Leap Academy with Ilana Golan
Dr. Rajiv Shah: Working with Bill Gates, Barack Obama, and More to Tackle Global Crises
Tue, 11 Mar 2025
At just 36 years old, Rajiv Shah got a call from Hillary Clinton. Days later, he was running USAID. Less than a week into the job, a massive earthquake leveled Haiti. He had no time to prepare. He had to act. That was one of many high-stakes bets in his career. From launching a $5 billion vaccine program with the Gates Foundation to fighting Ebola and leading global humanitarian efforts, he has tackled some of the world’s biggest challenges and won. In this episode, Rajiv joins Ilana to share how he makes big bets, leads through crisis, and asks the right questions to solve impossible challenges. Dr. Rajiv Shah is a physician, economist, global development leader, author, and President of the Rockefeller Foundation. Known for achieving the impossible to drive global change, he led U.S. responses to crises like the Haiti earthquake and Ebola outbreak as USAID Administrator.. In this episode, Ilana and Rajiv will discuss: (00:00) Introduction (01:55) From Immigrant Kid to Global Leader (04:02) A Life-Changing Service Trip to India (07:00) Leaving Medical School for Politics (11:22) Joining the Gates Foundation (13:10) A 'Big Bet' That Saved 20 Million Lives (15:00) How Strategic Questions Unlock Big Solutions (19:31) Leading USAID Through Haiti’s Earthquake (26:38) Earning Obama and Biden’s Trust in a Crisis (30:22) Fighting the Ebola Outbreak with Military Support (33:22) Tackling Energy Poverty at the Rockefeller Foundation (38:54) Why Real Change Requires Big Risks (44:38) How Great Leaders Balance Change and Stability (47:08) The Power of Connection and Shared Values Dr. Rajiv Shah is a physician, economist, global development leader, author, and President of the Rockefeller Foundation. Known for achieving the impossible to drive global change, he led U.S. responses to crises like the Haiti earthquake and Ebola outbreak as USAID Administrator. Previously, at the Gates Foundation, he helped expand childhood vaccinations and led health and agriculture initiatives. His book, Big Bets, explores bold solutions to the world’s toughest challenges. Connect with Rajiv: Rajiv’s Website: rockefellerfoundation.org/ Rajiv’s LinkedIn: linkedin.com/in/drrajivjshah/ Resources Mentioned: Rajiv’s Book, Big Bets: How Large-Scale Change Really Happens: https://www.amazon.com/Big-Bets-Large-Scale-Change-Happens/dp/1668004380 Leap Academy: Ready to make the LEAP in your career? There is a NEW way for professionals to Advance Their Careers & Make 5-6 figures of EXTRA INCOME in Record Time. Check out our free training today at leapacademy.com/training
Chapter 1: How did Rajiv Shah become a global leader?
My grandfather actually emptied his retirement account to buy a one-way ticket for my dad to come to America because they had so much faith back then that this was the country where if you worked hard and played by the rules, the sky was the limit for you and more importantly, your children. That's my story.
I grew up in a tight-knit immigrant community outside of Detroit, primarily a few years in Philadelphia, outside of Philly. And my dad worked at Ford for 34 years. And so I'm a child of the auto industry. I always thought I'd grow up and get to design cars for a living, and it didn't quite work out that way.
And I think you mentioned that in 1995, you had some summer experience that shaped you a little bit. Will you share that?
Actually, even earlier than that, as a kid, I was told by my family, my community, that I should be an engineer or a doctor. I kind of found both interesting. But over time, I got more and more interested in policy and service. I was, I think, a junior in high school watching on a day off an extraordinary visit when Nelson Mandela came to Detroit.
We never got in Detroit visitors like Nelson Mandela. That was for LA and New York and stuff like that, DC. I was just glued to the TV as he went to the Ford auto plant and talked to workers and then closed out his day at my favorite baseball stadium in America, Tiger Stadium, the old Tiger Stadium, to a packed crowd, talked about concepts like love and honor and values and service.
And I was blown away by the moment and by the experience, even though I was just sitting in my living room the whole time. And I decided I wanted to get an opportunity to do service work abroad. So you fast forward a little bit. I went to college. And as my
college tenure was ending, I had an opportunity to go do some service work in rural South India in a rainforest area with a tribal community called the Soliga. It was a development and health program created by a gentleman named Dr. Sudarshan, who went on appropriately to win the Right Livelihood Award for his just selfless service. But he was a doctor. He'd gone into the bush and
He had established a program that was effectively about treating kids and people with leprosy and epilepsy and tuberculosis. But because he was so overwhelmed by the hunger and starvation he saw in the children in those communities, he started a feeding program. He started a livelihoods program. And he just dedicated his life to helping this community thrive. survive and then rise.
