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There's fourteen million citizens that are shareholders, right? Yeah, yeah. So how does that actually work in practice, though?
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So the, the fourteen million citizens have universal education, universal healthcare, and they all have a pension plan, and it's run by the Rwanda Social Security Board, who is about two and a half billion dollars.
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So even though it's a poor country, there's some rich organizations. So we're about one percent of their assets, very tiny amount.
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They give us the money to keep going, and, and then I have the trippy kind of thing that I get to say, which is I'm driving down in a Land Rover going through the savanna and the veldt, and I see an old woman, barefoot maybe, pile of potatoes on her head, and I get to say, "That's my boss."
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Welcome to the show, everyone, where we talk about innovation in medicine before the outcomes are certain. I'm Timothy Wheeler, and I'm joined by my co-host, David Tsai.
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Michael Fairbanks, he left Pennsylvania for the first time at twenty years old for a village in Kenya. The village taught him something that would shape everything that followed. No one wanted to be saved.
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They wanted a partner. Michael spent the next four decades advising heads of state across the developing world. But advising wasn't enough. Twenty-five years ago, he became a Rwandan citizen
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and began building alongside President Kagame. He co-founded a pharmaceutical company, majority owned by fourteen million Rwandans. Now, they build medicines for diseases the global market has chosen to ignore.
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Not charity, ownership. The moral purpose is clear. Everything else is still a bet. Please enjoy our conversation with Michael Fairbanks. And to support us, please check out our links in the description.
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Because at the end of the day, we're all patients, and we deserve better. This is your first podcast that's outside of Rwanda, right? Yeah. Oh, yeah. Yeah.
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Has there been a, a reason for that, that you've decided not to be too public inter-- on the international stage so far?
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For the first few years, it was just to make sure the science worked and not get out ahead of ourselves. Now we're so optimistic about the science, it's, it's time to lift- Great...
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our head up above and, you know, start talking about things. You're, you're pushing the envelope on so many levels, which is what's fascinating. Yeah, I think so.
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It's an infectious disease company owned by Africans who employ only cancer scientists [laughs] to solve the problem of infectious disease, so it's just, it's not normal.
Load full transcript
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Well, as I said, thank you so much for coming on here. You're a presidential advisor to Mandela and five Colombian presidents, Rwandan citizen, pharmaceutical co-founder tackling the world's most infectious disease.
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I mean, we truly could do a few episodes here, so let's just start at the beginning. Paint us a picture of your childhood growing up and then what it was like to be going to Kenya at that time.
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[laughs] No one's ever asked me that before. That's, uh, that's really interesting. I grew up in Scranton, Pennsylvania, which is the-- we kind of joke that it's the Paris of Appalachia.
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You know, it's at the northern end of the Appalachia region. And it's a coal mining, uh, community, and I'd never been anywhere at all.
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And I decided after my sophomore year of college that I was gonna join the Peace Corps and, uh, go somewhere very remote and, and try to be helpful. I was very idealistic about it. Yeah, I had a similar experience.
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I decided not to do Peace Corps, but I bought a one-way ticket to what was war-torn Colombia at the time. Yeah, yeah. And wound up working there for two years, pretty deeply w- in human rights.
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I did meet a number of Peace Corps volunteers. None of them became presidential advisors. [laughs] How does that then translate to you becoming a head of state advisor?
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Well, you can answer the question on multiple levels, right? You have an affinity for Africa and for working in the Global South. The second is your, your appetite for rational risks is higher than most people's.
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I'm sure you found this in Colombia. You were just doing things that your family would think were just outrageous.
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But then I went to graduate school and focused on economic development, and then I joined Chase Manhattan on Wall Street to do Africa banking and began to accumulate the skills, the attitudes, the business approaches that would help me to help other people.
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And so, um, I was working as a management consultant focused on developing countries. And one day, two guys had come in and, uh, asked me if, uh, they could talk to the people working on poor countries in the company.
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Well, there was nobody doing that, and I was very junior, but I said, "I'll, I'll help you." And it turned out that one of them was Andres Pastrana, who you probably know became president of Colombia many years later.
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Yeah. And his friend, Luis Alberto Moreno, became the- Wow... president of the In-Inter-American Development Bank. And they became two of the most important people in the hemisphere.
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But they were just college students at Harvard when I met them.
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And then they invited me to Colombia, and I gave a few speeches, and the next thing you know, they ushered me into the then president, uh, Gaviria, César Gaviria, and they hired me to lead a process to improve their export competitiveness and their private sector development.
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And that, that project succeeded.
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So all of a sudden, I'm in Venezuela, I'm in Peru, I'm in Ecuador, and then one day I get a call from Nelson Mandela's, um, office that he is running for election, and he needs a plan, and would you come to South Africa and, and talk to him?
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Wow. So that's how it got started. You know, I hear a lot of good intention under what you're saying.
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You did mention a little while back, you know, African banker, and I think a lot of people, when you hear that, okay, white guy born in Pennsylvania becomes an African banker. Yeah.
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What made your approach different to maybe the stereotypes that I'm thinking about? Yeah, that's a great question. So Most advisors to poor countries deal in the domain of macroeconomics.
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So they, they focus on four things: stabilize the economy, privatize the industry, liberalize the trade, and, uh, democratize the decision-making. And then-- And it's very top-down.
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You know, "Here's the twelve things to do, and you should be fine. And if it doesn't work, it's because you're not smart or you don't have the courage to do the right thing." That was the model.
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My model, rather than top-down, was bottom-up. Like, "Let's, let's build the businesses-" Hmm... "and let's focus on exporting, and let's focus on high-end rising wages for the average worker."
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W-w-- The macroeconomists might say, you know, "Keep wages low because that keeps the cost structure low and allows you to export."
