Author Talks: Why big gambles can lead to even bigger payoffs

In this edition of Author Talks, McKinsey Global Publishing’s Raju Narisetti chats with Dr. Rajiv J. Shah, president of The Rockefeller Foundation, about his new book, Big Bets: How Large-Scale Change Really Happens (Simon & Schuster, October 2023). Dr. Shah sheds light on how listening, learning, and building partnerships has helped him play a role in creating meaningful solutions to address poverty, disease, and hunger. An edited version of the conversation follows.

Why did it seem like the right time to write a book on big bets?

I wrote this book because it is possible to be optimistic about solving some of the biggest problems we face in the world. When you look out there, sometimes it’s easy to be cynical. Can we address the existential threat of climate change? Can we harness new technologies, like artificial intelligence, in a way that lifts people up, as opposed to creating threats? Can we fight hunger and poverty with a sense of purpose and actually succeed?

Many of the lessons I’ve learned over the last several decades have taught me that, yes, we can. We can be successful at winning these battles if, in fact, we have a big-bets mindset. I wrote the book to help create a road map for people who are much like I was when I was younger.

I knew I wanted to make a difference in the world. I grew up in suburban Detroit, sketching cars and dreaming of being in the auto industry. I knew I wanted to help change the world, but I had no idea how. I hope the book helps people on their paths.

Why should one start making big bets by asking simple questions?

Big bets are efforts to fundamentally solve complex global problems. Often, because of the complexity, it’s hard to see the solution. So when Bill Gates and Melinda Gates read an article about rotavirus as a disease killing 600,000 young kids around the world, almost exclusively in poorer and lesser-developed countries, they asked how we can actually save all of these lives.

That led to the creation of the Global Alliance for Vaccines and Immunization—later Gavi, the Vaccine Alliance. I write about this in the first chapter. Bill would ask the question over and over again, what would it cost to vaccinate every child on the planet?

To answer that, you had to know what it would cost to vaccinate a single child. So many public health experts and others, because of their deep expertise, would say, “Gosh. That’s a tough question to answer. You can’t think of it that way. There are so many different factors that go into it.”

Yet by persisting, doing the math repeatedly, we were able to glean answers. While the answers proved not to be entirely accurate, the exercise of doing the modeling and of thinking big—that the goal is to immunize every child on the planet, not just a village somewhere, through charitable means—actually helped. It created a strategy for Gavi that, over time, has helped immunize 980 million children, has helped save 16 million lives, and has shown that if we persist, big bets can be dramatically successful.

What is the difference in thinking about improvements versus solutions?

I’d make the case that big bets are actually about solving the big problems we face, as opposed to making incremental improvements. It’s not always a Bill Gates story. When Barack Obama was president of the United States, he made a big bet related to the Ebola crisis in 2014 and said, “Look, we’re going to fight Ebola in West Africa and beat it there so that it doesn’t threaten the rest of the world. That way, we can serve our humanitarian purpose in those communities that were deeply affected.”

In general, that effort was wildly successful, because we were able to break through the complexity, identify where cases were happening, and devise innovative strategies to address those cases. Ultimately, instead of the 1.6 million cases the CDC [Centers for Disease Control and Prevention] had predicted would take place, there were about 30,000 before Ebola was ended in that time frame.

Why are concerns from people you really respect a road map in disguise?

This was something that had taken me a long time to learn. I wanted to write about it in the book so that others could benefit from it. Sometimes, especially when you’re at an early stage in your career, you come up with ideas and solutions, you propose them, and you want everyone to accept them.

Often, you have more work to do. When people express concerns, those concerns can actually be a true road map, so that if you overcome them, you can be successful. My most prominent early example of that, which I write about, was an effort to restructure the way the world financed and procured vaccines at scale for children.

I drafted a memo and had a one-on-one meeting with Bill Gates in his private suite at a hotel in New York. When he pulled the memo out, it was covered in red marks. He opened the conversation with a phrase like, “Hey, Raj, this is the stupidest thing I’ve ever heard,” and he proceeded to attack the concept.

