William Hanage
THE WASHINGTON POST – As a genre, vaccine development memoirs are a bit niche. But, given how important vaccines are to us all, and not only against COVID but also many other diseases, we could stand to know a lot more about how these lifesaving products come into being and how they can be developed so darned quick.
Chief Executive of Pfizer Albert Bourla is ideally placed to provide such insight, and the subtitle to his book Moonshot – Inside Pfizer’s Nine-Month Race to Make the Impossible Possible – sets up expectations of a breathless page-turner. But the skill set that makes for a successful chief executive of an international pharmaceutical company does not necessarily produce sparkling prose, and Moonshot is at times a pedestrian account of a truly remarkable scientific advance achieved under extraordinary pressure.
As Bourla lays out early on, it is a long and uncertain voyage from the germ of an idea to a shot in the arm, so my main area of curiosity was just how Pfizer managed such an absurdly rapid turnaround. Unfortunately, Bourla, who took on the duties of chief executive in 2019, sheds little light here.
According to Moonshot, the trick was mostly to tell people to do things more quickly. There is obviously more to it than that, but pretty much all the book describes is adequately funded development steps alongside each other in parallel. A bold decision to be sure but not the stuff of startling innovation. As Bourla observes: “it would be painful to take a USD2 billion write-off in my second year as CEO if the project failed. But I also knew it would not take the company down, and it was the right thing to do.”
This contains two truths; it was very much the right thing to do, and a company the size of Pfizer could take the risk. Much of the challenges were in the logistics of getting doses into people once the vaccine was developed.
There is a hint of difficult and necessarily bold decisions about where to run clinical trials and which vaccine candidates to take forward. These choices were obviously made well, or Bourla would not be in a position to write such a book, but there’s scant information on how they were made. In place of such detail, we read about management innovations such as decisions taken in the Purpose Circle (the executive meeting room where top leadership sat in a circle of comfortable chairs rather than at a conference table) and corporate mantras such as Time is Life or Science will Win. Some readers will be inspired while others find their toes curling at the management-speak, but the slogans suggest the effort required to inspire a diverse team.
Among that team are Ugur Şahin and Özlem Türeci, the married couple at BioNTech who spent years of preliminary work developing the mRNA vaccine technology used in Pfizer’s vaccine. Bourla is rightly fulsome in his praise of BioNTech – he could arguably be more fulsome yet.
Some of the most interesting parts of the book describe events after Pfizer’s vaccine began to be rolled out in different countries. One of the single boldest and, in retrospect, best decisions of the pandemic was that of the British government to massively ramp up its vaccination efforts in January 2021. The country had been eager to move past the virus and declare it endemic (sound familiar?) but was instead slammed by the Alpha variant.
Over that bleak winter, Britain saw greater pandemic mortality than the United States has experienced at any stage, but the toll could have been even worse were it not for an accelerated campaign conducted during a desperate lockdown: Public health authorities raced to get vaccines into people before the virus reached them. According to Moonshot, Britain was the beneficiary of the Trump administration’s failure to promptly distribute its own doses of the vaccine, gaining three million extra shots. Future doctoral theses will be required to estimate how many lives were saved.
Similarly, a close collaboration with Israel provided some of the best data on how the vaccines performed in the real world in which immunity can wane, and against a nimble virus that continues to churn out variants. The book is correct that Pfizer’s vaccine, like the others, stands up remarkably well when it comes to preventing the worst consequences of infection.
In 2020, the goal was to produce a vaccine that would provide as good or better protection than immunity following infection, so we need not face the virus completely unprepared. We are fortunate that we have multiple vaccines in our arsenal. Moonshot is studiously silent about these competitors, which were produced on a schedule almost as rapid as that of Pfizer.
We can expect the best accounts of the race to vaccines will be written by outsiders, and for these authors Moonshot will be a reference. For sure, the book is flawed; it seems uneven and unsure of its target audience, mixing up accounts of logistics with starry-eyed meetings with world leaders, while flinging around technical terms like “reactogenicity” without explanation.
It makes a few errors of fact – at one point confusing the alpha and delta variants, for instance – and chapters on vaccine equity are too shallow to be satisfying contributions to discussions on that important issue.
Yet Bourla’s character and enthusiasm – when they emerge – lift his narrative. For instance, an account of his parents’ narrow escape from the Greek port city of Thessaloníki during the Holocaust is moving in itself, but in noting the fate of Jewish family members less fortunate, he also reflects on those we have lost, the value of human life and how it can be bettered, and his voice shines off the page.
Moonshot might inspire others to devote themselves to the hard work of making effective vaccines – heaven knows we need them for diseases including tuberculosis, malaria and beyond. And none of us should forget: mRNA vaccines are an astonishing technical and logistical achievement, a marvel of the modern age. Time is life, and science will win.
