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Gates Foundation on Taking Investment Risks Others Can’t (or Won’t) · StartUp Health NOW Podcast

• 0:00
  [ on-hold music] I immigrated to the US when I was young. Uh, we came just with a couple of suitcases, and the majority of my family was in rural China.
• 0:18
  So when we first went back to visit, really, like, my journey [chuckles] to my grandma's home, um, we did a domestic in-country transfer, um, drove quite a while, and when there were no more paved roads, we got on, like, a small wooden boat, barely bigger than a canoe, went down the river, and when [chuckles] there was no more water, uh, we got out and we walked.
• 0:44
  And that was my, my journey to see my grandma and, and the rest of my extended family.
• 0:49
  [on-hold music] Welcome to Startup Health NOW, the podcast celebrating the entrepreneurs and innovators reimagining the future of health. I'm Logan Plaster.
• 1:03
  Today's episode is a conversation with Annie Ye, a digital health innovation program manager at the Bill & Melinda Gates Foundation.
• 1:10
  A graduate of Harvard and the Wharton School, Ye previously worked in tech strategy at Samsung.
• 1:16
  We wanted to call her up and get some practical tips and wisdom about how healthcare startups can partner with the Gates Foundation.
• 1:23
  In the conversation, which was held in front of a virtual audience of founders from the Startup Health portfolio, we talked about funding priorities at Gates, what successful partnerships look like, and we even got specific about submitting RFPs.
• 1:35
  It was inspiring as well as tactical, so I hope you enjoy. And don't forget, if you like hearing inspiring stories from healthcare's innovators, make sure you follow Startup Health NOW wherever you get your podcasts.
• 1:46
  Now, on to the interview. [on-hold music] So Annie, we want to start by getting to know you a little bit. So you've worked in business analytics, uh, you've even worked in entertainment.
• 2:02
  Um, uh, y- now that you're in this high impact global health role, I kind of just wanna hear your story of how you got here, uh, what were some of the steps to, to l- uh, getting into this role at the Gates Foundation?
• 2:16
  Yeah. So perhaps I can start off with my, um, the initial experiences of my career. As you had mentioned, I worked in business intelligence at a consumer packaged goods company that sold health and beauty products.
• 2:28
  And so I was really passionate about, uh, the use of data to tell stories behind the numbers.
• 2:34
  And then I actually wanted to work on even more data, so I found myself working on the Olympics at NBC Universal, building up the first, um, internal [audio cuts out] data infrastructure and advanced analytics on top for the Winter Sochi Olympics.
• 2:51
  And, um, really, it was a, um... I had a sense that perhaps advertising in media entertainment wasn't quite the career path that I wanted to go down towards long term.
• 3:05
  So I actually did a hackathon [chuckles] in digital health, um, and that really sparked my interest in digital health specifically.
• 3:14
  And so I, um, had some experience in corporate wellness at Jiff, uh, and then worked in Samsung on Samsung Health specifically, which is the pre-installed application on all Samsung mobile phones.
• 3:31
  And, um, really enjoyed my time there, but wanted to make a, have a more global perspective in a way on the ways in which digital health can actually make impact and affect lives, and that's how I found myself at the foundation.
• 3:48
  And I will note that I did start virtually [chuckles] at the foundation, right at the beginning of the pandemic and all the craziness. So, um, I am a bit newer to the foundation side.
• 4:01
  Uh, y- you came on to the Gates Foundation, uh, fully virtual, uh, I believe, during COVID. Yep. What was that experience like?
• 4:08
  I, a lot of folks on this call have had to deal with hiring and team building through that process. So, so give us your perspective on that.
• 4:16
  So I'll say that because my team [chuckles] was working on COVID directly, I definitely felt like I got to know my team well through all the meetings and all of that hecticness and craziness.
• 4:26
  Um, but I think that in terms of the team building component, um,
• 4:32
  with it being so crazy, um, I actually initiated a step challenge with my team, just a way for us to be able to move, but also to connect with each other on a different level.
• 4:46
  We also instituted kind of the team that had the lowest number of steps each week also got, like, a creative punishment [chuckles] that they would do.
• 4:56
  So maybe it was, like, uh, they could, like, maybe, like, pick a song that they could step it up to or maybe, like, do a drawing of something.
• 5:03
  But just another medium to get to know each other, but also to have a l- add a little bit more health in our already very crazy, stressful lives as it was.
• 5:15
  Um, and I think part of starting virtual, like, as a new person, is trying to get to know team members where we can't, I can't exactly gauge body language quite as well, and so it's really about...
