Welcome, welcome, welcome to armchair expert I'm Dan Shepherd, I'm joined by Maxim Mismo, so there how are you? Great. How are you doing? Wonderful.

We're back in the attic. We're back home. I'm sitting in the chair. Feels good today.

We have a very, very, very smart one on one of these people were Monica and I were talking to and just getting more and more depressed the more we learn about their life and accomplishments.

God has done so much, too much, too much, too much smarter. He's smart. He's too much smarter than I think.

Raj Shah, Russia is the president of the Rockefeller Foundation.

He is a former American government official, physician and health economist who served as the 16th administrator of the United States Agency for International Development from 2010 to 2015 under Obama.

What an accomplished guy. And from Michigan. Yeah, you love that. I do love that. Anyone from the Mitton. So please enjoy the fascinating Shah.

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Rodge, first of all, we are so sorry for being late, because as I researched you, you have like 43 jobs I don't even like. I read the committees you were on and stuff.

And I'm like, how does a man have this many titles and still function? 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 and thought about that.

Not me, me, but it is nice to meet you because I know we're both actually from around Detroit, which is awesome.

Oh yeah. Girl, you're now. So your parents emigrated in the 60s in Ann Arbor. Is that correct?

Yeah, the late 60s, actually. First to Pasadena in California. And my dad worked on the Apollo projects after that event went to Detroit. And so I was born in Ann Arbor and we grew up around Detroit and Canton in West Bloomfield. Oh, sure. I mean, I wasn't born yet.

I was born at St. Joe's Hospital in Ann Arbor. So my mother ran a Montessori school in Ann Arbor and then later in West Bloomfield. And my dad worked at Ford the whole time I was growing up and spent 30 years at Ford. And then Ford had a spin out called Visteon and he was with this down.

Oh, no kidding. So, A, I used to cruise in high school in Plymouth.

Have you ever partaken that we would go down to or was it over on Woodward like Woodward eight and Nine Mile. Yeah, OK.

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.

We just sat down ashamed. I've never seen anything like that.

I took my wife there like long after we were together. And she was like, this is the strangest thing I've ever seen. She's like, where are these people going? I said, Nowhere. We just drive in circles. Well, and it took me a while to figure out that she didn't think it was just awesome. I was 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.

Yes. Oh, my God. Yes.

Sitting on this. So many people sitting on the side of the street just watching cars drive by. It's so specific to that culture like no other city has that.

Yeah, my high school offered pre engineering, automotive drafting from seventh grade onward. And now I thought that was totally normal. 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? And what school did you go to? Birmingham Grove's High School. Oh, right, right, right, right, right.

That's a fancy school monitor. Oh yeah. So, oh, I grew up kind of poor, but then my mother built this company that worked for General Motors and it became kind of big in them. My little sister went to Cranbrook, so she's like a rich kid.

Wow. That is a fancy school, right? Yeah. Okay, so you went to U of M. Was that an obvious choice?

Yeah, I pretty much wanted to go to Michigan and ended up there, started actually in engineering. I thought I would be in the auto industry because, you know, that's what you did. Yeah. And early on I sort of changed to go to the liberal arts college and broaden my interest and took on other things. But certainly I started out that way.

But your first degree is a bachelor of science. But in economics, yes. Yep. Michigan had a phenomenal economics department and there was a professor named Soul Hyman's 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. And I just thought it was like magical arts. You know, it's like knowing all this stuff that explains how the world works. And really that one professor got me so hooked on economics that I just thought I wanted to do that.

I also wanted to be a doctor. And so I kind of ended up doing both for a little while.

But really quick, you're right there is this like the invisible hand, the Adam Smith invisible hand. There's something magical about it, right. And unmeasurable force that's clearly operating and working. And we can see the outcome. But the thing itself is not tangible. It's fascinating.

Yeah, it's fascinating. 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 in the late sixties, which was not at all one of those successful economic environments. And 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, we were like, wow, they are poor, bright, 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 to make a difference in 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. OK, so you you leave you avam and then you go to Penn.

Oh, Monica. We like fancy schools. You haven't picked up on that, so you're going to get a lot of we've even created a term or uni files. So yours reads like a penthouse forum letter. Oh, we're horny as fuck for all of us.

I've never heard anyone read my bio and compare it to a penthouse forum. So that's kind of exciting thing.

I guess you go to Penn and you get a masters of science in health economics. So really quickly, just can you give us a broad stroke of health economics?

It's basically the economics of health care and the. Thank you. OK, great. And I was in medical school and I was also at the business school simultaneously. And in business school, I sort of wanted to learn about how the health system worked. And, you know, I was at the time or it was just after the big Clinton push on health care reform in America. And so that was in the news a lot. And that kind of shaped a lot of my interest in saying, you know, we should be able to figure this out if we're spending all this money.

And 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. But, you know, probably the best thing for me about being a pan was they really encouraged you to kind of explore different interests, which is not true in every medical school training program. So I. I applied three times to join Al Gore's presidential campaign, got rejected all three times.

And then finally, when he moved his campaign from D.C. to Nashville, I was invited to come down and just work as a volunteer. And that really, more than anything, changed my career.

Yes, because you have you have like political interests. You I mean, it's not weird. It's very cool. You're a polymath. You have all these different interests. And what I like about it is you end up ultimately why we're talking two days. You kind of get to synthesize all these different things. But just really quick that the health care system, it is uniquely complex, right?

Because it has all these layers of multiple businesses on top of ultimately treating people for illness. There's all these other factors, these intermediaries that the insurance providers, hospital networks. Is there a more complicated system out there? I mean, there's so many factors involved, right? Yeah.

I mean, no, there really isn't. We spend in America more than four trillion dollars a year on our health care system. And we have kind of at best, a middle ranking amongst industrial countries on population health outcomes. And frankly, right now, you can't get a simple test 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 health care system ever devised by human beings.

So and, you know, my sister's is a surgeon in New York and can't get a test if she needs one. So it's it's a big deal and it's a big problem in American health care has been underperforming on basic public health attributes for decades.

Yeah, and it's fascinating because the medical insurance complex, it does mirror our society almost perfectly. Right. 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. And which is so true of everything in America, right? Yes. For the top one percent, it's fucking awesome. And then for nearly everyone else, it's falling short, right? Absolutely.

You see that in general. You know, when you look at America's health before this coronavirus crisis, 40 percent of American households didn't have four hundred dollars to cover an emergency. And the number one emergency they were concerned about having to cover was a medical or health one. And for that, 40 percent of all American households, you know, most of them don't have a doctor. The emergency room is their primary engagement point. So now you know that, frankly, emergency rooms are just not safe places to be from.

Rival the contagion perspective. They've they've effectively been shut out of a health care system or they take really high risks. And on the flip side of it, you're right. I mean, if you want a laser guided robotic surgery with a peaceful 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. Now, when we look at the PPI, the four trillion dollar PPI, do you know off the top of your head at least ballpark, like what percentage goes to doctors, what percentage goes to hospitals and what percentage is going to just insurance companies?

Like who who's making the bulk of that four trillion dollars? That's a good question. I don't know the exact numbers. I think in general, from a profitability perspective and the insurance industry and the pharmaceutical industry by far and away make the most profit. Most hospitals in America operate on almost no margin. You know, one or two percent of net patient revenue on an annual basis. Is there is there margin there like a. Restored, yeah, exactly, they're very, very, very efficient from that perspective and very non-profit in their basic approach.

And, you know, physicians and doctors don't really I mean, you just look at their take home pay relative to other occupations. America, it's not dramatically out of line. So they're not the ones that are really benefiting from the system we have today.

Yeah, there's also the sports analogy. It's like people will read, I don't know, Shaquille O'Neal is going to get 25 million dollars and they're kind of appalled by that. And then I'll go like, what? Would you be happier if Jerry Buss got that money? Because someone's going to get the money. And I think the guy who's putting on the show probably should get a good chunk of that money. Yeah. Similarly, the doctors are putting on the show.

I feel like if anyone should be profiting abnormally, it should be them doctors and primary care physicians.

And one of the one of the proposals we're trying to make happen and we're working in cities like Boston and Baltimore to create programs that do this is to create an entire community health care 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 rebuilt the American agricultural system. As a result, we could do something like that by employing people right now when so many people need work in order to address coronavirus and its consequences.

And what would the people do? What would what would be the equivalent of them planting the trees? 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, causing more suffering economically for families that are just shut down or they have to abide by social distancing. And the two main elements of it are broad, ubiquitous testing, making sure anyone symptoms or no symptoms, who needs the test can get a test regularly.

