Great. Good morning, everyone, and welcome to our 46th Annual Global Healthcare Conference. My name is Asad Haider. I'm the U.S. Pharma analyst here at Goldman Sachs, and we are very privileged to have Albert Bourla with us to kick off this conference. Albert's the CEO of Pfizer. Albert, thank you for being with us. Great pleasure. Albert, we have about 35 minutes, so I want to start with a big-picture question for you on the external environment, which I think is something that everyone is trying to figure out. You're the perfect curtain raiser for this conference, given your role as the chair of the Pharma Lobbying Group. You have a very unique perspective, and you have front-row seats on what's going on in Washington, D.C., with respect to policy and all these overhangs on the sector. Level set for us to kick the conversation off on where things stand in your most recent conversations with the administration, particularly as it relates to this drug pricing MFN executive order. What should we be expecting to hear this week? I believe this week marks the 30-day mark from the time that the executive order was first put out. What are the range of outcomes that the industry is expecting, both near-term as well as how this plays out over the longer term? Yeah. Apparently, there is a lot of anxiety with investors, which is very obvious in the multiples of all the pharma that have been depressed to levels that I think they do not make sense, but they are there because uncertainty always punishes. Okay. Trump brings radical change, and there are a lot of risks with that and opportunity because the status quo is changing. On the risks, you mentioned one of the most important, the MFN and the executive order that came on that. There is also, do not forget, the tariffs, but it is something that is hanging in there. I can speak about both. On the opportunities, there are significant opportunities with the small molecules, large molecules exclusivity that I think the administration is very sympathetic to it, including Secretary Kennedy, including President Trump, etc. PBM reform, the same. The 340B, for the first time, has been recognized as a major issue that needs to be resolved. Deregulations and expedition of the regulatory process, those are the opportunities. We are working to make sure that we mitigate the risks and we do not let them happen, and we work also equally intensively to make sure that the opportunities materialize. Now, on the MFN, I do not know what we will hear in 30 days. I do not believe we can hear much because the administration already started a series of meetings with companies. Pfizer went there, and other companies went as well. The meetings were cordial, but they were not digging into the substance yet. It is just trying to understand high-level ideas and no commitments. What could be the outcomes of something like that? It could be from nothing to very big. There are two aspects. One, it is what will happen to the MFN. One, it is what will happen to the U.S. prices if they can come downwards towards, let's say, European or international prices. The other is what happens to international prices, and they can come upwards, more close to the... We are working on both. There are different parts of the administration that are handling one versus the other. The Secretary of Health, Dr. Oz, those are the people that are handling what happens with the MFN in the U.S. Secretary Lutnick, the U.S. Trade Representative, even Secretary Bessent are dealing with negotiations with the other countries that include right now how they can take their prices up. The U.K. was the first example of a deal that happened. I guess on that point, maybe just double-click on that. I guess the industry has been adamant about European countries raising prices to pay for their share of innovation. Just maybe talk us through the mechanism of how that happens. I understand that happened in the U.K., but how does that happen across the rest of the continent? One question we're also getting from investors is, can European budgets actually support higher drug prices? Look, first of all, yes, they can, but they have very big budgets, and we represent in U.K. 0.3% of their GDP per capita. That's how much they spend on medicine. Yes, they can increase prices. Are they willing to do it? Of course not. They don't. They are having, let's say, kind of free riding all these years, and they want to continue that. We had a situation that the U.S. government never stood up to them about drug pricing. Never, until now. Every time that there were trade negotiations, it was all about steel, it was all about cars, it was all about AI, never about medicines. This time is different. I don't know how much passion they will continue demonstrating, but in my discussions with them, they have quite a bit. They don't like it, and they think that the average should go up. Now, I don't think that the discussion should be that product X in the U.K. has this price or in Germany has this price and in the U.S. has this price because you will be lost into that situation of how many products and where is high, where is low, which is all over the place. As a concept that the countries should spend a percentage of their GDP per capita, as for example, they have requested for defense in NATO, so you need to spend 5% of your GDP into, let's say, defense, a mechanism that everyone should have a percentage that they spend on innovative medicines. Of course, every country can decide how they want to allocate that and if they will do it by removing the clawback, which is very common in Europe, if they will do it by removing some mandatory rebates, or if they will do it by increasing prices. That should be the demand of the U.S. government towards them. This is what we have explained. Just