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[MUSIC] It's a pleasure sitting across from you on stage after interning at the Gates Foundation this past summer.
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So I want to spend some time today talking a little bit about the values and decisions that have really shaped where you are today.
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As well as hear a, a little bit of your thoughts around where you are going.
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As well as where the Gates Foundation is going.
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>> Sounds good, I'm glad to be here. >> Great.
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So let's start off by talking about two of the really big pillars that have been constant in your career, healthcare and education.
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And in fact, your father was a pharmacist and your mother was a teacher.
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So, I'm interested to hear a little bit about how, what kinds of lessons they taught you.
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And how have those lessons really shaped, the way you've thought about your career?
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>> Oh, as you all just heard, I grew up in Reno, Nevada, biggest little city in the world.
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And although I'm a California native.
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So now that I'm in Seattle by the way I'm getting all sorts of grief about Kaepernick.
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[LAUGH] lot of trash talk up there.
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But, but, but I, I feel like today and my entire career it has been so heavily shaped by how I was raised. I'm one of seven kids.
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And, number two of seven, and from a very early age there was- >> There were a couple of things that, that I got from my parents that stay with me today.
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One is a fierce love of reading and learning, from my mom, who was an English teacher.
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and, and a sense of the privilege it is to be involved in health, from my dad, who's a pharmacist.
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And being able to work in my dad's drugstore when I was young, and seeing how my dad was so focused on people who were suffering or sick.
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And trying to make them better, made a big impact on my wish to see if I could do something to contribute in medicine.
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>> And you've made a lot of really unorthodox decisions in your career.
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First going to Uganda in the late 1980s to study HIV/AIDS at a time where not very much was known about the disease.
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And later, leaving the number one pharmaceutical company to go to what was a relatively new and struggling biotech company, Genentech.
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Not a lot of people would take those kinds of risks.
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So tell me a little bit about what you were looking for at those times.
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How were you weighing the benefits versus the costs of those decisions?
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>> Yeah I think it's, it, actually learned a lot of lessons both about leadership and about risk taking from both of those, opportunities.
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So I had been at, at UCSF for seven years when the Rockefeller Foundation came to UCSF.
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And asked UCSF to study heterosexual transmission of HIV.
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It's hard to remember now, but at the time.
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In 1988 it AIDS was thought to be a disease related to either being gay or having a blood product.
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And it, there was a myth then that in fact there was this secret homosexuality going on in Africa.
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And that must have been why.
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That people were too embarrassed to confess that they were gay.
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But that, that heterosexual transmission of HIV was probably a myth.
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And so, when Rockefeller came to UCSF.
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UCSF asked me and my then husband, who's an infectious disease doctor, to move to Kampala to work in Uganda.
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And, and I have a very distinctive memory of one of my dear colleagues, Bob Cohen.
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Telling me that I would ruin my apa, academic career by moving to Uganda.
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It was really good advice.
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And in fact [LAUGH] it actually it, it, it was good advice because he was right.
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For two years, I didn't publish.
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Uh,uh, I didn't schmooze or interact or do things you do to become a tenure-track faculty member.
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And when we came back from Uganda which was a completely life changing experience in every way.
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There, there were two things stayed with me.
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One is that my academic career was over.
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And I needed to leave and figure out how to pay the rent, and, amd make a living.
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And two, that I would never be the same.
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And that my own expectations of myself.
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All the privilege I had had my whole life.
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And what I expected from myself as a leader.
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And as somebody who, who was so fortunate to have education and clean water and great parents and a great family and a wonderful husband.
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That I needed to give back.
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And I needed to do something.
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I will tell you when I became chancellor at UCSF I called up Bob.
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[LAUGH] And I said hey Bob I made it back.
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[LAUGH] So I can work down all right.
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[LAUGH] I just skipped that whole associate professor thing.
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[LAUGH] So, so that was that was a huge risk it, it especially to my burgeoning academic career. But a really good risk.
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So that later when I was at Bristol-Myers Squibb and I was working on Taxol.
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Which was their number one cancer drug and a terrific, new advance in chemotherapy.
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I visited Genentech and that was in, in 95.
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And Art Levinson was the head of R and D and Art talked to me about Genentech's wish to be a cancer company.
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But Genentech had no marketed products that were cancer drugs.
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But they had terrific science an incredible vision that Art had that they would lead in cancer.
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And that Genetech would transform how people were treated who had cancer.
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And I was so deeply inspired by that vision that I thought, well, you know, nothing may come of this, but I want to be part of that.
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And having had the experience of taking a risk before.
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And knowing that the consequences of not taking that risk and not seeing what might be possible wasn't acceptable to me.
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And, and so that, that career risk taking seemed, seemed totally reasonable.
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Which is probably why I'm not at UCSF anymore, I'm at the Gates Foundation.
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>> And you mentioned Art Levinson. >> Mm-hm. >> Who hired you.
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Really helped you catapult your career as an executive at Genentech.
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Art has said that when you first got there, you were a little bit soft.
