Dr. Rajiv Shah: Working with Bill Gates, Barack Obama, and More to Tackle Global Crises

[00:00:00] [00:01:00] Ilana Golan: Dr. Rajiv Shah is the president of the Rockefeller Foundation, previously global crisis response in USAID and various health related efforts in the Bill and Melinda Gates Foundation. He's also the author of the book, Big Bets, explaining how large scale change really happens. This is your ability to see that it's possible to change the world. And it's just, to me, it gives me goosebumps. Raj, thank you for being on the show. Dr. Rajiv Shah: Thank you, Alana. It's so exciting to be with you. Ilana Golan: It's amazing. So take us back in time, Raj. I mean, you are a [00:02:00] kid to an immigrant. How do you think this shaped you to do the things that you do today? Dr. Rajiv Shah: Well, you know, I was born in Ann Arbor, Michigan. I bleed blue. My parents were both immigrants from India. They both came here without a lot of resources, but with educational scholarships. Dad, my grandfather actually emptied his retirement account to buy a one way ticket for my dad to come to America because they had so much faith back then that this was the country where if you worked hard and played by the rules, the sky was the limit for you and more importantly, your children. That's my story. I grew up in a tight knit immigrant community outside of Detroit, primarily, a few years. In Philadelphia, outside of Philly, and my dad worked at Ford for 34 years. And so I'm a child of the auto industry. I always thought I'd grow up and get to design cars for a living. And, uh, it didn't quite work out that way. Ilana Golan: And I think you mentioned that in 1995, you had some summer [00:03:00] experience that helped shaped you a little bit. Will you share that? Dr. Rajiv Shah: Actually, even earlier than that, as a kid, I was told by my family, my community, that I should be an engineer or a doctor. I kind of found both interesting, but over time I got more and more interested in policy and service. And I was, I think, a junior in high school watching on a day off an extraordinary visit when Nelson Mandela came to Detroit. We never got, in Detroit, visitors like Nelson Mandela. That was for L. A. and New York and stuff like that, D. C. And I was just glued to the TV as he went to the Ford auto plant and talked to workers and then closed out his day at my favorite baseball stadium in America, Tiger Stadium, the old Tiger Stadium, to a packed crowd, talked about concepts like love and honor and values and service. And I was blown away by the moment and by the experience, [00:04:00] even though I was just sitting in my living room the whole time. And I decided I wanted to get an opportunity to do service work abroad. So you fast forward a little bit, I went to college. And as my career college tenure was ending, I had an opportunity to go do some service work in rural South India in a a rainforest area with a tribal community called the Solaga. It was a development and health program created by a gentleman named Dr. Sudarshan who went on appropriately to win the Right Livelihood Award for his just selfless service, but he was a doctor. He'd gone into the bush. He had established a program that was effectively about treating kids and people with leprosy and epilepsy and tuberculosis. But because he was so overwhelmed by the hunger and starvation he saw in the children in those communities, he started a feeding program. He started a livelihoods program. And he just dedicated his life to helping this community survive and then rise. Well, [00:05:00] he was at the time in his forties, I was just a college grad. I was like 20, 21 or 22. And I kind of went there with this idealistic view that I wanted to be like him. And I got there and I took this long trip from Ann Arbor, Michigan to a place called the B. R. Hills. I had a backpack and mosquito repellent and all that stuff. And they put me in this little hut in the back and I unpacked. And that first night I was just. eaten by mosquitoes. I was super hungry, very tired. And I realized quickly that I didn't have what it took to be basically a saint. I mean, this was a gentleman who said, I'm going to give it all up and dedicate my life to helping each child that walks through the door. In fact, I'm going to go out into the villages and find those kids. And I knew that I couldn't do that. Give that much of myself. But I also knew I wanted to spend my life working on these types of issues. And back then in the mid nineties, [00:06:00] 14 percent of the global population was hungry. 11. 5 million kids under the age of five would die of very simple, preventable diseases. And I just started learning about those issues and saying, how can I be involved in working on them in one form or another? Ilana Golan: Incredible. And as a young person seeing these things and trying to figure out like it can actually traumatize you or it can fuel you. Why do you think it actually fueled you versus traumatize you and want to like run away and never look back, right? Like, why do you think is the change? Dr. Rajiv Shah: Well, I think it fueled me because I saw people making a difference. I saw other medical students from a local Indian medical school working with Dr. Sudarshan to change the trajectory of these kids lives. I saw kids who were deeply malnourished, who were four, five, six, seven years old. And I saw them get resuscitated because of, they'd come into a feeding program and get [00:07:00] targeted feeding support and some medical attention. And I understood even then, you know, if it weren't for these folks, nobody else was going to provide that care and those services. you know, I met this, this young girl, maybe five or six, that very first night I was, there, I decided I'd go for a walk in the, Outskirts of the village and I