Ep 9: Leadership During COVID

Eric Schmidt
October 20, 2020
41
 MIN
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October 20, 2020
41
 MIN

Ep 9: Leadership During COVID

Drawing on his decades-long career in public health and finance, former World Bank President Dr. Jim Yong Kim shares his perspective on the leadership we need during COVID-19

What does leadership look like amid a pandemic? Drawing on his decades-long career in public health and finance, former World Bank President Dr. Jim Yong Kim shares his perspective on the leadership we need during COVID-19 and what earlier crises teach us about the steps to take when all hope seems lost.

Episode Transcript

Dr. Jim Yong Kim (00:05):

It's absolutely crazy that we have not invested literally hundreds of billions of dollars on shoring up the public health response. And I still don't know why Eric, is it because the country doesn't believe in public health. I don't understand why, but there's just a fundamental disconnect here, between understanding the root of the problem and then the actions that we've taken.

Eric (00:32):

The coronavirus pandemic is a global tragedy, but it's also an opportunity to rethink the world, to make it better faster for more people than ever before. I'm Eric Schmidt, former CEO of Google, and now co-founders Schmidt Futures. And this is re-imagined a podcast we're trailblazing leaders imagine how we can build back better.

Eric (01:08):

On one hand, COVID has cast a blinding light on the lack of global leadership that exists today. United States, which had been the captain of liberal world order since world war II has stepped back from the international stage while nearly every country on earth has been set back by the pandemic. On the other hand, COVID has shown us how individuals can act to make their world better. We've all heard the stories, chefs opening soup kitchens, doctors and nurses risking. And in some cases sacrificing their lives to treat patients. A hundred year old veteran who walked laps around his yard to raise millions for the British National Health Service.

Eric (01:47):

On this episode of Reimagine, we'll take a look at the future of global leadership at the international and individual scales. Leadership can take many forms and it can call for different actions at different times. But, no matter what it looks like, it's essential for prosperous and stable communities. How leaders across the globe at all levels of life, decide to act at this moment, could shape the next several decades of world history.

Eric (02:21):

Joining us now is former World Bank president, Dr. Jim Yong Kim. Dr. Kim is a physician and anthropologist, the former president of Dartmouth college and a recipient of a MacArthur Fellowship. He's also the co founder of Partners In Health, a path-breaking nonprofit that has delivered community focused health care to people in Haiti, Peru, and other developing nations around the globe. Establishing a model that has been replicated globally and helped improve the lives of hundreds of millions of people.

Eric (02:50):

During the coronavirus pandemic Partners In Health has worked in tandem with the State of Massachusetts to expand their contact tracing capability. Dr. Kim is a leader in the truest sense of the word. Thank you for inspiring a global movement in public health. And thank you for being with us today.

Dr. Jim Yong Kim (03:06):

Thank you, Eric. It's great to be with you and thank you for your leadership. You've been working in so many different areas. If I think back and all the different things that we've worked on together it's great that you're doing this and thank you for having me on the show.

Eric (03:20):

It seems to me, you served in the World Bank for seven years, did a global role. But because of your background in infectious disease, you must have had a very strong reaction when the pandemic started about what to do, what happened?

Dr. Jim Yong Kim (03:35):

Eric, when I heard about SARS, the SARS-CoV-2 in China, it immediately grabbed my attention because I had actually been working in the World Health Organization in 2003, right at the tail end of the first SARS outbreak. I had run the campaign of my good friend, JW Lee, and he won the election to be director general of the World Health Organization in 2003. And so I went over to Geneva to run his transition to taking over the organization. And my job because I had been trained in infectious disease, was to work with the SARS team.

Dr. Jim Yong Kim (04:10):

So I was there as it was sort of dying down. And I just remembered very clearly what it took for them to show the kind of leadership that brought that outbreak to a close very quickly. And so when I heard what it was happening in China, it immediately struck me, "Boy, this is different, there are people who are asymptomatic, who seemed to be transmitting the infection. This could be very big, very quickly." And so I started getting in touch with my friends. My friends who had run the SARS response in 2003, were back in charge now. And so I talked to them and they said, "This could be huge."

