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

One morning, I got to the office, and on the other line, it was like, Hi, Raj, this is Hillary Clinton. And I said, Oh, hi. How are you? And she said, I was talking to the President, and he and I would like you to run USAID. And my first week on the job, there was a massive earthquake, 8. 0 in Haiti, and the President asked me to lead a global response. And that was my, I think, sixth day on the job.

Dr. Rajeev Shah is the President of the Rockefeller Foundation, previous lead global crisis in response in USAID and various health-related efforts in the Bill and Melinda Gates Foundation.

In the mid '90s, 11. 5 million kids under the age of five would die of very simple preventable diseases. Over a two-year period, we actually modeled what it would cost. 20 years later, nearly 20 million kids' lives had been saved. 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, do it at massive scale.

What do you think in your reputation caused you to get a phone call from Hillary and then the President?

I think part of it was Dr..

Rajeev Shah is the President of the Rockfiller Foundation, previously-led global and Response in USAID in 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. It's just, to me, it gives me goosebumps. Raj, thank you for being on the show.

Thank you, Elana. It's so exciting to be with you.

It's amazing. Take us back in time, Raj. I mean, you are a kid to an immigrant? How do you think this shaped you to do the things that you do today?

Well, 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. My 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. My dad worked at Ford for 34 years. I'm a child of the auto industry. I always thought I'd grow up and get to design cars for a living, and it didn't quite work out that way.

I think you mentioned that in 1995, you had some summer experience that helped shape you a little bit. Will you share that?

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 found both interesting. But over time, I got more and more interested in policy and service. 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 LA and New York and stuff like that, DC. 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. I was blown away by the moment and by the experience, even though I was just sitting in my living room the whole time. I decided I wanted to get an opportunity to do service work abroad. You fast forward a little bit. I went to college, and as my college tenure was ending, I had an opportunity to go do some service work in rural South India in 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. But He was at the time in his 40s. I was just a college grad. I was like 20, 21 or 22. I went there with this idealistic view that I wanted to be like him. I got there and I took this long trip from Ann Arbor, Michigan, to a place called the BR Hills in Southern India. I had a backpack and mosquito repellent and all that stuff. They put me in this little hut in the back and I unpacked. 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. I couldn't give that much of myself. But I also knew I wanted to spend my life working on these types of issues. Back then, in the mid '90s, 14% of the global population was hungry. Eleven and a half million kids under the age of five would die of very simple preventable diseases. I just started learning about those issues and saying, How can I be involved in working on them in one form or another.

Incredible. As a young person, seeing these things, I'm trying to figure out, it can actually traumatize you or it can fuel you. Why do you think it actually fueled you versus traumatize you and want to run away and never look back? Why do you think it's the change?

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. Sudharshan to change the trajectory of these kids' lives. I saw kids who were deeply malnourished, who were 4, 5, 6, 7 years old, and I saw them get resuscitated because they'd come into a feeding program and get targeted feeding support and some medical attention. I understood even then, if it weren't for these folks, nobody else was going to provide that care and those services. I met 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. 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 staring at me like I must have been so strange to look at with my backpack and my mosquito spray and all that. She ran away as she should have. And I just thought, 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 off for it. I was hooked from that first moment, but I didn't quite know how to find my path.

That's incredible. You did start in medicine school, and you decided at some point to leave medicine school. Talk to me a little bit about that. I'm sure we share parents that for me was also, you're either a lawyer or you're a doctor. You cannot choose anything else.

Grad school where you can get employed and paid was the theme. I did. I ended up getting a full scholarship to go to medical school, and and also study economics and business, and I did that simultaneously. I was working through that. I wanted to get a shot at participating in American politics. 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. I wrote this heartfelt letter, and I put in the mail, and I thought, who says no to someone who's going to volunteer for free? The answer is Al Gore's campaign. They said no twice. Then they moved their campaign office from Washington to Nashville, Tennessee, and a friend told me, Just do it one more time. I sent a third letter, and they said, We'd love to have you come to Nashville. 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 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 most were high school kids and young kids.

And that's how it all got started.

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 your trajectory to become a doctor. You have your life almost scripted for you, and you're taking almost this 180 degrees to help Al Gore. And not only that, you try again and again, which is 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?

First, I didn't know at the time. I just wanted to try it and give myself a chance. And I like to in retrospect, that big bets start with betting on yourself. 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. 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 have this scholarship. We'll hold on to it for you. Go try this, and you'll never look back. And that's what happened. Then, of course, we lost that campaign, by the way. So I found myself unemployed, not sure what to do, thinking, Oh, I really screwed this up, went back to med school, but now I was behind, finished up there briefly, and then one thing led to another. And through a friend who I'd met on the campaign, he said, Hey, 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.

I said, Well, maybe I could do that, and I joined the Bill and Melinda Gates Foundation.

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. It's who knows you and for what you want to be known for and to put yourself out there. I just love that because, again, I could also sense somebody getting really confused by the fact that now you're starting from scratch, and that could throw you off as well.