ran this girl who just stared at me and she's Barefoot and hungry and looked impoverished, but also full of life and big eyes and she just stared at me like I must have been so strange to look at with my backpack and my mosquito spray and all that. And she ran away as she should have, right? And I just thought, you know, if you get to be involved in expressing that humanity, you actually get a lot more back than you give. You get a sense of humanity. And you feel better up for it. I was hooked from that first moment, but I didn't quite know how to find my path. Ilana Golan: And that's [00:08:00] incredible, right? You did start in medicine school and you decided at some point to leave medicine school. Talk to me a little bit about that. And I'm sure we share parents that for me was also, you're either a law, you know, lawyer or you're, you're a doctor. You cannot choose anything else. Dr. Rajiv Shah: Grad school where you can get employed and paid was sort of the theme. Yeah. So I did. And I ended up getting a. full scholarship to go to medical school and also study economics and business. And, and I did that simultaneously. And I was working through that. I wanted to get a shot at participating in American politics. And so I kept applying while I was a student. For a job, not even a job, a volunteer opportunity. Wasn't even expecting that anyone would pay me to work on Al Gore's presidential campaign. And I wrote this heartfelt letter and I put it in the mail and I thought, Who says no to someone who's going to volunteer for free? The answer is [00:09:00] Al Gore's campaign. And they said no twice. And then they moved their campaign office from Washington to Nashville, Tennessee. And a friend told me just do it one more time. And I sent a third letter and they said, we'd love to have you come to Nashville. So the day after I took my medical board exams, my then girlfriend, now wife and I got into. My little Mercury Cougar, this little black car, drove 14 and a half hours from Philadelphia to Nashville, Tennessee. Stayed in Al Gore's mom's best friend's pool house for the next three months as I started on the campaign as low as you can start as a volunteer driving people around because I was the only volunteer that had a car and the most were high school kids and young kids and that's how it all got started. Ilana Golan: It's incredible. And I want to make sure the listeners get this because sometimes in order to leap so much higher, you do need to take a step back to the thing that is more interesting for you. And Raj, at that point, you're in general on a [00:10:00] trajectory to become a doctor. You have your life almost scripted for you, and you're taking almost this like 180 degrees to help Al Gore. And not only that, you try again and again, which is kind of a pattern in your life. No is not an option. So you just continue. What made you decide that this is your calling, that this is the right thing for you? Dr. Rajiv Shah: First, I didn't know at the time. I just wanted to try it and give myself a chance and I'd like to note in retrospect that big bets start with betting on yourself and while that sounds grandiose, I didn't have the courage to do that on my own back then. It was my girlfriend at the time, now wife, she knew me better than I knew myself and she's like, this is something you want to do. I had an amazing advisor. A gentleman named Dr. Sandy Schwartz at the University of Pennsylvania Medical School, who said, you know, you have this scholarship. We'll hold on to it for you. Go try this and you'll never look back. [00:11:00] And that's what happened. And then of course, we lost that campaign, by the way. So, so I found myself unemployed, not sure what to do, thinking, oh, I really screwed this up. Went back to med school, but now is behind, finished up there briefly, and then one thing led to another. Through a friend who I'd met on the campaign, he said, Hey, you know, Bill Gates is looking for someone who knows a little bit about economics, a little bit about Health and medicine, a little bit about policy and politics, but not too much on any of those fronts. And I said, well, maybe I could do that. And I joined the Bill and Melinda Gates foundation. Ilana Golan: Which is incredible because I think it also boils down to the things that we talk a lot in Leap Academy. A lot of the biggest opportunities will come from the hidden market, right? It's who knows you and for what you want to be known for. And to put yourself out there and I just love that because again, I could also send somebody getting really confused by the fact that now you're starting from scratch and that could [00:12:00] throw you off as well. Dr. Rajiv Shah: Oh, absolutely. In fact, I mean, I was lost. I was back in school, but I knew I didn't want to go through with being. a practicing full time physician. I knew I'd sort of fallen in love with policy and service, if not politics. And then my closest friends from the campaign were all doing super interesting things. And I was back in school. So I was really lost, but at the same time, I tell people now that especially early in your career, when you make decisions. You should place a high priority on the people you'll meet in that role, because that network will tend to expand your own thinking and open up opportunities and reshape you as an individual in a way that can be very powerful. And, you know, if you look at the team that joined the Gates Foundation when Bill and Melinda first set it up, it was just an extraordinary group of people. And the fact that I got to be basically an early intern there [00:13:00] made all the difference in the world. I got to learn from some really special leaders, including Bill and Melinda, but also others at the institution. Ilana Golan: Right. And you talk a lot about it. In your book, but I think one of the things that strike me when I read this kind of a book is these audacious goals of vaccinating everybody in the world, right? These audacious goals that to everybody else will sound okay. That is a dream and you just break it down to asking small questions. And can you talk a little bit about that, Raj? Dr. Rajiv Shah: Yeah, one of the chapters of book is called ask a simple question because. My job as the sort of analyst on the team early was to basically model out what it would cost and what the strategy needed to be to ensure that every child on the planet was fully vaccinated. And at the time, about 40 percent or 45 percent of the global population was fully vaccinated. As I mentioned, an 11. 