them. The fine, he says, tracked the size of the revenues, not only the severity of the conduct. Bextra was a big product, so the fine was large. What happened in 2003 was very bad. He does not think the same thing has happened since. From 2009 to now he claims a stellar record of complying with every regulation, plus internal processes and a culture that sets aside people who think otherwise. Lawsuits will still come, because there are a lot of lawyers. Doing the right thing, he says, is still the only way to end up on the right side of history.

Joe Rogan had flagged aggressive Pfizer marketing on mainstream channels. Fridman’s worry is subtler than legality: if Pfizer sponsors the shows people use to learn what is going on, those shows may go soft, not because anyone called, but because losing the sponsor is scary. Bourla denies aggressive marketing. Prescription ads are highly regulated, cannot make off-label claims, and must say the bad things that can happen, sometimes at more length than the good. People have a right to know a product exists. Sponsorships, he says, are very few. A team reviews even a $2,000 spend for conflicts and for the reputation of the people or programs involved. Most of it goes to patient organizations. They try not to sponsor things that could even be *perceived* as influence. Fridman still worries about implied pressure. At MIT he had been heartbroken by how financial constraint, even in a rich place, failed to bring out people’s best. He does not want to blame money for everything. He does want large sponsors not to get in the way of the best of human nature.

How do you show a vaccine is safe and effective in months when previous ones took years? Bourla’s answer is that most of the calendar is the confirmatory Phase 3, and Phase 3 costs a lot of money — in this case almost a billion. Normally you do not risk a billion in blinded data until many experiments have convinced you that you are putting the right product into that study. They did not have the time, so they risked the money. They condensed the calendar toward Phase 3. The Phase 3 itself, he says, had to follow all the rules any such study follows.

The earlier work was a funnel. They tried about 20 vaccine candidates, nailed that to four, then two, then one. They tried multiple doses, starting very low in humans after animal work, watching reactogenicity and immune responses, across ages, and multiple schedules — a second dose at three weeks, four weeks, or six months. Only then did they take what they believed was the best combination into a large study with thousands of people, vaccine versus placebo, the two looking identical.

The injecting physician does not know which is which. He knows a barcode. Only a computer knows. To get into that computer there are keys, and at least two people must put their keys in, and those people have legal obligations never to look before they are allowed. Volunteers live their lives. You count infections in the vaccinated versus the not, and you watch safety signals — heart attacks will happen in 50,000 people because they happen in life — and you ask whether the rates differ. None of that, Bourla says, was new. What changed was money and heart. Instead of 30 hospitals recruiting 50,000 people over a year, they used 150 hospitals and finished in three or four months.

People, he keeps saying, underestimate what they can do. Ask for something that looks impossible and they think outside the box. Pfizer’s normal yearly vaccine production was 200 million doses. They did not ask for 300 million of a new shot. They asked for three billion. The discovery phase of a new molecule, like the COVID pill, usually takes four years. They asked for four months, and that is what the team did. Manufacturing, he later notes, delivered three billion doses that year and was on track for four billion the next, about a billion a quarter. Fridman, who had spent the previous day with Elon Musk, wants the public conversation to sound more like rockets and less like politics: the beauty of the engineering, not the fight around it.

Fridman lingers on safety. A lot of people think the Pfizer vaccine, of which he has taken two shots, is unsafe. What does Bourla say to them? They should not fear that, Bourla answers. It is completely wrong. There is no medical product in the history of humanity that has been tested as much as this vaccine. It has been administered to hundreds of millions of people, and because of COVID those people have been scrutinized constantly. Health authorities look for every signal worldwide and ask whether it is vaccine-related. Electronic medical records timestamp the shot and what happened after. Certainty that it is as safe as the data sheet says is, he claims, higher than for any other product.

He adds that people should not listen to information spread on purpose. Fridman flinches at the word *misinformation*. In the Soviet Union, anyone who opposed the state was spreading misinformation. Wearing a tie does not make you more likely to possess the truth. Bourla, who is not wearing one, agrees that power should not get to stamp that stigma on others. He still thinks science and the analysis of data are accomplishments of the society, and that non-scientists dismissing highly scientific results is not the same as an autocratic regime. Fridman’s disappointment is aimed at science communicators: they did not speak with empathy, did not put ego aside, rolled their eyes at people without PhDs who have children, who are afraid, and who do not know whether to trust a CEO who might only care about money.

