Rajiv Shah

[0] Welcome, welcome, welcome to armchair expert.

[1] I'm Dan Shepard.

[2] I'm joined by Maximus Mouse.

[3] Hello there.

[4] How are you?

[5] Great.

[6] How are you doing?

[7] Wonderful.

[8] We're back in the attic.

[9] We're back home.

[10] I'm sitting in the chair.

[11] Feels good.

[12] Today we have a very, very, very smart.

[13] One of these people where Monica and I were talking to and just getting more and more depressed, the more we learned about their life and accomplishments.

[14] God, he's done so much.

[15] Too much.

[16] Too much smarter than us, too.

[17] smarter.

[18] He's too much smarter than us, too.

[19] Raj Shah.

[20] Raj Shah is the president of the Rockefeller Foundation.

[21] He is a former American government official physician and health economists who served as the 16th administrator of the United States Agency for International Development from 2010 to 2015.

[22] Under Obama.

[23] What an accomplished guy.

[24] And from Michigan.

[25] Yeah, you love that.

[26] I do love that.

[27] Anyone from the Mitten.

[28] So please enjoy the fascinating Raj Shah.

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[32] He's an armchair expert.

[33] Raj, first of all, we are so sorry for being late because as I research you, you have like 43 jobs.

[34] I don't even like, I read the committees you were on and stuff.

[35] I'm like, how does a man have this many titles and still function?

[36] So in addition to being well -versed on health and economics and all that stuff, you probably need to write a book on time management.

[37] Have you thought about that?

[38] Not me, not me. But it is nice to meet you because I know we're both actually from around Detroit, which is awesome.

[39] Oh, yeah, girl.

[40] Now, so your parents emigrated in the 60s?

[41] Dan Arbor, is that correct?

[42] Yeah, the late 60s.

[43] Actually, first to Pasadena in California, and my dad worked on the Apostle.

[44] projects.

[45] After that, he went, went to Detroit.

[46] And so I was born in Ann Arbor, and we grew up around in West Bloomfield.

[47] Oh, sure.

[48] I mean, I wasn't born yet.

[49] I was born in St. Joe's Hospital in Ann Arbor.

[50] So my mother ran a Montessori school in Ann Arbor, and then later in West Bloomfield.

[51] And my dad worked at Ford the whole time I was, and spent 30 years at Ford, and then, you know, Ford had a spinout called Vistion, and he was with Vistion.

[52] Oh, no kidding.

[53] So, A, I used to cruise in high school in Plymouth.

[54] Did you ever partake in that?

[55] We do, or was it over on Woodward, like Woodward between 8 and 9 mile?

[56] Yeah.

[57] Okay.

[58] We did a live show last summer at the Fox, and I showed Monica what happens on Woodward with all the muscle cars cruising around.

[59] We just sat on the side of the road.

[60] I've never seen anything like that.

[61] I took my wife there, like, long after we were together, and she was like, this is the strangest thing.

[62] I've ever seen.

[63] She's like, where are these people going?

[64] I said, nowhere.

[65] We just drive in circles.

[66] And it's awesome.

[67] And it turned out that she didn't think it was just awesome.

[68] I was like, I don't understand why you don't think this is awesome because we did this for year after year after year growing up.

[69] Yes.

[70] Oh my God.

[71] Just sitting on the side, there's so many people sitting on the side of the street just watching cars drive by.

[72] It's so specific to that culture.

[73] Like no other city has that.

[74] Yeah.

[75] My high school offered pre -engineering automotive drafting from seventh grade onward.

[76] Wow.

[77] Like, I didn't occur to me that every kid in America wasn't doing pre -engineering drafting because I'm like, what do you learn then when you go to school?

[78] And what school did you go to?

[79] Birmingham Groves High School.

[80] Oh, right, right, right, right, right.

[81] That's a fancy school, Monica.

[82] Oh, it is?

[83] Yeah, so I grew up kind of poor.

[84] But then my mother built this company that worked for General Motors, and it became kind of big.

[85] and then my little sister went to Cranbrook, so she's like a rich kid.

[86] Wow.

[87] That is a fancy school, right.

[88] Yeah.

[89] Okay, so you went to U of M. Was that an obvious choice?

[90] Yeah, I pretty much wanted to go to Michigan and ended up there.

[91] Started actually in engineering, thought I would be in the auto industry because, you know, that's what you did.

[92] Because, duh.

[93] Yeah, and early on, I sort of changed to college and broadened my interest and took on other things.

[94] But certainly I started out that way.

[95] But your first degree is a bachelor of science, but in economics, yes?

[96] Yep.

[97] Michigan had a phenomenal economics department, and there was a professional economics who sort of famously applied Keynesian economics and could explain how to help the country both avoid recessions and pull out of periods of unemployment and downturns.

[98] And I just thought it was like arts.

[99] You know, it's like knowing all this stuff that explains how the world works.

[100] And really, that one professor got me so hooked on economics that I just thought I wanted to do that.

[101] I also wanted to be a doctor, and so I kind of ended up doing both.

[102] Well.

[103] But really quick, you're right, there is this, like the invisible hand, the Adam Smith invisible hand.

[104] There's something magical about it, right?

[105] An unmeasurable force that's clearly operating and working, and we can see the outcome, but the thing itself is not tangible.

[106] It's fascinating.

[107] Yeah, it's fascinating.

[108] And I also thought it was a way to explain you know why some countries were really wealthy and why so many other countries were not and my parents came from India and the was not at all one of those successful economic environments and so even though my grandfather was an accountant and you know they had a decent education by our standards when we visited them when we were kids they are poor right and they have all the attributes of living like that And so when I really started to learn economics and I thought this is a discipline that can explain the differences and then maybe you can figure out how in the trajectory of really developing countries as they try to move billions of people out of poverty through economic growth, that was really exciting to me. Okay, so you leave U of M and then you go to Penn, Monica Buckle of a fuck up.

[109] We like fancy schools if you haven't picked up on that, so you're going to get a lot of...

[110] We've even created a term.

[111] We're unifiles.

[112] So yours reads like a penthouse forum letter for us.

[113] We're horny as fuck for all this.

[114] I've never heard anyone read my bio and compare it to a penthouse forum letter.

[115] So that's kind of an exciting thing, I guess.

[116] You go to Penn and you get a master's of science in health economics.

[117] So really quickly, can you give us a broad stroke of health economics?

[118] It's basically the economics of health care.

[119] Thank you.

[120] Okay, great.

[121] Moving on.

[122] And I was in medical school, and I was also at the business school simultaneously.

[123] And in business school, I sort of wanted to learn about how the health system worked.

[124] You know, it was at the time or it was just after the big Clinton push on health care reform in America.

[125] And so that was in the news a lot.

[126] And that kind of shaped a lot of my interest in saying, you know, we should be able to figure this out.

[127] Yeah.

[128] I thought if I was going to be a doctor, if I knew something about economics in that industry, you'd be able to perhaps, you know, have more influence and help more people than just your individual patients.

[129] But, you know, probably the best thing for me about being at Penn was encouraged you to kind of explore different interests, which is not true in every medical school training program.

[130] So I applied, you know, three times to join Al Gore's presidential campaign, got rejected all three times.

[131] And then finally, and he moved his campaign from D .C. to Nashville, I was invited to come down and just work as a volunteer.

[132] And that really, more than anything, changed my career.

[133] Yeah, so it's weird because you have, you have, like, political interests.

[134] I mean, it's not weird.

[135] It's very cool.

[136] You're a polymath.

[137] You have all these different interests.

[138] And what I like about it is you end up ultimately, while we're talking today, is you kind of get to synthesize all these different things.

[139] But just really quick, the health care system, it is uniquely complex, right?

[140] Because it has all these layers of multiple businesses is on top of ultimately treating people for illness.

[141] There's all these other factors, these intermediaries, the insurance providers, hospital networks.

[142] Is there a more complicated system out there?

[143] I mean, there's so many factors involved, right?

[144] I mean, no, there really isn't.

[145] We spend in America more than $4 trillion a year on our health care system, and we have kind of at best a middle ranking amongst industrial countries on population health outcomes.

[146] Now you can't get a simple test.

[147] to tell you if you have COVID -19 in the richest, most powerful country in the world with the by far and away most expensive, fanciest healthcare system ever devised by human beings.

[148] So, and is a surgeon in New York and can't get a test if she needs one.

[149] So it's a big deal and it's a big problem.

[150] And American health care has been underperforming on basic public health attributes for...

[151] Yeah, and it's fascinating, too, because the medical, insurance complex, it does mirror our society almost perfectly, right?

[152] In that, on some levels, you can point to our medical system and say it's the best in the world, like people from other countries travel here to get procedures, which is so true of everything in America, right?

[153] Yes, for the top 1 % it's fucking awesome.

[154] And then for nearly everyone else, it's falling short, right?

[155] Absolutely.

[156] You see that in general, America's health, before this coronavirus, crisis, 40 % of American households didn't have $400 to cover an emergency.

[157] And the number one emergency they were concerned about having to cover was a medical or health.

[158] And for that 40 % of all American households, you know, most of them don't have a doctor.

[159] The emergency room is their primary engagement point.

[160] So now, you know, that frankly, emergency rooms are just not safe places to be.

[161] Right.

[162] Contagion perspective, they've effectively been shut.

[163] out of a health care system or they take really high risks.

[164] And on the flip side of it, you're right.

[165] I mean, if you want a laser -guided robotic surgery with a piece of post -operative experience, there's no other place in the world you'd rather be than America, if you have the right coverage and you can cover the out -of -pocket costs and you're connected to the right providers.

[166] Now, when we look at the pie, the $4 trillion pie, do you know off the top of your hand, at least ballpark?

[167] Like, what percentage goes to doctors?

[168] What percentage goes to hospitals and which percentage is going to just insurance companies?

[169] Like, who's making the bulk of that $4 trillion?

[170] That's a good question.

[171] I don't know the exact numbers.

[172] In general, from a profitability perspective, the insurance industry and the pharmaceutical industry by far and away make the most profit.

[173] Most hospitals in America operate on almost no margin.

[174] You know, the kind of net patient revenue on an annual basis is their, is their margin.

[175] They're like a grocery store.

[176] Yeah, exactly.

[177] They're very, very, very efficient from that perspective and very non -profit in their basic approach.

[178] You know, physicians and doctors don't really, I mean, you just look at their take -home pay relative to other occupations in America.

[179] It's not dramatically out of line.

[180] so they're not the ones that are really benefiting from the system.

[181] Yeah, there's also the sports analogy.

[182] It's like people will read, I don't know, Shaquille O 'Neal's going to get $25 million, and they're kind of appalled by that.

[183] And then I'll go like, well, would you be happier if Jerry Buss got that money?

[184] Because someone's going to get the money.

[185] And I think the guy who's putting on the show probably should get a good chunk of that money.

[186] Similarly, the doctors are putting on the show.

[187] I feel like if anyone should be profiting abnormally, it should be them.

[188] Well, doctors and primary care physician.

[189] And one of the proposals we're trying to make happen, and we're like Boston and Baltimore to create programs that do this is to create an entire community health corps in America that would be a little bit like the Civilian Conservation Corps after the Dust Bowl that just went out and planted millions of trees and American agricultural system as a result.

[190] We could do something like that by employing people right now when so many people need work in order to address coronavirus.

[191] and its consequences.

[192] And what would the people do?

[193] What would be the equivalent of them planting the trees?

[194] Well, we've put forth a major proposal to accelerate testing and contact tracing in America is really the only way to restart the economy without, you know, economically for families that are just shut down or they have to abide by social distancing.

