Lower-income countries opted not to order Pfizer vaccine, says CEO

NEW YORK • Pfizer's chief executive officer said low-and middle-income countries had opted not to order the company's Covid-19 shot, in a letter posted online after US President Joe Biden's administration said it supported waiving patents to expand global access to vaccines.

"We reached out to all nations asking them to place orders so we could allocate doses for them," Pfizer CEO Albert Bourla said in a letter addressed to his employees.

"In reality, the high-income countries reserved most of the doses. I became personally concerned with that and I reached out to many heads of middle/low-income countries by letter, phone and even text to urge them to reserve doses because the supply was limited."

Most low-and middle-income countries he contacted decided to place orders with other vaccine makers either because the underlying technology used in Pfizer's shot was still untested, or there were local production options available, Mr Bourla wrote.

He said some countries did not even approve the vaccine, which Pfizer developed with its German partner BioNTech.

Last Wednesday, United States Trade Representative Katherine Tai said the US would support efforts to reach a deal on waiving intellectual property protections for Covid-19 vaccines, in a reversal of longstanding policy.

Proponents of the move say it could expand access, though critics say there is no current capacity to begin producing cheaper versions of vaccines like the one made by Pfizer.

In a letter responding to the public debate over the proposal, Mr Bourla said Pfizer and BioNTech use a tiered pricing model for their vaccine.

Middle-income countries are asked to pay half of what the highest-income nations do, while low-income countries are offered the shot at cost.

Such tiered pricing was pioneered by Gilead Sciences as it commercialised its HIV drugs.

Pfizer and BioNTech are on track to deliver three billion doses this year to more than 116 countries, Mr Bourla said, and the 450 million doses delivered to date have been heavily weighted towards higher-income countries that pay the most. In the US, the two-dose regimen is priced at US$39 (S$52).

Mr Bourla expects 40 per cent of doses, or more than one billion, will go to low-and middle-income countries this year.

"We expect the supply balance to weigh in their favour in the second half of 2021," he said. "And to have virtually enough supply for all in 2022."

Next year, the Pfizer-BioNTech partnership will likely be able to deliver four billion doses, he said.

Although Pfizer has not been shown to charge the most for its vaccine, and has adjusted prices down for less wealthy countries, its product is not the cheapest.

For example, documents show that Colombia paid about US$12 a dose for Pfizer's vaccine, and South Africa agreed to buy doses for about US$10 each, bringing full regimens to US$24 and US$20, respectively.

Meanwhile, South Africa committed US$5.25 a dose for AstraZeneca's vaccine. This is in line with the company's pledge to sell the product at cost.

Still, logistics may be as important an issue as price.

Dr Ezekiel Emanuel, a medical ethics and health policy professor at the University of Pennsylvania, said the Pfizer-BioNTech vaccine still poses challenges for countries without robust infrastructure to maintain it at ultra-cold temperatures.

"It's the most difficult to handle of them all," he said. "And that adds to the problem. It's not only low-income countries that were hesitant to take that up."

Mr Bourla met virtually with Ms Tai last week.

In the letter, he said such a patent waiver threatens to disrupt Pfizer's ability to manufacture the shots to scale, given that raw materials are in short supply.

"I worry that waiving of patent protection will (disincentivise) anyone else from taking a big risk," he said. "The recent rhetoric will not discourage us from continuing to invest in science."

BLOOMBERG