Bourla takes that. Humility is a virtue. Education is not, and never will be, a metric of humility, empathy, or good human qualities. People who talk down are wrong, and they undermine public health, because people are not stupid. They can see when you do not respect their need to learn about something that affects their mother and their kids. The vast majority of the unvaccinated, he says, are afraid. They do not have an agenda. A small number of people have made a business of profiting from that anxiety.

He offers himself as the exhibit. Someone wrote that the Pfizer CEO had been arrested by the FBI. He read it and laughed: all right, that is where they take it. The point of the story was to plant a doubt — if the FBI took him, maybe skip the vaccine. A week later the same kind of site said his wife had died, with a photograph of her. He did not laugh. He was pissed. He found his kids to say that if they read something, Mom is fine. Then he remembered her very old parents in Greece, and they started calling, because Greek papers would pick it up. The people who wrote it knew very well that his wife had not died, and that the implied cause was the vaccine. That, he says, is a narrative formed on purpose to profit from the stress of good people. Fridman turns the same skepticism the other way: common sense should also be used on the people who make money saying it is all a scam. Think on your own. Everyone can manipulate you. Everyone also has the capacity to do good.

Fridman does a small Shakespearean reading of Bourla’s Twitter. Had he over-represented effectiveness by highlighting a study with 100 percent efficacy, technically correct and easy to misread? Bourla’s reaction is fast: he never said a naked 100 percent. Every time that number appears, he says, he rushes to add that in biology there is nothing 100 percent, because when you go to the millions it will not hold. Some endpoints in the studies were 100 — deaths, or a South African cohort — in small numbers. When the numbers get much bigger, 100 becomes 95 or 96. The direction is the point. He is careful about what he tweets, and other people give second and third opinions, because people are listening to every word. Someone who only picks information and only emphasizes the positive is not, in his view, someone to be trusted. He wants himself and Pfizer to be trusted.

Many people felt the vaccine had been presented as a cure that would not need regular boosters. Did he believe that? In the first months, when people asked whether they needed another shot, he said they did not know. Around April and May 2021, first data in hand, he started saying a booster around eight to twelve months after the second dose, then likely annual revaccination, absent a new variant. Then Delta came, and the booster moved toward six months, then three. Then Omicron, still poorly measured in this conversation, suggested two doses might be challenging and three worked. Countries were already pulling the third dose forward. He does not yet know how long protection will last, or whether a tailor-made Omicron vaccine will be needed. If it is, they can make it. Capacity at the time was about a billion doses a quarter, four billion a year; half old and half new would still be four billion.

On mandates, Bourla splits the question. It is a difficult decision, and it is not his to make for a country; public-health officials have to make it. He did have to make it for Pfizer employees. He balanced the fear of people who wanted colleagues vaccinated against the fear of people who did not want the shot, and he mandated it, with exceptions for health and some religions. They were already at 90 percent when they announced it. That took coverage to 96. The remaining 10 percent, he felt, was never going to move, because a small number of people are truly scared. In Pfizer’s case it worked. He is happy for the people in that extra six points — a lot who will not get the disease, some who will not die. He still will not prescribe the same move to a government.

Fridman is opposed at the public, federal level, for reasons that are about freedom rather than medicine. Coming from the Soviet Union, he thinks mandates are a really bad idea even if they are good for the health of the populace. Preserving the freedom not to take the shot, while doing the hard work of convincing people, is a powerful thing about the country. Direct compulsion, to him, is lazy. Bourla lets the disagreement stand. If you are elected to run a country, he says, you should be ready to make difficult decisions, and no matter what you choose there will be fake stories and you will not please everyone.

Should children be vaccinated? He thinks they should, including ages five to sixteen. Fridman asks him to steel-man frightened parents. Bourla instead remembers the months before pediatric approval, when many more parents, in his telling, were shouting for a vaccine: I am protected, my husband is, my older son is, and my little sweetheart below the age is not. Now some parents fear the vaccine more than the disease. They are a smaller number, and they fear more for their kids than for themselves, because they love them more than they love themselves. The risk to children is low, Fridman notes. Bourla says the rate is lower, and children still die, still go to hospital, and schools still stop when a case appears. That disruption is itself a health cost.

