Reflecting on the evolution of the foundation: A Q&A with Mark Suzman

On Wednesday February 2, 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 his first inaugural Annual Letter, the recent announcement of new board members, the co-chairs' continued commitment to the foundation, the impacts of 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.

THOKO MOYO: Mark, good morning. I just want to say, this is the first time we’re doing this on video and it’s my first time hosting. I should probably start by introducing myself. My name is Thoko Moyo. I joined the Bill and Melinda Gates Foundation about seven months ago as the Director of Global Communications.

It’s been a really busy, fantastic seven months, lots happening, some of which we’re going to talk about today with our CEO, Mark Suzman, but let me start just by formally saying, welcome to everyone watching. Thank you so much for subscribing to The Optimist. We really appreciate the engagement, the questions, the suggestions that you send us, and we’re really honored to have so many of you RSVP to join us.

I should note before we get started, I want to wish everyone that’s celebrating a very happy Lunar New Year. And I also want to say to the people in the U.S. where I am, a happy Black History Month, we’re into day two. And I guess if we’re looking for one more thing to sort of call out, happy 2/2/22 because today’s the second of February 2022. Lots to call out!

Why don’t we get started? Mark, we got over 500 questions for this subscriber call. There’s a lot of interest in the news at the foundation that we’ve put out in the last couple of weeks. You published your first Annual Letter as a CEO of the foundation, and you also announced a new board.

Why don’t we start with your letter? You reflected a little bit about your time in the foundation. Tell me, how has the foundation evolved in the 15 years that you’ve been here?

MARK SUZMAN: Yeah, it actually was a complete coincidence that the announcement of the board coincided with literally the week of my 15th anniversary at the foundation. I used my Annual Letter a little bit to just reflect on the evolution of the foundation in the time I’ve been here because it has changed dramatically, not changed in terms of our focus and our priorities and our core mission – which remains a world where every person deserves the chance to a healthy and productive life, and our focus is in areas like global health development and education in the U.S. But really in how we engage, how we partner, how we try – and I quote Graca Machel (who I actually quoted from a Q&A I did with her when she visited the foundation, she’s an amazing leader in her own right in Africa on many dimensions) about how we need to listen with respect to partners because it’s difficult for a foundation like ours.

I sort of reflect a little bit on how we’ve changed and built our international offices. When I joined, we had no international offices at all, and now we have large and growing presence in China, India, in several African countries, Ethiopia, Nigeria, South Africa, and with partners in Europe and Japan as well.

All of these are just part of how we’ve sort of changed, grown, adapted, tried to get smarter and better about how we use our resources, and it was a nice occasion to reflect on that.

THOKO MOYO: And congratulations on your 15 years. I think you’re coming into three years as CEO as well.

MARK SUZMAN: Yes, lots of anniversaries.

THOKO MOYO: Lots of anniversaries!

Let’s turn to the board of trustees and the governance announcement. I know there’s a lot of interest in that and a lot of curiosity. We got questions about the foundation, how and why they were chosen, and what’s next.

Let’s start with this question from Jessica Milman, who asked, how will the foundation’s governance actually change with the addition of the new board members?

MARK SUZMAN: We have always had, I’ll call it, a slightly unusual governance. Originally, our board used to have three people on it, Bill and Melinda and Warren Buffett. And it met only once a year, in May normally, to approve the annual budgets and our longer term plans.

With Warren’s decision to step down last year from the board and other changes, obviously including Bill and Melinda’s divorce, but also the death of Bill Gates Senior, who had been an honorary co-chair and was a great voice and mentor and leader around the foundation, we thought it was important to be able to strengthen that governance and bring in some strong outside voices.

What we’ve done is added four new board members. We now doubled in size, we have six members. I am joining the board in my capacity as CEO, and then we have three amazing new people, Strive Masiyiwa, Minouche Shafik, and Tom Tierney, who I’d be happy to talk a little bit more about.

The board will now be much more like sort of a formal, regular board, which will meet three times a year. The board will have the formal authority over our budget and annual planning. It will engage deeply on some of the key strategic questions we’re facing from our diversity, equity, and inclusion work, to how we’re working to strengthen external partners, to how we navigate the changing currents of philanthropy today. And so, we actually have our very first meeting of the board next week, in just six days, and I’m really looking forward to it.