[195] And the two main elements of it are broad ubiquitous testing, making sure anyone, symptoms or no symptoms, who needs a test can get a test.

[196] And the second piece is tracing context, which just means when you get a test result, you identify who are all the people that that individual has come into contact with in the last four or five days and then go and know they all need a test and make that whole circle of people that both got the test and now need more testing to ask them to self -isolate.

[197] or self -quarantine or take themselves out of circulation, so to speak, to protect everybody else.

[198] The workforce we've proposed would help actually do those tasks, identify who you need to go speak to, connect with them, tell them, oh, you were in touch with somebody who had a positive result, so you need to get a test and you should take yourself circulation for 14 days or so in order to protect others in your community.

[199] And I'll say it sounds like a lot of work, and it sounds maybe.

[200] somewhat technical.

[201] I led the West African Ebola response during the and we hired and trained almost 11 ,000 community health workers throughout West Africa, so that was in half a dozen countries.

[202] And we asked the U .S. military to work with a nonprofit group called Tire that is a well -known Doctors Without Borders is the common English name.

[203] And they created a protocol and within two days, they were able to train cohorts of people, and they just ran large -scale military protocol training.

[204] Yeah, they went village to village, right?

[205] I remember seeing, like, footage of this.

[206] They just got mobile and started walking.

[207] Absolutely.

[208] And we gave them all protective equipment.

[209] We gave them protocols.

[210] Usually when there was a positive fight of Ebola, anywhere in West Africa, these teams would go out to that individual, find out who they were in touch with, and protect the people they were in touch with, by doing further testing and isolation.

[211] And the result, which was really successful, was to just knock down the cases and the transmission of Ebola in that context very, very quickly.

[212] So it can be done.

[213] In that case, we actually deployed the U .S. military, including military lab transport for blood samples.

[214] At the end of the day, we got testing down from it taking eight to ten days to get a confirmation around a test, down to under four hours.

[215] hours.

[216] And we tracked that, and we followed it, and we just threw resources to do it until we got there.

[217] And I look around and I say, if America could do that so effectively in West Africa.

[218] In 2014.

[219] In 2014, we should be able to do it right here at home in America.

[220] Well, yeah, that was going to be my question.

[221] So that was seen as a very, very successful effort on y 'all's part.

[222] And I wonder what level of frustration you have, you know, six years later going, what the fuck, you know, we already learned this lesson and we already had success.

[223] We have a playbook.

[224] That's right.

[225] And we know how to do this, which is why at the Rockefeller Foundation, we sort of pulled together scientists and industry leaders.

[226] Actually, we pulled together kind of former administration officials from both Democratic and Republican administrations and national action plan to do just that.

[227] It'll cost about $100 billion over the course of a year, which, you know, until about a month ago, seemed like a lot of money.

[228] But now we're spending trillions on dealing of this crisis.

[229] For about $100 billion, we think we could actually implement a testing program that would go from 1 million tests a week in America to 3 million tests within eight weeks and then 30 million tests within six months.

[230] And then we should have home kits and point of service testing options.

[231] And basically, you know, before you go to work, if you need to confirm, either to yourself or others that you don't have coronavirus in America you should be able to take a test but within minutes and go on to work I couldn't agree more you know there's a lot of themes to your work over the last 20 some years one of them is you work very well bipartisan Lee I'm going to invent a word you also are synthesizing a lot of different things and a lot of different things play together in these interesting ways that I don't think your average and has a sense of, right?

[232] So you've worked extensively on agriculture, you've worked on health.

[233] All these things can funnel into a national security debate.

[234] I think a lot of people see headlines, like we're giving X amount of aid to some country they've never heard of, and they don't understand it, and they don't understand why we're giving those people money and not taking care of our people.

[235] And on the surface, these are very good critiques, I think, but I don't think people really work backwards from what we spend on our military, right?

[236] So that annual DOD budget is like $1 .4 trillion or whatever it is.

[237] And that's to have guys go kill people in response to things very far downstream that probably could have been prevented.

[238] And I just think in general, and we just interviewed this great guy who wrote a book called Upstream, you know, shifting our actions from reactionary to preventative is just a very hard proposition to get Americans to embrace.

[239] And it's frustrating, I'm sure, for you above all people, but just me as someone who reads the newspaper, I just think, man, we're trying to treat something that's so far downstream.

[240] We're at the symptoms level, as you just said.

[241] And we're never, ever putting any investment into prevention or anything.

[242] And then the same can be said about national security.

[243] It's just like it costs so much less to prevent a country from being starving, no economic options, and then they turn to some military organization.

[244] We have such a great history and knowledge of how this cycle works and such a limited appetite to prevent it.

[245] I would love for you to kind of just tell us how agriculture affects our safety, how health affects our safety, how all these things ultimately really will be on your doorstep in a different way.

[246] I agree with everything you just said.

[247] And what I find striking is actually when you talk to people about American leadership around the world and the very basic idea that when we help other people achieve the basic tenets of the American dream, just the basic.

[248] tenets, you know, the pursuit of life, liberty, and happiness, and liberty in particular.

[249] They are so grateful for American values and American leadership, and it does enhance our safety dramatically.

[250] In fact, the story of American leadership after World War II has been, it's been an absolutely bipartisan mission to organize and use American leverage, American power, and American influence around the world to stand up for our values.

[251] I think Eisenhower, when he, when he became president after World War II and said, we're going to put in place an institutional such that this doesn't happen again.

[252] And we got the UN and the Brent, the World Bank and the Breton Woods institutions, the World Food Program.

[253] I think Kennedy and Nixon, you know, all the way through as President George W. Bush mounted perhaps the most successful global health effort in saving tens of millions of lives from HIV AIDS in Africa.

[254] And that was a pursuit of passion and commitment to humanitarian justice, but it was also that having, you know, 30 failed states in Africa where the core of their productive economy had just collapsed and, you know, 10, 15 % of the population per country were dying to secure America's safety.

[255] So I think it's been a bipartisan mission since World War II.

[256] And I saw it firsthand, like, you know, for what, for about two percent of the cost of the Afghanistan war, we got eight million of Afghan girls into school.

[257] And, you know, the number before America engaged on that specific project was basically zero.

[258] And, you know, anyone who's been on the ground in Afghanistan alongside our troops, an honored to do, knows immediately that those eight million girls are the basis of our security for the future.

[259] Well, you know, I've been twice and I didn't see a single woman.

[260] Is that right?

[261] Yeah.

[262] I was like, where are the women?

[263] Yeah, you got to look.

[264] You got to get out there.

[265] I would visit rural communities, you know, with David Petraeus or whomever else was kind of in charge of the military effort on the ground.

[266] And we'd go in, all the men would be lined up in the front to greet, you know, the Americans.

[267] and they would, and then we'd ask, and we'd say, can we speak to some of the girls that are in school?

[268] And they were in full burqa, and usually in a schoolhouse, in a private room, and we'd talk to them.

[269] And the mothers would all say, you know, the reason we know that America cares about Afghanistan is because you're sending our girls to school.

[270] And it costs, for every dollar we spent on the Afghan war, it costs less than a sense to run a program that got, you know, the 8 million.

[271] girls into school that built out thousands of kilometers of roads and infrastructure.

[272] And all difficult, but, you know, that's what we did in South Korea after the war that changed the economy.

[273] It's what we did in many other parts of the world.

[274] And you're right.

[275] That is getting upstream.

[276] That is sort of saying we don't want to deal with the consequences of extreme poverty, of huge amounts of injustice, the persecution, you know, of an entire generally want to unlock stability and peace because America does well when other countries are stable and peaceful.

[277] And we're seeing that happen kind of in reverse right now.

[278] You know, the U .S. is so behind on this coronavirus response that we're not an usual role of helping others.

[279] And the agency I led, the U .S. Agency for International Development, which would be on the front lines of this, is now actually asking other nations to send us protective equipment and test kits and things like that.

[280] You experience for many of those other countries and kind of, you know, it's unfortunate right now.

[281] A humbling state of affairs right now.

[282] Now, when you left Penn, what kind of doctor are?

[283] You're a medical doctor.

[284] You could prescribe me medicine.

[285] I'm sort of useless.

[286] I left Penn, having gotten a medical degree, but went on to join Al Gore's political campaign.

[287] Then I joined Bill Gates' foundation when he and Melinda were just starting out, spent eight years working with them and loved basically.

[288] And then I joined the Obama administration.

[289] What a life.

[290] Oh, no. This is, you've nothing, you haven't heard anything yet.

[291] Oh, my God.

[292] This is nothing.

[293] I can already tell he's resistant to let me go through it.

[294] The parents, I mean, your parents just must be, I can't imagine one of their children is you.

[295] And the other one is a surgeon.

[296] Did we, did you say surgeons?

[297] Yes, yes, yes.

[298] A surgeon, yeah.

[299] Oh, my.

[300] My parents are so upset right now hearing this.

[301] Yeah.

[302] Well, I'll tell you, my parents, I was.

[303] medical school to volunteer on Al Gore's campaign, and I was going to stay at Al Gore's mother's pool house and drive younger volunteers to the library every day.

[304] They thought I was kind of throwing it all away.

[305] Sure, they weren't right.

[306] But I loved that experience and made some of my best friends in Nashville during that year.

[307] And frankly, so many of those folks have gone on to offer amazingly effective service during the Obama.

[308] I'm really proud of that team.

[309] Okay, so what excites me the most is I have probably my deepest fascination of any two gentlemen are John D. Rockefeller.

[310] I've read Titan, I think, four times.

[311] Wow.

[312] Have you read it?

[313] Oh, yes.

[314] Oh, three cents.

[315] It only gets better and better.

[316] I mean, what a fucking book.

[317] But then my other, my new fascination, of course, is Bill Gates, driven largely by that Netflix docu -series.

[318] And I could be completely misled.

[319] So let me just say I'm probably been manipulated by the documentary bill.

[320] What I gleaned from that is, is every dollar that is donated to any organization should go through Bill Gates.

[321] And here is why.

[322] He's so fucking pragmatic.

[323] My wife is incredibly philanthropic, and I've seen her involved with, at this point, over 100 different organizations in the last 13 years.

[324] And my frustration is, in my relief with Bill Gates is so rare does somebody have, kind of a background like you do, where they have a true understanding of market, they have a true understanding of economics.

[325] They understand everything that will be involved to execute this great utilitarian or altruistic idea.

[326] But you need, like Bill Gates, the fact that he brought products to market successfully, he built an organization that functioned at the highest level.

[327] And he has brilliant ideas.

[328] I'm like, yes, give that guy all the money.

[329] He needs no political help.

[330] He has all the approval.

[331] He has the money.

[332] He's independent.

[333] He's pragmatic.

[334] He cares yet.

[335] He's a robot.

[336] There's so many things I love about it.

[337] So the fact that you have in some capacity worked for both of these people, what is it about Bill?

[338] Do you share that opinion of him that he has this very unique suite of attributes that he both cares and is so fucking logical and pragmatic?

[339] I'm hugely biased, but I agree with pretty much all of that.

[340] You know, he is, he's both brilliant and so deeply committed to learning.

[341] And it's both Bill and Millian.

[342] I took for granted because I was fairly.

[343] young when I started working with them.

[344] I just took for granted that, oh, yeah, if you were trying to save the most lives in the world, you know, you would look at the World Health Organization tables that publish years of life, find out the causes, then, you know, make a list, then identify the cheapest ways on a per year of life loss method to save that year of life.

