How the Gates Foundation Partners With Health Startups
On a recent Fireside Chat, Annie Ye, digital health innovation program manager at The Gates Foundation, discussed foundation priorities and best practices for startups seeking to partner on health projects.
At a recent StartUp Health Fireside Chat, we connected with Annie Ye, the Program Manager of Digital Health Innovation at the Bill and Melinda Gates Foundation. Ye has experience in technology and analytics strategy and joined the Foundation at the outset of the pandemic to refine and connect a number of technological initiatives and strategy teams. Here are 10 important takeaways we learned.
Take (Virtual) Initiative
More than a year after the pandemic’s onset, the adjustment to virtual work continues to pose challenges for many around the globe. After joining the Gates Foundation at the outset of the pandemic, Annie experienced the added strain of “trying to get to know team members where [you] can’t exactly gauge body language quite as well.” For managers and founders actively onboarding new team members, she recommends taking the initiative of reaching out, offering small-group programming, and fostering individual-level conversations to begin building trusting virtual relationships. Annie notes that such efforts, alongside weekly inter-team “step competitions” to encourage employee health during quarantine, made her transition to the Foundation a smooth one.
Quest for Care Unites Us
Whenever Annie calls her family in rural China, they exchange a greeting in Chinese meaning “How is your body doing?” or “How is your health?” Attuning to one’s health and seeking better healthcare outcomes, she noted, is a uniquely consistent and unifying thread connecting families like hers, and humans as a species, across the globe. Having lived through recent exponential developments in healthcare infrastructure both in her community and in her grandparents’ in rural China, Annie testified to the criticality of keeping healthy both mentally and physically and to continue pushing the boundaries on access to high-quality healthcare. She put the mission of improving global health as simply to “open the door for the most disadvantaged to pursue their own dreams and their opportunities.”
Impatient Optimists
At the Gates Foundation, Annie says, “we like to think of ourselves as impatient optimists, who are working to reduce the inequity around the world by focusing on the areas of greatest need, and taking both risks that others either cannot or will not” to make markets work for the most disadvantaged. Annie works within the Global Health division, home to many program strategy teams which themselves represent a spectrum of focuses, from specific diseases including malaria and more recently, COVID-19, to those that are “disease-agnostic.” Annie works with the Innovative Technology Solutions (ITS) team, which identifies potentially transformative emerging technologies and makes targeted short-term investments to assess their viability in specific global health contexts. Then, the ITS team connects the appropriate Foundation programs with the most promising technologies to assist in implementing them in other areas, such as diagnostics, drug discovery, and vaccines.
Upscaling Community Health Workers
More specifically, Annie’s role in the digital health innovation initiative within ITS means that she’s constantly looking for proof of concept within emerging digital technologies, alongside co-development with field partners in the global south. At its core, her team is seeking out ways to “upscale community health workers,” who are those going door-to-door delivering healthcare, primarily in very remote environments, with often no more than a high school-equivalent degree. In fact, Annie added, the very idea of community health workers originated in China during the 1960s, when the Barefoot Doctors program launched to connect rural China with better healthcare. It’s particularly in these sorts of rural areas and low-resource settings that communities benefit greatly from the recent proliferation of global healthcare technology.
Collaboration Is Key
Unsurprisingly, a key ingredient in the Foundation’s operations is constant communication between the 37 different program strategy teams. This “very relational” work involves “a lot of stakeholder management,” which is instrumental in optimizing product distribution when healthcare innovations become available to global markets for large-scale implementation. Annie is particularly enthusiastic about the further development of Rapid Diagnostic Tests (RDTs) in further honing the mitigation of COVID-19 and other ongoing diseases, especially after the incredibly rapid response to COVID-19 revealed the potential of fast-tracked, cross-sector collaboration potential to remarkably impact global health.
RDTs
At the moment, the area of health Annie is most focused on is refining data modeling to figure out whom to administer RDTs — previously for malaria and now, of course, for COVID-19. Rapid diagnostic tests (RDTs) are low-cost ways to track infectious diseases; the process of optimizing RDT administration within populations involves ‘assessing risk, integrating population and individual priors, and developing AI-enabled diagnostic tools.’ It wasn’t until the Department of Health and Human Services’ mandate on reporting all COVID-19 tests, both negative and positive, that a dramatic industry shift towards seeing case connectivity analysis as a prerequisite for RDT manufacturing emerged. The sudden public awareness of RDTs has greatly increased industry use of connectivity metrics rather than simply regulatory restrictions as guidelines for production and distribution.
Startup Partnerships
While the majority of grants the Gates Foundation makes fall within their funding priorities, wherein they invite proposals by directly contacting startups, the Foundation does occasionally award grants through published Requests for Proposals (RFPs,) a subset of which includes their annual grant challenges. The Foundation makes two types of investments, the first of which is grant funding, which comes with global access terms attached: the charitable dollars of the Foundation must be spent either “in a way that contributes to the public good, or, especially if it’s with for-profit organizations, [towards providing] affordable pricing” in their target geographies. The second form of investments are program-related investments (PRIs), which seek to support the charitable impact of program strategy teams rather than financial return. PRIs govern private foundations’ charitable giving and generally aim either to stimulate private-sector innovation, organize more efficient markets, or garner external funding for other foundation priorities.
What’s a Grant vs. a PRI?
Grants are most often given to companies in experimental stages of development, with limited proof of concept, and funding Seed or Series A rounds with a few investors. The Foundation caps grant size at a few million dollars, and typical grants fall anywhere below this figure, depending on companies’ demonstrated need. PRIs, on the other hand, are designed for organizations that have established their product-market fit, are funding Series B or later, and have very strong financial backers. The typical PRI investment is about $5M. Despite their differences, both PRI and grant funding ensure that parts of the company are working with segments of the population of interest to the Foundation’s strategy teams.
Where Startups Fail
Companies seeking the Foundation’s funding, particularly for-profit startups, often fail around Global Access terms. The Foundation focuses very specifically on low-income populations and looks for two types of global access terms when evaluating startups for partnership. On the research side, the Foundation looks for data to be open in how it’s funded, and then published in open-access journals. Where most companies struggle legally, however, is on the product-side, where they may encounter challenges selling into specific geography because the Foundation “looks for accessible and affordable pricing” when taking products to target populations. Sometimes, the Foundation looks for a certain cap above cost; in dual-market strategies, it’s only with products targeted towards global southern markets that they must verify what global access terms look like.
Brass Tacks of Partnership
While joint partnerships between the Foundation and health innovation companies often yield high-level alignment and overall social benefit, when you get down to the brass tacks, it’s all about how the foundation’s charitable dollars can “fund work that flows into our target geographies at an affordable pricing or in ways in which knowledge that has been funded is open and accessible to people,” says Annie. Many startups are understandably eager to partner with the Foundation because they have so much funding, but Annie encourages founders to check for alignment with the Foundation’s funding priorities, to understand the grant application process, and to read up on global access terms to see if a partnership is possible and realistic.
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