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You needed to learn how to make tough decisions.
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Do you agree with that assessment?
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>> [LAUGH] >> And if so, how did you develop that ability.
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It depends on your definition of soft. >> Sure.
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>> [LAUGH] >> [LAUGH] So Ar, Ar, Art was my boss for most of the 14 years I was at Genentech and we remained really close friends and colleagues.
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Which I think is, is one of those special things that I hope that all of you in your careers get to experience.
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The combination of a boss who is so inspiring and so driven and passionate about having a successful company.
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And making a difference for patients.
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And sometimes, so deeply annoying.
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>> [LAUGH] >> [LAUGH] >> And, and there were two things annoying about Art for me that I grew to be really fond of. One was him pushing me.
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That I should be tough on, on everything.
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That, that as driven as I am and as I was.
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It was okay to be demanding others in service of what we were trying to accomplish.
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That I shouldn't be embarrassed about that, or think that people would think that I'm, or too tough.
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And so I do think there was sorta a toughness factor, and not being afraid of asking people to overachieve.
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In service in what we were trying to do that I learn from Art.
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But the other thing, and a really special thing that I push myself to think about all the time is.
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I got from Art that he really felt like I consistently underestimated myself.
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And in, in the best of ways.
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He would demonstrate to me that he was gonna keep raising the bar for what he wanted from me or what he expected from me.
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And yet, he was completely confident I was up to it. Even when I wasn't.
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And, as a leader and as somebody who mentors or manages other people, that sense that.
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It, it isn't being nice to them to underestimate them or be easy on, on them.
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But to say I'll bet you're capable of more and, and yeah, I, I'm gonna ask you hard things, but you're up to it.
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That was a really special thing to have a boss like that.
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I'm very grateful for that.
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>> What is, what do you think it's like to work for you at this point?
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So, Art was a tremendous influence.
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No, I'm interested to know.
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I think you, how would you, how do you think the people who work for you describe your leadership.
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>> Gosh, I should, can I make up something really great?
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[LAUGH] And hope they'll live up to that.
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Well, I'll tell you what I hope they would, they would feel.
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When I get excited about things, I'm all in, you know. >> Mm-hm.
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>> And I'm I've been so incredibly lucky to be involved with things from trying to change the way cancer's treated to creating a great university.
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To literally changing the world through our work at the foundation.
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I hope that what people who I work with would say about me is I'm fierce and demanding and and sincere in my wish that we make a big difference.
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And what I want it to be like when I'm leading is both fun and exhausted.
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Cuz I, I honestly think it's you don't get great things without trying hard.
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And you know, this room's filled with people who are overachievers. I know that about you.
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And so many overachievers feel like, oh my god, you know, I need more work-life balance.
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Or I need to be easier on myself or I need to get more sleep.
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But there's something really special about being fierce when you're doing something important, or you wanna create something special.
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And, and, I hope that, that when I'm at my best, I'm fierce.
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>> I know you've said before carpe diem is, is something that you really believe in.
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So it's interesting to hear how that plays out in your leadership philosophy.
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Um,you see, I think one of the interesting things about your career is that you've spent time both on the commercial sector side.
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And in the, the not for profit education as well as now the philanthropic sector.
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What do you think the lessons are that you took from your time on the corporate side to UCSF when you went there as Chancellor.
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Huge recession, budget cuts across the state, what were the biggest things that you were thinking about.
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And how did you take your perspective, your very unique perspective, and use it to make change?
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>> Well, I, I think the, the, the experience I had in the corporate sector was helpful to me in moving to UCSF.
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And now to the Foundation in a couple of ways.
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One is, and it's something I like a lot, about the for profit publicly traded company world.
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There's a certain orderliness, and set of expectations that come regularly.
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Once a quarter you have to tell the whole world how you're doing.
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And you have to do so with metrics that are widely understood.
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Earnings per share, sales.
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If, if you're in product development, number of approvals, product launches, do people like your product? Are they using them?
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And I think particularly when you're in science and when you're in the R&D world, it can be easy to continue to push the finish line forward.
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And, and to, to put off accountability.
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And so, I think first and foremost the commercial world resonated for me in a very high accountability, metrics-orientated way.
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And so bringing that model of high accountability and using metrics to, to the academic world was important to me and served me well.
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The other aspect of, of the private world that that I brought to use at UCSF, and already was at use at UCSF.
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But I probably expanded is the wish to have effective public, private partnerships, and to be realistic about them.
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And I, I'll give you an example.
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I, I think one of the most efficient ways for people to lead.
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Is to be really clear about what you're asking of people and what the outcomes are.
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Too often in academia we would be approaching private companies and somehow, out of fear of rejection, I think, we would be unclear.
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We would be asking for charity.
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Like, could you write us a check because you care about UCSF and we're going through a tough time?
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But we would pretend it's a business deal.
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And I would often talk to faculty members about these, these public private partnerships and push ourselves first, but then the companies as well.
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Is this a part of your business plan.
