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Dr. Susan Desmond-Hellmann, Guide of the Gates Foundation

On her second anniversary as chief executive of the Bill & Melinda Gates Foundation, a global colossus of philanthropy, Dr. Susan Desmond-Hellmann wrote of progress against smoking in the Philippines, polio across the world and sleeping sickness in Africa.

Before joining the foundation, she led development of the cancer drugs Avastin and Herceptin at Genentech, then was chancellor of the University of California, San Francisco. We spoke for an hour at her office in Seattle. A condensed and edited version of the conversation follows.

What are some of the coolest, most surprising things the foundation is doing?

What I think the foundation ought to be known for is making sure we do things that others can’t or won’t. So I wrote about the tobacco work for a couple reasons. One, people probably didn’t know we did tobaccocontrol work. I’m an oncologist, so I know that tobacco is the cause of death for six million people.

What did you do in the Philippines?

They increased the tobacco tax. So we can pay, and did pay, for a group that can supply them with legal aid. If you’re a relatively small government and Big Tobacco, you might call it, has a legal staff that can challenge your use of a tax or a policy, you could access excellent legal advice.

Tell us a little bit about how you’re trying to figure out what’s killing millions of kids before their fifth birthday.

If you look at what’s happened 1990 to 2015, vast improvement. But we want to decrease by half again that under-5 mortality by 2030. About 40 percent of those deaths now are in the first 30 days of life, most coming actually on your birthday. So here’s a good news story. We know where pregnant women have H.I.V. in sub-Saharan Africa, so we can do extremely effective, nearly universally effective ARVs [antiretrovirals] for pregnant women. Using that precision public health, we decreased H.I.V. transmission from mother to child in sub-Saharan Africa by nearly half in five years. So we’re doing surveillance.

You’re doing actual autopsies?

What we’re doing actually is minimally invasive tissue sampling. So the way that we used to do it — and we still do it —- is actually reasonably effective but excruciatingly difficult. A baby dies and you go to Mom, and it might be weeks after the death, and you say, “Did the baby have a fever, were they holding their stomach, did they vomit?”

A verbal autopsy, it’s called. What we’re doing is adding minimally invasive tissue sampling: liver, lung.

Are mothers receptive or horrified that you’re suggesting this?

These families have lost a child. And to my delight, the principal investigator said that one of the things that people felt is this helps with closure.

How will you use the information?

Most importantly, we can start to see here’s what we believe about epidemiology of H.I.V., TB, malaria, all of the things that we think are going on, and here’s actually truth. I want the Minister of Health to say here’s why babies die in this community, in my country. What do I have in my tool kit? What are the kinds of medicines I want my government to buy?

Bill Gates and the foundation have joined the fight against polio. Do you think this is going to be the year that it ends?

It’s almost like you’re afraid to celebrate, but Nigeria has been poliofree now for over a year, and that means the continent of Africa has been wild polio virus-free for over a year. And we’re down to Pakistan and Afghanistan. I’m a believer. I think we’re at the end of polio.

[On family planning] Melinda has now made it this cause to get. …

Absolutely, 120 million more women [receiving contraceptives] by 2020. That’s a lot of women, and you do have these now phenomenally effective long-acting contraceptives: implants, injectables, IUDs.

There’s an effort to develop an injectable that the woman herself can use.

The potential for self-administration is huge. She may not want others in her house to know she’s using contraception. It gives her agency to make her own decisions on spacing her children, and it makes her more powerful.

You’ve been managing the foundation for two years now, and you’ve been managing Bill and Melinda Gates. What have you learned about their styles, their passions?

I would say that the two of them have three things in common: They’re fierce. They’re so all in. They’re generous. And they’re really committed to their family. It’s a family foundation, and I’m a big family person. I’m one of seven kids, my husband’s one of seven kids. So I’ve had the opportunity to see them as parents and the Gates as a family. Bill Sr. works here. That’s kind of fun, too, and it’s so big a part of the history of this place.

So it hasn’t complicated your life.

Oh, of course it’s complicated my life.


Bill and Melinda are my bosses. And like when I was accountable to the president of the University of California or the C.E.O. of Genentech, I always like to understand how do I work with my boss. Melinda’s really instinctive. Melinda connects with the human condition. We’ve had this new work in poverty, and we were talking about incarceration at a young age. And I was telling Melinda how sad it made me and how I just wanted to cry when I heard this young man’s story. And Melinda said
sometimes, you just have get to that place where you just can’t even stop thinking about it and you cry. Then you think, “How can we help?”

And what about Bill?

Bill is more the numbers guy. I go on trips with Bill and Melinda separately. The trip I took with Bill, we’re driving through Tanzania, and he misses nothing. He’s got the population of Tanzania, G.D.P. of Tanzania, what proportion of their population is educated. He’s looking at every sign. “Wow, there’s three telecom companies in Tanzania.” He’s basically got an Excel spreadsheet of all the data and facts about every country we work in. So his intellect and his ability to connect dots and use data and analytics to try and frame a problem or a strategy is extraordinary.

You’re answering to both of them.

I’m answering to both of them, and what I’ve tried to do is to tap into each of their — they call them in their letter — their superpowers. They have very different superpowers, and yet what unifies them is this commitment to equity and generosity.

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