Dr. Jim Yong Kim (04:48):

And so I started talking to folks in the United States. I talked to Tony Fauci very early, Tony and I had worked on four different epidemic, pandemics, epidemics and pandemics before the outbreak of COVID-19. He confirmed to me that this could be really bad. And as we were watching, the thing that horrified me most was that we seem to be giving up on a really mounting of vigorous public health response.

Dr. Jim Yong Kim (05:16):

When president Trump said, "Well, the cases are at 153, and I want to hold them right there." That was extremely alarming to me. Even at that stage, we were seeing states that only had a few documented cases and the public health officials seem to be saying, "Well, we can't do the standard public health response. We can't do the testing and the contact tracing, the isolation, the quarantine. We can't do that. We don't have the resources, we don't have the testing." It was so striking to me because this is precisely what we were hearing in the early 2000s around HIV. In Africa, for example, we were hearing the sense of defeatism. There people were saying, "Well, there's so many people infected with HIV. There is just no way we can treat them in a place like Africa."

Dr. Jim Yong Kim (06:00):

And when I was at the World Health Organization, those were exactly the kind of arguments we were having to say, "No, we can't be so defeatist because there's 25 million people in Africa infected with HIV. We can't tell them that they're all just dead. That will destroy not only the social fabric, but it will destroy the economy of these places." And then as the pandemic was spreading to the United States, I just couldn't believe that public health officials, were falling back into the same sort of defeatism. You heard lots of things, "Oh, it's too late to do contact tracing." Well, there was community spread. It was going to be difficult to do contact tracing. But what we were saying is, Okay, then we need to start now so that we get ready for a time when the cases start going down, and then we can implement this full public health response.

Dr. Jim Yong Kim (06:51):

But the defeatism was just so broad. CDC was not providing leadership. The testing, which should have been exploding in terms of accessibility was growing very, very slowly. It was like I was watching a train wreck happening right in front of me. And I couldn't believe it.

Eric (07:09):

Do you think this is because people did not believe in science or that they were distracted by politics or they'd never seen it before and they weren't ready for something new. What's your analysis as a physician of the failure at that moment?

Dr. Jim Yong Kim (07:23):

Eric, was a bunch of things at the same time. So if we look at the countries, places, even regions that have been successful, Korea for example. The reason Korea was so successful in its response is because it had actually changed its laws. When MERS struck in 2015, there were only like 10 cases of MERS in all of Korea, but they handled it in a way that was just disastrous. There was no communication system. They didn't know where the people who had been infected were moving to. And so they changed the law and said that if this ever happens again, if we ever have an outbreak like this again, the laws will change and the government will then get access to not only your GPS on your phone, but they'll get access to your credit card records, where you've made a transaction. That fear around MERS prepared Korea.

Dr. Jim Yong Kim (08:11):

The fear from the original SARS outbreak had Hong Kong, China, Taiwan, many Asian countries were ready for it. So that's part of it. We weren't ready. And traditionally these kinds of epidemics had not affected Europe and the United States. They were sort of things that were happening in the developing world. And so there was a kind of incredulousness, kind of disbelief that this could ever overrun a place like the United States. But also I'm saying that the public health community didn't respond quickly enough.

Dr. Jim Yong Kim (08:42):

It's also true that we spend almost nothing on public health. Something like 2% of overall health expenditures are on public health, the other 98% is focused on curative care. So the whole system was not set up in a to be able to respond effectively. The biggest issue though, was the fragmentation. You cannot handle an outbreak like this, with multiple groups and even state by state. And within states, you'll see local board of health by local board of health. That kind of fragmentation is deadly in responding to outbreaks like this.

Eric (09:15):

What I hope will happen is after this disaster, there'll be more uniform standards. What was interesting to me was you found a governor in Charlie Baker, a Republican by the way, in Massachusetts. And they appear to have behaved the best at a governor level and at a state level. Is that true today?

