1 Big Idea to Think About

  • Prevention is often overlooked when attempting to create leverage. But, when you prevent a problem, you intercept a problem that would be massively discombobulating. One of the best bets you can make in your life is to prevent problems when they are small and more manageable.

1 Way You Can Apply This

  • Be the optimist in the room. Realize that while we face big challenges, the solution starts with small steps. And there is always something that can be done to move a solution to big problems forward.

1 Question to Ask

  • What is my natural reaction to big problems? Am I optimistic or pessimistic? And how might being more optimistic help me or those I work with achieve the solution faster?

Key Moments From the Show 

  • A “listen-first” strategy – Dr. Shah’s interactions with Bill Gates Sr. (3:11)
  • How to communicate during big bets (7:25)
  • The foundational importance of children’s health in overcoming poverty (13:22)
  • It’s realistic to be optimistic about solving the world’s biggest problems (27:30)
  • How to tell a better story about solving the problems we face (32:38)
  • Making a big bet on controlling the Ebola epidemic (34:52)

Links and Resources You’ll Love from the Episode

Greg McKeown:

Welcome back, everybody. I’m Greg McKeown, and I’m the author of Essentialism and also Effortless, two New York Times bestsellers. But really, in those books and beyond, I am here with you on this journey to learn and to share the things that I’m learning along the way. 

Go back with me a few years ago. Do you remember that there was an unbelievable outbreak of Ebola in West Africa? Every day the news explained how more cases had been discovered than the day before. Perhaps you remember, as I did, how close we got to a full worldwide pandemic of a completely different level than the Covid pandemic that we all experienced and went through. We got so close to something that would’ve been more like the Black Plague that destroyed half of Europe. A curse so strong it’s a miracle that humanity even survived it. And maybe you don’t remember it because, after all, it’s closer to 10 years ago now and because it didn’t turn into that. 

In Effortless, there’s a whole chapter that I give to the powerful idea of prevention. When you prevent something serious from happening, that is often 10X leverage because you intercept a problem that would be massively discombobulating. We will explore this in part two of my conversation with Dr. Shah. 

Dr. Shah is the president of the Rockefeller Foundation right now. He previously to that was responsible for USAID, including being on the very front lines of the response to that Ebola crisis. Now, you may never have heard of Dr. Shah before. You may not have followed the story especially closely, but you can be absolutely sure that the work that he and others around him did prevented an unbelievably dire situation from happening around the world. As is often the case, we don’t always remember the people that prevent problems. That’s part of the problem. That’s the disincentive. But in this episode, we get to celebrate somebody who did. And whatever our political persuasions happen to be, we can be grateful that people like Dr. Shah have stepped up to contribute in their way so that we can contribute in our way. Let’s get to it. 

My invitation at the beginning of today’s conversation before we really get to the podcast is to go and read the chapter in Effortless about prevention. It’s the final chapter before the conclusion. 

I want to come back for just a second to what you were saying about Bill Gates Senior. Can you share a little more about your interactions with him personally or what else you learned about this? Let’s call it listen-first strategy.

Rajiv Shah:

Well, he was just an extraordinary presence. He’s very tall; he was a very tall gentleman, a very accomplished lawyer in his own right and had a big firm named after him and just an extraordinary leader. But if you walked into his beautiful office and sat across from him, he would listen so intently to you, and I was like a 20-something kid that he made you feel like whatever you were thinking was the most important and most unique insight around. And so between that and his sense of humor, which was fantastic and charming, there was always a sense that, okay, we were doing something special here, but we were never going to take ourselves too seriously. And I think that humility was important. 

And by the way, it wasn’t, I mean, I write about Patty Stonesifer, the CEO, who had this phrase about, we started to break down problems with, we start with a blank sheet of paper, just no assumptions, really just trying to learn honestly and openly.

