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Gates Foundation CEO Sue Desmond-Hellmann, pictured here at the 2018 GeekWire Summit, led an expansion of the philanthropy’s ambitions and executive team. (GeekWire Photo / Dan DeLong)

Sue Desmond-Hellmann, the physician and scientist who led the world’s largest philanthropy as CEO of the Bill & Melinda Gates Foundation for more than five years, announced Thursday morning that she will leave the role early next year.

Mark Suzman, a 12-year Gates Foundation veteran, was named as her successor, the fourth CEO in the 19-year history of the Seattle-based organization.

“This was without a doubt the toughest decision of my career,” Desmond-Hellmann wrote in a message to the Gates Foundation’s employees Thursday morning, reminding them that one of her mantras is to “take your own pulse first” before charging ahead. “Over the last few weeks and months, I have done just that and concluded that I need to slow down.”

In an interview with GeekWire this week, Desmond-Hellmann cited the toll of the travel required by the role, and the growing needs of her own family. In addition, she said she feels confident in the Gates Foundation’s executive team, which was expanded and strengthened under her leadership.

“I wanted us to be able to have an executive leadership team that could put in place a budget and allocate assets that were consistent with what Bill and Melinda wanted to do but didn’t require them to be involved every step along the way,” she said. “And then finally, the succession planning led to me recommending Mark Suzman to succeed me. So the organization’s ready, I’ve got a successor ready, so it’s a good time for me to step down.”

Asked about the biggest challenges Suzman will face in the role, Desmond-Hellmann cited the inherent difficulty of pursuing audacious goals while also being pragmatic.

“One of the things I love about Bill and Melinda is they’re really ambitious. And I can tell you that it’s no fun to say no to Bill and Melinda. But occasionally, we have to say, ‘Not yet,’ or, ‘Not so fast.’ ” she said. It’s important to find the right balance, she added, “because it’s a lot of money, it’s a lot of capital, and making sure it’s spent wisely and that it creates a more equal world, that’s the job.”

Gates Foundation CEO Sue Desmond-Hellmann and her successor Mark Suzman. (Gates Archive)

Desmond-Hellmann said she continues to have a strong relationship the Gateses, and with Warren Buffett, the billionaire investor who is giving away the majority of his fortune via the foundation.

“One of the things that I really value about working here is the incredible generosity of the three of them and the involvement of Bill and Melinda,” she said. “It’s been an intense five-and-a half years, and we remain good colleagues.”

In statements released by the Gates Foundation, Bill and Melinda Gates both praised Desmond-Hellmann and expressed confidence in the philanthropy’s future under Suzman’s leadership.

Melinda Gates said Desmond-Hellman brought an “incredible set of attributes to the foundation: scientific expertise, tested leadership skills, a passion for building a strong internal culture, and, above all, a dedication to the mission of making the world a healthier, more equal place.”

Bill Gates cited Desmond-Hellmann’s work to launch the Gates Medical Research Institute and expand the foundation’s efforts in U.S. poverty and economic mobility, in addition to its core initiatives in global health and U.S. education. He described Suzman as a trusted adviser for more than 12 years.

“As we conclude our foundation’s second decade of work in global health and education, I have never been more optimistic about the opportunity to improve life for the world’s poorest,” Bill Gates said.

Desmond-Hellmann was the first person without a Microsoft pedigree to lead the $46.7 billion philanthropy, and she will be succeeded by the first Gates Foundation CEO from outside the country.

Suzman, a native of South Africa who is currently the foundation’s chief strategy officer and president of Global Policy & Advocacy, will start in the role in February. He worked in senior policy and strategy roles at the United Nations before joining the foundation, and was a correspondent for the Financial Times in Johannesburg, London, and Washington D.C. earlier in his career, covering issues including apartheid.

Desmond-Hellmann described Suzman as smart and intellectually curious with strong judgment and a sense of humor. In addition, she said, “Mark is very committed to the success of his team members, including women,” calling him “a real champion of women and the focus we have at the foundation on gender and gender empowerment.”

Sue Desmond-Hellmann in Bangalore, India, in 2016. (Gates Foundation Photo)

Desmond-Hellmann began her career as a practicing oncologist in San Francisco. She moved to Uganda to provide medical care to patients with HIV/AIDS and cancer alongside her husband in 1989. When she returned to the U.S., she continued her work as a physician for several years before taking a position at the biotech firm Genentech developing gene therapies for cancer.

After 14 years with Genentech, Desmond-Hellmann went on to serve as the first female chancellor at the University of California San Francisco.

When she interviewed for CEO of the Gates Foundation in 2014, she took an unusual approach. She wanted to provoke Bill Gates — the famously fierce co-chair of the foundation and co-founder of Microsoft. The goal was to find out whether she could have the type of spirited debate that was important to her previous roles, so she asked Gates about criticism that the foundation was spending too much on a nearly-eradicated disease, polio, when it could be focused on other priorities.

“Boy, he did get really fired up … I enjoyed him getting fired up because he was mad at the problem of polio,” she said, speaking on stage at the 2018 GeekWire Summit. “He wanted to get rid of polio, but I didn’t really test what it was like for him to get mad at me.”

During her time at the Gates Foundation, Desmond-Hellmann saw polio nearly eradicated, a key focus of the nonprofit. But she also cited setbacks in the fight against polio as an unexpected challenge.

“We underestimated how hard polio would be,” she told GeekWire this week. “I wish I could have had the foresight to know how long this journey would be and I think that not knowing that, we may have advanced some of our investments in the R&D space, or how we thought about polio control earlier, had we known that 2019 would be a such a tough year.”

Other achievements under her tenure include expanded access to contraception for women around the world, new vaccinations, and advancements in medicine.

Sue Desmond-Hellmann, CEO, Bill & Melinda Gates Foundation (left) visits the World Mosquito Program, Brazil, in Rio de Janeiro on June 19, 2018. Luciano Moreira, Project Director (right) of the program shows Sue around one of the research labs.
Sue Desmond-Hellmann, CEO, Bill & Melinda Gates Foundation (left) visits the World Mosquito Program, Brazil, in Rio de Janeiro on June 19, 2018. Luciano Moreira, Project Director (right) of the program shows Sue around one of the research labs. (Gates Foundation Photo)

Desmond-Hellmann also led the foundation into new areas of philanthropy, like domestic poverty. Early on, the Gates Foundation was largely focused on disease and poverty in developing nations, and education in the United States. But in 2018, the organization launched a $158 million initiative to combat poverty in the U.S.

“Here in the U.S., we recognized some things after nearly two decades in education, and that is that many things that cause inequity in the United States happen outside the classroom,” Desmond-Hellmann said during her GeekWire Summit talk. “That’s a big ‘aha’ for us. We have not stopped focusing on education as the escalator out of poverty or low-resource situations. What’s new for us is the recognition and the investment … in economic mobility and opportunity.”

Earlier this week, Desmond-Hellmann announced she will donate her five-year bonus from the Gates Foundation to former Seattle Seahawk Doug Baldwin’s philanthropic project, a community center for kids and families in Renton, Wash.

In October, Desmond-Hellmann stepped down from Facebook’s board of directors after serving more than six years. She was the second woman to join the tech giant’s board.

She wrote this morning in her memo to employees, “At first, I thought cutting back on work commitments outside the foundation—such as my role with Facebook—would allow me to carry on as CEO. What’s become clear, however, is that to care properly for myself and my family, I need to move back to California and can no longer work full time.”

“I will miss the foundation, and especially all of you, so much.”

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