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Having been raised in the African villages and understanding the people, uh, at their level, said, "No, no, we need to export things where the wages go up. We don't wanna compete on how poor we can stay." Mm-hmm.
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"We wanna compete and get richer because we're competing on, you know, technology and, and focused market and segmentation." Well, of course, that became irresistible to presidents in Latin America and in Africa.
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Mm-hmm, mm-hmm. 'Cause I'd say, "We're not gonna lower the value of the currency, and we're not gonna underpay the people," which a macroeconomist back then would say. Mm-hmm. It's completely opposite.
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Let's do the opposite. Yeah. You know, we'll have to focus on value-added industries and exports where so much money comes back, we can
raise the wages.
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Now, what, with that new social contract, what that does is it says, "We're going to make our society stronger, not compete on how poor you can keep the people until the society disintegrates." Mm-hmm. I love that.
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Y-and you, you wrote a book about this, right? I did. It's called Plowing the Sea.
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I published it at Harvard Business School, and that, of course, created more demand for my services 'cause all of a sudden, Ashraf Ghani is calling me, who was then at the World Bank, and later on became President of Afghanistan.
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So then I'm working for Ashraf in, in, uh, Kabul, and, uh, yeah, it became very- I have to say, Michael, you're very humble, and you speak very calmly [laughs] about these names that both Tim and-- Tim and I are probably jumping out of our seats just hearing.
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Well, I, I-- actually, I wanna tap into that too, David. Gi-give us a scope of the breadth of the number of countries you've worked at. Haiti- It's about twenty-five countries.
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Um, mo-most of which were a failure, I, I, I hasten to add, you know, 'cause you go into a difficult situation. Um, I worked for a long time in- Right...
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you know, Bolivia and Jamaica and Haiti and, uh, many other places that did not succeed, d-- where I was not helpful. Yeah. Mm-hmm. Uh, I wanna put the blame on me.
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I think it means that I wasn't able to find a basis, uh, to improve their receptivity to the, the strategies that I was, that I was recommending. I don't wanna say they weren't courageous enough to make the...
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That's what, that's what all the advisors do because most of- Mm... most of us fail most of the time. So, so what happens- Yeah...
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is a lot of the Harvard people, the IMF people, the World Bank people, they come in [clears throat] and they lay a big fat document on people. They haven't found the leaders. They haven't found the innovators.
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Then when nothing happens, they say, "You're not smart enough" or, "You didn't have the political courage to do the right thing," and they take their check, and they walk away.
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And I, uh, again, I think 'cause of the village I lived in for years and the local languages I practiced, I knew that if it wasn't working, I had a lot more to do with it than, than they did.
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I just wasn't getting it right. But it's- Well, I love that you're acknowledging your- Yeah... your failures here and- Yeah... and giving that honest, you know, self, self-reflection.
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Um- I have a few, few threads here if I can jump in, Tim, real quick. Yeah. [laughs] Yeah. I, I love this, Michael. You're so interesting. Uh, I did change management at Genentech. Oh, wow.
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It's very difficult to- Yeah... for a huge com-company to get around different ideas. Yeah. I mean, it's, it's like the Titanic, and you're trying to steer it a different way, so I completely understand.
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I think you need to give yourself more credit for what you've already done. [laughs] Oh. Um, but we are the culmination of our experiences. I think in this modern day- Mm-hmm...
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and age, especially with AI, a lot of these newish founders-- I work with a lot of new founders, first-time founders. Yeah.
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They think they know everything, but I think what you've told and h-what I'm hearing is, like, the Peace Corps, working in the villages, working boots on the ground, that's led to every, all of your success in building who you are.
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I mean, you can't trade that for just something that ChatGPT will say, you know, uh, experience-wise, right? It's, it's true. It, it's true. It has a lot to do with it. Um, I mean, it gave me credibility.
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[clears throat] This isn't some guy flying in from Harvard who is gonna tell us what to do. Like, he's lived here in Africa. When I first met Julius Nyerere, the founder of Tanzania, it's a fantastic scene.
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He's, he's in the Carlyle Hotel in New York City, you know, where the Beatles stayed and where Marilyn Monroe and John F. Kennedy cheated on everybody.
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Um, so I'm at the Carlyle Hotel with Julius Nyerere, and I'm ushered into the room. I've never met him before, [clears throat] and he's on the phone speaking in Swahili, and he thinks I don't understand him.
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Why would, why would he? [laughs] But he, he, he- I love this... but he's yelling at somebody, and he's saying, "Don't listen to the Americans. They, they want you to build a democracy and then build a country.
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Build a country and then build a democracy."
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Which I thought, "Oh my God, I'm sitting in the founder of African socialism, the founder of Tanzania, and I'm listening to him in Swahili yell at somebody else, and I don't know who it is yet."
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He gets off the phone, and so I start speaking in Swahili, "Mwalimu," 'cause that was his nickname in, in Tanzania. It means teacher. Mwalimu, and you have to say it that way, not Mwalimu, Mwali- Uh-huh. Mwalimu.
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And he, he like, uh, you know, startles. And then I said-- keep going in Swahili. I said, "I heard everything you said. I'm sorry. I didn't mean to, you know, hear those things, but who were you talking to?"
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He's laughing. He-- 'cause he got so exposed, and he's got this great attitude, and he sits
down on the couch, and he goes, "I was speaking to the president of the Congo." And I was telling him, "Don't, don't, uh- Wow...
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don't listen to the Americans on this one because you need to build the country first." And then we started talking. We became ver- we became friends in like moments, um- Yeah... because I had- Wow...
