Last year, Albert Bourla had a choice and he decided to take a massive risk. The CEO of the pharmaceutical giant Pfizer could have made it easy for himself by accepting billions of dollars and participating in Operation Warp Speed, the US government's initiative to create multiple vaccines as fast as possible. But he preferred to remain independent.

Bourla decided to invest $2 billion (€1.6 billion) in BioNTech, a startup company in western Germany. His instinct was right: BioNTech came up with the formula for the first COVID-19 vaccine to be approved by the United States, EU and other governments. By the end of the year, Pfizer had produced 50 million doses of BioNTech's COVID-19 mRNA vaccine, BNT162b2. The goal for 2021 is to produce more than a billion doses.

For many, Bourla and BioNTech founders Özlem Türeci and Ugur Sahin are heroes in the global fight against COVID-19. The companies had previously collaborated on a flu vaccine in 2018, and their latest endeavor could save the lives of incalculable numbers of people.

Viagra and more

Pfizer got its start in 1849, when Charles Pfizer and his cousin Charles F. Erhart, both of German descent, founded Pfizer & Co. in New York and started producing an antiparasitic drug called santonin. Today, Pfizer has more than 100,000 employees, and one of its bestsellers is the erectile dysfunction drug Viagra.

New challenges arose in 2020 for the pharma sector, which generated global sales of about $1.1 trillion in 2019. The rapid development of multiple COVID-19 vaccines showed what the industry could do under enormous pressure. However, the real test might only be beginning for a sector that has often been accused of being more interested in maximizing profits than in saving lives.

'Pfizer exercised pressure'

A few weeks ago, only the mass-circulation press was using the expression "vaccine debacle" in Germany. But now it's being employed widely, by politicians and much of the population. The gist: while countries such as Israel, the UK and the United States are vaccinating populations in large numbers, the EU — represented by an incompetent negotiating team — failed to order enough doses in time. On top of that, the narrative goes, the EU was also too tightfisted.

Peter Liese, a member of the European Parliament for the Christian Democrats and a medical doctor, has regularly appeared on German TV talk shows to counter that argument. 

"Pfizer exercised pressure on the European Commission," Liese told journalists in August. "Pfizer apparently did not initially want to accept something that is the law in Europe — namely that, when a mistake is made and somebody is hurt, there has to be liability."

The negotiations dragged on and finally concluded in November. For weeks, more than 20 lawyers for the US giant sat across the table while the European Commission's negotiators kept a low profile and did not comment on the proceedings.

In retrospect, said Liese, this was a mistake. "The reasons were not communicated because the Commission always behaves well. There was the question of privacy, and it did not want to disavow the negotiating partners," he said. "But it would have made a different impression on the public, and there would have been more pressure on Pfizer, of course."

When Liese met with BioNTech scientists during the stalled negotiations process, he could sense how uncomfortable they were with the issue. "I could read in their eyes how embarrassed they were that a contract with the EU might actually not be signed despite the fact that they were working in the EU and had been given EU support to develop the vaccine in the first place," he said.

The issue of liability has been lost in the current discussion, but Liese said had the European Union not been so assertive on this point, fewer people would be as willing to be vaccinated at all. "Those in charge at Pfizer have failed to satisfactorily refute the accusation that they put profit over health," he said.

Argentina's raw deal

Argentine Health Secretary Gines Gonzalez Garcia exploded when asked about Pfizer at a press conference earlier in February. The company, he said, had "behaved very badly."

In August 2020, more than 6,000 Argentines responded to a call to participate in the phase 3 trials of the BioNTech-Pfizer COVID-19 vaccine. Half of them received the vaccine; the other half were given a placebo. The participants saw themselves less as test subjects than as contributors to the formalizing of a contract.

They would be disappointed. Not a single dose has been administered in Argentina now that the vaccine has been approved. Argentina is currently supplied with Russia's vaccine, Sputnik V.

Government officials have also said they were unable to find an agreement with Pfizer regarding liability. "They are responsible for the vaccine, not the state," said President Alberto Fernandez. "The state buys, and they sell. I do not understand why we should provide them with a standard that would absolve them of all civil and criminal liability."

Pfizer has argued that the negotiations did not fail for reasons of liability, but because Argentina did not want to pay for the transport of the vaccine, which must be stored at an extremely low temperature.

"The market rules the world: That's just the way it is," said Hugo Pizzi, an epidemiologist based in the Argentine city of Cordoba. He has written more than 20 books about infectious diseases, and is one of the country's most renowned doctors. "And many countries are happy to follow these rules. How else can you explain that Canada has bought more vaccines for its population than necessary — instead of showing solidarity."

Pizzi said he would tell Pfizer's CEO to "think about the tragedy the world is going through, about Argentina's contribution to the vaccine being approved and about what's most important: solidarity!"

