Lessons Learned With Tony Coles

Tony Coles in conversation on his distinguished career in medicine and biotechnology, including his roles as CEO of Cerevel Therapeutics and chairman and founder of Yumanity Therapeutics where he was instrumental in advancing potential new treatments for Parkinson's disease and Amyotrophic Lateral Sclerosis (Lou Gehrig's disease).

Lessons Learned is a roundtable series, open to term members and younger life members, which features distinguished speakers who reflect on their career experiences, the choices they made along the way, and the lessons they have learned from them.

HAASS: Welcome, everybody. Welcome to today's Council on Foreign Relations Lessons Learned with Dr. Tony Coles. I'm going to preside and, as I expect you all know since you are here, that Lessons Learned is a series where we invite individuals who have had a really interesting and important trajectory in the course of their lives and their careers to basically reflect on it, and hopefully we can glean some lessons from their experience, from their successes, even their frustrations or failures, that we can all make use of. Dr. Coles and I will talk for about 25 minutes then we'll open it up to you all. I really want to make this useful to you. We raise between the two of us the average age of participation in this meeting significantly. And again, the purpose of this is--it's getting close to the point where basically the two of us, even if we learned some lessons, can no longer apply them, but that doesn't apply to either of you. I've got to get three conflicts of interest out of the way before we begin. One is Dr. Coles is a member of the Board of Directors of the Council on Foreign Relations, which means that I have to be particularly polite and respectful to him. Second of all, we do some business together. And thirdly, and most important, we're good friends. That said, I will be merciless in my questioning and if I'm not I hope you will pick up from where I left off. So Tony, thank you for doing this. You're one of the busiest people I know. You're one of those people I know who basically, almost like Mel Brooks in The Producers, you've committed about 250% of your time and energy to any number of pursuits, but I want to begin with the basics. I thought of being a doctor once. When I was 14 or 15, after high school on Wednesdays, I think it was I went to the local hospital and there was a group called Medical Explorers, and we all put on our white coats. And very quickly, I decided this was so not for me, beginning with blood and I don't know how many other things. Tell us how you went down the path, however, because you obviously saw it through. 

COLES: Well, first of all, Richard, thank you for having me. I could not imagine a better way to spend the next hour than to be in conversation with you. I hope we are here to prove that you actually can teach an old dog new tricks and even you and I can learn some new lessons. I'm sure that the Q&A period will reveal that momentarily. But to answer your question, it's fascinating because this was probably one of those epiphany moments. I was nine years old, interestingly enough, and I was in a--this is how focused and directed I was as a nine year old—so, I was in a conversation with my father about possible careers and he said, you know what, you could actually be a doctor. And I said, well, could I be a basketball player as well? And he said, well, yeah, you could do that as well. And-- 

HAASS: After Jay, there's a precedent. 

COLES: —Yes, exactly. I'll just do both. So, because if that's possible, I'll be a basketball playing doctor and that reveals then the mentality of a nine year old focused mind. So. But that was where I had the first inkling because I really did love living things and biology and all things and say, for a short period of time where I thought about being a marine biologist and a lawyer when I was in high school, and then recognize that I actually didn't like to write and that was not a good career choice. It's always been about medicine.  

HAASS:  Oh, I was remiss, I failed yet again, in my presiding duties and responsibilities. I did not summarize your career. But I think either I'd have a chance to do the conversation, or I could summarize your career. But Tony is basically a serial starter upper and CEO in the biotech space, which is really one of the most exciting spaces in the country right now. And he, as you'll hear, is doing all sorts of exciting and important things in addition to what he does in other spaces. And we will get to that, but his principal job now is he's executive chairman and CEO of a company called Cerevel Therapeutics. Okay, so you decided to become a doctor, you went to med school, did you ever practice medicine? 

COLES: You know, I saw patients for the six years that I trained both in internal medicine as an intern and resident, and then the three years that I was a cardiology trainee, a total of six, and saw patients the whole time and loved it. And in fact, it is the one thing that I actually miss about the career choices I've made since that time, just patient contact and being involved in someone's life in that way. You know, it's an intimate space to be invited into someone's life that way and I really miss that connection. And in some ways, maybe I make up for it with the employees that that I'm honored to lead. But those six years were really formative in terms of thinking about the role that health and healthcare plays and leading to this particular career choice in the biopharmaceutical industry. 

HAASS: So you got--but you also got your Master's in Public Health. 

COLES: I did. I did. 

HAASS: And what was it that took you off the path of basically becoming a resident and practicing, be it based in a hospital or being a cardiologist. You had your fork in the road and you took it, as Yogi Berra would say, so what was your fork in the road? 

