Q&A | Tadataka Yamada, Gates Foundation

Dr. Tadataka "Tachi" Yamada, president of the global health program at the Bill & Melinda Gates Foundation, joins his boss Bill Gates in becoming knighted today.

In receiving the title of honorary Knight Commander of the Order of the British Empire (KBE), Yamada was lauded for his work with U.K.-based pharmaceutical giant GlaxoSmithKline. Yet that work has had its share of controversy, including a GSK patent lawsuit against the South African government to stop it from distributing low-cost generic AIDS drugs.

Recruited in 2005 to lead the foundation's largest division, he directs a $1 billion budget and a vaccine development partnership with his former employer, GSK.

Here are edited excerpts of an interview with him in May.

Q: What was happening at GSK while you were there?

A: We got ourselves into this bind. Frankly, a lot of us in the company asked ourselves why we were working there -- what we were supposed to be doing.

I was head of R&D and had been a board member. I really felt we had to do something very visible commiting to patients who needed our medicine. We set up a research unit in Tres Cantos, Spain, which was focused only on drugs for diseases of the developing world, primarily malaria and TB.

It was really interesting because the decision was made. We give all this money to local charities, to museums, to the ballet -- why don't we just not do that, but do something really meaningful with the money? So in a way our local community suffered, but it made everybody in the company feel better. It was very motivating. For me, it was really an awakening of a sense of real responsibility for what was going on in the world.

Q: At what point did you decide to leave and work at the Gates Foundation?

A: [In November 2005] I came to actually check to see that our programs were doing well; Rick Klausner who was head of global health was leaving. I wanted to just make sure that upon his departure the commitment to the programs we were involved in with the Gates Foundation-funded organizations, like Medicines for Malaria Venture and the Global Alliance for TB, were going to be OK.

After the meeting, Patty [Stonesifer, the foundation's CEO] said she wanted to talk to me. We talked and the subject of my coming to the foundation was discussed. For me it was a no brainer.

Q: Why?

A: My whole career has been focused on seeing how I can have greater impact on patients. I started as physician. I figured being a physician was about being a good doctor to your patients. That's true, but I learned in medical school you have to be a good scientist to be a good doctor, so I got interested in science.

I was recruited by a headhunter to join the board of a phamaceutical company. I thought, boy that would be interesting, maybe I could learn something. After I joined the board I learned what a pharmaceutical company is, what it does, and the idea that you could make a medicine that affected millions and millions of people's lives, that became very appealing to me.

After I had seen kind of what the problems were in the developing world and we got involved in this whole thing of making medicines for people all over the world, the Gates Foundation offered an opportunity to have that direct impact on so many peoples lives. It was a slam dunk for me. It was like I trained my whole life to do this. It takes everything that I've learned about science and medicine and business to do this well.

Q: What is your main focus right now?

A: What is the goal of the foundation -- it really is a reflection of the benefactors' concern about inequity in health care throughout the world -- and, I guess, a fundamental bias to apply science and technology to provide solutions to this inequity.

So what the global health program does [are] three principal activities: to do everything in our power to provide access to existing health care solutions; to do research and development into new solutions for health care problems for which there are no or inadequate solutions; and to commit to advocacy so that we can bring new interest and funders to supporting the kind of work we do.

Q: How does your GSK experience apply here?

A: When you talk about discovering, developing and delivering new solutions for health care, that's exactly what a phamaceutical company does. Now in the Gates Foundation, the solutions are not always drugs or vaccines.

The approach that a phamaceutical company might take to developing a new medicines is very much a similar approach: understand the fundamental basis of the disease to get a lead as to what might work in preventing it or treating it, then develop that lead into a real full-fledged solution or product, then figure out how to deliver that product.

Now the delivery part is where I think the not-for-profit world could learn something from the for-profit world. Phamarceutical companies are masters at marketing. If they have the solution, they will try to reach everybody in the world that should benefit from the solution and have them understand why it's important for them.

