Big Bets: How Large-Scale Change Really Happens

Rockefeller Foundation president Shah’s encouraging debut couches advice on making broad social change in stories from his career. He illustrates how asking “a simple question” can “reorient thinking, crack open possibilities, and reveal paths previously hidden” by recounting how during his time advancing global vaccination efforts for the Gates Foundation, he asked UNICEF, vaccine makers, and health workers “what would you do if you had a magic wand.” He learned that UNICEF’s inconsistent funding sources made it difficult for vaccine producers to plan around their needs, leading Shah to focus on securing long-term funding commitments. Entreating readers to “keep experimenting,” Shah recalls realizing as administrator of USAID during Liberia’s 2014 Ebola outbreak that the conventional response—isolating the infected—was not feasible given the scale of the epidemic, prompting him to support more culturally sensitive measures, such as providing protective gear so traditional burial teams could safely bury the dead, which had previously been a transmission hazard. Shah’s uplifting stories of helping coordinate medical care in postearthquake Haiti and increasing access to Covid-19 testing in the U.S. over the first year of the pandemic underscore his message that meeting apparently insurmountable goals requires thinking big, though the broad recommendations (“take concerns as challenges”; “when you screw up, own it and apologize”) sometimes feel like afterthoughts to his anecdotes. Still, this will inspire. (Oct.)