Leadership and continuity in a time of change: A Q&A with Mark Suzman

On Friday, July 9, Mark Suzman, CEO of the Gates Foundation, joined a conference call to answer questions from subscribers to The Optimist on a range of issues, including the upcoming search for new board members, the continuing response to COVID-19, and the foundation’s work on gender equality. Below is a transcript of the call, which has been slightly revised for clarity. Listen to the recording of the call below, and head here to subscribe to The Optimist to receive invitations to future calls.

Thanks to everybody for joining today. It’s obviously been an eventful couple of months for us at the Gates Foundation, with the announcement first of Bill and Melinda’s divorce and then Warren Buffett’s decision to step down as a trustee. But our work at the foundation, and our priorities and programs, are not changing in any fundamental way. In fact, at a time when the COVID crisis continues to challenge vast parts of the world, especially in Africa, Asia, and Latin America, all three [Bill, Melinda, and Warren] have been urging us to stay very focused on our current work.

At the same time, they have agreed to a number of steps to try and ensure our long-term sustainability as a foundation. Those steps include: First, the commitment that Bill and Melinda have made to provide an additional $15 billion to our endowment, which will bring it to around $65 billion. Warren also provided his latest gift of a little over $3 billion—he gives on an annual basis by selling a certain number of Berkshire Hathaway shares. And then, with Warren stepping down, Bill and Melinda have agreed to expand the number of our trustees, because currently we have three trustees—the three of them—and with Warren’s departure, we are down to two. So they asked me and our chief operating officer, Connie Collingsworth, to begin a process of looking at what the right kind of expansion should be, looking at different models and other practices. Then we’ll come back, Bill and Melinda will make some decisions by the end of this year, and we’ll announce additional trustees.

Then there is a final clause that Bill and Melinda have agreed to, and thought it was important to be transparent about, as part of their divorce settlement: While they fully expect to keep working together, they have agreed that, if after two years either one of them feels they cannot continue to work with the other, then Melinda would step down as co-chair and trustee and receive some personal resources from Bill for her own philanthropic efforts.

However, it’s really important to emphasize—and both Bill and Melinda have assured me, individually and together—that their long-term intent is clearly to remain co-chairs of the foundation long into the future. And they’ve been demonstrating that every day in how they’ve been showing up at the foundation and engaging deeply in the day-to-day work, from the COVID response to approving new strategies and resources for work in polio and gender equality. So essentially those are significant changes which we’re working around on the governance structure, but the main message is full steam ahead on the core work and priorities of the foundation.

As I said, we’re right at the beginning of this process and we really want to take some time to be thoughtful and deliberate. You know, we are a distinctive kind of entity as a charitable trust—we don’t actually have a traditional board, we have trustees. In trying to think through the way we operate, we also want to reflect on how the foundation has changed and grown. We used to be much smaller, with only a couple of hundred employees at the time the original trustees were set up. We only were based in our Seattle headquarters with a small office in Washington, D.C. We now have over 1,700 employees. We have offices across Asia, Africa, and Europe.

So certainly, we’ll be thinking in terms of geographic diversity, given how much of our work is overseas. We will certainly take into account gender and other types of diversity. But really the criteria, I think, that Bill and Melinda will be looking for are strong, independent, credible voices who are able to bring distinctive perspectives, whether it’s about expertise in some of the areas that we work on or just general understanding and advice on how the foundation should navigate wider global currents and issues, especially in this time of much greater scrutiny on philanthropy and the role of philanthropy. So we really don’t have more details at this stage, but we will share them when we have them. And, yes, the intent will be to have a broader and much more diverse set of voices, because that’s what we think will help the foundation.

That’s a very important question, and very timely given the COVID wave that is currently affecting much of Africa. It looks to be the most serious wave yet. I wouldn’t say the continent had largely escaped the previous waves, but COVID had not had as serious an impact as in many other parts of the world, and with the Delta variant that seems to be changing. Speaking personally, I’ve had friends and family affected back in my home country of South Africa, including an old friend who died of COVID last week. So it does make it very personal and brings home the continued massive inequities in global vaccine distribution.

In terms of the overall response, we’ve really been working both globally and with the particular process in Africa from the very start of the pandemic. Our very first grants around the pandemic were made to support the Africa Centres for Disease Control in February of last year, before a single case of COVID had even left China, to try and help build capacity for testing and training across Africa. And we’ve continued to provide significant direct support to the Africa CDC and a number of individual African countries, from Ethiopia to Nigeria, South Africa, and Kenya. In specific areas, we’ve been working very hard with the African Union on the provision of treatments like dexamethasone, the main steroid that can be used for treating people who have COVID, and oxygen provision. We’ve been working in multiple countries [through partners] where oxygen shortages have been a huge challenge.

