Current General Studies Magazine (September 2015)

General Studies - III "Science & Technology Based Article" (Using big data to prevent disease)

The priorities of the Bill & Melinda Gates Foundation are driven by what governments care about and the disease environment, says CEO Sue Desmond-Hellman

Dr. Sue Desmond-Hellmann, CEO of the Bill & Melinda Gates Foundation, spoke exclusively to Rukmini S. about disease eradication, big data, and how the Foundation is planning its end. Excerpts:

You’ve come in as CEO in an organisation that is so closely associated with the priorities and passions of the couple who started it. What has it been like to become its first outside CEO?

The organisation is 15 years old now. I’m the third CEO but the first from outside Microsoft. Before I took the job, I spent a lot of time with Bill and Melinda [Gates]. I recognised that I was going to work for a family business, and that if we had shared values and I understood what they hoped to accomplish and was excited about it, that it would be a good job and if not, the opposite. So I feel and felt very good about the fact that Bill and Melinda and I are very focussed — as is the entire Foundation — on solving inequities. I also understood from them that now that the Foundation is 15 years old and [at an] incredible scale and scope, they hoped that I would bring my management and leadership capabilities to the Foundation. So things that any organisation 15 years old works on — making things simpler, easier, bringing out the best in our employees — that’s what my attention has been on.

Is there also a discussion on the future of the endowment and the Foundation? I hadn’t realised that it’s finite and that its end needs to be planned for.

For all philanthropies this is an ongoing discussion. There isn’t one right way to do it. Some philanthropies like Rockefeller will carry on after the death of the people who bequeath their fortune to them. Others have been planned by the people who donate their wealth to them that they will end. So Bill and Melinda have planned that the Gates Foundation will be here but after they pass and the passage of time, the Foundation will end. So that brings with it something that I actually like a lot, which is: we better get things done! I mentioned [that] I spent time with Bill and Melinda, and I had spent time earlier in my career in global health, and the urgency that Bill and Melinda have to solve the problems we’re focussed on is, I think, a major asset. And the fact that the Foundation will not exist forever brings that sense of pace and urgency. It also brings a sense of urgency to the people we partner with, knowing that they won’t be able to turn to the Foundation 50 years from now.

You’ve talked about the value of big data in public health. Given that the Foundation has a clear focus on certain diseases, is there enough emphasis on what data shows is the real burden of disease in developing countries?
The global burden of disease sets the compass. But we work with governments. Our emphasis is driven in part because of investments we’ve made, but also because of what nations, governments, the United Nations want. In India, happily, health is very big on the government’s agenda. So we can provide technical expertise to enhance what India has on its agenda.

There are two other qualities; one is: how tractable is it? Even if something is very common but if there isn’t…polio is such a good example because we have a polio vaccine. So if we have a vaccine-preventable disease, that sets the operating conditions where we can aspire to get rid of the disease.

The other one is what are we good at? Like all organisations, the Foundation has more expertise at some things than others. So we try and look at opportunities where we can provide data or tools or funding to our partners and collaborators. So our priorities are driven by what governments care about, what the environment for that disease is, and what we aregood at. That gives us a good way forward.

Polio seems to be one of the places where these three things came together. Are there lessons from polio for other disease-driven eradication programmes?

In India, the first is within polio, moving from oral vaccines to IPV (Inactivated Polio Vaccine). Then there’s rubella, rotavirus — for India, a big problem with diarrhoea — and then there’s Japanese Encephalitis. Those are vaccine-preventable diseases and because of the conditions we talked about earlier, we’re very enthusiastic about collaborations here. It’s not always that collaborations are this harmonious! There’s definitely been a role modelling effect in Nigeria and it’s given us some confidence for Afghanistan and other geographies, and it gives us some enthusiasm for other areas of disease eradication.
In your work in cancer, you talked a lot about precision medicine — tailoring medicine to an individual’s needs and environment. Since it would be so much more resource-intensive than the standard practice of medicine, is it something that could work in the developing world too?

I’m a cancer doctor. And one of the things I was excited about was having the chance to work on therapies that were targeted at only women who had a certain type of breast cancer. That was so exciting for me because we maximised the chances for health and minimised the chances of side effects. That for me was seeing in real life what precision medicine could look like.

Now I’m excited about precision medicine that isn’t for the rich and thinking of what would it look like to do precision public health. We’ve been doing a lot of thinking about Ebola and on the ways it spread. Using big data to understand the conditions that made it spread is exactly what we need for epidemic prevention. It makes me even more excited to think that we can use our technical expertise for the people who need it the most, who are among the poorest in the world. It needs to be culturally competent, it has to be affordable, but we must make those technological solutions available to the poorest of the poor. I’m a little excited about that.

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