JUST IN: Hillary Clinton Hosts Fireside Chat On Healthcare And Innovation At 2026 CGI Meeting

Please welcome to the stage Carmen Rojas, Nubar Afeyan, and Hillary Rodham Clinton. And I am thrilled to be back at CGI and especially to be talking about the issues that we're going to be addressing all today and tomorrow. And we have two people with us who are literally following Aisha's advice, which is to keep working through doubt, keep expanding possibilities, keep getting things done, pass by our perceived limitations, reimagine what's possible. And I want to, you know, thank you both for being here. And Nubar, I want to start with you. Some of you know him as the pioneering CEO, founder, brain behind Moderna, and all that it is doing to protect our health and to solve problems. But also, you are the chief executive officer of flagship pioneering, which invests in a lot of companies. And you have so many patents, you know, I don't know how you keep track of them. But what I want to ask you about is, in the field in which you have spent your life, health, biology, science, how do you think about moving past what is, quote, realistic and instead asking what's possible? How do you challenge yourself? How do you challenge that mindset so that it's not blind trust, as we heard from Aisha, it's earned trust to catalyze breakthroughs like you did with Operation Warp Speed. And now with a, you know, vaccine that is in the works, to deal with cancer? Well, first, thanks so much for having me. It's great to be back wearing a different hat. I've been here before representing some of our humanitarian and philanthropic activities, and I'm happy to be here in my professional capacity, which isn't that different, it turns out, as I'll describe. So I run a firm called Flagship Pioneering that set out about 26 years ago to ask the question, what if the act of making breakthrough innovations and creating companies could become the product of organizations, of systems, of a learning environment, as opposed to what we're used to, which is one in a thousand companies does something remarkable, and then we celebrate them when we make movies. But in the end, it's not a scalable process. And that's kind of what we've been doing. And to your question, how do you overcome the gravity of reasonableness? You start, at least for me, by asking the question, why would we expect reasonable people doing reasonable things, creating extraordinary outcomes? Just ask yourself the question. And yet, every dollar of investment is looking for reasonableness. That's what due diligence is about. That's what large companies, small companies, grants that get a bunch of people, they're assessing how likely is it to work. If it's really likely to work, then a hundred people are working on it. Now, of course, there's an onslaught of foreign R&D centers that are also competing. So we kind of asked ourselves, could you instead prosecute the present from the future backwards? Could you use the facility that we all have, which is ironically suppressed in the sciences, which is imagination. In arts, imagination is encouraged. In science, you're supposed to be grounded with truth, and then little approximations a little bit further from the truth. We asked ourselves, what if we could just ask, what if you could inject the molecule in a person and make any protein drug you want? We asked that question in 2010, and that question led to the creation of Moderna. We did not start with a solution. We did not start with a problem. We started with a what if. We could envision possibilities, and then work backwards from there. So we used that. We used the notion that reasonableness results in commodity innovation. Unreasonableness, once in a while, will give you breakthrough innovation. And all of those things, 25 years later, have taught us how to really take on what seems impossible, but that's a bit of a mirage. It's just not yet possible. That's the way we view it. Well, I really appreciate your idea about how you push the limits, how you create a new reality by imagining what's possible. And in the field of philanthropy, we have Carmen, who is also not afraid to make bold moves. At the Marguerite Casey Foundation, you just pledged at least $500 million to non-profit grants over the next decade, which is a 50% increase over your average giving in the past, and way beyond the 5% threshold that most foundations, you know, feel that they have to meet legally, but don't often go much further. And how did you arrive at this decision, and why now, and what have been the immediate outcomes, Carmen? Yeah, so first, thank you so much for having me here today. I could not be more delighted. And second, happy Hispanic Heritage Month to Latinos in the audience. At Marguerite Casey Foundation, we are really working to support organizations that are delivering on the promise that government can work for us. And so I'll start with 2025. In 2025, we increased our payout to a hundred million dollars. And this is three times what we normally give out, because I think we can all agree that we are not living in normal times. And so our board and our staff got together as we were entering 2025 and asked two simple questions. Is it our job as an institution to exist perpetually and keep our assets? Or is it to meet this extraordinary moment with extraordinary action? And we made the choice to actually meet the moment. Thank you. And we learned a lot. You know, we're a pretty small team, and we moved three times the amount of