THOKO MOYO: Mark, the question that’s on a lot of people’s minds is, is this board really going to challenge the way the foundation does its work. Have we just brought in people that are our friends, that are part of an exclusive group? Are they really going to challenge us?

MARK SUZMAN: Absolutely. Let me say two things. First, we unequivocally remain a family foundation. This is the Bill & Melinda Gates Foundation. Bill and Melinda remain co-chairs. We’ve been clear and they’ve been clear with the incoming board members that we are not looking to change our mission or change our priorities. Those are set.

What we are looking to do is be challenged to be smarter, better, and more effective. The issues and topics we work on are incredibly complex and difficult. We know as a foundation, particularly with the resources we have, it’s difficult to get honest feedback. Many of our partners are not really incentivized to give us hard feedback or honest dialog because they’re often looking for partnership or resources.

And so, what we were looking to do was select people who already knew us, [individuals] that Bill and Melinda had personally worked with and engaged with in some capacity, and they had worked with us, so were eyes open about what the foundation is and how it operates. And who also had amazing expertise and background that could really add value to helping us make better strategic decisions.

And in each of them, I think that’s exactly what we’ve got. Strive Masiyiwa, who is a long-time business and philanthropic leader in Africa, has been engaged in development issues for a long time, both through his and his wife Tsitsi’s private philanthropy in areas like education, but also he was chair of AGRA, which is our major partner looking at agricultural development in Africa, where he succeeded Kofi Annan.

He worked with Melinda and Sri Mulyani Indrawati, who’s the Indonesian finance minister, chairing a commission a couple of years ago we called Pathways for Prosperity, which was looking at ways for technology to help leapfrog and accelerate development.

And most recently, he’s been the African Union Special Envoy trying to tackle vaccine inequities and bring in treatments and other supplies to combat COVID. In that capacity, he’s been quite publicly critical of initiatives like COVAX, which we have been supporters of, which certainly as of last year, had not been meeting the targets that we’ve had for servicing Africa.

Similarly, Minouche Shafik, who is now the head of the London School of Economics, is a longstanding global leader in international development, having had senior positions at the IMF, the World Bank, running the UK’s development agency, the Bank of England.

And for people who are interested in this, she has an amazing book out, a new book called What We Owe Each Other, A New Social Contract, where she challenges and pushes in a range of areas, including in gender equality, which is one of our core priorities.

And Tom Tierney, who’s the third, is a longstanding, deeply thoughtful adviser and leader in the world of philanthropy generally. How and where is the best use of philanthropic dollars, that’s a challenge that we have to think about all the time because we don’t want to displace or substitute government or private capital.

And so, each of them really bring an acute sense of where the foundation has strengths and gaps, and absolutely, I have no doubt will be challenging us privately and potentially from time to time publicly as well to make sure we’re doing better.

THOKO MOYO: We have the independent perspectives. What about the question of diversity? How did that factor into the selection?

MARK SUZMAN: Well, these are people who bring a diversity of expertise, of knowledge, of their own backgrounds. But the board can be, it’s starting at six people, it has provision to be up to nine people, and we are actively looking at potentially additional members who would broaden our technical, our geographic and our gender diversity.

But we have made a commitment last May that we would announce a new board by the end of January, and we wanted to meet that deadline. That’s why we came with this group. But we’re very excited to have them. We think this is a strong group in its own right and hopefully we will add some really good people as well in the future.

THOKO MOYO: Yeah, that’s actually a question that Kate Grant had asked about whether or not we planned to expand the board at any point.

Let’s go back to what the board’s actually going to be doing and the impact that they’ll have on the foundation. You mentioned that there won’t be any strategic program direction or grantmaking, any changes in our program direction and grantmaking. Can you just talk about that a little more. Do you see the board influencing that? Do you anticipate change?

MARK SUZMAN: Well, I want to separate out what I mean by our priority focuses, which is to say, we’re not going to shift, if there was a proposal that we should be shifting our priorities to heavily working on environmental issues, for example, we wouldn’t do that. Not because they’re not critically important, but that’s not our priority.