It extended to Bill and Melinda, where we’d travel through, call it rural northern Nigeria together and sit in a hut with a family and ask them questions about their lives and about their agricultural experiences and about what it took to vaccinate their own child and how many steps did you have to take to walk to the clinic and how available were services. So there was always a sense that we were going to learn by actually listening to others by reading, and by being humble in the process of learning. And I think that came from Bill Sr. But it sort of permeated across the early team,

Greg McKeown:

Well, through the whole culture. One more back to Bill Sr. When you say you sit across from him, can you describe any specific behaviors that he employed to be able to make you feel as a 20-something-year-old that I think what you said is that what you were saying was the most important thing in the world.

Rajiv Shah:

I don’t know that it was anything super unique, but you would sit down, he’d ask you about your work, and then he’d listen and ask more questions. And we called them co-chairs. At the time, he was sort of in charge, and I was decidedly not yet. He just had that inquisitive spirit and just the kindness. And so I think it was pretty simple stuff, but in a pretty extraordinary package.

Greg McKeown:

But somehow strikingly surprising, that’s what you’re saying about it, is that when you say he sets the tone, that’s because he could have set many different tones, and not least of all, and I’m not speaking out school to describe this. I mean, I just had the president of Microsoft on the podcast and asked him about his experiences. He’s one of the only people that has been at Microsoft for the 30 years. He’s been there through the three CEOs. What were the experiences, and how has he seen them differently? 

He said what’s the same between those three eras is curiosity. That’s consistent with what you’ve been saying about Bill and traveling across Nigeria with Bill and Melinda. But what’s different with Satya now is that in his first meeting with his executive team, he brings a copy of Nonviolent Communication with him to that meeting to signal to the executive team.

The way we’ve communicated in the past is insufficient for us going forward. Yes, we’ve had this sort of radical disagreement, this we lean into debate, which sometimes given a bad name, it can be toxic if you’re screaming at each other as they were. “That’s the dumbest thing I’ve ever heard.” 

I mean, of course, that can be toxic. I think it’s less toxic than silence in meetings, which is what I see as more typical in meetings. But of course, there’s something better than that as well. So let me ask you this. By the time Bill and Melinda were in the foundation, did you see any of that sort of former stylistic norms? Was some of that still there? You’ve just described and asked the simple question, was there still this sense of that’s the dumbest thing I’ve ever heard, or was that cleansed from the tendency by them? What’s your experience? 

Rajiv Shah:

When I was there, there’s both. So I have a whole chapter in the book dedicated to when we created what I think is the world’s first big social impact bond, which was a structured financing project with a group of European governments led by Gordon Brown, the chancellor then of the UK. And when I gave Bill the proposal for that project, his reaction might’ve been those exact words. But then he spent an hour with me, one-on-one arguing as to why it was not a good idea. And what I realized is actually that was a roadmap for solving this problem because his insights and his critique were mostly on point. A few things might not have been, didn’t get born out by fact, but mostly it was a roadmap for where instead of hearing, “Oh gosh, I’m not that smart,” or “Oh gosh, I should just put this project away and do something else.” 

I actually heard, “Here’s a roadmap. If you solve these six or seven issues I have, then I’ll be all for it, and then we can get it done. And if we get it done, we can raise billions of dollars overnight and use that to reshape the global supply base for vaccines and immunizations and kickstart this big effort.” 

And I will say we got it done after it took three years, we got it done. We raised $6 billion, and 20 years later, we can say 980 million kids have been vaccinated, and 16 million child lives have been saved.

Greg McKeown:

Yeah, I’m really pleased that you’ve brought this chapter up and this story up because this seems to have been, unless I’ve misread it like, oh, I don’t know, how would we say it? Like the tallest poll in the tent of your career. Certainly to that point where it’s a multi-year process. I mean, I don’t want to go on because I want to go back to that single moment. That’s the dumbest thing I ever heard. Who’s in the room? Just you two?

Rajiv Shah:

Yeah, just the two of us.

Greg McKeown:

Okay. So that’s a big deal at the foundation.

Rajiv Shah:

Well, I’d gone to New York because he was in New York, and that’s where he had time.

Greg McKeown:

So you had flown to New York for this meeting? Okay, so it’s a big deal. You’re not happy.

Rajiv Shah:

Yeah, no, it was the biggest deal. It was my first one-on-one meeting with Bill, for sure.

