Perspectives

First days are always daunting, but for Susan DesmondHellmann her first day as Chief Executive Officer of the Bill & Melinda Gates Foundation (BMGF) will be more nervewracking than most. As of May 1 she will be answerable to the richest man in the world for delivering on the foundation’s US$3 billion plus annual outlay on research into everything from better seeds to malaria eradication. Is she feeling the pressure? “There are a lot of people who are looking to the foundation, and in the world of philanthropy there’s a lot of visibility to the Bill & Melinda Gates Foundation, so I certainly feel accountable and responsible for doing a good job.” But, she asserts, “I’m up for it”. With a track record that ranges from clinical research, global health, and the sharp end of commercial drug development, she seems to be made for it. The beneficiary of what she describes as “one of those classic, 1960s middle-class American childhoods” in Reno, Nevada, Desmond-Hellmann was convinced she’d be an orthopaedic surgeon until her first encounter with cancer patients during her third year as an undergraduate medical trainee, and after graduating in medicine from the University of Nevada she moved to the University of California, San Francisco (UCSF) to specialise in oncology. It was there that she met her future husband Nicholas Hellmann, an infectious disease specialist. Shortly after their marriage in 1987, UCSF got funding to loan the couple to Makerere University in Kampala to study Kaposi‘s sarcoma and HIV transmission. They arrived in Uganda in 1989, after decades of political turmoil had left their mark on the country. “It sounds trite, but for us, it was just stunning to see the difficulty that our colleagues in Uganda experienced”, she says. “I just never took the opportunities that I’d had for granted in the same way ever again.” The couple returned to UCSF in 1991, but the lack of opportunities in translational science at the time persuaded them to move on. A brief stint in private practice underlined how important clinical research had become to them, and after Nicholas was offered the chance to work on early antiAIDS therapies at Bristol-Myers Squibb in Connecticut, Desmond-Hellmann followed him there, working with the team developing paclitaxel (Taxol). “It was very much serendipity that I ended up there, but I was so excited about the work I got to do, and felt I had an affinity for it”, she says. Soon after joining the Taxol team, Desmond-Hellmann was leading it; the kind of progress that was bound to catch the eye of Genentech’s then Head of Research and Development Arthur Levinson. What happened next is part of pharmaceutical folklore, as Desmond-Hellmann helped to mastermind one of the most profitable drug-development pipelines in history, including the approval of two of the first targeted cancer therapies, for Genentech. By 2009, www.thelancet.com Vol 383 April 26, 2014

when Roche completed its takeover of Genentech, she was considering taking early retirement when a new challenge presented itself. “The Chancellor at UCSF announced he was stepping down, and I was approached”, she recalls. “It wasn’t something I had on my to-do list, but I thought it was an interesting opportunity to do something very different.” How different would soon become readily apparent. “I joined as Chancellor in the early days of a major recession in the US that hit California and public institutes like UCSF particularly hard. It’s impossible to overstate what a challenging time it was”, she says. The move from a private company to a large public institute with its own internal politics also took some getting used to. “Most of the faculty are basically on soft money, and they’re driving their programmes in a very challenging environment. That complexity, the fact that people were engaged in their own agenda, that was a big transition that was both humbling and important in my own learning”, she says. Tellingly, none of those challenges prevented DesmondHellmann from embarking on a programme of structural reforms to cut administrative inefficiency and forge closer links with private industry, something that still stirs up controversy. “There definitely were concerns, and there remain concerns in academia, about conflicts of interest, privatisation. I think what helped most was that I was clear in my actions that I did and do value that UCSF is a public institution, and I think my actions spoke and speak for themselves”, she says. But Desmond-Hellmann is robust in her defence of the importance of public–private partnerships for driving innovations that ultimately benefit society. “UCSF is not going to sell products, devices, or drugs, so if we want great breakthroughs to reach society it will be through industry”, she argues. “I believe strongly that the wonderful discoveries of UCSF’s faculty should reach society, and public– private partnerships are enabling of that.” Forging similar partnerships with industry will continue to be an important part of the BMGF’s goal of delivering technologies to improve the lives of the world’s most disadvantaged; a mission that was central to DesmondHellmann’s decision to join the foundation. “At Genentech we had an aspiration to change how cancer patients were treated, at UCSF we believe that through our training and clinical care and research we would literally change the world, and at the Bill & Melinda Gates Foundation they’re trying to leverage their assets to make a better world”, she says. “As a leader, I need to look at how I can put my energy into making sure all that passion and all that talent and good intentions and resources has an impact.”

Susan Merrell/UCSF

Profile Susan Desmond-Hellmann: taking charge at the Gates Foundation

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Susan Desmond-Hellmann: taking charge at the Gates Foundation.

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