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eavesdropped on that conversation, and he thought that was so, so hysterical. You spoke the language. Yeah, yeah. Yeah. And idiomatically. I don't speak it, uh, beautiful like he does. He, he actually translated,
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uh, Shakespeare's Julius Caesar into Swahili, which is one of the books- Wow. Wow... I read in the little mud hut and st- and learned Swahili. Wow. Oh my gosh. He tr- he was a scholar- Really?...
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and he was a poet, and he was amazing person. Um, and so I don't- Incredible... speak it like he does, but I speak it like we call it the KiSwahili cha msituni, the bush Swahili. So I know the ants- Oh...
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and the plants and the food and, uh, you know, those kinds of things. And so to speak to someone like him, who was a scholar of Swahili, a true scholar, it was a fantastic moment.
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Well, and you speak to it gave you cre- uh, credibility. Yeah. And that's for sure. That's a good story of that, but it also, what, it shaped your perspective. Absolutely.
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And, and, and I'll tell you what, even in that very first meeting, I was telling him about my concepts and how to, how we would move forward together,
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and he invented socialism in, in all of Africa, certainly in East and Southern Africa. He invented it.
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It was called Ujamaa, familyhood, and he brought it back from Europe, and he inspired the whole continent to think about socialist principles. But I was a capitalist. I was talking about exports and wages and all this.
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So I'm going through my whole thing with him and I said to him, "Malimu, does this... Um, am I offending you or is this interesting?" And he comes over and he puts his hands on my knees.
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We're sitting on the same couch, and he said, "You know, Michael, I'm an old socialist, but I'm not a fool." And he said, "What you're talking about-" Oh... "is the right way going forward." And, and Nyerere- Nice...
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was one of the few great leaders in the world who was willing to talk about his own mistakes. And he said, "I made a mistake-" Mm... "with socialism in Africa. I made a mistake the way that-" Wow...
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"I built the country." And he said, he said, "What you're talking about is the way forward."
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And we worked together for a while, but he died, uh, not too long after that, uh, of, of cancer, and that's why he was in New York in the hotel, because he was seeking cancer treatment, I, I later learned, so.
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I have to say, I could sit down with you for hours just to hear these stories 'cause this is the, the texture that you don't read about. You know, we have our w- worldview and view of heads of state based off- Yeah. Mm.
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.. of these little snippets, and especially today, really gotten ourselves into putting people- Yeah, yeah... in boxes of- Mm-hmm...
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conservative and liberal and socialist and capitalist, and to hear that you're speaking to people like, I know you were an advisor to Fidel Castro. Yeah, yeah.
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And, uh, people that, that are thinking more nuanced, they're, they're leaders for a reason. But you're, um, a banker from the United States. Yeah. Right?
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Yes, you, you now have a background and a cachet from Africa, but how does that, uh, wind up happening that you actually have a relationship with Castro and, and was there meani- meaningful advising there?
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It was going very well. And I'll tell you, I had a lot of respect for the, the Cubans. They, and the later on with the Rwandans, they reminded me of the Cubans.
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The Cubans had a very shared vision, un- una vision compartida, a very shared vision of how the world- Mm-hmm... should work. So I go right into Fidel's office. Wow.
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Carlos Lage, the vice president, Roberto Robaina, the foreign minister. Wow. The f- all these famous guys.
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And I had a s- a canned speech that I use at Harvard and other places where whenever I get to the socialist model, I always say, you know, that this was a form of, uh, economic development that had the least probability of success, and I would hammer it.
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The problem with classic socialism is the over-responsibility for the affairs of the average person. And then all of a sudden I'm thinking, "I'm in Castro's office with his entire-" No kidding. [laughs] "...
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cabinet, and I'm talking about the problems of Cu- what the hell is my problem?" Don't people go to jail for that? Yeah, people go to jail for that. [laughs] Uh, and, and, and I'm like, "Oh my God."
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And I, I, I think I started to shake. Like, I think I had- Wow... a palpable, uh, fear of it all of a sudden. I'm like, "What the hell is my problem?" Yeah. You remembered where you were.
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[laughs] And, and, and Lage, the vice president, he comes over and he shakes my hand at the end, and he goes, "You know, I just wanna say thank you because you told us what you thought was the truth today, and nobo- nobody ever does that."
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And that's how they received me. Wow. Wow. Well, that's- It's amazing... that, that speaks to why, over and over, you became an advisor to, uh, heads of state and presidents, 'cause you do speak the truth.
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Going from all of that background, how then do you wind up going to Rwanda- Yeah... and then basically having a next-level relationship with Rwanda? Yeah. Thank you for asking that. I love Rwanda.
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Rwanda gives me hope and courage every day. It's, it's, uh, such, it's just the best place. Um, so I g- Oh...
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ga- garnered a certain reputation, and then the president of the World Bank, uh, Jim Wolfensohn, um, said, "There's a new president in Rwanda.
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He was just elected, uh, a couple of weeks ago, and h- he's gonna need some of your kind of input." Um, so he introduced me to the president. Um, so I've been with him ever since the beginning, and that was 25 years ago.
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Paint a picture too, 'cause at this moment, Rwanda's just coming out of one of the worst genocides in our lifetime. Oh, yeah. Uh, I mean, it was 30 years ago. It was...
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And, uh, yeah, so they, they came out of the genocide. They were led by, uh, another person initially, and then Paul Kagame was elected by parliament to, uh, take over, uh, the country in, um, April of 2000. Mm-hmm.
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And, uh, you know, people thought he was a bushmen. They thought he would, you know, cause reverse genocide. They thought he was- Yeah... uh, not a competent person. And he was the opposite of all of that.
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Th-this is the only head of state in the world trained by the Cuban military and the American military out in, in, in Kansas, and, uh- Wow... the only, only one. Yeah. That's interesting.