In our not-for-profit world. we tend to think: If you have something good, well everybody should take it up; but actually you have to sell it. This is like your mother saying: Take it, it's good for you. No kid is going to take it unless he feels somehow it's cool to do it.

How is it that the tobacco industry sells tobacco? Frankly tobacco is sickening when you try it -- you cough, you get sick; but they've convinced kids that it's cool to smoke.

Remember the character Joe Camel? The whole point is it was cool. What I think is really great about smoking cessation in the United States is that the balance has shifted now. It is no longer cool to smoke. You're kind of a social outcast if you smoke.

The whole thing about public perception and the linkage of the perception to who you are as an individual is really a very important part of marketing, whether it's clothes or cigarettes or health care solutions…

So I tell our team: it's not enough to actually make a new solution; you actually have to figure out how to deliver it, and that is a very complex issue of having the right resources, having the right infrastructure, but also creating the demand.

Q: What are some of the areas you're working now to use this marketing approach to change the perception of a disease or treatment?

A: We're thinking about it in a lot of diferent ways. We have a very big project in HIV prevention in India which focuses on female sex workers, MSM [men who have sex with men] and IV drug users. In this case we have to empower the sex workers so they can demand their customers use condoms.

The whole program is about social empowerment. Even though you're a sex worker, you have rights, you have strength. There's building a community around these sex workers through working with the local communities, giving them a sense of power- ownership of their own bodies and their own capabilities and ensuring that they demand that their customers use condoms. That's changing a perception of who you are.

If you just give condoms and say, "Use them," you haven't solved the problem until you actually empower the female sex workers to have a sense that they have the right to ask people to use condoms and to refuse services unless a condom is used.

Another upcoming example -- now we have data that shows that female-to-male transmission of HIV can be effectively prevented by circumcision. with 50-60 percent efficacy; I don't know how we're going to start this campaign or what we can do. There are a lot of social issues and customs. But in thinking about how to do a circumcision program, you clearly have to think very carefully about what it takes to convince somebody that this the right thing to do for themselves.

Q: How do you avoid the perception that this billlionaire in Seattle is trying to control the lives of poor people in Africa?

A: On the ground I don't think anybody links what's happening to them to Bill Gates. At the national level, the press, government officials may have a very clear idea of Bill Gates. But I think on the ground -- a bed net comes- first of all, more often than not, we're never doing it ourselves, but working through an intermediary -- a not-for-profit, a non-governmental organization -- they may be much more familiar with Nothing But Nets and organizations like that.

We certainly don't dictate what anybody does. We provide grants, guidance, suggestions. We hopefully can foster the sharing of best practices amongst our grantees. But I do believe the field is going to benefit greatly by understanding the concept of marketing, social marketing -- the whole business of creating demand.

Q: Aren't pharmaceutical companies worried if they create a successful new vaccine they will face political pressure to produce more?

A: As head of R&D at GlaxoSmithKline -- and we were one of the very, very big players in HIV medicines -- I would go to meetings with my colleagues, heads of R&D, and they would tell me: Why are you guys in HIV? Because all you do is get a lot of flak for being in that field; from the developed world you'll have the HIV activists raining criticism on you and then the developing world people will steal your medicines.

Well, if the pharmaceutical companies don't do it, then who's going to do it? It's just not going to happen. So there's a sense of absolute social responsiblity in staying in the field.

But I also think we have to even the playing field for the pharmaceutical industry. In the case of vaccines, one of the great new vehicles is what's called the advance market commitment a concept whereby donors will provide commitments to guarantee that if a vaccine is made, approved and a decision is made by a government to purchase it that there will be a subsidy on the price such that the overall market for the vaccine will be X size.

Kristi Heim: 206-464-2718 or kheim@seattletimes.com.

Sandi Doughton: 206-464-2491 or sdoughton@seattletimes.com.