to give you a number to understand the realities, the U.S. is spending 0.8% approximately of GDP per capita on innovative medicines, let's say 10 years within their launch. Germany, 0.4%. It is a big difference, and they need to step it up. By the way, Italy and Spain, 0.5%. I guess in a world of MFN, would Pfizer potentially rethink launch strategies in Europe? Would you consider walking away from countries if there's a significant disparity between U.S. and European prices? I think yes. I don't think we will walk out from, we will remove our products from the market there. We will just remove them from reimbursement. We will leave them in open market, and the products will be available at the price that if they don't want to reimburse, let them not do it, which is how in Europe things will work. It's not something that we would like, and it is not something that we want to go there at all. We prefer to find a solution that can motivate Europeans to do a little bit more, can motivate here pharmaceutical companies to reduce their prices, but also in a way that it's sustainable for the industry. Don't forget something, which is very important with lower prices. In Europe, let's say they pay a price by having low prices. 43% of medicines that they are approved by EMA are, on average, available, are reimbursed. In Europe, reimbursement is available, right? So approximately 43%. Those medicines that they are in the list, they are available to all. They are not three-step edit and pre-authorized, and you need to pay out of your pocket the entire amount, the first $2,000 or $5,000. These things, they do not exist. The volumes are tremendous. Right now, the abandonment in the U.S. for scripts that they are out of pocket is, let's say, north of $150. It is 50%. It is a very, very huge amount of abandonment that you have. If you reduce prices, but you open access, the impact, and we have calculated multiple times, is not that dramatic. Maybe just to wrap up on the drug pricing thing, just double-clicking on the U.S., I think there's a lot of confusion about what the mechanisms and the avenues for implementing these price changes potentially could be. In the U.S.? In the U.S. Is it people think it could get wrapped up in IRA? Maybe it's CMMI demo project. Could it be part of the budget reconciliation process? Just maybe talk through high level, what are the avenues with which we could actually see something get done? First of all, there are avenues that involve legislation and avenues, which means Congress, and avenues that do not. I believe, with all my discussions with Congress leadership and Congress members, there is no appetite for any legislation around that at all. We need to focus at the time, the highest possibilities, what can happen with regulations, right? The CMS has the ability to do what we call demonstration programs so that they can demonstrate something to the Congress that can legislate. Are those mandatory or voluntary? I'll tell you. First of all, cannot affect commercial because it's completely out, and cannot affect Part D because there is a non-interference clause that is there. It was lifted only for the IRA products and for nothing else. It is Part B that legally someone can do something like that. A demonstration program cannot be all Part B products, all countries, all states, because it's a demonstration program. It needs to be a small thing so they can demonstrate. Now, we know that there is a very different appreciation of what is the authorities that this government has, and they tend to go to the extremes so they can use, "I want to do a demonstration, and I can do everything." Yes, those can happen. In my discussions with them, I don't think that they are looking to destroy the industry, let me put it that way, right? They are looking to find the solution. Okay. Maybe just to wrap up, Albert, on the external environment, just a couple of words on tariffs. I guess you're one of the few global pharma companies that hasn't quantified or announced any new U.S. manufacturing, right? You said you're well-positioned, and you don't need to do this. I guess the question is, I mean, do you think the administration wants to see new CapEx investments, and do you think it diminishes your negotiating leverage in any way, shape, or form? I think yes. They would like to see new investments. They would like to see jobs creating in the U.S. As I said multiple times, Pfizer has invested in the past in U.S. manufacturing. We have 13 sites right now. Two are very big distribution, but 11 are manufacturing sites in the U.S. that we could transfer products. It is not without any investment and cost if you want to transfer. It is very different, the cost to transfer manufacturing from Ireland to a U.S. existing facility than to build a whole new facility that will take five years, and it is a huge investment. We also invested a lot in these facilities, and we will continue doing it. I do not think it makes sense to make announcements of future investments in an environment that it is very fluid. The reality is that we are business people, and the business people will look at the environment. Can I do more investments if there are tariffs and MFN? Probably not. Can I do more investments if those things are not there? Probably yes. We wanted anyway to do it because of resilience of the supply networks. We saw in COVID that you are suffering with this global network of supply chain. Many companies, and I think what you are seeing here, it is the result of they want to have resilience in the U.S. U.S. for U.S., resilience in China, China for China, resilience in Europe, Europe for Europe. This is what we are all doing. We will do that. What can get in the way, it is if we have to reduce dramatically our investments because