[345] And then you'd pull together every company, every national organization and say, okay, let's go save six million children's lives doing XYZ immunization project.

[346] But that actually happened.

[347] And we all did that.

[348] And Bill and Melinda and Patty Stonecipher, who led the foundation.

[349] And was it malaria was that number one thing?

[350] That number one thing was global immunization.

[351] It was an effort called the Global Alliance for Vaccines and Immunization.

[352] And in addition to raising, putting in billions of dollars, we also raised billions of dollars.

[353] You raised $5 billion, right?

[354] Yeah, well, I think you're referring to a specific instrument where we did the first ever social impact bond, but we effectively worked with a group of banks and issued on behalf of UNICEF, a major security that raised more than $5 billion.

[355] And that $5 billion allowed us to do long -term, large -scale purchase contracts for the types of vaccines that you'd need resource poor countries, which technically are just slightly different than the types of vaccines that were being manufactured and sold for more industrial and wealthier countries.

[356] And the net effect of all of that is after 20 years, billions of dollars of expenditure and probably thousands of people working together around the world.

[357] we helped immunize more than 700 million kids, saved more than 6 million children's lives.

[358] And I think created a model we can now use for changing the way the coronavirus testing industry works in terms of moving from a cottage industry that is small scale to a more organized public -private collaboration that's very least the needs of society.

[359] But I'm deeply proud of what we all got done then.

[360] and Bill and Melinda are just exceptionally committed and very, very talented leaders.

[361] I would say one area where I think Bill would disagree with you.

[362] Oh, okay, good, good.

[363] Well, if he were here, it'd probably be more than one.

[364] Oh, yeah.

[365] You know, you said he can do it all alone.

[366] And I think the thing we learned was you actually needed to engage in politics.

[367] You needed to engage governments.

[368] You needed other partners, and you needed companies and scientists all working together.

[369] And, you know, it was a special time.

[370] I remember when I led a specific project, which was oriented around Warren Buffett, giving a lot of his wealth.

[371] And, you know, we were able to, in that moment, really get the best of the best to solve any major problem.

[372] And so when we focused on global immunization, you know, we could pick up the phone and just pull together.

[373] that really systemically transform global vaccination.

[374] And at the end of the day, you know, there are 120 million or so kids born every year.

[375] And we could track going from 40 million to 60 million to 80 million to annually getting their vaccines and just make that a mission with real quantitative rigor around tracking results and being really business -like about delivering outcomes.

[376] Yeah.

[377] And I guess what I most specifically meant was there's a moment where he goes, look, here's what's going on with global warming.

[378] Here's what no one likes.

[379] Unfortunately, nuclear is probably the answer.

[380] No one likes that.

[381] I guess that's what I mean in his independence, that he could go, no one wants to say this.

[382] Let's go, why don't they like it?

[383] And let's solve those three reasons people don't like nuclear energy.

[384] That's just a position most people can't afford to take.

[385] I appreciate his independence in those moments.

[386] Stay tuned for more armchair expert, if you dare.

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[405] Now, how frustrating is it for you to have spearheaded such an enormous global vaccine agenda with non -industrialized countries, only to be living in an industrialized, richest country in the world where there's a sector of people trying to convince people not to vaccine.

[406] Does that not, were you not, like, what the, I'm up there trying to do this thing.

[407] You guys have the knowledge, you have, you're the literacy rate, the fucking income, and really, you're trying to undo this?

[408] Well, it's always been disorienting for me because it's always true that wealthier communities, it's not economies, right, for the anti -vax movement is stronger.

[409] specifically in the wealthiest communities in the United States, not just in the United States broadly.

[410] And that's also true for the community that have been against certain technologies in the food system, including transgenic technology or genetically modified technology.

[411] And while there's truth to all of those issues, the reality is vaccines in general, are absolutely necessary for population health and all the data indicate that the safety concerns are met relative to the and that's even more true in developing countries.

[412] And that's true for agricultural technology as well.

[413] And the reality is if we're going to avoid food crises and hunger as our global population goes in people, we have to embrace and safely use appropriate technologies in the food system also.

[414] Yes, one of the things that frustrates me is there's just a blanket GMO, right?

[415] But I don't think some people recognize what some of that GMO is.

[416] So everyone would agree they don't want round up all over their food, right?

[417] Because we're going to get all kinds of downstream issues.

[418] I don't want to get sued, but there's some fucking downstream issues.

[419] Now, I remember reading that they had taken a gene out of an aloe plant and put it in some corn or something like that.

[420] And an aloe plant's completely bug resistant, just naturally by its own DNA.

[421] Now, to me, that's a great bit of GMO.

[422] Like, I don't understand the hesitation just because of the label.

[423] Well, I sometimes in the Obama administration, they called me Mr. Sweet Potato Head because I always advocated for these beta -carotene rich, basically vitamin A -rich versions of sweet potatoes in parts of Africa.

[424] but I've sat in northern Uganda that have been in communities ravaged by war.

[425] Some of the things they've seen are inexplicable from the perspective of our common humanity, and they're starving.

[426] And the main item they eat and are fed are sweet potatoes.

[427] And if you enrich them such that they have more beta carotene and therefore more pro -vitamin A, you can actually improve a number of health outcomes for these young kids and to grow up healthier, to have a chance to learn, and things like that.

[428] And so when people from outside who haven't sat and talk to those kids and those families say that they should not have access to that kind of technology, advocate for them, and it's just wrong.

[429] And this is something I think Bill and Melinda have done well.

[430] I think John D. Rockefeller wrote about this in Titan.

[431] Like really solving these tough problems just requires learning and listening and the humility to ask questions and be willing to learn.

[432] And I'm always worried about those who, you know, think they know all the answers because of a particular experience they've had in a particular community that might or might not be relevant once you feel skill.

[433] Yeah, probably more persuasive, like a post on Facebook, sadly.

[434] Like, that's what you're arguing with.

[435] Yeah, exactly.

[436] Is someone's opinion on Facebook.

[437] Now, the other kind of theme that runs through your work is early on at Penn, you got a $500 ,000 grant, right, to study hospital efficiency.

[438] Yes.

[439] And was it your early education and economics that made you recognize like money is going to be a huge part of this?

[440] And your ability to raise and access money is a huge part of the successes you've had.

[441] Well, just to go back to that Penn example, you know, there were just two graduate students, myself and a friend of mine, and we built this.

[442] this little regret to tell you a little bit about when you merged hospitals how to drive efficiencies on discharge issues and things like that.

[443] And when we submitted that grant, not at all expecting the two grad students were going to win.

[444] At the time, that was a lot of money.

[445] Oh, God.

[446] And when we got blown away and we thought, wow, this is going to be fantastic.

[447] And it reinforced my commitment and my interest in just using data to solve problems.

[448] And that was kind of a quirky application of it, but an important one.

[449] and the story we talked about with immunization was very much about using data to solve the problem.

[450] Like unless you knew how many kids needed to be vaccinated, how many were not getting vaccinated, country by country, county by county, set goals and then built solutions that achieve them quantitatively, we weren't going to get there.

[451] And so, you know, I feel fortunate because I've had the chance to do that on efforts that range from addressing food incidents.

[452] Africa to bringing power and energy and renewable energy to large parts of the developing world where a lack of access to electricity actually keeps people mired in subsistence poverty.

[453] But that was really the when I was in government.

[454] We tried to transform the way America engaged on these issues abroad by just being more results -oriented, more quantitative, and more disciplined about the use of data and measuring results.

[455] And, you know, I that from Bill and Melinda in that early setting.

[456] But in my view, it actually allowed us to say to the American taxpayer that for a fraction of 1 % of the public budget, we were saving lives and having real impacts around.

[457] Me, you mentioned kind of a bipartisan support.

[458] To me, I found just as much enthusiasm for that approach from Republicans as from Democrats.

[459] It really did bring people together.

[460] And it was like, okay, if you're going to be responsive.

[461] about doing what we're going to get behind you.

[462] Well, that's what I kind of beat this drum on here on this podcast, and I'm sure people are sick of it.

[463] But, you know, I am a big, bleeding heart liberal.

[464] There's no question.

[465] I'm a progressive.

[466] Yet I see the intrinsic value in having conflicting points of view to make each side better.

[467] I really do value the right.

[468] And I think here's the situation where it's so often on the left, there's more of a big -hearted mission statement, but sometimes, yeah, the efficiency, the outcomes, they're not as stringent as they should be.

[469] We are spending people's money.

[470] So I appreciate the rights, insistence that these things yield results, that they're good use of money spent.

[471] And I think you're in one of the overlaps that can best exemplify when both parties are working together for an outcome.

[472] Yeah, I think that's right.

[473] I also think building bipartisan cooperation on these types of issues about the math.

[474] It's also about the relationships.

[475] One of the most surprising things for me was I found getting to know on a really personal level, faith -based Republican senators, for example, and key Republican members.

[476] I still today consider friends, and even though we don't agree on most issues politically, I admire the service they offer.

[477] And I admire the fact that they have an inner core of values that desire to serve.

[478] And, you know, we can disagree on lots of things, but also find the opportunity to agree.

[479] And by agreeing on some things, America was able to mount the largest investment in addressing food and hunger that we did since World War II.

[480] We were able to create an effort to electrify much of Africa, which didn't exist before.

[481] And we were able to pay.

[482] pass both of those bills through a very divided Congress and get it signed by and that to me is I feel like if we can do it there, we ought to be able to do it right now on COVID and just solve this problem because this is a solvable problem.

[483] And people, I really believe most people, not everybody, but most people, their service to matter in improving the lives of the American people.

[484] Well, yeah, I think some benefit of the doubt and some goodwill, just first acknowledging that both sides are truly in their heart trying to make the place better.

[485] And it's really just a debate over how that's done.

[486] But here again is where I bet it overlapped.

[487] I don't know anything about this, but I can tell you both when I was in Afghanistan in 2007 and in nine, they were starting to send a ton of special forces down to Africa.

[488] And so I do wonder if your electrification program, if it gained momentum because there were starting to be all these hot spots of terrorist activity because of the unrest and poverty.

[489] Yeah.

[490] Well, I think without question, that's true.

[491] And without question, the military leaders from Admiralis, perhaps most known for, you know, getting Osama bin Laden to David Petraeus, to all the other major generals that we could name, you know, Jim Stabridis, the head of Eurosac and NATO, they are very strong advocates for powerful values -based American leadership abroad.

[492] And they They said we need to make these investments in development and humanitarian efforts at a far higher level.

[493] They advocated for more staffing for the State Department and for USAID than even the military.

[494] And they were the ones who said our national investment in global security is out of balance.

[495] And we need to get the balance right by increasing the investment to use our diplomatic and development expertise around the world.

[496] And frankly, you know, had that mindset.

[497] really taken hold and been implemented effectively, I personally don't think we'd be dealing with coronavirus at the scale with it here in the United States.

[498] I mean, we had created in that era a program called PREDICT at USAID that was designed to look all around the world, identify zoonotic, which is animal to human, of particular types of viruses that could then become global pandemics and connect to early warning systems that would sound the alarm earlier, get people resources, fight these things when they're local and contained in a place to dealing with a global emergency like we are dealing with right now.

[499] And that's just one of so many different examples of how we can get upstream of these things if we really apply American leadership more effectively.

[500] Again, and it's just so frustrating that to convincing people that is actually a greater savor of lives.

[501] When I was just looking at yesterday, I was just in a debate with a friend about what were the deadliest wars and everything, and you just go through them, right?

[502] And you get down to Afghanistan, we have been there now for 19 years and 2 ,200 Americans have died.