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He, um, he, uh, ha- the, the parliament in Rwanda has two-thirds women, the highest participation of women in the history of the world. That's incredible. They've had eight to nine percent- Wow...
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economic growth every year for twenty-five years. And the capital now- Wow. Wow... is starting to look like Dubai, the skyscrapers and beauty. There, there's not a mango peel- That's incredible...
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or a cigarette butt on the, on the, on the ground anywhere in the country, because on the last Saturday of every month, they call it Umuganda, the entire country comes out, and they clear debris from water sources, they build fences for old ladies, they pick up the litter that they, that they...
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It's, it's, it's, it's an exquisite country. That's unheard of. It's the Singapore of the jungle. It's the s- it's the, it's the Switzerland of the heart of Africa. It's, it's an amazing place. Michael, I, I apologize.
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My only [laughs] my only recollection of Rwanda is actually from Hotel Rwanda. Yeah. Right. Well, Hotel Rwanda was- Right... filmed in South Africa, and almost nothing about it is the truth.
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[laughs] So I'm f- I'm very down- Yeah... I'm very down on that c- Yeah... on that movie. That's good to know. But I think that's for, for most of us and most of our audience- Mm-hmm...
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we, we, we picture that has- Yeah... past 'cause it was such a brutal past- Yeah... and so in our face. And then, you know, I, I've traveled also. I actually went, did a PBS frontline with President Sirleaf- Oh, sure...
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who became the first female president- Yeah... of an African country and was in, staying at her compound- Yeah... right after they were coming out of war. Yeah.
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You know, so I've seen these kind of tides turned, but what you're speaking to is that Rwanda feels like it's something special- Yeah... has happened there.
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It, it w- it was a portal into everything that was wrong with humanity, and now it's a portal into everything that is good. And by the way, I call Ellen Johnson Sirleaf Ellen because she was my first boss as a banker.
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She was my first bo- [laughs] Oh, no way. I'm serious. I'm serious. Of course you guys are connected. Who don't you know? [laughs] And she w- Yeah. She was my first boss. Um, yep.
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I hear sh- she's, she's a, she's a difficult boss, right? She's a tough lady. I remember the day that I was leaving, she- She's the Iron Lady. The Iron Lady. Yeah. That's what, that's what, how she's known. Yeah.
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She's the Iron Lady. Yeah. That's how you become president of, uh, Liberia. Yeah. She's, she's, she's tough, uh, slogging, that's for sure. Yeah. But she won the Nobel Peace Prize- Wow...
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and she has done good for women- Yes, she has... all across Africa. But, uh, I have stories there too. [laughs] I'm sure. Exactly. That's why we said we have to have like ten episodes with you.
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Um, so President Kagame, this is a guy that has some controversy around him- Yeah, yeah. We can talk-... as well, right? Can you actually... M-maybe that's where we start with. Yeah.
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Like, is there some controversy around him? Is it merited? You know, the controversy exists because the people who caused the genocide
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and the people who stood idly by while the genocide occurred, which was a lot of Americans, feel like that if they could make him into some sort of a bad guy, it will absolve them of their own complicity in the genocide.
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Mm-hmm. So- Yeah... so America could have stopped the genocide. Some military friends of mine who,
uh, took to Rwanda once said, "I-if we had two F-15s and a hundred Army Rangers, we could have stopped this in a day."
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But we didn't- Right... we didn't get involved because France was a NATO ally and because we had just lost people in Black Hawk Down in Somalia, and President Clinton didn't want another episode like that.
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I was in the room- Mm-hmm... at the St. Regis Hotel in Aspen, Colorado when President Bill Clinton and President Paul Kagame met each other. Wow. And, and, and the President Clinton- Wow... apologized to him.
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I was in the bar at the St. Regis Hotel- Really? Wow... in Aspen, Colorado. Wow. And Clinton apologized, and he got weepy about it.
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And he's gone on to say it was the greatest mistake of his presidency, and that's a guy who made a few pretty critical mistakes. Wow.
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Well, obviously, th- those types of intimate experiences then were able to shape and, and gain your appreciation of Kagame and...
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But how do we then go from you being a presidential advisor to now being a co-founder of a pharmaceutical company? Yeah, that's a good question. I'm not sure [laughs] it's even clear in my head.
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[laughs] I was like, "What, what just happened?"
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Um, years before COVID, years, like two thousand and seventeen, President Kagame and I were having a dinner at the Kennedy School of Government here in, in Cambridge, and he, and he was saying, "We don't have this generative capacity to protect ourselves."
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And I said, "We should start a biotech, and we should develop our own drugs." And he, and I, and I said, "Do you want me to do that?" And he said, "Yeah, I want you to do that." It was that, that trivial.
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That, that simple. That simple. So but, but where did you get the, the initial concept? I love that. Yeah.
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So I've been an investor in biotechs for about thirty years, and so I know everybody in Boston, and, um, I knew where the scientists were. And well then, we started the company before COVID.
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And even when nice people like the Danes and the Canadians decided not to give enough drugs to Africa, w-we were already up and running, and we could produce our own- Mm-hmm... COVID things in our own labs. Wow.
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Yeah, but that just strengthened our, our fortitude to do this. So we're focused on, uh, tuberculosis and NTMs, and, uh, we have an HIV vaccine, RSV vaccine.
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We have about eight or nine vaccines and three, uh, uh, therapeutics, and they're all working. And, and in fact, I could tell you- Hmm...
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that we've put our TB drug into very sick TB patients with outstanding results in safety, which is the hard thing with TB, and in efficacy.
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And so we, we have, we have a capa-- a generative capacity now in Rwanda to produce the, uh, vaccines and the drugs that, that we might need if the world doesn't help us. So, so it's, it's, it's fantastic.