COLES: So, this actually is a great vignette, maybe, for the conversation because we're talking to an audience that's interested in global affairs and foreign policy. Part of the public health program included a mandatory course, this was the Harvard School of Public Health, it was a mandatory course called the ethics of public health. And as a consequence of that required course, we studied all of the health systems around the world, the UK health system, the Canadian health system, and we actually studied how Fidel Castro managed the outbreak of HIV AIDS in the early 80s. And what was unknown to me at the time, was that he actually quarantined, rounded up and quarantined, all of the HIV positive men in Cuba. In addition to violating their civil rights and their human rights, this was the most effective way he thought for managing this disease. Now, we could never contemplate doing something like that in this country. But yet that happened in the world, and I grew up with the notion that healthcare and the right to healthcare and the access to health care, and the preservation of human and civil rights, were all kind of God given laws of physics, in a way. But when I studied what happened in that particular case, I recognized that everything I'd grown up thinking about how impermeable the right to healthcare and the access to healthcare was, was just not true, and if it could be--if it was malleable, that I could help change it and theoretically change it for the better. And so I got fascinated with this concept of population-based health care long before that quote, that term was coined, because the mutability of healthcare systems and the opportunity to improve the delivery of health care was a notable thing. So, then I thought about being a healthcare staffer, going to Washington, working on the Hill, staying in Massachusetts and working at the statehouse to advocate for healthcare and access to healthcare, and then recognized that there was this whole thing called the biopharmaceutical industry, and got a wonderful phone call from Merck, asking if I would ever consider leaving the practice of medicine and going to work for Merck. And that was the beginning of this. 

HAASS: Just one afternoon out of the blue the phone rang, it's like, "Hi, my name is Mark Merck, and how would you like to come work with us?" 

COLES: Pretty much. (Laughs.) Although I will tell you one of the other jobs-- back to your 250% commitment in life—one of the other jobs I had, in addition to going to graduate school and catheterizing patients as a cardiologist, was to run the minority recruitment program for Mass General Hospital. And part of that included doing a collaboration with Merck, where they gave us a grant for a three-year program to provide research opportunities for minority candidates who could eventually come and be trainees. And that's how I actually got to know the folks at Merck and about a year and a half into this relationship that's when the phone call came. So, in a way, it was kind of out of the blue, but there was at least some history there and it was intriguing. It was terrifying, but intriguing. 

HAASS: Why'd you say yes to Mr. Merck? 

COLES: Because I thought the opportunity to affect change at the largest level would be possible through that venue. If I stayed in the practice of medicine, I could change one life at a time, but if I could go and help set practice standards and treat multitudes of patients with new discoveries and new therapies, I had the opportunity to treat or to impact hundreds of thousands--if not millions--of lives and that's turned out to be true.  

HAASS: Fantastic. So, let's talk about some of the places you've had that impact. Onyx, was Onyx your first big business relationship? 

COLES: No, no. I spent time, I spent 10 years, in the pharmaceutical industries, so between Merck and Bristol Myers Squibb, and then after that decade spent--transitioned to the biotech industry. They may sound similar, but they're really fundamentally different. One's-- 

HAASS: Just be clear for us so I can ask you that. So, for those of us who aren't scientists or doctors, at what point does the pharmaceutical business end and the biotech business begin? 

COLES: Yeah, these days they have blended into one in a sense and so we've coined the term biopharmaceutical industry, but 20 years ago they were really quite distinct. If you think about Merck and Pfizer, the earliest examples of success for pharmaceutical companies, they were chemical companies, or chemistry companies, and so all of their therapies really were born out of innovations that were made in chemistry. So starting really with the molecule and then looking for an application of disease. This is true for antibiotics, in the case of Pfizer, and it's true for steroids, in the case of Merck, and they were the innovators in the 30s and 40s of these therapies. So these were chemistry-based approaches. With the elaboration of the human genome in the late 1990s, that actually gave us a lot of insight into the biology-based approaches for trying to unlock the basis of disease. So where a pharmaceutical company will start with a molecule and then screen it against several hundred diseases to see if anything works, biotechnology companies start with the biological basis or the logic basis of disease and then will work backwards to identify molecules that will interact with biology in a very specific and a desired way. And the human genome elaboration gave us better insight into how that process might happen efficiently, because we then understood the genetic basis of disease in a lot of cases. 

HAASS: I want to return to that in a few minutes when we talk about the current situation. But Merck, Pfizer, companies like that, these were big, established, large corporations. But where you've subsequently made your mark is with much smaller, often startup-type situations. So talk about that, because you know this is lessons learned. What is it--did you know you had what it took to be successful with startups? Or did you discover it along the way? Is it different? The kind of person who would succeed at Merck as opposed to succeeding, say, at Cerevel or Yumanity, one of your previous companies. Is it different? 

COLES: I think it is different. I think there's something about, let's call pharmaceutical, corporate America, in a sense, its corporate pharmaceutical business, its big company, most of these companies have 30 to 60-70,000 employees. And if you just examine the Latin root of the word corporate, it means body, as we all know, come from Latin corpus. So you have the functions of the hand and the function of the foot and the function of the brain, and they're all, in a way, disparate, and there's a coordination through the CEO, the executive team, but if you're the hand, you don't try to walk and displace the foot. And that's a really interesting approach because it silos the activity, it partitions the learning in many instances, and so a lot of pharmaceutical companies work on breaking those silos down and really fostering teamwork.

