Africa: We Can Make Our World Better - Mark Suzman of Gates Foundation

AllAfrica's Juanita Williams speaks with Mark Suzman, the CEO of the Bill and Melinda Gates Foundation, the world's largest philanthropy. He assumed the position this month.
20 February 2020

Cape Town — AllAfrica's Juanita Williams talked with Mark Suzman, the CEO of the Bill and Melinda Gates Foundation, the world's largest philanthropy. He assumed the position this month. In this second part of the interview, he discussed how his early career as a journalist in his native South Africa influences his perspectives; about the possibilities of eliminating malaria and reducing HIV, TB and other diseases; addressing hunger and undernutrition amid the climate crisis; and the biggest challenges he faces. Part 2. [See Part 1]

You began as a journalist. What do you think is the importance of storytelling in achieving the sustainable development goals? And what is the appropriate role of the media in achieving peace and prosperity on the continent of Africa?

Storytelling is absolutely essential. One of the lessons the Gates Foundation has learned, I'd say the hard way, is that not everyone is persuaded by data and statistics alone.

We are a slightly unusual organization and my bosses are slightly unusual people - Bill and Melinda Gates - because they are persuaded by data. They are very data-heavy. If the numbers tell us we should do X or Y, they believe that. And the numbers tell us the world has been getting better. For example, there is progress in child mortality and vaccination.

But we also know from survey after survey that the vast majority of people don't believe that. They think the world is getting worse, or they think there are more challenges. The reason for that is that most people respond emotionally. Yes, facts are important but you need to contextualize facts in stories.

When you talk about progress, for example, unless people believe that progress has already happened, they're skeptical about the ability for it to happen in the future. So if you say, "We can meet the [United Nations] Sustainable Development Goal (SDGs) for eradicating extreme poverty", most people say, "That can't be true." But then if you can factually point back and say, "Actually, we've more than halved extreme poverty over the last 15 years, and let me explain it to you with a couple of stories. Here's what's happened in Ethiopia. Here's what's happened in Ghana. Here's what's happened in Vietnam. Here are some people who have lifted themselves out of poverty and are now able to put their kids in school and have opportunities." That makes it meaningful and accessible.

That's particularly important with the SDGs, because at one level, they are comprehensive. There are 17 goals that look across both people and planet – it's the intersection across the two. We know we need a cleaner environment. We need sustainable cities. But we also need to focus on the core areas of health, of education, development, economic growth, etc.

Media is the way the public learns what's possible and can hold governments accountable

That's a complex set of issues. When you have 17 goals, that's a tough story to tell, let alone saying you have more than a 160 targets! The risk is that some people start falling asleep. So you have to make those real, and show how they're connected and then tell the real stories around them.

Again, that's one of the reasons I am so excited [see Suzman interview Part 1] about the Gender Equality goal. Not just as a goal. I think stories, using the model of telling what this means for a young girl or woman in today's Africa and how it is going to help transform her future and the future of her children, is one way of telling that story effectively.

The media is absolutely essential. Media is the primary conduit by which the general public gets access to news and stories, and understands these prioritizations. And – this is a very important 'and' - is able to understand that they should be holding their own governments accountable.

The SDGs aren't like an optional wish lists. Whether they've noticed or not, or whether they will acknowledge it or not, every government in the world signed up to those as a commitment to their own citizens. We need that accountability, so having media play that role is critical.

There's often a general reluctance on the part of media to tell too many 'good news' stories. And, yet, we at AllAfrica know that when we do a story about good things happening – or that can happen – they do very well. Our audience notices. What do you think is the reluctance?

It's a constant tension. You know the famous saying, "If it bleeds, it leads". You have to treat that as a baseline of how humans operate. In the good news stories, some of the problem is it's tough to make these things accessible. That another 24 thousand people were lifted out of extreme poverty today still feels very abstract. It's personalizing it. Can you concretize it in an individual, in a story, and then show how and why that actually matters, and is a connection back to you as the reader.

That's always going to be a challenge. This is not a new challenge of 21st century media. We constantly need to make it a story about people – that is fact based. I do think it's important that we keep trying.

Later this month I'm attending a conference of Anglican bishops and others in Zambia, sponsored by the IsdellFlowers Initiative, to discuss ending malaria. Could you speak about this moment, when people are saying that not only can we reduce malaria – we can end it?

The fight against malaria is almost as old as humankind. In many ways it has been the deadliest scourge. Bill Gates notes that the deadliest animal by far is the mosquito.

The good news is that the overall malaria incidence rate, mortality rate, has halved since 2000. Still, the vast majority of those deaths do take place in Sub-Saharan Africa, particularly central and tropical Africa, although it's all over the continent. But that's been through prevention, largely. It's through the provision of bed nets and other basic tools which help reduce mortality, especially for children.

We can eliminate malaria – in many ways the most deadly disease we face – but we must double down.

But it's a constant race. The mosquito doesn't stay still. Mosquitos have been evolving to be resistant to the insecticide in the nets. So we've now had to develop a new kind of insecticide net. That's something we at the Gates Foundation have been working on.

And in the last year or so, there's been some slightly depressing news. It looks like that the steady reduction has stabilized - and maybe begun to reverse. So you've got to double down.

One is about researching new treatments and cures, and we're very significant funders around that. We have a malaria vaccine that's actually been rolled out in a few African countries, but it's only partially effective. It's not going to be the full answer. And you need new treatment. We're putting a lot of investment into 'a single elimination radical cure'. If you get malaria, could we give you something that cures it in a day or two. You need all of those tools coming together.

In terms of eradicating it from the continent – absolutely! We believe, and in fact, the World Health Organization and other partners including us have come together, and there is a broad vision. We believe we can completely eradicate malaria by 2040. That would be an ambitious goal, and and I think it's absolutely achievable.

