Philanthropy, Optimism and Taking Risks with Dr. Sue Desmond-Hellmann
All Lives Have Equal Value
Reducing disease and inequality across the globe
Physician, scientist and philanthropist Dr. Sue Desmond-Hellmann, CEO of the Bill & Melinda Gates Foundation, shares her unique career path, describes her vision for a world where every person has the opportunity to live a healthy, productive life and offers career advice for aspiring leaders and innovators.
(Below) Dr. Sue Desmond-Hellmann at Universitas Gadjah Mada in Yogyakarta, Indonesia, learning about breeding mosquitoes to fight dengue. Photo ©Gates Archive/Eric Elofson
Claire Stinson: Hello and welcome to Contagious Conversations. I'm your host Claire Stinson. Every episode we'll hear from inspiring leaders and innovators who make the world healthier and safer for us all. Contagious Conversations is brought to you by the CDC Foundation, an independent non-profit that builds partnerships to help the Centers for Disease Control and Prevention save and improve more lives.
Joining me by phone today is Dr. Sue Desmond-Hellmann. A physician, scientist and philanthropist, Sue has devoted her career to improving the human condition. Trained as an oncologist, she spent 14 years at biotech firm Genentech where she led the development of Avastin and Herceptin, two of the first gene targeted therapies for cancer. Today, as CEO of the Bill & Melinda Gates Foundation, Dr. Hellmann leads the organization's vision for a world where every person has the opportunity to live a healthy, productive life. Welcome Sue.
Sue Desmond-Hellmann: Thank you. Thanks for having me.
Claire Stinson: We're excited to talk to you today. So to start, let's talk a little bit about your background. Who were the biggest influencers of your career?
Sue Desmond-Hellmann: Well I would say the biggest influencers evolved over my career. I would start with my dad, who is a pharmacist, and had a huge influence on how I thought about using a brain that likes math and science—because I'm like my dad that way—and using it in service of others. And every day my dad went to his drug store and worked with folks in the community, and the physicians who he talked to on the phone and helped people, and I really loved that, and definitely wanted to have a life like I saw for my dad.
Later I met somebody else who reminded me a little of my dad but had a huge influence in a very different way, and that was Dr. Holly Smith. Holly Smith was the chief of medicine at University of California San Francisco, and like my dad, he had this way as a physician of connecting the science, and the details of the work, to why it mattered for people.
What I loved about Holly is he had this way of using his leadership, how he communicated, his sense of humor, to bring everybody along to knowing that you were part of something special, and I really loved that. I definitely wanted to follow Holly. I found him incredibly inspiring, but one of the things that really touched me the most is I just liked how he made me feel. He made me feel like I was part of something bigger than me, something special and important and historical.
Claire Stinson: Well that's a wonderful tribute to both of those people, and it sounds like wonderful influencers in your career. You are the CEO of the Bill & Melinda Gates Foundation. How did you come to lead one of the world's largest health philanthropies?
Sue Desmond-Hellmann: Well, it certainly wasn't in the master plan, I'll tell you that! As I mentioned, from the earliest that I can remember, I just loved this sense of being part of something special and historical, and so I knew that Bill and Melinda had created the Bill & Melinda Gates Foundation in the year 2000. So I was a fan of Bill and Melinda, then a fan of the foundation. The fundamental principle that the foundation's built on is all lives have equal value. So that has a lot of resonance and meaning for me, but what was most important for me and I actually left this kind of dream job at University of California San Francisco, which Doctor Smith, who I mentioned earlier, was part of me going back to UCSF and I really wasn't looking to leave.
But what is so inspiring to me about Bill and Melinda and the Gates Foundation is this: all lives have equal value isn't just a slogan. The Gates Foundation is absolutely passionate about using the capital we're lucky to have, the philanthropy of Bill and Melinda Gates and Warren Buffett, but contributing in meaningful ways to lifting people and really making sure that that investment, that money, the philanthropy, allows people to lift themselves out of poverty. So everyone has a chance for a happy and productive life.
Claire Stinson: It's such an important mission and it sounds like you all embodied the saying, "You have to practice what you preach."