On the biotechnology side of things, these are companies that are oftentimes four or five people. And I've done almost everything in the biotechnology industry that you can possibly do except for wash beakers, and I wouldn't rule out that that might actually be in my future. (Laughs.) So it's, you roll up your sleeves, you do what's required, you are both simultaneously hand, foot, brain, ears, and nose. So you have to learn a new way of operating. Complicating all of this is the training to be a physician, which is really interesting, is all individually oriented. So if you're the physician, you're trained to be the person who operates, the person who resuscitates someone, it's all individually based as opposed to team based. So not only do you have to break down the learnings of how to succeed as an individual, when you make a transition to business you then have to break down the learnings of how it is if you can cut across multiple areas and, essentially, draw to do anything that needs to be done to be successful. And that is, I think, that true definition of entrepreneurship, it's that certain something that says you're never too good to do just about anything, and just about anything can be figured out. And those are two of the keys for an entrepreneur. 

HAASS: And did you figure this out by reading entrepreneurship 101? Did you observe it? Did you trip over it? Did you get there after making many mistakes? I'm just curious, like, what was it, what helped you unlock the code? 

COLES: You know, I was always a little bit of a misfit in corporate pharmaceutical America. And I actually couldn't in the early days tell whether it was that I just didn't know what I was doing as I had been seeing patients one day and then was running spreadsheets the next. So I couldn't really tell, well, maybe there's a learning curve here, maybe I just have to just work hard and figure this all out. But five or six years into it, I just recognized that there was a certain degree of conservatism, a certain degree of that corporate spirit that I was talking about a moment ago, that was just not consistent with who I was. I would ask questions about why it is that we don't think this particular way and the answer would come back oftentimes, it's because we don't do it that way. Which was never a satisfactory answer, because I thought, well, what if there's a better way? The answer would still be, well we just don't do it that way. So intellectually, it wasn't satisfying. It wasn't gratifying in terms of creating, you know, the most amount of success, and when we start--when I started applying some of the things that were just logical, even though there wasn't a roadmap for how to do it, we actually started creating success, and extraordinary success. My first real big job was to take an $800 million business and to grow it to $1.3 billion in 18 months. That's remarkable and explosive growth, but it required us turning the cube to look at the particular problem in a very different way. And that's when I began to get the inkling that well, maybe I'm not cut out to be part of a corporation, maybe I want to find the place where I can find a spot on the horizon and tack to that, or tack toward that, using whatever ingenuity that the team and I can muster. And that's when the doors started to unlock. But they were hard lessons to learn because you wonder sometimes well, why am I such a misfit? Why don't I belong here? And the minute I got to biotechnology, I recognized I was home. It's really quite fascinating. 

HAASS: Let me raise another related question, which is, I would expect when you looked around the laboratory or the office, there weren't too many other African Americans. So I'm curious about various sides, to what extent was that a factor in the way you were perceived by your colleagues? Also in the African American community were there people who said why are you doing that, we need more doctors, we need you as a heart doctor, whatever? How did it work and in various directions? 

COLES: So let me contrast what it was like as a physician with entering industry, I think that might be useful. I've already told you that I was chairing the minority recruitment committee. So we had the problem in the practice of medicine and I, like many people who've had the kinds of experiences I've had, I'm accustomed to being the one of only or one of two or one of a handful in almost every setting that I've been in. So after a while you get used to it, and you work, obviously, to try to improve that. It's quite interesting, and this isn't a race point, but when I announced that I was leaving the vaunted halls of Harvard and Mass General, I had any number of people, probably a couple of dozen people, who came to me and said that I was a traitor, just like that, that I was moving to the dark side, that I actually was giving up this kind of precious education that had been--that I'd been privileged to have. And as I look back on that, and there was a really interesting, poignant comment from the person who was responsible for the cardiology department at the time, and he said something when I went to tell him I was leaving to go to industry, he said something very curious. And this this was where the intersection of race and maybe privilege or elitism comes together. He said, I know you people, you people always want to run before you walk. Now, I didn't know whether he meant other 32 year old’s or whether he meant exactly black people, because somehow you people, which is always something that sets off an alarm, is an expression to suggest wait your turn. And he said, in fact, you should stay for a decade and write papers and then you should leave. Well, that was clearly the wrong advice. And when I joined the corporate role, when I joined Merck, the same issues about the scarcity of representation, what (inaudible), but we had a really forward leaning, almost visionary, leader for the US business where I was working at the time, who said this is a problem and he asked me and a couple of colleagues, another black woman and a white male, interestingly enough, to help unlock the issues here and figure out how we might address it. So I am accustomed to being one of a few, I'm accustomed to working hard in this vineyard, as they say, and have been since I was in college, because it was a big part of my college experience. Because if I've been blessed with these opportunities, how is that we can open doors for others. But it has sometimes been race-tinged and it has sometimes not served me well, because a subsequent boss after this assignment at Merck just said, you will cease and desist from any of these efforts and put all that stuff away. It's really quite interesting and quite fascinating that when the patron for the project left the company the new boss just said, this is just garbage and it's standing in the way. So there are there all sorts of stories to be told. But I in a way feel like a pioneer, and what's interesting, and maybe a little sad, is I still feel like a pioneer. Here I am, 60, I've been doing this for 30 years collectively between medicine and business, and I am one of four biopharmaceutical CEOs in the world. One of whom, Ken Frazier, my good friend, just announced their retirement on Friday. So I'll now be one of three black biopharma CEOs. And I still feel like a pioneer. 

HAASS: Understandable, for good reason. What do you tell young black women and men now, if they're thinking of careers in medicine or biotech, what's your advice to them? 