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We're a clinical company. And we're in our f- our D round of f-funding, and it's African majority owned and run. How are you choosing what you're tackling within medicine?
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So we have a humanitarian effort, which is like TB and, uh, Lassa fever, which is a hemorrhagic disorder in West Africa that kills virtually every pregnant woman who gets it.
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Um, then we have a for-profit effort, like an RSV vaccine, a mumps vaccine, and things like that.
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And so we're mixing that [coughs] if we can make a lot of money with certain things, we could take that money and put it into the humanitarian effort and distribute those things, you know, at cost or below cost, uh, to, to the people who really need them.
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I also am reading about tuberculosis is, is still the- Yeah... number one killer in the world. It is. Right? For- It is... w- and we don't think about that in the United States- No... right?
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Even though I grew up in Scranton, a couple of miles away from one of the biggest tuberculosis sanitariums in America, because TB had been- Wow... a problem historically.
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I mean, TB killed Henry David Thoreau and Mimi Eisenhower. Um- Mm... one out of every seven people who ever lived died from TB, and one out of every four in the United- Wow... States in the nineteenth century.
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So it's a terrible disease. Um, and it's about to get worse because of American and other people's cutbacks in global healthcare.
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TB is gonna go from one point two five million deaths last year to about one point five million deaths this year, and that's because we've- Wow...
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cut back our health budgets in order to buy, uh, bullets and airplanes to wage war. Mm-hmm. I actually just-- I wasn't even searching.
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I was fed an article right before this conversation about tuberculosis in- Yeah, yeah... the United States. We're starting to see it in urban centers again.
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It's entirely treatable with a six to nine-month regime if you take your oral tablets every day. But you need to get the tablets every day. You need to take them.
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You start to get the toxic effects and get very, very ill, and then you stop taking them. Mm-hmm. And that's what creates the drug-resistant brand of TB. This is a huge problem in Africa- Yeah...
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and in Asia, where sometimes people are coming from villages. There's a whole 'nother level of dynamic with that. A-a-absolutely. Russian prisons is a, a choke point. Um, Haitian UN camps- Hmm...
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where many African countries, it's endemic, but also it, it is in some parts of Asia. Dirty little secret, the embarrassment of Canada is that the-- it's endemic to the entire north of Canada.
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All the, all the Native populations- Really?... um, are, are- Oh, wow... being killed by tuberculosis right now. It, it, it's everywhere. I didn't know that. Yeah. Wow.
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Um, a lot of the big pharmaceutical companies in the world are not going after this problem, right? Can you- Yeah... w-why are they not going after this problem, and why are you deciding to?
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Because of the fifty or so insurance jurisdictions in the world, um, forty-eight of them don't have insurance, and, and so there's no one to pay the big pharmaceutical companies for their effort. And TB is hard.
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The bacilli are inside something called the granuloma, which is necrotic. There's no blood flow. It's practically dead tissue, and getting medicines into it is really, really hard. And so it's expensive- Mm-hmm...
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to research. It's expensive- Yeah... to make, and there's no profit in it. They have laid off of it to, to their eternal shame. So a lot of them will hear this 'cause- Yeah...
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I'll post this on something where, you know, scientists see this, this kind of podcast. Uh, but it's to their eternal shame.
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Even people who came up through the medical schools as infectious disease doctors and now run some of the big global pharmaceuticals, they won't touch it because there's no profit in it.
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The a- the average cancer product- Yeah... has a ninety-five percent profit margin, so only five percent cost, ninety-five percent profit.
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In TB, it'd still be fifty or sixty percent profit, but that's not big enough for them to want to, to, to do, to do this. So David is nodding up and down 'cause he knows what big pharma- Yeah... how they operate.
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A million things to say in response. Yeah. This is all David's fault, by the way. This is it. This is- [laughs] I'm, I'm trying not to be part of this- This is an intervention-... issue, Michael... David.
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This is a secret intervention. Um- Yeah. No, I, I, I completely agree. I, I worked at a place called Global Blood Therapeutics. Uh, I've worked in sickle cell disease most of my career- Mm...
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um, starting at the, the site. I actually enrolled patients, worked with patients, um, at the clinic. My heart's with the patients- Yeah... has always been. So Global Blood did something very unique.
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Ted Love, he came out of retirement to, to run the company.
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He said we would eventually, no matter what, you know, charge the, the US the bulk of the cost and actually provide, uh, as much as we can freely or at very subsidized cost to- Nice...
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to Africa, where it's obvious that it's much needed. Nice. I love that model. I think that's what we need- Yeah. Yeah... more of, and I love what you're doing.
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I'd love to dive a little bit deeper into what is a process that you guys go through to get a drug approved.
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What we've done with our drugs is we, we consult with the American FDA, and we make sure we're doing things ways that they would approve. But we're doing the actual trial in TB in South Africa.
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So we're going through a consultation process in Washington and then the real review process in, in, in South Africa, all the time keeping our eyes on America because as you do a phase two, you've got to come back and do trials in America and all, all around the world.
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Um, I'm very happy to say that the National Institute of Health, they have a subset called the Vaccine Research Institute, and they're huge supporters of ours with advice and guidance, and sometimes they do a little bit of work.
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So even though you hear about the terrible healthcare cutbacks at the FDA and the, and the NIH, we found them to be incredible to work with and very encouraging. That's great to hear.
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And part of that is 'cause we're African, and they think that replicating this model of African ownership, why can't we have a pain management biotech in Nigeria? Why can't we have a cancer institute in Botswana?
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The-- Could this be a model for something else? And we're, we're making it work so far. I need, I need to, I need to make sure to mention Dr. Daryl Drummond, Dr. Sachin Maralkar, Dr. Dmitry Karputin, and so many others.
