The world’s biggest philanthropy is entering a new era, a third phase of sorts, but is hardly settling into a comfortable routine of funding the same old things or losing its upstart mindset.
Susan Desmond-Hellmann is the new chief executive officer for the Bill & Melinda Gates Foundation and the first non-Microsoft outsider to take the helm of an organization that, for better or worse, sets much of the international agenda for global health, aid and development. Desmond-Hellmann takes over as Gates Foundation CEO from Jeff Raikes, who took on the job after Patty Stonesifer.
Both Raikes and Stonesifer were former Microsoft executives with little prior experience in philanthropy or international development. Desmond-Hellman, a physician, academic and former biotech exec, did medical research years ago in Africa with her physician husband Nick Hellmann, who formerly worked on HIV/AIDS for the Gates Foundation and now works at the Elizabeth Glaser Pediatric AIDS Foundation.
“It’s easy to underestimate how much global health has changed in the last 15 years since the foundation started,” said Desmond-Hellmann. “When Nick and I worked in Uganda (in the late 1980s and early 1990s), before all this was called global health, people’s expectations were very low…. Now we are talking about eradicating polio, or malaria and we have so many more resources for these problems. It’s amazing!”
Yet Desmond-Hellmann knows just talking about these challenges, or even throwing more money at them, is only the beginning.
“These are really hard problems,” she said. “The Gates Foundation has signed up to do a lot … I see my job as CEO as helping translate these strategies into reality. I’m going to be really dogged about making sure we have an impact, on how to best accomplish these goals most simply and effectively.”
Stonesifer, as the original CEO for the nascent Gates Foundation, essentially presided over a start-up organization that quickly transformed the global health landscape, almost single-handedly reviving moribund interest in children’s vaccines, polio and malaria research, to name just a few features of the transformation.
Raikes’ job was more about managing growth – the foundation doubled in size to some 1,200 employees today – and implementing a major internal reorganization. The reorganization has both narrowed the focus of the Gates global health program to emphasize product development (i.e., new drugs, vaccines) while simultaneously expanding the foundation’s anti-poverty portfolio aimed at getting at the root causes of inequity by investing more in agriculture, women’s empowerment and access to financial services.
The Gates Foundation, launched some 15 years ago with an ambitious, optimistic and, some would say, overly simplistic agenda, has become much more complex in its strategy and structure, Desmond-Hellmann said. But that doesn’t mean they don’t still believe in keeping things simple.
“I’m not in the camp that criticizes a narrow focus or looking for simple solutions,” she said. “I like the focus on metrics and on solving problems. That’s how you get thing done.”
But it is also, some critics say, a strategy that by definition avoids some of the more complex and perhaps fundamental causes of poverty – the ones that have no obvious solutions or are easily quantified and measured.
The Gates Foundation is big on inventing a better toilet, for example, but doesn’t invest much time or resources into the highly political and fraught challenge of encouraging basic water and sanitation infrastructure development. The philanthropy is working on improving financial services to the poor, like mobile banking, but takes no position on global tax avoidance or other aspects of international trade that tend to fuel inequality and poverty, especially in the developing world.
These kind of criticisms and concerns are a bit much to hit Desmond-Hellmann with as she has only just been given the helm at the philanthropy. But she says she intends to make humility, and an embrace of constructive criticism, an important counter-point to the philanthropy’s vaunted ambitions and impatient optimism.
“Just look at polio,” Desmond-Hellmann said. Despite an extraordinary push by Rotary International, WHO, Gates and others that succeeded in getting the numbers of polio cases down to a few hundred, she said, the infectious disease has resurged and eradication remains a future hope. “Getting to the last case, the last mile, is really hard.”
But Desmond-Hellmann, who, prior to taking the Gates job, was chancellor for UCSF (University of California, San Francisco) and before that a top executive at Genentech, is used to hard jobs. And she has shown no inclination to shy away from controversial proposals or positions.
Now, as the CEO for a foundation run by two of the world’s richest people, she says one of her biggest challenges – beyond any specific program goals – will be to help do more than just find the best, simple, measurable solutions for any particular manifestation of poverty and inequity. What’s needed to make many of these solutions aimed at creating a better world more sustainable, she said, is to shift the power of the marketplace more in favor of the poor.
“Capitalism is great, very effective at delivering many things,” said Desmond-Hellman. “Where capitalism largely fails is as a tool for helping the poor. Markets have failed the poor and one of our jobs at the foundation is to really focus on market failures, to find a solution there.”
The new product-development-orientation of the global health program under former Novartis executive Trevor Mundel is a perfect example of this, she said. While the Gates Foundation continues to support major efforts aimed at improving basic health care and delivery of services, like children’s vaccines, through its development program under former PATH President Chris Elias, Mundel’s program is narrowly focused on doing R&D for the poor.
“We’re not turning our global health program into a mini-drug company,” Desmond-Hellmann said. “We’re focusing on solving problems that Pharma and the biotech sector won’t solve.”
So maybe Desmond-Hellman is not as enamored with simplicity as she thinks. Solving the polio problem is simple in concept, difficult in reality. Curing the marketplace of its tendency to ignore the problems of the poor sounds about as complex as it comes.