Letter to Albert Bourla Ph.D., Chief Executive Officer and Chairman, Pfizer

Letter

Dr. Bourla,
As COVID-19 continues to threaten our population's health and stretch economic, health care,
and social infrastructure systems in the United States, it remains clear that this is a global health
issue. As is the nature of any pandemic, our safety and well-being are not assured until we
address the spread of COVID-19 in every country.

While uptake of COVID-19 vaccines has been robust in the high-income countries of the world,
there are still significant regions of the globe--particularly sub-Saharan Africa, but also parts of
Latin America, Eastern Europe, and Central Asia--where vaccination has lagged significantly,
due at least in part to production constraints. Only 3.1 percent of people in low-income
countries--about 700 million people--have received even one dose of a WHO-listed SARSCoV2 vaccine, and only 10 percent of the roughly 3.3 billion people in lower-middle income
countries are fully vaccinated. We clearly need more of every aspect of the vaccination supply
chain, but we critically need to increase the production of vaccines.

In this regard, I am encouraged to see that a major pharmaceutical research and manufacturing
company recently announced it would grant a royalty-free license for a COVID-19 treatment
pill to the United Nations-backed Medicines Patent Pool, making molnupiravir available in
more than 105 countries.

Merck's molnupiravir can significantly reduce hospitalization and death, and rich nations have
moved quickly to secure supplies of the drug for their own populations. According to the New
York Times (27 October 2021), the United States's deal with Merck "fixes the price [of the drug]
at $712 per course." A generic version produced under a royalty-free license could sell for
somewhere between $8 and $20 for low- and some middle-income countries. While by no
means a perfect solution, Merck's decision to forego a royalty on molnupiravir is an ethical one
in light of our continuing global crisis. It is my hope that your company might follow a similar
path as it continues to manufacture and develop vaccines and treatments for COVID-19.

I appreciate that biologics like vaccines differ from "simple" molecules like antivirals (such as
molnupiravir) in that biologics require not just particular chemical ingredients, but also a great
degree of tacit and technical knowledge for the construction and growth of the most effective
COVID-19 vaccines. I am also aware of your concern that transferring the knowledge and tools
for making these vaccines would be extremely challenging because of the newness of this class
of vaccines, as well as the need to maintain quality control and assurance.

Even so, our global recovery from the challenges of this pandemic--and more effective
response to the next one--provides a strong incentive to work to overcome this challenge.
While I understand your preference for in-house production, it appears that there are generic
pharmaceutical firms with the technical capacity to measure up to the requirements of your
production standards and substantially increase global vaccine availability. As reported in
Nature (15 September 2021), the chair of the Medicines Patent Pool notes that the researchers in
the pool have vast experience in leading pharmaceutical firms, ensuring best practices, and that
the pool "does not give licenses to manufacturers working in a garage."

Given the urgent need for additional vaccine supply--both to the benefit of our country as well
as those deep in the throes of the pandemic, I urge that your company give serious
consideration to taking the following steps:
 To license your vaccine and/or pharmaceutical treatment to the Medicines Patent
Pool as soon as possible;
 To commit to participate in WHO's South African technology transfer hub and
PAHO's Latin American hubs, to ensure quality protocols in the production of
vaccines; and
 To follow Merck's lead and commit to a royalty-free license to the MPP for
upcoming COVID-19 treatment drug you are developing.

Pfizer has already made a huge contribution to ameliorating the impact of the pandemic here in
the United States; I hope that you will now consider the above approach to sharing those
benefits with the rest of the world

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