Well, he was at the time in his 40s. I was just a college grad. I was like 20, 21 or 22. And I kind of went there with this idealistic view that I wanted to be like him. And I got there and I took this long trip from Ann Arbor, Michigan to a place called the B.R. Hill's in Southern India. I had a backpack and mosquito repellent and all that stuff.
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Chapter 2: What inspired Rajiv Shah's career shift from medicine to politics?
And they put me in this little hut in the back and I unpacked. And that first night I was just eaten by mosquitoes. I was super hungry, very tired. And I realized quickly that I didn't have what it took to be basically a saint. I mean, this was a gentleman who said, I'm going to give it all up. and dedicate my life to helping each child that walks through the door.
In fact, I'm going to go out into the villages and find those kids. And I knew that I couldn't do that. I couldn't give that much of myself, but I also knew I wanted to spend my life working on these types of issues. And back then in the mid nineties, 14% of the global population was hungry. 11 and a half million kids under the age of five would die of very simple preventable diseases.
And I just started learning about those issues and saying, how can I be involved in working on them in one form or another?
Incredible. And as a young person seeing these things, I'm trying to figure out like it can actually traumatize you or it can fuel you. Why do you think it actually fueled you versus traumatize you and want to like run away and never look back, right? Like, why do you think is the change?
Well, I think it fueled me because I saw people making a difference. I saw other medical students from a local Indian medical school working with Dr. Sudarshan to change the trajectory of these kids' lives.
I saw kids who were deeply malnourished, who were four, five, six, seven years old, and I saw them get resuscitated because they'd come into a feeding program and get targeted feeding support and some medical attention. And I understood even then, if it weren't for these folks, nobody else was going to provide that care and those services.
I met this young girl, maybe five or six, that very first night I was there, I decided I'd go for a walk in the outskirts of the village. And I ran into this girl who just stared at me and she's barefoot and hungry and looked impoverished, but also full of life and big eyes. And she just stared at me like I must've been so strange to look at with my backpack and my mosquito spray and all that.
And she ran away as she should have. And I just thought, you know, if you get to be involved in expressing that humanity, you actually get a lot more back than you give. You get a sense of humanity. and you feel better off for it. I was hooked from that first moment, but I didn't quite know how to find my path.
That's incredible, right? You did start in medicine school and you decided at some point to leave medicine school. Talk to me a little bit about that. And I'm sure we share parents that for me was also, you're either a lawyer or you're a doctor. You cannot choose anything else.
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Chapter 3: How did Rajiv Shah contribute to the Gates Foundation's vaccination efforts?
And one morning we had BlackBerrys back then, my BlackBerry rang. So I picked it up. And on the other line, it was like, hi, Raj, this is Hillary Clinton. And I said, oh, hi, how are you? Not a phone call I usually get. And she said, you know, I was talking to the president and he and I would like you to run USAID, which...
Obviously, he's been in the news now a lot, but a passionate collection of 10,000 amazing human beings and civil servants and foreign service workers with the sole mission of really making our country safer and stronger by projecting the best of our values, often into very difficult circumstances and communities and often at great personal risk.
And my first week on the job, I was very, very fresh. You mentioned I was 36. I was new to that agency. I had just finished touring our emergency operations center when I got a note from my front office that said, Raj, the president would like to speak to you, which also hadn't happened at that point.
And it was because there was a massive earthquake, 8.0, in Haiti that had led to 21 of 22 ministries collapsing. It had led to loss of communications and visuals on what was going on. Ultimately, 250,000 people would have perished in what was the largest humanitarian catastrophe we had ever experienced to that moment.
And the president asked me to lead a global and whole-of-government civilian military response. And that was my, I think, sixth day on the job. So it was pretty intense. But it was also a chance to see America's values in practice being applied at a moment of real need to a neighbor that's two hours from our shores.
Incredible. And Raj, I want to go there for a second. But before that, what do you think in your reputation caused you to get a phone call from Hillary and then the president? How did you create such a reputation for yourself at such an early age to be known for that?
I've listened to some of your other guess, also say something very similar, which is, look, a lot of this is luck. And in that moment, I consider myself just lucky. I think, practically speaking, there are lots of great candidates for a role like that. A lot of people wanted that role, and any of us could have been highly qualified to get it. So a lot of it in that setting was luck.