You need to do it in steps. One of the first steps is the so-called E8 southern African countries. That's the area where we could and should prove a model – we hope in the next few years - about how you can eliminate malaria. It gets tougher and tougher when you get into 'the malaria backbone' – the swathe of countries that goes from northern Mozambique, through DRC (Democratic Republic of Congo), bits of northern Zambia. That's where the density is much higher and more challenging. You need to do combination of intensive treatments you know and prevention, and still do all the research into more radical cures or vaccines.

But, absolutely, this is the moment where we can get real energy and momentum around how we come together as a continent and eliminate what is still, in many ways, the most deadly disease we face.

In light of those hard challenges, there is the HIV study that has ended – the trial of a vaccine that has been proven to be ineffective. After four years – it's a setback. It will add to the skepticism you mention about the possibilities of positive change, and to negativity. What are the next steps?

There are multiple next steps. At the foundation, the issues we work on are not easy things. Trying to find an HIV vaccine is incredibly difficult. So what you need to do is take risks.

One of the advantages we have as a philanthropy is we can take those risks. It's more difficult for a government to underwrite something that fails, because immediately someone will stand up in Parliament and say, "Why are you wasting our taxpayers money on something that didn't work?" Whereas we know you have to take multiple shots on goal. It's the philanthropic equivalent of venture capitalism. The majority of things you do will fail, but something will succeed. So you need to be constantly looking across the spectrum.

Yes, that particular trial - the fact that it ended in what in futility, didn't have the impact we hoped, is always depressing. It's a set back for the people - we're deeply grateful for the volunteers that helped support it - but we are making multiple investments in this with multiple partners. I remain completely convinced we will end up with successful interventions, not just in HIV, but in TB, in malaria, in all these other diseases that have been going on for many, many decades. We believe – and our vision of long-term success in the foundation is we hope all of those will at some point become history.

The Gates Foundation has recently launched an agricultural technology initiative. Achieving food security and improving nutrition become even more challenging with the climate crisis, and now it's intensifying, How will this initiative try to address the problem, and how will the insights and accumulated wisdom of local farmers be tapped and incorporated?

First, what we call 'climate adaptation' as opposed to 'climate mitigation' is in many ways a neglected part of the discussion around the climate crisis. There's so much attention being focused - correctly - on 'can you reduce fossil fuel emissions?', 'can you reduce global warming?', that it often ignores the fact that global warming is already happening, and it is already disproportionally affecting the people who had the least to contribute to it. Smallholder farmers across sub-Saharan Africa and Asia are already dealing with bigger fluctuations in their growing seasons, more floods, more droughts and other related issues.

Global warming is already disproportionately affecting the people who contributed to it least.

The initiative you're talking about is actually building on work we've been doing for many years and trying to intensify it. Some of it is research and development - actually developing crops that are going to be more drought and flood resistant. That's not something that will naturally come from traditional farmers, because what they traditionally knew doesn't work in the current climate. That really requires no scientific research and development know-how, and that's the kind of thing we're able to apply and do. We have a number of initiatives underway in doing that, from breeding more drought-resistant maize [corn] and cassava and sorghum and other related crops which are heavily used in Africa.

The second bit, which is very much about how you draw on and work with the wisdom in communities of farmers, is the techniques you use to help support and intensify productivity on the land they already have. That's about more effective regeneration of soil, which you can do both through both natural mechanisms and through judicious application of fertilizer, where you make sure you're not overusing or under using, and you're customizing your fertilizer use for the soil you actually have.

An initiative we've helped support has been what we call 'an African digital soil-health mapping' initiative. We've now used satellites across the entire continent Africa. You can actually look at what the chemical composition in the soil is, and that allows you to be much more customized about what kind of additional nutrients does the soil there need in order to grow the crops that the farmers need or which crops are best suited to that soil.

How do we then take that knowledge and pull it back down into the region so the farmers themselves have that as a tool, which allows you to have a much more environmentally sensitive and productive growing season – and similar techniques around how you do more effective water use and limited irrigation?

What you are trying to do is combine both the old and the new. Wat is some of the best new science dealing with these unprecedented challenges that climate change is causing? What are the best existing traditional practices? And how do you make sure that the ones that are most effective are spread and used much more widely by those communities and farmers? That requires the farmers themselves. The best people to share those lessons are the people who have been doing it - not some white-coated technical expert who comes in from the United States.

We have some other tools. For example, in Ethiopia we support Digital Green, which is a set of tools and videos, which show and explain in local languages and local terms. Here in the kinds of tools and techniques you can use in order to improve your productivity. That's the kind of work we're doing, and we're seeing some very encouraging early results.

As you come into the position of CEO, what do you think is the greatest challenge for the Gates Foundation? I know it's a big question, but you must have thought about it!

I'd say there are two linked challenges. We call ourselves impatient optimists. We've talked about the challenge of the world understanding not only that progress is possible, but that it's happening, and that it can be accelerated. In the current global political environment, for a variety of reasons, there's more skepticism about that. There's less commitment to thinking globally and thinking about these interventions. So for an organization that exists and believes in that fundamentally, I think we've got to double down on helping make that happen. That is one part of the biggest challenge.

The second challenge, which is linked, is how do you actually make sure that that focus on impact - changing lives - stays at the forefront? When you do become a big organization, any organization, you have to guard against becoming a bit more complacent about the ways in which you operate.

I don't think any institution does that naturally, but we're now 20 years old. We're not a little start-up anymore. I think one of my roles is how I make sure that we are continuing to take on board the freshest thinking, staying open to new ideas, being open to critical partnerships and conversations. Unless people give us honest feedback, and we take it and change, we simply cannot be successful at what we want to do.

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