And the second piece is tracing contacts, 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 notify them that 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 yourself, quarantine or take themselves out of circulation, so to speak, to protect everybody else.

And the workforce we've proposed would help actually do those tasks, identify who who you need to go speak to, connect with them, tell them, oh, you were in touch with somebody who had a positive results. So you need to get a test and you should take yourself out of circulation for 14 days or so in order to protect others in your community. And I'll say it sounds like a lot of work and it sounds maybe somewhat technical. I led the West African Ebola response during the Obama administration and we hired and trained almost 11000 community health workers throughout West Africa.

So that was in half a dozen countries. And we asked the US military to work with a nonprofit group called Medecins Sans Frontier that is a well-known Doctors Without Borders, is the is the common English, you know, name. And they created a protocol. And within two days, they were able to train cohorts of people and they just ran large scale military like protocol training.

Yeah, they went village to village. Right. I remember seeing like footage of this. They just got mobile and started walking. Absolutely. And we gave them all protective equipment. We gave them protocols. Usually when we when there was a positive case identified 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.

And the result of that effort, which was really successful, was to just knock down the cases in the transmission of Ebola in that context very, very quickly so it can be done. In that case, we we actually deployed the U.S. military, including military labs, helicopter transport for blood samples. At the end of the day, we got testing down from taking eight to ten days to get a confirmation around a test down to under four hours. And we track that and we followed it and we just threw resources and ingenuity at it until we got there.

And I look around and I say, if America could do that so effectively in West Africa in 2014, 2014, we should be able to do it right here at home in America.

Well, yeah, that was going to be my question. So that was seen as a very, very successful effort on your part. 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. We have a playbook.

That's right. We have a playbook and we know how to do this, which is why at the Rockefeller Foundation, we sort of pulled together scientists and industry leaders. Actually, we pulled together a kind of former administration officials from both Democratic and. The Republican administrations and came up with a national action plan to do just that, it'll cost about one hundred billion dollars over the course of a year, which, you know, until about a month ago seemed like a lot of money.

Now, where we're spending trillions on on dealing with the symptoms of this crisis for about one hundred billion, we think we could actually implement a testing program that would go from one million tests a week in America to three million tests within eight weeks and then 30 million tests within six months. And, you know, by then we should have home kids and point of service testing options. 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, find out the result 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 those 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 American has a sense of. Right. So you've worked extensively on agriculture. You've worked on health. All these things can funnel into a national security debate. 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.

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. So that annual DOD budgets like one point four trillion dollars or whatever it is, and that's to have guys go kill people in response to things very far downstream that probably could have been prevented. 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.

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 are trying to treat something that's so far downstream. We're at the symptoms level, as you just said, and we're never, ever putting any investment into prevention or any of these things.

And the same could be said about national security. It's just like it's cost so much less to prevent a country from being starving, no economic options, and then they turn to some military organization. We have such a great history in knowledge of how this cycle works in such a limited appetite to to prevent it. 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.

Well, I agree with everything you just said. 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 and other societies achieve the basic tenants of the American dream, just the basic tenants, you know, the pursuit of life, liberty and happiness and liberty in particular, they are so grateful for and connected to American values and American leadership. And it does enhance our safety dramatically.

In fact, the story of American leadership after World War Two has been it's been an absolutely bipartisan mission to recognize and use American leverage, American power and American influence around the world to stand up for our values. I think Eisenhower, when he when he became president after World War Two and said we're we're going to put in place an institutional architecture such that this doesn't happen again. And we got the U.N. and the World Bank and the Bretton Woods institutions, the World Food Program, I think Kennedy and Nixon, you know, all the way through as President George W.

Bush mounted perhaps the largest, most costly and most successful global health effort in saving tens of millions of lives from HIV AIDS in Africa. And that was a pursuit of passion and commitment to humanitarian justice. But it was also a recognition that having, you know, 30 failed states in Africa where the core of their productive economy had just collapsed and, you know, 10, 15 percent of the population, poorest country were were dying was not a way to secure America's safety.

So I think it's been a bipartisan mission since World War Two. 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 Afghan girls into school. And, you know, the number before America engaged on that specific project was basically zero. And you know, anyone who's been on the ground in Afghanistan alongside our troops as as I've had the honor to do, knows immediately that those eight million girls are the basis of our security for the future.

Well, you know, I've been twice and I didn't see a single woman. Is that right?

Yeah. I was like, where are the women? Yeah, you get you got it. You got to look at other 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. And we'd go in and they'd have you're right, all the men would be lined up in the front to greet the Americans. And they would. And then we'd ask and we'd say, can we speak to some of the girls that are in school?

And they were in full burqa and usually in a schoolhouse, in a private room. And then they'd let us in and we'd talk to them. And the and the mothers would all say, you know, the reason we know that America cares about Afghanistan is because. Are sending our girls to school, and it costs for every dollar we spend on the Afghan war, it's it costs less than two cents to run a program that got the eight million girls into school, that built out thousands of kilometers of roads and infrastructure and all difficult.

But, you know, that's what we did in South Korea after the war that changed the face of that economy. It's what we did in many other parts of the world. And and you're right, that is getting upstream. That is sort of saying we don't want to deal with the consequences of extreme poverty, of huge amounts of injustice, the persecution of an entire gender. We want to unlock stability and peace because America does well when other countries are stable and peaceful.

And we're seeing that happen kind of in reverse right now. You know, the U.S. is so behind on this coronavirus response that we're not able to play our usual role of helping others. 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, which is a new experience for many of those other countries.

And kind of, you know, it's unfortunate right now, a humbling state of affairs right now. Now, when you left Pan, what kind of doctor are you're a medical doctor.

You could prescribe me know I'm sort of useless as a doctor as I left 10, having gotten a medical degree, but went on to join Al Gore's political campaign. Then I joined Bill Gates's foundation when when he and Melinda were just starting out, spent eight years working with them and loved basically every minute of it. And then I joined the Obama administration.

Put a life on this. You've nothing you haven't heard anything at all like that. Nothing I can already tell he's resistant to. Let me go through it.

The parents I mean, your parents just must be I can't imagine one of their children is you and the other one is a surgeon. Did did you say surgeons?

Yes. Yes, yes. Yes. Yeah. Oh, right. Well, my parents are so upset right now hearing this.

Yeah, well, I'll tell you my account. When I told my parents I was leaving medical school to volunteer on Al Gore's campaign and I was going to stay at Al Gore's mother's pool house, drive, drive younger volunteers to the library, you know, every day they thought I was kind of throwing it all away and I wasn't sure they weren't right.

But yeah, but I loved that experience and made some of my best friends in Nashville during that year. And frankly, so many of those folks have gone on to to offer amazingly effective service during the Obama administration. I'm really proud of that team.

OK, so what excites me the most is I have probably my deepest fascination of any two gentlemen are John D. Rockefeller of Red Titan, I think four times.

Wow. Have you read it? Oh, yes. Not four times. Maybe three said it only gets better and better.

I mean, what a fucking book. But but then my other my new fascination, of course, is Bill Gates, driven largely by that Netflix docu series. And I could be completely misled. So let me just say, I've probably been manipulated by the documentary, but what I glean from that is every dollar that is donated to any organization should go through Bill Gates. And here is why he's so fucking pragmatic. My wife is incredibly philanthropic and I've seen her involved with at this point over a hundred different organizations in the last 13 years.

And my frustration is in my relief with Bill Gates is so rare. Does somebody have kind of a background like U2 where they have a true understanding of market? They have a true understanding of economics. They understand everything that will be involved to execute this great utilitarian or altruistic idea. 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. And he has brilliant ideas.

I'm like, yes, give that guy all the money he needs. No political help. He has all the approval is the money is independent. He's pragmatic. He cares that he's a robot. There's so many things I love about it.

So the fact that you have in some capacity worked for both of these people, what is it about, Bill? You share that opinion of him that he has this very unique suite of of attributes that he both cares and is so fucking logical and pragmatic?

I'm hugely biased, but I agree with pretty much all of that. You know, he is he's both brilliant and so deeply committed to learning. And it's both Bill and Melinda. And so I took for granted because I was fairly young when I started working with them. 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 loss, find out the causes, then, you know, make a list and then identify the cheapest ways on a per year of life loss method to save that year of life.

And and then you'd pull together every company, every and. Every international organization and say, OK, let's go save six million children's lives doing X, Y, Z immunization project and but that actually happened and we all did that. And and Bill and Melinda and Patty Stonesifer, who led the foundation then there, that malaria was that number one thing that that number one thing was global immunization.