5 million kids were dying under the age of 5. Many of those deaths were vaccine [00:14:00] preventable disease. And almost all of the unvaccinated kids were in 70. Plus developing economies around the world. So we looked at that challenge and we would keep coming back and Bill would have us all gather in this big cavernous kind of conference room on the top floor of this renovated call center, which was the early headquarters of the place. And he'd keep asking, what would it take to vaccinate every child? And some of the best experts in the world would come in. And say, well, you can't really think about it that way. That's a little too ambitious. Here's how this works. It's very complex, but he kept coming back to that simple question over and over and over again. And what I, and over a two year period, we actually modeled what it would cost. We figured out what the cost benefit was. We studied the industry enough to understand that you couldn't even get to that goal unless you reshape the global supply base for vaccine manufacturing, and you couldn't do that without reshaping the way the world [00:15:00] finances vaccines. And frankly, we created this innovative group of capital markets experts, mostly in New York, called the Out of the Box Group, that invented a structure that became something called the International Finance Facility for Immunization, that helped reshape that global marketplace. You know, 20 years later. Tens of millions of additional children have been vaccinated while billions, more than a billion vaccinations have been delivered and nearly 20 million kids lives have been saved thanks to not just the small team in that conference room, but the thousands of people working together across different institutions and across 70 countries over two decades. And that's a big bet. Big bet is saying, I don't just want to help a few people somewhere. I want to solve a problem like vaccine preventable disease, do it at massive scale. And if it takes 25 years, and if there are going to be ups and downs, and we're experiencing a down point right now, I'm going to stay in the fight. Ilana Golan: And to [00:16:00] me, that's incredible. And I think you also share really beautifully how you moved from getting angry when people are not understanding the mission to actually asking a beautiful question. If you had a magic wand, what would you do? Right? And to me, that was actually really, really interesting because you also asked this to a lot of the different stakeholders. So you're getting a lot of different information. And now you're starting to understand the magnitude of the issues. But now you can start. Solving them. Can you talk a little bit about that? Because again, it's just incredible to see how you took such a big problem and you broke it down to the small pieces. I didn't even think of the supply chain until I saw it in your book. But now you're starting to like just solve the things that are standing in the way. Dr. Rajiv Shah: Well, I think that methodology, by the way, is textbook Silicon Valley, right? It's just starting with a clean sheet of paper and saying, I'm going to disconnect from them. The current way things are done to understand what could be and to [00:17:00] identify a strategy for achieving a truly audacious goal in that case, vaccinating every child on the planet, which, by the way, we estimated would cost many, many multiples on an annual basis of the entire endowment of the Gates Foundation at that time. So it wasn't even something we had anywhere near the resources ourselves to accomplish. It just helped the world. See, If we came together and they did in this platform now called the Vaccine Alliance, that we could solve this problem together. And I'd say that the biggest part of that methodology is being clear about the goal. And that's where Bill was extraordinary. Whenever we all tried and I tried, I'll try to say, can we kind of have a more incremental and more quote unquote achievable goal? And the answer was, well, you can do whatever you need to do initially, but you got to stay focused on the big picture goal. And we're going to use that to make criteria based decisions. A second big thing is asking a lot of others and we would go around and people would say, well, [00:18:00] You know, you can't do this because the regulations at UNICEF don't allow you to procure vaccines in a multi year contract over a long period of time. You'd say, okay, you know, how do you get people to think differently, think outside of their own set of constraints? And we would say, if you have a magic wand, you know, what would you do? And then you'd get these folks who You could call them bureaucratic, but the minute you unlock their creativity, they have the expertise and the knowledge to actually generate solutions that are transformational. And so, so the magic wand tool is just a way to break people out of. That's sort of, well, we're not allowed to do this or we don't do this. Or this isn't how things are and let them get to how things could be. And then the final thing I'd just say is success begets success. So once