THE ASPEN INSTITUTE ASPEN IDEAS FESTIVAL 2015 AFTERNOON OF CONVERSATION: SUE DESMOND-HELLMANN Benedict Music Tent Aspen, Colorado Wednesday, July 1, 2015 1
LIST OF PARTICIPANTS: KITTY BOONE Director, Public Programs, Vice President Aspen Institute WALTER ISAACSON President & CEO Aspen Institute SUE DESMOND-HELLMANN CEO of the Bill & Melinda Gates Foundation * * * * * 2
AFTERNOON OF CONVERSATION: SUE DESMOND-HELLMANN MS. BOONE: Welcome everybody to the 11th annual afternoon of conversation at the Aspen Ideas Festival. (Applause) MS. BOONE: This is the time when we transition from the first half of the festival and say farewell to our colleagues that have joined us and welcome those of you that are joining us for the second half of Aspen Ideas Festival. I want to quickly make sure that our wonderful volunteers that are in the Hotel Jerome watching this live stream and colleagues at Greenwald also feel very welcome. We've had an amazing week so far from what you all have shared with me and I can't thank you for your support and enthusiasm, and I hope you will give us feedback about what you've experienced so that we can do more of the same. This afternoon we are once again thrilled to have a group of high school students from all over the United States and from the African Leadership Academy. Could we please welcome the Bezos scholars? (Applause) MS. BOONE: These are remarkable kids who are going to leave the festival and go and create festivals of their own in their high schools and some of them have landed in the White House presenting and it's pretty exciting to have them with us. We have a very different afternoon. We're going to get going right away. You will hear some organ music, you'll hear some remarkable conversation, and you will also engage in conversation. And thank you for being here. And we'll get going right now with Walter Isaacson and Sue Desmond-Hellmann. Thank you. (Applause) MR. ISAACSON: I'm sure you know that Sue Desmond-Hellmann is the CEO of the Bill & Melinda Gates Foundation. She was also chancellor of the University of 3
California at San Francisco and a great professor of oncology, cancer research and I will even give the name of professor because they are great friends of Aspen, the Arthur and Toni Rock professor at UCSF; worked everywhere, with HIV AIDS all over the world and it's really cool that a real scientist as well as real humanist like yourself is leading the Gates Foundation. Welcome. be here. MS. DESMOND-HELLMANN: Thank you. Very happy to MR. ISAACSON: You just came back from Malawi, right? What did you learn, what did you bring back from a trip like that? MS. DESMOND-HELLMANN: Well, first of all thank you for having me here, I want to make sure particularly my friends from San Francisco know that I was drawn to the work of the foundation because of its audacious goals; ending polio, cutting childhood mortality in half, unbelievable, right? How about add to that decrease hunger, reduce poverty, and make sure more Americans get to and through college. So what I learned when I went to Africa and I just got back from Malawi, South Africa, and Nigeria is that it's great to have audacious goals, that's -- it's terrific, it's all talk and -- MR. ISAACSON: Wait, I see one of our scholars who is from Malawi. They can't stop smiling. MS. DESMOND-HELLMANN: Where is the scholar from Malawi? All right. You have a great country, you have a great country. And being in Malawi as you know was such a reflection for me to move quickly from goals and metrics to the reality of what it's like to work in the toughest places on earth and ask the question what will it take, what will it take. So I suspect that most of the people in this room like me landed in the Aspen Airport. So let me make real what it will take in places I just left in Sub-Saharan Africa. Let's say you were getting off that plane and like I heard, the pilot says, welcome to Aspen, it's 95 degrees outside, seemed a little hotter than I expected. 4
Now as you exit the plane I'll give you an ice cube, okay, I'll give you an ice cube. That ice cube three days later you should know that a mom with 6-yearold twins will come to your clinic and she is dependent on you that that ice cube is still frozen to save the lives of her 6-year-old twins. Now I want to add one more thing to that equation, the electricity is completely unreliable, mostly nonexistent and there's no running water. You better get that ice cube to those twins. So what I learned and one of many examples is vaccine delivery, if we're going to end polio and cut under-5 mortality in half, all of that has to work. So what I saw in Malawi, in Nigeria, is the reality of the cold chain, that sounds to me cold chain, supply chain sounds very fancy, but it is keeping frozen vaccine all the way from when it hits the country's borders to when those 6-yearold twins and their mom who carried them on her back for 10 kilometers is ready for them to have their vaccine. MR. ISAACSON: Now, you just said the audacious goal of ending polio. If I'm correct, we've only eradicated one disease in history, right, smallpox? MS. DESMOND-HELLMANN: That's right, one human disease in history. In 1980 smallpox was eradicated from the face of the earth, it was actually a cattle and ruminant disease called rinderpest that's only the second disease ever eradicated. You've got to remember that for the Jeopardy show, but only one ever in the face of the earth and not only only one, but there is litany of tries over time where the globe has failed to eradicate disease. So the ambition to end polio started in earnest in 1988. MR. ISAACSON: Unlike other foundation presidents, you are an actual research scientist. What do you bring from that background to the world of philanthropy? MS. DESMOND-HELLMANN: Well, I hope what I bring is the reality of moving from innovation technology to what will it take for human beings to benefit from that science. When I worked all day long, everyday as a cancer researcher, I got to work on some great products. People 5