Sue Desmond-Hellmann: Well, you know it's funny 'cause I often am kidded by people and it's easy to tease someone like me to say "Oh it must be really tough, you've got all that money. When you were a chancellor and leading a university you had to raise money, now you get to give money away." I actually hear that a lot, and here's the thing that I think is probably under estimated: how much the Bill & Melinda Gates Foundation uses metrics and outcomes. We don't measure how much money we give away, so much as we measure impact, and collaborate on everything we do.
So let me give you an example of impact because I think it's really inspiring when people think pessimistically or optimistically. We're optimists, but we're optimists for a reason. Here's a fact that I don't think people would realize: fewer people than ever before in history are living in poverty. That's just amazing.
When I think about giving money away, I think about investing in human capital and I think that's actually a really wonderful way to think about it as an investment and in human capital. It is all about that potential and opportunity for a great life.
And so when I think about those investments, I think about examples like in Indonesia where they doubled how often people could use contraception, family planning. They reached nearly 60 percent of the ability for women to access contraception. And that allowed them to have a GDP growth of 5 percent per year for two decades.
That's a real example of an investment in something, contraception, that's a public health investment and it translates into economic success because it's an investment in human capital. Another really good example is in Ethiopia where many of us when we were young thought of Ethiopia as kind of the poster child for famine. And now Ethiopia's projected to almost eliminate extreme poverty by the year 2050 and that's specifically because they've invested in agriculture, nutrition and health.
So for me, the wonderful thing about the mission and about the accountability and the metrics-driven foundation that Bill and Melinda have set up, is you can actually make investments in my favorite thing, which is humans, and human capital and that can translate into success either measured by one person at a time or for a country.
Claire Stinson: That's such an interesting way of explaining that, and I think that's really going to resonate with our listeners, so thank you for that. What do you see as the most important value of public-private partnerships?
Sue Desmond-Hellmann: I'm really glad you asked that question and I have to say that one thing that I think is a shame is to look at the world of private industry as like having a "black hat" or being the bad guys. I reject that. And I'm sure for your listeners, they all know people, or they might be people, who work in private industry. And so here's the reason I'm excited to collaborate with private industry, even working at a not-for-profit. What I know is that some of the most exciting things in the world are happening in the private sector. And so I want to tap in to the talent, the brilliance, the pace, the sense of urgency, actually, I want to tap into the power of private industry.
Sue Desmond-Hellmann: We could talk about HIV or tuberculosis or malaria. These are massive long-standing problems of the world, so we need big, big solutions. And what I'm really glad to tell you is that we can use important charitable mechanisms to work with private industry to tap into what they're good at for a global good. One of those financial tools that's somewhat popular and your listeners might have heard of is called a volume guarantee. So a volume guarantee is a pretty simple tool where we use the money we have in the bank. We use that tool to collaborate with two private companies, Bayer and Merck, who agree to reduce the prices of their contraceptive implants.
So this is long-acting contraception, and they did that in return for us committing to a certain amount of purchases over six years. So we just said, "We'll backstop the fact that you're going to sell at this lower price." Up to now, more than 42 million implants have been distributed to the world's poorest countries as a result of that volume guarantee.
So that's a fantastic example of so many women having access to contraception at an affordable price, and us using our risk capital to encourage companies to go to places of the world where they might not feel confident they can actually do business. So it's actually not corporate social responsibility, it's on their profit and loss statement.
And so that's the kind of approach we take so that everything we do has a charitable intent, it's all for people who might be struggling or who might have in front of them inequalities because of an inability to pay. But in using the capital that we have, we can encourage companies to go to new areas of the world.
It's estimated by 2050 there will be 2 1/2 billion people in sub-Saharan Africa. That's actually more than double the U.S. and Europe. So I also encourage companies to think about where their future customers are going to be. It's not that you should go to Africa because Africa is often the source of where people think about philanthropy going or not-for-profits are going. Africa's an exciting place these days, and sub-Saharan Africa is an area with a lot of youth, a lot of talent. And I mentioned human capital; there's more potential for great human capital in sub-Saharan Africa than virtually any place in the world.
Claire Stinson: The value of public-private partnerships is so important to us here at the CDC Foundation as well, so we appreciate you explaining it in that way. And now a transition to a question that is a bit on the lighter side. Sue, you do so much important work on a daily basis in your job. How do you relax and recharge?