• 5:28
  I, I did feel like I, I did a lot of reaching out, and I think that if you're on the other side, so if you're, uh, a manager or a founder and you have team members who are onboarding virtually, really taking the initiative or the first steps to reach out to them or to have some of the smaller group conversations, whether it's, um...
• 5:48
  We actually, we use Teams, not surprisingly [chuckles] at the foundation because of Microsoft.
• 5:53
  And so if you can have some of those, like, bigger group meetings, but then split it off into breakout rooms, those are, I think, really nice ways to have more of the individual level conversations to start to getting to know...
• 6:06
  people better, um, and then really to start building that relationship and trust that way. Nice.
• 6:13
  So you moved from, uh, fields like advertising and a- analytics where, you know, there were quicker successes and confirmations of what you're working on to global health, which is not for the faint of heart and where there are no quick fixes.
• 6:28
  You know, it takes long-term commitment, something we t- talk about a lot.
• 6:32
  And so I wanna know, what's an experience you've had, uh, or a person you've known in your life that motivates you really to improve global health, regardless of the obstacles? Like, what helps you keep going?
• 6:46
  So this actually comes back to my family, and really I immigrated to the US when I was young. Uh, we came just with a couple of suitcases, and the majority of my family was in rural China.
• 7:03
  So when we first went back to visit, really, like, my journey [laughs] to my grandma's home, um, we did a domestic in-country transfer, um,
• 7:16
  drove quite a while, and when there were no more paved roads, we got on, like, a small wooden boat, barely bigger than a canoe, went down the river, and [laughs] when there was no more water, uh, we got out and we walked.
• 7:29
  And that was my, my journey to see my grandma and, and the rest of my extended family in these concrete houses in rural China.
• 7:39
  And, uh, each time we visit, we would go a bit further by car until eventually five years ago, we could get all the way to the front door.
• 7:47
  And I should note that the first time I visited was probably about a little over two decades ago. Wow. So it's quite, quite a bit of, uh, infrastructure change.
• 7:57
  Um, and obviously we couldn't visit very often, but we definitely regularly communicated.
• 8:02
  First it was by sending [laughs] physical letters via international mail, and then we got to calling cards, um, and then most recently it is through video, although the connection isn't quite consistent, but that's also through the use of mobile phones.
• 8:17
  Um, and the consistent question we always ask each other on both sides is, "Shēn ti zěnme yǎng?" which directly translated is, "How is your body doing?" Or, "How is your health?"
• 8:30
  And that's a really important question, consistent question to ask because on both sides we're seeking better opportunities, whether it was my parents and I in the US or it's our direct relatives and the extended families in rural China.
• 8:46
  Because really without our health, we can't pursue those opportunities for ourselves or for our future generations.
• 8:54
  So really in seeing how far both sides have come in pursuit of those opportunities, I know how critical it is to really keep healthy both mentally and physically, and to have access to high quality healthcare when needed.
• 9:08
  So in the global health context, the environments are definitely very challenging in terms of what we work in, and I also see those same similarities in those back, like very initially, over two decades ago when I visited the rural countryside in China.
• 9:25
  So I really know how far people can come when they can live healthier lives.
• 9:30
  And so that's why I really belong-- believe very strongly in the mission of improving global health, because it really opens the door for the most disadvantaged to pursue their own dreams and, and their opportunities.
• 9:43
  I love that. Let's talk about the Gates Foundation. It is a, it's a household name. I think it is something that a lot of folks on the call are probably curious about how it operates, how, how it really functions.
• 9:55
  So, uh, start by giving us a bit of a insider's cheat sheet about the Bill and Melinda Gates Foundation, uh, and just how it works from the inside. Yeah. Um, so the foundation obviously is very mission-driven.
• 10:10
  Uh, we like to think of ourselves as impatient optimists who are working to reduce the inequity around the world by focusing on the areas of greatest need and taking those risks that others either cannot or will not, and really making markets work for the most disadvantaged.
• 10:27
  So I work within the global health division. It's part of, um, or well, it's one of six program divisions at the foundation.
• 10:35
  So in global health, we have program strategy teams that vary from covering specific diseases such as HIV, malaria, TB, to those that are disease agnostic, so teams such as the Institute for Disease Modeling, Vaccine Development and Surveillance, and then the team that I work on, which is Innovative Technology Solutions, or ITS.
