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Bloomberg Businessweek March 8, 2021I t’s not every day that a head of government goes to the
airport to greet a cargo shipment, but the pandemic
has changed many things. On Jan. 10, Israeli Prime
Minister Benjamin Netanyahu motorcaded to Ben Gurion
International Airport, southeast of Tel Aviv, to watch a ship-
ment of 700,000 vaccine doses from Pfizer Inc. emerge from a
blue-and-white El Al Boeing 787-9.
“This is a great day for the state of Israel, with a huge ship-
ment that has arrived,” Netanyahu said, exuding a confi-
dence few world leaders have mustered since the crisis began.
“I agreed with my friend, Pfizer Chairman and CEO Albert
Bourla, that we would bring shipment after shipment and
complete the vaccination of the over-16 population in Israel
during the month of March.”
Bourla had thrown Netanyahu a political lifeline. Faced with
surging Covid-19 cases and an election in March, the prime min-
ister latched on to Pfizer’s vaccine as his best hope to stay in
office. Standing on the tarmac, he bragged that 72% of Israelis
over the age of 60 had already been vaccinated, thanks to
shipments that began in early December, and that more doses
would come soon. That was because he’d struck a deal with
Bourla to use his country as a test case for Pfizer’s vaccine.
Vaccine distribution still has the feel of a zero-sum game.
Five days after Netanyahu’s victory lap, Pfizer told other non-
U.S. customers that it would cut near-term supplies while it
briefly closed its vaccine manufacturing facility in Belgium
for an upgrade.
Panic and anger rippled through world capitals, nowhere
more so than in Rome. Italy, which has suffered one of the
highest Covid death rates and which had successfully set up
a mass vaccination program and inoculated more people than
any other European Union country, was waiting for new doses
when Pfizer announced the cuts. The country’s virus emer-
gency czar at the time, Domenico Arcuri, lashed out, com-
plaining that Pfizer had cut its shipments by almost 30% just
as Italy was about to start vaccinating people older than 80
en masse. He warned that Italy could take unspecified action
against the company.
Days after Arcuri aired his grievances, Pfizer began ship-
ping millions of doses to Israel. Within a week, Israel expanded
its rollout to include 16- to 18-year-olds.
“Look, we are very angry,” Luca Zaia, president of Italy’s
Veneto region—one of the areas most affected by Covid, with
more than 9,800 deaths—told reporters, sitting in front of EU
and Italian flags. He’d recently learned that supplies to his
region would be cut 53% for that week. “I want to understand
what Nobel Prize winner they paid to organize the distribution,
or which principle or algorithm they used.”
It didn’t come from some algorithm. The vaccine allocation
was the product of a company struggling to apportion doses
while demand far exceeded supply, using an opaque process
that appears to have involved a mix of order size, position in
the queue, production forecasts, calls from world leaders,
the potential to advance the science, and of course the desire
to make a profit. “Everybody wanted [deliveries] in the firstquarter, and we tried to allow discussions and negotiations to
spread things so everybody would get in an equitable base,”
Bourla says. The countries that hadn’t placed orders wanted a
place in line, and those that had placed early orders wanted to
buy more. “It was a constant negotiation,” he says. “Everybody
wanted it of course earlier.” Pfizer says the agreement with
Israel didn’t affect doses going elsewhere.
Israel had two things going for it: Netanyahu had offered
to pay roughly $30 a dose, about 50% more than the U.S. gov-
ernment, according to people familiar with the deal. He also
agreed to share countrywide data on the vaccine, a two-dose
product based on an experi-
mental platform called mes-
senger RNA, or mRNA. It’s
being used almost exclusively
in Israel, in what amounts to
a large-scale effectiveness
study. (Pfizer considered
offering the same arrange-
ment to Iceland, but the
country didn’t have enough
Covid cases to make a study
meaningful.) By Feb. 22, Israel had given first doses to 47% of
its 9 million people, making it the world leader. Italy, mean-
while, had administered first shots to 3.6% of its citizens.
Bourla says the agreement with Israel will provide data that
will transform the world’s understanding of how to end the
pandemic. “They are trying to extract the scientific informa-
tion that the whole world is waiting on right now,” he says.
“We’ll get data on symptomatic and asymptomatic transmis-
sion very quickly.” Indeed, the news out of Israel on Feb. 24
was remarkable: The vaccine prevented 94% of Covid cases in
almost 600,000 vaccinated people.
As the first company to develop an authorized Covid vac-
cine, which it did in partnership with Germany’s BioNTech SE,
Pfizer wields enormous power. Bourla had been Pfizer’s chief
executive officer only a year when the pandemic began and
almost immediately faced choices no pharma executive would
normally be making. Government policy matters, as does the
behavior of individuals, but to some degree vaccine makers
determine where infections will decrease and which econo-
mies will reopen first. Their customers are elected national
leaders who’ve designed intricate vaccination programs with
public-health officials, but those leaders are learning they’re at
the mercy of what manufacturers such as Pfizer deliver.
In the past few months, Bourla has taken on an almost states-
manlike role, holding calls with heads of state, including for-
mer U.S. President Donald Trump, European Commission
President Ursula von der Leyen, and Canadian Prime Minister
Justin Trudeau. Netanyahu boasted in January that he’d spoken
with Bourla 17 times, with the CEO even taking his calls at 2 a.m.
Bourla says he’s talked to Netanyahu “even more” since then.
Pfizer’s first-out-of-the-gate status has also offered Bourla a
sales opportunity like none other. He’s locked in orders from
more than 60 countries on undisclosed commercial terms. MOTTI MILLROD/REUTERSHealth Minister Yuri Edelstein and
Netanyahu welcome a shipment of vaccines
at Ben Gurion Airport on Jan. 10