I think part of it was we knew, again, interesting given current events, but we knew that for America to have a strong development and humanitarian enterprise, we'd have to take a tough, hard look at reforming USAID and making the enterprise much more results oriented, much more accountable and much more efficient. And I think I had built a reputation for being
very quantitative, very results-oriented, and very businesslike practices I learned from Bill Gates and others in pursuit of this mission. This is not about just doing good. This is about the strategic application of American power in a hyper-efficient, results-oriented manner. And no one ever gets all the way there, but we made huge strides against that. And I think that reputation helped also.
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Chapter 4: How did Rajiv Shah handle the Haiti earthquake crisis as USAID Administrator?
I mean, literally the only people who didn't were named Rockefeller because obviously your parents were already doing so well off. Today, it's less than 50%. Actually, over the last 30 years, it's probably less than 50%. So the reality is a lot has changed and it just creates a lot of turbulence, a lot of change.
Most of the last elections since 2000 have been change elections, one form or another. And that is a signal that there's a lot of uncertainty and lack of confidence in too many communities across this country. So I tell my teams, we have to stay focused on our mission.
We're trying to end energy poverty around the world by giving every single family a chance to live in a community where the cost of energy is low, where energy is abundant, where businesses can grow and where they can participate in digital economy.
There's still 800 million to a billion people who live literally without any electricity, no light bulbs, no power tools, and no real upward mobility through the job market if there's no energy deployed. And so we do a lot of that type of work all over the planet.
And we have a plan and an infrastructure and a set of partners where we're really operating at scale to reach people with what we think of as the core driver of human dignity and opportunity. In the United States, we observe that
chronic disease is out of control, and that if we treat food as medicine in a more structured, science-based way, we can largely reduce the prevalence of prediabetes and diabetes in the US population, something that costs us more than $300 billion a year.
And there are more amputations performed every year in the United States as a result of diabetes than in all of the wars in Iraq and Afghanistan put together over the last two decades. We have some scientific and innovation-oriented ideas that we're investing in and getting behind and building partnerships in order to deliver results for people at home and around the world.
In our family, we have this thing of going every year to a place to give perspective to the kids. Otherwise, they grow up with a Silicon Valley. I have everything I need. So we've definitely seen it in Ethiopia. We've seen people without any electricity, no toilets or anything in Myanmar. So we've definitely seen some of this. And I absolutely love that.
But again, for you trying to lead something like this, like sometimes there's cash issues. Yeah. Share a little bit, one maybe challenge that you feel like you needed to go through that shaped you to the leader that you are today, Raj.
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Chapter 5: What leadership lessons did Rajiv Shah learn from major global crises?
Part of how we maintain an appetite for risk and a capacity to work that way, I think, is just being really true to our core DNA. That's the founding construct of this institution was not to be a charity that's all things to all people and not to try to meet every immediate need.
but rather to find those areas where science and innovation make problem solving at scale possible in a way that lifts humanity. I mean, this was a place, in addition to helping basically create the modern field of international science-based public health,
It was the Rockefeller Foundation well before I got here that invented dwarf wheat varieties and yielded a green revolution that moved 800 million people off the brink of hunger and starvation and earned the Nobel Peace Prize for that effort. So I think part of it is studying your past and saying, how do we have ambition to do things at that scale?
And if that's your North Star, it's hard to live up to, but you get to at least try in every successive generation.
As a leader, and I know we have a lot of people jumping into C-suite, etc. Maybe a little tip of you jump into C-suite. There's a little bit of balance between let me just change everything to, you know, let me just do everything the way you've done. How do you balance it? Because I think that's something that everybody's contemplating a little bit about.
Well, I think you have to be careful and pick your, should we call them fights? Pick your efforts, pick your initiatives carefully.
You know, pick things that are important, that are big, that are consequential, that will make a difference for you, for your institution, for the people and community of customers you might serve and be selective about those things that have the greatest level of impact. I mean, we told that story about vaccines because Bill Gates chose that
intervention because it was the most cost-effective way to reduce disease burden and deaths amongst people who are vulnerable. So be analytic and critical in deciding what you're going to do. And then I would say, when you do it, I would use these basic principles that I write about in the book. Really focus on building a culture of innovation and being data-driven on innovation and
really focus on building partnerships. I mean, today in a society moving this fast, you have to have partnerships, public, private, left, right, finance and engineering. And then third, and perhaps most important, is just be willing to measure results and learn along the way. Because the one thing you know is your plans will not work. And it's really about how you adapt.
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