• 11:01
  And we identify the emerging technologies that have potentially transformative applications for global health and really make very targeted short-term investments to determine the viability of applying these innovations in specific areas of global health.
• 11:21
  And we will then connect other foundation programs with the most promising innovations to provide guidance on how to apply them to areas like diagnostics, drug discovery, and vaccines.
• 11:33
  And also very specifically, 'cause you, you asked for the cheat sheet, but it's quite a long cascade here. [laughs] So very specifically, I work on the digital health innovation initiative within ITS.
• 11:43
  So what that means is that, uh, we look for the proof of concept within-- with these emerging digital technologies, along with co-development with our field partners in our focus geographies.
• 11:58
  And really, we're looking for ways to upskill community health workers who are the ones that are going door to door to deliver healthcare, especially in the very remote settings.
• 12:08
  And they'll often have high school education at best.
• 12:13
  Um, and actually I hadn't realized this, realized this originally, but the concept of community health workers actually originated from China in the 1960s with the Barefoot Doctors program, uh, to serve-rural China with better healthcare.
• 12:27
  So these are very low and, uh, low resource and remote settings that are utilizing actually the proliferation of mobile technology. So now we are looking at how digital services can sit on top of that mobile technology.
• 12:44
  Sometimes it might be Android-based operating system, but because of the challenging power and connectivity issues in the environments that we work in, uh, we are often looking for offline or low connectivity services.
• 12:59
  Yeah. I wanna hear more about some of these top areas of interest that you have. You know, mentioned community health workers and these rural settings.
• 13:06
  But quick question, how does the Gates Foundation, with so many areas of interest and, uh, verticals and sections within sections, how do you handle sort of cross foundation integration, sharing of ideas, et cetera?
• 13:22
  Can you give us a glimpse of that? Yeah. So the 37 different program strategy teams fall within the divisions that I had mentioned.
• 13:33
  So that means that like the, the global health division will have about 20 program strategy teams.
• 13:40
  So we are definitely connected in terms of one division being able to see where our team, for example, that works on more disease agnostic innovations can see where it can apply to say like the vaccine delivery and surveillance team, for example.
• 13:59
  And in terms of the other divisions such as global development, which has a team in there that specifically looks at deployment and delivery of some of these innovations, we work very closely to see at what point some of the upstream research and development innovations can be at a point to deploy more broadly at scale.
• 14:22
  So it's-- it definitely has a lot of stakeholder management involved in the work that we do, and at the foundation we do-- everything i- is very relational as well to make sure that we are con- in constant communication with others so that we can approach this work overall as one foundation.
• 14:42
  Got it. You started to, to touch on this with the community health worker bit.
• 14:47
  Um, but if you could give us sort of a lightning round of sort of the top priorities that your team has, top, uh, technologies that you're exploring, the things that you're most interested in, I think this group will, will...
• 15:00
  They'll be very curious to know kinda what your priorities are and where your head's at. Yeah.
• 15:04
  So my team actually looks at the spectrum of care from prevention and monitoring to clinical assessment, diagnosis and triage to clinical decision action. So- That's a broad spectrum. Yeah, it is a very broad spectrum.
• 15:20
  So breaking it down, um, and I'll note too that when we talk about community-based setting, we are talking about level zero with community health workers who are going door to door.
• 15:29
  And so for us, level one would mean a local health clinic where it sometimes it could take a couple of days on foot in order to get there. So we're really focused on level zero.
• 15:40
  And within that very broad spectrum, um, we're focused on risk assessment and integration of population and individual priors.
• 15:48
  So that is an example of data modeling of whom to test, and also the development of AI-enabled diagnostic tools, such as utilizing a mobile device to measure a newborn's baby, uh, shape and size.
• 16:03
  And we also have a focus area on connected rapid diagnostic tests, which are similar in hardware to pregnancy tests.
• 16:11
  And we're focused on them not only being machine readable, utilizing computer vision on the results, which have actually shown to be better or on par with expert reads, but also the key there is connectivity of the test results.
• 16:26
  Um, and so some of the work that we are working on, I had joined during COVID time, was really looking at COVID rapid diagnostic tests because we had been working on ones on malaria right prior to that.
• 16:38
  Um, and then lastly, we also have a focus on behavior change systems. So this is not only about the digital tools themselves, but also on how these digital tools can be adopted.
• 16:53
  So really looking at what are some of the images that could lead to a higher successful uptake of content and protocols that would ultimately lead to high quality health outcomes.
• 17:06
  So, so those are the verticals and some of the strategies. Are there any particular technologies that you are, uh, particularly excited about right now and following up on? Yeah.