Dr. Jim Yong Kim (09:34):

I've known Charlie for quite some time. He and I shared a chief of staff. Steve Kadish was a guy who was chief of staff for me and the chief of staff for Charlie. And so Steve got me on a phone with Charlie and I said, "Charlie, we can still go after this virus. The places that have been successful are the ones that have gotten aggressive and chased down the virus." Look at where outbreaks are happening, following clusters, doing the kind of testing tracing and isolation and quarantine. That's been the staple of a public health response. Going back to John Snow, in the original cholera outbreak in London, that started the feel of public health.

Dr. Jim Yong Kim (10:11):

John Snow, it's a great story because there was, these deaths coming from cholera and he kept tracing and tracing and tracing what these people who were dying of cholera had in common. And it turned out to be a single pump that was being used for drinking water. And his intervention was to take the handle off the pump and the case just stopped. And so that was more than a hundred years ago. It's just the classic thing that you always have to do in a pandemic. And literally no state in the United States was doing it as it should be done.

Eric (10:44):

You can see that pump in the Soho part of London today, it's on a little street corner as a testament to public health. What do you think will happen in the next few months in the United States. As it gets colder, people be more inside, on the other hand, many of the republican governors who resisted, seem to be more amenable to doing what public health professionals are recommending. What's your thought for the next three to six months?

Dr. Jim Yong Kim (11:10):

Well, I think there's been a lot of improvement in things like the ability to treat patients. I mean, just simple things that we didn't know at the beginning of the pandemic that we know now. Like for example, when people are having a real breathing difficulty, they found that putting them on their stomachs actually helps quite a bit. Just little things that have improved the outcomes in a hospital setting. I think people are more used to social distancing and the using of masks. But here's what I fear. I fear that with school starting up and I've been involved with many different school systems, everything from elementary and high schools and universities.

Dr. Jim Yong Kim (11:51):

I think that with the start of schools, you're going to see an impact that's delayed because, it takes time. First, the young people will be infected and then they have to go home and infect the older people. And then the older people can get sick over time. And this can take even a couple of months. We're not going to know the impact of opening the schools for at least a month or two. I think there's going to be an impact there. I think going indoors is going to make a big difference. We should have been having discussions about air filtration systems in buildings six months ago, because this is an issue. I mean, on airplanes because they have the so-called HEPA filters that can stop the spread of viruses.

Dr. Jim Yong Kim (12:27):

Airplanes are interestingly pretty safe and there've been very few infections on airplanes in the pandemic. But there are a lot of buildings that were built in a way to try to conserve energy. And so, this notion of sick buildings came up ans part of it was to try to recirculate the air in a way that reduced heating costs, but that in turn has caused viruses to spread very easily and buildings like that. So as we move back into buildings, I'm worried about cases going up.

Eric (12:57):

We should mention by the way that there's a standard called MERV. And one of the simplest things that you can do for your own building, is upgrade the filters. And often that's just a higher quality filter that costs a hundred dollars, that can actually save your life.

Dr. Jim Yong Kim (13:10):

Absolutely. Again, that conversation Eric is happening now, but it should have been happening six months ago. So I think in the United States, the best way to describe it, is I think that we all fell into kind of a collective magical thinking. And when I talk to business leaders and these are all friends of ours, they're at people that we've known for years. The sense of it was, "We'll have a vaccine soon enough and with better treatments and better vaccines, we'll get on top of it." But that's actually not the case. I mean, when you think about when there is a vaccine, which economies will be affected most quickly and most positively. Well, it's economies that are already doing much, much better. So for example, China's had very aggressive efforts and are among the dozen plus or so countries. They're trying to keep cases at zero.

Dr. Jim Yong Kim (14:00):

When the vaccine really kicks in and is available. What you'll see is that the few lagging sectors in China will come up to speed and there'll be running at a hundred percent. In places that have uncontrolled community spread, where we're not able to determine where people are getting infected, where we're not chasing clusters like the United States, It will take longer. The standard for approval by the FDA is 50% effectiveness. And as of today, only 50% of Americans say that they will definitely get the vaccine if it's available.

