When Rajiv Shah, M.D., joined The Bill & Melinda Gates Foundation in 2001, the then-fledgling organization was trying to do something many experts thought was impossible. Its founders had committed $750 million to ensure that all children in the world’s poorest countries were immunized against vaccine-preventable diseases. But no one knew exactly how, or even whether, that could be done. 

“We weren’t afraid to be seen as naïve by asking simple questions about how the global vaccine system worked (or rather, didn’t work),” says Shah, who is now president of The Rockefeller Foundation, one of the world’s leading philanthropic organizations supporting scientific research. “And when we were given an unsatisfactory answer, we did the work ourselves to come up with a better one.”

The audacity of the effort – which ultimately led to the immunization of more than one billion children worldwide – stuck with Shah, forming the bedrock of what he calls his “big-bet mindset.” Honed through two decades of work in government and philanthropy, it’s a conviction that even the world’s thorniest problems can be solved through bold ambition and action. 

Shah will describe that philosophy in a talk at 6 p.m. on Jan. 31 in Duke’s Karsh Alumni & Visitors Center. The event, formally the Victor J. Dzau Distinguished Lecture in Global Health, is hosted by the Duke Global Health Institute and is free to the public, but registration is strongly advised. A reception will precede the talk at 5 p.m.

Shah says he hopes his talk will inspire optimism that progress is possible, even in the face of dire predictions about the health and environmental impacts of climate change. 

“Many people these days have a cynical outlook on our planet’s future, and I completely understand why,” he says. “But I have also seen that people—like those at Duke and elsewhere—can make big change."

In his talk, Shah will draw on the successes and occasional failures of teams he’s worked with over his career, which includes appointments in the U.S. Department of Agriculture and as administrator of the U.S. Agency for International Development (USAID). He’ll draw on stories from his new book, Big Bets: How Large-Scale Change Really Happens, which he describes as a playbook  for taking on complex global challenges. 

He'll also offer advice about avoiding the “aspiration trap,” the sense of helplessness that can come when contemplating the enormity of problems such as climate change. 

“Often, that feeling discourages us enough that we lower our ambitions or convince ourselves that we cannot make a real difference. So instead of chasing big goals and trying to fundamentally solve problems, we lower our sights, trying to just incrementally improve a situation,” he says. “Those efforts may still help a lot of people, but they rarely create the long-lasting, transformative change we need today.”

During his visit to Duke, Shah will be joined by Adam Silver ’84, commissioner of the National Basketball Association and vice chair of the Duke Board of Trustees. As a trustee for The Rockefeller Foundation, Silver was instrumental in helping the foundation accelerate national COVID-19 testing during the early days of the pandemic, Shah says. 

“Adam’s commitment to giving back is inspirational, as is his dedication to fostering innovation and forging global connections, which we all must do to be successful and make a meaningful difference in the world.,” Shah says.