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EEC 416: Combating a Public Health Crisis with Dr. Seth Berkley, CEO of GAVI
00:31:15
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A
Foreign. And this podcast is part of a series on excellent international leadership. So I hope you will enjoy it. It's reissuing it, and it explains how these powerful leaders, what they credit their success to enjoy. So. Hello, Seth.
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B
Hi.
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A
So tell me in two minutes or a little more a little bit about your bio.
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B
So I'm a physician and an epidemiologist. My specialty is in infectious diseases. I'm from the US Obviously, and came here to Switzerland to join GAVI as its CEO about four years ago. I was involved with the creation of gavi. So I've been following it for a very long time, but felt it was the right time to come and take up the reins.
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A
And what led you to become CEO of gavi?
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B
Well, Gavi is an extraordinary institution. It is a global partnership, public, private partnership, and its goal is to try to take some of the new vaccines that are so powerful in saving children's lives and get them to children who need it throughout the world. And it's been extraordinarily successful. We've been able to immunize more than half a billion children and Prevent more than 7 million deaths over the last 15 years since we were launched at the World Economic Forum in Davos in 2000. But in addition to being able to immunize the children, we help build the health systems of countries to make sure vaccines get out. And we also work to shape the marketplace for vaccines to try to reduce prices over time, because that's important to sustaining these efforts and also to bring new manufacturing manufacturers in to create a healthy and competitive marketplace.
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A
Very interesting. And what was your leadership strategy? First of all, what was your vision when you came and what was your leadership strategy?
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B
Well, in terms of vision, GAVI started off relatively small with one vaccine and added a few more. And the challenge was there were still powerful vaccines that could make a difference. So the vision was, let's take all of the vaccines that exist that can make a difference and are cost effective and make sense for children of living in developing countries, and let's make those available. And as part of that, let's really work on trying to accelerate the effort so it moves quicker. And so, for example, we've used innovative financing mechanisms to be able to take vaccines, working with the marketplace, creating artificial markets so that we can accelerate this. And vaccines traditionally had taken 15 or 20 or 25 years to get to children in the developing world, if they got there at all. And, for example, in the pneumonia vaccine, the pneumococcal vaccine, when it came out in the West, Within a year of that, we began to roll it out in developing countries. Eventually, after three or four years, we have it in 54 countries. And as an example of the acceleration that what we've been able to do in terms of leadership characteristics, the critical issue for us is that all of this is done in partnership. And the reason I say that is we don't have people on the ground in countries. We work with country governments, we work with WHO and UNICEF and the World bank and the G Foundation and other partners who help provide technical assistance to countries and help support them. But at the end of the day, if we're able to make it sustainable, it has to be working through countries. The last thing I'll mention on this is that because we believe in sustainability, there's no free lunch here. So if you're a very, very poor country, you pay a little bit each dose of vaccine, and that's not necessarily to cover the cost, but to get a conversation going between ministers of health and ministers of finance and to get a line item set up, a foreign currency to purchase vaccines. As the countries become wealthier, they then take on a larger percentage, and then finally when they get slightly wealthier, they graduate from our support. And this is a very interesting way to work. We currently purchase vaccines for 60% of the world's children. And over the next five years, we expect to have 22 of our 73 countries graduate. So this is going to be a big transition time for us.
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A
What was some of your biggest challenges?
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B
Well, the first challenges, of course, are we're working in some of the most difficult countries in the world. Getting vaccines out to North Korea, to Somalia, to Yemen, to Pakistan. Places like this, of course, are very challenging. But the other part of this is to get a system of sustainability and to get governments to prioritize high priority actions for their citizens. You know, if you were to fund anything in the health area, vaccines would be at the top of that list. Their cost of they prevent disease, they target the future generations, people most vulnerable and have a dramatic effect on life expectancy. So this should be the first thing countries fund. And the challenge, of course, is that politically that may not be where they're driven. So part of this is getting not just country leadership, but also civil society and corporate leaders to argue for the importance of this type of work in countries.
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A
So what was your biggest difficulty in implementing this biggest challenge or even a failure? And what did you learn from it? How did you overcome it and what did you learn from it?
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B
Well, I think, you know, for us One of the great issues is how do we balance speed with care and how we work? And so, for example, you know, we're very sensitive to our donor resources. Of course, when countries are poor, we subsidize their vaccine cost with funding from our donors. And one of the things we always want to make sure is that that money is well spent. We've had now 10 cases of misuse. Each time that happens, we ask the question, why did it happen? What could we have done to make it better? And that's a very important part of what GAVI does, because we are a learning organization. The good news is that we've had 100% commitment of repayment for all of our misused cases. And so far, we've received 92% of the funds back. So with schedules for the last little bit. And for that, it's a learning experience for us. But for countries, because once they understand that they have to make good on this and they have to put better systems in place, then the idea would be, over time, that they get better and better systems, which helps them not just in vaccines, but for all of the programs they're doing.