resources that we normally do in an eight-month period. And the organizations that we support were ready for those resources. For us, we saw this as a real opportunity to be able to land dollars in communities across this country that are proving every day that the government can be an agent for good, should be working to make people's lives better. And so we made this next commitment of half a billion dollars over the next decade, because we see it as our job as foundations to move lots of money right now. If this is a moment where many people are describing as crisis, if this is a moment of crisis, then it's unconscionable for institutions like ours to sit on resources that could be so helpful for communities on their front lines. And so this is an invitation that I give to donors, to foundations in the room, to anybody who has a rich cousin, this is a moment to give out money, lots of it right now. You know, as you were describing that, Carmen, I was thinking about what Bill said this morning about how CGI was really created to mobilize civil society to fill the gap between what the market can provide, what government can provide, but also to be partners with government and business. But now with government receding so much, that gap is even wider. So your approach makes such good sense. But let's talk about risk, because nothing is risk free. And, you know, Neubauer, you can't be bold without taking risks. You just described how you wanted to go beyond realism to possibility. And you said something else that really made an impression on me, that oftentimes breakthrough ideas get discarded early because experts judge them in their most fragile, early stage. And they often discard ideas that many years later, like mRNA, was for many years, you know, discarded. And you came and understood its potential. But how do we strike the balance between protecting an idea and recognizing when something is going to fail? It's not a good idea. The risk is too great. And you've heard from Carmen that she now has increased her risk appetite to be quite high. You obviously have because you make a lot of bets. But at some point, how do you make the distinction? So let me just, you probably could tell from both of our answers that we have our own mindsets and our own belief system. So let me share with you how we think about this issue. So in innovation, the way you think about risk is that the further out an idea is, the lower the probability of success. You ask experts and they help you figure out whether something is likely to work, less likely. And that's the notion of risk. It's essentially an estimate of probability of success. Beyond the edge of where experts can judge the probability of success, what is there? Well, we know today that that's what people are going to be working on 10 years from now, because today we couldn't tell what will be evaluated 10 years from now. So what we call that in general is uncertainty. So at the edge of high risk, people believe is uncertainty, which is nobody can tell you if it's going to work. We generally and investors and innovators stay away from that. The worst thing in Wall Street, the worst thing is uncertainty. Our belief system is that actually uncertainty is where the breakthroughs of tomorrow exist today. And if you approach the uncertainty prosecution, doing work in uncertainty in a way that you could persist, that eventually the payoff is very different than if you just go after risk. So I would argue to people in the room that are in the business of assessing risk, that you're essentially fighting with other people over how good you are at assessing risk reward. If you jump over to uncertainty and not consider it as high risk, but rather unknown probability, some of the time that unknown probability results in a very good result. So what does that take? It takes an environment that first understands that, protects that, and is very fact driven as opposed to opinion driven. So often when you when you talk to experts who get views that are largely kind of opinions that because just based on practice, based on their expertise. What we want, when you go further out, you got to get facts. The facts tell us. So in fact, as I was listening to the last Aisha's comments about blind trust, et cetera, we have a slightly different view. We believe that scientific, future oriented scientific work entirely starts with faith. It's ironic. You might think, what does science have to do with faith? I think everything. Faith is belief without facts. The difference between what one might call religious faith and the faith that we use in science to do things that are well beyond the adjacencies is that it's our job to go get the facts. So we no longer have to believe without facts. We actually believe with facts and that's called science. All science is, is faith converted into what we call truth. So if you stay away from that level of reaching out to first deal with what requires some amount of faith, now it's not blind faith. It's faith that where you can diversify. You don't do one thing at a time. You do many. And then you gather facts, facts, facts. So for us, this recent years of debate in the last year or two about whether we should trust scientists or doctors or science in mRNA or in vaccines or et cetera. It's a very scary notion because science wouldn't work if you pit facts against opinions. Long ago, we did away with that. We said, you know what? If you want to argue facts, come with your facts. You don't get to make up