It was an effort called the Global Alliance for Vaccines and Immunization. And in addition to raising putting in billions of dollars, we also raised billions and billions. You raised five billion dollars, right? Wow. Yeah. Well, I think you're referring to a specific instrument where we we did the first ever social impact bond, but we effectively worked with a group of banks and issued on behalf of a really on behalf of UNICEF, a major security that raised more than five billion dollars.

And that five billion allowed us to do long term, large scale purchase contracts for the types of vaccines that you needed for 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. And the net effect of all of that is after 20 years and billions of dollars of expenditure and probably thousands of people working together around the world, we helped immunize more than 700 million kids, saved more than six million children's lives, and I think created a model that 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 large scale to meet the needs of society.

But I'm deeply proud of what? Well, we all got done then. And and Bill and Melinda are just exceptionally committed and very, very talented leaders. I would say one area where I think Bill would disagree with you. Oh, that is if he were here to give you more than one. You know, you said he can do it all alone.

And I think the thing the thing we learned was you actually needed to engage in politics. You needed to engage governments, you needed other philanthropic partners, and you needed companies and scientists all working together. And, you know, it was a special time. I remember when I led a specific project which was oriented around Warren Buffett giving a lot of his wealth to the Gates Foundation. And, you know, we were able to, in that moment, really get the best of the best to solve any major problem.

And so when we focused on global immunization, you know, we could pick up the phone and just pull together the people you'd need to really systemically transform global vaccination. And at the end of the day, you know, there are hundred and twenty million or so kids born every year. And we could track going from 40 million to 60 million to 80 million to 100 million annually, getting their vaccines and just make that a mission with real quantitative rigor around tracking results and being really businesslike about delivering outcomes.

Yeah, and guess what I most specifically meant was there's a moment where he goes, look, here's what's going on with global warming. Here's what no one likes. Unfortunately, nuclear is probably the answer. No one likes that. I guess that's what I mean in his independence, that you could go. No one wants to say this. Let's go. Why don't they like it? And let's solve those three reasons. People don't like nuclear energy. That's just a position most people can't afford to take.

I appreciate his independence in those moments.

Stay tuned for more armchair expert, if you dare. We are supported by Ben and Jerry's, what a privilege it is to say we're supported by Ben and Jerry's. Listen, Ben and Jerry's and Netflix have turned up something extra special. When you pop open a pint of Netflix in chilled ice cream, you can experience the magic of things that go perfectly together, just like your Netflix watch list.

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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 a industrialized, richest country in the world where there's a sector of people trying to convince people not to vaccinate? Does that not were you not like what the IMF they're trying to do this thing. You guys have the knowledge, you have the literacy rate, the fucking income, and really you're trying to undo this?

Well, it's always been disorienting for me because it's always true that wealthier communities, it's not even just wealthier economies. Right. For the anti VAX movement is stronger, specifically in the wealthiest communities in the United States, not just in the United States broadly. And that's also true for the community of people that have been against certain technologies in the food system, including, you know, transgenic technology or genetically modified technology. And while there's truth to some concerns in 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 benefits achieved. And that's even more true in developing countries, and that's true for agricultural technology as well. And the reality is, if we're going to avoid food crises and hunger as our global population goes north of nine billion people, we have to embrace and safely use appropriate technologies in the food system also.

Yes, one of the things that frustrates me is there's just a blanket GMO. Right. But I don't think some people recognize what some of that GMO is. So everyone would agree they don't want Roundup all over their food because we're going to get all kinds of downstream issues. I don't want to get sued, but there's some fucking downstream issues.

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. And aloe plants completely bug resistant just naturally by its own DNA. Now, to me, that's a great bit of GMO. Like, I don't understand the hesitation just because of the label. Well, I earned the nickname sometimes in the Obama administration. They called me Mr. Sweet Potato Head because I. I always advocated for these betacarotene rich, basically vitamin A rich versions of sweet potatoes in parts of Africa.

But I've sat with kids in northern Uganda that have been in communities ravaged by war. Some of the things they've seen, you know, are inexplicable from the perspective of our common humanity. And they're starving. And the main food item they eat and are fed are sweet potatoes. And if you enrich them such that they have more betacarotene and they're therefore more Provitamin A, you can actually improve a number of health outcomes for these young kids and give them a chance to grow up healthier, to have a chance to learn and things like that.

And so when people from outside who haven't sat and talked to those kids and those families say that they should not have access to that kind of technology, I've been a strong advocate for them. And it's just wrong. And this is something I think Bill and Melinda have done. Well, I think John D. Rockefeller wrote about this entitled, like, really solving these tough problems just requires learning and listening and the humility to constantly kind of ask questions and be willing to learn.

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 start working at real scale. Yeah, probably more persuasive, like a post on Facebook, sadly. Like that's what you're arguing with. Yeah. Someone's opinion on Facebook.

Now, the other kind of theme that runs through your work is, is early on at Penn, you got a five hundred thousand dollar grant, right, to study hospital efficiency. Yes.

And it was it your early education and economics that made you recognize, like money is going to be a huge part of this in your ability to raise and access? Money is a huge part of the successes you've had.

Well, just to go back to that ten example, you know, there were just two graduate students, myself and a friend of mine, and we built this little regression model that would tell you a little bit about when you merged hospitals, how to drive efficiencies on discharge issues and things like that. And when we submitted that grant, not at all expecting that to grad students for when at the time that was a lot of money. Oh, God, why don't we got that grant?

We were just blown away and we thought, wow, this this is going to be fantastic. And it reinforced my commitment and my interest in just using data to solve problems, you know, and and that was kind of a quirky application. All of it, but an important one in that setting and the story we talked about with immunization was very much about using data to solve the problem, like unless you knew how many kids needed to be vaccinated, how many were not getting vaccinated, country by country, county by county, set targets, set goals and then built solutions that achieve them quantitatively.

We weren't going to get there. And and so, you know, I was I feel fortunate because I've had the chance to do that on efforts that range from addressing food insecurity in 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. But that was really the transformation of when I was in government. 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.

And, you know, I probably learned a lot of that from Bill and Melinda in that early setting. But in my view, it actually allowed us to say to the American taxpayer that for a fraction of one percent of the public budget, we were saving lives and having real impacts around the world. And to me, you mentioned kind of a bipartisan support to me. I found just as much enthusiasm for that approach from Republicans as from Democrats. It really did bring people together.

And it was like, OK, if you're going to be responsible about doing this work, we're going to get behind you.

Well, that's what I kind of beat this drum on here on this podcast. And I'm sure people are sick of it. But, you know, I am a big bleeding heart liberal. There's no question I'm a progressive. Yet I see the intrinsic value in having conflicting points of view to make each side better. I really do value the right. And I think here is the situation where so often on the left, there's more of a big hearted mission statement.

But sometimes, yeah, the efficiency, the the outcomes, they're not as stringent as they should be.

We are spending people's money. So I appreciate the right's insistence that these things yield results, that they're a good use of money spent. And I think you're in one of the overlaps that can best exemplify when both parties are working together for an outcome.

Yeah, I think that's right. I also think building bipartisan cooperation on these types of issues is not just about the math, it's also about the relationships. 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 of the House who I still today consider friends. And even though we don't agree on on most issues politically, I admire the service they offer and I admire the fact that they have an inner core of values that drives their desire to serve.

And, you know, we can disagree on lots of things, but also find the opportunity to agree. And by agreeing on some things, America was able to mount the largest investment in addressing food and hunger around the world that we did since World War Two. We were able to create an effort to electrify much of Africa, which didn't exist before. And we were able to pass both of those bills through a very divided Congress and get it signed by the president.

And that to me, is I feel like if we can do it there, we ought to be able to do it right now, Unkovic, to just solve this problem, because this is a solvable problem. And people I really believe most people, not everybody, but most people show up wanting their service to matter in improving the lives of the American people. 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.

And it's really just a debate over how that's done. But here again is where I bet it overlap. I don't know anything about this, but I can tell you both, when I was in Afghanistan, twenty seven and and they were starting to send a ton of special forces down to Africa.

And so I do wonder if you're electrification program, if it gained momentum because there were starting to be all these hotspots of terrorist activity because of the unrest and poverty.

Yeah, I think without question that's true. And without question, the military leaders from Admiral McRaven, who's perhaps most known for, you know, getting Osama bin Laden to David Petraeus to to all the other major generals that we could name. You know, Jim Stavridis, the head of Euro SEC and NATO, they all became very strong advocates for powerful values based American leadership abroad. And they they said we need to make these investments in development and humanitarian efforts at a far higher level.