There’s no question that the vaccine inequity, and the fact that a little over 1% of Africans currently are fully vaccinated, does leave the continent at much greater risk. I think that is something which has drawn belated attention. This is something we’ve been trying to point out for a long time.

But the world has started to take more action. The recent G7 summit did provide funding for COVAX, which is the effort for a collaborative group to pool resources for vaccines across multiple countries. The idea was to provide subsidized vaccines for what’s called the 92 poorest countries around the world that can’t provide for themselves, and also provide some additional ones for wealthy countries. And what’s happened is that they have been unable to get supply. The rich countries basically have bought up nearly all the available vaccines.

And so while COVAX has contracted [for vaccines], they have not been able to get significant supply. That context was exacerbated by a challenge when India had its huge surge, because the primary supply that COVAX had been expecting in the first part of this year came from the Serum Institute of India—actually production that the Gates Foundation helped provide support to finance the production of. India ended up having to restrict exports to deal with their own very significant COVID surge earlier this year. So that’s led to the significant shortfalls. ’s led to the significant shortfalls.

But the good news is, with the additional resources, there’s much more supply now coming on tap. So COVAX is on track to provide nearly 2 billion doses by the end of this year. We should see steady increases in supply and production in the coming months. Obviously, that is not as fast as we would like and would have hoped, but it is good news for right now. And we will be hoping, in the latter part of 2021 and into early 2022, to see significant increases.

Yes, that’s also a really important and very timely question, because last week saw the Generation Equality Forum in Paris, which was actually the 26th anniversary of the Historic Beijing Women’s Conference—that had been delayed a year because of COVID. Melinda Gates participated in that and announced our latest commitment of $2.1 billion in gender equality interventions over the next five years, with a particular focus on family planning, on women’s economic empowerment, and a new initiative on trying to encourage women in leadership. a new initiative on trying to encourage women in leadership.

One of the steps that I took when I became CEO last year was to elevate gender quality into a full division under its own president, simply because I felt it’s critical to both recognize the interventions being important in themselves and also as something that needs to lift up the work across all our other programs and shift our focuses. So, for example, in our agricultural development work, which is one of our larger strategies, we simply cannot reach the goal of improving productivity among smallholder farmers unless we recognize that women are 50% of the labor on farms but often have access to smaller plots of lands. They’re less likely to have access to credit, they have less time available to farm because they have more household duties, they’re less likely to get government extension services. And so you need a deliberate, clear focus on how to target and provide extra resources to those women if we are going to reach our broader goals. That’s also true in areas like financial inclusion and much of our health care work.

So we see gender equality both as a commitment as an end in itself, such as in the commitments that Melinda made last week, and as a critical enabler and platform for all of our wider work to be successful. In terms of where that’s concentrated, yes, the vast majority of those resources will be spent in the Global South. It includes resources for what are called women’s empowerment collectives, where we’ve invested extensively in India over the years. These are self-help groups of women that often come together around savings and other resources. They have provided a critical platform around increasing social payments for women, who are more likely to invest in their children and households. who are more likely to invest in their children and households.

So we’re very excited about this particular area of work. And we hope that the Generation Equality Forum, which led to a lot of commitments by governments, the private sector, other philanthropies, and civil society, will force much greater accountability and follow-up in these areas, because unfortunately one of the lessons of the original Beijing conference was that it was an amazing event, but there was very little follow-up. This time around, we wanted to make sure that this event is followed by systemic accountable, measurable action that lifts up women and girls.

In the United States, by far the largest part of our work is in education, because we see—and this is something Bill and Melinda feel very strongly personally—education as the best platform for mobility from poverty. And we know that, unfortunately and particularly for students of color and low-income students, that pathway to coming out of poverty is often very, very difficult and has additional obstacles. They come from school districts that are significantly under-resourced. They don’t have the family backing and resources. This is something that we’ve seen truly exacerbated in the COVID crisis as schools closed, because so many of those students did not have access to the internet or computers. We’ve seen a drop-off in enrollment disproportionately affecting Black, brown and low-income students.