Dr. Jim Yong Kim (14:31):

So you're essentially going to get 0.5 times 0.5, which is 0.25% of the people will be immune, if in fact that 50% number is correct. And that's not enough for herd immunity. In a situation where there is a vaccine, you might see much more dangerous behavior, while in fact, the number of people who actually develop immunity will be relatively small. We also don't know how long these vaccines will protect. And so, the reality of the matter is we're going to have to be really thoughtful about the public health aspects of this disease for a very long time. And the ones who got it under control are the ones who will get back to almost complete normality very quickly, countries like the United States will be still battling this. Tony Fauci says at least until the end of 2021

Eric (15:22):

Probably longer, I think. A simple way of thinking of it, is that the magical thinking you're describing was fast to say, that it was more important to prioritize opening up business than keeping people healthy. But in fact, businesses can't operate, if people are afraid and they need to be healthy. And second that a vaccine would show up relatively early and once ubiquitously available, it would solve all known problems. Neither is true. Now, if you were the head of the World Bank today, and after seven years of service, you did a fantastic job. And the United States called you and said what you would do to help the United States. I think he would offer to the United States $10 billion to do a broad, rapid testing. And you'd say your country needs a rapid testing program to get the data in order to manage all the clusters and so forth. I know that's wishful thinking, but is that analysis correct? Is that in fact what you would do?

Dr. Jim Yong Kim (16:16):

I have to tell you, this is not fundamentally a financial crisis, it's a public health crisis. And we cannot get out of the financial crisis until we deal with a public health crisis. And that's been born out, I mean, Australia, right? So, Victoria state, it's under lockdown, but about the rest of the economy is doing okay, because they took the right approach, the aggressive public health approach. And in the United States, we did now worth three, four trillion in terms of fiscal stimulus and unprecedented monetary policy that is the overall, for example, the G7 countries.

Dr. Jim Yong Kim (16:51):

I just done on a session with the speakers of the G7 parliaments and the total that they've spent on financial support for people during the crisis is $6 trillion. And in the United States, there has been literally almost nothing to support public health systems.

Dr. Jim Yong Kim (17:07):

When Speaker Pelosi asked me to work with their group and some Partners In Health, did on putting together language for the next stimulus bill, which of course has been shelved, but we put in it $75 billion for what we call TTSI, Testing, Tracing and Supported Isolation. It would be among the largest amounts of money for public health in the history of this country, but actually a drop in the bucket compared to what's needed. And almost nothing compared to what has been spent so far on fiscal stimulus.

Dr. Jim Yong Kim (17:37):

And so it's absolutely crazy, that we have not invested literally hundreds of billions of dollars on shoring up the public health response. And I still don't know why, Eric is it because the country doesn't believe in public health. I don't understand why, but there's just a fundamental disconnect here, between understanding the root of the problem and then the actions that we've taken.

Eric (18:02):

My bias is, it's, just a thinking error. It's thinking that it's a trade off between economic growth, which we favor and public health, which we also favor and you have to solve both. What's interesting is your $75 billion is roughly 2% of the stimulus that's already gone in, which, is largely to get people through the pandemic rather than the 2% that you propose to end the pandemic. And this ignores the enormous human cost of a thousand deaths per day, which we seem to be ignoring because of our political system we're off on other important problems. The United States has roughly 5% of the population of the world and roughly 25% of the deaths. So this notion of American exceptionalism in terms of our ability to respond our political system, I think has been given at least a temporary death blow.

Dr. Jim Yong Kim (18:52):

We'll see. I mean, there's certainly some very, very brilliant very accomplished scientists, raise the notion of a herd immunity. And that may be what will happen is that the virus will quickly run through the population and we'll achieve herd immunity more quickly than you imagine. And therefore, people getting infected might not be such a bad thing. What I've kept saying is, look in the United States, it's not a matter of herd immunity, it's herd calling. And we know exactly who's going to be called, elderly, people in nursing homes, people with underlying conditions and unfortunately African American Latino, native American communities have been hugely disproportionately affected in terms of number of people who are sick. And the number of people who've died. The percentage of the population versus the percentage of overall deaths is just horrific in some places more than half the deaths are in the African American community. And they make up a very small percentage of your population in places like Wisconsin, you see numbers like this.

