Brigid Bergin: It's The Brian Lehrer Show on WNYC. Welcome back, everybody. I'm Brigid Bergin, filling in for Brian today. Pick any of the following news topics: climate change, racial injustice, the rise of AI, the conflict between Israel and Gaza. It feels like the world is facing a multitude of huge challenges all at the same time, and it can be easy to feel deeply pessimistic about solving them.

The Rockefeller Foundation president, Dr. Rajiv Shah, thinks it's actually realistic to be optimistic about solving some of the world's biggest problems. Through his work on vaccinating nearly a billion children around the world, leading the effort against the Ebola outbreak in West Africa, and responding to human humanitarian crises in Haiti, Afghanistan, and other places, he knows a thing or two about responding to humanitarian crises and going for bold improvements.

Dr. Shah is author of a new book, Big Bets: How Large-Scale Change Really Happens, and he joins us now. Dr. Shah was the former head of the American humanitarian agency, USAID from 2009 through 2015, and we'll also ask him about the ongoing humanitarian crisis in Israel and Gaza. Dr. Shah, welcome to WNYC.

Dr. Rajiv Shah: Thank you for having me.

Brigid Bergin: Listeners, it's probably fair to say we have a few of you out there who identify as idealists, wondering if any of you used your idealism to help your communities or get involved with organizations. What do you want to share about choosing optimism in the face of uncertainty? Or if you're looking to get started, maybe you have a question for our guest, Dr. Rajiv Shah, president of the Rockefeller Foundation.

Call us now at 212-433-WNYC. That's 212-433-9692. You can also text at that number, and of course, you can tweet @BrianLehrer. Dr. Shah, we're going to get into some of your work I outlined in the intro, but first, can you tell us a little bit about your background and how you got into this work?

Dr. Rajiv Shah: Sure. Well, it is great to be with you. I am from around Detroit, Michigan. My parents are immigrants to the United States from India. Early on, I decided I'd go become a doctor, but I also had a number of experiences that made me want to be involved in social service and social change at scale. One thing led to another, I ended up working in my early career with Bill and Melinda Gates because they set up their foundation, later for President Obama running USAID, and now as the president of the Rockefeller Foundation.

I get to be exposed every day to people who have done some extraordinary things on behalf of humanity, whether it's saving millions of lives from vaccine-preventable disease, preventing or responding to famines. I've gotten to see good work at scale transform reality for tens of millions of people. The book Big Bets is designed to help people see that, as you said, it is realistic to be optimistic about making change happen even, and especially, at tough times like these.

Brigid Bergin: Your book is about how somewhat ordinary people blundered through eventually making change in the world, and what set them and you and your work apart was this big bet mindset. Can you explain what a "big bet" mindset is?

Dr. Rajiv Shah: Yes. Too often, when we try to tackle problems like climate change or hunger or humanitarian catastrophes, we think doing good is good enough, and we settle for small incremental actions that do help in a small way but don't actually fundamentally solve the problem we're encountering. My argument is having had a chance to see firsthand what it takes to actually solve the problems we're facing that we can be much bolder in our ambition and we can be much more businesslike in the way we conduct ourselves when we do these large-scale humanitarian efforts.

I've learned that in beating back the Ebola crisis in West Africa, which was predicted to have 1.6 million cases, and we ended it with only 30,000, including almost none in the United States. I've seen it in fighting hunger after major food crises multiple times and bringing together bipartisan coalitions to do so. I've seen it in bringing public and private partners together to vaccinate 980 million children around the world over 20 years, saving 16 million lives. I think it gives me hope that we can, in fact, tackle the challenges we face today.

Brigid Bergin: Dr. Shah, thank you for that. I think some listeners, because of my cold perhaps, thought I said 8 billion children worldwide instead of 8 billion. For our texter who called in with that, or texted that correction, yes, I did not say 8 billion. I apologize if it sounded that way. I'm a little congested, but thank you for clarifying the number.

Let's talk a little bit about, you explained what the big bet mindset is, but in order to get there, you say that we need to avoid what you describe as the aspiration trap. How can big aspirations sometimes trap would be changemakers into maybe not doing anything at all?

Dr. Rajiv Shah: Well, I think that's the biggest challenge we face is take an issue like child poverty in America. It's easy to say child poverty is the result of extraordinarily complex problems that have overlapped and trapped nearly a quarter of America's kids in poverty. Yet, we know, just looking over the last two years, an issue that our foundation has worked very aggressively on, the refundable child tax credit, single-handedly eliminated child poverty for 50% of America's poor kids.

We know it works. We know it's effective. We know those kids go to childcare and go to school and learn and have better nutrition, and the money's used highly effectively. Yet, we live with a high level of child poverty in one of the richest countries in the history of the world because in our heart of hearts, we think it's too complex to actually be bold about solving that problem.