of tariffs or MFN. All right. Let's move to Pfizer-specific questions on business trends. Yes. Albert, so I guess just starting with your 2025 guidance, on the first quarter call, you talked about 2025 guidance being de-risked for the balance of the year from a financial delivery perspective, just given the very strong jumping-off point that we made in the first quarter. So I guess what could challenge those core assumptions from here? I think in P&Ls, there are elements like revenues and cost lines. We feel extremely good about our cost lines. We are doing very, very well in controlling them, and we will continue that. The margins will expand. We are also feeling very good on the revenues right now. We reported the first one, which in our projections was higher, way higher than what we were expecting for Q1. I know that there was a misalignment with the street, but in our numbers, it was really very solid. You will see the second quarter. In the marketplace, I am sure we are following the scripts, et cetera. We are gaining share. We are maintaining share when you are attacked. We are very well on the revenues. Clearly, there is a wild card, which is COVID, because COVID, it is all backloaded. Backloaded means that the biggest part of the revenues are coming on the third and fourth quarter. If for any reasons that science doesn't predict and we can't explain, there is no COVID suddenly in the second part of in the fall, winter, that will reduce our sales, and that's an exposure. Doesn't seem that is the case in the last few years, and doesn't seem that is the case in Asia, that already the wave has started with a very strong, actually a very strong COVID wave with very severe symptoms. I keep that as one of the risk factors, but that's the only one that I see right now. I just want to press you a little bit on that, given the importance of how the COVID franchise delivers, as you said, in the back half with respect to numbers. I guess your guidance assumes steady state COVID relative to 2024, but there have also been some recent CDC recommendations with some pretty ambiguous language around who should get vaccinated, pregnant women, et cetera, right? What gives you confidence that the demand trends are going to hold up, even if there is a? Yes. There are two issues. One, it is what about the science of this recommendation? The other is what will be the impact on the demand? On the science, we have said our opinion. We completely disagree. This is based on nothing, and it's just ideological and shouldn't be there, but it is. On the impact, very, very small, almost nothing. Basically, in the ages that they don't recommend, the vaccination rates were very, very small, not only in terms of how much of the COVID was going there, but also what percentage of this population is getting a vaccine, which tells you that the percentage of this population that gets these vaccines are people that really need it, people that the doctors are worried about it. They have an underlying condition, but it's serious, and they really worry, and they give it. We don't expect on that. The uncertainty on COVID is not because of these things. The uncertainties are going to have a wave or not, as we always have. Science says we are going to have Asia started, but that's the only uncertainty. I think on CNN last week, in an interview, you made some comments about when you were getting asked about vaccines, about making some tactical moves in the near term. I was intrigued with that statement. What did I say in CNN? I think you said you're making some tactical moves around vaccines in your interview. Can't remember. All right. Maybe I misunderstood. All right. Let's talk about cost cuts. Obviously, you've made some great progress on productivity improvement programs over the course of the year and operational efficiency perspective. That has been a theme for a few quarters now. Maybe talk us through what innings of that we're in right now and how much more opportunity is there to sort of squeeze more costs out of the enterprise. We announced that we are going to have in the next two years, incremental to what we said, $1.7 billion on OPEX, and that's $1.2 billion in SIMA that is going to the bottom line, basically, and $500 million in R&D that will be reinvested. It is improving the productivity of R&D. We also announced that we are going to see an improvement in margins, in gross margins, because there is a $1.5 billion goal in manufacturing. We feel very good that those targets will be achieved, as we have achieved those targets until now. We are very good in doing that. The thing that makes me even more proud on that is we do it without affecting the performance of the top line because we are very strategic how we do it. It's not that it is democracy. Everybody, a billion means 10% cut, cut or 6%, 7%. You cut your cost 6%, 7%. It's two things that are driving. One, it is deployment of technology, that it is automation, digitization, and AI, very big part of it, both in cost of goods and in OPEX. The second is simplification. Our big corporations, they have built, let's say, significant infrastructures that they are quite complicated. There's duplication that really costs a lot of money. We go very, very seriously after that. That's why we don't affect. We are not reducing, for example, field forces, right? We are not reducing the amount that we spend in promotions. Actually, we have a big shift in the amounts that we spend from promotions, from TV to social media, where it is the return, the ROI of social media compared to TV. It is multiple ahead, right? We are doing a lot of these things that allows us to reduce the cost, and we'll continue doing that. Yeah, remarkable progress on that front, certainly. Maybe we'll move to capital allocation and just