COLES: You know, the practice of medicine, I think, has changed so much since I saw patients. Not the technical aspects of it, but the research component of it, the time-based measurement of productivity, which is part of this kind of corporate healthcare phenomenon that's been the wave for the last 20 years or so. And so what I say is, if you want to come to academic medicine and be a physician and be a physician researcher, know that the ability to fund your research will be very competitive and very tough. Because we all know the story of the funding for the National Institutes of Health, which is the primary funder for research grants and how that budget has been compressed over the last 15 years, making it exquisitely competitive. If you just want to come and you want to see and treat patients, then really be certain and be assured. And this is advice, whether someone's Black, White, Asian, Hispanic, because the road to training is so long and so complicated, that many of my colleagues now on the other side of it really wonder whether it was worth it, mostly because of the corporatization of healthcare. And so whatever that scientific yearning is, that desire to help people, to transform people's lives, all those things that inspired me when I went to medical school, if those are the things inspiring people, I suggest that they ensure that there's a healthy dose of reality for what's ahead. 

HAASS: I want to talk to you about two nonprofits you're involved with. One is the Museum of African American History and Culture. Why did you opt for that? Why did you opt to get involved in that? And what do you see as the significance of that institution? 

COLES: So there are two dimensions to that. There's a personal one that I want to share—that I want to talk about the more abstract one, but let me start with the personal. When my wife, Robin, and I have been involved in a number of efforts, initiatives, projects, not for profits, philanthropic endeavors, and as we were trying to determine where we would spend our time or get involved, we actually went to our sons, interestingly, because we'd been approached to get involved with the Smithsonian African American Museum. And we asked our sons, and it was curious, and I don't know exactly what made us engage them in the conversation, they were of age at the time, they were adults, and they generally have really interesting things to say because they're interesting folks. So we're having this conversation and they said to us in unanimity, of everything you guys have ever done this is the most important and meaningful thing to us that we think will actually create a legacy. Now, that's a pretty compelling response and that actually made Robin and me stop and think that with their blessing, I guess, that this would be a good thing to do. But I relate that personal story because so often, and you've got kids, and you've got great kids, and I know your kids, and they probably challenge you on a daily basis, but when they framed it that way, I thought how could I not. Now, on the other end of that, I got involved in raising money for the museum, for that opening of that museum in 2016, very successful campaign, exceeded the goals. I'm now involved in raising the endowment for that institution, and the reason I do both of those things is the following, and this is the less tangible one. When I look at the faces of Black and white people and Hispanic people who would stand on queue to get in that museum, and how the experience of visiting that place would move people to tears, such that people almost regarded as a mecca, people would travel from all over the country to come to this institution. And I think about the telling of this part of an American story because this is Black History Month, which is always a curious misnomer, in a way, because we never have American History Month, so it's curious thing, because in fact, the story of Black Americans in this country has been interwoven and intertwined and entangled with the story of American history and that's what this museum represents. But in a powerful way, it moves people when they stand at the casket of Emmett Till and they imagine that fourteen year old boy lying in that casket mangled because of the way that he was killed. That's the stuff of change, and for that reason, that is one of the most important institutions in this country because it reminds us of the stories that we have long buried and forgotten. 

HAASS: Something tells me your boys did not have the same reaction about legacy when you said you were thinking of going on the board of the Council on Foreign Relations. 

COLES: They said you could take a pass on that one. (Laughs.) 

HAASS: (Laughs.) Thank you for not listening to those young men. 

COLES: Sometimes they give bad advice. (Laughs.) 

HAASS: We appreciate it. Let's just raise one other issue and then we'll open it up to our members. Which is, here we are, the Council has been virtual for about a year now, eleven months or so, basically the country has been wrestling with the pandemic for about eleven/twelve months. It was here almost exactly a year since the first known death as a result of COVID-19. This is called lessons learned, what lessons have we learned from this last year collectively about successes and failures in terms of wrestling with, contending with this virus? 

COLES: So let me put my public health hat on first because I think that's the easiest to answer. If it were ever clear, and it was really clear to me early on in my career, that the action of one person, Fidel Castro in this case, literally made a difference in the lives of the HIV men who were quarantined in Cuba, all effectively to control and prevent the spread of HIV, which was required at the time because of the poor infrastructure in the country. So I'm reminded once again, that the actions we take or don't take as a society really have meaning and impact. These are not abstract matters, that we think well someone will figure it out, or they will take care of it, know that they is us, actually, and pro-action really makes a difference. So, could we have actually altered the course of this particular pandemic in this country? I fully believe that that's true if we had been better prepared, and this isn't a criticism, this is really an observation about the application of population-based health care, which I've already said is what motivates me to do what I do. So I really do think beyond an individual or the system, society has a responsibility in the administration of public health to affect even better outcomes than if we didn't get involved. So that's one. 