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I'm kinda taking credit for their innovations. These are the guys... This is your team, though. This is the team. But they come into work early in the morning. The innovation is theirs.
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I've created, uh, the funding and the context and the connections and things like that, but, um, I'm not much good to the company as a scientist, that's for damn sure.
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Well, I mean, in much smaller missions than yours, uh, there, there... it always takes a team, right? Yeah.
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And considering the complexity of everything that you are dealing with here, breakthroughs in the world's most infectious disease- Yeah.
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And you're also working in Rwanda and trying to create a new system, a pro- public/private- You're right. P- yeah... ownership system. Yeah. PPP, public private partnership. Yep. Yeah.
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And so it's one thing to have this vision. How do you make this work- Yeah... and last? You don't let investors choose you, you choose investors. So what I have is nine or 10 philanthrocapitalists, you know.
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They wanna make money. They've made money by working hard their whole career, but they also believe in something else. They believe in taking a little bit extra chance for the global good. Mm-hmm.
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So I've been very blessed by those kinds of folks. Um, the people of Rwanda have put a lot of money into us, and that's why they have the majority- Mm-hmm... ownership of, of the company.
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And, um, and by keeping our costs low and by being efficient in our process, which most big pharmas are not, we can actually do this cheaper. Like we got, we got through our phase one now in TB for about $25 million.
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If, if you ask David's colleagues, it could be 40, 50, 60, $90 million to do the same work. Mm-hmm. And, um, because they don't know what they're doing, and everybody has a big ego.
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And, you know, we have, we have, you know, a very small decision-making unit. If we have a problem, Daryl and I sit at a table. We address the problem, it's addressed, and now we move. We don't have committees.
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We don't have layers of bloated salaries. Um, we don't go off on crazy things that, you know, might make a fortune but usually don't. Uh, so it's, it's a whole different ethos.
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It's- We, we, we- Michael, it's, it's so fragmented in the US, all the different pharmas. Everyone's trying to get their own piece to compete with each other- Yeah... doing the same thing, so I, I completely agree. Yeah.
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Yeah. Yeah. And we're, we're in Waltham. We're not in the center of Boston. We're in Waltham, Massachusetts, and we're in a inexpensive building, and we're on the first floor.
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So everywhere we can look to save money, we do that. But what you're creating with tuberculosis too, it's a technology- Yeah... right? It's a, it's a, it's a delivery technology that may have other ramifications.
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Big time. Big time. 'Cause we can do something that none of the big companies have figured out how to do yet, which is we can target and bind our medicines, our vaccines, to very specific places in the human body.
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So what that does is it allows us to use a smaller dose, which brings down costs. Mm-hmm. It allows us not to have side effects on our medicines because they don't float systemically in the bloodstream.
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They just go right to the problem. And the, that's, that's what we-- that's our competitive advantage. We can target and bind. It lowers costs, it lowers side effects, and it creates greater efficacy.
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It's very interesting. So your cust- your, your company is based in the US, and then you run your trials in, in Rwanda, and then you give it back to Rwanda. How, how does that all work then?
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So we're, we're, we have two, uh, good-sized labs and offices, one here in Boston area and the other in San Francisco. So we built the labs around where the people we want to work with live.
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We, we didn't, we didn't build something and then attract people here. We found the best people. "Where do you wanna live?" "We wanna live in San Francisco." "Okay, we're gonna build you a lab." They're very happy.
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That's one of the reasons they've stayed with us.
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The other thing is that we have partnerships and validation from the National Institute of Health, the Gates Foundation, the European Investment Bank, from the N- NIH V- VRC people, and from CEPI, which is the Coalition for Epidemic Preparedness.
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They've given us more money in grants than we've ever raised privately because they believe in our mission and our technology. They're also charmed finally by us being African.
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Because when I first went to them and I said, "Well, we're this African company, but we have no IP yet, and we..." They would laugh at us, like literally not return phone calls. Now we show the data
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and, and we're African, and it's the most charming thing they've ever heard. So they're writing, just standing up and writing checks to us.
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So the science is starting to show, and things are g- starting to get, uh, uh, I'm not gonna say easy, but there's starting to be a clearer path now.
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I would say, I'd say the way to put it is that, um, that we squeezed a lot of risks out of the system now, and now it's about execute, execute, execute. Mm-hmm.
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You know, w- five years ago, we didn't know if the science would work. Well, t- that's, that's been clarified. It works. So now- Mm-hmm... how do you get into trials at the right time? How do you pick the right partners?
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We wanna do manufacturing in Senegal. We wanna do trials in South Africa. We, we've raised our money from the Caribbean to Europe, all across North America.
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Um, and, and we did something really good, which is we didn't, we didn't raise a lot of money at first. We raised money after every scientific milestone has been achieved. So what does that do? Mm-hmm.
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By raising it that way, you keep the valuations going up and up and up every time you raise money, and that keeps the Rwandan people in charge because their initial investment hasn't been diluted.
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Well, and that's actually perfect timing that you brought that up. Correct me if I'm wrong, you're the first African-owned pharmaceutical company?
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Yeah, we s- we, we think we're the, the only African biotech that is doing discovery of new drugs and will be vertically integrated into trials and manufa- We think that. We're...
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I, I hesitate to say we are, but I ha- I haven't found anyone else- Right... who's doing it. There's 14 million citizens that are shareholders, right? Yeah, yeah, yeah. So how does that actually- Going through that...
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work in practice, though? So the, the 14 million citizens have universal education, universal healthcare, and they all have a pension plan. They all have a pension plan. Mm.
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And it's run by the Rwanda Social Security Board, who is about two and a half billion dollars. So even though it's a poor country, there's some rich organizations.
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So we're about 1% of their, of their assets, very tiny amount. Um, and they give us the money to keep going.