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Are we part of your business plan cuz that's called a deal? What do you need? What do we need?
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What, what money exchanges hands?
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What are the expectations?
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Or do you have a charitable part of what you're doing that you'd like to give us a check and we'll thank you and, and be grateful.
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Those are really different things.
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And the consequences of misunderstanding the difference between a deal and charity are high.
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And so, partly because I had come from the private sector.
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Understanding what a head of R and D or a head of a company is looking for for their company.
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And what UCSF needed and was looking for for us as a public institution, hopefully there'd be some marriage.
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But if there wasn't, it was better not to even start.
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>> One of the more controversial proposals that you had at UCSF.
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Was potentially separating some of the operations and finances of the UCSF campus from the UC system.
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That didn't end up coming to fruition and I'm curious to know, is there anything that you learned from putting that proposal out there and having it in some senses fail in the way that you didn't intend, what could you have done differently if anything?
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I think that, that I learned a lot of lessons for, from that one is I think it's eh, in service of the university being a great institution.
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I I'll tell you what I feel good about.
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I feel good about pushing, pushing really hard that anything I could do to serve the governance of UCSF in a positive way, and leverage all the assets that UCSF had and has in service of being the best institution we could possibly be for California and for the world.
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Is something I was very motivated by and driven by, in my quest to increase the independence of UCSF on the governance front.
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Where I think I probably, underestimated is the passion with which the Regent's look at the whole of the ten universities of California as, as one.
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And although I thought it was pretty low risk for them to take a graduate student only life sciences, only, am I selling you? [LAUGH]. >> [LAUGH].
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>> As an experiment, one-time only, low consequence, [LAUGH] I, I think I underestimated two things.
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One is the history and the passion with which people care about the unified UC system, and the other thing is how quickly my colleagues, especially at Berkeley, wanted to go with me. >> [LAUGH].
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>> And so me positioning this as a one-time experiment, only UCSF as Berkeley was kind of latching on and, and coming along, it kind of made it seem like a sham that this was a one-time small experiments.
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and, and so I learned a lot from that, and I also learned about the importance of not going so fast that you kinda hit a wall but you know, at the Gates Foundation, we have this saying that we're impatient optimists.
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My impatience may have gotten the best of me [LAUGH] cuz I wanted it now, and and my optimism probably, got the best of me, too, in thinking that people would go along.
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On the other hand my successor Chancellor Hawgood continues to reap the benefits of the Regent's understanding better the business model of UCSF.
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How UCSF operates, how an academic medial center receives funds and the importance of being nimble in today's world of healthcare?
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And so I hope that the institution and, and Chancellor Hawgood continue to reap the benefits of leaning out maybe a little ahead of my skis. [LAUGH].
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>> As a, as a Biotech Executive, eh, really responsible for the R&D side of things.
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You really have to become very comfortable with the risk of failure very early on, and think about the portfolio, and how you're gonna manage that appropriately.
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How do you as a leader think about treating failure and taking risks, and how do you sort of, let that viewpoint trickle down within your organization?
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>> The risk of failure to me is something that is a part of being an innovator, I don't think you can do excellent innovation without- >> [COUGH] >> Failing.
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And, and- >> [COUGH] >> Failing serially sometimes, but, but I think that there's, there's a couple of ways that I thought about that and I continue to think about that.
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Think of the key part about leadership to have an environment that accepts failure, and welcomes failure and encourages people to take risks.
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But I mentioned before how, eh, how, how accountability's really important to me, and so one of things I think in, in any venture when you have a portfolio of projects, and I had a portfolio of projects at Genentech and I had a portfolio of projects at the foundation that we oversee.
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No institution fail serially and succeed, and so what, what I would always ask of people, and, and especially in the clinical trials world, so that pertains to the, the things we're doing in global health, but, but even more broadly.
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Our job as innovators is to seek truth, and if you're making a new product for human beings, truth might be the that product is neither safe, nor effective.
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What the company needed us, and actually what the world- >> [COUGH] >> Needs now, is clear answers that we believe.
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Sometimes the answer is no, and so the job of people who are innovators is to quickly and efficiently get an answer that we believe, and so I try to set an environment where I rewarded, clear, efficient answers.
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And I particularly awa, awarded in face of human health, if the answer is this is unsafe, this isn't good for patients or there's a better drug that somebody else has and it's not gonna be us.
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Eh, if you reward and celebrate the people, who get to that answer, good things happen.
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If you, if you expect the answer is always yes or that people have projects that always succeed, you start playing small ball?
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You have small incremental progress, if any progress at all and if people find an answer that's a no?
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They don't wanna tell you that and so part of, the most important part of leading an innovative environment for me is enabling people to seek the truth and tell you the truth.
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>> I know you've had a chance to think a lot about seeking truth and how to create that kind of culture within an organization at the Gates Foundation which you joined last May.
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So it's been not quite a year yet, but a lot has happened since then and I'm curious, you know, now that you've had some time under your belt, what do you want your personal legacy at the Gates Foundation to be as it heads into its you know, upcoming 15th year.
