January 18, 2012 | The Editors

Chris Elias: the exit interview

Later this year, Dr. Christopher J. Elias, president and CEO of PATH since September 2000, will join the Bill & Melinda Gates Foundation as president of their Global Development Program. Recently, we sat down with Chris and posed some of the questions we’ve been dying to ask for more than a decade.

When you arrived, PATH had a budget of $44 million and a staff of about 300. Now our annual budget is about $300 million and we’ve got more than a thousand employees. I’ve heard that when you took the job, the board told you they didn’t expect either the staff or the budget to grow.

They expected it to increase a little bit. They showed me a graph with typical S-curve growth. The graph leveled off at $60 million.

So, is this what you signed up for?

No, of course not! And that speaks to what has happened in global health. Nobody knew what was going to happen in global health. Had they known, they probably would have hired somebody else. Before coming here, I was a country director for another international NGO [nongovernmental organization]. I managed a group of 20–22 people in Bangkok with a $2 or $3 million a year budget. And so hiring me to run an organization with 300 staff and $44 million budget was a bit of a stretch. If they knew where we were going, they would never have hired me.

Click on images to enlarge.

What impressed you about the organization then and is it the same thing that impresses you now?

A lot of things are different now than they were then, but what’s the same is important, and it’s at our core. What impressed me the first time I met people from PATH in the 80s was PATH’s entrepreneurial, can-do, solutions-oriented approach. It’s hard to imagine now, but back then there was a lot of cynicism in the global health field. I think it came from facing such great need, having such potential, and really having so little political and financial support. At PATH, that wasn’t happening. You can’t be an entrepreneur and be a cynic.

We’ve talked how the organization has grown and changed over the past decade. How have you changed?

My hair turned gray.

Yeah, and you’re probably a lot more tired.

You know, I’m actually less tired. Partly because the organization scaled and, probably more importantly, the field scaled and attracted the kinds of political and financial support that was a source of pessimism once upon a time. It’s a pretty exciting time now. As a consequence, I’m much more upbeat. We’ve got some very important successes at scale and we’ve got incredible science. We have models for harnessing that science and applying it to the world’s problems. Plus, we’ve got political commitment and pretty strong financial commitment. We have to make sure that financial commitment doesn’t decline in the economic recession, but all the ingredients are there to have the next decade be even more exciting than the previous one.

What are the highlights of your time here?

I think being able to scale the organization without losing the entrepreneurial nature that drives our success was probably the biggest accomplishment. As organizations get bigger, they often get sclerotic and rule-laden and create structure that puts them out of their own business. And I think we’ve succeeded in avoiding that.

Another accomplishment has been building our field capacity. When I joined PATH, roughly a quarter of our staff was based in the field. Today it’s roughly half. I think growth of our field staff has helped us to be better attuned to the needs of the countries and communities where we’re working.

Where’s the most memorable place you’ve been on PATH business?

When I visit our offices in the field, I generally do three things: meet with PATH staff internally; meet with key donors and partners, usually in the capital city; and visit field projects. The latter is my favorite, especially since it provides an opportunity to interact with our staff in a less formal setting.

I have many memories from these visits and it is hard to single out the most memorable. One was visiting a very old TB hospital in Odessa, Ukraine, with Katya and Elena from our Kiev office—the worn-out steps of the hospital left a vivid image of how long TB has been a big problem in Ukraine. Witnessing the spectacle in Ouagadougou when the president of Burkina Faso launched the national roll-out of the meningitis vaccine after almost a decade of development was another highlight. Finally, my frequent visits to Kenya over the years have given me an interesting and awe-inspiring view of the growth of PATH’s largest field program. I was very happy that my last field visit for PATH was to Kenya for the celebration of the 20th anniversary of the Nairobi office, our first in Africa.

It’s time to move into the celebrity gossip portion of the interview. I’ve heard that you talked to Angelina Jolie at the World Economic Forum in Davos. True?

No. I saw her across a room…I’m not sure you should put this in the blog.

Oh, come on.

Well, I was sitting in this room during a coffee break and the reason I remember it is it was my very first time at Davos, and Angelina Jolie was walking across the room and so was Harmid Karzai. They were going in different directions, but I thought, “This is an interesting place.”

How about Ashley Judd? You were on a panel with Ashley Judd?

I wasn’t on a panel with her; I was at a dinner with her.

Seated next to her?

No, but we did have some conversation that I can’t remember now.

OK, finally, one word: Bono. What’s he really like?

You know, I don’t know him that well. I met him in passing at Davos—it’s going to sound like I live in Davos—that’s the only place that I go where there are any celebrities.

But you went to a U2 concert and got backstage?

No, it’s not backstage. It’s called something like the VIP reception area.

Sounds promising. Who was there? Anybody you recognized?

No. I don’t even think Bono showed up.

You know, this isn’t going to help with recruiting.

Yeah. I don’t know if the celebrity angle is really the way you want to go.

OK, let’s talk about your new position, which focuses on global development. If you have good health, don’t you have a much better chance at having successful economic and social development?

Yeah! And that’s actually been studied. In 2001 the World Health Organization convened a commission on macroeconomics and health. The commission reviewed all the data and found that, sure enough, what we think of as common sense is actually true. If you have poor health, you’re likely to be much less economically productive. And if you’re economically productive, you’re much more likely to have better heath. We know from the meningitis studies that we did in Burkina Faso that one of the most common reasons people are pushed into poverty is they have an episode of meningitis in their household that consumes three to four months of their income. And we also know on the upside, that once people start earning more money, they purchase better health care and education for their kids. So, yes. There’s a loop between economic opportunity and health.

Sounds interesting. But what will it feel like to leave PATH for the last time?

It’s going to be really hard. That I know. It’s mitigated by not having to pull up roots and move to another city. I’m only going ten blocks away. And the Gates Foundation and PATH have a lot to do together, so I’ll be back. But it will be hard to turn in my key and actually leave the building.

Right now you work in a standard PATH cubicle. Do you get an office with your new gig?

I do. That’s actually one of the better jokes I heard. Somebody said to me, now I know why you took that job at Gates. You decided you wanted an office after all.

Global health quiz

When Chris Elias joined PATH in 2000, how many of our offices were located in Africa? See the answer on Friday.

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