Dr. Jim Yong Kim (19:53):

200,000 deaths is not acceptable ever, but I think in this particular time, it's especially not acceptable when you see the differential mortality among poor people, among people of color and among those with underlying medical conditions, It's not fair. And because of that, it's even more important to put in place the public health response, as Speaker Pelosi's team put together this notion of a TTSI Testing, Tracing and Supported Isolation. What we found in Massachusetts, Eric is so interesting that it turns out that our contact tracing program, which also helps people, especially people who are living in crowded households without very many resources, by getting them into a situation where the positives can isolate with food, with diapers, with whatever they need in order to stay safe and to be able to survive, that it's been a sort of boon for social justice.

Dr. Jim Yong Kim (20:49):

The contact tracing program itself has equalized the ability to stay safe and to protect yourselves in family settings, from COVID. This is what we've been suggesting. We've been suggesting that the United should invest in a massive contact tracing program that can balance the scales a little bit and help those who have been shown to be disproportionately at risk for COVID to be able to survive the epidemic like everybody else.

Eric (21:15):

It's interesting that at one point in Massachusetts, 63% of the cases were in nursing homes. And that was known because of the contact casing program that you put in place. Now let's put your economist hat on, which is the way I actually know you as opposed to, as a doctor and an epidemiologist, infectious disease expert. You've just said that the countries that have been the roughest, if you will, in terms of contact tracing and containment will emerge the strongest. And you've also said that when a vaccine arrives, they are also favored. That would say, the victory, at least in the short term goes to those cultures because there'll be able to emerge stronger. Is that correct? Furthermore, what happens to Latin America? We don't focus very much for some reason in the United States about Latin America, but there is a horrific pandemic going on right now. The countries of Latin America are closed, a lot of suffering, a great deal of people who live very close to each other, relatively poor health systems and an awful lot of deaths. What happens to the various parts of the world and in what order in the next year.

Dr. Jim Yong Kim (22:20):

Let's start with Asia. So it's sort of the Western Pacific region, because again, New Zealand and Australia have done extremely well in responding to the virus. And again, I think New Zealand and Australia were much more aware of SARS. The first SARS in 2002 and 2003, then than most sort of westernized countries. So, they continue to do very, very well. We've seen in Hong Kong, moving back and forth out of lockdown. And each time they moved back and forth, they learned something. For example, in Hong Kong when the restaurants opened, you had to have masks everywhere, but once you got into a restaurant, you could take it off and have your dinner, but they weren't separating the tables so that there were six feet of space. And there were some infections happening in the restaurants. There were also exemptions that they had given for mariners and people who are working in the airlines about testing and quarantine, they're getting rid of those.

Dr. Jim Yong Kim (23:15):

Every time they go in and out, they learn something, they get better with it. Now, if you look at Europe, Germany has done very well. And Germany has done very well, very few deaths because they've protected their elderly much, much better than other Western countries. Chancellor Merkel, who I know that you know well, and I've worked very closely with her when I was at the bank. She's a physical chemist and she really looks at the data. And she's the only head of state that I know, that constantly talks about, R0, the reproduction number. She's always talking about, they're watching it carefully. They're not going to zero, but they're trying to keep the R0 right at around one. And they're doing it with a very aggressive testing and contact tracing program.

Eric (23:58):

We should mention that, R0 refers to the number of people that the average case infects. So an R1 means that you get it and then you infect, no more than one person.

Dr. Jim Yong Kim (24:09):

Right. And if it's above one, the epidemic grows. If it's below one, the epidemic shrinks. They've done very, very well. Generally speaking though, Europe has done pretty well. I mean, my good friend and now head of the IMF, Kristalina Georgieva, I talked to Kristalina when she was back home in Bulgaria visiting. And Kristalina told me that she thought, that what happened in Northern Italy really shocked the Europeans and that very much like the impact of SARS in Asia, the horror of what was going on in Northern Italy, really woke everybody up. In Europe, they sort of started thinking of themselves as a single entity and move forward. I think Europe will end up doing okay. And I think across the board, the vaccine will have much quicker, much stronger impacts in Europe than it will in the United States and Latin America.