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And I believe it's in its 15th year, right now.
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So what do you want your legacy to be there?
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>> Well, eh, eh, it, there's a few things that I care about most, Some of them are short term, but you're asking about legacy, eh, it's not uncommon for people to remind me that I am the CEO of the largest foundation in the world, and that's interesting.
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>> [LAUGH] >> [LAUGH] big is good.
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We have scale, we can make important things happen, so in the, in, in the simplest of ways I'd rather be known, as the best foundation in the world.
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And the foundation that, that made a really big difference, that made important things happen.
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And, so what that means for me, it kinda breaks down into if I want us to move from biggest to really that's, that's the foundation that if I have wealth, makes me wanna be a philanthropist.
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If I can do a job that makes me wanna work in that not for profit sector, eh, eh, if I wanna vote a certain way is it's to vote for the kind of policies that enable the work the foundation does.
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All of that means that the work we do at the foundation needs to take our investments, which in the bigger world, although we're the biggest foundation are small versus government and, and other sectors.
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Especially, the private sector, that, that our work enables that transformation we wanna have happen and that, that that's visible and meaningful.
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And that we attract great talent because the culture of the foundation means that, you know, I'm, I'm on the Proctor and Gamble board, and it's really interesting to me that people like Scott Cook and Meg Whitman still talk about that early on, their first job was at Procter and Gamble.
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I want people to say, you know, during my career, I was at the Gates Foundation, every bit as much as Meg says, you know, I was a Product Manager at P&G, because that means that's a special life-changing experience for that person, so I wanna lead the organization that is that organization.
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>> What do you think are gonna be the biggest challenges for you to get to that goal which having worked at the Gates Foundation I, I, love, and definitely adhere to, what are those challenges going to be and how are you mitigating them through your leadership?
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>> Well, I think there's challenges on two fronts, one is, we have audacious ambitions, you know, if, if I start running off the list it makes me feel a little sweaty you know, [LAUGH] it just it, it's solve polio, tackle malaria, tuberculosis, HIV [COUGH] African Sleeping Sickness im, improve lives for small holder farmers.
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Get 120 million more women on modern contraception by 2020 oh, oh, and fix the US educational system while we're at it. >> Okay, [INAUDIBLE]. >> [LAUGH]. >> [LAUGH] that too, ,.
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So, I, I think on the impact front, because we're tackling some of the world's hardest problems with metrics, we're really visibly pushing ourselves to make a huge difference.
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And so for me, being a great foundation starts with impact and, and that impact requires us to be great collaborators, work with others towards is very important, audacious goals and so, doing that effectively means it starts with the, the awareness we have of our place in the world- How can our capital service leverage, serve as lubricant, be transformational?
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What are the unique things we can do as a foundation that others won't do?
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And on the culture side, it is hitting that sweets spot that I mentioned before, I always felt like my best days at work have come just in the perfect middle of feeling really comfortable and free, like I can do anything and totally terrified and being frozen.
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And, and so somewhere at the Gates Foundation I want people to feel like, man I can make anything happen but we we have just incredible talented people, who should feel that way.
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And it's a high wire act to pull off, what we're trying to pull off, so can we just hit that middle, you know, where you're both terrified and excited.
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Making a culture for really talented people where it feels just right,- >> [COUGH].
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>> Exhilarated not overwhelming, excited, and little terrified that kind of culture is special and wonderful, and takes enormous energy every single day, to live up to that.
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>> You're working with two of the most engaged and smartest philanthropists that there are in the world, Bill and Melinda.
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I feel I have a responsibility to ask what so many of the audience are, are thinking, what's it like to work with them?
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And in particular, how have you had to adjust your leadership style in order to work effectively with this type of partnership?
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Well, I work at a family business. [LAUGH]. >> [LAUGH].
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>> Or as other people in the foundation world have told me, your donors are alive. [LAUGH]. >> [LAUGH].
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>> They're very alive I can tell you.
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[LAUGH] Happily, eh, eh- >> [LAUGH].
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>> It, you know, it's eh, I'm not sure how to answer your question, I, I, I learned a very important leadership lesson and, and we talked about Art Levinson.
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And, and eh, eh, it, one of the most important things I learned from working with Art, who came from R&D to being CEO.
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He did not adjust his personality to become the CEO, [NOISE] he was as goofy and as, as nerdy as he was when he was the head of research when he became the CEO.
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And so I think great leaders, and I know leaders that I admire show up as himselves every day.
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And so when I approached being the CEO with Bill and Melinda, I knew they were two extraordinary special people and I said I'm just gonna be myself.
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Uh,eh, it, and I'm gonna be myself through the whole interview process, and if that's embarrassing to them or if I'm too weird or, you know, they don't like how I operate, then they'll figure it out during the interview process.
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And they won't be surprised.
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And so I had an interview with Bill that was funny- >> [COUGH].