we started to make some small progress. More people got on board when we got Wall Street to really help us shape. I think it was the world's first [00:19:00] notable large scale social impact bond that raised 5 billion that sold without any unique backing. And that was outcomes driven by actually vaccinating kids and measuring the results along the way. That unlocked the market and the supply base. For a global initiative that went on for many decades. So success begets success. And those are some of the themes I think that come together to make it possible. Ilana Golan: When you hear this story, you think you'd probably 60 by now, but no, at that point you're like 36 and you're deciding to tackle the next thing and you joined the USA. And you tackle some big issues really early on. What was it like? Why did you decide to do this move and a little bit of the challenges that came right when you joined? Dr. Rajiv Shah: Sure. Well, I'd left Gates to join the U. S. Department of Agriculture as their chief scientist and overseeing the research and economics enterprise. And we were working a lot on [00:20:00] international food security issues in that role. And one morning I got to the office, I used to get there pretty early. Other people weren't there yet. 7730. And one morning, we had BlackBerrys back then, my BlackBerry rank, so I picked it up. And on the other line, it was like, Hi Raj, this is Hillary Clinton. And I said, Oh, hi, how are you? Not a phone call I usually get. And she said, you know, I was talking to the president and he and I would like you to run USAID, which obviously has been in the news now a lot, but a passionate collection of 10, 000 amazing human beings and civil servants and foreign service workers with the sole mission of really serving humanity. Making our country safer and stronger by projecting the best of our values, often into very difficult circumstances and communities, and often at great personal risk. And my first week on the job, I was very, very fresh. You mentioned I was 36. I was new to that agency. I had just finished touring our emergency operations center when I got [00:21:00] a note from my front office that said, Raj, the president would like to speak to you, which also hadn't happened at that point. And it was because there was a massive earthquake 8. 0 in Haiti that had led to 21 of 22 ministries collapsing. It had led to loss of communications and visuals on what was going on. Ultimately, 250, 000 people would have perished in what was the largest humanitarian catastrophe we had ever experienced to that moment. And the president asked me to lead a global and whole of government, civilian military response. And that was my, I think, sixth day on the job. So it was pretty intense. But it was also a chance to see America's values in practice being applied at a moment of real need to a neighbor that's two hours from our shores. Ilana Golan: Incredible. And Raj, I want to go there for a second, but before that, what do you think [00:22:00] in your reputation caused you to get a phone call from Hillary and then the president? How did you create such a reputation for yourself at such an early age to be known for that? Dr. Rajiv Shah: I've listened to some of your other Guests also say something very similar. Which is, look, a lot of this is luck. And in that moment, I consider myself just lucky. I think, practically speaking, there are lots of great candidates for a role like that. A lot of people wanted that role, and any of us could have been highly qualified to get it. So, some of it, a lot of it, in that setting was luck. I think part of it was, we knew, Again, interesting given current events, but we knew for America to have a strong development and humanitarian enterprise, we'd have to take a tough, hard look at reforming USAID and making the enterprise much more results oriented, much more accountable, [00:23:00] and much more efficient. And I think I had built a reputation for being very quantitative, very results oriented, and very business like. Practices I learned from Bill Gates and others in pursuit of this mission. This is not about just doing good. This is about the strategic application of American power in a hyper efficient results oriented manner. And no one ever gets all the way there, but we made huge strides against that. And I think that reputation helped also. Ilana Golan: So you're six days or whatever into the job. How do you, first of all, not just. Dr. Rajiv Shah: The lesson I drew from that that I write about in the book is to just ask for help a lot. And I'll tell you, my instincts are always to be kind of quantitative and data driven. And so we built a scorecard very quickly and we had a basic strategic construct for how one would have to step in and [00:24:00] provide. Immediate search and rescue services to identify any people who are still alive amongst the rubble that required getting teams from across American counties into Haiti. It would require getting basic urgent needs, mostly water, food, and. Urgent medicine in place. It would require deploying the USS comfort to do 22, 000 surgeries, including limb reattachments and other lifesaving surgeries that were conducted. And it would require mounting the largest, fastest food assistance program we had ever done. And within hours, within about 36 hours, we were up reaching millions of people with. Food and targeted nutrition services that undoubtedly saved lives. Aside from all that, a huge part of it was just asking for help. And this will tell you about the character of people who worked at USAID. I was new and they knew that I didn't know this, that I hadn't been through a humanitarian response of this scale. I got to [00:25:00] my office. I spoke to the president. I can tell you about that. And if you want, and that night spent all night