All of his points of critique proved to be a real road map. We spent the next two and a half years addressing those points one by one. In the end, we encouraged governments—many European governments—to support something called the International Finance Facility for Immunisation.

We raised billions of dollars for vaccine procurement, specifically. We did so by issuing the very first social-impact bonds that the world had seen, successfully. That helped to begin the transformation of global vaccinations. Concerns can be a road map. You just need to have the right mindset to see them that way. I left that meeting feeling a little beaten up, but, in the end, I was glad that it happened.

You don’t seem to be a fan of following standard operating procedures, as a default, in a crisis.

I write about my time at USAID [US Agency for International Development], where I helped lead global humanitarian efforts on behalf of the US. Whether responding to the tragic 2010 earthquake in Haiti that, in a moment, killed or injured more than 250,000 people in Port-au-Prince or addressing the Ebola crisis in West Africa, the first reaction, in a lot of these emergency situations, is to respond the way we’ve always done so before—to use standard protocols.

Many times, the challenge is that new crises are fundamentally different. With Ebola, for example, the standard protocols called for the use of Ebola treatment units and severe isolation for people who tested positive. That works for a small rural outbreak. However, in 2014, we were facing a massive urban outbreak with a disease that had some genetic variants. That strategy was not primed to work very effectively. Instead, we were able to innovate. We experimented, listened to local leaders, and identified new solutions.

The solution that actually stopped more than 70 percent of the Ebola cases in that time frame came from local communities. It involved creating burial teams that would enter homes, identify people who had just died of the disease, and wash and care for their bodies; then placing those infectious bodies in WHO-approved body bags; and removing them from the local community before the disease could spread further. It also involved doing that in a way that was sensitive to local customs of honoring, loving, and caring for those who had just passed. That strategy didn’t exist when we started our response. It was the listening, learning, and experimenting in the heat of crisis that ultimately made that effort successful.

So the most important thing about data during a crisis isn’t perfection but speed?

While responding to a crisis and trying to innovate in the moment, I’ve learned that we often need a common template to help everyone understand the goal and how to achieve it. Frankly, to experiment in those settings, you need access to data and to data that’s fast.

One of the biggest challenges is that people want data that’s perfect. Data that’s perfect takes time to collect. Whether you’re aiding in a famine in Somalia or in a pandemic in West Africa, you want data that’s fast and easily observable. It can be good enough, instead of perfect. It can help you identify what works and what doesn’t. That mindset has to define how you execute these responses.

Why is it important to leverage formal and informal boards during crises?

I’ve deployed and used out-of-the-box groups of experts who could sit outside the system, look at it, and say, “You know, that’s gonna work,” or, “That’s not gonna work.”

In one example, we pulled together a group of capital market experts in New York to look at how vaccines were financed and procured on a global basis. They came up with extremely innovative ideas that helped us reshape that market.

During the Ebola crisis, we spoke with a group of epidemiologists and nongovernmental experts who said, “Gosh. From what we’re seeing on the ground, the standard approach that everyone’s taking is unlikely to be successful. And here’s why.”

Even during the COVID-19 crisis in the United States, we had an out-of-the-box expert group that helped us identify testing as a major gap, in diagnostic capacity, even here in the United States, where there’s tremendous diagnostic capacity. Testing just wasn’t being applied to COVID-19 with a sense of dramatic urgency and scale. Those experts helped us craft a path.

Having those out-of-the-box advisory groups that are not in the heat of the response but have the expertise to critique the way you’re doing things and opening yourself up to that critique are critical to success.

Big bets require building collaborations and partnerships, sometimes with like-minded individuals and often with unlikely partners. Through the course of my career, I’ve found it very useful to have either your formal board or informal board structures to help you do that.

It’s our board and their engagement that helped us build collaborations, whether in our efforts to address child mortality at USAID, where we had informal boards involved, or in our biggest single effort at The Rockefeller Foundation—in our attempt to end energy poverty for hundreds of millions of people who live in the dark. Building collaborations enabled us to raise more than $1 billion from other philanthropies and bring together a very diverse coalition of development banks and private investors to try to bring the green-energy revolution to the poorest communities on the planet.