We have selected over the last two decades areas where we think we have particular expertise, where there are gaps and needs that philanthropic capital can fill. Those are particularly in the global health space where you have huge needs across infectious diseases that disproportionately affect the poor and other challenges, but also in areas like agricultural development, financial inclusion and, of course, education in the United States, where it’s a critical ladder for particularly Black, Brown and low-income students to engage and find a path to success. And so, those are the things that are not changing.

Within that, we absolutely are looking for ways to change, adapt, shift our investments, shift our pockets, shift our approach. To take two examples that are shifts we’ve made recently (and that I think the board will help us look at future ones) is we’ve been increasing our focus on gender equality year on year. Not just as a sort of slogan, but as a deeper part of what and where can we invest, and not just in our existing programs, but in key areas like women’s economic empowerment or specific health needs for women. We’ve expanded that budget and we’ve expanded our range of partnerships.

Similarly, we recently announced a set of expanded investments in climate adaptation. I said we don’t focus on the environment particularly, but we do focus on it in the sense linked to our agricultural development program, because we know that it’s the smallholder farmers, the rural poor, largely in South Asia and sub-Saharan Africa, who are already most impacted by climate change. And there are big gaps in trying to help them adapt. How can you get more drought or flood resistant crops or livestock, better techniques for managing water and soil, etc.

Those are the kind of areas where, again, we expect the board to engage and help us think about where we should make strategic shifts and strategic shifts in positioning, but it’s within that overarching framework of our core priorities.

THOKO MOYO: There’s a question that comes up time and again about the commitment of the co-chairs, particularly Melinda. We all know that there is a provision that should they not be able to work together, this is in the public domain, that she has the option, if she chose to, to leave the foundation. There’s just been questions about, well, how committed is she? I think a lot of it’s coming off the back of their divorce. What’s your engagement been with the co-chairs so far and what can you say about that?

MARK SUZMAN: We felt it was important to be transparent that that clause exists. It’s a clause in Bill and Melinda’s divorce settlement that says that Melinda could leave at some point.

But let me be very clear that Bill and Melinda are both fully committed to being the long-term co-chairs of the foundation. That that’s a commitment that they’ve made to me, that they’ve made to the incoming trustees, and that we see every day. I see it in private and public interactions.

They just in the last year since their divorce have been jointly engaged, making a number of big external commitments, which we’ve made on big increases in support in our nutrition work, in our gender equality work, and climate adaptation I already mentioned, in our recent reupping support to the Coalition for Epidemic Preparedness Innovations.

And internally they are engaging. They lead our COVID response meetings on a regular basis. They jointly approve each of these new areas of work that I talked about, like climate adaptation and gender equality. And so, they are really fully engaged and it’s great to see.

Obviously, we’ll be working a new model with the board. As I say, our first board meeting, we’ve announced the board, but we haven’t had a meeting. Our first meeting will be next week. And so, we’ll be working out I think a clearer dynamic of how we onboard the board members, make sure that they do have the space and platforms to engage with Bill and Melinda, and with me and with our other leadership. But we’re full steam ahead.

THOKO MOYO: I had my first opportunity to be in a meeting and actually see and hear from Melinda, and I got the same sense of energy and forward-looking and excitement about the foundation. But it’s a question that comes up, and I think it’s one that we’ll need to continue to answer in the way that you have.

I want to make sure I tackle the main questions that have come in. Like I said, we had over 500 questions. I hope I’ve picked the ones that are really representative of the areas that our subscribers and partners are really interested in.

Let me go to a question that came from Saunand Somasi in India. The question they were asking was, have other widespread diseases taken the backstage due to COVID, the pandemic, and what about routine immunization programs? I guess as you reflect on the future of the foundation, how has the pandemic impacted on work and going forward?

MARK SUZMAN: I would refer people, if you haven’t seen it, to our Goalkeepers Report, which came out last year and documented some of this.

But the short answer is yes, there has been a knock-on impact on other diseases that disproportionately affect the poor, that we’ve seen setbacks and slowdowns in our HIV and malaria work.