On the business front, I'll tell you, and you've offered the disclosure that I'm a member of the board of Regeneron, which has therapies to treat and theoretically prevent COVID. I've been amazed at the remarkable speed with which innovations have occurred. I think of this period in time, as a business executive and a scientist, as the platinum age of science and I can't imagine any other era, at least during my life, where literally within eight months we've got an effective vaccine when I know that those therapies have taken five to ten years to develop in times past. And that's a remarkable credit to the advance of science and the weaving together of meeting a problem and utilizing science to actually achieve the goals that we've been able to achieve, so that's really remarkable.  And then I'd offer maybe a personal reflection, that I think if we ponder how we, if we're in this position again, and undoubtedly, we will be it may not be ten years but the Spanish influenza outbreak from one hundred years ago, right around the time of the Council's founding, reminds us that history often repeats itself. I guess I wonder what we will do differently and whether there might be a better organic approach, governmental and otherwise, government and business, to actually stem the progress of whatever that scourge might be in the next, you know fifty years or seventy-five years or one hundred years. Have we learned sufficiently that the actions of society can curtail and improve the outcome? And we've got plenty of countries to demonstrate that. And then have we learned sufficiently how to harness and utilize the advances of science to complement what we have to do on a public health basis? Those are those are just a few reflections of at least how I've processed what's happened the last eleven months. 

HAASS: Fantastic. I could go on, but I will show uncharacteristic restraint and not— 

COLES: That's a shock. (Laughs.) 

HAASS: —That is a shock, like I said it's uncharacteristic. Why don't we open it up to our members for their questions, though, I may follow up one or two questions if the temptation strikes. 

STAFF: (Gives queuing instructions.) 

Our first question will be from Maryum Saifee. 

Q: Maryum Saifee, I'm a Foreign Service officer with the State Department. Thank you so much for this presentation. The State Department, much like the biopharmaceutical industry, is struggling with racial disparities across all levels. The number of Black women Foreign Service officers was two percent in 2002, as a data point, and only went up to three percent in 2017. Our new Secretary of State has made diversifying the Department a top line priority, which is really great news. Building up what you've already talked about, what advice would you give to Secretary Blinken on tangible interventions that don't just focus on recruitment but actually retaining a diplomatic corps that looks like America? Thank you. 

COLES: Thank you, Maryum. It's a terrific question. It's really the question that's confronting all of corporate America as well as the government. Let me just share a couple of very quick thoughts, if I might. I think leadership makes all the difference so the simple articulation of that goal by Secretary Blinken is you have no idea how important and helpful that is because once the leader actually sets something as a priority, things generally happen and it's really remarkable how the simple articulation of a goal brings or calls things into existence. And let me share a couple of points of view. I built an executive team at the second company I was ever CEO for at Onyx Pharmaceuticals, in the sciences, in business, with PhDs, etc. On the executive team, there were more women than men, and more people of color, or diversity, than the normative and that didn't happen by accident. It had happened largely because I set forward an objective to build the most diverse team, not for the sake of diversity because I close my eyes when I reviewed resumes and thought about people and imagined who had the skill set best to do the job. And it's remarkable what happens when you close your eyes effectively or figuratively and ask that question and you eliminate the consideration of where this person went to school or what their background might have been, but you assess intellectual agility, raw talent, potential, all of those kinds of things and it's remarkable what happens. Unless we think this is a one off, we've just completed building the board at Cerevel Therapeutics where I'm Chair and CEO, and on that board of eleven there are three people of color, there are three women, and it's probably one of the most diverse boards in the biopharmaceutical industry and that's why I know leadership makes all the difference. So that simple articulation is really very important. And secondly, I'd say for the business world, harder to do at State, attaching or linking progress to compensation is essential because it's really quite remarkable how, at least in the business world, when compensation is at stake, how you can actually get different results. But I appreciate your question and I admire the fact that the Secretary has taken this position. 

HAASS: He said two things since I've spent so many years working at State because it is an important question. One is to make sure--compensation you're limited in government, unless we raised the taxes of the wealthy, which you may not approve of Dr. Coles. (Laughs.) But one is real opportunity, to make sure that young Foreign Service officers get real opportunity and rather than having to kind of make it the caboose of their career. And the other is training, one of the things the military is so good at, which has a very high percentage of African Americans and other people of color, is the training opportunities are fantastic, the investment in people. So whether you end up making a whole career, or five years, or ten years, or you do your twenty, you come out with so much more capacity than what you came in. You've had interesting experiences, and you have greater capacity, and you're still young, and you've got several chapters left. And the State Department and the Foreign Service needs to adopt that kind of mentality to really invest much more in its people and I think that will really also help with the pipeline. 

COLES: I love that because it really does mean looking for talent in unusual places. I love that. 

HAASS:  Great. Good. Sam, let's get some more questions. 

STAFF: Our next question is from Daniel Gilmer. 

Q: Yes, Daniel Gilmer here. Thank you, Dr. Coles, for sharing your time and wisdom with us today. Fortunate to become an equal co-inventor at Rockefeller of an asset currently in phase three, I became interested in the commercial side of science, so I went to McKinsey for time, and now I work in R&D at Pfizer. Looking at your successful career as a pioneer, if we look ten, fifteen years out, what do you anticipate being valued in senior leaders in biotech and/or on the pharma side, which is not necessarily highly valued today? And do you see a continued blending of biotech and pharma companies in their approaches, or perhaps a return to a more specialization of those subsectors? 