Dr. Jim Yong Kim (25:01):

Latin America, I'm just extremely worried about. I mean, I've spent years working in Peru and early on in the pandemic. The president of Peru called me saying, "We can't get the tests. Can you help us get more tests?" We some phone calls and tried to help him. But it's been very disappointing to see the response. And in Brazil there's been just outright denial, but again the heads of the states in Brazil have then stepped up and done fairly well.

Dr. Jim Yong Kim (25:29):

In Mexico again, Amlo has said, "We're not going to test." which was crazy. And then again the governors of the states of Mexico had to step up and some of our are doing well. But what we know, as these fragmented responses in the end are going to always lead to much greater difficulty.

Eric (25:47):

As our listeners know, you spent seven years running the World Bank. One of my favorite institutions, my father had been appointed as one of the governors of it. So, I know it well and think it very important in the world. And the World Bank gives financing for important developmental projects. When you were in the World Bank, you began a program, one of the first of its kind to do things around health and medicine in the World Bank. What were you successful with in the World Bank? And what were you frustrated by?

Dr. Jim Yong Kim (26:16):

In the early days of the AIDS pandemic, we desperately wanted the World Bank to take a stronger role. But it did not until later. When I got into the World Bank, I realized, why. That, so much of what the world bank does has to be requested by the countries. So if they're not asking for money for health and education, it's very difficult for us to force it upon them. Because, they have to actually pay the loans back.

Eric (26:42):

Oh, I see. Because, you're loaning them money. You're not actually giving them the money. You're a bank.

Dr. Jim Yong Kim (26:46):

There're some grants, like Haiti after the earthquake was given a lot of grant funding and some of the poorest countries are given grant funding. But even the lowest interest loans, I mean, the lowest interest loans are great. They're over 40 years and you can pay back over 40 years and they have basically 0% interest. So that's great, but still you have to pay it back. And if you don't pay it back, you can get in trouble in terms of accessing the capital markets for anything. What we tried to do is when they asked for loans for health and education, of course, we said, yes and we provided technical support. But what I focused on, was how do we make the case that investing in health and education is the most important thing you can do for economic growth? And so I asked our teams, what's the evidence for improvements in health and education's impact on economic growth?

Dr. Jim Yong Kim (27:38):

So we looked at just four indicators. The first was infant mortality. The second was under five mortality. The third was adult mortality. And the fourth was something that we invented called learning-adjusted years of education. Learning-adjusted years of education meant that we've done so much more testing in the schools, even in Africa over the last 15 or 20 years, that we can tell you whether a year of schooling in Malawi is worth the same as a year of schooling in Singapore. And it's not, it's worth less than half in terms of the testing outcomes.

Dr. Jim Yong Kim (28:13):

And so we can give you a number in terms of your effective learning-adjusted years of education. So Singapore and South Korea, something like 11.5, in terms of your basic education. Malawi is something like five years. So even though they may have gone to school for 12 years effectively, they've gotten five years of education. So if you put those four indices together, they are more highly correlated with economic outcomes than anything else we've measured. So we started-

Eric (28:45):

Even better than building roads and school. All the traditional things that infrastructure that were bank product. So education and people turn out to be even more important economic growth?

Dr. Jim Yong Kim (28:56):

Yes.

Eric (28:56):

Wow.

Dr. Jim Yong Kim (28:57):

Right. So, you looking back over 25 years, the numbers are very dramatic. I wanted to find a name for it that would make sense to minister of finance. Eric, I spent my most of my career prior to the World Bank dealing with ministries of health. And we'd always fantasized about getting access to ministers of finance who make all the decisions about budgets. For seven years, I spent most of my time with ministers of finance, as an anthropologist so we've got to understand what makes them tick, how they make their decisions. And so we started something called the Human Capital Project. And with the doing business index, that was always my busiest week of the year. That after the doing, business rankings came out and the doing business rankings are so controversial. The bank is looking into these things now, but it's the one thing where we actually ranked countries and the heads of state hate it when they're ranked lower than countries they feel superior to.