They advocated for more staffing for for the State Department and for U.S. aid and the. And even the military and they they were the ones who said our national investment in global security is out of balance and we we need to get the balance right by increasing the investment in how we use our diplomatic and development expertise around the world. And frankly, you know, had that mindset really taken hold and been implemented effectively, I personally don't think we'd be dealing with coronavirus at the scale.

We're currently dealing with it here in the United States. I mean, we had created in that era a program called Predict at USA that was designed to look all around the world, identify zoonotic, which is animal to human transmission of of particular types of viruses that could then become global pandemics and connect to early warning systems that would sound the alarm early or get people resources fight these things when they're local and contained in a place as opposed to, you know, dealing with a global emergency like we are dealing with right now.

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

And it's just so frustrating that convincing people that is actually a greater saver of lives. 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. And you get down to Afghanistan. We have been there now for 19 years and 2200 Americans have died. Almost nothing when you compare it to World War One or the Civil War or anything. 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. And yet we have a very hard time prioritizing that version over the go put boots on the ground.

Yeah, it's hard to weigh and compare the loss of human life. I mean, I've been at Ramstein Air Force Base and been with our troops who have been injured, returning from the field. U.S. aid had 9000 foreign service officers around the world. And and we lost more than one during my tenure. 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 conversation that I'll never forget. So, you know, every loss of life is just so tragic, which is why, like, right now, it's not OK, in my view, to just say, well, we're going to lose 80000 Americans or we're going to lose 220000 Americans. I guess that's my point. You would never say that about a military operation. We're going to send all these guys over there. And we predicted worst case, two point two million, right?

Yeah, never. The number one job of every government through history is to enable life for their people. I mean, that is truly the most basic responsibility of any form of government since the beginning of time. And so I was really frustrated by these these estimates, you know, and a sense that, well, that's just going to happen. That doesn't have to just happen. We know, as you said, we have the playbook. We know how to solve these challenges.

But it takes leadership. It takes cooperation. It does take, in my view, real public private partnership and real bipartisanship, because there's some there's some really interesting hurdles.

Right, because I was just watching 60 Minutes and they had a story about this Canadian company. They're kind of breakthrough is they have an algorithm that's tracking. They got access. They convinced somehow the airlines to give them passenger data. And then also they've gotten cooperation with some phone service providers. Right. So not only can they watch everyone that flew out of Juhan, they can also then track where those phones go and where they would maybe travel to. And then they're tracking these hotspots and they're like, you know, there's synthesising all this data, air flights, mobile data.

And here's a great situation where it is going to have to be bipartisan because you're dealing with significant liberty issues, 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 percent right. And, you know, the basically the Rockefeller Foundation action plan, which we haven't just put out there, we've put 50 million dollars against actually implementing it is based fundamentally on making testing broadly accessible to the American population in a strategic and achievable way, and then tying it to contact tracing, which includes the digital tools that you just described, you know, because to do contact tracing. Effectively, for covid-19, you just need to use digital technology and it's a lot of mapping and it's a lot of geolocation, but we know that all that data exists.

And frankly, to some extent, we've we've given up quite a lot of individual privacy for the convenience of in my case, 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. And underlying that is a fundamental shift in American privacy. So I would argue that as long as you protect the unique patient identifiers, the names of individuals, you don't you don't actually have to lose more privacy than we've already lost.

You just have to use it to save people's lives as opposed to sell them shoes.

But but you, man, you're right. What an irony and what a hypocrisy that we are fine. And whether it persuades us to buy something. But if it were to save our lives, we're so hesitant and resistant.

So, yes, you had a couple of titles and one of them I got really confused by. So in 2009, you became the USDA chief scientist of agricultural research that was under Obama. But also in 2009, you start working for the United States Agency for International Development. You said how do you both those jobs at the same time?

You don't you know, I started in the Department of Agriculture as our chief scientist, and there's something called an undersecretary for our science programs. And by the way, the US Department of Agriculture, for those who don't have as much familiarity, is one of those amazing institutions. It's one of the oldest institutions, the American government. The program I ran was tied to the land grant university system in America and all the other the and A&M schools are perhaps the best known of those, but also the historically black colleges and universities.

And that program was founded in 1862 by Abraham Lincoln in the midst of the Civil War. 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. And so it both is amazing to me how 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.

Yeah, you're right.

I don't hear people bringing up the USDA quite often unless they're talking about a steak they bought, I guess. 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 and they said, would you move over and lead USA Today? So I had to leave that job and take the other one.

And then on day five of the new job, there's a seven point oh earthquake in Haiti and two hundred thousand people die. And you're tasked, right, with one of the biggest humanitarian relief efforts ever. That's your job. Day five. Go, go. Right. Make it happen.

That was my job. I'll say I was really I don't know what the phrase is.

It's wet behind the ears or green. I was telling you, let's put it that way. And I was like thirty six and knew the government in that kind of a role. So the earthquake happened in a few hours, not even a few hours. A few minutes after the earthquake happened within an hour, I got a phone call from the White House and they said the president's going to call you. What number should he call you at? And I was so new that I didn't even have any of my appointees, you know, political appointees on board yet.

So it was just me and this massive office with basically no political staff. And so I looked down and I said, well, call my BlackBerry. So I gave him my my BlackBerry phone number and hung up. And then someone came. I said, well, who is that? I said, well, the president's going to call. And, you know, the president had never called me before. So I go to the I look at my BlackBerry and there's like one bar and I'm in this.

Oh, my God, I don't like a building in D.C. So I go and I put it by the window and I prop up a desk. And sure enough, the president calls and I start and I take out a notepad. And, you know, I wanted to do a really good job because the president and he calls and he said, not just our president, it's Obama. Exactly. And so he says, I'm putting you in charge of a whole of government response and, you know, I want you to make us proud.

I said, absolutely, sir. And I and I then took my pen out and I was like, ready to write down what he said next. And the and the line went dead. And I was like, oh, my gosh, I just hung up on the president. So I looked at the BlackBerry and it still had three bars. You know, it's propped in the window and in like thirty seconds later, he was in the the White House briefing room and CNN was on behind me.

And he says, I just spoke to Administrator Shah. I've asked him to deploy the Coast Guard, use the US military like he lifted like. Six or seven things that I took my notes and we were off to the races. 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, 200000 people who had just lost their lives and a nation that had been flattened.

And we should do everything we could to save lives and support our neighbors. But he also understood and said that this is a chance to demonstrate to the world how American power can be used for good. And, you know, from Kennedy to Obama and Clinton, I mean, our presidents have have understood that. And and we did everything. We deployed the USS Comfort. We saved more lives during the urban search and rescue effort. We deployed teams from L.A. County and Dover.

We you know, we coordinated a 52 nation effort to help Haiti. And six months after the earthquake, the rate of diarrheal illness in Port au Prince was much, much lower than it had been the day before the earthquake and was years later. The rate of child mortality and child hunger had been cut by more than 50 percent. Investment was up for 400 percent on an annualized basis. Haiti is still a difficult place to make growth, and institutions and society work effectively for a lot of reasons.

But we did everything we could and frankly, we were proud of it. And American troops work side by side with our humanitarian leaders, and they delivered for for what they needed to do. 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 for covid. Yeah.

So then in 2015, Brage got appointed to the U.N. as one of six to review global pandemics in 2015. So you minimally well, in 14 you did Abullah, but you've been for the last six, seven years. I mean, pandemics is kind of what you're focusing on.

Yeah, I think that that effort was you know, if you look at what happened with Ebola in 2014, there was a wave in March of 2014 that that came was responded to and got reduced in rural Liberia. And then sometime in June, the virus most likely mutated, became an urban virus, and the transmissibility became far more intense. And we saw a big spike happen in the summer. And it was our judgment, the U.N. 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 in the summer.

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. And once we made that judgment, we put in 3000 troops. We built out laboratory infrastructures. We worked with our partners like the World Food Program, to do a helicopter transport with our military. And we went out and trained and hired 11000 community health workers on a short term basis.

But to be part of the response and that response worked extraordinarily well so that, you know, within eight to 12 weeks, we saw a massive reduction. So the question the panel was trying to ask is, how do we make sure this doesn't happen again? How do we make sure we don't miss the early warning? How do we make sure we enable strong leadership? How do we build preparedness? Because we know these crises are going to be more frequent in the future because of increased travel?

Well, how did you know it would increase? Mostly because of population growth and the increasing interaction between humans and animals as a result of both population growth and other elements of our food system and the way we live. And that zoonotic spread where you have reservoirs of virus in animals, that that's 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 prevent. And so, you know, solving this stuff before it starts is stopping it at the at the animal to human transmission point.