Greg McKeown:

And it’s the biggest single conversation of your life till this point. Is that right? Is that fair?

Rajiv Shah:

I think I was married at the time. You’re going to get me in a lot of trouble with my wife.

Greg McKeown:

That is so valid. What you just said, though. I love that you called me out on that.

Rajiv Shah:

Professionally.

Greg McKeown:

Professionally. No, that’s really right. I’m sure you’re not fully joking, but I really appreciate that. That’s absolutely true. And I love that you just said that. So most important professional conversation you’ve had at that point, but your wife’s involved in this conversation, right? You’ve been talking to her about it, too, I’m sure. So all this preparation, she’s helping you go to the room, you’re just at the offices or your hotel? 

Rajiv Shah:

It was at his hotel suite.

Greg McKeown:

So it’s like the presidential hotel suite. You walk in, are you feeling terrified, or are you feeling like, no, I’ve got my prep work done? It’s like the debate series that I was doing. I know my brief, and I am prepared for this conversation.

Rajiv Shah:

Yeah, I think it was probably both. Definitely careful, and I knew it was an important conversation, but I also felt prepared. But I would say both.

Greg McKeown:

Did you expect this to be the first thing he’d say to you?

Rajiv Shah:

Not entirely because you walk in and you think your ideas are brilliant, right?

Greg McKeown:

Well, you’ve paid the price, so you’ve thought through a lot of factors here you are shooting from the hip.

Rajiv Shah:

By the way, it wasn’t just me. It was teams of people across several organizations working for months and months.

Greg McKeown:

With and countries.

Rajiv Shah:

And financial structuring experts and capital market leaders from Wall Street Bank. So it was not, I was just a vessel or messenger in that setting for a construct that a lot of really smart people had put together.

Greg McKeown:

Well, and Gordon Brown’s no small presence, especially at that time on the world stage. I think I would argue that he was probably a more dominant, influential figure as the chancellor than even when he became Prime Minister, which is surprising. But it wasn’t there for very long and perhaps wasn’t especially suited to that kind of, I don’t know.

Rajiv Shah:

I would just say I think Gordon Brown and his team, a woman named Sri Ti Ra, and a number of others had put together a really important and innovative proposal to restructure how the world finances what they were calling global public goods. If protecting us all from pandemics is a goal we all share together, how do we finance that task together and get it done? If addressing the fact that when deep hunger crises happen, instability flourishes all across the globe, how can we prevent that from happening? And in this context, how can we put a floor of basic health under children across this planet so you don’t have communities where a very high share of kids die under the age of five, which leads to all kinds of poverty trap type of issues that hold us back as a global society. And so I would say his leadership and his team’s leadership was pretty extraordinary even back then.

Greg McKeown:

Yeah, well, precisely. You just said something, though, that really caught my attention because I’ve been involved with all sorts of organizations, but we both were part of the Young Global Leader Group at the World Economic Forum, and one of the things that surprised me, let’s say in a disappointing way, was how rarely I felt that the subject of children and family was even discussed in a formal way at any of the events. Of course there’s other good beyond those things, but because it’s like the idea of straightening the deck chairs on the Titanic if you do everything else, but not those things. That’s so foundational. But you just talked about that, the idea of children. And I wonder just if you could talk to me about that. How present is that in your own thinking in your work now, of course, even beyond that initiative in your work at the Rockefeller? 

Rajiv Shah:

I’d say it’s not just present in my thinking. I think if you look at scholarship and assessments of democracy, peace, stability, and ultimately inclusive growth, what you find is that the whole cycle starts with the health of children. And it’s a little counterintuitive, but as children survive and everyone knows they’re going to survive, and then families invest in their education, especially girls in their education, it turns out families then have fewer children. And the total fertility rate country by country goes down, and that sort of starts the cycle of fewer kids being born, but more education per kid leading to more economic growth and productivity growth later in the cycle of their human development. And that’s been the natural story for how southeast Asia, parts of Latin America now, and parts of Africa are effectively moving out of poverty and moving up the economic ladder of productivity trade and economic stability. And so the idea that it all starts with children is something that I think is less known to people and is actually quite important. And Amartya Sen has done some of the extraordinary early work identifying that reality.