sort of use of cash, and then I'm going to take a pause and see if there are any questions before we go through some of the rest of my questions. Just on M&A and BD, just maybe your updated view, Albert, in the context of the deal that you recently did with 3SBio to license that PD-1/VEGF bispecific. Obviously, there's been a tremendous amount of excitement about this class as potentially disrupting the standard of care. There's been a flurry of recent news flow. You're going to be paying all in about $6 billion for this asset. So talk us through how you landed on this asset specifically and that price tag. We paid $1.2 billion. I hope we will pay $6 billion because we will pay $6 billion if the whole thing is very successful and sells a lot because there are milestones over there, right? The $1.2 billion, it is what right now we put at risk, plus all the development costs. I think, first of all, this is a fabulous asset. It is in a class that it is highly promising. It is the only class that has demonstrated benefits against PD-1s in the decade that these PD-1s are there and dominating the landscape. There is nothing else like that. The data that this company had were very good, but of course, there were data in China. You need to know the company, and you need to be very careful in China how you do the due diligence. We sent teams in China that they spent weeks, that they went to the sites, they viewed the scans one after the other. They interviewed the physicians that they are understudying. You did not do due diligence in a data room. We sent people on site, and we feel very comfortable. I met the CEO. They are credible guys. We feel very good about this asset. Now, why this asset is strategic for us is not only because on itself can represent as a standalone a very big opportunity because that is better than PD-1s if that continues to be the case and will be proven, but also because we have the largest ADC portfolio. Our ADC portfolio is based on a payload that is called Vedotin. Vedotin has been proven that because it creates immunogenic cell death, it has synergistic effects with PD-1s. All these parts of results are together with Keytruda, right? With any PD-1s, you put together this ADC with a PD-1, and you have much better results than if they are standalone. For us to have the new, let's say, standard of immunotherapy as part of our portfolio is very strategically important given that we have all the ADCs. How does it affect then the Summit partnership, that announcement that you had earlier this year? The Summit partnership was a research collaboration. We did not have any financials on their molecule, and they did not have any financials on our molecule. It is exactly because the ADCs and the PD-1s, PD-L1s, they have synergistic effects. They wanted, and we wanted, to do a study between their molecule and one of our ADCs. They are giving us the product. We are running the study. That is there. It is not the discussion right now, but it was not that we had an economic interest on there. I was a little surprised, actually, to see an oncology deal before we saw something in cardiometabolic or even INI, just given the vocabulary of the company recently has been sort of almost de-emphasizing BD in oncology and vaccines versus INI and cardio. Maybe just talk through sort of any updated thinking there. Yes. The truth is that for oncology, for us, the bar is much higher because we have plenty of assets. We are operating in full capacity right now with R&D organizations. It is not that we are looking to get it. Clearly, in other areas, we have higher interest. Cardiometabolic, obesity, let's say the internal medicine, it is clearly an area that we have very high interest. We are looking. Obesity, for example, we do believe that obesity is a very big area and a high unmet medical need. We do think there is a lot of risk with pricing. We are looking at it very quickly. All calculations and valuations that we may do or not for deals include the stress test of pricing should go down and what happens in that case, right? MFN or non-MFN prices, I think, because of competition. There is also a lot of players that are right now emerging, particularly in China. There is tremendous science on obesity, et cetera. We are looking at all of that. One thing it is very clear, we do not want to overpay. Sometimes in valuations, it is already embedded a premium that is really very, very high. We will only do it if we think that we can find a promising asset at valuations that a disciplined approach could make sense. The reason why to go and do it, it is because we have such a big expertise and legacy in metabolic diseases in-house that really, and it is primary care. It places both commercial and research on the strengths of this company. This company was built on this type of assets, right? Yeah, we will go for it. We are not going to overpay. Right now, there are a lot of crazy demands. In terms of your M&A firepower, you've put bands of $10 billion-$15 billion as the ballpark. Is that still the consideration in the context of this year? Yes, it is still the consideration in the context. And already we did $1 billion of that. I do not think we would like, I mean, we never say never on anything, but probably I would prefer not to do one of fifteen, but to do a few smaller deals. It needs to be strategic and at good value for the shareholders. I guess I have to ask you about the dividend. There still seems to be some investor debate. You and I have talked about this. Recognizing that this is a core part of your stated capital allocation strategy, what, if any, are the circumstances in which you may reconsider that view? Only if there's something catastrophic. There is no way that right now we are very clear. We are going to maintain our