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And, uh, and then I have the trippy kind of thing that I get to say, which is I'm driving down in, you know, Land Rover, you know, Land Cruiser going through the savanna and the veld, and I see an old woman, barefoot maybe, pile of potatoes on her head, and I get to say, "That's my boss."
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You know? Mm. [laughs] That's amazing. So here, here's a question, though, you know, for our audience members that are, are thinking about this. Um, you know, there's plenty of corruption here in the United States.
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We hear about a plan that's happening like this, and we'd probably be championing it. But we hear about it in Africa. Mm-hmm.
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We hear about it in Rwanda, a place where we don't know and a place where we think of corruption. What do you s- say to those audience members that are having those thoughts? It's a, it's a terrible problem.
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Not in Africa, but like I gave a talk at Harvard Medical School a few weeks ago, and all they... They didn't wanna know about the medicine. They wanted to know about how much I owned of the company.
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They wanna know who's on the board of- Right... directors. They wanna know what controls- Mm-hmm... 'cause they just assume it's a lot of corruption. And I'm embarrassed for them, but I also kind of understand.
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So here, here's, here's my s- here's my answer. We're only six or seven years old.
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We've been audited, uh, three times by American public, uh, accounting firms, uh, twice in Africa, and once by SEPI, the three and a half billion dollar global fund, and nobody ever asked us- Mm-hmm... to, to audit us.
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I put the audits in place with PricewaterhouseCoopers, for example, and said- Mm-hmm... "Find anything that we can do better. Find anything that's wrong 'cause I wanna publish the results." Amazing.
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So we have, we have to do things. Well, the optics are clearly important in this. A- absolutely, 'cause people are looking for me to learn, you know, I own 80% of the company when I own 7%, you know?
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And David will tell you, 7% as a founder of the company's, uh, you know, uh, is, is, is not much. Much. It's not much. Yeah. So... And I have to say, Jim, I think [laughs] in, in America we have just as much.
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It's just probably hidden in the shadows- We're, we're just better-... for corruption. We're just better- For sure... at it in America. [laughs] Yeah. No, that's, that's- Yeah...
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100% the case, but I mean, there's a real reason why, Michael, you've had to really take the optics into- Yeah... consideration with every step- Yeah...
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of the way, with fundraising and- Well, and then, and then on our board of directors.
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You know, our founders were Donald Kaberuka, who was the president of the African Development Bank and the chairman of The Global Fund in Switzerland that manages money for the whole world of infectious disease. Wow.
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And another founder, uh, director of this was Paul Farmer, maybe the most famous physician in the world, a university professor at Harvard Medical School and, uh, you know, a l- a living, a living saint until he passed away three years ago.
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Well, he's definitely a, a, a legend in global health, and so he was a real actual personal- Oh, yeah... personal influence for you. Oh, yeah, yeah.
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No, we went to Paul early on, and we said, "You know, we wanna do this right, and what do we focus on?" And several feet away from where he, uh, ultimately passed away, we were...
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We, Daryl and I had a meeting with him, and he said, "Focus on the toxicity because that's what's keeping people from continuing on the drug, and focus on the entire value chain," you know? Like how- Mm-hmm...
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this thing gets approved and regulated and manufactured and distributed because what the geniuses at the global pharmas do is they focus on a big fancy drug that, you know, kinda works, but it's toxic.
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It can't be manufactured. It can't be transported to Africa, and they forget the whole thing. But our
guys- Mm...
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being older and experienced, they've developed drugs before from concept to bedside and gone public with their ideas and made billions of dollars. They know how to do it.
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So I, I, I, I opted for the well-rounded, experienced track record person with no drama versus the post-doc genius- Yeah... disruptor who turns out to be disruptive in more ways than you're counting on. You know?
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Honestly- Man, there's so much-... sounds like, sounds like a place I would wanna work [laughs] Yeah, yeah. Well, you're invited. Ideal Pharma. [laughs] You're invited to apply. I, uh, I like you already.
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[laughs] Again, there's so many things that we could be going into here. We are looking at our... needing to wrap up time-wise, so this is a big bet that you've made on many levels.
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We're talking to some founders that are making a bet on something like tuberculosis, the world's most infectious disease, but you're making a bet on a system. What does success look like for you?
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Success looks like in, in less than 36 months, so coming up fast, we have a monetization where we return all the capital to the ladies with the potatoes on their head times 50. Mm. That's, that's, that's success. Wow.
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Times 50.
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L- likewise, we have the global standard of care for tuberculosis and a couple of other things so that, so that when someone gets sick with TB They go to a community health worker who sits them down, gives them an injection, an infusion,
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and they take another one 30 days later, possibly another one 30 days after that, and they're cured. That, that's- Mm...
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so it's a financial return to the average citizen of Rwanda, and it's a global standard of care in tuberculosis with a whole pipeline of interesting things behind that.
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You've done so many interesting things in your life and, and dealt with so many issues in, in so many countries. Is this, is this the, the, the hallmark thing that you're trying to do right now?
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What it is, what it is, uh, Tim, is the thing that makes everything else make sense. [laughs] Mm. You know? The culmination. [laughs] The culmination.
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If you- If I, if, if, if I'm just speaking personally, yeah, it's the thing that makes everything else finally make sense. Hmm. I love that. There something tangible you can see.
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'Cause when, when I asked you what success was, you went right to the image of the people- Yeah... the people that you're- Yeah... working for, which are the Rwandan- Yeah... citizens and the, the agricultural farmers.
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So you, you, you have their faces in, in your mind as far as that is gonna be success of- Oh, yeah... helping them out. Yeah, for sure. It goes back to Peace Corps, where we started.