That's the aspiration trap. It's not trying hard enough to tackle the social challenges we face. The same could be said of climate change and allowing the very high level of fossil fuel-based emissions to just persist year after year until quite recently when we made big investments to actually turn that around.

Brigid Bergin: You also write that to get to a solution, you need to understand the problem in its most essential form. You need to have the courage to ask the simple, even naive seeming questions. What does asking simple questions help you accomplish?

Dr. Rajiv Shah: Well, I should say I learned that practice from working for Bill Gates when we were trying to take on this huge task of making sure every child on the planet had vaccines so that they wouldn't die of simple, preventable diseases. He just kept asking, how much does it cost to vaccinate a child, so we could figure out how much it would cost to vaccinate all children.

The experts would say, it's so complex, it's hard to think of it that way, but in reality, we were able to break it down, understand the cost structure, raise the billions and billions of dollars it took to address that issue, reshape the global vaccine market and save 16 million child lives. The task of asking a simple question can help you break through the complexity, find those innovative solutions that can scale and reach very large numbers of people, and create a path forward for how to deliver measurable results even in tough social change efforts.

Brigid Bergin: If you're just joining us, I'm Brigid Bergin from the WNYC newsroom, filling in for Brian today. My guest is Dr. Raj Shah, president of the Rockefeller Foundation, and former head of the American humanitarian agency, U-S-A-I-D or USAID. We're talking about his new book, Big Bets: How Large-Scale Change Really Happens.

Dr. Shah, people probably think that the Gates Foundation was able to effect change because Bill Gates is a billionaire, but you write about how to deliver transformative change, you have to get people to take risks with you often requiring you to jump first. Can you talk about how you helped to create the international financing facility for immunization and how it helped change how vaccines get distributed?

Dr. Rajiv Shah: Sure. Well, we learned early on that even if we wanted to vaccinate every child on the planet, the supply base did not exist to do so, and so we had to sit with companies around the world and ask ourselves, "What would it take to reshape the way the world finances vaccination to reshape the vaccine industry to have enough product at a low enough cost to actually reach every child?"

To make a long story short, that required inventing a new social impact bond that allowed countries to pay for vaccination after the efforts were successful. While it was a somewhat complex financial structure, the whole thing worked because a few people, in this case, our foundation, the Gates Foundation at that moment, offered to guarantee that structure when it was kind of risky and controversial, and that offer helped many other country governments: Germany, France, the United Kingdom, Norway, say, "Okay, this is now going to happen, so we'll be a part of it. We'll make it happen."

The beauty of that was after people had that confidence and they all jumped in, the very act of everybody else joining the project allowed us to execute the bond issuance in a highly effective way without even requiring the guarantee to begin with. That basic structure, the Rockefeller Foundation team used to help create the antigen testing market in America during the Covid crisis and has been replicated many other times.

The point is, often when you're doing something really innovative in the social sector, people wonder, is it going to work? They sit on the sidelines. What you actually need to do is take some risks, make it clear to people it is going to happen, get them to join you, and that'll make it even more effective at making large-scale change happen.

Brigid Bergin: Wow. I want to bring in some of our callers, Van in Midwood. Van, welcome to WNYC.

Van 1: Oh, thanks. Doctor, I follow you on LinkedIn. I'm also a physician but no longer practicing medicine. [chuckles] I have a startup where we're tackling unemployment in folks who are legally blind, including me from a rare cause. The bigger problem is with diabetes and age-related microdegeneration, as you already know. We basically are using AI to have building devices to help for navigation.

Unemployment in the division-impaired community is somewhere between 60% and 95% depending on how blind the person is. It's a really unmountable task, but I was going to say, one of the things that I think, and you speak to this, is just to not accept no or that can't be done and just keep at it. I think having a disease that gives you a disability fuels that fire. Thanks for doing what you do.

Brigid Bergin: Van, thank you so much. Go ahead, Dr. Shah.

Dr. Rajiv Shah: Well, I just want to say, Van, thank you for your leadership. I think you prove that it's possible to be a big better, and you are fighting through adversity to do some extraordinary things on behalf of other people that might suffer from similar challenges. That's exactly the spirit I wanted to highlight in the book. I feel like so much of our modern social media and news media makes people feel powerless in the context of these big problems we face in the world.

Yet, leaders like yourself create a sense of optimism and give us hope that, hey, we can actually help people who are blind, be employed and more effective, and lead more rewarding lives. Our foundation is making a big bet right now on food as medicine for certain types of chronic disease prevention activities that we hope will dramatically reduce the prevalence of diabetes and diabetic-related ailments, including macular degeneration. Thank you for just being a great example of what this book is all about.