[503] I mean, almost nothing when you compare it to World War I or Civil War or anything.

[504] And yet the amount of people that would die due to this pandemic due to the things you're talking about will greatly outsize that, right?

[505] And yet we have a very hard time prioritizing that version over the go put boots on the ground version.

[506] Yeah, it's hard to weigh and compare the loss of human life at Ramstein Air Force Base and been with our troops who have been injured returning from the field.

[507] USAID had 9 ,000 foreign service officers around the world and we lost during my tenure.

[508] And, you know, sitting with those young kids and explaining how their father had been in Afghanistan, had been a hero, had been working on behalf of America to keep our nation safe, that's a tough that I'll never forget.

[509] So, you know, every loss of life is just so tragic, which is why, like, right now, it's not okay, in my view, to just say, well, we're going to lose 80 ,000 Americans or we're going to lose 220 ,000 Americans.

[510] I guess that's my point.

[511] you would never say that about a military operation.

[512] We're going to send all these guys over there and we predicted worst case 2 .2 million and the best case, yeah, it never happened.

[513] I mean, the number one job of every government through history is to life for their people.

[514] I mean, that is truly the most basic responsibility of any form of government since the beginning of time.

[515] And so I was really frustrated by these estimates, you know, and that, well, that's just, going to happen.

[516] That doesn't have to just happen.

[517] We know, as you said, we have the playbook.

[518] We know how to solve these challenges, but it takes leadership, it takes cooperation.

[519] It does take, in my view, real public, private and real bipartisanship.

[520] Well, because there's some really interesting hurdles, right?

[521] Because I was just watching 60 Minutes and they had a story about this Canadian company.

[522] Their kind of breakthrough is they have an algorithm that's tracking, they got access, they convinced somehow the airlines to give them passenger data.

[523] And then also they've gotten cooperation with some phone service providers, right?

[524] So not only can they watch everyone that flew out of Wuhan, they can also then track where those phones go and where they would maybe travel to.

[525] And then they're tracking these hot spots and they're like, you know, they're synthesizing all this data, air flights, mobile data.

[526] And here's a great situation where it is going to have to be bipartisan because you're dealing with significant liberty issues.

[527] you're dealing with privacy issues and there's got to be some cohesion to figure out how we can protect both sides and yet have a system that actually functions like this one in Canada seemingly did much quicker than everyone else yeah i think that firm by the way identified coronavirus in the united states before any official entity in the united states so so you're 100 % right and you know the other foundation action plan uh which we have just put out there, we've put $50 million against actually implementing.

[528] It is based fundamentally on making testing broadly accessible to the American population in a strategic and then tying it to contact tracing, which includes the digital tools that you just described.

[529] You know, because to do contact tracing effectively for COVID -19, you just need to use digital technology.

[530] And it's a lot of geolocation.

[531] But we know that all that data exists.

[532] And frankly, to some extent, we've given up quite a lot of individual privacy for the convenience of, you know, if I want to buy a bicycle or a pair of shoes, if I even just think it, much less say it at the dinner table, my feed is pretty tailored to exactly the bicycle or the pair of shoes I want to buy.

[533] And underlying that, it's a shift in American privacy.

[534] So I would argue that as long as you protect the unique patient identifiers, the names of individuals, you don't actually have to lose more privacy than we've already lost.

[535] You just have to save people's lives as opposed to sell them shoes.

[536] But, man, you're right.

[537] What an irony and what a hypocrisy that we are fine that it persuades us to buy something.

[538] But if it were to save our lives, we're so hesitant and resistant.

[539] So yes, you had a couple of titles.

[540] and one of them I got really confused by.

[541] So in 2009, you became the USDA chief scientist of agricultural research.

[542] That was under Obama.

[543] But also in 2009, you start working for the United States Agency for International Development.

[544] You said, how do you both those jobs at the same time?

[545] You don't.

[546] You don't.

[547] I started in the Department of Agriculture as our chief scientist and there's something called an undersecretary for our science programs.

[548] And by the way, the U .S. Department of Agriculture don't have as much familiarity is one of those amazing institutions.

[549] It's one of the oldest institutions in the American government.

[550] The program I ran was tied to the land -grant university system in America, and all the in A &M schools are perhaps the best known of those, but also the historically black colleges and universities.

[551] And that program was founded in 1862 by Abraham Lincoln in the midst of the city.

[552] And it led to a rise in American agricultural productivity and economic competitiveness and education that far outstripped every other nation on the planet for the next 50 years.

[553] And so it both is amazing.

[554] Extraordinarily important, the Department of Agriculture has been in American history and how broad and, you know, significant it is today, even though no one really knows much about it outside of the folks who are there.

[555] Yeah, you're right.

[556] I don't hear people bringing up the USDA quite often unless they're talking about a steak they bought, I guess.

[557] And then, and then, you know, kind of, I'd say seven or eight months into that job, I got a call one morning from Secretary Clinton and then from President Obama.

[558] And they said, would you and lead USAID?

[559] So I had to leave that job and take the other one.

[560] And then on day five of the new job, there's a 7 .0 earthquake in Haiti and 200 ,000 people die.

[561] And you're tasked, right, with one of the biggest humanitarian.

[562] relief efforts ever.

[563] That's your job, day five.

[564] Go.

[565] Go, Raj.

[566] Make it happens.

[567] That was my job.

[568] I'll say I was really, I don't know what the phrase is.

[569] It was wet behind the ears or green.

[570] I was very new.

[571] Let's put it that way.

[572] And I was new to government in that kind of a role.

[573] So the earthquake happened in a few hours, not even a few hours, a few minutes after the earthquake happened within an hour.

[574] I got a phone call from the White House and they said the president's going to call you number should he call you at?

[575] And I was so new that I didn't even have any of my appointees, you know, political appointees on board yet.

[576] So it was just me in this massive office with basically no political staff.

[577] And so I looked at all my BlackBerry.

[578] So I gave him my BlackBerry phone number and hung up and then someone came up and said, well, who is that?

[579] I said, well, the president's going to call.

[580] And you know, the president had never called me before.

[581] Okay.

[582] Sure.

[583] So I go I go, fuck at my Blackberry, and there's, like, one bar.

[584] And I'm in this company building, Ronald Reagan building in D .C. So I go and I put it by the window, and I prop up a desk.

[585] And sure enough, the president calls, and I take out a notepad.

[586] And, you know, I wanted to do a really good president, the president.

[587] And he calls and he says, well, not just a president, it's Obama.

[588] Exactly.

[589] And so he says, I'm putting you in charge of a whole government response.

[590] And, you know, I want you to make us proud.

[591] I said, and I then took my pen out, and I was, like, ready to write down what he said next.

[592] And the line went dead.

[593] And I was like, oh, my gosh, I just hung up on the president.

[594] So I looked at the Blackberry, and it still had three bars.

[595] And like 30 seconds later, he was in the White House briefing room, and CNN was on behind me. And he says, I just spoke to Administrator Scha.

[596] I've asked him to deploy the Coast Guard, use the U .S. military.

[597] Like he, oh, oh, oh, seven things.

[598] And so then I took my notes and we were off to the races.

[599] But the amazing thing there was on day one, the president was crystal clear that this was both a moral calling that we had two hours from our border, 200 people had just lost their lives and a nation that had been flattened.

[600] And we should do everything we could to save lives and support our neighbors.

[601] But he also understood and said that this is a chance to demonstrate to the world how American, for good.

[602] And, you know, from Kennedy to Obama and Clinton, I mean, our presidents have understood that.

[603] And we did everything.

[604] We deployed the USS comfort.

[605] We saved during the urban search and rescue effort.

[606] We deployed teams from L .A. County and Dover.

[607] We, you know, we coordinated a 52 nation effort to help Haiti.

[608] And six months after the earthquake, illness in Porta Prince was much, much lower than it had been the day before the earthquake.

[609] And years later, the rate of child mortality and child hunger had been cut by more than 50%.

[610] Investment was up 400 annualized basis.

[611] Haiti is still a difficult place to make growth in institutions and society work effectively for a lot of reasons.

[612] But we did everything we could.

[613] And frankly, we were proud of it.

[614] And American troops work side by side.

[615] leaders, and they delivered for what they needed to do.

[616] And that mindset of we're going to do whatever it takes to succeed at this mission is the one that I think we need right now for COVID.

[617] Yeah.

[618] So then in 2015, Raj got appointed to the UN as one of six to review global pandemics in 2015.

[619] So you minimally, well, in 14, you did Ebola, but you've been for the last six, seven years, I mean, pandemics is kind of what you're focusing on.

[620] Yeah, I think that effort was, you know, if you look at what happened with Ebola in 2014, there was a wave in March of 2014 that came, was responded to, and got in rural Liberia.

[621] And then sometime in June, the virus most likely mutated became an urban virus, and the transmissibility became far more intense.

[622] spike happened in the summer and it was our judgment the UN kind of panel that included a few heads of state and some former administration officials like myself and some others that much of the world missed that spike and then after that most of the international response was not working in in sort of July, August, and September until the United States said we're going to really lead here.

[623] And once we made that in 3 ,000 troops, we built out laboratory infrastructure.

[624] We worked with our partners like the World Food Program to do helicopter transport with our military.

[625] And we went out and trained and hired 11 ,000 community health workers, but to be part of the response.

[626] And that response worked extraordinarily well so that within 8 to 12 weeks, we saw a massive reduction.

[627] So the question the panel was trying to ask is, how do we happen again?

[628] How do we make sure we don't miss the early warning?

[629] How do we make sure we enable strong leadership?

[630] How do we build preparedness because we know these crises are going to be more frequent in the future?

[631] Because of increased travel?

[632] How did you know it would increase?

[633] Mostly because of population growth and the increasing interaction between humans and animals as a result of both population growth and other elements.

[634] of our food system and the way we live.

[635] Zoonotic spread where you have reservoirs of virus in animals that sort of every now and then jump into the human population and become transmissible across humans is what we really look for and try to predict and so solving this stuff before it starts is stopping it at the animal to human transition point.

[636] I guess what I'm wondering is would it be beneficial that all these areas of great population had a food source that was very predictable and manageable and, I mean, would that be helpful?

[637] Yes, that would be helpful.

[638] And I think what would also be even more helpful because there will be spread is early warning systems.

[639] So during the Ebola crisis, I spent a lot of time personally with heads of state on the phone, you know, saying, hey, our folks on the ground are saying there's X number of cases.

[640] And they would say, well, you know, it isn't valid.

[641] yet, and if you say that publicly, it will be shattered.

[642] And so, you know, we need to validate the data first and this and that.

[643] It was Ellen Johnson -Serleaf, who subsequently won the Nobel Prize, and appropriately so, that kind of broke through that as president of Liberia and said, you know, publish the data as you think it is, because the world needs to know and we need the help to solve this.

[644] But that economy, you know, collapsed.

[645] It went down 33 % in GDP and And in a poor country like that, I'd spread hunger.

[646] So we had to address that by bringing in a lot of food and support for those very vulnerable populations.

[647] But the point is, you know, in this case, I think China clearly was not transparent about data early on.

[648] And what our panel had proposed was an early warning system where scientists get case data and share it automatically without necessarily needing governments.

[649] to approve the Rockefeller Foundation subsequently built data -sharing agreements across many, many countries around the world.

[650] China has proven more difficult to be part of that system.

[651] But outside of China, many of those systems exist because of that effort to take place.

[652] But the idea is to have a science -driven system so that if there are cases somewhere, you don't really need that local mayor or governor or head of state to agree with you.