Sue Desmond-Hellmann: Oh I'm a complete sports nut. Running, walking, skiing, swimming, cycling, you name it. My only limitation on sports is that my ambition and my enthusiasm outstrips my talent. So I love to tell people that my only asset on sports is I'm always color coordinated!
Claire Stinson: We'll be right back with Dr. Sue Desmond-Hellmann.
Since this is a show about contagious conversations we want to hear from you. Each episode we'll ask you a question and this episode's question is, "What is your favorite thing to do to recharge after a busy day?" Just email us at firstname.lastname@example.org to answer. That's email@example.com. And if you share your thoughts with us you'll have the chance to win some Contagious Conversations merchandise. Now back to our conversation with Sue.
Claire Stinson: The Gates Foundation is open to taking risks in its philanthropy. Why is that important to you, Sue?
Sue Desmond-Hellmann: I would say that taking thoughtful risk has always been something that I have seen during my life as translating into making special things happen. And I use the words "thoughtful risk" because I think as I mentioned, I'm a clinical scientist by background. That means I'm always doing things no matter what roles I've had that involve people, humans. When you work with humans and not Erlenmeyer flasks or test tubes the consequences of being wrong are higher.
And yet, if you deal with things as serious as HIV/AIDS or cancer, if you don't take risk, the pace of progress is too slow. And so philanthropists are also reluctant to take risks especially when it's humans. It's someone's mom or dad or child or brother or sister, but also, you can be embarrassed—and nobody likes to be embarrassed. If you take a risk and it doesn't pay off, you have to confess that it didn't work out.
One of the things that I think is underestimated is the risk of big, bold collaborations. And there's two big, bold collaborations that are about 20 years old right now that I want to mention because I think these are two areas of risk taking that a lot of people who were here at the foundation before me contributed to that I want you to know about.
One is Gavi, the Global Vaccine Alliance. Gavi is a really special public-private government partnership that allows a collaboration where new vaccines can get to some of the most low-resource areas of the world. And the Global Vaccine Alliance over the 20 years has meant that 700 million children have been able to be vaccinated against a variety of disease. And basically the way that Gavi works is these vaccines are distributed all over the world at affordable costs for governments and ministries of health. And that's a really special thing. Companies can see that there will be a market for these vaccines. The governments can work with Gavi, especially when they have low compatibilities and they're struggling to make sure that their citizens are vaccinated. So literally everybody wins.
And the second of these big, risky collaborations that was put together is the Global Fund for HIV, TB and Malaria. The Global Fund is just an amazing thing, and has saved approximately 27 million people from dying from these infectious diseases. And again, the Global Fund is an effort literally all over the world to pool funds and resources to make sure that people in low-resource areas of the world have access to medicines to prevent or treat these really terrible infectious diseases that differentially affect the poor.
And so I think what's interesting to me is taking risks can be taking risks on trying a new medicine, it could be taking risks to try and use a new campaign to do behavior change, or it can be risking bringing people who normally don't actually work together—governments all over the world, not-for-profit sector, the for profit sector—in service of improving people's lives. And in many ways I think that's some of the most inspiring work I've seen at the foundation. And it really means not just putting yourself out there, but now in 2019 and 2020, going back and asking for more money to keep driving these really key partnerships.
Claire Stinson: It goes to show that anything important in this world is worth the risk, you know, and it's worth taking that jump and that leap of faith, and you have to put in the work and so that's an important lesson for all of us. So your foundation's blog, The Optimist, is always interesting and has really inspiring content. What areas of global health are you most optimistic about right now?
Sue Desmond-Hellmann: We often talk about the big, important infectious diseases that the Global Fund focuses on as HIV/AIDS, tuberculosis and malaria as if all three are very similar. But they're actually very, very different. So let me maybe put those three into perspective and then talk a little bit about why I think 2018 might have been a truly seminal year for TB, which I'm even surprised at hearing myself say that, because I didn't think I'd say that last year.
But let me maybe start with HIV and malaria because I think all three diseases are worth talking about. HIV/AIDS remains one of the terrible, terrible dilemmas of my life I will say as a physician. So I started as a physician in San Francisco. When HIV hit San Francisco one year, it was defined before I was an intern and so my entire experience post medical school was so heavily influenced by HIV that my husband, who's an HIV doctor and I, lived and worked in Uganda for two years right after we joined the faculty at UC San Francisco.