Oh, absolutely. In fact, I was lost. I was back in school, but I knew I didn't want to go through with being a practicing full-time position. I knew I'd fallen in love with policy and service, if not politics. Then my closest friends from the campaign were all doing super interesting things, and I was back in school. 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. 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. The fact that I got to be basically an early intern there 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.

You talk a lot about it in your book, but I think one of the things that strike me when I read this 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 all questions. Can you talk a little bit about that, Raj?

Yeah. One of the chapters of the book is called Ask a Simple Question, because my job as the 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 % or 45 % of the global population was fully vaccinated. As I mentioned, an eleven and a half million kids were dying under the age of five. Many of those deaths were vaccine preventable disease. 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 conference room on the top floor, 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 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.

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 reshaped the global supply base for vaccine manufacturing. You couldn't do that without reshaping the way the world finances vaccines. 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. 20 years later, tens of millions of additional children have been vaccinated. Well, 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.

To To me, that's incredible. I think you also share really beautifully how you move 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? To me, that was actually really interesting because you also asked this to a lot of the different stakeholders. 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 just solve the things that are standing in the way.

Well, I think that methodology, by the way, is textbook Silicon Valley. It's just starting with a clean sheet of paper and saying, I'm going to disconnect from the current way things are done to understand what could be and to 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 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, we all tried to say, Can we have a more incremental and more 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, 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, how do you get people to think differently, think outside of their own set of constraints, We would say, If you have a magic wand, what would you do? 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. The Magic Wand tool is just a way to break people out of the, 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. Then the final thing I'd just say is success begets success. 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, noted quotable, 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 un the market and the supply base for a global initiative that went on for many decades. So success beget success. Those are some of the themes, I think, that come together to make it possible.

Well, I hope you're enjoying this amazing conversation. We have a lot more to cover, but don't forget to like this video and subscribe to our channel. Now, if you're looking to fast track your own career, figure out what's next for you, get that clarity, fast track your own growth, check out that free 30-minute training. You'll get a lot of value out of it. It's sleepacademy. Com/sleepacademy. Com. That's sleepacademy. Com/training. Now, let's get back to the show. When you hear this story, you think you're probably 60 by now. But no, at that point, you're like 36 and you're deciding to tackle the next thing. You joined the USAID and you tackle some big issues really early on. What was it like? Why did you decide to do this move? A little bit of the challenges that came right when you joined.

Sure. Well, I'd left Gates to join the US Department of Agriculture as their Chief Scientist and overseeing the research and economics enterprise. We were working a lot on international food security issues in that role. One morning, I got to the office. I to get there pretty early. Other people weren't there yet, 7: 00, 7: 30. One morning, we had Blackberries back then. My Blackberry rang, so I picked it up. 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. She said, 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 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. 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 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.

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. The President asked me to lead a global and whole-of-government, civilian military response. That was my, I think, sixth day on the job. 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.

Incredible. Raj, I want to go there for a second. But before that, what do you think 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?

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 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 that 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, 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. No one ever gets all the way there, but we made huge strides against that. I think that reputation helped also.

You're six days or whatever into the a job. How do you, first of all, not just panic, freak out?

The lesson I drew from that, that I write about in the book, is to just ask for help a lot. I'll tell you, my instincts are always to be quantitative and data-driven. We built a scorecard very quickly, and we had a basic strategic construct for how one would have to step in and 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 life-saving surgeries that were conducted. It would require mounting the largest, fastest food assistance program we had ever done and within Within about 36 hours, we were up reaching millions of people with food and targeted nutrition services that undoubtedly saved lives. But aside from all that, a huge part of it was just asking for help. 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 at this scale.

I got to my office, I spoke to the President, I can tell you about that if you want. And At night, spent all night in the office, 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 offices officers, kept calling, and they kept saying, 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, five different people in the middle the night, and they were sure enough there as soon as they could get there. 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 at 4 hours a day to run this response. We mounted the largest and most effective humanitarian response in the first six months that our country has ever seen. We did that by taking help from people from around the world. We took help from the US military that were heroic landing planes in tough environments, deploying 3,000 people, General Ken Keen, a three-star commander down there, handing out food himself alongside humanitarian partners.

We took help from private sector partners that had something to offer. So that spirit of, We're not going to own this thing. We're not going to 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.

Incredible. 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. 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.

The next morning, we had our first briefing in the oval office. It was my first meeting, actually, outside of ceremonial stuff in the oval. I got there a little bit early because you certainly don't want to be late for that. And I walked in, and the only two people in the office were the President and the Vice President, both behind the desk. Obama was 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. Then Obama sees me walk in and shuts down the conversation and walks over. He's like, Raj, come in, sit down. I was a little panicked, 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. 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 need the military. It was a very collegial conversation, but I knew that it would take more than just me to succeed. And Craig was one of the guys in the meeting. So on the way out, I 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. And 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 going to do this? My advice to your listeners, wherever you are in your journey, is open up and 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.

How do you not take this into your sleep, into everything you do?

At that point, I wasn't sleeping much. I was pretty easy to not lose sleep over it because I was just wasn't sleeping.

