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Gates Foundation's New CEO: Why We Can Eradicate Four Diseases in the Next 15 Years

The Gates Foundation has its sights set on guinea worm, elephantiasis, blinding trachoma and polio.

Courtesy: Gates Foundation

The Bill and Melinda Gates Foundation’s annual letter in January marked the charitable organization’s 15th anniversary and set a bold agenda for the 15 years to come: Halve the number of children who die before the age of 5 and wipe four diseases off the planet.


To put those ambitions into context, one in 20 children die before age 5 and the world has only managed to eradicate a single infectious disease, smallpox, in the history of humanity.

“The goals on a good day could be called audacious and on a bad day, ridiculous,” said Susan Desmond-Hellmann, who became the foundation’s chief executive last May after years as chancellor of UC San Francisco.

But these kinds of lofty aims were precisely what she signed up for, she said.

During an interview with Re/code in the foundation’s horseshoe-shaped glass and limestone headquarters three blocks from Seattle’s Space Needle, Desmond-Hellmann said she was drawn to the role by the foundation’s mission statement: “Every life has equal value.” She also saw it as a chance to address global health challenges on a scale that few physicians could ever dream.

See video of the interview below.

Desmond-Hellmann began her career as a medical oncologist, spending several years studying HIV and cancer as a visiting faculty member at the Uganda Cancer Institute before moving into private practice. Before UCSF, she served as president of product development at Genentech, where she helped shepherd two of the company’s blockbuster cancer drugs, Avastin and Herceptin, into the marketplace.

Desmond-Hellmann describes the Gates Foundation as a giant anti-poverty program, attacking the problem globally and domestically through education, development and health care. It has contributed nearly $33 billion in grants to date, including almost $4 billion in 2014.

Last week, the foundation announced its biggest investment yet in a private company, committing $52 million to CureVac, an early-stage startup that has developed a promising approach to creating new vaccines cheaply and rapidly. Put simply, it piggybacks on messenger RNA, which plays a pivotal role translating DNA into proteins, to produce customized proteins capable of battling disease — effectively nudging the body to produce its own vaccines.

Among other recent grants, the foundation donated tens of millions of dollars to contain the Ebola epidemic and accelerate the evaluation of treatments, and dedicated hundreds of millions more to battling malaria and other infectious diseases.

Contenders for the four that the organization hopes to eliminate by 2030 include guinea worm, river blindness, elephantiasis, blinding trachoma and polio, the paralytic disease that continues to infect hundreds of people annually more than 60 years after Jonas Salk first developed a vaccine.

In her conversations with Re/code, Desmond-Hellmann highlighted the challenges of getting past that last kilometer in infectious diseases, the hard lessons of the Ebola outbreak and what she wants the history books to say about the foundation.

The interview that follows, which includes quotes from a follow up phone conversation, has been edited for length and clarity.

Re/code: You’re still relatively new in this position, less than a year. How are you changing the direction or shifting the priorities of the Gates Foundation?

Susan Desmond-Hellmann: When I came to the foundation I specifically had a discussion with Bill and Melinda [Gates] about the strategies and focus of the foundation. I did not have the ambition to change the strategy.

One of the reasons I’m here is I love the mission of the foundation and the rally cry, I think you could call it: “All lives have equal value.”

We want people to all have a chance at having a happy and productive life.

Why is health such an important tool for achieving that goal?

Globally, from the start, Bill and Melinda were really struck [by] how unfair it felt to them that children didn’t have an equal chance because if you’re born and you have a very high chance of dying before you’re even 5 years old, how could you have a chance at life? How could you have equity?

If you look at the countries where we operate and you look at countries that are really struggling with poverty and inequity, one of the things that happens in many of these countries is that even simple, affordable tools, like vaccines, one of our favorite tools, don’t get to where they’re needed. There’s not access to prenatal care, there’s not access to simple things like a safe delivery, family planning.

So for us, when we look at cost-effective ways of thinking about improving people’s ability to have a chance at life, health is such a great lever.

 Desmond-Hellman visits the L10K Gemane Gale Health post in Ethiopia last June.
Desmond-Hellman visits the L10K Gemane Gale Health post in Ethiopia last June.
Courtesy: Gates Foundation

How has the Ebola outbreak affected the thinking not just about Ebola, but the importance of identifying emerging outbreaks and responding to them quickly and aggressively?

There are three areas where we’ve started to really think about lessons learned and impact in the future.

One of those is the importance of primary health care. It has not missed anyone’s attention that one of the reasons Ebola could take hold in these three West African countries was the absence of a working primary health care system.

The second thing Ebola points out to all of us is how much disease tracking [matters]: Knowing something that’s happening and recognizing it early is very important.

And the last one, and something again the foundation is deeply immersed in, is how do you think about driving product development for things that the world needs, but capitalism and business on its own wouldn’t naturally make remedies [for]?