Often, no single individual, and arguably no single institution, has the reach and the ability to do all that. Deeply engaging your board, formal or informal, in building those collaborations is essential. Big bets only work if you have unlikely partners willing to hold hands, for decades sometimes, until results are achieved.

Do you need to give up control to win big bets?

In pursuing big bets, giving up control is essential to achieving scale and sustainability. One example is our effort to fight energy poverty around the world. There are more than 750 million, almost 800 million, people who fundamentally live in the dark. They’re trapped in poverty, because they don’t have access to electricity.

That access can now be provided through renewable electrification. It’s a major effort that we’re pursuing all over the world. However, The Rockefeller Foundation started this work maybe more than a decade ago in the small rural communities of Bihar and Uttar Pradesh, in India.

We saw great results. We were really encouraged by that and built out hundreds of solar minigrids that were providing electricity to local towns and villages and changing the lives of communities in those areas. Yet we could never, on our own, extend that to the nearly 800 million people who live in the dark.

So we partnered with big companies like Tata Power to build out 10,000 solar minigrids in rural India. We built partnerships in Africa. We built an alliance called the Global Energy Alliance for People and Planet with 19 other partners.

The result is that we now have the ability to imagine being successful over time at real scale. But the other result of all that is we are no longer in control of our own program: we transitioned our team into a new organization. We built a board for that organization that’s now fully independent.

We hope that entity will help lead the world to make sure the energy technology revolution that is so critical to fighting climate change is also just and equitable and reaches those who need it most.

Are we doing enough to tackle climate change?

Well, climate change is a great example. Especially coming out of the COVID-19 crisis, you’ve seen Europe, the United States, and even China make big domestic investments in transitioning their energy economies.

You’re not seeing the kind of global cooperation required for us to succeed as a planet at fighting climate change. In fact, if you look at the amount of renewable-energy deployment that has taken place in Africa, for example—a continent with 50 percent of the world’s land and solar radiation and potential for solar energy—less than 1 percent of all renewable energy technology deployment in the last two decades has been in Africa. At the same time, the continent has almost 600 million people who effectively live with energy deprivation and, therefore, in poverty. We can do a lot better, but we have to come together as a global community.

In the United States, we have to work across party lines, Republican and Democrat, and in global coalitions to address these challenges. We have to see those challenges as big bets. We have to see them as achievable problems if we can identify meaningful solutions and have to stick with those solutions for decades. The future of our planet is what’s at stake.

What do you mean by ‘make it personal’?

I am very hopeful, actually, in the potential of politics in Washington, but also elsewhere, to bring people together to solve big problems. I’m hopeful as my experience has taught me that you should make it personal—one of the chapters is “Make It Personal.” Generally, our political dialogue is based on fighting over policy or, even worse, on insulting people on Twitter [now X]. Instead of doing that, if we actually get to know folks in a deep, personal, meaningful, and authentic way, we can make extraordinary things happen. In 2008 and 2009, we faced a global food crisis. There were children in Haiti eating mud cakes. They didn’t have access to food, and food prices skyrocketed.

In that context, we built a bipartisan coalition to renew American leadership on fighting hunger around the world. Over time, that coalition, together with dozens of other countries, has helped move almost 100 million people from the brink of hunger.

That achievement was possible only because in the United States, some deeply conservative, faith-based Republican senators held hands with progressive administrations, including President Obama’s, in order to take on that fight. I have sat with and learned from and prayed with those senators; their commitment to addressing hunger and poverty in that setting is just as authentic as anyone else’s.

But in order to get there, you had to do a lot of listening, a lot of learning, and a lot of building of personal relationships that cut through the political noise. I hope that’s the kind of mindset that inspires our leaders in the future to go after the challenges we face.

You say that at age 44, you discovered you were unlikely to become a billionaire?