dividend, and we are going to maintain a growing dividend. Is it going to be an MFN that kills the industry? It is a very different story. Under normal circumstances, which includes known and unknown competition, costs, investments in other areas, et cetera, our delivery is very high priority. Our dividend is very high priority. Because we were able to deliver very nicely, if you saw our cash flows last year, they were very, very good. We went way below our stated target for the end of the year. We went already last year, right? It went really, really well. That's why we announced suddenly for this year we can have $10 billion-$15 billion also on BD while maintaining our dividend, while maintaining our R&D, and while continuing delivering. I think we are good on that front. Take a pause there and see if there are any questions from the audience. Okay, maybe, Albert, we can get into some of, double-click on some product pipeline-specific areas. I guess just maybe to finish up on obesity, just the status of the oral gipper and just how you're thinking about this competitive positioning, timing of the readout. I think within probably beginning of next year, right, readouts. It is right now in phase II, PD-L1, excuse me, of GLP-1, on the backbone of GLP-1. Both exciting. Yes. I guess on ELREXFIO, you've repeatedly talked about that being one of the more underappreciated assets in your portfolio and you're aiming to move up the treatment paradigm. Can you just maybe walk us through the strategy and the vision in multiple Myeloma? Yes. ELREXFIO is right now approved and is doing quite well in a very small indication. The triple, basically patients that they fail multiple lines of therapy, four, five, six lines of therapy, right? Now there is a new indication that the study should read out, is event-driven, but should read out by the end of the year, that is going to failing of two lines of therapy. That is improving dramatically the commercial opportunity because not only triples the amount of patients that are available with this. If it is one, now will be three. Also the duration of treatments in this population are much, much longer compared to the duration of treatments for people that they fail five or six treatments because they are unfortunately, they do not live that long. That is the second. We have four that take us all the way to the first line, et cetera. Of course, you need to have the studies being successful. The probability of success, it is on the reasonably high levels given what we have seen so far. The market potential, it is exponentially bigger. That is what I do not think the street has modeled appropriately. We went back again and again, and I asked my people, are you sure? Let us see this assumption and that assumption and that assumption. There is a very big difference in the street's assessment and what really I think and my team thinks that the product can do. Okay. Vyndaqel, just any updated thoughts in the context of the emerging competitive environment? I don't think will be an issue and a threat for us. There are already patients. I don't think any patient will switch from Vyndaqel to something else. There are the new patients that are coming that they will have to compete. They will have to compete against a physician's experience of years because the same physicians will prescribe to the new patients. They have some familiarity with Vyndaqel. They have to compete against our commercial muscle, which is very, very strong in the area. I think it's always not the same when it is with competition or without, but this is not something that worries us, particularly in the years that we have until the patent expires. Okay. I guess on bladder cancer, this is an area that's getting a little bit more interest. You're approaching this space with your subQ PD-1. You have this upcoming readout for Padcev in muscle invasive. Can you just maybe frame your perspectives and the outlook? I will. I will start with Padcev. Everybody understands the potential. It's more or less the story with Elrexfio. The new indication of Padcev, it is really increasing significantly the population and the duration of treatment. That's one. I want to speak about the subcutaneous that people have. They think the way that they see it, okay, it is a subcutaneous Keytruda alternative. Probably will not do that well. This is not the point. This is not why we developed it. We developed it particularly for use by urologists. Bladder cancer, when it is non-muscle invasive, bladder cancer is not treated by oncologists. Not at large, almost dominantly is treated by urologists. The current standard of care, it is through they basically putting into the bladder BCG, right, which is something that is killing the tumor. There are significant benefits if you include a PD-1. The problem is that the current PD-1s, they need an infusion center. The urologists, they do not have infusion centers. In their mind, when there is a need for PD-1, they need to refer their clients to go to an oncologist so that they can use an infusion center to give also the PD-1. We have done repeatedly market research. If you had a subcutaneous that you can give in your practice as you are giving the intra-bladder infusion, would you use it or would you continue? Overwhelmingly, they will use in the practice. It is easy to understand and believe. They have control, and they do not need to send their customers somewhere else. That is the value of this subcutaneous because it has been developed in this specific indication and had spectacular results. I think that also will be a good surprise. Okay. That's maybe a great place to wrap up, Albert. We're just about time. Thank you very much for that perspective. Thank you. Really appreciate you having you here. Thank you very much.