[653] You need your scientists to call other scientists into the fight and begin the processing of sequencing, developing vaccines, understanding therapeutics, what could work, and doing the contact tracing immediately so that you lock these things become global pandemics.

[654] Yeah, like in other crisis arenas, if there's an earthquake, you're not waiting for the mayor to go like, yeah, yeah, it is, it is.

[655] let's say it is.

[656] Like, because I imagine the measuring of it transcends borders or something.

[657] Yeah, and here there's an appropriate debate.

[658] If you look across, you know, December, January, the data that was made available to let you make a judgment about, is this thing really going to spread aggressively or not?

[659] Known for those that were right on the front lines, the scientists knew what was going on.

[660] But it's not clear that the data sent over to the World Health Organization or others was in fact very clear about that and completes.

[661] This is one of those issues you don't really want.

[662] It's a little bit like the Federal Reserve.

[663] You don't really want the political folks managing that day -to -day making tactical decisions.

[664] Similarly, we need a system around the world where scientists determine the risk, merging new potential pandemic threats, and a global scientific network maps and deals with it and it stays sort of outside of local politics.

[665] Stay tuned for more armchair expert, if you dare.

[666] So now, okay, a couple cool things about the Rockefeller Foundation that I think.

[667] Prior, and correct me if I'm wrong, but prior to Rockefeller, right, medicine was not research -driven at all.

[668] It was just reactionary.

[669] It was people had ailments and we tried to treat them.

[670] there was no standard of education across the country.

[671] Yeah.

[672] I mean, isn't that where the phrase snake oil salesman comes from?

[673] Yeah.

[674] And so there's no research.

[675] There's no funding because you can't make money to try to find out what causes the diseases to begin with.

[676] There's no incentive to prevent disease at that time.

[677] So a couple of the amazing things, Rockefeller, with the help of many people said, was, A, we need some kind of standard, right?

[678] We need a standard of what a doctor can do.

[679] And so, if I'm correct, I think he modeled after he said, Johns Hopkins is doing it right.

[680] Their doctors are great.

[681] So let's get them to build this curriculum and this set of standards.

[682] And any university around the country that will adopt this system, I will fund.

[683] And, of course, all these universities said, yes.

[684] So now we have a standard baseline of what a doctor should know, which is phenomenal.

[685] At that time, it's a paradigm breaker to even think about that, right?

[686] Absolutely.

[687] And then he starts, he funds the medical research center in New York that actually starts preventing all these things.

[688] And the one that blows my mind right is in the late 1800s, there was this stereotype that all Southerners were lazy, right?

[689] And it just seemed like probably xenophobia.

[690] But then come to find out this thing, hookworm that some very significant percentage of Southerners got, like in the 30 percentish range, get hookworm because they don't wear shoes there, culture.

[691] for whatever reason and and Rockefeller goes well how do we fix this oh you take some iodine pills oh really and then it's gone in three days and then you you return to normal energy levels and then all you got to do to prevent it is wear shoes and so he funds this whole thing to go out in boots on the ground like you're saying walking from village to village holding little seminars to educate people on hookworm treating the people and by god fucking fixes what was tens of millions of people who felt tired and he was a part of so many things like that i don't think anyone recognizes how lasting Rockefeller's impact was on this country and the world.

[692] It's enormous.

[693] Yeah, I couldn't agree more.

[694] The foundation was started more than 100 years ago on the premise that science should be applied to lift up all of humanity.

[695] And if you think about it, it was the science age.

[696] Remember, and people would go see the Ferris wheel and the lights.

[697] And it was all like science transforming industry.

[698] And he wanted to say, how do we make science transform?

[699] humanity.

[700] And so the two big hundred year for the Rockefeller Foundation in the application of science to transform humanity have been health and agriculture.

[701] And on the health side, you're right, they created the discipline of modern medical education, of science based.

[702] The program you described in the southern part of the United States became the model for a county -based public health system.

[703] concept didn't exist before.

[704] It went on to house all these malaria programs.

[705] Those malaria research programs in Atlanta in particular were turned over to the federal government and grew into the Centers for Disease Control.

[706] So in fact, you know, when the Rockefeller Foundation way back, well before my time, but when they wanted to create an international public health system, they said, okay, we're going to help you create the League of Nations after World War I. But our requirement is that we want you to have an international public health that brings this science -based public health to every part of the world.

[707] And the League of Nation said, well, you know, we're just getting started.

[708] We can't really do that right now.

[709] So Rockefeller said, okay, we will house inside our foundation that committee.

[710] And later, they spun out that committee as the World Health Organization.

[711] Get the fuck out of here.

[712] That's why WHO is technically older and not immediately a part of the United Nations even today, is that it's the U .N. because it's fun out.

[713] And the big huge insight that I continue to be amazed by is that team understood that you got to look at these things systemically and actually solve the problem.

[714] If you're going to do a small grant or a nice charity project somewhere.

[715] And people should.

[716] Like I'm all four charity projects that make lives better in communities.

[717] But they had the capacity and the vision to say, let's get the best scientists, build an infrastructure, and let's stay with it for 30 years until we've eradicated hookworm from the American South.

[718] Or let's invest in a decades worth of research to develop a yellow fever vaccine, and then let's distribute it around, build an international public health system.

[719] And if we have to house it for 20 years before we spin it out, we'll do that.

[720] But because we're in for the long run.

[721] And that ability to be in for the long run was just awesome.

[722] Just, yeah.

[723] I was younger, I met Dr. Norman Borlaug, who's the longest -standing employee the Rockefeller Foundation, won the Nobel Peace Prize, Presidential Medal of Freedom, Congressional Medal of Honor.

[724] I mean, he's such an amazing human being.

[725] He's an agricultural researcher.

[726] He was at Rockefeller, I think, for 45 years.

[727] And somewhere along the way, they invented a certain type of wheat variety that helped triple and quadruple wheat yields in India and Latin America.

[728] And he's credited with moving almost a billion people off the brink of starvation through his science and his courage in applying that science.

[729] What people don't realize is they started that program in the 1910s, 50 years later or 70 years later, that it paid that kind of fruit.

[730] And what I love about this institution is that ability to just make big bets, over a long period of time.

[731] Yeah, it's really incredible.

[732] If I were you, I mean, and I'm sure you are, like, stoked to work for a group with the track record they have.

[733] Yeah, it's amazing.

[734] I can say it.

[735] I'm stoked.

[736] Yeah.

[737] And the reason is, even in what we're doing now on COVID, like we are able to the very best people together.

[738] And you could be the CEO of an industry company, or you could be a big investor or a public servant.

[739] But it's getting those people together to say, how would we solve this problem, which is why when we looked at testing, we wanted to say, how can we solve this for America and then the world, as opposed to just support kind of the expansion of testing in a particular place?

[740] Yeah, and so what is the most challenging link in the testing situation right now?

[741] Well, we think the only way for the American economy to get out of this extreme crisis that's just crushing, crushing, crushing, maybe half of American families in terms of having to choose between their lines is, in fact, broad access to testing.

[742] And we put forth a plan that's like $1 million today, $3 million in eight weeks, $30 million in six months, as I mentioned.

[743] The way to effectively get there is not that different than what we did and what we did in antiretroviral drugs for HIV -AIDS.

[744] It turns out that all of these labs place really kind of small, short -term, purchase orders for tests and test kits and supplies.

[745] And dominated by a handful of manufacturers, see those purchase orders coming from, you know, economically weak entities on a relative basis.

[746] And they fulfill them in the short term, but they don't make the investment to build out the capacity to get 10x or 30x the volume of testing materials and supplies into the system.

[747] So the first thing we're doing is pulling together the buyers, states, local governments, and saying we will pull the purchasing so you can go out there and make a contract happen that might go a year out instead of just a few weeks out.

[748] And together, that contract plus financial backing from Rockefeller would allow those companies to say, okay, this is secure, this is real.

[749] we're going to make the massive investments we have to make now to scale up the availability of testing for America for the next year.

[750] And that's the core insight.

[751] When that infrastructure is built, is it agile?

[752] Could it then go to the next one that's coming?

[753] I mean, is that the theory?

[754] Yeah, yeah, it could.

[755] In theory, it could.

[756] I mean, in practice, we've also observed that there's a lot of now, and there needs to be more going in.

[757] and our proposal is about a $100 billion investment over the course of a year, which would allow for a reimbursement rate at $100 per test.

[758] The test is in network, out of network, you know, done at a research lab, done at a Lab Corps or Quest Lab, and it would just make the system less complicated and more efficient, particularly for the next year.

[759] And frankly, you know, we'll do fine in that environment.

[760] And so we're at war as a country.

[761] And so we're asking that industry to dramatically scale up its production of these critically needed tests to invent some new ones and get them through the process quickly.

[762] Bring a financial backstop so that they at least don't lose money doing that.

[763] But we need that as a nation right now.

[764] And then I would imagine, are you already preemptively trying to prep for the mass production of the vaccine when it's available?

[765] Like are people ahead of that?

[766] Is that being looked at and funded?

[767] Yeah, there's an organization called CEPI that has been doing that on a global basis.

[768] I'd say Bill Gates and the Gates Foundation have been vaccines and we're very focused on testing and that sort of works together well.

[769] And we're going to need that massive scale of production, distribution, and consumption, ultimately use of vaccines.

[770] But that's going to take a while.

[771] I mean, that's 12 to 18 months away.

[772] And just to put it in perspective, we're losing right now $500 billion a month in GDP loss because of this shutdown.

[773] And while for me and my family, I'm getting more time with my kids that I have ever in my career and I love it.

[774] And it's become this both challenging but also a special moment.

[775] Practically speaking, for most American families, this is deeply.

[776] And, you know, like everyone.

[777] People, we now see who is an essential worker, and we see that those workers have not gotten a raise in 40 years, that almost all the gains of the American economy have gone to capital and not labor, a family medical leave that's paid, they don't have the security of any real savings, and they don't have a living wage.

[778] And nevertheless, they're out there risking their lives so the rest of America can be safe.

[779] And so the reason we need to be more aggressive about testing and tracing is to make sure that the half of all American households that are living that way can survive the next year, the next a crisis right now that is unbelievable.

[780] We have more unemployment in America than we have had since the Great Depression.

[781] And there's a lot of talk about the stock market, but there's not.

[782] not a lot of talk, the reality of life for those working American families.

[783] It seemed that this whole thing started pretty apolitically.

[784] And now it seems like it's funneled into the two camps.

[785] By the way, I see both sides.

[786] I mean, like you just said, there are people, you can't go to the hospital.

[787] There's all these kids now that were born in the last three months that aren't on their schedule already for vaccines.

[788] There's going to be collateral ripple effects.

[789] People are right to question whether those effects will be worse than what.

[790] what the COVID unchecked?

[791] I think it's, that's an appropriate question.

[792] It is a fair question, by the way, it's gonna get a lot worse in August because the next flu season starts kind of mid -August, you'll have a host of new viruses that have symptoms that look like COVID.

[793] And without a 10x, 30x increase in testing, you're not gonna be able to know the difference.

[794] And I fear that that's gonna prevent schools from being operational.

[795] I think it's gonna really prolong the misery on America's working families.

[796] And so are we seeing more bipartisanship right now?

[797] I'd say part of why we did the plan we did, we brought together Republicans and Democrats and said, what can we agree on?

[798] And we put a plan forward that and I was on today with about 40 members of Congress and working through that.

[799] I would say my observation is both sides have real merit to their ideas.

[800] But that's not.

[801] Where do you have merit to your ideas?

[802] Like Democrats say we should use the Defense Production Act much more aggressively.