have heard of Herceptin, one of the products that I'm still really proud of. We knew when I started working on it that there was something really interesting about the science, but what I'm proud of is that women with breast cancer live longer as a result of our work. I want the work that the Gates Foundation does with NGOs and governments and universities and brilliant people to save lives and I bring getting it done and the reality that the science only matters if we save lives and change lives. MR. ISAACSON: At one of the morning panels, I think it was Joe Echevarria or maybe Broderick Johnson was talking about, you can't just have programs, programs have to be moved into policy, otherwise they just become oneoff things. You mainly do programs in world of philanthropy. How do you work with the government or even business to make a partnership so that it become real policies? MS. DESMOND-HELLMANN: We don't do anything alone and we actually like to cite the African proverb, if you want to go fast, go alone, if you want to go far, go together. So let me give you an example again on the vaccine front, Gavi, the Global Alliance for Vaccines, is a worldwide collaboration involving multiple governments, multiple NGOs, many donors. We have supported Gavi and many others have supported Gavi. It's a policy on foreign aid that many governments have and all credit to them and what this has allowed is 7 million lives to be saved that would not have had vaccines for the poorest children in the world if not for a global alliance that requires partnership, collaboration, policy and advocacy every single day to get that done. MR. ISAACSON: And one of the things you mentioned Herceptin and that was I think you were the president of product development at Genentech. MS. DESMOND-HELLMANN: I was. 6
MR. ISAACSON: And you helped pioneer the field of precision medicine. Explain what that is and how that's going to transform medicine? MS. DESMOND-HELLMANN: Well, precision medicine is a, it means a lot of things to people. It means at its heart and soul that patients are able to get the right medicine for their disease at the right moment. And that may be a preventive medicine, it may be a therapeutic medicine. I'll tell you, these days I met with some of the most amazing people this morning here at the Aspen Ideas conference who talked to me about precision agriculture, I like to think about precision public health. At its essence it is bringing all of the ability we have to bring big data, technology, and innovation to bear so that people have a more personalized fit-forpurpose approach to what they need. I think actually you can think about our programs in education as personalized or precise. Every student learns differently, every classroom is different, every teacher has his or her own way of teaching. So that personalization, that thinking what does that child need right now from us, from their teacher, from their community, I think the precision medicine that I've been completely obsessed by for a long time actually does scale. It is in its essence the way that we at the foundation think about all lives have equal value and everyone deserves to have a chance, no matter what their resources are. MR. ISAACSON: And so the notion of a targeted therapy that you would have done as an oncologist, that translates almost like a targeted programs or targeted precision for each problem? MS. DESMOND-HELLMANN: Right, so I'll tell you that one of the things that is the most astounding about what's possible in science now, and many people probably saw it with Ebola, you can literally using the best science in the world trace back the start of this current epidemic with Ebola, know where it came from -- 7
MR. ISAACSON: Yeah. MS. DESMOND-HELLMANN: -- know how it traveled, and when new Ebola cases come up, start to do the contact tracing using the best of sequencing and the most rapid throughput. So we can use those tools, they are necessary, but the other thing we learned about Ebola, they are insufficient. MR. ISAACSON: Right. You know, you could probably date the beginning of the computer revolution to 50 years ago, it's been 50 years, probably ever since your colleague Bill Gates broke into the computer room at Lakeside High School and decided to reprogram the computer there. We seem now to be moving the next 50 years into a new revolution, that's not a computer revolution, but a life sciences revolution based on the combination of big data, technology, and the life sciences. Will that be as