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?

Yes, that would be helpful. And I think what would also be even more helpful, because there will be spread is early warning systems that are deeply connected. 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. And they would say, well, you know, it isn't validated yet. And if you say that publicly, our economies will be shattered.

And so, you know, we need to validate the data first and this and that. It was Elton John. And Sirleaf, who subsequently won the Nobel Prize and appropriately so, that kind of broke through that as president of Liberia and said, you know what, Raj just published the data as you think it is, because the world needs to know and we need the help to to solve this. But that economy, you know, collapsed. It went down 33 percent in GDP.

And in a poor country like that, that leads to widespread hunger. So we had to address that by bringing in a lot of food and support for those very vulnerable populations. But the point is, you know, in this case, I think China clearly was not transparent about data related to covid early on. And what we or our panel had proposed was an early warning system where scientists get case data and share it automatically without necessarily needing governments to approve the sharing of that data.

And the Rockefeller Foundation subsequently built data sharing agreements across many, many countries around the world. China has proven more difficult to be part of that system. But outside of China, many of those systems exist because we helped support that effort to take place. 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, you need your scientists to to sound the alarm, call other scientists into the fight and begin the process of sequencing, developing vaccines, understanding therapeutics, what could work and doing that, the contact tracing immediately so that you lock these things down before they become global pandemics.

Yeah, like in other crises, arenas, if there's an earthquake, you're not waiting for the mayor to go like. Yeah, yeah, it is. It is. Let's let's say it is like because I imagine the measuring of it transcends borders or something. Yeah. And here there's an appropriate debate. 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 by then?

It was well known for those that were right on the front lines. The scientists knew what was going on. 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 complete. So so we just said this is one of those issues you don't really want is a little bit like the Federal Reserve. You don't really want the political folks managing that day to day making tactical decisions. Similarly, we need a system around the world where scientists determine the risk related to emerging new potential pandemic threats and a global scientific network maps and deals with it.

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So now, OK, a couple of cool things about the Rockefeller Foundation that I think prior and correct me if I'm wrong, but prior to Rockefeller, right, medicine was not research driven at all. It was just reactionary. It was people had ailments and we tried to treat them. There was no standard of education across the country. I mean, isn't that what they were the phrase snake oil salesman comes from? Yeah. And so there's there's no research.

There's no funding because you can't make money to try to find out what causes the diseases to begin with. There's no incentive to prevent disease at that time. So a couple of the amazing things Rockefeller, with the help of many people said was A, we need some kind of standard. Right. We need a standard of what a doctor can do. And so if I'm correct, I think he modeled after he said Johns Hopkins is doing it right there.

Doctors are great. So let's get them to build this curriculum in this set of standards. And any university around the country that will adopt this system, I will fund. And of course, all these universities said yes. So now we have a standard baseline of what a doctor should know, which is phenomenal at that time. It's a paradigm breaker to even think about that, right? Absolutely. And then he starts he funds the Medical Research Center in New York that actually starts preventing all these things.

And the one that blows my mind, right, is in the late eighteen hundreds, there was this stereotype of that all southerners were lazy. Right. And it just seemed like probably xenophobia. But then come to find out this thing, hookworm, that some very significant percentage of Southerners got like in the 30 percentage range, get hookworm because they don't wear shoes. They're culturally 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 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 in the world. It's enormous.

Yeah, I couldn't agree more. You know, the foundation was started more than a hundred years ago on the premise that science should be applied to lift up all of humanity. And if you think about it, it was the science age. Remember, there were world fairs and people would go see the Ferris wheel and the lights. And it was all like science transforming industry. And he wanted to say, how do we make science transform humanity? And so the two big hundred year investments for the Rockefeller Foundation in the application of science to transform humanity have been health and agriculture.

And on the health side, you're right, they created the discipline of modern medical education, of science based public health. The program you described in the southern part of the United States became the model for a county based public health system. That concept didn't exist before it went on to house. All these malaria research programs, those malaria research programs in Atlanta in particular, were turned over to the federal government and grew into the Centers for Disease Control. So, in fact, you know, when when the Rockefeller Foundation way back well before my time and yours, of course.

But when they wanted to create an international public health system, they said, OK, we're going to help you create the League of Nations after World War One. But our requirement is that we want you to have an international public health committee that brings this science based public health to every part of the world. And the League of Nations said, well, you know, we're just getting started. We can't really do that right now. So Rockefeller said, OK, we will those inside our foundation, that committee.

And then years later, they spun out that committee as the World Health Organization. And that's how I got here. That's why WHL is technically older and not immediately a part of the United Nations. Even today, it was that it started before the U.N. created by now. And the big, huge insight that I continue to be amazed by is that team understood that. You got it. You got to look at these things systemically and actually solve the problem.

If you're going after hookworm, don't just do a small grant or a nice charity project somewhere. And people should like I'm all for charity projects that make lives better in communities. But they had the capacity and the vision to say, let's get the best scientists, let's build an infrastructure and let's stay with it for thirty years until we've eradicated hookworm from the American South, or let's invest in a decade's worth of research to develop a yellow fever vaccine and then let's distribute it around the world.

Or let's build an international public health system, and if we have to it for 20 years before we spin it out, we'll do that. But because we're in for the long run and that ability to be in for the long run was just awesome, just awesome. And I met as young, 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.

I mean, he's such an amazing human being. But he was an agricultural researcher. He was at Rockefeller, I think, for 45 years. And somewhere along the way, he they invented a certain type of wheat variety that helped triple and quadruple wheat yields in India and Pakistan and much of Latin America. 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. What people don't realize is they started that program in the 1910s.

You know, it was 60 years later or 70 years later that it paid that kind of fruit. And and what I love about this institution is that ability to just make big bets over a long period of time. Yeah, it's really incredible.

If I were you, I would I mean, and I'm sure you are, like, stoked to work for a group with the track record they have. Yeah, it's amazing. I can say it. I'm stoked. And yeah. And and the reason is, even in in what we're doing now on covid, like we are able to pull the very best people together and you could be the CEO of an industry company or you could be a big investor or a public servant.

But it's getting those people together to say how would we solve this problem? Which is why when we looked at testing in Coronavirus, 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. Yeah. And so what is the most challenging link in the testing situation right now?

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 lives and their livelihoods is, in fact, broad access to testing. And and we put forth a plan that's like one million today, three million and eight weeks, 30 million in six months. As I mentioned, the way to effectively get there is not that different than what we did in vaccines and what we did in antiretroviral drugs for HIV AIDS.

It turns out that all of these labs place really kind of small, short term purchase orders for tests and test kits and supplies. And the industry, which is dominated by a handful of manufacturers, see those purchase orders coming from, you know, economically weak entities on a relative basis. And they fulfill them in the short term, but they don't make the investments they need to make to build out the capacity to get 10x or 3x the volume of testing materials and supplies into the system.

So the first thing we're doing is pulling together the buyers, states, local governments and laboratories 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 and together. That contract, plus financial backing from Rockefeller and and banks would allow those companies to say, OK, this is secure, this is real. 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.

And and that's the core insight, in my view, when that infrastructure is built, is it agile? Could it then go to the next one that's coming? I mean, is that the theory? Yeah. Yeah, it could. In theory it could. I mean, in practice, we've also observed that there's a lot of money going into this now and there needs to be more going in. And our proposal is about 100 billion dollar investment over the course of a year, which would allow for a reimbursement rate at 100 hundred dollars per test.

Whether or not that test is in network, out of network, you know, done at a research lab, done at a lab core lab. And it would just make the system less complicated and more efficient, particularly for the next year. And frankly, you know, the companies will do fine in that in that environment. So we're at war as a country. 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.

And we're offering a financial backstop so that, you know, they don't at least don't lose money doing that. But we need that as a nation right now.

And then, I would imagine, are you already preemptively trying to prep for the mass production of the vaccine when it's available, like our people ahead of that? Is that being looked at in. Funded and yeah, there's an organization called Sepi that has been doing that on a global basis, I'd say Bill Gates and the Gates Foundation have been very focused on vaccines and we're very focused on testing. And that sort of works together well. And we're going to need that massive scale of production, distribution and consumption ultimately, you know, use of vaccines.

But that's going to take a while. I mean, all estimates indicate that's 12 to 18 months away. And just to put it in perspective, we're losing right now 500 billion dollars a month in GDP loss because of this shutdown. And while for me and my family, frankly, I'm getting more time with my kids I have about my career and I love it. And it's become this both challenging but also special moment. Practically speaking, for most American families, this is deeply debilitating.