Greg McKeown:

And what you’re talking about, I think more broadly is the effect of industrialization, right? We’ve seen it already in the West. We’ve been through industrial revolutions, and what we have just seen is that certain areas of the world haven’t gone through industrial revolutions. And so they’re still, for complex reasons, not able to see that generative process. Your comment, though, makes me curious about something with you. I just happened to read this today. I’m just going to find it here and see your reaction because what you just described was the upward cycle of a society. That’s what you’re describing. And if your children are more likely to live at birth, then, I mean, it is a terribly harsh kind of way of having to think about those decisions. But then you have fewer children. You don’t have to make up for the likelihood of some of your children dying.

I mean, I don’t know, but I want to get to this comment, this thing I read today, but I want to pause on that for a moment. There is something really hideous about the idea that somehow when we talk about either the past in the industrialized countries when child mortality rates are so much higher, or in the developing countries now where it’s so much lower, it’s almost like, well,, yeah, I mean they kind of knows this is part of the arithmetic, which I’m not saying it wasn’t, but it’s not like they didn’t die, and it’s not like they didn’t mourn in exactly the same way as we would mourn if our children died. It’s just an unimaginable suffering that we’re describing. I don’t know. Your thoughts.

Rajiv Shah:

Well, I’d say absolutely. And in fact, later in my career, I spent time with families in Afghanistan and the Democratic Republic of Congo and in the US military service, all of whom had lost children, some to simple diseases and some to the ravages of war. And the reality is, it’s the same grief everywhere. And our ability as a global community to understand that it is not just the morally right thing to do, which it absolutely is to save the lives of children, but investing in their education, in their growth, and their ability to thrive and be hopeful is what is the dignity that we offer each human being and that we as a country are safer, we’re more economically prosperous, and we’re more true to our best authentic values when we make that work a big part of our foreign policy and our national security strategy. And so when I ran USAID, that was our mission, and part of my mission was ensuring that others in the military, in congress, and in the global community understood.

Greg McKeown:

Could see and connect the dots. 

Rajiv Shah:

This mission is about our country, it’s about our security, and it’s also about our morality.

Greg McKeown:

Yeah. Well, it is, isn’t it? Here’s the thing that I read, Harvard sociologist Carl Zimmerman’s central thesis in his book Family and Civilization posits that “there are three distinct family types or stages, the trustee family characterized by high fertility and a focus on the common good, the domestic family characterized by a decline in fertility, increased individualism, and a focus on personal happiness. And the atomistic family characterized by extremely low fertility and intense focus on individual desires and the disregard for the common good.” 

According to Zimmerman, “civilizations tend to go through cycles where they transition from trusty family systems to domestic family systems and eventually to the atomistic family system. The decline of the family institution, particularly the transition from trustee to domestic to atomistic  family forms, is associated with the decline in the eventual collapse of civilizations.” 

Okay, so that’s an interesting thing to have happened to read today when you are describing the upward mobility of a society, which I’m not disagreeing with.

This is really self-evidently true in all of the industrialized countries, but perhaps there’s a sort of a second side to this where a society sort of loses the things that built it and then overemphasizes this self-actualization and so on. And we’re seeing in the west now falling literally we are falling below the replenishment rate. Japan is the first on that list, but most of Europe is. America, if it wasn’t for immigration, would also be at that point. I wonder if you could just speak to that as well because it’s like the second side of that sort of similar description you were having. 

Rajiv Shah:

I think if you look across 80, 90 countries around the world, you’d see total fertility rates from replacement level, which might be like one point something to 2.2 in that range. But a lot of these nations started at 5, 6, 7, and basically, until you get 5, 6, 7 down to something like two or three, it’s very hard to create the sort of upward economic mobility at scale that we were describing. And so, if you look at it, they literally call it the demographic dividend. The demographic dividend is getting the total fertility rate down to a more manageable number, investing in kids and investing in their ability to survive, their ability to thrive, their ability to learn, and the economic structure of their society so they can have jobs and be productive as adults. And that process over 25, 30 years is the process that transformed Southeast Asia, transformed Latin America just in our lifetimes.