COLES: Thank you, Daniel, for the question. You know what's really interesting is, I actually think that the next ten to fifteen years in the pharmaceutical industry, let me make that distinction or address it through that lens, will be about individuals who can see possibilities and thread the needle. We have regarded leadership skills and criteria within corporate America, and by this I'm really speaking to the current iteration of pharmaceutical companies, based on what people have done, the success of their previous careers, all of these kinds of things, and building a skill set that is a corporate skill set in a way. This is where I think the blending of corporate skills and entrepreneurial skills may actually come together because we know that science is becoming more complicated, I've talked about the platinum age, but business is also becoming a lot more complicated as well. There are policy conversations around reimbursement and what's fair and appropriate, balancing that with the need to spend on innovation and new discoveries. So there are all these thorny things and not the least of which are the immediate crises that arise from time to time like Ebola or COVID. So I think we're going to be looking for leadership that has an entrepreneurial spirit. Pardon the use of that expression, but someone who values the ability to tack in a direction, and agile enough to change directions and get a superior outcome. So that's one thing.  I also do expect the current explosion in scientific knowledge to continue. So I think that even faster ways of bringing scientific biological discovery into the realm of human health and therapies is going to be really important as well. And the Moderna example or the Pfizer example with the vaccine for COVID is one of the great examples of how we've taken the latest thinking in terms of RNA-based technologies and brought them to humans in record time. That platform is building for the innovations happening in science and the cycle times are going to become faster and faster, not the least of which is to address any challenges that might arise. So entrepreneurship, the integration of science and business, and leveraging this platinum age of science into real human health therapies, I think are two of the areas that are going to be big trends in the next ten to fifteen years. 

HAASS: I know you got a medical education and you did your master’s in public health. You've gone on and you've been in any number of business environments, you've done well, but one thing you didn't do was get a business degree. Have you done well because of that? Despite that? What is your sense about what is or what would have been the utility of a business degree given your trajectory? 

COLES: You know, I think, by this point, I had been in school for fourteen years and I wasn't looking forward to another two years to get a business degree, nor was my wife and nor was our, you know, our vanishingly small checkbook at the time because it would have been mine to pay. So it's a great question because when I interviewed at--I said Merck called, I didn't tell you the rest of the story, but when I interviewed, I was sitting in the CEO's office because the CEO, who was a physician at the time himself, interestingly, built a program to attract physicians to business because he rightly, I think, believes physicians could be good business people with a little bit of training. So I asked him the question. It's really quite interesting. And at the time, I remember this so clearly, it was in 1992, NAFTA had just been signed and we proceeded to have a really interesting conversation on his impressions of NAFTA and the impact on business. And I turned to him and I said, you know, I don't have a business degree, do I need one? And in characteristic form, this guy called Roy Vagelos, who is still with us, and one of my great mentors, he looked at me and said, "Tony, I don't have a business degree and I did okay." And I thought, well, that's compelling because then there's probably a path for someone who doesn't have a business degree and I was relieved, actually. After 14 years of school, I was tired. I wanted to get to work and support my family. But as I think about it, as you frame the question, what's interesting is, I think I've probably been able to think more--I don't want to say out of the box or innovatively--but I've probably been unconstrained in my thinking without knowing what the typical business analytics are that you should apply to a problem. So in a funny way, and paradoxically, I think it's allowed me to accelerate this transition to entrepreneurship. It's an interesting question. I've never really thought of it that way, but I think that's right, Richard. 

HAASS: Sam? 

STAFF: Our next question is from Eddie Mandhry. 

Q: Thank you very much. It's a real pleasure to hear from you and your really insightful commentary on these important issues. So my question is on trust as it relates to the challenge of vaccine hesitancy among the Black and brown communities in the United States and beyond. By the way sorry, by introduction, my name is Eddie Mandhry, director for Africa at Yale University. And so, you know, there are historical legacies of medical injustice, the Tuskegee study and so on, and you couple that with kind of misinformation in this era we're in. How do we build communal trust in either vaccine acceptance or participation in the underlying research that kind of helps medical advances? Any thoughts on how we can restore that kind of trust? 

COLES: Yeah, this is really hard, and it's unusual for me as an entrepreneur to say that it's really hard, but it's hard. And I appreciate your references to the challenges that brought us here, really largely through the lens of societal conflicts and societal issues because there have been legitimate reasons for people in Black and brown communities to be concerned. And when you break that kind of trust societally, because society is the only thing we have holding us together, that contract, that social contract, becomes compromised and it's really difficult to regain. But let's assume for a moment that we recognize that and that we can at least begin to approach it. There are a variety of things that people are considering today, one is increasing the number of Black and brown people in clinical trials and there are a number of initiatives underway to make that happen. Back to the very first questions, it's quite interesting, given the social justice conversation the country has been engaged in in the last year, as part of the corporate objectives we've set at Cerevel, we've actually set a target for increasing the number of Black and brown participants in our clinical trials. And that's where I think the leadership matters and the articulation of those kinds of goals will be very important.  People have also tried other things, including finding, if you will, the trusted partners within communities, whether they be church based or community based, but those individuals who then can advocate and vouch to try to persuade others to join in or to participate. I think that's been met with mixed success and largely because of the breaking of the societal contract that I talked about at the top of my comments. So I really do find this one very, very difficult. There is a fear that within the community, and it's a morbid fear, that participation in these kinds of trials will just lead to further experimentation and ultimately not a good outcome. And it's problematic. And we've seen this even in the caring administration of chronic diseases like diabetes and high blood pressure, let alone something that is as lethal as COVID. So, this will remain both an area of study. One of the things, I have an idea actually, that we should use the four Black medical schools in this country, Morehouse, Meharry, Howard, and Drew in LA, and begin to study this question intensively there because those catchment areas actually do support a disproportionate number of Black Americans. And if we can combine some of these initiatives, such as taking the trusted sources, communities, with the academic power of these institutions, we might be able to make progress. So, that's an idea that I have on my short list of things to sit down and think about because I do think we can actually learn something and if we can learn and pilot there, maybe spread it more broadly across the country, but it's one of the most nettlesome problems in public health today. 