And and, you know, like everyone, 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 the American economy have gone to capital and not labor. And they don't have family medical leave that's paid. They don't have the security of any real savings and they don't have a living wage. And nevertheless, they're out there risking their lives so the rest of America can be safe.

And so, you know, the reason we need to be more aggressive about testing and tracing is, is to make sure that the half of all American households that are living that way can survive the next year, the next 18 months like this is a crisis right now. That is unbelievable. We have more unemployment in America than we have had since the Great Depression. And and, you know, there's a lot of talk about the stock market, but there's not a lot of talk about the reality of life for those working American families.

It seemed that that this whole thing started pretty apolitically. And now it seems like it's funneled into the two camps, by the way. I see I see both sides. I mean, like you just said, there are people you can't go to the hospital. There's all these kids now that were born in the last three months that aren't on their schedule already for vaccines. There's going to be collateral ripple effects. People are right to question whether those effects will be worse than what the covid unchecked.

I think that's an appropriate question.

It is a fair question, by the way. It's going to 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-19. And without a 10x 30 X increase in testing, you're not going to be able to know the difference. And I fear that that's going to prevent schools from being operational. I think it's going to really prolong the misery that we are inflicting on America's working families.

And so are we seeing more bipartisanship right now? I'd say part of why we did the plan we did we brought together Republicans and Democrats in America and said, what can we agree on? And we put a plan forward that is actionable. And I was on today with about 40 members of Congress and working through that, I would say my observation is, is both sides have real merit to their ideas. But that's not the issue. The issue isn't what where do you merit to your ideas?

Like Democrats say we should use the Defense Production Act much more aggressively. That's true. But if we're not going to do that at a 30 X scale up of testing in America and there's no indication that we are, then we've put forth a public private approach that can actually work to deliver results for American families now and as opposed to just prolonging the political conflict. And similarly, I think many on the right or the conservative side have embraced an eagerness to open up very quickly without having data systems in place.

And they're going to be looking at big, immediate pandemic rebound waves. We've seen this in South Korea. We've seen in parts of China. We've seen it in Singapore, which provided the best lockdown, as you'd imagine, of any place on the planet. And even they've had multiple recurrent waves when they open up. So we need to be more like Germany or Iceland, someone that's taking testing seriously or South Korea. This is a bipartisan action plan because, look, if you're a frontline health workers, my sister is, as I mentioned in New York, you're taking risks every day.

You need to get testing and you don't really care right now whether the solution comes from one type of approach or another type of approach. You just are risking your life and deserve to have a test. And that's the mindset we used in putting the plan forward. And now we're working with, you know, a dozen cities where we're going in half a dozen states. We're working with a few Native American lands to to implement this effort. And and hopefully we'll get the federal government working with us at scale also.

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, it's crazy. We don't have an antibody test that we can say is, you know, above 99 percent. I know there's a couple out there that all of it's theoretical. How long's it been here? How many people have it? And we're all just guessing on some level until we actually have that data.

So it's like to me, step one has always been everyone get tested. Yeah. And just to put it in perspective, because we work very closely with mayors around the country, I've had in the last 48 hours three different mayors of major American cities tell me the same story. They said, you know, I gave a press conference and then someone tweeted at me and said, I have 500000 test kits, you know, in Asia somewhere. So I sent it to my procurement team and they're chasing it down.

I mean, that is no way to run a country or for a national response. And we are America, for goodness sakes. We're the strongest and most capable nation on Earth when we want to be. And we can't have, you know, 200 different local leaders chasing tweets that have come in with offers to sell them things. There needs to be cohesion to the system. We have to bring it together. And, you know, we'll do it initially and then we'll get the federal government and others to join as this starts to work.

But bringing that together and creating a disciplined clearinghouse that's data driven, that can place large long term purchase orders, that's backed by the financial capacity of our endowment and other institutions, is is where we're going with this. And we believe it will work at changing the numbers.

I'm so grateful that you're doing. Yeah, yeah. I have two nosy questions and I'll let you go.

One is so Rockefeller was the first guy to have a billion dollars, right.

How much money is in this endowment at this point? So right now we have about a five billion dollar endowment. We have a fund that we raise and spend alongside an endowment called Compact. So we offer other families and institutions that are large scale giving operations usually sign on at about twenty five million each and we raise and spend a few hundred million dollars through that vehicle. And we have an investment platform for people who want to make impact oriented investments. And we raise we raise money and expand it through that platform as well.

So all three of those really define our capacity financially. But I'd say, you know, the other thing that Rockfeller did over more than 100 years was just invest in people there, 14000 Ph.D., trained leaders around the world that are called rocky docks because they got their degrees with support from the Rockefeller Foundation and I'd say half of Africa's agriculture ministers, Iraqi ducks. So so we have this awesome network of people that we can tap into around the world.

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 vulnerable families improve their living conditions. So I find that more than the money right now, because money is you know, there's plenty of money, to be honest. It's the ideas. It's the people we can bring together. It's the commitment to delivering results. And it's the approach of saying, let's cross these divides.

Let's get the manufacturers together with the lab directors and figure this out, or let's get Republicans together with Democrats and be a bridge that can help just deliver results when they're needed. Yeah, what a jewel. What a jewel. OK, so my last question and it's related to that. So John D. Rockefeller found it eventually overwhelming. People knew he was going to give out money and then he was going to try to make the world better in the onslaught of requests became such right that he ended up employing his friend to run in and sift through all these requests.

So are you you have three kids. You're a human being.

Do you find that the weight of how many people probably want your involvement daunting? I do.

I actually just honestly, I do. Through my work, I've had a chance to really connect with and see extraordinary people in tough circumstances do things that I just consider so courageous and so brave. 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 Congo and help girls who have been subject to rape and violence or folks that fight trafficking around the world.

And because we now have, you know, access to these resources, you have this, like, real desire to just do everything you can to help all these people that you know are hero. And you know how hard they work and you know of their deep personal commitment, they've given their lives, you know, their careers and their lives to just service, we just don't have the ability to help all of them. Yeah. So I do get a lot of requests that I have to unfortunately say no to.

And it does kind of weigh on you because you just 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 they're touching and the sense of service that underpins it. But the flip side of that is, you know, we save our firepower for these kind of big systemic transformations and the ones that were betting on now broad testing in the United States and around 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.

And there's going to be a big crisis coming later this summer and in the fall because of health crises causing a food crisis and ultimately a major global investment to end energy poverty, using new technology and renewable technology, working with companies around the world to move a billion people out of extreme poverty by getting them reliable access to electricity. And we think we can do those things. And we've studied them. We know the issues. We know the people were out there making it happen.

I'm really proud of our teams. We have teams all around the world. And, you know, this is a crisis that has a lot of risk, especially for our Nairobi team or our New Delhi team or our Bangkok team. But they're out there working hard, continuing to kind of pursue the mission. So if we can't support everybody and it gets personally tough to say, yeah, yeah, but but we save our firepower for our biggest bets.

Yeah, well, listen, Michigander, you're fucking awesome. I'm so glad you're at the helm of the Rockefeller Foundation. Just grateful there's people like you that have dedicated their lives to service. And by God, where we'd be without y'all is unimaginable. So thank you so much and thanks for taking the time to talk to us. I'm sure your phone your phone was busy.

Well, thank you and thank you. It's nice to meet you this way. And Monica, nice to meet you. Can I just while I have you on, I do have access to five billion dollars. Do you know that over ninety nine percent of Americans don't own Ferraris? I just don't know anyone.

So like sleep at night knowing there's so much I don't know. Yeah, I figured you might be a car guy. Your background we have, but we'll have to solve that some other way. I saw Ford v Ferrari with my with my kids that I just love them. Oh right. Yeah, yeah, yeah. All right. All right. Thanks. So hopefully talk to you again soon. Yeah.

Take care. And now my favorite part of the show, the fact check with my soul mate Monica Padman. Hi. Hi. Well, you know what, I got to speak to Jason DeLeon today about what Jason de Leon. Of course, people heard that episode. He's a premier archeologist. Yes. Winner of the MacArthur grant and anthro teacher at UCLA. And I said, hey, how do you feel about this Cinco de Mayo thing? Because I Monacan I got in this big debate about it.

You know, he laid out a bunch of different things. He's like personally, he's like, I love it. I think it's great. Yeah. Like a fucking sombrero is a half. But he said he's like, the reason your St. Patrick's Day thing doesn't I'm not sure it works perfectly is he's like, I don't know if they were celebrating St. Patrick's Day when they were also shooting on Irish people.