in the office, right? Working 24 hours and overnight, all of our best people, our most experienced people from Afghanistan, from India, from Pakistan, from Peru, all us foreign service officers kept calling. And they kept saying, you know, you don't know me yet. But I'm the best person at water and sanitation in a crisis. I'm on a plane tomorrow. I will come help. And I heard that story from maybe three, four or five different people in the middle of the night. And they were sure enough there as soon as they could get there. And our teams. Stayed in hotels. There was a huge storm. We called snowmageddon back then that kept people from going home. They just stayed in hotels. They're like, we're not going to miss the chance to be here. 24 hours a day to run this response. And we mounted the largest and most effective humanitarian response in the first 6 months that our country has ever seen. And we did that [00:26:00] by So, Taking help from people from around the world. We took help from the U. S. Military that were heroic landing planes in tough environments, deploying 3000 people. General Ken Keane, a three star commander down there, handing out food himself alongside humanitarian partners. And we took help from private sector partners that had something to offer. So that spirit of we're not gonna own this thing. We're not gonna have sharp elbows. We know we need help. We're going to take it from absolutely anywhere is my advice to people who find themselves in a situation that seems beyond their initial capacity. Ilana Golan: Incredible. And I'm literally getting chills here. Raj, you did have an interesting story when you talked to the president. Around that. Take us there for a second. And I do want to see how did you not freak out? How did you not panic? How did you just not like, Hey, you know what? This is not for me right now. Dr. Rajiv Shah: So the next morning we had our first briefing in the Oval Office. It was my first [00:27:00] meeting actually outside of ceremonial stuff in the Oval. So I got there a little bit early because you certainly don't want to be late. And I walked in and the only two people in the office were the president and the vice president. Both behind the desk, Obama's kind of looking towards me and Biden was looking out the window. And as I walked in, I heard Joe Biden tell President Obama, he's like, Are you sure about putting this Raj Shah guy in charge of this? He's 36 years old. He just got to Washington. We have this other guy. He mentioned a gentleman named Craig Fugate, a wonderful, outstanding leader who ran FEMA, the Federal Emergency Management Authority. And then Obama sees me walk in. And shuts down the conversation and walks over. It's like, Raj, come in, sit down. So I was a little panicked, you know, and I was like, Oh my gosh. But then I sat down and then everyone else came in, secretary Clinton, Napolitano, the whole team, and we just got into it. You know, we went through the scorecard and we said, here are the things that have to happen. Here's where we need the coast guard. Here's where we [00:28:00] need the military. And it was a very collegial conversation, but I knew that it would take more than just me to kind of succeed. And Craig was one of the guys in the meeting. So on the way out. I like went up to Craig, put my arm around Craig and I was like, Craig, I need your help. And he's like, absolutely anything you need, I'm on it. And he and a couple of his guys came over to USAID and for the next three weeks, basically worked out of our emergency operations room side by side with me as we led that effort. I do think the tactic is asking for help. I think too often people find themselves in that moment and they go inside of themselves and they say, Oh my gosh, how am I to do this? My advice to your listeners, wherever you are in your journey. Is open up, ask for help and be willing to take it. It ultimately makes you stronger and it serves the results you're trying to deliver more effectively. Ilana Golan: And how do you not take this into your sleep, into everything [00:29:00] you do? Dr. Rajiv Shah: At that point, I wasn't sleeping much. So it was, you know, it was pretty easy to not, uh, lose sleep over it because I, I just wasn't sleeping. Ilana Golan: You're not sleeping. Dr. Rajiv Shah: And, you know, the truth is once you have that. Collaborative leadership style. I think people then know it. They mimic it. You get invited in more. They come to help you out more and you get to say thank you and deliver results and learn from great leaders. I mean, I learned a ton the very first time I walked into the Pentagon. It was at the invitation of the chairman of the Joint Chiefs at the time, Admiral Mike Mullen to deliver the chairman's briefing to thousands of troops all around the world. And yeah, You know, out of what they call the tank and it was just the spirit of let's do this together is so important in government. It's important, I think, in the private sector and it's important in civil society. Ilana Golan: Incredible. And I think you do emphasize it a lot because we are stronger as a group. So if you can lead with others, you will be stronger. And I think that's such an [00:30:00] interesting pattern in your book as well. And again, you deal with Ebola. Like, I mean, you took some big things. for you. I don't know if you want to talk about it, but then I also want to understand, like, how did you move to the Rockefeller Foundation? Why did you decide to do the shift? And you guys have some pretty audacious goals as well. So take us there a little bit. Dr. Rajiv Shah: We do. Well, I'll say my tenure at USAID came to a close around the Ebola crisis. In fact, I was going to leave a little bit earlier and I extended my time in office. In order to help lead that response, and I would just remind our collective listeners that in the summer of 2014, the mortality rate from Ebola was 75%. That compares with what everyone now knows is a mortality of COVID well under a single percentage point. And what it meant was anyone getting it was likely going to die. And it was pervasive across. Three West African countries anchored [00:31:00] in Liberia and also at the time, the CDC had predicted there would be 1. 