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A
So they learn a lot on the way.
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Absolutely.
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A
So what on your career path, is there a person or a situation or a mentor with regards to your leadership?
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So what was important for me is that this is not a typical path. And when people ask me on how you get to do what, something like I do, if I wanted to be the world's best cardiologist, after all, I'm a physician. It's quite clear. There's a few cardiac centers you could go to, there's a few mentors you could work with to do something like this. And having skills in public and private sector, what you need to do is make your own pathway. And in doing that, you need to find your own mentors. And so for me, I've had different types of mentors and a number of them. The founding dean of my medical school was a physician, a humanist, a renaissance man, taught me a lot about how to be a caring physician. I worked in a ghetto clinic in Mississippi with Martin Luther King's physician and learned about what it was like and the values that were associated with that. And then I worked with Bill Foege, who was the head of the Task Force for Child Survival, the head of the US cdc, a great leader, a public health leader, who ultimately President Carter took to be head of the Carter Center. And he taught me about how to work with partnerships and work globally. So this has been my modus Operandi is to find people who have specific skill sets and to learn from them, emulate them and keep them close as mentors.
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A
So what would you say is one trait you possess that makes you an effective leader? One in particular for a lot of.
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B
What we do here, it's, I would say, grit and perseverance. These are discouraging, difficult things. And you have to go in with a sense of we can do this and keep moving forward and improvise along the way. So for me, that's a really important characteristic that has to be there. The other is to be a really good listener. Because given that this is a partnership, not all the partners are aligned. We're aligned on the long term goal, but we're not all aligned on how to get there and what each partner should do. So it's a challenge to listen to all the different points of view and then to try to piece together a way to work together to get there. And this is important because I believe that the great problems of the world will not be solved by governments, will not be solved by NGOs, will not be solved by private sector or the UN. It'll be solved by interesting combinations of these different groups working together using their comparative advantage. And that isn't always easy to do.
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A
So what do you think it takes to get all these multiple stakeholders aligned?
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Well, I think one of the challenges knowing when to lead from the front and when to lead from behind. And Gavi is not as well known as it should be in some sense. And the reason is, is that often the credit goes to the countries, it goes to our partners, it goes to the people doing the work. We don't print our name on cars, even though we're buying those. We don't print our name on refrigerators because what we're trying to do is build sustainable programs for countries. So understanding when you sit back and let others get credit and be in the spotlight. But then sometimes when there's a problem, there's a difficult issue. You can't sit back sometimes you have to drive forward and make people focus on the difficult problems that exist. You can't hide, say, well, you know, we don't really want to deal with that problem because, you know, the country's problem or it's somebody else's problem or we really can't do that. You say, look, here's a problem. How do we then align? How do we work together to solve it? That's the challenge.
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How important is innovation within your company? And would you say you have an innovative way of leading innovation is absolutely.
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Critical to what we do. And the reason GAVI was set up outside of the un, even though we work closely with it, is allowing us to have that iterative loop that's necessary for innovation. So let me give you a couple. I mean, there's dozens and dozens of examples of innovation. But GAVI was the first organization to do a program we call ifm, the Innovative Financing Facility for Immunization. So the idea was, instead of getting donors to donate on a yearly basis, could we get a financial commitment over a very long period? In this case as long as 20 or 25 years? With that legally binding commitment, you can then go out to the capital markets and raise money. But you can do it any time during those 25 years. So what you're able to do, if you want is to front load the money is to actually, even though the money's getting paid out over 25 years, you can use that process to allow you to bring money up front, which then can be used to jumpstart immunization programs and make a difference. Another example is we've been working very hard to try to engage in the Islamic world. Very important. Many of our countries, 50% of the children, live in Organization of Islamic Cooperation countries. And in doing that, we actually have recently floated a sukuk bond, and this won prizes for the largest ever sukuk for social good. A sukuk bond is a bond that conforms to Islamic requirements for fundraising. And so we're constantly asking, how can we do a better job and how can we engage? And just to finish that story, it turns out a lot of the bonds we did were in the Uridashi market in Japan at the time. The interest rates and the payments were very good. But. But turns out they were extraordinarily popular because bonds in Japan are often bought by older women. And they love the fact that they had stable bonds, good return on investments, but that these bonds were saving children, they were vaccine bonds. And so they sold out very quickly.
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Very interesting. So on management level, how do you motivate people who work for you?