Brigid Bergin: We have another caller named Van, this time from Westchester. Van, welcome to WNYC.

Van 2: Hello, I'm not as cool as the other Van. [laughs] I also work in advertising, which contributes to this whole social media and all this powerlessness that you feel. I just want to know as an individual, how do you facilitate these changes, these incremental big changes? It's like, I feel helpless because I don't know what I can do as an individual who doesn't have a nonprofit, who doesn't have a startup to help people. What can I do?

Dr. Rajiv Shah: Well, thank you so much, Van. I appreciate that because that is ultimately how so many people feel. I think the first step is truly just being aware of some of the problems that you want to work on and learning about them enough so you can genuinely be optimistic about learning that there are solutions out there. Whether it's child poverty, homelessness in your community, fentanyl abuse, which is something I just received a great idea on from an extraordinary American leader who has big ideas on how to solve that problem.

Whatever it is that really is you're passionate about, find that passion, get really smart on those issues. Then I would say engage deeply. There are so many opportunities to partner with local nonprofit organizations. I'm a big believer in public service, and a lot of the book is about Democrats and Republicans coming together, shockingly and surprisingly, to do extraordinary things like fight hunger and poverty around the world.

I would say get involved in elections, learn about, and ask your elected representatives about the issues you care about, and often people even in their work lives, depending on where they work, and find a way to make sure their organizations are involved in these types of efforts. That's especially true for climate change, which is fundamentally about private companies and commercial businesses changing the way they behave and operate so that they can be part of the solution and not part of the problem. I'd encourage you to get involved, if that makes sense to you, in your workplace environment in the same spirit.

Brigid Bergin: Thank you, Van, so much for your call. We don't have any more Vans on the line, Dr. Shah, but we do have some more callers. I want to get in a couple more questions before we go back to the phones. As the former head of U-S-A-I-D, USAID, you have dealt with major human catastrophes in Syria, Iraq, Afghanistan, and elsewhere. I wanted to get your take on Israel and Gaza.

On Thursday, the White House announced that Israel has agreed to daily four-hour pauses in fighting in Northern Gaza to allow Gazans to flee for humanitarian aid and to be let in. Since then, The New York Times reports that Israeli troops stepped up their push to empty hospitals in the North, including Al-Shifa Hospital. To what extent do you see pauses as a solution, either in the long or short term?

Dr. Rajiv Shah: Well, I'll tell you, I've had a chance to be in the West Bank and Israel, and USAID and the United States, of course, provides a tremendous amount of assistance in both settings and humanitarian assistance in Gaza, often through Mercy Corps, the World Food Program. I look at what is happening with great dismay. Obviously, the horrific attacks against Israel led to 1,200 deaths, 5,600 wounded. Even 300 of the Israeli defense forces have been killed in the fighting. In Gaza, more than 11,000 people have already been killed and 27,000 already wounded, 74% of whom are women, children, and the elderly.

I believe a true solution requires Israel to believe and appreciate that it is in Israel's national security interest in the medium to long term to conduct their operation in a manner that is protective of civilians and protective of women, children, and the elderly, and frankly, protective of those patients sitting in those hospital beds that are so deeply vulnerable. This is not just about a tight military action, this is about laying the groundwork for peace and stability based on demonstrating an appreciation for the dignity of all people, which has to happen on both sides. It can't just be a one-sided effort.

Specifically to your question, humanitarian pauses have worked in the past. Usually, for them to work, they have to be longer than four-hour windows. We've done humanitarian pauses for polio vaccination campaigns, even during the war in Afghanistan, during tribal conflict and terrorist conflict in Pakistan, and in many, many other cases. Usually, you need a much bigger window than a four-hour window in order for that to be effective and safe for the humanitarian actors, many of whom will be physicians that are trying to save lives in the moment.

I'd say the other piece that should be acknowledged is through humanitarian action, probably requires meaningful efforts for evacuations, and right now, that's simply not possible. As you know, there's nowhere really for people trapped in Gaza to go and be safe and be protected because of both the geography and the geopolitics of the region. The United States is working on, I know, all of those elements, some more publicly, some more privately, but much longer humanitarian pauses are needed to be successful.

Real evacuation strategies coordinated with Israel's neighbors and Gaza's neighbors are essential to being successful at protecting humanitarian priorities during a necessary but horrific conflict.

Brigid Bergin: Dr. Shah, I want to ask from your perspective as a medical doctor according to Gaza's Health Ministry, Al-Shifa staff members and some 8,000 displaced people are sheltering at the hospital. They're suffering from thirst and hunger. We understand that the Red Cross and Red Crescent are negotiating with Israel to evacuate 36 premature babies but no agreement has been reached.