• 17:16
  So on, on what I had mentioned in terms of the rapid diagnostic tests and the connectivity parts of it. So we had...
• 17:24
  And, and these are huge in terms of being very low cost in geographies that we're interested in for a multipli- multitude of infectious diseases.
• 17:35
  And where I think, I think especially with COVID and whereas a lot, probably a lot of the world didn't know that much about RDTs before this, um, but now not only is there more broader public awareness, but really in terms of the COVID, in terms of the RDT manufacturer and governmental bodies are looking at being able to manufacture, putting more energies to manufacturing these, but also in terms of the connectivity component.
• 18:06
  So for example, um, coming back to the COVID example that I had mentioned earlier, last, uh, right, so this would've been probably like starting at last April, uh, we had convened diagnostics manufacturers of these RDT tests and had worked on different work streams.
• 18:24
  So one being the actual product development because-COVID being a new disease, needing to go through the chemistry of that, and then one on connectivity and one on market shaping.
• 18:36
  And I'll say that the connectivity one probably had the biggest challenge in terms of the manufacturers really grasping the need for connectivity.
• 18:48
  And really it wasn't until HHS mandated the reporting of all COVID, both negative and positive, um, that there was a big shift in industry overall on looking at connectivity as a requirement of the manufacturing of these tests.
• 19:08
  Gotcha.
• 19:08
  And so whereas before, uh, when we were working on these machine readable RDTs for malaria and other infectious diseases, we were working with, uh, regulatory, but certainly the speed in which the response has been to COVID has been very rapid and comprehensive.
• 19:24
  And so the excitement here is not only that this is something that we can bring to our target geographies in the Global South, but that there are, through the cross-sector collaboration essentially between government, nonprofit, and also industry, we're really getting to a place that we can-- this as a tipping point for what we had been working on prior to COVID, and now being able to see that realization more, uh, like much, much closer now.
• 19:57
  Got it. Got it. Interesting.
• 20:00
  Well, a big question I know a lot of folks in this call will have is getting down to the, the brass tacks, how does G- the Gates Foundation actually partner with, uh, health innovation startups?
• 20:13
  So let's talk about some of the details, um, you know, big company versus small, kinda how far along they typically are, how you do some of those assessments. What, what are some of the, uh, the rules of the road? Yeah.
• 20:26
  So there are, um, from a channels perspective, just so you all know, we typically don't make grants outside of our funding priorities, uh, and generally we'll directly invite proposals by contacting organizations.
• 20:41
  However, on the foundation side, we do occasionally award grants through published requests for proposals, such as those through our annual grand challenges. So I definitely invite you all to take a look.
• 20:52
  Um, I think the grand challenges RFPs usually go out sometime in the fall, so it's a, a good time to check maybe, like, right before then to see if anything has been published.
• 21:02
  So then when it comes- Two quick-- two quick que- two quick questions. Where do they look for those RFPs? So it would be... So we actually have an RFP section on our website. Okay.
• 21:14
  And then grand challenges are actually a subset of those RFPs, and I'm happy to send the link over to you and to disseminate afterwards as well. Perfect.
• 21:24
  And then second question, you said, uh, you only invest within your funding priorities. The best-- What's the best way to just know exactly what those funding priorities are?
• 21:34
  Also on the [chuckles] website, um, we actually- Same place? Yeah. Well, it's not, it's not, it's not, it's not the same subpage, but it is the same, like, core webpage.
• 21:44
  I'm hearing-- [chuckles] lesson I'm hearing here is do your research. Go to the Gates Foundation website. Make sure you do all the reading. Um, with-- S-stay within the funding priorities. Uh, know about the RFP process.
• 21:56
  Okay. Uh, continue. I interrupted you. [chuckles] Uh, so I mean, that's the...
• 22:02
  Definitely if you're able to get information on the website, and we actually recently revamped it, so hopefully it's easier and more, um, yeah, more accessible, but if not, I'm always happy to, if you wanna shoot me a, a email afterwards too if...
• 22:17
  to the extent that I know about certain funding priorities and where, um, your organization could fit in. So in terms of the investments that we make, there are two types of investments.
• 22:31
  One is called grant funding, which is probably more common of what you hear of the foundation, like giving out grants, and that's through, like, a discussion of a concept note and then a formal investment proposal, which then translates into funding, uh, given for an agreed upon set of outcomes, and these will have global access terms attached to it.
