Q&A: This pediatrician leads one of the world’s largest philanthropies

Priscilla Chan, MD, has worn many hats. The daughter of Chinese immigrants who fled Vietnam in refugee boats, grew up near Boston, served as an interpreter for her grandparents and was the first person in her family to graduate from college.

She was an after-school teacher in social housing and a pediatrician at a safety net hospital in San Francisco. In 2016, she co-founded The Primary School, a nonprofit that provides K-12 education and perinatal care in the San Francisco Bay Area.

Her goals to improve health, science and racial justice on a global scale are also multifaceted.

“I love being on the front line. I love being with kids and families, but I have to say that the systems we work in make it very difficult to really have that impact,” said Dr. Chan in an interview with AMA Executive Vice President and CEO James L. Madara, MD .

dr. Chan discussed the Chan Zuckerberg Initiative, which she co-founded with her husband Mark Zuckerberg. The initiative aims to improve education and tackle other challenges, such as eradicating disease. dr. Chan, an AMA member, manages day-to-day operations and recently spoke with Dr. Madara on the goals of the initiative and her role as a physician-trained leader.

Recorded for presentation to senior AMA executives, this interview has been edited and condensed for clarity and readability.

Dr Madara: In 2015, Priscilla and her husband, Mark Zuckerberg, founded the Chan Zuckerberg Initiative. Would you like to tell us about your own training and how it relates to and influences the initiative?

dr. Chan: My family story is why I do the job I do. My parents, my grandparents came to this country as boat people during the Vietnam War as refugees… with the belief that there must be a better future somewhere else. And how incredible is it that it all worked out? I had great mentors at my school. I had people watching me, great public schools. And I ended up as a Harvard student with opportunities I didn’t even know existed.

And I felt so overwhelmed with all kinds of emotions, but a big one was gratitude – that I had to give back.

When I co-founded the Chan Zuckerberg Initiative with Mark, it was really – from my perspective – how can we make the systems work better? How do we give primary care practitioners better tools? …

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Dr Madara: There must have been a learning element from the beginning of the initiative to today. Can you say something about that?

dr. Chan: I was convinced for a long time that I had to go to business school or that there had to be a paper, a book, a reference that I could look at and tell me what to do.

Turns out – I don’t think there is. As a leader, the questions you face are often the ones that don’t have a clear answer. We have to deal with that in medicine. There are tradeoffs and you have to make the best choice possible. Being able to look at data, look at imperfect data and make a decision is something I do every day.

Dr Madara: The initiative is described here [in Recode] as “one of the best-funded philanthropy in human history.” Your initiative has deep pockets, but in the US health care system alone, we have a $4 trillion annual ecosystem. How do you choose and choose impact strategically, given this huge system in which you participate?

dr. Chan: The world we work in is a huge ecosystem. And we are a very small part of that. So when we say that our goal is to cure, prevent and control all diseases by the end of the century, we are 100% not doing it alone. We’re just confident that if the ecosystem works together, and if we do our part – as well as many, many others – we have a chance to do that.

We have a great multidisciplinary team of scientists, computer biologists, data scientists, engineers, product designers, policy makers and user experience experts. And they have unique skills to understand a problem and build software.

Before the pandemic, we had built a tool called IDseq that would allow us to take the output of a sequencer from any sample. What the software would actually do is pull out all the human DNA and then identify what’s left and compare it to the known library of infectious diseases.

And we were able to help scientists and health professionals identify – free of hypotheses – what infectious agent might be in a sample. That was great and we were excited about what it could do for unknown diseases. …

When COVID-19 occurred, the software was able to immediately identify cases of COVID-19, and even one of the first cases in Cambodia, one of our partner sites.

We have sent our scientists. We sent our user experience experts. We sent our wet lab trainers to public health departments to try and meet their needs — another set of practitioners who needed to be able to do metagenomic sequencing of COVID-19 to understand the barriers coming into their communities. We were by no means the public health system, but we were able to fill a gap to allow those practitioners to do their best work quickly.

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Dr Madara: When we talked about the AMA strategic framework earlier, we made the point that the newest accelerator in our framework has to do with health equity. I know you are interested in community work, but also in justice. Can you say more about that?

dr. Chan: We cannot achieve our mission and vision of curing, preventing and controlling disease for all if we do not take health equity into account. It is a generalization, but largely true, that our basic scientific research overrepresents white men of European descent or people of European descent in general.

And that leaves out many people who are not represented in our scientific understanding of the human body. We just launched an RFA [request for application], looking at bringing in different datasets of people from all different ancestors who are traditionally underrepresented.

We also look at age. I may be a little biased because I’m a pediatrician, but development happens and we can’t just extrapolate that kids are little people. A baby is also not the same as a teenager. And so, how do we actually understand the course of development in different age groups, over the span of a lifetime, to enable us to better understand and better serve people of all different ages and backgrounds?

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