So for me HIV is powerful and awful and real and I saw it in both men who have sex with men in San Francisco and then in heterosexuals in Uganda, the terrible scourge that HIV is, and it remains today with nearly 37 million people in the world still infected with HIV/AIDS. The single most important thing the world needs for HIV is a vaccine. That hasn't changed, and we continue at the Gates Foundation and others to invest in vaccines, which are long-term solutions while working with the tools we have to prevent and treat HIV.
The story with malaria is different. Malaria we have lots of tools and in malaria we keep thinking we're making it. Two years ago in malaria we realized that there was a flashing yellow light and that was at the steady progress that the world has been making with bed nets and artemisinin and some new tools and things that we were bringing to the malaria battle. We slowed and stalled on malaria. Really tough to slow and stall, and we with many others around the world are redoubling our efforts on malaria to have new tools, new approaches that are more regional in nature. Thinking about regions of the world where we can control and get ahead of malaria again.
But in 2018, one of the things that was so very interesting is in tuberculosis. From a product development perspective, TB has lagged behind HIV and malaria in new tools and new approaches. And one of the reasons that TB has lagged is it's a really tough disease to study
From a clinical science standpoint, TB is hard to diagnose. You need a sputum sample. It sits in the lungs, so it's in a tough setting. Having somebody get a good sputum sample, put it on a slide and look at it under the microscope, I have to say, I have mostly worked in my life in rich world settings, and it's hard to do in a rich world hospital. It's really hard to do in the field. And then if you're diagnosed with TB today, even with TB that's sensitive to drugs, you have to take three drugs for six months, and you really have to take all those drugs or resistance can rapidly emerge. So tuberculosis in many ways is one of the hardest global diseases to tackle.
But here's what happened last year that gives me some new optimism about TB. There were two publications last year in the second phase of testing that showed some optimism, gave me some optimism about TB vaccines. It is not an exaggeration to say that in 2018, something happened in tuberculosis that's not happened before, which is the suggestion that we might be able to have an active vaccine. That's big news, and it gives me some optimism.
Claire Stinson: Well that's something worth being optimistic about. That sounds like there's so much opportunity there for all three of those diseases. So on the flip side Sue are you pessimistic on any issues?
Sue Desmond-Hellmann: Well, you know I'm just naturally not pessimistic happily! I don't tend to think that way but I will say that I am nervous about populism or nationalism depending on the word that you want to use. It appears to be a trend over the last couple of years that individuals who are struggling or nations who have struggled through the big recession or challenges with employment and getting a good job, the American dream, has led to people thinking about their own country and questioning things like overseas development assistance or a global view of the world and I just reject that.
I'm sympathetic to people who are struggling in their own country and want to make sure that that gets addressed, but the one thing we found focusing on infectious diseases at the Gates Foundation, and we were reminded of this with the Ebola outbreak in 2014, and we're being reminded of it again with the threat of Ebola in DRC, is that a health threat anywhere in the world is a health threat everywhere. And so no matter who you are, having a world where people have the chance for a healthy, productive life actually lifts all of us. It's good for everyone from a health standpoint, from an economic standpoint, it's also something that I think many young people who aspire to have a life that has meaning, it's meaningful to think about the globe and to think about what's possible when everybody wins and everybody benefits from innovation. I would say I'm not pessimistic, but it makes me nervous that people are thinking more nationalistically.
Claire Stinson: That's interesting, but you were able to make that an optimistic answer, so I appreciate that!
Sue Desmond-Hellmann: I warned you that I'm an optimist! I will say though, on the keeping me up at night, there's one more thing that also keeps me up at night that I want to mention because you're in Atlanta and you're at the CDC Foundation. And that is people getting bad information about vaccines. What people call the anti-vax movement. You know, here's the thing I know. I know everyone loves their children. I know every mother, every father, every family values their young people and their babies, and so when moms or dads or families are scared about vaccination, it just makes me really sad. It makes me really sad and it makes me worried about them and the information they're getting and how they're learning about the role and the importance of vaccines from their pediatrician and their community and it makes me really nervous for the world.