And so completely, the fact that there are still about a billion people that have been excluded from that natural path is a big part of what Rockefeller and Gates Foundation, USAID, we work on in this context. And the truth is today there’s a technology frontier and a set of ideas and a set of experiences that should allow us to finally reach the billion people that have not experienced that upward mobility. And I write about those ideas in the book, but it’s possible. Now, is it possible that, well, then, you go so far that you’re off into the challenges raised by the quote? Maybe that’s true, maybe that’s true in some societies, but in the places where we’re doing the bulk of our work, they’re really not close to that yet.

Greg McKeown:

No, I understand what you’re saying. I just had on the dean of the business school at Cambridge University, who’s written a series of books on trends, and he pointed out that there are more grandparents in Japan than grandchildren. So that’s like they are way beyond replenishment rates now in Japan with massive, so what I think you just said is, “Hey, listen, we’re not focused on that. We’re focused on these other issues,” but do you have a reaction to this, to the problem of the West?

Rajiv Shah:

Oh, absolutely. I mean, and look, you can look even in a more narrow way, and you’ll see if you break into the United States and look at the data by different subcategory categorizations of our demographics, that there are communities that are not at replacement. There are communities where deaths of despair have actually removed a significant share of the sort of employable workforce from different communities. There’s a declining white male life expectancy, which is sort of both a shocking reality in the data and undoubtedly affecting American politics in a way that makes it harder and harder to build a hopeful, aspirational kind of politics across all of our demographics. And so I appreciate that. It’s a very real concern and a very real issue.

Greg McKeown:

When you think about Big Bets. Now that you’ve gone on this journey, of course written this book, it’s the next part of your journey as far as I can see. Why, really, did you write the book? I mean, of course, there’s multiple reasons, but your career was in a good place without it, right? You don’t need it for a career or is this, what’s it really about?

Rajiv Shah:

So, to be honest, I wrote this book because I feel like I see every day people become, and sometimes they’re young people. My kids are friends of their kids and sometimes they’re professional colleagues, but I see people become cynical and negative or pessimistic.

Greg McKeown:

They can’t change things.

Rajiv Shah:

About our ability to make change happen at scale. And frankly, if I paid more attention to social media, I feel like that message gets amplified, and our news can be overwhelming. And even just a few years ago, young kids in school were talking about extinction as if it were an unsolvable reality they were going to face. And in the midst of all that, I thought, “Gosh, I’ve been so lucky to get to learn a way of thinking about making and solving some of the world’s biggest problems from people like Bill and Melinda Gates.” 

I’ve actually, long after Nelson Mandela visited Detroit, I actually got to meet him and work with him on the immunization and vaccine project, and it was one of the most special moments in my life. I write about President Obama’s big bets of supporting the largest humanitarian response to the Haiti earthquake and beating back the Ebola pandemic in West Africa when everybody thought we’d have hundreds of thousands of cases right here in the United States.

These are unheralded stories of success, and I write about bringing Republicans and Democrats together to really change the way America fights hunger around the world. And I feel like through those experiences, I’ve learned from some pretty extraordinary people. Some are household names, others are just in communities doing work. You probably haven’t heard of them, but they’re deeply inspiring, and I wanted to share a positive vision of what I think it takes to make large-scale change happen. So there are more people who think, “Hey, it’s realistic to be optimistic about tackling the challenges we face.” 

And that’s why I wrote it. What I’m amazed by frankly, is people are now sending me by email their big betts, their ideas. I love getting to see the fruits of that in the sense that some people have read the book, they’re excited, and they are thinking of how they want to make their next contributions. And it only builds on my enthusiasm for the idea that big betts can galvanize a positive, optimistic view of the world.

Greg McKeown:

It seems to me that part of the motivation could be described this way to put into words the presumption of optimism that was in your own home, growing up with your parents, the same optimism, which I think really grabbed my attention before. And also in this conversation of your grandfather in a country he’d never been to, sending his family there. That’s the city on the hill. I mean, there’s something so optimistic about that. It’s like you grew up in that, maybe in the Montessori schools. It’s like you trying to capture in a bottle what you were breathing all the time. Does that seem like a reasonable way to say it?