He reaches for polio: how many kids have it now, fewer than are in hospital with COVID, and everybody still gets the vaccine. Fridman notes polio was deadlier for children. Bourla’s reply is that it is not now, and they still vaccinate, because the child needs to be protected. The unique worry with the COVID shot is that mRNA is a new kind of technology used at this scale, and a parent is choosing for someone who cannot choose. Bourla turns the sentence around. Choosing to vaccinate children, he says, is making a choice so that something — the disease — cannot hurt them. That is why vaccinations have been done forever. He knows people are concerned. He is a scientist and a parent, and he is telling you that vaccines are a very good thing for kids.

The hour brightens when it turns to Paxlovid, the antiviral. Bourla calls it a real game changer: a course you take only if you get COVID, pills day and night, twice a day, for five days. Instead of ten of those people going to hospital, only one will, in the figures he cites. The numbers are small. No one died, so efficacy on deaths was 100 percent, and he immediately adds the caveat that in the real world, at very high numbers, it may be 99. Even discounted, the result is spectacular for something you can take at home. The surge problem in Europe and the United States, he says, was full ICUs, paralyzed hospitals, postponed elective surgeries. Keeping people out of those buildings, and keeping them from dying, is something they did not have before.

Fridman asks the controversial question: ivermectin. Has it been studied enough? Did Pfizer consider it as a comparator? He mentions Dr. John Campbell and the online fight over comparisons with Paxlovid, and the attraction of a cheap drug without patents. Bourla groups it with other compounds that were claimed as the solution and then were not. As a scientist, talking with Pfizer scientists, he does not see any reason a parasiticide would act on COVID. They have not seen a paper describing results. He does not think there was a paper in any peer-reviewed, reliable scientific magazine supporting the claim. They are focused on saving lives, not on craziness.

Fridman pushes back: there are quite a lot of papers; the studies are small, so there is no conclusive evidence. Bourla says he has not seen any that are reliable, small or big. Some of the big ones were retracted, which means they were not legitimate. He reminds Fridman of chloroquine: for God’s sake, how many people died because of that? That, both men agree, is the dangerous and sad thing. Paxlovid, Bourla says, has been studied in thousands of people and will sit under regulators and under hospitals that will see, within weeks of use, whether the statistics move. Two epistemic styles are on the table. Fridman wants to stay open until the data are fuller. Bourla treats a missing mechanism as a reason not to wait. They will often land in the same place. In a vacuum of evidence, they will not.

What gives him hope after two hard years? Human ingenuity. The world of 2020, for all that needed fixing, was better at large than fifty or a hundred years back — poverty, human rights, science, quality of life. He is positive that humans can create, and always create, a better future. Fridman then asks the personal question. Bourla has helped save millions of lives and is still one biological organism with an expiration date. Does he ponder his mortality? Is he afraid of death?

When he was young, he told people he was fearless of death; he could not care less. The first time he wanted to be around was when he had kids. Then he hoped to see their wedding, hoped to see their children. If something scares him, it is the possibility that he will not be part of their lives anymore, that he will not be watching. He hopes there is life upstairs so he can watch from there. Fridman says the view from upstairs is nice. The ridiculous last question, with two minutes or less: what is the meaning of life? Bourla repeats something Steve Jobs said. Death is life’s biggest invention. It eliminates the old and gives place to the new. Life is moving forward, creating new things. Everyone is a contributor; no one is the owner. Always add something beautiful into the world, maybe a little bit of love.

He is happy, he tells Fridman, that he can brag to his kids that he was on this podcast, because Fridman is their hero. The episode landed in December 2021, with Omicron just beginning to spread. The structural fight the hour never resolves is still the one Fridman named at the top. Breakthroughs of the kind Pfizer just ran require putting money, risk, and organizational habit on the table at once. Trust requires answering questions while people still have them, not after the blank has been filled by someone else. Those two clocks do not run together. You still have to use your own mind, on the company that says it will save you and on the stranger who says it will hurt you.