Pfizer's 'mercantilistic approach'

Marta Diez, Pfizer's country manager for the Andean cluster, was ecstatic after signing a contract to supply Peru with 20 million doses of the COVID-19 vaccine. "It is a great honor to work with the Peruvian government, with the common aim to make the COVID-19 vaccine available to Peruvians as fast as possible," she said.

Peru has one of the highest COVID-19 mortality rates in the world. Almost 44,000 of the 32 million inhabitants have died of the disease, and Peru desperately needed the vaccine.

But Victor Zamora, who was Peruvian health minister when the pandemic began a year ago, is not in the mood for celebration. He was "very surprised considering the run-up," he said. "Pfizer knows at what price and on what terms countries are buying. The company knows which countries have accepted which clauses."

As in the EU and Argentina, the negotiations with Peru were tough and went on for months. Though Pfizer has called the negotiations confidential, Zamora said the company had demanded guarantees in case the state could not pay. There are reports that company officials sought access to state property as collateral.

Godofredo Talavera Chavez, a surgeon and the president of Peru's medical federation, said the company's strategy was no surprise. "Pfizer has a mercantilist approach. They used their power to sell Viagra and they're doing exactly the same with the vaccine," he said.

He said he was particularly angry because more than 300 of his colleagues had died in intensive care units as part of their efforts to fight the pandemic. 

Wariness in Nigeria

When Aisha Isa Yusif heard about the BioNTech COVID-19 vaccine, she got scared. Usually, the lawyer and human rights activist is not easily perturbed, but she has not forgotten what happened 25 years ago in Kano, the fourth-largest state in the country.

"When I hear the word Pfizer, I think about the lawsuit that Kano's state government filed against the pharmaceutical company,” she said. "My homeland wanted compensation for the families who were hurt by Pfizer."

During the meningitis epidemic in 1996, children in Kano were administered an oral antibiotic called Trovan as part of an operation that was passed off as humanitarian. What none of the participants or their parents knew was that Trovan had not been approved. According to official statistics from the government, 11 children died and more than 200 suffered permanent side effects such as paralysis, blindness, deafness and brain damage. Pfizer initially refused to take responsibility.

Eventually, Pfizer settled out of court with the state of Kano and agreed to pay $75 million in damages. According to WikiLeaks, Pfizer hired private detectives to look for evidence of corruption on the attorney general's part.

It is cases such as these that have made the Danish physician Peter C. Gotzsche one of the pharmaceutical industry's biggest opponents. Though he used to work for the industry, he grew increasingly skeptical and has now written several books in which he shares his misgivings, including Deadly Medicines and Organized Crime: How Big Pharma Has Corrupted Healthcare.

"They are worse than any other industry," he said. "Corruption, bribery and the marketing of non-approved drugs are expected." He said Pfizer has been one of the world's worst companies in the past 50 years, and can't understand why the pharma industry is allowed to make so much money in a pandemic: "There should not be any patents for vaccines. They should not be a capitalist commodity but something produced for the general good."

Could COVAX help?

Led by the Global Alliance for Vaccines and Immunization (GAVI), the World Health Organization and the Coalition for Epidemic Preparedness Innovations, the global COVAX initiative would allow rich countries to pay for poorer countries to receive vaccines. The goal is to make available 2 billion doses in 2021 in order to put an end to the current, acute phase of the pandemic.

"We are making up to 40 million doses of our COVID-19 vaccine available to the COVAX initiative this year,” Pfizer wrote in a statement in response to a request for comment from DW. "Our priority is to bring treatment and vaccines to those who need them as fast as possible."

Elisabeth Massute, an advocacy officer at Doctors Without Borders, is not impressed. "It's just 2% of the vaccines that can be produced this year and next year," she said. "When you look at how many countries will actually be provided for by COVAX, it's clearly not enough."

Massute does not consider herself an opponent of the pharma industry, but she said governments should stand up to the companies more.

"Why does the German government, for example, not say: 'We have given out so much money via our research ministry, and we will therefore attach certain conditions to the funds?'" she asked.

After all, BioNTech received €375 million in research funds to develop the vaccine as quickly as possible.

What will be decisive for the industry's reputation in the long run will be whether it agrees to waive patents. India and South Africa have already requested that this be done so that any company in the world could produce vaccines.

Pfizer, so far, has insisted on reserving its intellectual property rights. Protection is relevant for several reasons, according to the company. "First, because it helps to protect patients from potentially dangerous counterfeit and unapproved products. Second, it protects companies from improper use. Patent protection enables voluntary licensing, which allows us to make our products globally available in order to fight the pandemic," it said in a statement.

Massute doesn't believe this is a valid argument. "If you look at those who discovered insulin, the patent was sold for a symbolic dollar. Or consider the researcher who developed the polio vaccine and asked: 'Could you patent the sun?' Health doesn't fit into the traditional rules of the system, because human lives don't have a price tag."

This article has been translated from German.