You're not sleeping.

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 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 out of what they call the tank. 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.

Incredible. I think you do emphasize it a lot because we are stronger as a group. If you can lead with others, you will be stronger. I think that's such an interesting pattern in your book as well. Again, you deal with Ebola 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, how did you move to the Rockfollet Foundation? Why did you decide to do the shift? You guys have some pretty audacious goals as well. Take us there a little bit, Raj.

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. 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 as a mortality of COVID well under a single percentage point. What it meant was anyone getting it was likely going to die, and it was pervasive across three West African countries anchored in Liberia. Also at the time, the CDC had predicted there would be 1. 6 million cases, including hundreds of thousands in the United States. 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. I helped lead that deployment in West Africa. 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 US 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. Again, very 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. 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. You can do that even in a big bureaucracy.

I love that you said that because, again, you can't connect the dots ahead of time. 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 once you see the results. I love that you're emphasizing this. It's the same with their career. I'll just say this, Raj, and 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, Raj.

Thank you for doing that.

I appreciate it. We can all do 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?

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. 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. One thing led to another, and I had the opportunity to become the President of Rockefeller Foundation. 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. 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. 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 engaging in invention of the yellow fever of seen abroad.

A tremendous history in the application of science for humanity, and it's just an honor to be here.

Incredible. You have some big goals. I mean, you're commenting climate change 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 normal. So, Raj, can you share a little bit?

Sure. Well, turbulence is normal, right? 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. That framework has changed our politics and our geo politics and our sense of confidence. When my grandfather made that investment of his retirement savings in a one a ticket to the United States, there was like a 90 plus % chance if you were born in the US back then, you would do better than your parents. I mean, literally, the only people who didn't were named Rockefeller because obviously your parents were already doing so well off. Today, it's less than 50 %. Actually, over the last 30 years, it's probably less than 50 %. So the reality is a lot has changed, and it just creates a lot of turbulence, a lot of change. Most Most of the last elections since 2000 have been change elections, one form or another. That is a signal that there's a lot of uncertainty and lack of confidence in too many communities across this country.

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 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. We do a lot of that type of work all over the planet. 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 prediabetes and diabetes in the US population, something that costs us more than $300 billion a year. There are more amputations performed every year in the United States as a result of diabetes than in all of the wars in Iraq and Afghanistan put together over the last in 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.

In our family, we have this day of going every year to a place to give perspective to the kids. Otherwise, they grow up with a Silicon Valley, I have everything I need. We've definitely seen it in Ethiopia. We've seen people without any electricity, no toilets, no anything in Myanmar. We've definitely seen some of this, and I absolutely love that. But again, for you, trying to lead something like this, 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?

When I started at the foundation, we had to make some real changes to the 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. 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 a really determined leadership team, we were 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. When we started that project, it would take four or five days to get a PCR-based test result, if you were lucky enough to get it in 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 US. And the US 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 on new cases of any pandemic so that if there's an outbreak somewhere in the world, authorities and labs and experts anywhere in the world can see it. We tried to stand that up. That didn't work because the politics were too hard and it was too complicated. We do things that sometimes work and make us really proud of the impact. We do things that sometimes fail and are 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.

That's incredible. Maybe one question. I'm just curious because I had Dan Ariely a couple of months ago, and he's an incredible behavioral scientist. 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 to spare it? I'm just curious.

Oh, no, we got that. We still do. 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 and science-based in making good judgments. We don't do our work ourselves. We are fundamentally tethered to bringing together unlikely partners and building coalitions. That simple process of doing that to earn the buy-in and the support you need in communities where you're doing the work itself. 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. 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. 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 the conspiracy theories.

I love that. I think that's a pattern that you keep talking about partnership. Again, you're able to somehow take... What is it? The organization is 111 years old, 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 little bit about that, but also your advice to people listening, your advice to your younger self. I would love to go there for a second.

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 thanks 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 its 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 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 have ambition to do things at that scale? If that's your North Star, it's hard to live up to, but you get to at least try in every success of generating.

As a leader, and I know we have a lot of people jumping into C-suite, et cetera, maybe a little tip of you jump into C-suite. There's a little bit of balance between, Let me just change everything to, 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 bit about.

Well, I think you have to be careful and pick your, should we call them Pick your efforts. Pick your efforts. Choose your battles. Pick your initiatives carefully. 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. 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 among amongst people who are vulnerable. 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 have to have partnerships, public-private, left-right, finance and engineering. 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 work.

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. Those things that did cause that reduction weren't even in our headspace when deployed. You got to be constantly experimenting along the way. You can only do that if you're very driven around measuring results.

You talk a lot about the scorecards in your book, which, again, for anybody listening, 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 last things that you would advise your younger self or the people who are listening and that you wish that you had that perspective?

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 Inhoff that taught me those lessons. A lot of that was driven by faith connections, even though we're of different faiths. 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 what's right in front of you and the decision or the transaction. 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.

Oh, my God. I love that, and you're right. 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 florists so much more. 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.

Well, thank you. And thanks for all you do to keep the mission moving ahead.

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