facts. Well, in the environment we're in, this is very, very different. And so we've got to fight back and just use the tools science gives us, the scientific method to achieve facts, even though in the beginning we didn't have any. And that's where breakthroughs come from. That's so important. That's incredibly important to remind ourselves. And, you know, some of the debate that we're having against science and against facts just doesn't understand the scientific method. You know, you don't come with a preordained conclusion. You have to work. And when you make mistakes and when you find new things and when you have to then adjust, that's the scientific method. And the search for certainty and for people to feel that, you know, they can never be questioned and they are absolutist is the death of science. But it's also what you're facing, Carmen, because, you know, you go to your board, you go to your constituents and you say, I want to increase our funding significantly. And I'm sure the questions were, well, what are you basing that on? How are you making those decisions? You're challenging established thinking about how foundations and philanthropy should work. So what are the risks you have to take into account? Yeah, as a as a CEO of a foundation in this moment that believes that the communities that we are meant to serve are experiencing great pain. And so there was just a greater risk in the inaction. I'll go through a bit of philanthropy nerd school for folks who are not from philanthropy. Most people in philanthropy treat fiduciary duty as the duty to grow your institution infinitely. Your endowment grows and grows and grows. And it doesn't matter what you're invested in on your endowment. So the greatest, the clearest example I can give you is a foundation that works to address climate change, but is overwhelmingly invested in petrochemicals or in things that actually hurt the environment. That's sort of the conflicting commitment. At Marguerite Casey Foundation, we made that decision long ago that that was not a commitment that we were interested in making, that we wanted to align all of our resources to serve our mission. We wanted to treat this 5 percent as a floor and not a ceiling, that we wanted to move resources, lots of them, right now to be able to meet this moment. And so as I think about risk, I think about the risk that everyday people are taking in this country to help other people believe that the government is and should be a force for good. We pay taxes. And so regardless of if you're in rural Washington, in Chicago, in Milwaukee, the ability to understand that those resources should actually be working to make your life infinitely better as opposed to so much harder is the call for us. Well, you know what I like about that is you're not saying that every bet you make will work. That's right. You're not saying that every investment, every donation is going to produce exactly what has been promised or you expect. So you have to have some tolerance for failure and failure should not be seen as the conclusion of anything. It should be seen as another step along the way to try to realize what your objectives are. And, you know, Noubar, you face that with Operation Warp Speed, with Moderna, and you made it possible to bring the fastest vaccine to market ever globally in history. But there had to be moments when you were like, what a huge responsibility. You know, how do we manage the risk? How do we make sure we don't fail? So, yeah, I can give you a long session if I'm going to talk about all the moments where we thought we might fail. You know, the way I would think about it is this. I think in a very nature driven way, in a very evolutionary way, you know, this is really a battle between surviving and thriving. When you're in survival mode, which is whatever you're doing, something that's never been done before, you're constantly under threat of extinction, of going away. I don't know how helpful it is to imagine that you're dead. Right. So that's not where human imagination is very helpful. So instead, what you imagine all the ways by which you could survive, and then you try to invest a little in each of those so that in some way, you will survive. So in the heat of what we were going through during Operation Warp Speed, I must say, many of the leaders, all the way down to the scientists, were not imagining that their experiments may not work. They were imagining that some of them would lead to a path forward. And at the end, when you're out of choices, that's when you accept that that particular journey didn't work out. But then you take the learnings and do another one. So I think that I think people pull up prematurely because we're kind of brought up to use our prediction powers now enhanced by AI to predict whether it's going to work or not. Who cares whether it's going to work or not? If it's your life at stake, if your survival, you just have to be more resourceful than the odds. And so I think I think that's something that oftentimes if you find yourself thinking, I've thought this through, chances are more likely I'm not going to succeed. And by the way, people around you who really care for you all want to weigh in on how crazy it is and how low the odds are that you're going to succeed because they care for you. They don't want to see you disappointed. When my kids were growing up, I figured I could get one thing instilled in them. And I did as often as I could. And I told them at a young age, disappointment is