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The interesting challenge at GAVI is slightly different. Because of our mission, we have people who are incredibly passionate on the mission and what we're doing. And so the issue isn't how you get those people motivated. The issue is how you prevent them from working 247 and burning out. And the challenge, of course, is there's so much to do that we have to control what new things we do. And so, for example, we were flat out working, trying to do what we do. And then Ebola occurred and we became engaged in how we would work to make sure if a vaccine worked for Ebola, it could be rolled out. That was the on top of existing work, we didn't have any additional capacity. When polio got close to the end game, the world said we need to switch vaccines. And who's the best group at introducing new vaccines? Well, it's Gavi. We've introduced 280 new vaccines in these countries. So the community came to us and said, do that again on top of our existing work. Now, of course, over time we're able to hire more people. But you know, when you want to get something done, go ask a busy person is the way the quip goes. And so in this case, our best staff ended up having to take on additional work. And so for me, motivation isn't the problem. It's making sure that people are able to pace themselves as much as possible and that we provide support for them, given the pace and engagement that they have in their work.
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So how do you make sure that they pace themselves?
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Well, part of that is having a conversation with people, Part of that is having the systems in place. And in an organization that has grown as fast as GAVI has, you know, we're operating now at about $2 billion a year in turnover. This has been a challenge, building the systems in place that are able to help people with their work. And so we're constantly asking how we can do a better job. And you know, in one sense you have to have systems, you have to respect them. But at the same time, if you don't live in an environment where people can question. So the rule here is it's fine to question it, but when you question it, come with a suggestion. So don't just say, I don't like this system. Come and say, this system would be better if we did the following things. And then we have to balance based upon. You can't change all the time. On the other hand, you can't be static with systems that could be improved. So this is part of the iterative learning process that we constantly go through.
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On a more global scale. What do you think are the biggest challenges leaders have today?
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I think that the biggest challenge, and it's particularly true for an organization like gavi, which is a knowledge organization, is that our staff, you know, we don't have a hundred year history, we don't have a mandate like the un. So what we are are the people who perform here and the way we perform and the metrics that show how effectively we perform. So I think one of the greatest challenges is how do you. How do you attract great people? How do you keep them motivated, as we talked about, and keeping them from burning out? And then how do you make sure that they stay with you? Because every time you lose somebody who has the knowledge, it's very hard to replicate that. So there's two parts to that. One is building the system so we can capture that knowledge. So if we do lose somebody, which of course happens, we have that knowledge there. But the other critical issue is we work in a global environment. We have people from 40 countries at GAVI. So making sure that there's a good environment to allow cultural sensitivity, to understand that communication is very different based upon what culture one comes from, and to have that type of environment that make people feel welcome and able to work in that situation is absolutely critical to the work we're doing. I think more and more that's going to be a leadership challenge, because, yes, there will be some enterprises that are local. I mean, your hair cutter will be local, your plumber will be local. But more and more, we're going to be thinking about these problems and issues on a global scale and managing a global workforce and all of those differences that occur. That's going to be a very important skill.
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When you hire somebody at Gavi, what kind of profile do you look at?
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So, I mean, critical is obviously what the job is and the particular skill sets of the job. But then how do you find somebody who is able to manage change? Okay, somebody who is able to work in a multicultural environment, somebody who is able to jump in and work on their own when necessary, and for many of our jobs, is able to travel and able to work in situations where you need, in one sense, the drive to try to make things happen and perseverance and engagement, as we talked about before, on the other hand, you sometimes have to have the patience of a saint. And I lived in Uganda for three years, and as an impatient New Yorker, many of my friends said, you're not going to survive there. And I joked afterwards, I said, I got a PhD in patience because, of course, I had to work at the pace that people were used to. But if I completely let down my drive, I wouldn't have been as useful as I ultimately was because I also worked to help drive things forward and make urgent things happen at a quicker pace. So getting that balance right is important.
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Can you explain the impact, if any, that social networking has made on your organization and on you personally?
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So my previous Organization was the International AIDS Vaccine Initiative, which was an innovative organization which I founded to try to accelerate the development of an AIDS vaccine for developing countries. And at the time we were kind of a little bit David and Goliath. We started from nothing and ultimately raised more than a billion dollars and accelerated vaccines and really got a lot of attention. And at that point I remember having maybe 20 what I would call a level reporters. These were reporters who had my home phone, I had their home phone and I trusted them. I could call them up and talk off the record. And it made communications pretty easy because when stuff would happen, they would call me and we would discuss these and they had the background. That's completely changed within one year. That's a number of years ago. I think 16 of the 20 were no longer specialized health reporters. And before you knew it, we started having sports reporters and, you know, leisure reporters talking to us. So they didn't necessarily have the background, didn't know what was happening. A lot of mistakes occurred and now it's shifted even more. And one of the exciting things about the social media world is that you can use that to get the message out, get it out globally and get it out correctly through your voice, through the information systems that you have. And so I think that's been the really positive part of it. The negative part of it relates to some of the anti vaccine movement. So, you know, anti vaccine movement is often filled with misinformation. And so if you're sitting in a developed or a developed country, I mean, here in Switzerland, our coverage rates for measles are well below 90% where they should be. And they're, you know, we see this movement in many countries. If you go on the Internet to get information on vaccines, you could go to a very reliable site and get the right information, but you could also be directed to a site that has a name that sounds like it's reliable, but in fact is a site that is filled with complete misinformation. And this creates a huge problem because vaccination is about trust. It's about mothers taking their healthy children and getting these vaccines. And so when misinformation spreads, it not only can cause outbreaks of disease, but it kills people. And so one of the challenges then is how we balance the useful parts of social media with the problematic nature of it.