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>> Cuz people had told me boy when he gets mad, you know, [NOISE] it's gonna be bad, so I thought well maybe I should test what it's like if he's mad. >> [LAUGH].
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>> [LAUGH] So, so I had read something about a criticism about the, the foundation's focus on polio eradication, you know, there's a lot of other problems in the world and we're spending too much and so, when I was interviewing with Bill, I said, so what do you think about all the criticism of the polio efforts?
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I thought, well, maybe that'll get him, you know, cuz I wanted to test what it would be like if he was fired up.
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And you know, he did react [LAUGH] and then I realized there's a really big difference between getting him fired up, and being mad, and being mad at me, which that didn't really test that well.
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[LAUGH] so happily I haven't had that experience- >> [LAUGH] >> [LAUGH] But, but I would say, I am so enjoying working with Bill and Melinda, they're very, very different from each other, and very complimentary, and, and what they have in common is incredible, almost impossible to explain generosity.
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And the, the most sincere wish that their generosity and their foundation changes the world in positive ways and that's real and fundamental and the reason I'm there.
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And, and Bill's impatience, doggedness, brilliance and, and everything that Bill is and everything he's brought to the world, he's bringing to the work at the foundation is, is just magnificent you know, it's just a really special, powerful thing.
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And Melinda's sense of social justice, her incredible caring for women and girls, she's like the world's best, most enthusiastic mom, it brings all that to the job, and so in any given day I get to work with.
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Bill and Melinda, or Bill or Melinda, and tap into all the power and passion and intellect that both of them bring to the job.
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And we have to get stuff done.
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And and that's their expectations.
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The other thing I'm learning, which I think is just a really important thing.
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Both in a family business, but in anything you do in life where you have co-chairs. They're not the same. They don't always agree.
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And so one of the most important things I can do is to point out whether coming at something from two different places.
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And it's part of, my background in science and technology.
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I think truth comes out of messiness.
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And I think that's an asset I bring to the foundation.
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That if Bill and Melinda disagree, or see things in different ways, because of their different perspectives, I wanna make that visible. I'm not afraid of that. In fact, I embrace that.
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Because my fundamental belief as a leader is, the more disparate voices, for me a big part of diversity and why I like diversity.
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Is the more different views that come from very different places, really good outcomes will happen.
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We'll get a, a better answer, or the best answer, from that.
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So I'm trying to tap into that part of me, and that affinity I have for differences to be a good partner for the two of them.
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>> I think one more question before we turn it over to the audience for Q and A.
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But, you have been able to balance that delicate intersection between having a successful career and also having a life of meaning.
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And that's a question I think a lot of us in the audience are trying to wrestle with right now is, how do we have both of those things?
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What advice do you have to share with us about how we can think about our careers going forward?
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>> Oh, it's it, it, one of the aspects of my life that we haven't talked about that's the most special to me is, I'm a cancer doctor.
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So as a cancer doctor, you interact with people in a really special way.
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And that is often you have to tell people that they're gonna die, faster than you hope, and faster than they would wish for themselves.
32:15
And I think in the, in the worst ways, and the worst days that made me feel like a failure.
32:21
Like I just couldn't fix things that I wanted to fix.
32:25
And the best outcome of that for me was what you talked about before my own sense of carpe diem.
32:30
You know, every day's precious.
32:33
Every week is a great week that I get to have.
32:36
And so, I just really believe in having fun.
32:39
If I'm in the middle of something hard, if I'm working, if I'm not at work, I want everything I experience to be meaningful and special.
32:49
And I've not always been great at work-life balance, but I'm really good at having fun.
32:54
>> [LAUGH] >> I don't believe in suffering. It just is overrated.
33:00
And I often tell people and in this, in academia I can you guys, no dismissal of academia, but this thing of being the most pitiful.
33:09
I told faculty members, do not come in my office and claim to be the most pitiful.
33:13
I'm not giving an award for that.
33:15
You know, I don't believe in it.
33:18
So, for me, and everybody's different, for me, making sure that I have fun.
33:24
That I get to enjoy my colleagues at work.
33:26
I spend a lot of time at work.
33:28
I should enjoy my colleagues.
33:30
I should find out what about them is interesting.
33:33
That I can learn from and I can enjoy. I really like sports.
33:38
I really enjoy being with my husband.
33:40
And I like my family and spend time with my family.
33:43
But just deciding that life's gonna be fun.
33:47
And that if there's every a week or a month where it's not, that it starts with me making sure it is.
33:54
And I tell my colleagues at the Gates Foundation, cuz we're all into it and we over-do.
33:59
We are serial over-doers. It's self manage.
34:04
Nobody's gonna understand as well as you do how much sleep you need, how much fun you need, how much exercise you need.
34:10
What you should eat, who you should surround yourself with.
34:14
So manage yourself so that you can be happy.
34:17
And I think if there's any one thing that I've tried to do, and I'm not always successful in doing it.
34:22
Is to manage myself, so that I enjoy life, and I can show up better if I do that.