So we’ve had a strong focus on that in the past year. We’re also looking now at whether there are new tools and interventions, both at the K-12 or high school level and in post-secondary education, which is access to college and universities. We recently supported a two-year effort called the [Postsecondary] Value Commission, which was looking at ways in which we could really enhance access to postsecondary education for the poorest and increase the value of that. I think it’s such a challenging situation where many students end up in debt or don’t complete their degrees, so we’re trying to look for tools to both increase access and increase the ability of students to stay in college and complete their degrees. So we have a large number of programs there. So we have a large number of programs there.

We also have an economic mobility program, recognizing that there are just additional [challenges] outside of education that do impact the ability of people to move out of poverty. We’ve sponsored a lot of work, for example, by the Harvard economist Raj Chetty, which has shown that actually mobility from poverty has slowed in the United States over the last two decades. We’ve seen challenges in other areas like eviction, when people don’t have access to housing. We’ve also been sponsoring an important set of work and data around how we limit those kinds of additional challenges, but the primary tool and the primary entry point is education.

Yes, that’s a critically important question because, you know, the reality is—as tragic and terrible as the COVID crisis has been—still many more people died of TB, HIV, and malaria over the last few years than died of COVID. But these deaths happen mostly in developing countries, so they’re less visible globally, and most of them are treatable and preventable if we can provide the right access and tools. So that’s why, when we made our COVID commitments—and we’ve invested over $1.8 billion to date in the COVID response—Bill and Melinda made very clear that would be additional to our existing resources, because we did not want in any way to try and move resources away from the critical work we do in areas like HIV, malaria, TB, and other neglected diseases.

We were particularly worried about the impact on malaria last year because the medical guidance for COVID is that, if you present with a fever, you should self-isolate and not go into the clinic. But that’s the opposite of what you should be doing if you present with a fever with malaria because early treatment, particularly for children, is so critical. There were some initial setbacks and challenges as a result of that. But the good news is those seem to have largely reversed in recent months.

We are really continuing to have a very strong focus on everything from improving access to bed nets to exploring new treatments in both malaria and TB. We’re actually [providing grant funding to partners who are] running a large clinical trial on potentially exciting new tuberculosis treatments in South Africa at the moment. HIV remains a big challenge too, and we’ve got some exciting new potential preventative treatments that we’re [funding the] research and development, and also continuing to provide and support efforts like the Global Fund to Fight AIDS, TB and Malaria, which provides antiretrovirals, bed nets, and other critical tools.

If there’s one thing I’ve learned as a leader over the last 18 months or so since it was announced that I was becoming the CEO, it’s plan for the unexpected. Because between COVID, having to shift to work from home, some of the broader challenges around diversity, equity, inclusion, and racial justice in the United States, and now obviously the recent challenges we’re facing on our own—Bill and Melinda’s divorce and related issues—it’s just very important for me to prepare for those unexpected things, but also to try and be as transparent as possible with our staff and with our partners, like those on the call.

And really one of the things that’s been most helpful and inspiring is seeing how our staff and our partners have all come together to respond to these changes and challenges as they come up. I wish I had a cleaner, better answer around that, but it’s been in some ways an inspiring experience to see how an institution like the Gates Foundation can play such a critical and important role when the world is facing unprecedented crisis of the kind of the COVID crisis that we’ve been facing, both on the health front globally but also, as I mentioned, in some of the education work and the corollary impact in other sectors that we’ve seen in the United States.

Well, there are a number of ways I could take that question. One way is just success in confronting the current COVID crisis. We exist so, and our mission is, that every person deserves the chance for a healthy and productive life. And the bottom line is we are in a world right now where that is not happening. We are seeing, again, these inequities in global vaccine distribution and in the support to those in need across the world.

So one bit of success will be: Have we helped contribute further to COVAX being able to provide those extra vaccines? Have we helped strengthen some of the health systems and structures across the developing world? To use this moment to actually have the world think much more about global health inequities? You know, perhaps one of the silver linings of the current challenge is that it has opened the eyes of the world to how frequent these inequities are and how real the dangers are of not providing proper monitoring surveillance around threats of global disease.

Within the foundation, I think success will be having a strong, expanded group of trustees. We will have strong, resilient, focused strategies in all of our work. One thing that I am excited about is, while we are going to be moving the foundation into a sort of hybrid work environment, we are going to start going back to our office in the fall. And I’m very much looking forward to being able to actually host and work with some of my staff in person. That will be one element of success as well, because I’ve spent nearly all the last year doing this remotely or on screen.