Dr. Jim Yong Kim (29:53):

So we thought let's put together a ranking of human capital investments. Let's put together a ranking that shows where these countries sit compared to all the others. Because we had such strong data linking investments in health and education to economic growth. We could project forward and say, "These are the countries that we think have the best possibility for growing economically based on their health and education indicators." And so, I did what you have to do at a place like the World Bank. I told everybody a year ahead of time that we were going to publish this index and gave everyone time to complain and to yell at the refs, which they always do. If have input on the methodology, but then in 2018, we released their report and I thought, it's the same thing I'm going to get, yelled and screamed at. But it wasn't. It was so interesting.

Dr. Jim Yong Kim (30:43):

The finance ministers really took it seriously. Nigeria, which came out ranked... We only could do a 157 countries, Nigeria ranked like 150 first out of 157. And because it's an oil producing country. It's the largest in Africa. I thought I was going to get yelled at by the government officials, but something very remarkable happened. The vice president... We give all the countries warning about when they're coming out. And when they got this, the vice president called all the ministers together and said, "This is a wake up call for us. We need to do something. We need to do something about these numbers. You know, that they reflect something very real." And so Nigeria became very aggressive and are now really trying to rethink where they sit in those numbers.

Dr. Jim Yong Kim (31:29):

Indonesia, which wasn't horrible, but partly because the minister of finance there was my deputy for five years. They took on a really aggressive program because their levels of childhood stunting, children who are two standard deviations below height and weight for age. The childhood stunting numbers were really high in Indonesia. And more than 30% of children were stunted. And they knew that this was serious. So that now they've got one of the best and most aggressive anti-child stunting programs in the world.

Dr. Jim Yong Kim (32:03):

So, you have to understand how these places work. I couldn't force them to take the loans, but what I could do, is to show them where they stood compared to others, and then tell them very directly that this has huge implications for your ability to grow in the future.

Eric (32:19):

My final question, where do you think global leadership will come from in the next few years? Do you think it will come from the Pacific Rim? Do you think it will come from newly elected democratic leaders that we haven't met yet?

Dr. Jim Yong Kim (32:34):

Eric, I think in many ways, embody this as much anyone I know. I think you have to at least be respectful of science and technology. You don't have to be an expert on it, but if you're not respectful of it and listen to experts, I think it's going to be hard to be a great leader. I think also the rise of nativism goes directly against what I think is the most important thing about leadership, is that people start trying to take responsibility for not just their own country, but for how the world works.

Dr. Jim Yong Kim (33:07):

And I know that that China is strongly criticized in so many parts of the world, especially the West, but I work very closely with them on many major projects. And I think that China is emerging as a leader. And despite all the criticism, I think the Western countries are going to have to find a way to deal with China's leadership.

Dr. Jim Yong Kim (33:29):

So much of African infrastructure was built by China and they were built on the basis of loans, but those loans could not have been independently received by those African governments on the open market. China did play an important role and any African leader in a quiet moment will tell you that China's role has been important. Indebtedness, those are real issues, but China is trying to step up to be a leader. And there's such a huge footprint in the global economy that we've got to learn how to deal with China's leadership. Maybe it's just hopeful thinking, but I think the sort of nativist inward looking xenophobic kind of leadership, I think that that kind of leadership will simply have to take a back seat. I think with climate change and with infectious threats like COVID-19 that we've seen, respect for science, respect for technology, the understanding that the world is connected in ways that no matter how much you say you're going to build barriers, it's impossible to do.

Dr. Jim Yong Kim (34:34):

There will be the recognition over time that you need multilateral institutions. I mean, if you want to recreate them, if you want to redo them, if you want to tear them down and build them again, go ahead. The fundamental multilateral reality of the way the world works, is not something that can just be ignored.

Eric (34:52):

Dr. Kim has been one of the great leaders in public health in my view for the last 30 years. Thank you so much for everything that you've done for us.

Dr. Jim Yong Kim (35:01):

Thank you, Eric. Thanks for having me.

Eric (35:06):

So where are we now in a lot of ways the world feels rudderless. And one of my biggest concerns is the 21st century will only bring more difficulties with challenges like climate change, demographic shifts and rapid technological development. A decrease in America's role globally has been going on for decades. The role, post World War II, where 80% of the GDP of the world was American, after the war, naturally had to fall off.