Malaria, after two decades of steady progress and reductions in malaria cases, has seen an uptick in the last year. In routine immunization, you mentioned there were big disruptions immediately after COVID first came on the scene in 2020, 2021. But more recently, there have been catchup campaigns coming up, so we’re addressing it.

But yes, there have been real setbacks across that and a lack of focus and prioritization because people get very distracted by COVID. I don’t mean distracted in a bad sense, it clearly needs to be a top priority, but you want to make sure that malaria, for example, which remains the largest killer of children in Africa and across the world, is fully addressed, that we don’t slow down our bed nets campaign, that we don’t slow down the work to develop a malaria vaccine. We have the first one of those approved last year, which was exciting, something that we have invested in over many years.

So yes, that is a real challenge and it’s something we’re very focused on, and it’s also why we made sure that all of our COVID work and our pandemic response have been additional. We didn’t want to displace any of our resources that were focused on the core areas of the other health needs, because those needs had only grown.

THOKO MOYO: I think you say that in your Annual Letter, you talk about our role being complementary and additive. Maybe just expand on that, now that you’ve started mentioning the additive role.

MARK SUZMAN: Well, in anything we’re looking at, we’re looking for where can we make a key difference. Malaria is a great example. Malaria is a huge killer and disruptor across the developing world still, especially in sub-Saharan Africa. It also has massive, long-term impacts beyond death with what we call morbidity. When people are sick several times with malaria, it affects economic productivity, it affects their ability to work. It affects economies. It’s a huge, huge burden on many developing countries.

But there’s been very little research into things like a malaria vaccine because for high-income countries, it’s a problem that’s largely been solved. And for people who are, say, traveling, there are prophylactics. You can take some pills and make sure you don’t contract malaria while you’re in a malaria region.

It’s that kind of gap where we see philanthropic capital having a key role. We then step in and say, okay, if there isn’t a market and these pharmaceutical companies are not investing in a malaria vaccine because they don’t see a market in high income, can we help create the market, can we help put in some of our resources to ensure that we are doing that work, that we can get more advanced there.

We recently had challenges with bed nets, which are a critical malaria prevention tool. [With] the insecticide we used, mosquitoes were learning to, or had evolved, to become resistant to it. We had to work to develop some new types of insecticides to put on the bed nets to make them be more effective.

Those are the kinds of areas where we look for a gap and try to find a space where the Gates Foundation’s resources and our technical expertise – always working with partners. In this case like the Global Fund to fight HIV, TB, and Malaria, and the countries themselves, but that’s a good example of how we try to operate.

THOKO MOYO: Earlier, you mentioned that we’re expanding our work in gender equity, and that was actually a question that came up from Beth Fredrick at John Hopkins. She wanted to know, how is the foundation integrating gender equality throughout its priorities, programs and investments? I think it’s worth going back to that. That’s a question that we hear a lot. So maybe you just want to dig a little deeper into that as well?

MARK SUZMAN: Yes, well, it’s two way. One of the things I did on becoming CEO was actually create a new gender equality division with a president to elevate it. But it’s a division where I’ve been clear that it’s a both/and. We have a gender equality division with its own budget and core priorities in areas where we can engage, which is focused on issues like women’s economic empowerment, getting better data around gender equality, helping look at key interventions and in health and economic development.

But beyond that, it’s also trying to be an enabler across all of our work at the foundation. The risk has always been that if you have a gender equality division, some of the other parts of the foundation don’t see that as a core responsibility for their own work.

And so what we’ve done in addition is we’ve made sure that literally every grant we make has what we call a gender integration marker. We have to look at and talk about, the program officer has to write about what the potential impact and role is around in terms of its impact on gender equality.

Because even in our research and development grants, it is really important to take a deliberate focus to think about. For example, whether potential treatments or interventions are designed to support the needs of women, whether it’s access to clinics to bring kids in for vaccinations or women smallholder farmers (to take an example where in our agricultural program, we know that women overwhelmingly have access to smaller plots of land), that they’re less likely to get access to credit, that they have less time available to farm because they have more household duties. But they are 50% of the labor force in most developing countries. And so unless you have a specific targeted approach that brings them in, we’re not going to meet our broader targets around reducing agricultural poverty or improving productivity.