overrated. And at the beginning, they had no idea what I was talking about. What do you mean? Disappointment is overrated. Just embrace it. Accumulate a lot of disappointment because sometimes you'll be appointed, whatever the opposite of disappointed is, because if you avoid disappointment, there's a lot of sayings. And you never score if you don't shoot. All these sayings are the same thing. Same in doing pioneering science, same in fighting a pandemic. And by the way, one interesting factoid you mentioned, we're working on cancer. The technology we used during COVID had been developed to go after individualized cancer therapies in 2016. Because we were working on that, when COVID came along, we were optimally prepared to make yet another version of it, in this case against the virus, overnight. So within days, we had the same vaccine that entered people's arms, treated billions of people, saved probably several million lives. If we had given up on the cancer program, we would not have been able to work on COVID. If we stopped working on COVID, we would not have learned how to scale up the technology in order to now use it for cancer, which you just very recently, we read out some results. So these things give you optimism that your job is survive and then thriving will find you. Well, I think that's good advice for life as well as everything else. You know, TGI is all about problem solving and partnerships. And Carmen, you are specifically focusing on organizers, people who can motivate and empower others. So in that context, advise our community of doers here. What is it that you want them to be thinking about? How do you want them to be organizing to meet these big challenges? I love this question because I feel like too often we don't talk about the how. And I think we forget about the extraordinary things that ordinary people have come together to win for all of us. The five day work week, the Civil Rights Act, fair housing. These were things that were brought to us, to all of us that live in this country, because ordinary people came together and believed that we deserved better. And the gift for me of community organizing is that it's reflective of this quote that I love to share with people that it's hard to hate people up close. And the gift of community organizing is that it brings people closer together. And at first they come together and they commiserate and they're like, why is my rent so high? Why am I working 60 hours a week and barely able to make ends meet? And then something really powerful happens. They realize they're not alone. They look around and they say, this is my neighbor. This is my friend. This is somebody. This is a stranger down the street. And we are confronting the same problems. And these problems aren't the result of any choices that they've made. But they're the result of a system. A system built by people that believe that opportunity is a good to be hoarded rather than what it really is, which is an infinite resource meant to be shared. The gift for me of community organizing is that it creates that connective tissue across people, across difference, across place. The most amazing stories are in rural communities across this country where new immigrants are working with people who have been there for generations to make their conditions better. And I think that there's no better antidote to the afflictions that we're facing right now than this bringing together that community organizing allows for. Well, I think you're spotting a trend because I think people are now looking for community in the real world, not just online. And that there are opportunities to promote that, nurture that, and then work to achieve common results. Last word to you, Noubar, and you are a proud immigrant. Well, look, I've been thrust into this role because people have been going against immigrants. I was very happy to be an anonymous immigrant before and just live as an American, which I'm also proud of being. But I will say this, when immigrants are by definition Americans, when they become American, Americans by choice. And it turns out that when you're an American by choice, you feel indebted and you feel like you've got to belong and you've got to work to belong. You don't you're not born into belonging. And your displacement gives you this experience of surviving and adapting and finding your way, which you can then take into your work and into your your philanthropy, your whatever work that you're doing. So I think that immigration is essentially the regenerative power of this country. This is why so many people end up. And and if we think if we think we have enough reserves not to need regeneration, then we probably don't need then we probably don't need immigrants. But I think we don't. And we're using up our reserves very fast. Reserves of innovation. Reserves of goodwill. Reserves of community building. These are all things that I think have benefited from wave after wave. So I really do think that the beauty is the mixture. This is the unique part about this country. You go around to a lot of countries. They're relatively more homogeneous. The diversity of thought. So I mean, however much people want to take on temporarily this notion of immigration, I think without it, we are not America. I've said before, this is my firm belief. If this country was named after a land, England, Iceland, Finland, Switzerland, this would be immigrant land. Oh, no. Thank you both so much for your work and your freedom. Thank you. Immigrant land.