HAASS: Thank you. Sam? 

STAFF: (Gives queuing instructions.)  

And our next question is from Valentina Barbacci. 

Q: Yes, good afternoon, or good evening as I'm based in London here. My name is Valentina Barbacci and I'm a term member of the Council on Foreign Relations working as a social and environmental impact advisor to a number of different social and other enterprises. My question is regarding two points that you touched upon in your remarks. One is with regards to lessons learned and how we could have had a better response in the United States particularly to the pandemic, so I would be grateful for you to expand on that. And perhaps tie in your second comment that I noted which was the corporatization of healthcare in the United States and how that might have hindered our ability to respond more effectively when you're trying to roll out a vaccine across the country, whereby one needs health care. And that could be an oversimplification, but I'd welcome your remarks. One last little interjection there is feeding into lessons learned, at the onset of this pandemic, or when we first recognized it in the United States, the Council on Foreign Relations had a call with an epidemiologist and it was very apparent at the time that there was a general and gross underestimation of the misinformation already coming at the time from Russia and China. So I'd love your feedback, if you could, have you feed those thoughts in as well to potential lessons learned that we could take forward as we respond.

COLES: Yeah, this is almost an hour in of itself, in a way, but let me touch on a couple of things. My comments about the corporatization of healthcare actually were more positive, because I think in this case, the corporatization of healthcare, or at least drug discovery or therapeutic discovery, really did help us with that kind of translation of novel science into human health therapies. So there I think we probably were able to accelerate something in eight months that ordinarily might have taken five, seven, or nine years, so that was a net positive.  But let me go back to the first part of your question. And to be really clear, I actually do believe without living in a truly extreme organic state, that the federal government holds a responsibility for the health of its citizens. And if you extrapolate that notion, and extrapolate it forward to not just counting and documenting cases, orchestrating and coordinating efforts, including the delivery of all of the equipment that we needed in the earliest days, there's a centralized approach that I believe would have helped in this particular case and I think we missed that opportunity. In the balance between the scientific world, the federal government, and the states, the federal government really did not stand to the preeminent position that I believe a government should stand to. In terms of the orchestration of care, the delivery and the distribution of supplies, finding the greatest needs. When you devolve the administration of healthcare in a crisis to fifty states, you'll find fifty answers and you will thereby underestimate or underutilize, you won't optimize, I guess is probably a better way to say it, the outcomes as if we were prioritizing care because when governors are fighting for ventilators with each other, that's just no way for us to think about this. So, I do think that the federal government missed a significant opportunity and I do think it actually caused us to be set back in some important ways. So those are just a few comments, as I said, we could go an hour on this topic, but that's one that I'd like to draw to and to say nothing of the role that we should continue to play with global health organizations and multilaterals. I think that's really very important because we can't isolate ourselves, either. So just a few quick reflections. 

HAASS: Let me chime in on too, even though it's your show, Tony, I'm going to chime in on too. One is, for all the criticisms of the federal government, and they are many and well deserved, I do think they get some credit for the approach to mass producing the vaccine at speed and rather than thinking of things sequentially, basically upfronting some of the capacity creation, and I thought that turned out to be somewhat risky, but useful thing to have done. So I think that aspect, at least, of the manufacturing side gets some points. Second, I think China deserves tremendous criticism for its behavior in the first month or so of the outbreak, but I think once things reached our shores, then I think it's mostly on us and I don't believe we can blame China, or Russia, or anybody else. Most of the misinformation was made in America and often came from high parts of our government and I think there we need to learn the lessons about what we did, or as you said before, what we didn't do. 

COLES: So atypically, I'm going to agree with you on both points.  Certainly, in terms of the speed with which the federal government responded in terms of vaccine therapy, discovery, and capacity. And hiring Moncef Slaoui as the czar for Operation Warp Speed was a brilliant idea. What I didn't mention was the role that private philanthropy and/or NGOs played in this country and I think Bill Gates by drawing our attention to the need to parallel process viral manufacturing capacity did a really important thing by showing us a different way to address this. So I didn't address the positive, but I agree I think the government actually did do a nice job on calling attention to and unifying that particular opportunity. 

HAASS: (Laughs.) I'm glad this is an on the record meeting because now people heard you say that you agreed with me. This is a first, probably a last, but I'm glad we caught that on the record. We have time for one or two more questions, Sam. 

STAFF: Our next question is from Michael Blake. 