6 million cases, including hundreds of thousands in the United States. And so, President Obama made a big bet, which, together with his team, of which I was one, was that we would, for the first time in our history, deploy American troops into a disease fighting situation, in a hot zone. And I helped lead that deployment in West Africa. And, to make a long story short, we had, instead of 1. 6 million cases, we had 30, 000 cases, and instead of hundreds of thousands of deaths. We had 11, 000 deaths. There were two cases in the United States and no transmission on U. S. soil. Sometimes some of the biggest wins you have are things that don't happen. But had a disease with that level of mortality started spreading across this country, you can only imagine what would have happened. And so, again, very [00:32:00] proud to be part of a national security team that understood That diplomacy, development, and defense can all come together to make us stronger by helping others. In a far away way. We didn't lose a single service member. Nobody got sick. We handled it very professionally, and I write about in the book. One of the core elements to doing that successfully was having a structured learning and innovation approach, because a lot of times when you're in a crisis moment again, your listeners in the Silicon Valley area would get this instinctively. You have to constantly innovate and learn, and you can do that even in a big bureaucracy. Ilana Golan: And I love that you said that, because again, you can't connect the dots ahead of time, right? You're going to have to experiment, you're going to have to innovate, you're going to have to try to do things, you're going to have to do big bets. And you can only make decisions from there, right? Once you see the results. And I love that you're emphasizing this. And it's the same with their career. And I'll just say this, Raj, and [00:33:00] I shared that a little bit. We did open up A free program for anybody that was laid off from USAID or the tech sector. We've had hundreds of thousands of people reaching out. So we want to help you. So reach out, but thank you for doing what you're doing, Buzz. Dr. Rajiv Shah: Thank you for doing that. Ilana Golan: I appreciate it. We can all do it together, right? And you, at that point, you're moving to the Rockefeller foundation. Again, some big, big things happening there. Why did you decide to leave? Dr. Rajiv Shah: I left government, I'd been there six years, six and a half, and it was The right time for our family. When I left, I actually started a small private equity firm with partners and started teaching at Georgetown. And I was doing those two things along with a bunch of others and realized that I missed the chance to be doing the work I was doing and. One thing led to another and I had the opportunity to become the president of Rockefeller Foundation. [00:34:00] This is an extraordinary institution. It really is. It was founded by John D. Rockefeller back in the day, 1913. And it was founded on a single extraordinary idea, which is that advances in science and innovation should be applied to lift humanity broadly. That was the simple idea. At the time, they were most inspired by advances in medical sciences. You know, medicine was transitioning from being something where you sold stuff off the back of a pickup truck that might or might not have any real scientific basis. To a more disciplined science based enterprise and we funded public health schools and medical schools and the Flexner report and. Institutions that ultimately went on to become the CDC eradicating hookworm at home and, and engaging in, uh, invention of the yellow fever vaccine abroad. So a tremendous sort of history in the application of science for humanity. And it's just an honor to be here. Ilana Golan: Incredible. And [00:35:00] you have some big goals. I mean, you're commenting climate change and electricity. You have some big, big, big goals. I want to talk a little bit about it, but also some challenging times for you, because as a leader, whether we like it or not, even if the mission is incredible, even if the teams are incredible, there's some scary times. And I want the listeners to also understand that that is kind of normal. So rise. Can you share a little bit? Dr. Rajiv Shah: Sure. Well, turbulence is normal, right? And so we live in a moment. In our society where technological transformation has happened so fast and continues to accelerate that it has just reshaped so many communities and their sense of opportunity. Some have skyrocketed through the roof, others have been left farther and farther behind, and that framework has changed our politics and our geopolitics and our sense of [00:36:00] confidence. When my grandfather made that investment of his retirement savings in a one way ticket to the United States, there was like a 90 plus percent chance if you were born in the U. S. back then, you would do better than your parents. I mean, literally the only people who didn't were named Rockefeller, you know, because obviously your parents were already doing so well off. Today, it's less than 50 percent. Actually, over the last 30 years, it's probably less than 50 percent. So, the reality is, A lot has changed and just creates a lot of turbulence, a lot of change. Most of the last elections. since 2000 have been change elections, one form or another. And that is a signal that there's a lot