Humanosphere

Dr. Tachi Yamada is leaving his position in June as head of the Gates Foundation’s global health program.

That’s big news primarily because the Gates’ global health program is so big, the largest program at the world’s largest philanthropy, accounting for more than half of the $3 billion the Gates Foundation spends every year trying to make the world a better, healthier and more equitable place.

So what does it mean that Tachi is leaving an organization that rivals (some say exceeds) the influence of the World Health Organization when it comes to setting the global health agenda?

I think it probably means a lot less than when his two predecessors left. Perhaps because of the maturity of the Gates global health program today, Tachi’s imprint on the program seems pretty faint. (Note: I call him Tachi because he prefers it, perhaps for the same reason Bill Gates prefers to be called “Bill” and not Mr. Gates.)

Dr. Gordon Perkin, the Gates Foundation’s founding director of its global health program and co-founder of PATH, was there when the Seattle philanthropy was struggling to figure out its mission (making both some mis-steps along the way with some amazingly bold moves that remain bold and amazingly successful today).

I think it’s fair to say Perkin, along with Bill Gates Sr., Patty Stonesifer, Bill Foege and a handful of other key players, really defined the initial direction of the Gates Foundation in global health — as a public health mission focused on finding the most innovative and effective ways to improve the health of people in poor countries.

Dr. Richard Klausner, the second director of the Gates global health program and former director of the National Cancer Institute, took the foundation’s flagship mission in a very different direction. Klausner, who spearheaded the philanthropy’s “Grand Challenges in Global Health” program and other similar initiatives, shifted much of the resources away from basic public health to more of a focus on science and research.

Klausner left abruptly, under a bit of a cloud due to publicity surrounding allegations of misconduct while at NIH and also some problems with his “management style” at the Gates Foundation. But I think it’s also fair to say that Klausner firmly established the Seattle philanthropy as a major player in the scientific community.

Tachi Yamada brought in yet another new perspective as an executive from “Big Pharma,” the pharmaceutical industry (GlaxoSmithKline, to be specific). Many were concerned when he came on board in 2006 that this signaled some kind of further shift at the Gates Foundation away from its original public health mindset and toward one more focused on industry and the private sector.

But so far as I can tell, nothing much changed while Tachi was at the helm. He has been fairly low-profile and the overall strategy seems the same.

The Gates Foundation has moved more into some arenas — such as maternal health — it had previously avoided as too messy and hard to measure. Credit Melinda Gates on that score. And the Seattle mega-philanthropy seems to have moved away from Klausner’s grand (grandiose?) big-science projects in favor of more targeted support for promising research.

Gates Foundation

Tachi Yamada with Indian child during polio vaccination drive

I talked to Tachi briefly today and asked him a few questions to attempt to characterize his tenure there. He recalled the first time I tried to interview him many years ago, after a talk he gave at the UW before he was officially on board at the Gates Foundation, and he refused he said, jokingly, “because the foundation Gestapo wouldn’t let me talk to you.”

(Ha! To be fair, I was probably the one who called them the Gestapo back then. They are a much better and more transparent bunch these days … though Tachi did have a media “handler” today listening in on our interview, as is the normal practice for the Gates Foundation.)

Q: What do you think has been the biggest change or impact during your time there?

TY: “I think we’ve brought an even greater sense of urgency to the problems out there. And I think we’ve also brought a great deal of innovation into the global health field.”

Q: What would you say to those who say the Gates Foundation has been too “techno-fix” in its approach, which has distorted the entire global health agenda?

“I really do believe our core strength is, and has always been, in developing technologically based solutions…. That includes innovative financing mechanisms (such as “advanced market commitments“), innovation in how we apply these solutions in the field and also in accountability, how we measure success.”

Q Many people think the Gates Foundation is a bit too impatient for success and that their “top priority” bounces around from one thing to another — from finding an effective AIDS vaccine, from eradicating malaria or polio to maternal health. What say to those who say you guys have a short attention span and aren’t consistent?

“We are impatient optimists and impatient to get from where we are today to where we want to be. On any given year, we may have a focus on one issue or another. That doesn’t mean we walk away from things. We’ve been supporting polio eradication for a long time and are trying to keep others from walking away. We continue to put significant resources into HIV vaccine research. And look at the meningitis vaccine that was recently rolled out for Africa. That took 10 years. So I don’t think that’s a fair criticism, no.”
“What we do is constantly assess progress and we’re not afraid to change directions. It’s what we have to do to make sure we get a good return on our investment.”

Q So what does this change in June mean for you?

“I’m hoping to stay in Seattle. I’m looking into some ideas. I grew up in Japan and have never done anything in Japan. I’m hoping to do something substantial there.”

Gates Foundation funding