• 22:53
  So global access terms simply means that for the charitable dollars of the foundation, we're spending it in a way that contributes public good.
• 23:02
  Or, uh, especially if it's with for-profit organizations, being able to provide affordable pricing in the geographies that we work in.
• 23:11
  Although, you know, if it-- they're not our target geographies, you're more than welcome to look at appropriate business models for the other geographies, so it's more like a, a dual income or dual market model.
• 23:22
  And then really the program strategy teams that I mentioned at the foundation, they're the ones that have the agency in terms of making these grants.
• 23:31
  And then the other type of investments we make at the foundation are called program related investments, and that's a term that's defined by, um,
• 23:40
  by government, and that also covers the charitable investments made by a private foundation.
• 23:46
  So the investments there are made to support the charitable impact of program strategy teams, and really they seek to achieve impact and not financial return.
• 23:57
  So PRIs in general at the foundation, what we think they're used for are for stimulating private sector innovation or setting up more efficient markets, uh, or attracting external capital foundation priorities.
• 24:11
  So that's the role that, uh, actually a team within the foundation called the Strategic Investments Fund has, and they work very closely with the program strategy teams to gauge the interest on whether a company could be considered for a PRI.
• 24:27
  And also-Uh, in case you were [chuckles] thinking of asking, they also have a section on our website, uh, so you can look up strategic investment fund, and they'll have some examples of companies that they've invested in.
• 24:38
  Um, but let me... That was a lot of information, so let me tell you a couple of the key distinguishing features between a grant and a PRI. Perfect. And hopefully that... Hopefully it clarifies it a little bit.
• 24:51
  Um, so basically for grants, grants are more on the experimentation page, uh, and so it's limited proof of concept, and if we're working with companies, that means that the companies we s- typically are engaging in are in the stage of either Seed or Series A.
• 25:08
  Probably there's very few investors, and typical grant size would be below a few million dollars. Um, but that's, like, the cap. So [chuckles] it could, like, go, like, on the very low end as well.
• 25:22
  Um, and then for PRIs, they are for organizations that have really found their established product market fit. So for the, like, for the particular technology that they have, usually they're in Series B or better.
• 25:35
  Uh, they have very strong financial backers, and the typical investment size is about $5 million. And again, um, some of that information is on the strategic investment fund website.
• 25:48
  And I also have, uh, two examples from my team, if that's helpful- Yeah. I would love to hear it... to give a little bit more context. Would love to hear an example.
• 25:56
  Oh, and by the way, someone from our team put the, um, RFP site in the chat, so if you wanna find that link, you can. And, um, w- Annie, this has been fantastic already. You've given so much information.
• 26:09
  This is gonna be one of those fireside chats where everyone's gonna want to find the blog post we create afterwards, 'cause we're gonna break all of this down, take the recording, and make sure it's all in there.
• 26:20
  So I've been scurrying my own notes, but, uh, w- just so you know, you're gonna be able to get all of this later as well. So Annie, would love to hear those two case studies. Yeah.
• 26:30
  Uh, so on my team, in terms of a grant that we've made to a for-profit organization, this is one that combines both research and product.
• 26:40
  So, uh, it's with a pr- for-profit company in India called Argusoft, and they're actually primarily ed tech and fintech, uh, but they wanted to do some CSR work back in their home state of Gujarat, uh, which has about 60 million people.
• 26:54
  So they've developed a community health worker application, um, and they... when they came to us to partner, it was really on doing continual development of innovation on top of that platform.
• 27:05
  Uh, so that includes the integration of some of the NIH diagnostic tools, including the ones for utilizing a mobile phone to gauge the size and weight of a baby.
• 27:17
  And, uh, we essentially provided for the grant funding for that platform, and also to see if there are ways to take that to other geographies as well.
• 27:26
  And then on the PRI side, uh, our SIF team made a PRI about $10 million in a s- in Series B in a company called Halodoc.
• 27:36
  So they're one of Indonesia's largest digital health startups, um, in telemedicine and drug dis- uh, d-delivery platform with about 20 million monthly active users.
• 27:46
  The aim of the, the PRI back in 2019 was to provide more accessible care to low income and rural populations, really utilize the company's technology platforms to support pilots, which would be funded via more grant funding.
• 28:02
  And I don't know if you, if you, um, were aware, but the company had also raised, uh, 80 million in Series C last month, and really what our PRI and grant funding ensures is that there are parts of the company working on the populations that we are interested in.