The Gates Foundation has started to look at: What are the tools that we can use from a business and a strategy perspective to stack the deck in favor of making those sorts of medicines?

Some of those tools will allow people to make a healthy business, on volume, but they have to very efficient. Some of the other tools may rely on ministries of health, governments, NGOs or philanthropies.

Is the CureVac investment an example of that — or does it fit into that framework?

We very much want to tap into all the power and urgency that the private sector brings to product development, so that’s in our wheelhouse.

We have internally, and we collaborate with some of the best and brightest scientists. Those scientists are always looking across the world for transformative technology. And this is such a good example of that. Our scientists and collaborators say this mRNA technology has some very interesting attributes that could very much change how we think about vaccine development and delivery. And that’s the kind of thing we want to invest in early.

Their technology could make vaccine development faster, cheaper and more nimble — and that’s very important given the pathogens we deal with and the world we live in.

Polio has been a big initiative for the foundation for a long time. What would it mean to eradicate a second disease? And how does the challenge get harder the closer you get to zero?

For polio, it means kids won’t get a paralytic disease. It means the world doesn’t have to worry about polio anymore.

That’s a major, major thing, but it’s really, really challenging.

When I try and describe to people why polio is so hard now, all I do is talk about the three countries in the world where polio remains endemic: Afghanistan, Nigeria and Pakistan. And most people immediately understand why that’s hard.

We do have effective vaccines for polio. [But it persists] in areas where the health care system or unrest is in the way, including really awful and destructive violence against polio vaccinators themselves. So this is a huge challenge.

That said, we’ve been encouraged by Nigeria. Nigeria had six cases of polio [in 2014] and that is extremely encouraging. If polio could be contained in the last endemic country in Africa, then a focus of attention can be Pakistan, particularly, and also Afghanistan.

I’m really inspired by the work, the work of people globally, to eradicate polio. Some of my colleagues at the foundation are really doing heroic work in terms of this last kilometer, so to speak.

 Desmond-Hellmann during a tour at the Kilimanjaro Christian Medical College in Tanzania last July
Desmond-Hellmann during a tour at the Kilimanjaro Christian Medical College in Tanzania last July
Courtesy: Gates Foundation

The Annual Gates Letter included pretty ambitious goals on the health front — halving the number of children who die before the age of 5 and eradicating four diseases. We’ve only eradicated one to date, so what’s changed? Why could we be on this precipice?

All of us are really inspired by the smallpox example and I do think thing Bill Foege (the epidemiologist who developed the strategy behind that effort) — who has written about this extensively and given us and others that inspiration — points out how much suffering and death has been eliminated by the eradication of smallpox. So that serves as a North Star.

What’s really changed is a couple of things. One is we’re bringing the best of science and new tools and approaches to this disease elimination battle. Science is better than ever as is our ability to tap into science even when markets fail.

And second is the collective effort across the globe. There are so many collaborators working together to get to that last kilometer.

One criticism of the Gates Foundation is that it’s so big with such deep pockets that it can really drive the agenda, and that it can mean funneling an overweighted amount of philanthropic resources down one pathway that might not be the right one — and might reflect more first world, pharmaceutical company perspectives about appropriate policies. What do you make of that critique?

One of the aspects that strikes me as surprising is the worry we have outsized impact from about $4 billion a year, in light of what’s being spent. There’s about $135 billion in overseas development money from countries. The National Institutes of Health spends $30 billion a year plus on R&D funding.

So when you look in that framing at the money from the Bill & Melinda Gates Foundation, I’m surprised people are worried about an outsized impact.

I think what sometimes people are saying is, “We want to make sure you’re listening.”

And I hear that. I am listening. One of the things we’ve started to do at the foundation is, we’re surveying our grantees and our partners, because we want them to know we’re listening, we hear their feedback, we hear what’s on their mind.

When you’re trying to innovate and make things better, you should take risks — thoughtful, calculated risks — and have a dialogue when what you wanted to happen doesn’t happen.

I’m a product developer in cancer. I learned a long time ago that the best way to make things better is to be bold, to be honest and to course correct. And that’s what I want to have said about the foundation.

 Desmond-Hellman speaks with representatives during a tour of the Ada-Lume Cooperative Union facilities in Ethiopia last July.
Desmond-Hellman speaks with representatives during a tour of the Ada-Lume Cooperative Union facilities in Ethiopia last July.
Courtesy: Gates Foundation

This year is the 15th anniversary of the Gates Foundation. How is that milestone affecting your thinking about where you go from here?

It is great for the foundation to push ourselves to ask the question: What have we contributed in our first 15 years? What I like about that framing is, it’s the perfect prologue to a discussion about what could we accomplish in the next 15 years.

We want projects to end, we want some victories, we expect these investments to pay off.

So we’re having a process internally and we’ve involved all the employees in this conversation, asking: What would we like the history books to say about the Bill and Melinda Gates Foundation in 2030?

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