Steve:                Hi.  Steve Mirsky here, and welcome back for part two of Scientific American Editor in Chief Mariette DiChristina talking with Gates Foundation CEO Susan Desmond-Hellmann.

Mariette:            You mentioned farming in Africa, and that's something I wanted to ask you about.  And I know one of the things the letter talks about is making Africa – helping Africa to be able to feed itself.  Can you tell us a little more about that?

Susan:                Yes.  The ambitions, again, by 2030 are to improve productivity so that Africa would be in a position to feed itself.  And the letter cites just one figure with maize, with corn, that there's five times the productivity in the U.S. than your average African farmer.  Seven out of ten people make a living in Africa off farming, so this really, really matters in Africa.  And it starts with feeding your family obviously, but could go to making a living, making some money.

So we focused on, and the Foundation has had a lot of investments in agriculture and farming, and we focused on everything from seeds to fertilizer to knowledge; agricultural extensions, places where farmers can learn more about being a successful farmer are traditional.  And again, maybe some of these innovations, like cell phones, can help farmers understand about soil conditions, understand about climate, forecasts.  Maybe they have access to saving, so they can both get something on a loan, which it helps to start out if you need to buy seeds or fertilizer, or they can have some savings for a bad year and get through hard times.

So a lot of the innovation and technology we focused on more broadly could be brought to bear for farmers.  And one other thing on farming I want to mention because it's important to us and is another theme at the Gates Foundation, and Melinda Gates has been a huge champion of the role of women and making sure that we include the lens of women and girls in everything we do at the Foundation.  Well, many, many farmers are women, and yet their access to the kind of technical assistance and the kind of innovation I've been talking about is even more limited than their male counterparts.  So when we think about farming we also think about the women farmers, not only being successful, having highly productive/more productive ability to feed their families or sell their crops, but also to have access to those funds.  Because it's really clear that the women are more likely to use those funds to send their kids to school or to get the family through a health emergency.

Mariette:            I think it's – I think those are excellent points and I'm thinking about equity and the deep learning we've discussed, business parties be getting involved, knowledge transfer.  But one of the things that climate in particular brings up for me – farming in particular brings up for me is thoughts about climate.  I said that backwards.  So I mean how do you see climate and the changes in climate affecting the various things that you're doing and what can we do about that?

Susan:                Well, climate has been a very serious and important part of this United Nations discussion I mentioned.  In fact, the S in SDG does stand for Sustainable Development Goals, and so the U.N. agencies are very much involved in making sure that climate change is a part of our ambitions over the next 15 years.  As a foundation we're deeply concerned about the impact of climate change on farmers, and that’s' partly why we wanted to make sure that any innovation or tools or approaches that farmers need to manage through climate change are available to those farmers.

As a foundation we haven't made investments that are very specific to climate change, although Bill Gates has a very particular interest in energy.  His energy investments have been his own personal investments outside of what the foundation has done.

Mariette:            How about disease movement, have you been looking into that?  You know, for instance, if mosquitoes head north again from, you know, in the Northern Hemisphere or south in the Southern, things like that?

Susan:                Part of what I think is fundamental to how the Gates Foundation thinks about global health and global development is a better ability to do disease tracking.  And so our need to understand how climate change, people migration, tragedies like hurricanes and earthquakes, or refugees, which there are many, have an impact on disease is really essential.  So we continue to make important investments in disease tracking, and you'll see more of that.

Something that we've been involved with recently that just today there's news on how the WHO is going to think about disease tracking and pandemics in the future as a result of Ebola and the beginning of the discussions on lessons learned on Ebola.  So Ebola points out many things, but one of the things is how important it is for us globally to have our finger on the pulse of what's going on on disease tracking.

Mariette:            I'm glad you raised Ebola, because I was going to say I'd like to now look at some recent news.  We've been looking ahead and what we're doing ahead, but I know the Foundation has been heavily involved in Ebola and Ebola response, and I'd like to hear more about how that's going as well.