of uncertainty and lack of confidence in too many communities across this country. So I tell my teams, we have to stay focused on our mission. We're trying to end energy poverty around the world by giving every single family a chance to live in a [00:37:00] community where the cost of energy is low, where energy is abundant, where businesses can grow and where they can participate in a digital economy. There's still 800 million to a billion people who live literally without any electricity, no light bulbs, no power tools, and no real upward mobility through the job market if there's no energy. deployed. And so we do a lot of that type of work all over the planet. And we have a plan and an infrastructure and a set of partners where we're really operating at scale to reach people with what we think of as the core driver of human dignity and opportunity. In the United States, we observe that chronic disease is out of control. And that if we treat food as medicine in a more structured science based way, we can largely reduce the prevalence of Pre diabetes and diabetes in the U. S. population, something that costs us more than 300 billion a year, and there are more amputations performed every year in the United States [00:38:00] as a result of diabetes than in all of the wars in Iraq and Afghanistan put together over the last two decades. We have some scientific and innovation oriented ideas that We're investing in and getting behind and building partnerships in order to deliver results for people at home and around the world. Ilana Golan: In our family, we have this thing of going every year to a place to give perspective to the kids. Otherwise they grow up with the Silicon Valley. I have everything I need. So we've definitely seen it in Ethiopia. We've seen people without any electricity, no toilets or anything in Myanmar. So we've definitely seen some of this. And I. Absolutely love that. But again, for you trying to lead something like this, like sometimes there's cash issues, share a little bit, one maybe challenge that you feel like you needed to go through that shaped you to the leader that you are today, Raj. Dr. Rajiv Shah: When I started at the foundation, we had to make some real changes to the [00:39:00] structure of our organization in order to get back to making the types of big bets that John D. Rockefeller had envisioned when he created the institution and strangely philanthropies. Can be tough to change for some reason, institutions that I think should have really the highest risk profile of institutions across society can tend to be quite risk averse and afraid of making mistakes, but we made those changes and it was difficult to do, but with a strong board and a really determined leadership team. We're able to do it. One of the big things we were able to do as a result of that was work on COVID with the first Trump administration and stand up testing infrastructure, especially antigen testing across America at scale. I mean, when we started that project, there were only. It would take four or five days to get a PCR based test result, if you were lucky enough to [00:40:00] get it in like April of 2000. And the lack of testing availability, retrospectively, has probably been the number one reason COVID became an out of control crisis here in the U. S. And the U. S. suffered the highest level of morbidity. And mortality relative to any OECD country on the planet against expectations. And we were able to do that as a big bet that worked in terms of getting testing stood up. Then after COVID, we said, well, we should build a huge data infrastructure. So everybody shares data together in real time on new cases of any pandemic. So that if there is an outbreak somewhere in the world, authorities and labs and experts anywhere in the world can see it. And we tried to stand that up that didn't work because the politics were too hard and it was too complicated. And it's that. And so we do things that sometimes work and make us really proud of the impact and we do things that sometimes fail [00:41:00] and our sources of learning for us as we go forward, but maintaining the willingness and the risk appetite to try to solve problems and not just make incremental improvements on a tough situation. That's what we try to do day to day. Ilana Golan: And that's incredible. Maybe one question. I'm just curious because I had Don Ariely a couple months ago and he's an incredible behavioral scientist and he was at the front of these massive conspiracy theories around COVID and all of that. Did you guys get any of that or was it pretty transparent? I'm just curious. Dr. Rajiv Shah: Oh no, we got that. We still do. You know, there's always an undertone of. noise related to those types of conspiracy theories. But the reality is our job is really to be data driven and science based in making good judgments. And we don't do our work ourselves. We are fundamentally tethered to bringing together unlikely partners [00:42:00] and building coalitions. And that simple process of doing that tends to Earn the buy in and the support you need in communities where you're doing the work itself. So when we stood up our COVID testing effort, we partnered with more than 40 mayors and local leaders across the country, Republican and Democratic, their health administrations, Navajo nation, NGOs. Core serving underserved communities in Los Angeles, and we said we want to listen to and learn from all of you and then transmit that learning to at the time the head of the program at HHS and then also take knowledge and resources from experts and make sure it reaches this vast network and that network mindset that determination to work in partnership. I think helps build the trust that allows you to either overcome or not succumb to the reference you made to people who are more worried about [00:43:00] the conspiracy theories. Ilana Golan: And I love that. And I think that's a pattern that you keep talking about partnership. And again, you're able to somehow take what is it? The organization is 111 years old, right? And you're able to keep the innovation, keep the partnership, reignite. The passion, I think it's rare and it's hard sometimes to keep it. I'd love to hear a bit, a little bit about that, but also your advice to people listening, your advice for your younger self, like I would love to go there for us. Dr. Rajiv Shah: Part of how we maintain an appetite for risk and a capacity To work that way, I think is just being really true to our core DNA. That's the founding construct of this institution was not to be a charity. That's all things to all people and not to try to meet every immediate need, but rather to find those areas where science and innovation make problem solving at [00:44:00] scale possible. In a way that lifts humanity. I mean, this was a place in addition to helping basically create the modern field of international science based public health, it was the Rockefeller foundation well before I got here that invented dwarf wheat varieties and, and yielded a green revolution that moved 800 million people off the brink of hunger and starvation and earned. The Nobel peace prize for that effort. So I think part of it is studying your past and saying, how do we, how do we have ambition to do things at that scale? And if that's your North star, it's hard to live up to, but you get to at least try in every successive generate. Ilana Golan: As a leader, and I know we have a lot of people are jumping into C Suite, et cetera, maybe a little tip of you, you jump into C Suite, there's a little bit of balance between let me just change everything to, you know, let me just do everything the way you've done. How do you balance it? Because I think that's something that everybody's contemplating a little [00:45:00] bit about. Dr. Rajiv Shah: Well, I think you have to be careful and pick your, should we call them fights, pick, pick your efforts, pick your initiatives carefully, uh, you know, pick, pick things that are important, that are big, that are consequential, that will make a difference for you, for your institution, for the people and community of customers you might serve. And be selective about those things that have the greatest level of impact. I mean, we told that story about vaccines because Bill Gates chose that intervention because it was the most cost effective way to reduce disease burden and deaths amongst people who are vulnerable. So, so be analytic and critical in deciding what you're going to do. And then I would say, when you do it, I would use these basic principles. That I write about in the book, really focus on building a culture of innovation and being data driven on innovation, really focus on building partnerships. I mean, today in a society moving this fast, you [00:46:00] have to have partnerships, public, private. Left, right, finance and engineering. And then third and perhaps most important is just be willing to measure results and learn along the way. Because the one thing you know is your plans will not, will not work. And it's really about how you adapt. I mean, the Ebola crisis was a great example of. Everything we thought we were going to do turned out to not be the items that caused the greatest reduction in contagion and transmission. And those things that did cause that reduction weren't even in our headspace when we deployed. So, you gotta be constantly experimenting along the way. You can only do that if you're very driven around measuring results. Ilana Golan: And you talk a lot about the scorecards in your book. Which, again, for anybody listening, like if you want to dream bigger, if you want to create bigger things, I highly recommend it. It's incredibly inspiring. Big Bets. Just incredible book. Raj, maybe [00:47:00] last things that you would advise your younger self or the people are listening and that you wish that you had that perspective. Dr. Rajiv Shah: Well, one thing I learned along the way and I wish I knew earlier was the power of what I called in the book, making it personal. But the power of connecting with people, not just based on a transaction or the work you might be doing, but on a deeper set of values that bind us together. In my case, when I ran USAID, it was my outreach to conservative Republicans in the Senate and a friendship with an extraordinary Senator who has since passed, named Jim Inhofe, that taught me those lessons. And a lot of that was driven by faith connections, even though we're of different faiths. And so I think sometimes we don't talk as much about our values, especially when we're younger in our careers and we're really focused on the spreadsheet or the numbers or what's right and wrong or [00:48:00] what's right in front of you and the decision or the transaction. And I would just encourage folks. At any point in their career, but I wish I knew this earlier, connect with people based also on values and your personal story and narrative, because those tend to be more durable, persistent and meaningful and rewarding than just getting your work done. Ilana Golan: Oh my God. I love that. And you're right. Like, I think as a kid, I was probably a little more transactional. And it's actually the trust and connection that you build that eventually flourish so much more. So Raj, this was so, so, so inspiring. I could probably talk to you for many, many hours, but thank you for coming in the show. Thank you for inspiring. Thank you for doing all the things that you're doing and giving your life to these big, big, big things that are changing our society and the world. Dr. Rajiv Shah: Well, thank you. And thanks for all you do to keep the mission moving [00:49:00] ahead.