transformative as the computer revolution was and how do you deal with that at the foundation? MS. DESMOND-HELLMANN: Well, I think the jury is out on how much big data and computing power will help us with life sciences. I am an optimist, I believe it will revolutionize how we think about health. How it impacts our work at the foundation is the aspirations we can have. When we think about disease eradication at the foundation, we want to use all the tools at our disposal even when the problems affect the world's most poor. And I think that's what the Bill and Melinda have done a great job of upping the ante so that everyone, no matter what their resources are, no matter what country they live in can have the best of science and the best of private industry come against the problems that they have. So we can use sequencing. We can partner to come up with better diagnostics and better tools. A good example is tuberculosis. So tuberculosis still ails so many in the world, there's so much suffering and resistance, that's a huge problem. We have collaborated with many scientists around the world using these new 8
computing techniques. What if you didn't need sputum on a slide with a microscope, again, often with electricity to diagnose TB? What if you had a rapid non-sputum diagnostic out in the field? Everything would change about TB. That's the kind of thing that's possible with big data computing power and some of the life sciences breakthroughs we see now. MR. ISAACSON: The Bill & Melinda Gates Foundation has really two main thrusts. One is global health and one is education in the U.S. Those of us who have been deeply, deeply involved with education in the U.S. and really think that it's a moral, economic, political issue of our time, we sometimes worry that the Gates Foundation kind of keeps edging more towards global health and all of those trips, perhaps you coming from the health side will be able to tip it back the other way. Are we going to see more effort in that zero to college pursuit that the Gates Foundation has been doing? MS. DESMOND-HELLMANN: So one of the things I think people underestimate is actually in our roots at the Gates Foundation, the foundation has been around now for 15 years, we're nearly past adolescence, so I think that's good. We started with a global libraries program and the original ambition was that everyone, no matter where they were, should have access to the Internet for learning and the global libraries quickly led to efforts on U.S. education. So U.S. education, we're in for the long haul, it's a very serious commitment that the foundation has had and continues to have. And so what I see at the foundation is a relentless energy that every student who goes K-12 in the U.S. should have access to an education that gets them ready for college, and even the people who have the worst odds should have the opportunity to get into college and finish college in a way that's affordable and accessible. MR. ISAACSON: I know you were just talking to Valerie Jarrett. We were talking about My Brother's Keeper and things. How does that tie in, the equal 9
opportunity agenda that we now feel so strongly about in this nation and your education agenda right now? MS. DESMOND-HELLMANN: Well, they tie together beautifully. One thing to keep in mind is the perspective that even though we have incredible resources at the Gates Foundation and we do, our resources are tiny compared to what we spent in the U.S. on education, what we spend in the globe on health. So knowing our resources are tiny we have to be very focused, and we focus on those school systems and school districts who are having the most stress and challenges often as a result of poverty. MR. ISAACSON: And what have you learned because there have been a lot of changes over the years in what Gates funds? MS. DESMOND-HELLMANN: Yeah. What we've learned is that the single most important variable in any classroom is the teacher. We learned that the teacher matters and we hear from teachers that they need tools, they need professional development tools, they need curriculum, they need to actually not feel isolated, particularly if they are in a small community, and they need to connect with others. So we've also learned that students need some what we call personalized learning. Many students learn in their own ways and I think My Brother's Keeper is a wonder ambition in part because we've learned that if the child gets to school -- Xxx -- child gets to school in kindergarten very, very behind, it's really tough to catch up. MR. ISAACSON: A few years ago sitting in that chair was Bill Gates, and he talked about this new thing that he's having his kids do, which was Khan Academy to keep up. And I think Ann Doer, she was right there, was sitting in the audience, quickly e-mailed Sal Khan because he was the original board member there, and it ended up being a great relationship. Sal is now on our board. But do you think -- we don't seem to be reaching the promise 10