Susan:                The Foundation hasn't been working in West Africa.  The three West African countries that have been affected haven't been part of the scope because, again, in the bigger world of the globe we try and be very, very focused on countries.  And so we worked a lot in Ethiopia, in Nigeria, in South Africa.  But Sierra Leone and Liberia and Guinea weren't areas where we had programs.  The Foundation does have an emergency aid fund that we've used often when there's something bad that happens in countries we're operating in.  So through that emergency aid fund in July and August we made some grants to people like WHO and UNICEF, who were working on Ebola, but in late August we started to hear from colleagues, "The foundation should help with Ebola.  We need you to help with Ebola." 

And so Bill and Melinda were incredibly generous, as they are, to agree in early September to a $50 million investment in Ebola from the Foundation.  And we focus that investment to make sure first of all that flexible rapid funding was available.  So we made literally within hours investments that WHO and UNICEF and the Red Cross and CDC could use to get on the ground and get personal protective gear and IV fluids, your basics, vehicles to get around.  So the first and foremost, let's get things done.

The second thing we did, and I'm really pleased to tell you that as awful as this has been for the countries involved, and it has been and remains awful when it happens, we invested specifically in the nearby countries: Nigeria, Mali, Senegal, Ivory Coast, to make sure it didn’t go further and create a global emergency that just the scope of which would overwhelm all of our public health efforts. 

And I think most famously one of the polio emergency operation centers in Nigeria was turned into an Ebola emergency operation center, and the government of Nigeria was able to keep their casing to 19.  When Ebola went to Lagos many people were terrified.  It was stopped.  A really great thing.  So those investments were very important. 

And then the third set of investments were in research and development.  And recently we added another $25 million, bringing our total to $75 million, and that $25 million was to supplement the research and development investments in four major areas: diagnostics, therapeutics, vaccines, and convalescent serum.

Mariette:            And when you say "therapeutics" are you speaking of replacement of fluids and the-

Susan:                On an R&D level the therapeutics would be a pill or a tablet specifically designed to stop Ebola.  Not a preventive, but a therapeutic, unlike the vaccine.

Mariette:            You and I both have come back from Davos, where I was very gratified to see many of the science and research sessions quite packed with people.  And it seems like there's a lot of well-meaning, you know, emotion, but as you've mentioned yourself already, sometimes people don’t know how to go about affecting change.  Are there any major take – and we've talked about various elements of this – are there any major take-homes that you have for people who would like to work with the foundation to do that? 

Susan:                Yeah, I would give you a few that have been observations that I would make.  And you know, I'm a product developer by background so much of the work in Ebola was very familiar to me from the time I spent in pharma and biotech, and yet very unfamiliar in that you needed something so fast it literally takes your breath away.  And so I would say the first thing that all of us collectively learned is that people really are willing to collaborate, and people are willing to step up and do their part to say, "Okay, this is an area where I can make a difference in this area." 

So having a spectrum of different products and different needs, one of the ways that our foundation can add a lot of value in addition to investments is convening.  So we can bring people together either in a meeting, a teleconference, and say, "Did you know that Welcome Trust is doing x?" or the "Harvard is doing y?"  And so people can learn what others are doing and either collaborate or make sure they're complementary to those efforts.  So I think first and foremost the need for teamwork and collaboration, just like with everything else on Ebola, was very clear.  And I think that was actually done reasonably well in the scientific community.

The second thing is just looking at impediments to going fast.  Now it has to be safe, it has to be ethical; those are values that are just not on the table.  But from a regulatory standpoint can't we go faster?  Can't we enable something globally from a regulatory and technical standpoint.  What about clinical trials?  How do we do clinical trials?  What's the role of randomized control trials in the face of a deadly epidemic?  How do you look at testing a new therapy when we know Western-type medicine can bring mortality down?  So there are some technical things about going fast that are very broadly applicable that I think the entire scientific community and translational community are going to learn from what does going fast mean and what do we learn about ourselves and our ambitions in that dialogue I think are really essential.

And the third and final thing I'll say is this starts with an Ebola discussion and now we're thinking, "Okay, can we stockpile things?  How do we learn as much as much as possible as we hope the epidemic is coming under control?"  But what about pandemic preparedness?  What about saying, "Is there a cassette?"  I keep wanting a sort of a plug-and-play.  It sounds really superficial or oversimplistic, but I want a plug-and-play.  I want to look at our best innovations and say, in the face of an epidemic, where we have to scientifically go fast, can't we use some of our new things about how we understand molecular biology, about plasma, it's about production?"