The hospital director says he has about three days' worth of baby formula. Can you just talk about what's at stake here and what the logistics behind an evacuation might need to be and how folks could potentially be moving forward?

Dr. Rajiv Shah: Yes. Well, I think first it is important to recognize that the reason we're in this predicament is not just Hamas' horrific attack against Israel, but also the very specific and explicit strategy Hamas has used to ensure to use these individuals, including babies, as shields for their own underground operations. That's an important point to acknowledge. I think in practice, the reason I said you need a much longer humanitarian pause and you need real evacuations is you can't in a four-hour period really address the critical needs here.

The argument I would make is that it is actually in Israel's national security interest to provide for long enough pauses and meaningful and real evacuation strategies so that as they proceed with a necessary military action, it's conducted with an explicit understanding that the dignity of every civilian matters. I think that's what the goal should be. I hope they can get there because it's good for them from a security perspective to have people in the region understand that as a democracy, Israel can stand for the dignity of all civilians, not just Israeli civilians.

Brigid Bergin: I want to go to Richard in Dobbs Ferry. Richard, welcome to WNYC.

Richard: Hello.

Brigid Bergin: Hi, Richard. You're on the air with Dr. Shah.

Richard: Oh, hi. Thanks for taking my call. I am a [unintelligible 00:22:26] raised Jewish person, married to a Palestinian by way of Saudi Arabia, Sweden, and San Francisco. When we got together, needless to say, it surprised both our families and not in a good way at least initially. As far as conflict, I think we've learned over the past 10 years a lesson as far as our personal discussions and conflicts.

I don't know quite how to summarize it quickly, but I guess I might say that we've learned that if you try to understand the other person's position in a conflict, not agree to it, not give into it, but if we can just try to understand where they're coming from, the understanding itself helps us connect and the other person feels it, even though you're not trying to do anything other than just understand.

Sometimes that can help the other side soften too. It's kind of helped us over the years build a bond. I guess I would offer that to other-- if maybe that's applicable to other situations worldwide, large and small. It's just something that we do.

Brigid Bergin: Richard, thank you for your call, and thanks for sharing your communication strategies. Dr. Shah, any reaction to that caller?

Dr. Rajiv Shah: Well, Richard, I appreciate that. I write in my book, Big Bets, about the basic idea that almost every big bet requires unlikely partners to come together, connect, and make extraordinary things happen. Your family sounds like an unlikely but rewarding partnership. In the same way, we need those types of collaborations across all kinds of divides. I see it across public and private.

Often, there's so much mistrust and lack of understanding that I encourage young people that want to be changemakers to get experience in both the private sector and public sector. In conflict settings from Eastern Congo to the Northern Triangle in Central America to certain parts of Pakistan to West Bank and Gaza, I have seen for years and visited people who are just making extraordinarily unlikely connections bring hope to those settings.

When I was last in the West Bank, I was part of a Google entrepreneurship competition, where Israeli and West Bank-based Palestinian entrepreneurs were competing for these Google prizes and learning from each other, and collaborating and building businesses together. You see that kind of hope. It's precisely because it's so unlikely that it changes our thinking and allows us to aspire to much more.

Brigid Bergin: Dr. Shah, I want to get one more question in before we let you go. One of the largest humanitarian groups in Gaza right now is the United Nations Relief and Works Agency for Palestine Refugees in the Near East. NPR recently reported that the agency is on the verge of collapse as Israel continues to "sap resources" like food and water to Gazans. That agency, as the name suggests, is funded by the United Nations. What is the role of the UN and the US in ensuring that humanitarian aid is ultimately let into this very tightly controlled region?

Dr. Rajiv Shah: Well, it's critical for both the United Nations as they've already done to call for the space for a humanitarian response that is effective and appropriate and can literally save the lives of innocent civilians. It is also almost always the case that there's no substitute for American leadership on exactly that point. I have been America's humanitarian representative on countless tragedies, and I know the way the world reacts to the moral voice of the United States of America.

This is the time to use that voice to both protect those innocent civilians and to ensure Israel's medium to long-term national security is in fact protected as well. I do think you're starting to hear that from Secretary Blinken and starting to see that kind of leadership from the United States. I think more of it will be coming in moments today, but it's absolutely critical that the US and the UN collaborate to make this happen.

Brigid Bergin: Dr. Rajiv Shah is president of the Rockefeller Foundation and the USAID administrator from 2009 to 2015. He's also the author of the new book, Big Bets: How Large-Scale Change Really Happens. Dr. Shah, thanks for giving us something to be optimistic about today, and thanks for joining me on the show.

Dr. Rajiv Shah: Thank you so much for having me.

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