Vivian Hsu is the Deputy Director for Strategy, Planning and Management for Vaccine Development and Neglected Tropical Diseases at The Gates Foundation. With a background in management consulting, life sciences and healthcare delivery, Vivian is focused on ensuring that the Gates Foundation selects and funds initiatives that will help the world stay resilient against a variety of diseases. 

Vivian Hsu, Deputy Director at The Gates Foundation

The Pulse: Can you introduce yourself and how you came to be at The Gates Foundation?

Vivian Hsu: I am the Deputy Director for Strategy, Planning and Management for both the Vaccine Development team and the Neglected Tropical Diseases team at The Gates Foundation. I come from a management consulting background, largely focused in the healthcare sector, specifically in life sciences and healthcare delivery. 

I came to be at the Gates Foundation, honestly, by a lot of persistence. I interviewed for close to five or six roles before I found my home here. I knew I wanted to spend my time working in global health as it’s a marriage of my interest in life sciences, my skill set, and my desire to improve the lives of people around the world. 

The Pulse: Given that your focus is around vaccine development, could you give a little context on what problems you are trying to solve in the Strategic Planning and Management arm of the Gates Foundation? 

VH: I am essentially the Chief of Staff for the Director of the Vaccine Development team and the Neglected Tropical Diseases team. I also played that role for a period of time for our Epidemic Preparedness and Response Team, our COVID response team as well as our Enteric and Diarrheal diseases team at various points of time over the past four years. 

This means I manage everything from our budget and finances, to team management, leading a group of project managers, coordinators, assistants, strategy officers, etc. I also provide thought partnership for all of our deputy directors with life sciences and PhD, global health, and public health backgrounds as they’re developing their strategies. I help them answer questions like “How are we going to best deploy this gift of funds to ensure we  have the most impact?” 

The Pulse: What are some projects that your team has focused on? 

VH: First and foremost, the primary thing we do at the Gates Foundation is give money away. Our board just approved a $8.6 billion budget for 2024 which means we will essentially spend $8.6 billion in global development, global health and US programs to advance strategies that we hope will ensure that all people have the ability to thrive and live a healthy and productive life.

In the vaccine development space, this means that we are a functional team that provides technical expertise and advances technological development in vaccines. One of the biggest projects or programs we have right now is really thinking about how we can increase access to mRNA technology. mRNA technology is the technology that was used in the COVID vaccines that were primarily deployed in much of the Western world. The vast majority of mRNA vaccines during COVID were deployed in high income countries, leaving low and middle income countries behind. This is partly due to cost issues and supply chain issues. However, a huge reason for this monopolization of vaccine access by high income countries was due to the massive contracts the countries made and their insistence on getting the vaccine first. So our team is looking at ways to ensure access to that technology in an effective and sustainable way. 

We are also focused on ensuring that there is an ecosystem that supports the development and production of vaccines in a high quality and affordable manner. We partner with organizations like WHO or GAVI, academics and vaccine manufacturers or other private companies to enable talent development, regulatory strengthening, policy making, etc. This is where we really want there to be resilience in the low and middle income countries – so that for future pandemics, these countries won’t be as vulnerable.

In the Neglected Tropical diseases space, we are focusing on eradicating eight of the diseases highlighted in the London Declaration – guinea worm, schistosomiasis, soil-transmitted helminths, onchocerciasis, trachoma, human-african trypanosomiasis, lymphatic filariasis, and visceral leishmaniasis.  One of our biggest ongoing projects is the expansion of the Reaching the Last Mile Fund in partnership with the UAE and other major donors which was announced at COP28 in December.

The Pulse: Since the COVID 19 pandemic, what are some trends that your team has been seeing with regards to vaccine development?

VH: Post COVID, from a vaccine development perspective, we are really seeing a trend toward vaccine nationalism. This sense of the need for every country to have control of their own vaccine production. There is a delicate balance of enabling sovereignty but also ensuring that there’s sustainability of these manufacturing entities. We are focused on investing in lean technologies that enable low cost of capital and lower cost of human operations to enable better pandemic preparedness. But even then, there need to be products for manufacturers to make in the interim such that those companies can generate revenue and retain talent. This issue is something that the entire vaccine space is wrestling with, not just us as an organization.

And then with regards to Neglected Tropical Diseases, the major challenge on the horizon is due to the intersection of climate change and health. As the climate is changing, the ecosystems around us change, expanding the habitats of various vectors like mosquitos and parasites which carry NTDs. We saw this clearly with the first community transmission of malaria in Florida in decades last year. The more the habitats of these vectors expand, the more risk of disease spreading and that really could set back the massive progress that has been made towards eradication to date. It’s easy to forget that there was a point in time where these diseases were not focused just in certain geographies, but actually were much more widespread around the world. And we just hope not to repeat that. 

The Pulse: As a final question, what advice would you give to your younger self as you looked to get involved in the public health space?

VH: I think that the global health world is a fascinating world, and there are so many different ways to approach it. There’s the life sciences and R&D perspective that is focused on innovations shaped to LMIC countries. For example, we see longstanding evidence that the rotavirus vaccine that is deployed in Western countries actually is far less effective in developing countries. Then, there is the question of how you deploy interventions, and how do you find funding for interventions that is sustainable? In addition, there are public policy elements, and communication elements to consider in global health as well. It’s an amazing sector because you have to look at all the angles, which also creates a need for different perspectives and experiences. I think that the strategic business mindset, financial acumen and talent for managing people and culture that an MBA brings to the work is incredibly valuable. So my advice would be that if there is passion and interest – anyone can get involved in global health.

Interviewed by Adhiti Rajesh, January 2024.

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On Feb 15-16, 2024, Wharton is excited to feature more expert perspectives at our annual Wharton Health Care Business Conference. This year’s conference is themed ‘The Resilience Edge.’ Conference details and tickets are available here.