There needs to be a way for us to go quickly and to be able to respond quickly in the face of mutations.  So I think that the whole scientific underpinning of pandemic preparedness is both incredibly interesting and another area where everybody's got their "I'm a good guy or a good gal, I want to help" hat on, which is really something that I'm happy to see.

Mariette:            You raise a fascinating area of what some people have looked at the moral responsibilities that we have as well, especially around emerging diseases or fast-moving diseases and the need to understand them scientifically, where we know for a fact, as you've said, we can mitigate some symptoms, but we're also trying to gather data so that we make sure our therapeutics are very sound.  That came up in an immunotherapy discussion that I had at Davos with Carl Jeun and Jose Bisalga, when you're working on immunotherapy and you have specific targeted tumors how, you know, is it still from a regulatory standpoint, is it still moral to wait and try to do other when you have a specific tumor that's specific to a particular person.  It's an interesting question.

Susan:                Yeah.  No, I think that, you know, I want to make two points on this kind of bigger ethical thing.  All of what we do in clinical trials, which is the heart and soul of what I've spent my career doing, is based on equipoise, and equipoise means there's a relatively equal chance of being right or wrong.  If you're faced with certain death equipoise just seems crazy to you as a patient.  And this has ever been an issue for us, how do we learn for future patients when there's a patient sitting in front of us who needs something?  And so I think this is a good and valuable discussion that needs to involve ethesis, community members.  Because it's also something that points out that values base is really essential, and these are tough discussions, whether you're thinking about potentially curative cancer therapy or potentially curative Ebola therapy, the same issues apply.  What's the acute setting and how do you make sure you learn for next time?  That's a massively hard thing to do.

The second thing on the ethics and what do we do in the face of these big health challenges is something that I've spent a lot of time on, again, coming from private industry and academia before coming to the Foundation, and that is something that is exciting about our Foundation's work, we want private companies to participate in global health.  And we want private companies to make a living and think that they can meet their business objectives while doing good.  So people call it doing well by doing good.  And we think that's a sustainability approach.

So one of the reasons that I was at Davis is to continue efforts that the Foundation has had going on that talk to private enterprise about what are the conditions they need to tell their shareholders or their owners that they can make a living doing product development for the poor.  And I think that's exciting and I think that's a trend that we'll see as people look at different areas where their biology, their science, their innovation can help, but they have to turn on the lights, pay their employees, and if they're a publicly-traded company, answer to their shareholders.

Mariette:            I love what you're saying, because one of the reasons that I was at Davos, as always, with a magazine named Scientific American, that has been around since 1845, we're hoping to create more scientific citizens in general.  You know, Scientific American is widely translated.  And before I finished our interview a thing I wanted to ask you is about something that's been implicit in everything you and I have just been talking about, but maybe we could make a tin bit more explicit, which is the need to be evidence-based, the need to look for facts and measurable outcomes to see how well things have done or not done.  I just wonder in closing if you have any final insights about how we can inspire other people to think along similar lines?

Susan:                Well, as you can tell, I'm really passionate about the work at the Bill & Melinda Gates Foundation.  And I had a great job as chancellor at one of the great scientific universities in the world, the University of California, San Francisco.  And yet I came to the Gates Foundation because I am so thrilled at something fundamental that Bill and Melinda have brought to thinking about making the world better, and that is accountability, metrics, a lens of return on investment.  Lots of people have good intentions, they're just not enough.  And so what I love about the Foundation, and it can mean that we're embarrassed, that we have a big, bold, metric-driven bet and it doesn't pay off.

But, you know, good for Bill and Melinda and good for the Foundation, 'cause I'm new; I didn’t make this up, but I inherited something really beautiful, which is on behalf of the world's poor, the people that are struggling to have a better life, we're going to work to set the bar high and then achieve that.  And I think if you do believe in evidence, if you do believe in metrics and science and if you come from a technical background, like I do, that's a beautiful thing.  Because a big heart and good ambitions is where it starts, but if we're going to execute on the kind of things we aspire to and if the globe is, that's not enough.  And so I think thinking about bringing that excellence to development to these areas is really exciting.

Steve:                That's it for this episode.  Get your science news at our website, www.ScientificAmerican.com, where you can also peruse our collection of e-books.  The latest in the series, just published, is called Inspired: The Science of Creativity. 

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