34:30
And that's been really good self-advice, and I'm trying to take it. >> [LAUGH]. >> Well, thank you, Sue.
34:38
So, we're going to now, turn things over to the audience for Q and A.
34:42
We've got some mics that are gonna be passed around on this first level.
34:45
If you could raise your hand and keep your hand raised.
34:49
Once you get the mic please stand up and share your name and affiliation before stating your question.
34:56
We also, have, hashtag that you can use in order to tweet your questions, which we'll also be taking.
35:04
That's a good option for those of you who are in the balcony.
35:07
So that hashtag is #GSBBFTT.
35:11
And we'll start with a question over here, please.
35:14
>> Well, thank you so much.
35:15
Marcello Palazzi, I'm a DCI Fellow here and founder of the B Corp, which is a group of progressive companies around the world.
35:21
We're big fans of your foundation.
35:23
Actually, one of the foundation I'm involved, Talbot Foundation, gave an award to Melinda Foundation last year.
35:29
So well, I have a question.
35:31
We in Europe, we see your foundation as a kinda model of what, a U. S. foundation can be.
35:37
And sometimes, the question is, you seem to be very focused on health, and that, and health.
35:41
And given that many of the challenges in the world are systemic, we just wonder whether you have discussion, you have discussion about.
35:48
This sorta dilemma being too focused versus being more of a generalist.
35:53
Because actually that's too traditional in many U. S. foundations. Thank you.
35:57
>> Thanks for the questions, so, so the foundation has, has a focus on global health, global development.
36:05
That includes agriculture, financial services for the poor,.
36:09
Some of the areas that are broader beyond health, and in the U. S.
36:13
our primary focus is on U. S. education.
36:17
The foundation is always asking ourselves about the scope of our work, and where we spend our time and energy and our funds.
36:25
And we often have small projects that are going on to access whether we should go into other areas and, and more broad.
36:33
One of the really positive aspects about the focus on global health as an example.
36:38
And I think why the Gates Foundation originally went down that road is it's really clear what the global burden of disease is.
36:46
And one can make very crisp decisions to use global burden of disease as your metric for what you're gonna tackle.
36:53
There's a clarity of that.
36:55
And a really clear purpose of doing that.
36:57
So that we can have metrics both for success and about what we tackle.
37:01
And when we look in some other areas, we always ask does the foundation have a unique opportunity to contribute?
37:08
And will we be able to measure and know if our efforts are making a difference?
37:13
Some of the most important things we're asked about don't have those attributes that are as easy to track or measure.
37:19
And yet, we continue to push ourselves to ask that question.
37:25
We have a question from Twitter?
37:27
>> Yep this is from first year MBA Daniel Burroughs.
37:31
He you say the Gates Foundation in the world, but is it big enough for objectives?
37:37
[BLANK_AUDIO] >> Yes, if.
37:46
So we're big enough to meet our objectives.
37:48
If we think of our funds and our resources which include the people's time and energy at the foundation as leverage.
38:00
And so, it's not uncommon for the foundation to be involved in an effort.
38:05
the, Global Alliance For Vaccines Initiative is a good example.
38:10
That are going to raise more than $7 billion to bring vaccines to the world's poorest people.
38:16
That involves a global effort on global vaccination.
38:21
On low price accessible vaccines.
38:24
Our efforts are magnified by the leverage we get when others come in.
38:29
So I think our ambitions are not too large.
38:32
If we think of our efforts as bringing others in and the leverage you get from the foundations investments.
38:42
>> I'm sorry, do you have the mic? >> Hi, my name's Austin.
38:47
I had a question that kinda of piggybacking off the, the response you gave to the first question.
38:51
When you said that there are a lot of issues that are very difficult to measure outcomes for.
38:56
And you're grappling with, kinda how to address that.
38:58
I was curious as to your thoughts on, do you think that all beneficial or positive outcomes that you're looking for are eventually measurable?
39:07
And if not, how do you think about making change in arenas where the outcome we're looking for may never be fully and accurately measured?
39:21
>> That's, it, it, the direct answer to your question is no.
39:25
I think there are important things we care about and should care about that can't be measured.
39:32
And that, that brings a dilemma.
39:37
It is one of the things that I think is important to recognize if you're in a not for profit world is you have to do better than good intentions. Right?
39:47
So good intentions don't change the world, by themselves.
39:50
So I would be open to thinking about something that can't have really clear, measurable outcomes.
39:56
Like number of kids vaccinated, number of, of people who's lives were saved because they didn't get measles, for example. Those are really.
40:04
You know as a physician, I, I got that. Right? Poverty.
40:08
Poverty's measurable, how much money a family has, poverty's a measurable outcome.
40:12
If you start to focus on poverty, you have to look long term.
40:16
But there are some metrics that can be associated with that.
40:21
Social justice is another thing that can start to get into things.
40:24
How do you know that you've got social justice?
40:27
What would be most important to me is that there's some way to know your investments are moving some needle.
40:34
So I think that there, there are maybe metrics that could be used that can start to get at it.