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What advice would you give a new leader that's gone into a leadership position? What tips advice would you give?
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Well, it's interesting, if you go back to the management literature OR management training 50 years ago, it was a very static phenomenon. It was a very hierarchical phenomena. People learned a set of critical skills, and they just implemented those. I think the most important thing for a leader today is that they have to be able to balance. I mean, the world is changing constantly. We have not only social media, we have changes in geographic locations and locus of power. We have new ideas and thoughts coming from around the world. So, you know, the leader of today has to be a little bit of a Renaissance man, understanding all of the different activities that are important in going into this, you have to keep in touch with the trends that exist across the world. You have to keep in touch with social media as well as the technical aspects of your work. You have to be a good communicator. You have to be a good strategist. You have to be a motivator of people. So there's a lot of changes that have occurred. And I think, you know, today the best leaders are ones who can play across all of these different spaces and do it convincingly. And I would say at the end, with heart, because at least in the type of work that we're doing, having sincerity, understanding what you're doing really matters to people's lives is really important and gives you credibility in the way you speak and the way you communicate, the challenges in front of you.
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So what do you do to continue to develop as a leader?
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Well, first of all, I try to look carefully at things that go on well outside of my area. So when I go, I attend, for example, the World Economic Forum every year. And when I go there, of course, I'm on panels that relate to my area, But I also go and try to pay attention what's happening in the banking sector, what's happening in a manufacturing sector, what's happening in completely different areas, because it helps me understand what techniques might exist, the new work that's gone on to automate activities, to use new tools to create efficiencies. These are things that one has to keep up with. And so I read the Harvard Business Reviews, I go to other leadership meetings, and when I'm traveling around, you know, I'm always asking questions to see, are there better systems, are there better ways of doing things than we are currently doing that? The other advantage of having such a diverse staff is that, as I mentioned, people come from all over the world to join Gavi, and we are constantly asking them, if you think things could be done better, tell us. And so often this bubbles up for staff. So you're, in essence, more of a servant leader than you are A top down leader. So the best ideas might come from a very low staff member who says, gee, I was working in a country on the other side of the world and we had this system that was really interesting and here's the way it worked and that's how we then find new ways of working. It's important not to be rigid, it's important to be fluid and to keep your eye on the prize.
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A
Very good, thank you very much. Is there any last message you want to give our listeners?
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B
I think an important question for many people today is what sectors they want to work in. Traditionally people have started out and said, well, you know, I want to work in the for profit sector, I want to make a lot of money or I see a good career path or I want to work in the not for profit sector and you know, have a lot of heart. And I think again the changes that are occurring, what's very interesting is people moving back and forth between those sectors and what that does is allows ones to use the tools that exist in the private sector along with some of the more socially important driving forces, mission areas of the public sector. And here at Gavi we have quite a mixture. We're almost 50, 50. It depends upon the period of time between public and private sector backgrounds in our staff. And that leads to a richness in and problem solving and engagement that wouldn't exist if everybody was coming out of the public sector or frankly if everybody was coming out of the private sector. As I spent time and earlier in my career, I spent a lot of time working on different corporate boards for large companies, small companies. Of course I had to stop most of that because here at Gavia, I want to make sure there's no conflicts. But it was very important because as somebody who grew up in the public sector, I thought, well, that private sector, they really know how to do things and turns out that it's different but it's not necessarily better. And I think you learn lessons if you move back and forth that help you in both of those sectors. So I think that's an important thing for people to think about as they set up their careers going forward.
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A
Thank you very, very much, Seth. That was great.
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B
Thank you for listening to the excellent executive Coaching podcast. You can subscribe subscribe to all future podcasts@excellent executivecoaching.com join us each Wednesday to learn more about the latest trends in leadership techniques and bring your coaching to the next level. To learn more about Dr. Burris CEO mastermind, use the contact form@Excellent Executive Coaching.com.