Here in Washington state where I'm sitting and talking to you now, we're having a big outbreak of measles. You know, measles! I talked about disease eradication, we really shouldn't have measles. The only thing more sad than a child being sick or dying of an infectious disease is dying of something that's easily preventable with a vaccine, and that would be measles. So the bad information that people have, the worries that people have about vaccines, when vaccines really are one of the most wonderful modern inventions that exist on earth.
I've called them, and I really avoid exaggerating things when I talk about medicine, but they are nearly a miracle. To be able in such a safe and effective low-cost way, to prevent disease in so many people around the world, is a special meaningful thing. And it's also something you're doing not just for your child but for your community and your school and where your child goes to school or where you go and work.
So I think all of us who care about health need to start talking to our neighbors and in our own community make sure it's safe and comfortable if someone's scared or nervous, that they can talk about what they're worried about so that we can have a really healthy community dialogue about protecting all children.
Claire Stinson: Absolutely, well said and communication and good information cannot be understated on this topic. It's such an important topic right now especially. Back to what you were saying earlier about your work at the Gates Foundation, what would you say is your biggest challenge at the Gates Foundation?
Sue Desmond-Hellmann: Wow, we don't work on any easy problems!
Claire Stinson: That's true.
Sue Desmond-Hellmann: I would say that's the case. I'd say that the biggest challenge is when we move from trying to solve problems in what people would call a vertical way. So I'm a product developer and I love, as you can tell from my story about tuberculosis, I love when I think we can solve a problem by making a vaccine.
I love when I think we can solve a problem by making a remedy because we know how to do that. We know how to look at targets, we figure out some novel ways of funding that, there's well established systems across the world, whether they're in private industry or academia or in government, about how you make new products available for health.
Here's what we don't know how to do in the world as easily, is change systems. The biggest challenge that we have and others have is what if you're trying to change the system by which we deliver healthcare? What if you're trying to change the system by which education is delivered? Changing health systems, changing educational systems, involves a lot more local community input, involvement, and, frankly, differences of opinion.
And so how a foundation like Bill and Melinda Gates Foundation participates in that dialogue and in that systems change work, I would say is a work in progress. We had a great experience in the last couple of years working with the government of Ethiopia. With the government of Ethiopia, we were working in very much disease-oriented ways: malaria, tuberculosis, working on things like pneumonia and diarrheal disease.
A couple years ago the government of Ethiopia came to Gates Foundation and many others and said, "Look we want to drive a health systems transformation for Ethiopia." They had watched Rwanda and what Rwanda had done in health systems transformation and they had really pushed themselves to get ahead of a very disease-oriented way of thinking about health.
And it's been a wonderful learning experience for us and a terrific collaboration with Bill & Melinda Gates Foundation and the government of Ethiopia to really transform how we work together and look at. Can the government of Ethiopia change their health delivery system and can we be supportive and partner with them in that when the drive and the direction comes from government of Ethiopia and we take our vertical aspirations, which haven't gone away. We still want to work together with the government of Ethiopia on pneumonia and diarrheal disease, but thinking about how the health system transformation and about the 2030 goal of universal healthcare and changing primary healthcare. So I think that is an aspiration and a direction that's both positive but really, really challenging work to do. That's some of the hardest work we're working on right now.
Claire Stinson: Absolutely. And I would say and agree that you do seem like an optimistic person. So the next question you will probably like more: What is your biggest opportunity?
Sue Desmond-Hellmann: You know I think the biggest opportunity is something that I do think I may have an overabundance of, but I actually think the world needs a little more of it. Part of the reason I think I'm optimistic is like feeling energetic. I'm not big on pity. I'm not a good patient, I will confess to that because I don't like needing help. I like helping, I like doing. The Bill & Melinda Gates Foundation's optimism is not driven for no good reason. It's informed optimism and I think especially for young people today the thing I'm optimistic about and the thing I'd love to tap in to even more at Gates Foundation is the sense that it is possible for anyone around the world to make a difference.
Claire Stinson: I think we can all learn something from you Sue and I love the idea of "informed optimism." I think that's the perfect way of explaining what you're talking about here. So I love that. Now, a really important question that I'm most excited to ask you about today. What advice do you have for others, especially women, who want to become CEOs and innovators like you?
