The following is adapted from “Big Bets,” by Rajiv Shah, with light edits for clarity.
In 2004, three years after joining the Gates Foundation, I was sitting on the edge of an ancient, very stiff, gold-colored chair. We had finally figured out what was causing childhood vaccination to lag. To really solve the problem, we had to find a way not only to vastly expand funding but to transform the system to ensure vaccines would be available for every child in the world. Some colleagues and I had hit on an idea of a social-impact bond to restructure how immunizations for the poor were financed, paid for, and distributed.
But to make the idea work, we needed partners willing to join, even lead, the process of making this all a reality.
Which is why Bill Gates and I were sitting in two stiff, gilt chairs in a room that seemed to be made of gold in Paris’s Élysée Palace, a short walk from the Eiffel Tower, hoping to convince French President Jacques Chirac to join in.
As I waited for my chance to speak, I was thinking about the clock— both the gold one on the mantelpiece and the one in my head ticking down the precious minutes with Chirac. This was a critical moment— if France joined us, we would have real momentum—and I worried we might run out of time to cover the details, or worse, that Chirac might balk. Privately, my fears ran even deeper. If we failed to get this new idea off the ground, my career at the Gates Foundation could fizzle right alongside our ambitious goal of solving childhood immunizations.
The personal stakes were high because, on the way to that golden room, I had taken some significant risks. I was learning that to make big things happen, and to get others to join you, you must sometimes jump first. The solution you’ve identified may appear to others as too remote or far-fetched or risky, so winning them as partners may require you to demonstrate your complete commitment to the solution at hand. Jumping first is risky, but it can be a critical factor in getting others to follow along too, ultimately building the wider coalition you need to succeed.
The meeting with Chirac, around a coffee table with a bowl of hot pink roses, was where we were going to find out if all the risk taking was going to pay off.
In the private sector, an entrepreneur may seek to be the first to make a big bet because it leads to the biggest payout. But in social-impact work like philanthropy, being the first to define a novel solution and put resources behind it is a different kind of risk and not rewarded in the same way. Other than the satisfaction of living in a better world, the incentives for big bets for humanity are far less tangible or personal, but the downsides for failure—blame, broken relationships, and dimming career prospects—can seem all too real.
By the time Bill and I found ourselves in Chirac’s office, I had already jumped first, risking my own word and the Gates Foundation’s credibility, and gotten others to follow—but none of that would pay off unless we convinced France and other rich countries that we were opening a clear path to vaccinate the world.
Big, transformational bets for humanity are about trying to lift up as many people as possible. You may find yourself within an organization unwilling to take on the risks to make that happen or unable to find partners to do the same. To have a chance at success, you’ll have to take risks to get others to take risks with you. There are going to be times when you must put yourself out there.
Patty Stonesifer, the foundation’s co-chair and president, pushed to find new answers. She had grown up as one of nine children in a deeply Catholic family that believed in community service. In the worlds of business and technology, Patty had excelled, and prospered, in the dynamic technology business because she was uniquely able to master the details of the present while simultaneously reimagining the future—a characteristic I would work to nurture in myself and come to spot in so many others in the years ahead.
Led by Patty, our team had reexamined the problem of insufficient vaccinations and found the root cause: The just-in-time approach to humanitarian donations and assistance wasn’t working. That realization gave us a place to focus our attention. It also gave me a new sense that a solution might be possible.
Still, simply seeing the possibility doesn’t make something as big as universal childhood vaccinations possible. That goal required simultaneously transforming the vaccine market and distribution network in dozens and dozens of countries. And doing that would require a large stream of money that would be available right away but also sustainable over the long term. That meant we had to convince many other big players to see what was possible and to take real risks to make it so.
The immediate implication was even bigger conference calls than we were already used to. Gavi’s universe of working groups expanded. We included public health experts in Geneva, humanitarian and frontline workers in Kinshasa, policy experts in think tanks in Washington, vaccine manufacturers in India, and investors and analysts on Wall Street. We talked to anyone willing to discuss potential solutions.