[803] That's true.

[804] But if we're not going to do that at a 30x scale up of testing in America, and there's no indication, then we've put forth a public -private approach that can actually work to deliver results for American families now, as opposed to just prolonging the political conflict.

[805] And similarly, I think many of the state or the constitutional, conservative side have embraced an eagerness to open up very quickly without having data systems in place.

[806] And they're going to be looking at big immediate pandemic rebound in South Korea.

[807] We've seen in parts of China.

[808] We've seen it in Singapore, which probably did the best lockdown, as you'd imagine, of any place on the planet.

[809] And even they've had multiple recurrent waves when they open up.

[810] So we need to be more like Germany or Iceland.

[811] someone that's taking testing seriously or South Korea, this is a bipartisan action plan because, look, if you're a frontline health worker as my sister is, as I mentioned, in New York, you're taking risks every day.

[812] You need to get testing.

[813] I don't really care right now whether the solution comes from one type of approach or another type of approach.

[814] You just are risking your life and deserve to have a test.

[815] And that's the mindset we used in putting the plan forward.

[816] And now we're working with these, we're working with half a dozen states, we're working with a few Native American lands to implement this effort.

[817] And hopefully we'll get the federal government working with us at scale also.

[818] Yeah, as a layman armchair expert, I have to say, I've consistently been like, all this is so theoretical simply because we don't have testing.

[819] It's crazy we don't have an antibody test that we can say is, you know, above 99%.

[820] I know there's a couple out there that all of it's theoretical.

[821] How long has it been here?

[822] How many people have it?

[823] We're all just guessing on some level until we actually have that data.

[824] So it's like to me, step one has to have always been.

[825] Everyone gets tested.

[826] Yeah.

[827] And just to put it in perspective, because we were mayors around the country.

[828] I've had in the last 48 hours, three different mayors of major American cities tell me the same story.

[829] They said, you know, I gave a press conference and then someone tweeted at me and said I have 500 ,000 test kits in Asia somewhere.

[830] So I sent it to my procurement team and they're chasing it down.

[831] I mean, that is no way to run a country or a national response.

[832] And we are America, for goodness sakes.

[833] We're the strongest and most capable of what we want to be.

[834] And we can't have, you know, 200 different local leaders chasing tweets that have come in with offers to sell them things.

[835] There needs to be cohesion to this.

[836] Bring it together.

[837] And we'll do it initially.

[838] And then we'll get the federal government and others to join as this starts to work.

[839] But bringing that together and creating a disciplined clearinghouse that's data driven, that can place large long -term purchase by the financial capacity of our endowment and other institutions is where we're going with this.

[840] And we believe it will work at changing the numbers.

[841] I'm so grateful that you're doing what you do.

[842] Oh, my God, yeah.

[843] I have two nosy questions, and then I'll let you go.

[844] One is, so Rockefeller was the first guy to have a billion dollars, right?

[845] How much money is in this endowment at this point?

[846] So right now, we have about a $5 billion endowment.

[847] We have a five billion dollars and expend alongside that endowment called Co -Impact.

[848] So we offer other families and institutions that are large -scale, giving operations usually sign on at about 25 million, and we raise and spend a few hundred million dollars through that vehicle.

[849] And we have an investment platform for people who want to make impact -oriented investments.

[850] And we raise money and expense as well.

[851] So all three of those really define our capacity financially.

[852] But I'd say, you know, the other thing that Rockefeller did over more than 100 years, was just invest in people.

[853] They're 14 ,000 trained leaders around the world that are called Rocky Docks because they got their degrees with support from the Rockefeller Foundation.

[854] And I'd say half of Africa's agriculture ministers are Rocky Docks.

[855] We have this awesome network of people that we can tap into around the world.

[856] And the credibility that comes with for more than 100 years, having done this, work really with a true public mission, with a desire to help improve their living conditions.

[857] So I find that more than the money right now, because money is, you know, there's plenty of money, to be honest.

[858] It's the ideas, it's the people we can bring together, it's the commitment to delivering.

[859] And it's the approach of saying, let's cross these divides.

[860] Let's get the manufacturers together with the lab directors and figure this out.

[861] Or let's get Republicans together with Democrats and be a bridge that can help just deliver results.

[862] Yeah.

[863] What a jewel.

[864] What a jewel.

[865] Okay, so my last question, and it's related to that.

[866] So John D. Rockefeller found it eventually overwhelming.

[867] People knew he was going to give out money and then he was going to try to make the world better.

[868] And the onslaught of requests became such right that he ended up employing his friend to run and sift through all these requests.

[869] So are you, you have three kids.

[870] you're a human being.

[871] Do you find the weight of how many people probably want your involvement daunting?

[872] I do.

[873] I actually, just honestly, I do.

[874] Through my work, I've had a chance to really connect with and see extraordinary people in tough circumstances do things that are so courageous and so brave.

[875] Hundreds, thousands of them, whether they are the folks that are kind of running those schools in Afghanistan that we talked about or people who run hospitals in the Democratic Republic of Congress who've been subject to rape and violence or folks that fight trafficking around the world.

[876] And because we now have, you know, access to these resources, you have this, like, real desire to just do everything you can.

[877] All these people that you know are heroes and you know how hard they work and you know of their deep personal commitment.

[878] They've given their lives, you know, their careers in their lives to just service.

[879] We just don't have the ability to help all of them.

[880] Yeah.

[881] So I do get a lot of requests that I have to unfortunately say no to.

[882] And it does kind of weigh on you because you just know how hard they're working on the other end and you know the difference they're making in the lives of people and the sense of service that underpins it.

[883] But the flip side of that is, you know, we save our firepower for these kind of big systemic transformations.

[884] And the, the ones that we're betting on now, broad testing in the world, particularly in Africa and South Asia, over time to overcome COVID -19, we're making a big bet on addressing food security in Africa in particular.

[885] And there's going to be a big crisis coming in summer and in the fall because of health crisis, causing a food crisis.

[886] And ultimately, a major global investment to end energy poverty using new technology and renewable.

[887] technology to working with companies around the world to move people out of extreme poverty by getting them reliable access to electricity.

[888] And we think we can do those things.

[889] And we've studied them.

[890] We know the issues.

[891] We know the people.

[892] We're out there making it happen.

[893] I'm really proud of our teams.

[894] We have teams all around the world.

[895] This is a crisis that has a lot of risk, especially for our Nairobi team or our New Delhi team or our Bangkok team.

[896] But they're out there of working hard continuing to kind of pursue the mission.

[897] So we can't support everybody and it gets to say no. Yeah.

[898] Yeah.

[899] But we save our firepower for our biggest bets.

[900] Yeah.

[901] Well, listen, Mishigander, you're fucking awesome.

[902] I'm so glad you're at the helm of the Rockefeller Foundation.

[903] Just grateful there's people like you that have dedicated their lives to service.

[904] And by God, where we'd be without y 'all is unimaginable.

[905] So thank you so much.

[906] And thanks for taking the time to talk to us.

[907] I'm sure your phone list is busy.

[908] Well, thank you.

[909] And thank you.

[910] It's nice to say, and Monica, nice to meet you.

[911] Hey, can I just, while I have you on and you do have access to $5 billion, do you know that over 99 % of Americans don't own Ferraris?

[912] I just don't know how anyone sleeps at night, knowing there are so many people who don't own Ferrari.

[913] I figured you might be a car guy, your background.

[914] We'll have to solve that some other way.

[915] I, I, I, I, I, I, I, I, I, I saw Ford v. Ferrari with my kids, and I just loved that movie.

[916] Oh, what a great movie.

[917] Yeah.

[918] All right.

[919] Thanks so much.

[920] We'll hopefully talk to you again soon.

[921] Yeah, take care.

[922] And now my favorite part of the show, the fact check with my soulmate Monica Padman.

[923] Hi.

[924] Hi.

[925] Oh, you know what I got to speak to Jason Delion today about?

[926] What?

[927] So Jason Delion, of course, people heard that episode.

[928] He's a premier archaeologist.

[929] Yes.

[930] I'm a winner of the MacArthur Grant, an anthro teacher at UCLA, and I said, hey, how do you feel about this Cinco de Mayo thing?

[931] Because Monica and I got in this big debate about it.

[932] You know, he laid out a bunch of different things.

[933] He's like, personally, he's like, I love it.

[934] I think it's great.

[935] Yeah.

[936] He's like, a fucking sombrero is a hat.

[937] But he said, he's like, the reason your St. Patrick's Day thing doesn't, I'm not sure works perfectly is, he's like, I don't know if they were celebrating St. Patrick's Day when they were also shitting on Irish people.

[938] Mm -hmm.

[939] He's like, and if they were shitting on them all week long, and then they were celebrating them on Wednesday.

[940] Well, that's what I said.

[941] I know.

[942] I know, I know.

[943] You only believe it if it's Jason.

[944] No. Well, that's also fair.

[945] It's fair that you only believe it if it's him.

[946] He can speak to that community more than I can.

[947] Well, here's what happens, I think, more generally.

[948] Yes, he is in the community.

[949] Like, my sometimes knee -jerk thing is, like, I feel like people are advocates for communities that are not even a part of.

[950] And so I question their intentions a little bit.

[951] Yeah.

[952] But to hear it from someone that actually has some experience with it.

[953] But also just quite often, I respect you a ton and you have a different opinion than me. And I go, huh, this is weird.

[954] I respect myself.

[955] Obviously, I hold my own thoughts in high esteem.

[956] And then I hold yours.

[957] And then I talk to somebody who's, in my opinion, more of a tiebreaker.

[958] Like, I consult them as a tiebreaker.

[959] Oh.

[960] But what was nice is he kind of said both things.

[961] Okay, that's good.

[962] I'm framing it as like a win for both of us.

[963] Again, I wasn't trying to say people shouldn't celebrate.

[964] I didn't read any of the comments.

[965] I don't know if people were mad at me about that.

[966] I'm sure they were.

[967] But I'm just saying, and I'm going to stand by this always, that you should take a few seconds to think before you ask.

[968] That's all I'm asking for.

[969] I don't, and I'm just never going to sort of back down on that opinion.

[970] I think it's okay to think.

[971] about the implications of the stuff.

[972] I agree.

[973] So.

[974] I don't ever want you to back down on anything.

[975] We wouldn't have a show if you backed down on everything, right?

[976] Dice.

[977] It's, um, I have to choose, though.

[978] Sometimes I feel like I have to choose between having an opinion that's maybe going to cause a fight or cause people to comment or whatever or just not say anything and have everyone be happy.

[979] Hmm.

[980] Well, I feel that way uncertain topics.

[981] There are a bunch of topics that I have opinions on that I'm just not willing to wait into the controversy over.

[982] My life's too short for it.

[983] It doesn't mean I don't have conviction about the opinion or whatever.

[984] It's just like, you know, life's too short to deal with the outcome of that.

[985] It's kind of a bummer, though.

[986] It is.

[987] It is.

[988] I think, you know, a lot of it's just evaluating whether you think it's going to be productive or not.

[989] And I don't think it's a, you're not selling yourself out by not vocalizing everything.

[990] It's just like which ones are productive and which aren't.

[991] Yeah, I think that's fair.

[992] And I do think sometimes I, this is a hard pill for me to swallow, but I think, I mean, I'm not in a relationship.

[993] So I don't have to juggle this as much.

[994] But like sometimes your opinion isn't worth the fight.

[995] Yeah.

[996] Well, and you and I are in a relationship.

[997] And that is the case sometimes.

[998] Like we've discovered recently that we're just better off not talking about Corona.