Q: Thank you so much, Tony. Good to hear from you and your voice. And I have to say--forgive me, let me identify myself. Michael Blake, term member out of New York, New York Assembly and Democratic National Committee. Truly one of the best, if not the best, conversations that we've had here, and we've all witnessed--yes--the agreement, so we'll appreciate that, Richard. The point that you mentioned earlier, Tony, around trust and entrepreneurship, which I think is so applicable in so many ways. There seems to be two separate conversations constantly happening around the research, vaccines, and in the distribution process itself. And I've been almost amazed on why it's been so separated, especially in communities of color, where we're now witnessing the conversations around CVS and Walgreens and others, and would just welcome your advice on, for those of us on the ground trying to build that trust, how do you merge those two conversations simultaneously, given the urgency of the matter? 

COLES: So thank you, Michael. First of all, great to hear from you and thanks for the question. I want to share another really quick vignette because I thought this was terrific. The company will go unnamed, but one of the several vaccine developers called me one day and said, we're actually going to pause our trials until we have adequate numbers of minority participants in this. It was an internal call, it was a judgment call, but I think it was the right call and that kind of leadership I think is really important because they put a marker in the sand to say we want good, accessible data where we can find it. And there are those leadership opportunities. We can debate how long you should go in the middle of a pandemic, but I applaud the company for that particular stance. As to people who are on the front line the distribution has been tough, it's been uneven, and it hasn't only been a race issue. There have been a variety of segments of the population who have turned back or turned down the opportunity to be vaccinated, including people who work in long term care facilities or patients in those facilities, for a variety of reasons I am sure. But what has been illogical from a public health point of view has been the challenge that we have found in the population that has the highest morbidity and mortality from this terrible disease, and that is in Black and brown communities in particular because they're both essential care workers, because they're on the front line and we know about the structural barriers to healthcare that are racially based as well. So there are a multitude of factors. I guess what I might propose, and New York would be an interesting place, is we know some of the reasons for that, and what I wonder is if we can't get underneath some of those. So making the vaccination mandatory, for instance, for frontline workers in order to return to their work, as an example. You'd hate to have an economic incentive behind it, but I think when it comes to public health and public safety, you do have to take extraordinary measures to ensure that the entire public is kept safe. So that might be one way to think about it. The structural barriers to equal health care access and health care delivery have been with us since the dawn of time, and they're likely to be with us for decades more, but I don't think we should underestimate the potential that training and education of healthcare providers and vaccine distributors--not the manufacturers, but the CVS's of the world--should pay to proactively go out and work against any bias that might be insistent, and find those individuals who are willing to have a vaccine. For those who don't want the vaccine, that's just tough. That's really tough. But I do wonder whether tying to an economic incentive might not being inappropriate. 

HAASS: Tony, we got about one minute left. What I neglected to point out is that so much of the work you've done professionally isn't about infectious disease, but it's about noninfectious diseases, noncommunicable diseases, ALS, Lou Gehrig's disease, Alzheimer's, Parkinson's, and so forth. Just say a little bit about that--because, you know, we're also focused on Moderna and Pfizer and these vaccines for COVID-19--just say a little bit about the slow motion crises, if you will, in the world of noncommunicable diseases and what's going on there. How much progress is being made? How much progress is there likely to be in these areas? I think people probably don't realize this, but even this past year, COVID-19 was not the leading cause of death in the world. It's still NCDs, it's still noncommunicable diseases. Just say a little bit about that. We'll make that the ending. 

COLES: Yeah, and I'll do this really fast, but a really quick epidemiology lesson. At the turn of the last century, the average age of death for Americans was somewhere between 58 and the early 60s--call it 62 or so. So here we are 120 years later and the average age, or the average mortality, is somewhere between 78 for men and early 80s--82/83--for women. So in 120 years, we have added 25, almost 30 years of life expectancy to people. What killed us then were communicable diseases, tuberculosis, and a variety of things that antibodies now cure. And so we started living longer and longer. So now that we're living longer and longer, we're finding the diseases of older age and old age becoming more of a problem. Back towards the neurodegenerative disease question that you posed, Parkinson's, Alzheimer's, and a variety of these diseases that typically happen as we age. So that's the context for why they're even bigger problems. What's been fascinating is that they are the last great frontier in biological and even chemistry-based discovery approaches for human therapeutics. This is, we've conquered cancer in many cases, not all but in many, we've conquered cardiovascular disease, we have done amazing things in terms of communicable diseases, COVID included now, but we haven't really made the kind of progress that we need to in neurodegenerative diseases, which is something that's a newer phenomenon in this grand scheme of the last 120 years or so. So I predict that time will catch up, that the emphasis that we had Cerevel and at Yumanity, two companies I'm involved in, are paying towards neurodegenerative diseases and neuroscience diseases, will eventually pay a dividend, especially in this platinum age of science. We just need a little bit of time, but we'll figure this out. That I have every confidence. 

HAASS: I'll tell you, since I'm about a decade older than you, I hope you work hard, and you work fast. Put in those weekends. We could go on for a long time here, but we won't. We have very few rules at the Council on Foreign Relations, but we try to start and end on time. So let me just say thank you. Let me say thank you for today, it was a great hour. Thank you for all you do, have done, and will do. Thanks for being a part of our community as a member of the board, and stay safe and stay well, and that's for you and for everyone in this meeting. 

COLES: Well, thanks for having me, Richard. It's been it's been amazing. I love the Council and I love the work we do. 

HAASS: Thanks, my friend. Take care everybody. 

COLES: Bye bye.