One session was another Patty innovation. What we came to call the Out-of-the-Box Group was an informal gathering of top minds to help sort out possible pathways to finance the vaccine effort. The group had three leaders: Patty, the World Bank’s Geoff Lamb, and the brilliant economist Mohamed El-Erian, from the global bond-trading firm PIMCO. These conversations with Wall Street capital markets experts helped us identify out-of-the-box ideas and new partners as we searched for solutions that no one had yet proposed or tried.
The Gates Foundation’s contact list was also growing thanks in part to Sylvia Burwell, the foundation’s chief operating officer. Sylvia, a West Virginia native with an unbelievably quick mind and an absolute commitment to doing the right thing, had worked her way up—after a Rhodes Scholarship and stint at McKinsey & Company—in the Clinton administration to serve as the US Treasury Department’s chief of staff. She had a true gift for hearing an idea and walking all the way through its potential risks and rewards.
Sylvia was also a world-class operator, perhaps the best-connected person at the foundation. She always knew exactly the right person to stress-test a proposal in Washington or any of dozens of other capitals. At one point, she introduced our team to a Pentagon budget expert so he could explain how the military combined massive contributions from allied nations to develop a new generation of fighter plane, the F-35.1 It was a very cool mechanism, but it didn’t work for us; the US military was better funded than anyone providing vaccinations.
At 30 years old, I wasn’t the best-equipped person to convince others to see all that was possible, let alone to convince them to take on the necessary financial risk. I knew the details—I could quote my spreadsheets row by row with my eyes closed. But I sometimes struggled with people who didn’t see an answer I felt was obvious. Even worse, I would grow visibly frustrated when someone saw the answer and even agreed with the importance of childhood vaccinations, but still refused to take risks to overcome the constraints.
I was lucky to have a friend and ally in Alice Albright. Alice is extraordinary—committed, smart, and innovative with years of experience in finance. Around the time I joined the Gates Foundation, she was named chief financial and investment officer of the Vaccine Fund, which managed Gavi’s the financial resources for Gavi, the alliance of institutions including the Foundation trying to scale childhood vaccinations. Alice is the daughter of Madeleine Albright, the former US secretary of state. I got to know Madeleine, first through Alice, and saw right away she was an icon for a reason. Madeleine was a forceful and righteous voice—and always helpful.
Alice helped me see partners in less black-and-white terms. I had initially judged anyone who expressed concerns as too cautious, uncreative, or just uncommitted. I personalized their hesitation and doubts. But Alice helped me see how people mostly worry about their own interests, reputations, and values. To achieve something at the scale needed, we had to convince a great many people—people who weren’t a part of our cause or any other—to do things differently and even risk those interests. Inspiration alone doesn’t get people to do that.
As we spoke with stakeholders who could help us better understand the vaccine system, one conversation illustrated the point. I asked a pharmaceutical executive whom we’d heard was sympathetic to the cause why he didn’t just increase production on the promise of the Gates Foundation and Gavi unlocking the vaccine delivery challenge, as it would put his firm in position for a windfall. This seemed to me like Bill’s kind of simple question.
What followed was a lecture, patiently delivered, on what it took to increase production. Increasing production required a new plant to be designed, permitted, and built. Producing vaccinations isn’t something any factory can do—it requires special equipment, regulatory approvals, and procedures. It all adds up to a lot of time and money. He then challenged me: There would never be enough credible demand from poorer markets to justify such a plant, let alone pay for it.
At first, I was frustrated by the exchange. Who wants to be schooled in all the reasons the answer was no? Usually when this happened, I would shut down a bit, stewing in anger and frustration at someone’s attachment to the status quo. But Alice helped me realize that it was better to take these sorts of conversations with stakeholders not as rejections but educations. What I was getting was a tour of this person’s interests, all of which could be useful down the line.
Talking to people on the outside of your team is essential to its success. Gathering dynamic thinkers unconnected to the core team can provide essential perspectives for solving the puzzle, which is why I would use the tactic in many moments of need in the years ahead. It was often where the most pivotal innovations sprang from. You can find the same by turning to people who are willing to push your thinking, tell you no, and educate you along the way.
Excerpted from BIG BETS: How Large-Scale Change Really Happens by Rajiv Shah, published by Simon Element, a division of Simon & Schuster, Inc. Copyright © 2023 The Rockefeller Foundation.