Making transitions in any career is challenging. When I left the Obama administration, I wanted to work on bringing energy to developing countries. I learned that energy access was the core constraint to growth, poverty reduction, and human equity.

I thought that the way to address that was through building a private equity firm, and I had some success with some great partners in getting one established. I ultimately found that making a long-term career of that wasn’t for me. I’d be better off in a role where I could bring together public and private partners in a different kind of context.

It was a good learning experience for me. It taught me how to engage private investors in the mission we had set. We engaged them to address energy poverty and to bring renewable electrification to the developing economies of the world. That lesson was incredibly valuable.

How do you hire people who are ‘good at complexity but are also fluid’?

Much like McKinsey, we look for athletes. We look for people who have the capacity to learn deeply and ultimately have the mental agility to pivot to critical issues in order to be successful.

One example of that I write about is when The Rockefeller Foundation found itself—like everybody else—closed and at home during the onset of the COVID-19 pandemic. We said, “Look. We’re an institution that literally helped create science-based public health 100 years ago. This should be our moment. We should rise up and really address COVID-19 at scale.”

I give a ton of credit to our teams who were able to basically pivot the work they were doing to immediately address both the causes and the consequences of the COVID-19 crisis. The pandemic led to our setting up a testing program that dramatically scaled testing in the United States and helped create the field of rapid antigen-based tests as a legitimate part of how to manage COVID-19 and of how to break out of the lockdowns.

Getting to be surrounded by people who are supersmart, learn new things quickly, and are so committed to the mission that they’re willing to say, “OK. I’ll change what I’m doing to address the current crisis,” is very special.

I have been very fortunate. I’ve seen that kind of team at USAID when we had to fight the Haiti earthquake. I’ve seen that in the heart of the Ebola crisis, where we literally took experts from across the country and sent them into a very dangerous operating environment in order to fulfill a humanitarian mission. And I saw that at The Rockefeller Foundation, as we’ve pivoted to address COVID-19.

Why did you make a big—unusual for Rockefeller—bet on removing Confederate statues?

Big bets are really about identifying innovative solutions to often long-standing and intractable challenges. Sometimes, when communities come together and have the courage to embrace those solutions, I feel like it’s in our mission to help them be successful, even if it’s risky.

In the case of the statues in New Orleans, Mayor Mitch Landrieu led a deeply community-led process of two to three years of dialogues about race, opportunity, and about what young minority kids saw when they looked up at a massive statue of Robert E. Lee as the prime monument in the city. The community decided that they wanted to take those statues down.

Mitch asked me if we could help them in a moment of crisis when their funding had fallen apart, a contractor’s car had been bombed due to involvement with statue removal, and White supremacist groups were coming into the politics in the community. We said, “Look. We have a short window where either we act or we don’t act.”

Sometimes, you just have to trust your moral instincts and do what you think is right. In this case, supporting Mitch, supporting a very diverse community that had done two to three years of real work to get to this point, felt like the right thing to do.

We privately and anonymously provided that support so they could take those statues down. We didn’t know at that time that would lead to a national dialogue about Confederate monuments and what they represented and how to handle them in different communities across this country. But we knew that supporting Mitch’s big bet was the right thing to do in that setting. So we did it.

What surprised you in writing this book?

What surprised me the most was how many times in the last 25 years big bets have been successful. It’s easy to be cynical about the challenges we face and about problems as intractable as public health, global poverty, climate change.

But in reality, we took on an effort to immunize a billion children, basically did that, and have saved 16 million lives through child immunization. We successfully fought back multiple pandemic threats, some well known like COVID-19 and others that people may not remember as well, like the Ebola crisis in 2014. America, in particular, has led the world in humanitarian responses to some extraordinary catastrophes.

Through all of that, I actually learned a playbook of how young people, in particular, can aspire to be changemakers. Anyone can be a changemaker if they adopt a big-bet mindset and are willing to think boldly—just as boldly as you would in the private sector. Think boldly about how you can actually make positive changes in this world.