40:41
And get a sense for if you're changing outcomes that you care about.
40:46
but, but what would make me unhappy is if we got into an area where we really had no clue.
40:52
I just don't see us doing that.
40:54
Because the chance to fritter away capital that could be used on something where we can measure outcomes, would just be too high.
41:03
>> Do we have a question from this side?
41:05
[BLANK_AUDIO] >> In speaking with, your predecessor of the Gates Foundation, Jeff Raikes.
41:16
He mentioned a wide variety of people who work in, in the foundation worlds.
41:21
Sorta nonprofit types or who are passionate about social justice, academics, who want to learn how to measure impact.
41:26
You know, with a lot of precision and private sector types who kinda just wanna get things done.
41:30
And all, all three of those types seems to be part of your career background.
41:35
So I guess my question is, you know, what do you think you bring most to your job leading the foundation?
41:40
And do you think the balance is right?
41:42
Do you think that those disparate voices are leading to truth?
41:45
Or are you trying to steer the foundation in, in one of those directions more than the others?
41:50
>> I, I think it's great to have people involved in the foundation world who come from a variety of backgrounds and sectors.
41:56
I think that's helpful and, and healthy.
42:00
what, I, I, and I do think the mix generates good outcomes.
42:06
what, what I would focus on is, is a couple of things that I think need to be balanced.
42:13
What we've seen in the philanthropic world is a lot of people who've been successful in the private sector come into the not-for-profit world.
42:20
And there's been a little bit of a culture clash.
42:22
And that's why I say this, this question of, we know good when we see it, and good intentions.
42:28
Have been sorta traditional in the not-for-profit sector.
42:31
Or were under funded and under salaried and under a lot of things, so don't expect too much.
42:38
That it can feel like that in the not-for-profit sector.
42:41
And so, I think bringing accountability, resources, talent.
42:46
Upping the ante is a really healthy thing.
42:50
On the other hand I think it's a valid criticism of a lot of newcomers to philanthropy.
42:55
And I put myself on that list, that we can bring a certain naivete.
42:58
And the naivete is bringing western solutions, or a western way of thinking, or a very techy way of thinking.
43:07
To problems that would be solved if we actually sat down with the woman in the village, and she could tell you why she can't get water.
43:14
Because of something simple that you tried to fix with a complex solution.
43:19
And so, I think that the, the, the combination of bringing the, those resources, that talent, that passion, that accountability.
43:27
With, with the humility to understand that on the ground in a different culture, you really don't know.
43:33
And everything's a collaboration.
43:36
I think that combination can generate something that can be very positive.
43:41
That and the last thing I'll say on that is the as impatient as I am.
43:47
I do think the most important great philanthropic outcomes are measured in years not months. >> Thank you.
43:57
I'll take a question from Twitter but I also want to say, please make sure to state your name and affiliation when we call on you.
44:04
>> So this is from Sharon.
44:05
She wants to know, you, you mentioned in the beginning about ways to motivate people and get them to provide clear answers and take risks.
44:14
What kinda behaviors don't you reward?
44:15
Or, or do you discourage? >> Oh.
44:20
[LAUGH] I'm trying to, I'm trying to, to, to give a short a short answer.
44:26
>> [LAUGH] >> Some of my least favorite probably my very least favorite is, it wasn't me.
44:35
That guy's the reason that failed.
44:37
If not for him or his function or his people, we'd be in a different and better place.
44:42
That's a really high on my list of, of an answer not to give.
44:49
the, the other one is, is that we work with a partner, and, you know, they saw it this way and that's because they're stupid.
44:58
Not because they disagreed with us, or they come at from a different point of view, or have a different experience.
45:03
Is it to, to underestimate either a partner or a different function.
45:07
I love team work and, and one of the great things I was thrown into when I worked at Bristol-Myers Squibb, is I got on a team when I worked on Taxol with Manufacturing, and Sales, and Regulatory and, and all these people who had no idea what they did.
45:21
But I came really quickly to understand none of the great stuff I wanted to have happen would happen without them.
45:27
And so the fact that I didn't know what Sales and Marketing did was me being ignorant not them having value.
45:34
[LAUGH] And, and I think that's, that's the very important thing, particularly for technical people, scientists, physicians, is not to over estimate the fact that because you know science, or IT, or something that you, that extends into knowing everything.
45:48
So that would be on the list too [LAUGH].
45:50
>> [LAUGH] Do we have a question from [INAUDIBLE]?
45:53
[BLANK_AUDIO] >> Hi, I'm Roz Naylor.
45:57
I direct the Center on Food Security and the Environment at Stanford and a professor of Environmental Earth System and Science.
46:03
I really enjoyed the interview on both your parts, it's really wonderful.
46:08
I had a questions about coming into a large organization where you have an incredible Global Health Program, Agricultural Development Program, Education Program.
46:18
And at one level you've got such talented people you want to just give the best incentives and let those divisions really take off.