of online education that we thought 10 years ago was going to be so transformative. How do we do set up? MS. DESMOND-HELLMANN: Well, I think there's a couple of things that we've learned about online education, I think the nation has learned about online education. It is not for the people who struggle the most in school, they're not going to go home and get on their computer and do what Bill talked to you about. That is probably the reason for -- MR. ISAACSON: So we could exacerbate the divide in opportunity. MS. DESMOND-HELLMANN: Absolutely, and it's been clear that having access to online is not going to help many of the students we want to help the most. On the other hand, online can address isolation. Online can provide great content, and online is also in its earliest period of time to expect that online education is perfect today without going through iterations I think is unwise. So we've learned that it's a learning curve, and that to test, learn, and adjust, like with so many new technologies is going to be part of that journey. But it doesn't replace the essence of a great teacher. MR. ISAACSON: What two or three things could best be done to make sure that technology decreases the divide and opportunity between rich and poor rather than what's happening now increasing it? MS. DESMOND-HELLMANN: And you mean specifically in education? MR. ISAACSON: Education. MS. DESMOND-HELLMANN: Yeah, no, I think that a couple of things. One is making sure that the technology is connected to the lesson plan and the entire curriculum that the students have. The second is not all online is created equal, and to have a high bar and to stress and push that there is actual testing. And the third, I think 11
this is the other thing I've learned in my travels, I just was in Kentucky listening to students, you know, I'm on Procter and Gamble's board. MR. ISAACSON: Right. MS. DESMOND-HELLMANN: We actually don't launch a diaper without checking with customers, right? So if we're going to do online education, what about the students? And hearing the voice of the students and what -- how the students like to learn, how they interact with any curriculum delivered online or frankly in the classroom. So I think we need in many of the aspects of what we're doing in our mission not to forget that there's a human being. So technology, innovation -- I love that, my boss loves that as you know, and that's terrific, but there's somebody who's going to interface with that online. How are they learning? How do they like to learn? How long do they like to sit at the computer with the online education? And so I think getting that customer feedback, that student feedback, that teacher feedback, really helpful. MR. ISAACSON: All right. My last question because you just talked about the human factor, this is -- nobody spread this around, this will just between us -- MS. DESMOND-HELLMANN: Oh, just between us. MR. ISAACSON: And the tent or tweeting. MS. DESMOND-HELLMANN: And -- MR. ISAACSON: So you now deal with Warren Buffett who's gotten much more involved, and I can see no two people more different than Bill gates and Warren Buffett, and yet they like play bridge online together. What's it like dealing with the two of them and how different are they? MS. DESMOND-HELLMANN: Well, you left out one very important person, Melinda. 12
MR. ISAACSON: And Melinda. MS. DESMOND-HELLMANN: Melinda. So I often laugh and actually the Seattle Times wrote a funny story when I joined the foundation, "She likes tough bosses," so hopefully I do. So my trustees are Bill, Melinda, and Warren. And it is unbelievably great to work with the three of them. I feel so privileged, but you ask about Warren. I'll tell you, Warren is somebody who I think is a role model on two fronts, and it's been a huge impact not only on me, but on Bill and Melinda. So Warren made a decision that he isn't an expert on philanthropy. And he knows that Bill and Melinda are deeply immersed, doing their homework, looking at data, using metrics, all the things he would want them to do, so without putting his name on it, he donated a big proportion of his wealth and delegated to Bill and Melinda. And that's an amazing thing. That says a lot about who Warren is and how he operates. And the second thing, and this is where he's been incredibly helpful to me, even the best companies are at risk for the ABCs, as Warren talks about them. And he outlined them in his 50th anniversary letter from Berkshire; arrogance, bureaucracy, and complacency. Now, who in this room hasn't experienced at any company, university, foundation, the ABCs of bloat. And so often at the -- I talk about this at the foundation, I push myself first and my colleagues on this; Warren for me is a north star on who you want to be. He said another thing to me I'll never forget, he talked about he and Charlie thinking about the Berkshire Hathaway they wanted to create. They talked about what the history books would record about them and then they lived accordingly. And when he talked to me about the foundation, I thought, okay, Bill and Melinda wrote about 2030 and what we aspire for the next 15 years. What are people going to write about our foundation? What's the history we're creating? Now act accordingly. He's a great role model and a great inspiration. 13
MR. ISAACSON: Great (inaudible) to talk. Dr. Susan Desmond-Hellmann, thank you very much. MS. DESMOND-HELLMANN: Thank you. Thanks. MR. ISAACSON: We'll follow your north star. MS. DESMOND-HELLMANN: Thank you. Thanks a lot. MR. ISAACSON: Right. (Applause) * * * * * 14