Those are the kind of ways we’re trying to build it in. It’s an ongoing challenge, if you like, because it has been underprioritized globally. We’ve seen it in the Generation Equality Forum, which Melinda participated in, which was trying to elevate them and raise more resources for this work. But it’s something that we now have embedded into pretty well everything we do.

THOKO MOYO: We’re coming close to time, but I do want to make sure we get a question in about sort of our regions. You mentioned earlier that one of the things that you were tasked with as you started the foundation was thinking about how we can get closer to communities, opening up offices in different parts of the world that we work in.

We got a question from Simon Okelo, who wanted to know what the Africa strategy is at the foundation over the next decade.

MARK SUZMAN: Well Africa, as you and I both know, is 54 countries. We don’t have just a straight continental strategy, but we know that it is an area of the world where many of the needs are greatest, particularly in the areas of global health and agricultural development that we talked about.

As I mentioned earlier, we have three offices on the continent currently, in Addis Ababa, in Abuja, and then Johannesburg. And we work pretty well across the continent, directly and indirectly and in every country.

What we try and do is combine sort of specific work, for example our Nigeria office will work both at the federal level and at the state level. We have MOUs with a number of states like Kano or Kaduna in the north around expanding primary health care. We have particular partnerships in areas like Lagos, where we’re testing new models of digital health.

We’ll have those in other countries as well, but then we’ll pull back and work with regional authorities. One of our strongest partners over the last two years has been the Africa Centers for Disease Control and Prevention, which was initially created after the Ebola crisis. We helped provide very early resources in the COVID response, as I write in my letter, to help them support all African countries get the capacity to do full testing for COVID. And we’ve made multiple subsequent grants to them over the course of the two years of the pandemic.

It’s a mixture of engaging with regional partners like that, the African Development Bank, the African Union, SADC, and then working on the ground in the countries and expanding our partnerships with organizations and partners on the ground.

THOKO MOYO: We’ll certainly have opportunities, I’m sure, in future conversations to talk about our strategies in different regions of the world and sort of get into that a bit more.

We’re almost at time, but Mark, I cannot let you go, I cannot end this conversation without asking you a question that was actually sent in by a very eagle-eyed subscriber. It’s to do with the photograph, the image that’s on your annual letter. You’re standing with, I think it’s Dr. Kelly Chibale at the University of Cape Town. You’re both wearing lab coats.

Now, if you look really closely, yours says “Andre H.” Now, unless I’m missing something, who’s Andre H? It’s not you.

MARK SUZMAN: No, it is definitely not me and it would be very dangerous to let me go unsupervised in any lab because I don’t have real expertise on that.

But this actually was the last major trip that I was able to take because travel has been so restricted by COVID, where we were visiting the lab that’s run by Dr. Kelly Chibale next to me at the University of Cape Town that we support, which does your amazing research and development work across a wide range of global health interventions.

I had to borrow a lab coat. And so Andre H., who I’ve since found is a very generous scientist, who also noticed it apparently, and has occasionally asked for it back.

THOKO MOYO: So you did give it back?

MARK SUZMAN: I did give it back, yes, Someday maybe I’ll get a lab coat with my own name on it.

But really, it was just that that was a great event and I hope sooner rather than later, obviously, depending on the course of COVID and other things, that I’ll be able to do many, many more such visits around the world.

THOKO MOYO: I think that’s all we have time for, Mark. Thank you so much for making this time, and especially thank you to all our subscribers and our partners and our colleagues who joined in to watch today.

We’re always eager to hear from our subscribers, so please send emails to [email protected], if you ever have story, ideas, questions or just comments.

Mark, I really appreciate your interest, we appreciate your time. It’s really been fun. I think video works, doesn’t it?

MARK SUZMAN: Well, thank you Thoko, for the questions, and thanks as always to everybody for engaging, for taking time to listen, to support. I hope you keep reading our newsletter. Send us thoughts, advice, comments. It’s not just our new board members we want to listen to. We’re very interested in opinions from all over us. Thanks.

THOKO MOYO: Thank you. Good night. Good day.