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You know, you come into my kitchen and you want a glass of water, I give you a, a peanut butter or, or jelly jar to drink out of. Uh, you know- [laughs]... we're, we're, we're nothing fancy.
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Well, and, and actually that's an important point too, because [clears throat] a little bit in the way you pictured it, we could be also misconstrued that it's almost like, okay, that's Social Security, socialism handout.
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But what you are doing is much more than that, right? The, what you've identified in other, uh, developing countries is they've made their money off the back of minerals that are- Yeah...
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exploited by [clears throat] outside companies. You're trying to grow industry from within Rwanda that's gonna last well beyond your lifetime and well beyond Kagame's lifetime. Is that right? Yeah.
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I mean, if you, if we could build a generative capacity for, for these amazing scientists in the diaspora, these Rwandan scientists in France and America, to come home and not just practice in another big, dumb company, but to be generative with their own solutions.
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You know, no one's gonna remember my name or Daryl's name, but the fact that that- Hmm... might continue after us, that's, that's a very exciting proposition. We talk about it every day. That's, that's a legacy- Yeah...
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right there. And, and Michael, I think what you said earlier about advising and, you know, w- sometimes it's a hit, hit, sometimes it's a miss, I think everything's added up to a giant hit. Oh, that's nice of you to say.
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So I think you should feel free to agree to that. [laughs] I, I hope and I believe you're right. We- A little bit more time will tell. Yeah, this does, it comes full circle.
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You've had a, you've had a bumpy road like all of us, and, but hopefully we're wishing you the best for success on this one on so many levels, 'cause, I mean, not only are you gonna have a huge impact in
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tuberculosis and on Rwanda, but this could be a, a whole new- Yeah... model and of, of, of industry, private-public partnership of taking on some of the world's greatest he- health challenges.
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I really, I really think that's going to happen. Wow. [laughs] Every time. I know, right? Every one of our episodes. W- yeah. I, I, I think...
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So first off, he is just way too humble. I mean, th- this guy does, he's sat with world leaders. Deep influence. We didn't even get, uh, to talk about more of his experience with Nelson Mandela.
Yeah.
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He's been a, he's been a- Yeah... actual influential advisor to many of the people that we know from history books or news. [laughs] But the, the crazy part, and this is super... Uh, uh, I think there's a thread here.
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These people that have been huge change makers, like N- Man- Mandela, right? Yeah. People that have, you know, transformed the world and make the world a better place- Mm-hmm...
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they've needed people to get there, and I think- For sure... he being a part of it, right, uh, all these folks h- probably have some form of Michael Fairbanks on their side to, to- Oh, yeah...
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help them get there, and I think that's the story we're trying to tell, like before the cure. Like, all these people trying to do innovative things, they didn't do it by themselves, right? No.
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There's, there's a story, there's a team, there's a, there's something that led there, right? There's always key teams. I mean, you can liken it to some of the, the great climbers in the world, where there was- Hmm...
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the Sherpa right behind carrying all their stuff and did- Oh... the exact same climb, right? That's a great analogy. Yeah. There's always a team w- a team there.
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And Michael, you know, he's been one of those not loudly making himself known, like the, the, the- Yeah... rest of us don't know the w- name Michael Fairbanks, but he's, he's been deeply influential in history.
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But what I love more than anything is him having a background as a banker working IMF. I mean, I'm a reader of Noam Chomsky and Eduardo Galeano and all of these- [laughs]...
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you know, historians that talk about some of the legacy of the IMF, but he appears to me to have a real genuine interest in, let's just put it simply, doing the right thing. Hmm. Mm-hmm.
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You know, not exploiting- S- saying the right things. [laughs] Saying the truth. Saying the, saying the truth, trying to have a tuberculosis drug be free for Africans, for Rwandans. Yeah. Yeah.
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And going to make the wealthier countries pay for them. And you see it in some of the decision-making where all of his advising really has genuinely been about building industry that's not the exploited industry.
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It's not- Yes... coal, it's not- Right... gold, where companies just come in, hire people for cheap, and take it out. Even when we're talking about electrification, lithium- Mm-hmm, mm-hmm... cobalt.
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Major, major- It's always an easy way out... you know, issues with human- Yeah... rights r- work. So he's, he's been, throughout his whole career, saying, "Step away from that.
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Let's develop other things c- that can actually holistically build industry from the ground up and can-" His number one passion late, uh, the last 20 years has been with Kagame and Rwanda. Yeah.
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And they've already had impact, but what an impact this would be, right? Yeah. It's huge. Honestly, I didn't even know about it until you brought him up as a, as a person.
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And so that's why he, he, he for sure is the only biotech doing this in the world. Wow. Um, where it's partly owned by, by the people, and he's flipping the, the model on its head. Is an interesting thing. He's got...
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I- it's a constant battle for him. At the end of the day, he might be- Mm-hmm... a Rwandan citizen, but he's a white guy from Scranton, right? Yeah, yeah. And so- Can- can't get more stereotypes than that. Y- yeah.
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Well, when you go into a room and talk and, and whether he's speaking to the Rwandans, he's gotta prove himself, or whether he's speaking to financiers or the Bill Gates Foundation or whoever that is, there's a constant uphill battle of what he has to prove, but he seems to be putting the pieces together and ma- ma- they're making incredible progress.
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Yeah. I'm, I'm super excited, especially to follow up with him in the future. Or season two on the road, Rwanda. [laughs] [gentle music] This is Before the Cure. I'm Timothy Wheeler, joined by my co-host, David Tsai.
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Together, we explore innovation in healthcare before outcomes are certain. Because progress doesn't happen in isolation. It takes trust, it takes courage, and it takes community.
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We're just beginning, so stay close at beforethecure.org. Because at the end of the day, we're all patients, and we can do better. [upbeat music]