Rajiv Shah:

Maybe. I also think all of that sense of possibility, which was instilled in myself and my sister and because of our personal family story, as you just alluded to, I never really understood how liberating and how real it could be until I had the experiences at The Gates Foundation in the Obama administration and now at Rockefeller connecting to all these change-makers out there that are effectively doing it. And we have a lot of media and information about things that don’t work and about wars and conflicts and disagreements and political breakdown. We don’t have a lot of media that says, “Hey, did you know that some of the most conservative members of the US Congress got together with the progressive side and reshaped how America is fighting hunger and poverty around the world? And that legislation has been reauthorized three times under different presidents and in different eras of political dysfunction?” 

“Or did you know that President Bush, George W. Bush, had a program that transformed the picture around AIDS and human survival and, as a result, probably a dozen or so African countries and their very economic viability?” 

People don’t know these stories. So I feel like having those positive stories told about scale and impact should, I hope, give people a sense of, yes, I can do this too. I can be a part of this. We can all make change happen together.

Greg McKeown:

I just got back from a conference that how does its intent and how do we tell a better story. And they were so concerned that there’s so much alarmism around all sorts of issues, but among, I mean, even calling it a climate crisis and so on, that you have now these anxieties that are associated with, especially around teenage girls especially. But the suicide rate for boys now is, I think, four times the size for girls. I don’t know. I feel very emotional about it all. It just seems such a tragic waste, and this idea of telling a better story seems to be part of your drive in writing this. Let’s tell a better story. There is hope, there is possibility. People are already working on it. It just doesn’t make it into social media. It doesn’t sell television. It gets drowned out by the suffocation of angry exchange. And that’s not at all how the book reads, and it’s not at all how it seems to be that you are seeing and facing the world. What am I missing?

Rajiv Shah:

Well, I would just say that in addition to that, I think the book, and we put a lot of effort into trying to distill these kinds of lessons that people can take away that are really super practical actions for how to make big bets possible and how to live a big bet mindset. And sometimes, it’s asking a simple question as we talked about or jump first, which was creating that social impact bond and just taking the risk to do it. But sometimes it’s keep experimenting, and the story of the Ebola crisis about how if we didn’t have data and experimentation baked into the structure of that, I don’t think we would’ve been as successful. Well, we certainly would not have been as successful. So I hope readers come away feeling exactly the sentiment you just shared, which is, “Hey, in a world that seems rife with problems, some of which just tear at your heart and confuse your mind as to why this is okay, we want an optimistic vision of what’s possible.” 

But I also hope they come away with, “Hey, if I do these four or five things, I can be the optimist in the room that’s very practically moving things forward in a positive way, and I can feel more empowered about my life, my career, and my contributions.”

Greg McKeown:

The Ebola crisis specifically, I thought we might all burn. When I was watching that, really, I thought, I mean, the trajectory was such, it was moving so fast, and of course, every day that it passes, the chance of success is reduced significantly. I just think it’s a complete miracle, and I mean that perhaps in all its meanings, it’s sort of a secular miracle that you have people that are working in a system and a commitment to it. And also maybe beyond that spiritual miracle. I mean, we’ve just seen what a pandemic can do, and I don’t mean the additional lockdowns, I just mean the damage directly straight from the pandemic. Precisely. And if it’s, it is a scale that is unimaginable, I mean reinvent, it would just be the black plague again, which destroyed half of Europe. It’s amazing they survived. It’s amazing. humanity survived the black plague. I felt we were on the edge of that, but we weren’t because now you just said because of this idea of testing. But I wonder if you could just give us a little more about that because I’d be amiss if we didn’t get more of the strategies from the book itself before we’re done.

Rajiv Shah:

Well, I think the book the chapter is called Keep Experimenting because President Obama made a big bet. He said, look, we’re going to try to trade beat back Ebola in three small West African countries in the hopes of doing the right thing for the people who live in those nations, but also in the hopes of protecting the rest of the world from an out of control pandemic. That, by the way, had a 70% mortality rate, hemorrhagic fever, where people are bleeding in public and dying, and the main transmission was in washing and caring for the bodies after people were deceased. 