• 28:23
  So on the grant funding side, my team has a specific grant in place on the behavior change component with what I had mentioned of one of our priorities and what we're really interested in, to better understand the technology based nudges that enable midwives to provide better, higher quality care.
• 28:41
  Um, because broadly speaking, unfortunately, Indonesia's maternal and newborn mortality rates reflect, uh, a poor quality of healthcare, especially since there's a poorly
• 28:53
  economic status of a pregnant woman and her access to quality care.
• 28:57
  So this is where we are working with digital health startup, for-profit, um, but really in the rural and low income populations that we are really interested in in one of our target geographies, and hoping to also bring some of those lessons to our arg- our other target geographies as well.
• 29:18
  What do you think are some of the key mistakes that startups make when they think, "Okay, maybe I can partner with the Gates Foundation. Maybe this is a source of funding for me"?
• 29:27
  What do, you know, w- what are the places where people fail, where they get it wrong? So
• 29:35
  I think [chuckles] a lot of times where we've reached the biggest barriers when it comes to talking to for-profit startups is around global access terms. So they think...
• 29:49
  A lot of times we see companies who are very excited to want to partner with the Gates Foundation, and, um, oftentimes think that, well, because it's the Gates Foundation, a lot of funding,
• 30:02
  a lot of different store- a lot of different populations could fall into that, but we are focused, uh, very specifically on low income Okay... and types of global access terms. So there's two types.
• 30:17
  Uh, one is for if you're on the research side, uh, we look for data to be open, uh, in terms of the data that's funded, uh, and to be published in open access journals.
• 30:28
  And the problem where most companiesRun the biggest conversations and headaches, I think especially with legal, is on the product side.
• 30:39
  So oftentimes this is selling a product into a particular geography, especially one that we're interested in, because we look for accessible and affordable pricing in those geographies.
• 30:52
  So that means that we are looking for like a certain, sometimes like a certain cap above cost.
• 31:00
  And again, I had mentioned earlier in a dual market type strategy, if it's something that you're selling to Global North high-income institutions, we don't really have any terms around that.
• 31:12
  But if it's to Global South geographies that we are very interested in, um, that's where we really need to have a clear understanding of what this global access terms look like for the particular work that we're trying to do through either the grant or PRI, and how we can come to a better understanding around that.
• 31:31
  I think, I think that's honestly the biggest one. Yeah. Because there can be a lot of like high level alignment and a lot of like overall social good that can be perceived to come from a, a joint partnership.
• 31:45
  But when you come down to the brass tacks of it, it's on how can the charitable dollars of the foundation fund work that flows into our target geographies at an affordable pricing or, uh, in ways in which the knowledge that has been funded is open and accessible to, to people.
• 32:07
  No, that's, that's super helpful, and I can see how that would help someone really frame their pitch.
• 32:12
  And it's also interesting just because you think about the thirty-seven different areas of interest all really coming down to this one concept of global access.
• 32:23
  And so in some ways it's so broad, and in other ways the idea is actually quite simple and narrow to say like, "Is this globally accessible? Are you hitting that, that note?"
• 32:33
  Uh, Annie, let's talk about what makes for a successful collaboration with a startup, maybe more theoretically, more generally.
• 32:41
  You know, you've got this analytics background, a-and I'm sure this group would benefit from, from hearing your wisdom about how to measure success.
• 32:50
  When you look at, uh, when you're analyzing a potential partner or a project that you've just gone through, what does it mean for, for it to be a success in your mind? Yeah.
• 33:02
  Um, and I'll actually weave parts of a answer to one of your earlier questions I realize I actually left off in my answer, which is like some of the, the pitfalls when it comes to, uh, partnering with the foundation. So
• 33:18
  in terms of a successful collaboration,
• 33:21
  at the core, and this is something that's a l-- that is harder to man- measure by analytics, um, but it's more on the mission driven alignment of how innovations work and how they become public goods.
• 33:35
  Um, and so something that is very, very important, um, where
• 33:42
  it's not a simple copy and paste of innovations from one geography to another, but it's about how, for example, we have the appropriate representation of the populations that we're trying to impact.
• 33:55
  So that's not necessarily just on the demographic side, like gender or race and ethnicity, but also on comorbidities, because, for example, there could be, um, an AI-enabled diagnostic tool that was developed, uh, in a place that doesn't have as high prevalence of HIV.
• 34:14
  And that really, uh, could interfere with how that tool was, was developed, um, in silo.