Sue Desmond-Hellmann: You sound like my brothers and sisters and in-laws who are always saying, "Talk to Aunt Sue!"
Claire Stinson: That's great!
Sue Desmond-Hellmann: So I'll put on my Aunt Sue hat. I have to say I come at being asked for advice with a lot of humility. I am so lucky to have had the opportunities that I've had. So for me, some of the best advice that I've been given is to keep learning.
It's kind of popular to say, "To be a lifelong learner," and I think that sounds really trite, but I will tell you that there have been a couple of times in my career when I've been in roles or jobs where I just think. "This might not be the right place for me or the right job for me." Or I'll feel anxious or uncomfortable and happily the advice I've been given and my own instinct is, "Well if I just learn more." If I just reach out to people and say, "What should I read?" Or "Is there a paper on that or a book I can read? I'll be more comfortable, less anxious and maybe this will work out or if it doesn't work out I'll learn something." So that's always been a huge asset for me. Because two good things happen as a result of that. The first good thing is, that I reach out to other people and ask for help, it's a tremendous sign of respect if I'm learning from other people. Everybody likes to know that somebody wants to know what's in your brain and so I think we all underestimate what a wonderful gift it is for a colleague to ask you to help them get smarter. So that's something that I also remind myself of, because it feels good if somebody asks me that way.
And the second thing is, even if you've had one of those years where you say, "This probably wasn't my best career year," but you took the time during that year to learn something new, boy that's an asset.
So I'd say advice number one is learn, learn, learn no matter what, learn a lot. The second thing is, be willing to take risks even if it's not clear that, that risk is good for your career.
I have joked about the best advice I didn't take was moving to Uganda and ending my academic career, which is actually true. But it was a good comeback, so it worked out all right! But for me, moving to Uganda before there was a global health infrastructure and really not publishing and not doing the kinds of things you need to do to stay on the academic ladder was the best thing I did. And it changed me as a person. It changed the way I thought about life and it made me more grateful and I learned so much from the Ugandans who I was fortunate to work with. I would do that over again in a heartbeat. And yet if you plotted out a career path to professor, boy there was a lot of zigging and zagging that had to happen after that to be a professor. It's not over indexing whatever ladder you're on but maybe over indexing on what you'll learn.
Claire Stinson: That's a really good solid piece of advice. I think we all wish we had an Aunt Sue like you! What would you say is the defining point in your career?
Sue Desmond-Hellmann: Well I hope it hasn't happened yet.
Claire Stinson: It's still to come.
Sue Desmond-Hellmann: So it's pending. No, I'm kidding. But I'm only half kidding. The one moment of my life as a grown up that I often look to as a place where I just literally kind of close my eyes and say, "I want to remember this moment," was the day that the drug Herceptin was approved.
So like so many women in America, my family's been affected by breast cancer, and one of my sisters and my mom have both had breast cancer. And having been a practicing oncologist and loving science and getting to participate at Genentech in the development of Herceptin, it just felt to me like I was so grateful to have a chance to be a part of that effort. And it was so hard, and so many times I didn't think it would happen, so that moment, and getting to be a part of it and getting to be on the front lines and experiencing that, just felt to me so special and so important and I would remember the history of medicine and that moment in time and that I got to be part of it. So I would say of so many wonderful things I've gotten to participate in, that made a huge impact on me.
Claire Stinson: That's very powerful and inspiring. Thank you for sharing that. Thank you so much for sharing your story with us today Sue, you have had a profound influence on global health and on behalf of the entire CDC Foundation we want to thank you for your partnership over the years.
Sue Desmond-Hellmann: Back at you! We, as you know, at Bill & Melinda Gates Foundation are big fans of CDC and the CDC Foundation, so I've been happy to have this conversation with you today. Thanks a lot for all your great questions.
Claire Stinson: Thanks for listening to Contagious Conversations produced by the CDC Foundation and available wherever you get your podcasts. Be sure to visit cdcfoundation.org/conversations for show notes and bonus content. And if you like what you just heard, please pass it along to your colleagues and friends, rate the show, leave a review and tell others. It helps us get the word out. Thanks again for tuning in and join us next time for another episode of Contagious Conversations.