[999] We're both very emotional about it.

[1000] I'm emotional about it.

[1001] I don't know if you're emotional about it.

[1002] I'm very emotional about it.

[1003] And it's just a topic that, like, we never end up feeling better afterwards.

[1004] You never convince me of anything and I never convince you of anything, which is rare because I think you and I are very open to being convinced by one another.

[1005] And I can recognize that on this one, my ears are closed.

[1006] And I think there's a lot of emotional stuff going on with me about Corona that makes probably my opinion less valid.

[1007] Do you want to talk about it?

[1008] Sure.

[1009] The reason this whole thing is very emotional for me is, and I talked to my mom about this yesterday, so I don't feel bad talking about her in this respect.

[1010] Often she came home and she said, we're moving to this guy's house.

[1011] And we said, why?

[1012] And she said, because we're all going to be really happy there.

[1013] And then we said, okay.

[1014] And then we went there and then we were not happy there.

[1015] And then I said, why are we still here?

[1016] because the premise has been proven wrong.

[1017] We're not happy here.

[1018] Everyone's miserable here.

[1019] So why are we still here?

[1020] And now, without her saying, I just can't fail at this again.

[1021] She wouldn't say that.

[1022] No, she didn't even know it at the time.

[1023] She didn't even know it at the time.

[1024] It became a new thing.

[1025] And to me, the explanation kept getting less and less plausible.

[1026] Sure.

[1027] And so for me, from my point of view, it was, okay, we have this virus corona.

[1028] We're not going to be able to get rid of it.

[1029] It's going to spread.

[1030] Now, the only thing we can hope to do is control the speed at which it spreads, so we don't overwhelm the medical system, and we got to flatten the curve.

[1031] And I was like, yep, that's a great plan, and it's the safe thing to do, and it's the right thing to do.

[1032] And in my opinion, which is all that really matters for my emotional context, is we didn't overwhelm the medical system.

[1033] It seems obvious we didn't do that.

[1034] and I think we can we can now change this without overwhelming the system.

[1035] And so I'm not sure anymore why we're doing it.

[1036] I feel like the premise is gone now.

[1037] And it's just bringing up this stuff for me where it's like, well, now what?

[1038] Now there's another thing or even yesterday, Chris and I got in a fight because I was like, well, we're going to get the antibody test.

[1039] It'd be great if we all have already had it because then we can just kind of travel through.

[1040] And she's like, well, no, we still can't do that.

[1041] that.

[1042] I'm like, well, wait, two weeks ago, you said that if we all had it, then what's to worry about?

[1043] And then I just feel like the goalpost keeps getting moved.

[1044] I'm having a harder time grasping the reasons why than I was originally.

[1045] Then it's, it's very oversized in my head.

[1046] It's really way more difficult than it should be.

[1047] Like yesterday, I was just overwhelmed by it.

[1048] Yeah.

[1049] And yeah, it makes me very emotional.

[1050] And I feel like I'm just stuck in something that I have no saying.

[1051] Yeah, it's hard for you to feel like people have control over you.

[1052] Mm -hmm.

[1053] And that they're changing the narrative on me. That's totally fair.

[1054] I and it's triggered actually by the fact, like if I were to argue about it with someone else, Clay's wife, it doesn't trigger it because I don't love her.

[1055] She doesn't love me. I don't feel like I'm doing something out of love.

[1056] because I am actually doing a lot of behaviors out of my love and respect for you and Kristen and our friends who also share this opinion.

[1057] So it's really interwoven with like love and doing something I don't want to do for love.

[1058] And it's just really complicated.

[1059] Right.

[1060] It is complicated because everyone's doing things they don't want to do for love, you know, not just specifically with this, but in life in general.

[1061] sacrifices that come with loving a person.

[1062] Yeah, big time.

[1063] And, but there is the point, and that's when you're trying to identify whether you're a codependent or not, are like, are you going down with someone's ship?

[1064] Like, just because someone believes there's a monster in the corner, you can only join them so much before you're like, no, I can't join you.

[1065] And I do think the inconveniences that it's presented are easier when you believe in the mission of it.

[1066] Yeah.

[1067] Like, I don't think I'm more inconvenience than you are.

[1068] You're equally as inconvenienced or more than I am.

[1069] And we are collectively way less inconvenience than most people.

[1070] I mean, like, I feel, to be honest, not very inconvenience, which is I'm glad you're saying all this because sometimes when we fight about it, I do think like, what is he not doing that he wants to do?

[1071] Yeah.

[1072] And I can't come up with anything.

[1073] And then I get frustrated because I'm like, I don't even understand what the point of this because it doesn't feel to me that there is a big inconvenience or a big loss.

[1074] Well, so the way you feel, like the really rooted feeling you have about protecting your grandparents, I have a very rooted feeling about our economy and the downstream effects of our economy sucking or doing well.

[1075] And I am panicked right now about what we're doing and what we're doing and what we're planting and what we're going to reap.

[1076] I'm very irrationally panicked about that.

[1077] Like, it takes up a lot of my time, my mental thought and my concern, and I'm very nervous about it.

[1078] It's like, you just can't read in the New York Times that only one in four adults is now employed.

[1079] Oh, it's awful.

[1080] I mean, it is.

[1081] And that, I, that scares me the way terrorism scares other people.

[1082] I feel that way about the economy, like, oh, that's what really will fucking decimate this country is, you know, just not being productive for three months.

[1083] Yeah, I understand that.

[1084] I'm sure my side of the argument is emotional too.

[1085] It has to be.

[1086] For me, I probably feel like I'm projecting a sense of, oh, you don't care about me because you don't want to protect me from this.

[1087] Yeah, and when my mom was, when I was telling my mom all about it, yesterday, the first thing she said is, I can only imagine if the inference that Kristen and Monica are making, or even if you're just interpreting it as you're not a good protector, that you're off the reservation.

[1088] She goes, knowing you who are a cape at five years old and told me you were superdex and you're going to protect me, I have to imagine to be seen as someone who's potentially a threat as opposed to someone that's keeping them safe is probably very hard for you.

[1089] And I think she's right.

[1090] Yeah.

[1091] I mean, I know if I were you, I'd go, then just be safe.

[1092] If you want to protect us, just be safe.

[1093] Yeah.

[1094] Yeah, yeah.

[1095] But we have such different opinions of what's safe so it gets tricky.

[1096] I can't imagine that we're unique in these stresses of this scenario.

[1097] I have to imagine people.

[1098] all over America are like living with people they don't agree with on this thing and it's got to be really hard.

[1099] Definitely.

[1100] Yes.

[1101] And I know that.

[1102] I know that when we're having these conversations.

[1103] I know that's a deep rooted thing with you about needing to protect.

[1104] Then sometimes I feel like, okay, then I have to make a decision sort of going back to what we were talking about with opinions is like I have to decide whether I'm going to lie.

[1105] And, you know, and, that I guess I'll just be fine with whatever, even though I'm not, even though I feel unsafe, to keep the peace.

[1106] Or I could keep saying what I feel, this scares me and know that there's going to be unrest.

[1107] So I don't like having to choose.

[1108] Yeah, yeah.

[1109] But sometimes do you have to choose?

[1110] Well, the other part was I was, discussing it with Eric and I was saying, you know, intellectually, I recognize I'm doing the exact wrong thing, which is instead of making you feel safer and making Kristen feel safer, I'm trying to get you to think the way I feel so then you won't feel unsafe to begin with.

[1111] Like, I'm trying to erase you even feeling scared to begin with.

[1112] and it's a it's not working and b i already know that's never how you make someone feel safer but it's so tempting for me to go like well if she just saw it the way i did she wouldn't be scared and it's such a waste of time for both of us yeah for me to try to convince you there's nothing to be afraid of right and it sounds i'm sure it feels like i'm just ignoring that you're saying well i do feel unsafe so i don't know what to tell you and i don't i don't walk around I don't wake up in the morning and feel unsafe.

[1113] No, you're not crazy.

[1114] I don't want anyone to think that you're like some militant crazy person.

[1115] No, I mean, I hope I'm not, but I also am taking it seriously.

[1116] When I think about like, oh, realistically, I see my family in 2020, probably not.

[1117] That's really hard for me. Yeah.

[1118] I mean, I've never done that.

[1119] And I don't like the idea of it at all.

[1120] and that's realistically what happened.

[1121] So.

[1122] You know, there's been a lot of guys in my meetings that are sharing about how reminiscent this is for them being sober in the 90s when the AIDS epidemic was at its peak and people were so afraid of it.

[1123] They were urged not to go to meetings because people didn't know how communicable it was and they were urged not to be lovers and to not be intimate.

[1124] and all this and they were just saying how much it's bringing up that trauma of that experience and they ultimately were like yeah this thing exists it's dangerous but we have to be together and we have to have our meetings and we have to be lovers and we have to you know it's just very complicated and that was something that was like no no you're dying from this thing like in the half of you who get this are going to die you know and they had such a unique situation for them as a community, they had to just go like, okay, well, what level do I feel safe?

[1125] It's going to be worth the risk for me at some point.

[1126] But that's the difference.

[1127] It's worth the risk for me. My risk is small.

[1128] Their risk is much higher.

[1129] And then subsequently, my grandparents are much, much higher.

[1130] Yeah.

[1131] And I can't make that decision for them.

[1132] Like, I, you know, I can't say.

[1133] What if your grandparents said to you, hey, we know the risks.

[1134] We want to see you.

[1135] Would you do it?

[1136] No. You want it?

[1137] Because my mom yesterday was kind of like, I know the wrists and I'm not going to not see my kids over it.

[1138] I'm going to roll the dice to see my kids, which I very much, if I were 70, you were telling me I couldn't see Lincoln and Delta.

[1139] I'd be like, you know, if I'm going to die of this thing, I'm going to die of it.

[1140] I'm going to see my kids because I might die of old age anyways.

[1141] Like I can see myself going, I don't really care.

[1142] I got to see my kids.

[1143] Hmm.

[1144] Yeah.

[1145] If they die, that's on me to carry the rest of my life.

[1146] That's not on them to carry.

[1147] Like, I don't want them to die.

[1148] And I definitely don't want them to die of anything that I could have a hand in.

[1149] Like, that's not an opportunity for me to aid in killing them.

[1150] Right.

[1151] Like, I'm just never, ever, ever going to be a part of something like that.

[1152] So I will see them when I know for sure it is safe to do that, which is likely a vaccine.

[1153] A long way away.

[1154] Yeah.

[1155] So I just feel sad, I guess, about...

[1156] Really, I just probably feel sad.

[1157] Yeah.

[1158] That's it.

[1159] Me too.

[1160] Yeah.

[1161] And we're in the luckiest scenario humanly possible.

[1162] We...

[1163] Yeah.

[1164] And we feel sad.

[1165] Mm -hmm.

[1166] So just imagine...

[1167] I do.

[1168] I imagine all day.

[1169] That's part of why I feel this whole thing like that.

[1170] Yeah.

[1171] This sucks so bad for so many people.

[1172] Yeah.

[1173] Anyway.

[1174] Okay, Raj.

[1175] Sorry, Raj.

[1176] We had some real housekeeping to do.

[1177] Well, this was a corona -heavy episode.

[1178] Yeah.

[1179] Okay, so you referenced the Adam Smith Invisible Hand, but we didn't really go into it.

[1180] So in case people don't know what that is, the Invisible Hand describes the unintended social benefits of an individual self -interested actions, a concept that was first introduced by Adam Smith in the theory of sentiments written in 1759.

[1181] invoking it in reference to income distribution.

[1182] Mm -hmm.