• 34:21
  And so being really aware, I think from that collaboration perspective of who are the end users that we're trying to impact and where we can measure is in some of these innovations at the core level, whether it's clinical trials, whether it's data that was collected, how representative are they of these geographies and these populations that we're trying to serve?
• 34:48
  Hmm. And also when you're talking about successful collaboration, uh, I do make a distinction between research collaboration and product collaboration.
• 34:58
  So on the research collaboration example, uh, we actually had worked with Evidation before, um, and this was, uh, conducting studies on bringing novel technologies to develop digital biomarkers for infectious diseases, namely flu, which was co-funded with BARDA, and this was actually pre, pre-pandemic.
• 35:21
  So when the pandemic hit last year,
• 35:23
  we actually were able to very quickly pivot to include COVID-19 in those studies, um, in terms of detecting the likelihood that an individual had been infected with the virus and to try and understand their susceptibility to the infection and cascading effects of the disease.
• 35:41
  And, uh, we were able to also publish a paper late last year that concluded the person generated health data could be a valid source for longitudinal real world data for detector-- detecting and monitoring COVID related symptoms and behaviors at population scale.
• 36:00
  So I think in terms of being able to quickly work with the startup, um, and especially on the research side, being able to, to publish the results and have the data be open, that's, that's a very important example of successful collaboration.
• 36:17
  Yeah. And then on the, on the product side, we worked with a
• 36:23
  company called VisualDx, and really it was to develop a low connectivity Android app while working on the ontology localization, specifically in Botswana.
• 36:36
  So this was to be used in the field by community health workers to really augment the workers and see if we canEspecially in the areas of context and priors on developing the diagnosis.
• 36:50
  So I think part of the challenge in terms of the, like, the metrics or the analytics of what you're asking for when it comes to successful collaboration is that some of these are on the research or innovation phase.
• 37:03
  So they're certainly successful if they fulfill the intended outputs and outcomes of the investment proposal in terms of was something successfully developed.
• 37:15
  In terms of the actual downstream impact, that's something that will take a little bit longer to see, because when it comes to deployment, that's actually one of the challenges, I think, in our work, where, you know, we as a funder, we don't [chuckles] actually do the-- like, like investors, we don't actually do the work.
• 37:32
  It's all on the grantees and the partners.
• 37:35
  And we can certainly convene to try and find the appropriate networks or the organizations, as Dorothy had, um, appropriately asked about, to make sure that they are the right individuals when it comes to more scale up and deployment.
• 37:53
  Um, but in general, on the innovation and research side, I think the metrics, uh, unfortunately are a little less tangible, although you can certainly measure them in terms of scientific breakthroughs on what has been proven before and what is that next frontier.
• 38:11
  What kind of characteristics in an executive team do you look for? What really stands out to you when you're looking for a collaborator?
• 38:19
  Well, what really stands out for us is really on the how, how mission-driven they are in terms of how much they believe in the work that they're doing and the impact that they're seeking to have on the world. Mm-hmm.
• 38:34
  And so I think that's, that's one of the, the biggest ones.
• 38:38
  And after that is also in terms of how they, how they approach the conversations that we have, because we often will be asking them to work in environments that they are very unfamiliar in.
• 38:53
  So when we push and ask questions like, "How representative is your core dataset?" Or, um, like specifically, "What are some of the, uh, comorbidities or additional information that you are able to collect?"
• 39:07
  The ones that are adaptable or also are open to the fact that there are additional improvements to be made, I think tho-those are the type of qualities that we are really encouraged to see in terms of the executive team.
• 39:26
  Interesting. Um, I've got a couple more questions of my own, but we're getting towards the top of the hour, so I wanna warn everyone that you've got an-another, uh, couple minutes to put a question in the chat.
• 39:36
  One last chance to ask your question of Annie, and then we'll have our, um, a chance to share biggest insights.
• 39:43
  Um, Annie, looking forward, you joined the Gates Foundation at a very interesting time for health innovation, this rapid adoption, this paradigm shift around virtual care, um, and you're getting to see this shift, uh, inside of a really transformational organization that's funding, uh, new initiatives at, at big levels and e-exciting new things happening.
• 40:07
  So I wanna ask you to sort of put on your futurist hat and sort of s-- having seen what you've seen for the last year, uh, knowing what you know about what the Gates Foundation prioritizes,
• 40:18
  where do you think we're gonna be in the next decade?
• 40:20
  W-w-- maybe, you know, highlight something, uh, one or two items that you think-- where you really see some, some exciting change that will take place over the next decade, um, based off of really this radical period of transformation caused by the pandemic.