Eric (35:37):

Americans now do not see themselves playing a global role in most places. And when the pandemic hit, America was not prepared. We could have, but chose not to. Decided to become the global leaders for democratic response, throwing off the contact tracing that was so invasive in the Asian countries. What we could have done, is we could have gotten our act together with our allies in the West and figured out precisely what Germany has done, where all of a sudden the death rates are quite low, adherence policies is quite high, masks work and the funding for public health was needed, happened.

Eric (36:16):

Because we didn't do that. We missed an opportunity for American global leadership among democracies, but the impact of that is much greater, because not only will the Asian countries emerge quicker out of the pandemic, but we will be struggling with the economic and healthcare costs of the pandemic for at least another year. We know what we need to do in the United States. We're just not doing it. We need to get R0, which is the rate of transmission of the disease from people to people well below one, and we need to stick it there.

Eric (36:45):

Once it's there, it will be possible to have economic activity come back quite quickly. Because we've not focused on broad tracing and broad testing. And because we've chosen instead to wait for a vaccine, which will take an uncertain and importantly long time from now, we're going to suffer at least for another six months, which from my perspective is unacceptable.

Eric (37:07):

We will need leadership at all levels of life. People who could bring communities together, make tough decisions and see opportunities where others don't. Somehow great leaders in a company or in a country managed to know everything that's going on. They're under lots of pressure and yet they make the right decisions, as judged by the outcomes that they care about or history. So when I look at leadership, I always start by saying, do they really understand what's going on? Do they have the cognitive capacity to really read the briefing materials and understand the implications of the decisions that are being proposed? Also, do they make decisions in a more collaborative way? Do they actually listen to their advisors? Do they sit in meetings where they actually debate outcomes, trying to find the best outcome, not necessarily the consensus outcome. The leader who thinks that he or she is the only decider, is ultimately one who will not get the optimal outcome.

Eric (38:04):

The only leaders I can imagine are ones in the future that will be successful, will be ones that can both deal with the extraordinary pressures, which are true by the way in autocracies as well as in democracies and the speed with which the issues come at them. So in our personal philanthropy, we decided to focus on leadership broadly defined. And the idea is instead of focusing on the current leaders, focus on the next generation or the next, next generation. There's lots of evidence that leadership skills break out early, perhaps in high school. So maybe by funding program called RISE, where we identify the top talents around the world at 16, 17, get them educated and give them the confidence to eventually become the great leaders of the world. We'll see if that works, but that's our goal.

Eric (38:47):

While many leaders have shown remarkable ineptitude in response to the pandemic, Dr. Kim is a testament to the enormous impact individuals can have through hard work, perseverance and strong leadership. Great leaders need a certain amount of humility and a certain amount of courage. The humility involves understanding that they don't know everything, that they depend on others. And that luck is part of the plan.

Eric (39:12):

Courage is the ability to see an outcome and push for it and see the outcome that makes things better and not listen to all the people chattering, preventing you from making progress. The easiest thing to say to a leader is, no, in a bureaucracy often says no, simply because it doesn't want to work harder, or it doesn't want to take on a new challenge. The duty of our leaders is to take on the bureaucracies that have benefited us by the way, and reform them and reform them against the challenges ahead. In this period. Great leaders will solve this problem and they'll get the credit for it from their citizens. Next week, we're reimagining work, organizational psychologist, Adam Grant, and former TaskRabbit CEO, Stacy Brown-Pilpot.

Speaker 3 (40:02):

There's another layer of this, which is potentially interesting, which is to say we could compare strong ties and weak ties professionally. So strong ties are the people that you work with closely, that you have a lot of trust with. And on average communication with those strong ties is up about 40% during the pandemic, right? We know that it's important to stay in touch with those people and to coordinate and collaborate, but our weak ties, there's more distance acquaintances. We're communicating about 10% less with them than we were before. And that's a problem because weak ties actually give us more new ideas than strong ties deal, right? You're strong ties, there's people you know really well tend to have redundant knowledge. Whereas, the weak ties are meeting different people. They're learning different things. And I think we also need structures in place to bring people from outside the team into to generate some fresh ideas.