[1183] Yeah, and the way I understand it, too, is like the invisible hand in the market that keeps everything equal, basically.

[1184] Like, there's all these things that make supply and demand worked and it gets agreed upon and the price is agreed upon.

[1185] And there's this invisible force making all this shit happen.

[1186] The DOD budget, you said, is $1 .4 trillion annually, 738 billion.

[1187] Yeah, I should have been more clear.

[1188] If you include Department of Homeland Security, you're going to include a couple things.

[1189] But it really is just the total defense budget, including DOD and Homeland Security and a couple of others.

[1190] Well, in 2019, the proposed fiscal year 2020 budget request for national security in total was $750 billion.

[1191] $7 .3 went to the DOD.

[1192] Hmm.

[1193] Hmm.

[1194] Okay.

[1195] Okay.

[1196] Oh, yeah.

[1197] You said 2 ,200 Americans have died in the Afghanistan war.

[1198] As of July 2008, there have been 2 ,440 U .S. military deaths in the war in Afghanistan.

[1199] 1 ,856 of these deaths have been the result of hostile action.

[1200] 20 ,320 American service members have been wounded in action during the war.

[1201] In addition, there were 1 ,720 U .S. civilian contractor fatalities.

[1202] That was in 2018.

[1203] Well, what's so sad is that 1 ,000 of those deaths were friendly fire.

[1204] That's how Pat Tillman died.

[1205] That's awesome.

[1206] It's just heartbreaking.

[1207] The guilt of being someone who, oh.

[1208] Okay, yeah, you said 200 ,000 people died in Haiti.

[1209] Yep, 220.

[1210] I'm sure, give or take.

[1211] Yeah.

[1212] I think there was a real hard time.

[1213] counting for a lot of the people.

[1214] I bet.

[1215] Oh, where snake oil salesman comes from.

[1216] Oh.

[1217] The phrase.

[1218] Oh, this is exciting.

[1219] Yeah, this is kind of fun.

[1220] Do you call that the etymology?

[1221] Is that the be like the book of a name?

[1222] Okay.

[1223] Like etymology in words is where it derived from.

[1224] Yeah.

[1225] Snake oil is a euphemism for deceptive marketing and health care fraud.

[1226] It refers to the petroleum oil or snake oil that used to be sold as a pure all elixir for many kinds of psychological problems.

[1227] In 18th century Europe, especially in the UK, viper oil had been commonly recommended for many afflictions, including the ones the rattlesnake pit viper.

[1228] A type of viper native to America was subsequently favored to treat rheumatism.

[1229] Oh, maybe I should try it.

[1230] And skin diseases.

[1231] Oh, my God, I have both.

[1232] You should try some snake oil.

[1233] Oh, I would love it.

[1234] Though there are accounts of oil obtained from the fat of various vipers in the Western world, the claims of its effectiveness as a medicine have never been thoroughly examined, and its efficacy is unknown.

[1235] It is also likely that much of the snake oil sold by Western entrepreneurs was illegitative in the United States, derived from any kind of snake.

[1236] Snake oil in the United Kingdom and United States probably contained modified mineral oil.

[1237] Mm -hmm.

[1238] Okay.

[1239] And probably opium.

[1240] Probably.

[1241] I think most of those cure -alls also.

[1242] had a nice 20 % opium.

[1243] So they felt like they were.

[1244] Yeah, you got fucked up and you stopped thinking about whatever your skin illness was.

[1245] When you're ever on those drugs, I guess if you're on like a, maybe if you're on a like a shroom or something, do you ever look different?

[1246] Has that ever happened to you?

[1247] You know what happens is, yeah, if you like stare at yourself in the mirror on shrooms, what will happen is you'll start looking at your skin and you'll notice areas of your skin are like really white or really red or really and you can kind of imagine that you're seeing like almost the blood flow through your face or something but it all it is never for me I can only speak for my experiences I'm never like oh no my face is bright red I'm like oh this is so cool on shrooms my face looks bright red and when I'm staring at a rock that becomes a lion I'm going this is so cool that I can see this lion in this rock because of this drug I I'm never thinking, oh, fuck, there's a line.

[1248] Oh, interesting.

[1249] At least for me, I'm in control enough that.

[1250] That's what's so neat about them.

[1251] They're like having a dream, but you're aware that it's a dream.

[1252] Oh, okay.

[1253] So you talked about hookworm.

[1254] You said 30 % of Southerners got it.

[1255] That was a full guess, by the way.

[1256] 40 %?

[1257] 40, even worse.

[1258] So I'm going to read a good chunk of stuff that I read about this.

[1259] Can I just add while you're queuing this up?

[1260] My grandma's from Kentucky, and all of my sayings come from her, because I spent the summers with her.

[1261] And she was, oh, it smells like a pole cat in here.

[1262] Still know what that means.

[1263] Oh, it's raining and it's sunny.

[1264] The devil's beating his wife.

[1265] And one of them was put on shoes, you'll get hookworm.

[1266] She was obsessed with hookworm.

[1267] And then as an adult, I'm like, is there even such a thing as hookworm?

[1268] So then when I read it in that book, I was like, oh, my God.

[1269] That's why she was so obsessed with hookworm.

[1270] 40 % of people had it.

[1271] Historical evidence shows the parasite ravaged the American South throughout the early 20th century as a result of poor sanitation and a lack of public health programs among the poor.

[1272] By 1905, the paracetologist Charles Stiles estimated that 40 % or more of the southern population was infected with hookworms.

[1273] As recently as the 1950s, hookworms were an intimate and ever -present threat.

[1274] Grammioz was fully formed at 1950.

[1275] In 1902, Charles Stiles, a medical zoologist from New York, finally dragged the hookworm out of hiding.

[1276] Stiles had been tasked by the Department of Agriculture to help farmers keep their animals healthy.

[1277] But he became fascinated with solving the riddle of the south -dusted workers.

[1278] He began collecting samples and soon identified the tiny culprit behind the workers' debilities.

[1279] I'm so grateful for people who are like, why is this happening?

[1280] And then they look.

[1281] Like, most people are just, you'd be like, that's weird.

[1282] And then just keep going.

[1283] Couldn't agree more.

[1284] Also, this is where I'm going to get in trouble.

[1285] But here's where this is a little bit like my fear of, like, you can't even make an observation.

[1286] So let's just say, if we were alive in 1905, everyone would be like, Southerners are fucking lazy.

[1287] Yeah, that's what everyone thought.

[1288] Yes.

[1289] And instead of going like, don't call Southerners lazy, that's wrong.

[1290] You know, the stereotype existed for some reason.

[1291] And someone was like, why are they lazy?

[1292] Oh, there's an explanation.

[1293] So it's a little bit tricky to just go like, oh, don't stereotype.

[1294] You know what I'm saying?

[1295] In this specific case.

[1296] So he must have said, okay, this is a stereotype, they're all lazy.

[1297] I know they're not genetically different than northerners.

[1298] So there must be an explanation for this.

[1299] Yeah.

[1300] I'm glad his conclusion wasn't, oh, northerners are just racist, let's call it racist, against southerners.

[1301] Right.

[1302] That explains it.

[1303] Right.

[1304] He dug more than that.

[1305] That makes, yeah.

[1306] He must have seen with his own eyes these people being very lazy.

[1307] Well, he did.

[1308] That was the whole thing.

[1309] He didn't understand why the work...

[1310] This is such a wild example.

[1311] He's working in agriculture and the workers can't work.

[1312] I wonder if they're like laying down taking maps and shit everywhere.

[1313] Like, I wonder if you went to the south and you saw people holding hose and stuff and fields just snapping.

[1314] With their heads down.

[1315] Stiles was convinced that ridding the south of hookrooms would make him productive.

[1316] But local doctors would not listen, dismissing him as arrogant or pointing out that his expertise was in animals, not people.

[1317] He was an interesting guy, but testy and hard to like.

[1318] He didn't suffer fools.

[1319] One of Rockefeller's gifts was he collected these people, people that everyone hated.

[1320] And so his medical research facility in Manhattan was full of people that had basically been kicked out of academia because they were so hard to work with.

[1321] That's cool.

[1322] Yeah.

[1323] There's like a home for misfits that had great ideas.

[1324] Okay.

[1325] Word of Stiles and his discovery, however soon reached John D. Rockefeller, who was actively looking for a certain type of philanthropy project.

[1326] Hookworms fit the bill.

[1327] Rockefeller didn't want to put money into things that would bring the American capital system income inequality.

[1328] Health, on the other hand, is not controversial, so no one wants their kids growing up sick.

[1329] Unlike in the north, Southern state public health agencies almost completely lacked funds or personnel.

[1330] In 1909, Rockefeller donated $1 million to create the Rockefeller Sanitary Commission for the eradication of hookworm disease, appointing Wycliffe Rose, a professor of philosophy in Nashville, to run the organization.

[1331] Rose began an anti -hookworm propaganda campaign and sent young doctors straight out of medical school to visit towns throughout the region.

[1332] Arriving on horseback with microscope and toe, the doctor said at makeshift clinics.

[1333] The townspeople often treated this as an event.

[1334] People showed up with potato salad and fried chicken to make a day.

[1335] Big stereotype.

[1336] A positive one, yeah.

[1337] A tasty one.

[1338] And some asked if they could be married in the hookworm tent.

[1339] Oh, how romantic.

[1340] We wed in the hookworm tent.

[1341] The doctors couldn't give the townspeople indoor plumbing and running.

[1342] Teach them how to construct what they called sanitary privies.

[1343] And they couldn't buy everyone's shoes, but they could tell people to be careful about where they walk.

[1344] So the other thing he was doing at the exact same time was he started all the first black colleges.

[1345] He spent so much money trying to get black folks in the South educated.

[1346] Wow.

[1347] Dude, he was, he was, I just called you dude.

[1348] You can call me, dude.

[1349] Dudeer?

[1350] This guy was like the ultimate clown purpose to do.

[1351] Yeah, I know.

[1352] It's really cool.

[1353] Yeah.

[1354] For all of his evil capitalist ways.

[1355] Okay, we'll see the first guy to have a billion dollars.

[1356] Yes, he reached a billion dollars on September 29th, 1916.

[1357] And the way he did that really quick is that the, who was it?

[1358] It was, uh, maybe Roosevelt who wanted to break all the trusts.

[1359] and he broke up the trust, but in doing so, they broke Standard Oil into like six different companies, but he owned Jordy Sheriff and then the stock value of all those companies individually shot up because the one big company was, it caused so much to buy a share of it at that point.

[1360] It was prohibitive.

[1361] But once it became accessible, when they broke up his trust, they like quadrupled his wealth.

[1362] Wow.

[1363] Yeah.

[1364] Jokes on whoever it was, whether it was Teodor Roosevelt or not.

[1365] Pretty cool.

[1366] Very cool.

[1367] cool.

[1368] Cool, dude.

[1369] Everyone should read Titan.

[1370] I was just about to say that.

[1371] I really want to read it now.

[1372] That's great.

[1373] Well, that's all for Raj, the most productive man on earth.

[1374] Yes, congratulations, Raj.

[1375] That's all.

[1376] Well, I love you.

[1377] Love you.

[1378] And I'm grateful for your unending patience in navigating our current scenario.

[1379] I'm grateful, too, for years.

[1380] All right.

[1381] Love you guys.

[1382] Bye.

[1383] on the Wondry app, Amazon Music, or wherever you get your podcasts.

[1384] You can listen to every episode of Armchair Expert early and ad free right now by joining Wondry Plus in the Wondry app or on Apple podcasts.

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