• 40:36
  So my answer actually is going to be on the collaboration front. Hmm. And that's because...
• 40:45
  So what we've seen kind of in this last year and what we continue to see, especially in global health, is that really a lot of our work has been accelerated due to the pandemic, um, not just of our own investments and our own priorities, but also from so many different governments, so many different industry companies, academic institutions, nonprofit organizations.
• 41:08
  And we've really seen the R&D timelines accelerate, and that is really due to the collaboration at- Hmm...
• 41:16
  between all the sectors that I mentioned, because it's shown us really a new frontier for this development and introduction.
• 41:23
  So before I had been talking about more of like the, the research and innovation, but also the deployment and introduction of these innovations are equally, if not prob-- um, equally [chuckles] as important.
• 41:34
  Um, and that will actually also include applications to other infectious diseases in global health as well. So really, there will be more emphasis on infectious disease platforms rather than specific disease verticals.
• 41:51
  And as we do see, like, that recognition, understanding of the value of, of digital tools, especially on the more seamless test reporting, um, to utilizing the data towards more effective responses in battling these diseases.
• 42:06
  I think at the core, though, is the an-- is the realization that by collaborating and working together, we can push so much further.
• 42:15
  And really, uh, some of the challenges that you had asked about in terms of global health being a very long and arduous process, some of that does come from a lot of the different players involved and how we can try and work together to get to a better place when it comes to global health.
• 42:34
  And with these new precedents that are set, I hope that only furthers to accelerate a lot of [audio cuts out]
• 42:42
  doing.We started this conversation with you talking personally about, you know, your, your motivations traveling to China to visit your grandmother, uh, seeing the, um, you know, difficulty to even reach her, you know.
• 42:56
  Uh,
• 42:57
  and I'm wondering, over the next, you know, decade of your work with the Gates Foundation, do you think about the tangible impact, the positive impact that your work could have really on your own family, those communities or communities like them in China?
• 43:11
  Well, the foundation actually doesn't have, uh, China [laughs] as a target geography, so, um, I think that- that's probably a little hard, but I mean, we do have a, an office- Would you, would you like to see that change?
• 43:24
  We do have an office in Beijing, um, but a lot of that is looking at where there are innovations in China that could be potentially brought to, uh, some of the geographies that we work in.
• 43:37
  And I think in China, uh, there, there has been a lot of work that's done, actually a lot by the Chinese government, um, and really their
• 43:53
  push and drive for better economic opportunities for a lot of the populations have gotten to a lot of healthcare for the majority of the population.
• 44:04
  I don't know if on the foundation side we will end up working in China specifically, um, especially since,
• 44:14
  i- like, given COVID, with a lot of the inequities that have been exposed in some of the current geographies we work in, I think that's where we'll continue to, to focus our energies. Very nice.
• 44:27
  You know, in our, in our remaining couple minutes here, uh, you've got before you a few dozen health tech founders, and I wonder, just kind of bringing it all together, what your words of sort of exhortation or encouragement would be to, uh, to founders that would one day hope to, you know, have a huge global impact, maybe one day work with the Gates Foundation, but are, are still in the, uh, nascent phases of what they're building.
• 44:56
  What, what are your words of wisdom or encouragement to them? Well, one, I, I really applaud you in funding and, and building your own organizations to make your own lasting impact on the world.
• 45:08
  And in terms of partnering with the organization, uh, with the foundation, I would say that, um, get a sense of where your work and your priorities might overlap with those of the foundation's.
• 45:24
  And where you see an intersection and overlap, that's where it would make sense to reach out. Um, you can reach out to me or if, if you already have people that you know in the foundation within your network.
• 45:36
  But to, to really keep a, I think, like, a, a warm pulse on where the foundation is headed.
• 45:44
  Our, our strategy reviews are once a year, so they might not be very, um, short cadences to keep in touch, but, uh, I think be consistent, um, and always bring what you are most passionate about to the table, and I think that's what's most important.
• 46:04
  Well, Annie, that brings us to the top of the hour.
• 46:06
  I think I speak for everyone when I say thank you for spending the last hour with us, uh, opening up about your priorities and the prior- priorities of the Gates Foundation, really giving us a look at how it operates and its, its mission and vision.
• 46:20
  Um, we know you're a busy person, so we appreciate the time. So thanks for joining us. Thank you all for having me. [upbeat music] Thanks for listening to Startup Health NOW.
• 46:37
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• 46:43
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• 46:51
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