Letter to Albert Bourla, CEO of Pfizer Inc. - Cardin, Brown, Schatz Lead Group of Senators in Calling on Vaccine Manufacturers to Increase Vaccines to Low-Income Countries to Fight the Covid-19 Pandemic

Letter

We write with grave concerns about Pfizer's commitment to providing vaccines for low-income and middle-income countries. We commend the company on its ground-breaking work in developing and manufacturing one of the most effective mRNA vaccines currently on the market, and we urge you to take immediate action to work with the Biden Administration, our international allies, and global public health experts to make the Pfizer vaccine immediately more widely available to communities around the globe and to tackle the ongoing significant disparities in global COVID-19 vaccine supply and access. Without a stronger commitment from you and your company, millions of preventable deaths will occur.

Vaccines represent the world's best hope at containing the COVID-19 pandemic, but our goals for effectively responding to the pandemic will remain out of reach unless we successfully ramp up our global vaccination effort and get more shots in arms as quickly as possible. While more than 6.5 billion COVID-19 vaccine doses have been administered around the world, they have been concentrated in high-income countries. Less than 10 percent of people living in low-income countries have received at least one dose of the vaccine,[1] and efforts to expand low-income and middle-income countries' access to vaccines have stalled. Despite a significant contribution from the United States, the COVAX international vaccine aid program has fallen hundreds of millions doses short of its vaccine distribution goals. All vaccine manufacturers outside China missed their 2020 production targets by 96 percent,[2] and are projected to miss their initial 2021 targets by about 50 percent.[3],[4]

If global vaccination rates do not improve, the virus will continue to threaten lives and our global economy. This situation prolongs the need for booster shots to maintain the vaccines' protection and creates dangerous conditions for the emergence of new variants that are potentially resistant to vaccines. In our global society, there is no question that these variants will spread to the United States; when that happens, our current vaccines may not be sufficient to protect the population. This is not just a hypothetical problem: the latest variant of concern--Omicron--clearly points to the need for swift and urgent action around the world.

If the pandemic is not controlled, there will be dire consequences in human and public health terms. Already, over five million people around the world have died of COVID-19.[5] If current trends in vaccination rates and preventative measures such as mask wearing continue, the Institute for Health Metrics and Evaluation (IHME) at the University of Washington projects that by March 1st 2022 there will be approximately 6.26 million reported deaths -- and nearly 13.63 million reported and unreported deaths -- due to COVID-19.[6] Among the remaining 230 million people who contract COVID-19 and survive, almost 25 percent[7] are likely to continue to experience chronic symptoms known as long covid, which will impact their long-term physical and psychological health as well as the health of our global economy.

Continuing to allow the global pandemic to run rampant will also hurt the United States' economy. High rates of infection in low-income and middle-income countries have reduced their capacity to meet factory production targets and maintain global shipping networks,[8] thus creating supply chain delays that contribute to inflation and damage American companies' ability to deliver goods and services. Furthermore, American cities and states continue to lose tourism revenue due to the pandemic. According to the United Nations World Tourism Organization (UNWTO), the Americas saw a 68 percent drop in international tourist arrivals in 2020 and a 65 percent shortfall in 2021, with improvements not expected until 2023 or 2024 if current trends continue.[9] Lastly, the pandemic has curtailed the entry of international university students and workers into the United States, with travel restrictions likely to remain in place for those who cannot access vaccinations.[10] These limits mean that the American economy will miss out on substantial financial, intellectual, and social contributions from these groups.[11]

As a pioneer in developing a highly effective mRNA vaccine, Pfizer is in a unique position to bring a swift end to the COVID-19 pandemic around the world. We appreciate Pfizer's commitment to provide 1 billion vaccine doses to the U.S. government at not-for-profit prices for donation to low-income and middle-income countries, and the company's efforts to ensure expanded and equitable access to its COVID-19 treatment pill.

However, more work is urgently needed in the short-term. Experts have estimated that another 4.5 billion doses are needed to fully vaccinate 80 percent of the world's seven billion people over the age of five years, and up to 6 billion additional doses may be needed in 2022 for booster shots to reinforce the efficacy of vaccines given to individuals in 2021.[12]

Pfizer is in a strong financial position to significantly increase its contribution to global vaccination efforts and has a responsibility to do so. Although the company did not accept any American federal funding while developing the vaccine, the German government provided a $445 million grant to Pfizer's partner firm, BioNTech, to expand vaccine trials and production capacity.[13] Furthermore, the United States government coordinated scientific expertise and research infrastructure,[14] provided Emergency Use Authorization from the Food and Drug Administration (FDA) to expedite the market launch of the vaccine,[15] and pre-ordered doses early in the development process to ensure healthy sales.[16]

Given all this public support, and the fact that Pfizer is expected to earn about $36 billion in 2021--and up to $54.5 billion in 2022 according to some projections--from sales of its COVID-19 vaccine,[17],[18] it is reasonable to expect the company to make a sizeable contribution to global vaccination efforts. By all accounts, Pfizer is able to do so without undercutting investment in the development of future mRNA technology or payouts to shareholders, as individual stock returns have increased by 52 percent since the end of 2019.[19]

Working to increase global access to the COVID-19 vaccine is consistent with Pfizer's Statement of Purpose,[20] which includes a commitment to health equity in obtaining access to the vaccine. It is time to move beyond statements of principle and take more substantial concrete steps to get shots in arms around the world.

We are dismayed at Pfizer's continued prioritization of vaccine orders for high-income countries,[21] lack of transparency about where COVAX and other low and middle-income countries are in the queue for vaccine deliveries, and resistance to sharing its technology and immediately ramping up global vaccine production.[22] There are many important ways in which Pfizer can make a more substantial contribution to global vaccination efforts and save countless lives. We call on the company to:

Provide more vaccine doses at not-for-profit prices to COVAX and low-income and middle-income countries as quickly as possible;
Increase the transparency of its processes and records, especially regarding the status of vaccine deliveries and the priority placed on fulfilling orders from COVAX compared to other countries;
Waive indemnification so that doses can be delivered to refugees and internally displaced persons to address urgent humanitarian needs;
Work with international partners such as COVAX to address financial and logistical challenges to equitable vaccine delivery;
Immediately increase manufacturing capacity and facilitate technology transfers with fair royalties, by engaging with international partners such as the World Health Organization to develop and resource additional mRNA facilities around the world; and
Engage with the Biden Administration to identify other barriers to global vaccination efforts beyond supply, and implement additional strategies to expand access to mRNA vaccines.
Thank you for your urgent attention to the matter of global disparities in vaccine supply and access. We stand ready to work with you to bring a swift end to the global pandemic.

Sincerely,