Mm hmm. He's like and if they were shitting on them all week long and then they were celebrating them on both ends, then I said, I know, I know, I know.

You only believe it if it's Jason. No. Well, that's also fair. It's fair that you only believe it. If it's him, he can speak to that community more than I can. Well, here's what happens.

I think more generally, yes, he is in the community like my my sometimes knee jerk thing is like I feel like people are advocates for communities that are not even a part of. And so I, I question their intentions a little bit. Yeah. But to hear it from someone that actually has some experience with that. But also just quite often I respect you a ton and you have a different opinion than me and I go home is weird. I respect myself.

Obviously I hold my own thoughts in high esteem and then I hold yours. And then I talk to somebody who's, in my opinion, more of a tie breaker, like I consult them as a tiebreaker. Oh, but what was nice is he kind of said both things that I was I'm framing it as like a win for both of us.

Again, I wasn't trying to say people shouldn't celebrate Cinco de Mayo. I didn't read any of the comments. I don't know if people were mad at me about that. I don't know. 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 act. That's all I'm asking for. I don't. And yeah, I just never going to sort of back down on that opinion. I think it's OK to think about the implications of this stuff.

I agree. So I don't ever want you to back down on anything. We wouldn't have a show if you back down on everything. Right.

Ice is it's I have to choose, though. 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. Hmm. Well, I feel that way on certain topics.

There are a bunch of topics that I have opinions on that I'm just not willing to wade into the controversy over my life's too short for it. Yeah, it doesn't mean I don't have conviction about the opinion or whatever. It's just like, you know, life's too short to deal with the outcome of that.

It's kind of a bummer, though. It is. It is. I think, you know, a lot of it's just evaluating whether you think it's going to be productive or not. And I don't think it's you're not selling yourself out by not vocalizing everything. It's just like which ones are productive and which aren't.

Yeah, I think that's fair. And I do think sometimes I this is a hard pill for me to swallow, but I think it's true. I mean, I'm not in a relationship, so I don't have to juggle this as much. But like, sometimes your opinion isn't worth the firefight. Yeah.

Yeah, well, and you and I are in a relationship and that is the case sometimes, like we've discovered recently, that we're just better off not talking about Korona. We're both very emotional about it. I'm emotional about it. I don't know if you're emotional. I'm very emotional about it. And it's just a topic that, like we never end up feeling better afterwards. 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.

Mm hmm. And I can recognize that on this one, my ears are closed. And I think there's a there's a lot of emotional stuff going on with me about Korona. That makes probably my opinion less valid. Do you want to talk about it?

Sure. The reason this whole thing is very emotional for me is when I talk to my mom about this yesterday. So I don't feel bad talking about her in this respect. Often she came home and she said, we're moving to this guy's house. And we said, why? And she said, because we're all going to be really happy there. And then we said, OK. And then we went there and then we were not happy there. And then I said, why are we still here?

Because the premise has been proven wrong. We're not happy here. Everyone's miserable here. So why are we still here and now without her saying, I just can't fail at this again? She wouldn't say that. No, she doesn't even know it. She didn't even know it at the time. It became a new thing. And to me, the explanation kept getting less and less plausible. And so for me, from my point of view, it was, OK, we have this virus Corona.

We're not going to be able to get rid of it. It's going to spread. 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. And I was like, yep, that's a great plan. And it's the same thing to do. It's the right thing to do. And in my opinion, which is all really matters for my emotional context, is we didn't overwhelm the medical system.

It seems obvious we didn't do that. And I think we can we can now change this without overwhelming the system. And so I'm not sure anymore why we're doing it. I feel like the premise is is gone now and it's just bringing up this stuff for me where it's like, well, now what? There's 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 tests would be great if we all had I've already had it because then we can just kind of travel through and she's like, well, no, we still can't do that.

I'm like, well, wait, two weeks ago you said that if we all had it, then what's to worry about? And then I just feel like the goalpost keeps getting moved. I'm having a harder time grasping the reasons why than I was originally. And it's it's very oversized in my head. It's really way more difficult than it should be. Like yesterday I was just overwhelmed by it. Yeah.

And yeah, it makes me very emotional and I feel like I'm just stuck in something that I have no say in it.

Yeah, it's hard for you to feel like people have control over you and that they're changing the narrative on me.

That's totally fair. And I understand. I get it.

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

So it's it's really interwoven with, like, love and doing something I don't want to do for love. And it's it's just really complicated.

Right. 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. There are sacrifices that come with loving a person. Yeah. Big time. And but there is the point and that's when you're trying to identify whether you're codependent or not. Are you going down with someone, the ship, 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.

Mm hmm. And I do think the inconveniences that it's presented are easier when you believe in the mission of it. Yeah, I don't think I'm more inconvenienced than you are. You're equally as inconvenienced or more than I am.

And we are collectively way less inconvenience than most people. 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? Yeah. And I can't come up with anything. And then I get frustrated because I'm like, I don't even understand what the point of this is, because it doesn't feel to me that there is a big inconvenience or a big loss.

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 are doing well. And I, I am panicked right now about what we're doing and what we're planting and what we're going to reap. I'm very. Irrationally panicked about that, it takes up a lot of my time, my mental thought and my concern and I'm very nervous about it's like you just can't read in The New York Times that only one in four adults is now employed.

Oh, it's awful. I mean, it is insane.

And that I that scares me the way terrorism scares other people. I feel that way about the economy like, oh, that's what really will fucking decimate this country. You know, I guess just not being productive for three months. Yeah, I understand that. I'm sure my side of the argument is emotional, too. It has to be 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.

Yeah. And when my mom was and I was telling my mom all about it yesterday, the first thing she said is. I can only imagine if the inference that Christine and Monica are making, or even if you're just interpreting as you're not a good protector, that you're off the reservation. Mm hmm. She goes, knowing you, who are kape at five years old and told me you were supertax and you were 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 and. And I think that I think she's right. Yeah. I mean, I know what if I were you, I'd go out and just be safe. If you want to protect us, just be safe. Yeah, yeah, yeah. That is such different opinions of what's safe. So it gets tricky. I can't imagine that we're unique in these stresses of this scenario.

I, I have to imagine people all over America are like living with people they don't agree with on this thing. And it's got to be really hard. Definitely.

Yes. And I know that I know that when we're having these conversations, I know that's a deep rooted thing with you about needing to protect. And then sometimes I feel like, OK, 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 and say that I guess I'll just be fine with whatever, even though I'm not even though I feel unsafe to keep the peace.

Or I could keep saying what I feel, which is this scares me. And I know that there's going to be unrest. So I don't like having to choose. Yeah. Yeah. But sometimes do you have to choose?

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, like I'm trying to erase you, even feeling scared to begin with. 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 the way I did, she wouldn't be scared. Mm hmm. 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's 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 do. I don't walk or I don't wake up in the morning and feel unsafe. No, you're not crazy. I don't want anyone to think that you're like militant crazy person.

No, I mean, I hope I'm not. But I also am taking it seriously when I think about, like, oh, realistically, am I going to be able to see my family in twenty twenty? Probably not. That's really hard for me. Yeah. I mean I've never done that and I don't like the idea of it at all and that's realistically what's going to have to happen.

So, 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, 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 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, OK, well, what level do I feel safe? It's going to be worth the risk for me at some point. But that's the difference. It's worth the risk for me. My risk is small. Their risk is much higher. And then subsequently my grandparents risk is much, much higher. Yeah. And I can't make that decision for them. Like, I you know, I can't.

What if your grandparents said to you, hey, we know the risks, we want to see you, would you do it now? You want it because my mom yesterday, I was kind of like. I know the risks and I'm not going to not see my kids over it. 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, I'd be like, you know what?

If I'm going to die of this thing, I'm going to die of it. I'm going to see my kids because I might die of old age anyways. Like, I can see myself going, I don't really care. I got to see my kids. Oh, yeah. But if they die, that's on me to carry the rest of my life. That's not on them to carry. Like, I don't want them to die and I definitely don't want them to die of anything that I could have a hand in.

Like that's not an option for me to aid in killing them. Right. Like I've just never, ever, ever going to be a part of something like that. So I will see them when I know for sure it is safe to do that, which is likely a vaccine. And that's a long way away. Yeah. So I just feel sad, I guess about really I just probably feel sad.

Yeah. Yeah. To me, too, yeah, and we're in the luckiest scenario humanly possible. We are, yeah. Yeah. And we feel sad. So just imagine I do I imagine all day.

That's part of why I feel this whole thing like that. This sucks so bad for so many people. Yeah, anyway, OK, Rodge, sorry, Raj, we had some real housekeeping to do here, this was a Korona heavy episode.