But then we got on the ground, and frankly, despite the deployment of American service personnel did not know exactly what solutions were going to work to carry out that mission. And so in that context, we tried a lot of different things, but you can only learn what works and what doesn’t work if you have real-time data.

And so I write about our efforts to deploy bioterror labs to get validated data. I wrote about efforts; we put young men on motorbikes, sent them into villages, got case reports of what was going on, and collated that data in a central data center, led by an extraordinary Swedish epidemiologist named Hans Rosling, who went down and led this effort. But the key was not having perfect, validated, accurate data. The key was getting a new spreadsheet every single day that told you where likely cases were and likely might be somebody saw something or likely might be a lab result that proved it, and it was counterintuitive because we all think data has to be validated by the Centers for Disease Control, and it might take four or five days, but we need to know the data. But here it was just having fast, even if insensitive data changed the nature of the response. 

It allowed us to see that these burial teams of people in full protective equipment with body bags going in and removing the bodies of the deceased before they could be honored in their more traditional cultural practices actually led to 70% transmission. We scaled up that strategy across the region, and instead of having 1.6 million cases, we had 30,000 cases. Instead of having hundreds of thousands of deaths, we had 11,000 tragic deaths, but only 11,000, and frankly, there were only two cases in the United States, and neither one was transmitted on US soil.

Greg McKeown:

Did you think in the midst of that, that it could go there, really could go global? Were you mixed between the emotion of hope and despair or fear and hope? Were you back and forth the whole time, or did you just have a sense of, like, no, there’s not an option? This has to be done.

Rajiv Shah:

I think we had, I mean, I certainly worried the whole team that this could spread broadly and the chat. I mean, that’s what the motivation for taking such a bold action was the absolute belief, and in fact, it did start to spread, so…

Greg McKeown:

Exactly.

Rajiv Shah:

It was not a very, it didn’t require a lot of extrapolation to see where this was going if we didn’t win the fight in West Africa. The challenge was having the mindset and the tools to do it and sort of introducing the idea that rapid fast data, even if imperfect, could help guide a response if we took a more experimental platform.

Greg McKeown:

Was that big bet then just in response to the outbreak, or when you say the three countries, is that because where the Ebola had spread or because that was already initiated, so this was still reactive?

Rajiv Shah:

This was reactive to those three nations. Yes.

Greg McKeown:

Yeah. Well, listen, I want so much to continue the conversation. I’m so curious, for example, about what your real aspirations are 10 years from now. I can see it. I can see it, but I won’t put you on the spot to make an announcement here. But obviously, you’re young, and obviously, you’ve had a very unique set of experiences that have prepared you for this. Most of the presence of the really large philanthropies in America, some of whom I worked with are much older than you, let’s say. That’s fair to say, right? It’s more like a Bill Gates Senior-type role. It’s very unusual that it would be you, and you were universally selected for it. Everybody on the board wanted it to be you. That says a lot about your competence. You’re a unique experience, but I’m absolutely sure we will see you reaching and aspiring for even further contributions, let’s say, in the future.

Rajiv Shah:

Well, thank you, Greg. It is great to be with you, and I love the chance to have this conversation. We’ll see what the future holds whenever I try to predict it that way, so I do the best I can and see where we land.

Greg McKeown:

Well, that’s what it is. Exactly. Listen, thank you so much.

Rajiv Shah:

Thank you. Thanks so much.

Greg McKeown:

Well, that’s a wrap with my conversation with Dr. Shah. Dr. Shah, among all of his other accolades, is the author of Big Bets: How Large Scale Change Really Happens. I hope that you have been inspired by his example. 

What is one thing you can do differently in your own life to make a contribution? Who is somebody that you can share this episode with so that you can be accountable to designing a life of meaningful contribution? A reminder that the first person who writes a review of this episode on Apple Podcasts will receive one year for free of the Essentialism Academy. Go to gregmckeown.com/essential for more details, and I’ll see you next time.