46:26
Yet at the intersection of those different divisions might be the most creative solutions.
46:31
For example, a number of the global health issues may really be dependent on much better nutrition, or the ending of malnutrition in those areas.
46:42
similarly, the best advances in agricultural development may be the solving of some of the productivity depleting disease issues.
46:51
How do you motivate really good creativity and productivity at the intersections when, when you really need some disciplinary strength as well?
47:03
>> That is so hard to do.
47:05
I can tell you that the, it's one of the biggest challenges.
47:07
I'll give you two ways that I've started to think about this. One is geography.
47:13
So, w, we can take advantage of the fact that we have multiple programs going on in certain geographies, like Northern India, like Ethiopia.
47:21
And we have what's called a tech panel, where we bring together in the geography, all of, the various silos in the foundation, who are working on different aspects of problems.
47:32
So it may be nutrition, family planning vaccination and agriculture.
47:38
But all being done in Ethiopia.
47:40
So bringing together those folks so that they know what each other are doing.
47:44
And coordinate through our country offices and through that geography can start to help us connect those dots and look across.
47:52
The other thing that I'm trying to do at the foundation is have a very strong executive leadership team.
47:57
If we can't expect people in the trenches to collaborate, if the executive leadership team isn't collaborating, and I think in the foundation, our foundation, we've expected the executive leadership team to focus a lot of business process and less on strategy.
48:12
I'm trying to turn that on its head, and have a much more strategic focus on the executive leadership team and look at those intersections.
48:20
Including the executive leadership team showing up in pairs, in geographies, and at the foundation, so we can start connecting at our level.
48:29
[BLANK_AUDIO] >> Oh, we'll take this question little.
48:35
>> Good afternoon I'm an MBA1 student to continue somewhat with Professor Nailer's question.
48:41
How do you balance the funding the funding of new technology versus the implementation of a specific technology on a sector?
48:49
And then assuming that, that varies by, by sector does this have implications for how businesses should consider opportunities?
49:00
>> There's, there's not a neat and tidy answer to your question.
49:04
So, so, I, I, I will tell you that the the way I start to think about this is there are times when delivery as you call it there sort of making existing tools reach where they need to reach. Makes good sense.
49:22
Often at scale, that's the job of the Ministry of Health for example or the Ministry of Agriculture.
49:27
So, so for me the delivery aspect of what we do has to be very clear, often involving innovation, or a pilot, or trying to do something that then can be scaled.
49:39
Because we're never gonna deliver on a global basis.
49:42
that's, that's for others to do that.
49:44
So we have to be extremely purposeful with our delivery methods, and, and be thoughtful about what that looks like, and how we make that real.
49:53
So that often involves delivery innovation.
49:56
So really important that delivery innovation is a part of what we do.
50:00
On the technology side we, we have an affinity, and I have an affinity for technology solutions.
50:06
But I look at technology solutions through a really clear lens.
50:10
And that is, is, will this really change things?
50:14
So I was involved in a discussion yesterday about cervical cancer.
50:19
Screening for cervical cancer and preventing cervical cancer is really hard at scale.
50:23
It involves women who are 35 to 50, a little older than typical use the health care system in a low resource country.
50:31
And you have to see many, many women before you can truly prevent cancer.
50:36
So, if we had a diagnostic that looks at Oncogenic Papillovi, Papilloma Virus.
50:43
If, if we had something that really was, was transformative in saying all these women don't need this expensive hard to execute screening.
50:53
That would be a transformative diagnostic.
50:55
That's the kind of thing I wanna find.
50:57
So often the best discussions I'm involved in talk about delivery, talk about a missing technology and the likelihood that we can provide something that transforms that delivery, that the ministry, government, others are providing because everything's easier after that.
51:14
That's where I think we're at our finest.
51:18
>> Given the limited time remaining I want to conclude with a question, Sue, that is near and dear to many of us in the audience.
51:26
What matters most to you and why?
51:28
[BLANK_AUDIO] >> What matters most to me is that the, as a leader I can allow for really talented people to do things that improve people's chance at a happy life.
51:50
The reason for me is, and it kinda gets back to how I was raised and the environment I was in.
51:55
Just, I became a physician because I really wanted, and want to think that, you know, to, to the, The Gates Foundation motto is all lives have equal value.
52:09
So that everybody has a chance to be healthy and happy and have a, the life they'd like for themselves and their families.
52:17
And so thinking about how you know, when I was a doctor and interacted with a patient one at a time, I cared so deeply that that patient would have a good experience.
52:28
And when I left the general practice of medicine and moved as a leader.
52:32
My hope is that many more patients and many more people. >> [COUGH].
52:36
>> Will have a chance to have the kind of life I hope for them.
52:41
And that the really talented people I get to work with are inspired and have that passion and oomph and drive to create those things, and that I helped.
52:51
>> Well thank you so much for your insights and your candor.
52:54
And we can't wait to see how you continue to improve the world.
52:58
So thank you so much, Sue. [APPLAUSE]. [MUSIC]