Yeah. OK, so you reference the Adam Smith invisible hand, but we didn't really go into it, 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 Moral Sentiments, written in seventeen fifty nine, invoking it in reference to income distribution.

Mm hmm. Yeah, and the way I understand it, too, is like the invisible hand in the market that keeps everything equal. Basically, like there is all these things that make supply and demand work and it gets agreed upon and the price is agreed upon. And there's this invisible force making all this shit happen.

OK, the DOD budget, you said, is one point four trillion dollars annually. Seven hundred and thirty eight billion. Yeah, I should have been more clear. If you include Department of Homeland Security, you got to include a couple of things. But it really is just the total defense budget, including DOD and Homeland Security and a couple of others.

Well, in 2019, the proposed fiscal year 2020 budget request for national security in total was seven hundred and fifty billion seven hundred eighteen point three went to the DOD.

Hmm. OK, OK, you. Oh yeah. You said twenty two hundred Americans have died in the Afghanistan war as of July. Twenty eighteen there have been two thousand four hundred forty U.S. military deaths in the war in Afghanistan. One thousand eight hundred fifty six of these deaths have been the result of hostile action. Twenty thousand three hundred and twenty American service members have also been wounded in action during the war. In addition, there were one thousand seven hundred twenty U.S. civilian contractor fatalities.

Mm hmm. That was in twenty eighteen. Well, what's so sad is that a thousand of those deaths were friendly fire. That's how Pat Tillman died.

That's a heartbreaking move.

The guilt of being someone who you said 200000 people died in Haiti. Yep. Two hundred and twenty, I'm sure, give or take. How could they really?

Yeah, I think there was a real hard time accounting for a lot of the people that. Oh, where snake oil salesman comes from.

Oh, the great. Oh this is exciting. Yeah.

You call them the etymology. Sure. Is that to be like. Yeah, ok.

Like etymology in words is where it derived. Yeah. Yeah.

OK, snake oil is a euphemism for deceptive marketing and health care fraud. It refers to the petroleum based mineral oil or snake oil that used to be sold as a cure all elixir for many kinds of psychological problems in 18th century Europe, especially in the UK, VIPR oil had been commonly recommended for many afflictions, including the ones for which oil from the Rattlesnake Pit Viper, a type of viper native to America, was subsequently favoured to treat rheumatism.

Oh, maybe I should try and skin diseases. We to have both sides of snake oil. I would love it 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. It is also likely that much of the snake oil is sold by Western entrepreneurs, was illegitimate and did not contain ingredients derived from any kind of snake.

Snake oil in the United Kingdom and United States probably contain modified mineral oil.

Mm hmm. OK, and probably opium problem.

I think most of the girls also had maybe 20 percent opium, so they felt like you got fucked up and you stopped thinking about whatever your illness was.

When you're over on those drugs, I guess if you're on like an. Maybe if you're on like a showroom or something, do you ever look in the mirror and you look different? Does that ever happen to you? You know what?

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 to your face or something.

But at all it is never for me. I can only speak from my experiences. I'm never like, oh no, my face is bright red, right? I'm like, oh, this is so cool. I'm 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'm never thinking, oh fuck, there's a light.

Oh, interesting. At least for me, I'm in control enough that that's what's so neat about them. They're like having a dream. But you're aware that it's a dream.

OK, so you talk about hookworm. You said 30 percent of Southerners got it.

That was a full guess, by the way, 40 percent for even more. So I'm going to read a good chunk of stuff that I read about this. Can I just add while you're cueing this up? My grandma is from Kentucky and she all of my scenes come from her. I spent the summers with her and she was always smells like a polecat in here still. No, that means. Oh, it's raining and it's sunny. The devil's beating his wife and one of them was put on shoes.

You'll get hookworm. She was obsessed with hookworm. And as an adult, like, is there even such a thing as hookworms?

So then when I read in that book, I was like, oh, my God, she's obsessed with hookworm. 40 percent of people had it. Historical evidence shows the parasite ravage the American South throughout the early 20th century as a result of poor sanitation and a lack of public health programs among the poor. By 1985, the parasitologist Charles Styles, estimated that 40 percent or more of the southern population was infected with hookworms. As recently as the 1950s, hookworms were an intimate and ever present threat.

Grandma was fully formed at 1950.

In 1962, Charles Styles, a medical zoologist from New York, finally dragged the hookworm out of hiding. Styles had been tasked by the Department of Agriculture to help farmers keep their animals healthy. But he became fascinated with solving the riddle of the South. Stunted, exhausted workers, he began collecting samples and soon identified the tiny culprit behind the workers abilities. I'm so grateful for people who who are like, why is this happening? And then they look like most people are just going to be like, that's weird.

And then just keep going. Clinton agree more. So this is where I'm going to get in trouble. But here's where this is a little bit like my fear of like, you can't even make an observation. So so let's just say if we were alive in 1995, everyone be like Southerners are fucking lazy.

Yeah, that's what everyone thought. Yes. Yeah. And instead of going like, don't call Southerners lazy, that's wrong.

You know, the stereotype existed for some reason. And someone was like, why are they. Oh, there's an explanation. So it's a little bit tricky, just like, oh, don't stereotype, you know, sorry that I did in this specific case. So he must have said, OK, there's a stereotype. They're all lazy. Yeah, I know they're not genetically different than northerners, so there must be an explanation for this.

Yeah, I'm glad his conclusion wasn't, oh, northerners are just racist.

Let's call it racist against southerners. Right. That explains it. Right. He he dug more than that. That makes. Yeah. Yeah.

He must have seen with his own eyes these people being very lazy. Why he did it was the whole thing. He didn't understand why this is a story. He's working in agriculture and the workers can't work. I want to and take an absent shit everywhere. Like I wonder if you into the south. These are people holding hoes and stuff fields is snapping their heads down. Stiles was convinced that ridding the south of hookworms would make the region more productive, but local doctors would not listen, dismissing him as arrogant or pointing out that his expertise was in animals, not people.

He was an interesting guy, but testy and hard to like. He didn't suffer fools.

One of Rockefeller's gifts was he collected these people, people that everyone hated. 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.

Well, that's cool. Yeah, it was like a home for misfits that had great ideas.

OK, where does Stiles and his discovery, however, soon reach John D. Rockefeller, who is actively looking for a certain type of philanthropy project? Hookworms fit the bill. Rockefeller didn't want to put money into things that would bring the American capital system into question like income inequality. Health, on the other hand, is not controversial, so no one wants their kids growing up sick. Unlike in the north southern state, public health agencies almost completely lacked funds or personnel.

In nineteen, Rockefeller donated one million dollars to create the rock. Sanitary Commission for the Eradication of Hookworm Disease, appointing Wickliffe Rose, a professor of philosophy in Nashville, to run the organization, Rose began an anti hookworm propaganda campaign across the South and sent young doctors straight out of medical school to visit towns throughout the region, arriving on horseback with microscope in tow. The doctor said at makeshift clinics of the townspeople often treated, this is an event people showed up with potato salad and fried chicken to make a day of it.

That's a big stereotype. A positive one. A tasty one. Yeah. And some asked if they could be married in the hookworm tent. So romantic.

We went in The Hague and the doctors couldn't give the townspeople indoor plumbing and running water, but they could teach them how to construct what they called sanitary privies. And they couldn't buy everyone shoes, but they could tell people to be careful about where they walk.

So the other thing he was doing at the exact same time was he started all the first black colleges. He spent so much money trying to get black folks in the south educated.

Wow. Did he was he was. I just called you. Do you know me. Did Duder thing and I was like the ultimate philanthropist. Yeah I know. It's really cool. Yeah. For all of his evil capitalist ways.

OK, we'll see the first guy to have a billion dollars. Yes. He reached a billion dollars on September 29th, 1916.

And the way he did that really quick, is that the who was it? It was maybe Roosevelt who wanted to break all the trusts and he broke up the trust. But in doing so, he they broke Standard Oil into like six different companies. But he owned Jordi Sharov. 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, it was prohibitive.

But once it became accessible, it just when they broke up his trust, they they like quadrupled his wealth. Wow. Yeah, that's joke's on everyone. Was Teodora Roosevelt or not. Pretty cool.

Very cool. Dude, I want to everyone should read Titan. I was just about to say that I really want to read it now. It's great. Well, that's all for Raj, the most productive man on earth.

Yes. Congratulations Raj. That's all.

I love you. Love you. And I'm grateful for your unending patience in navigating our current scenario. I'm grateful to for years. All right.

Love you guys. Bye.