Elizabeth Yee ’94 serves as Chief of Staff at The Rockefeller Foundation, which recently announced a plan to dramatically increase COVID-19 testing from 1 million to 30 million tests per week. If fully implemented, the initiative would be the largest public health testing program in American history – helping to get the country back on its feet.
Podcast editor Allen Murabayashi ’90 spoke to Yee, a friend of his who was featured in our winter 2020 issue of the Punahou Bulletin, about the initiative, as well as her own career path that led her to this new, high-profile role at the New York City-based foundation.
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Allen Murabayashi: Back in November, I had the opportunity to photograph Elizabeth Yee for a Punahou Bulletin profile. At the time, she was working as the managing director of climate and resilience at The Rockefeller Foundation in New York City, a prestigious appointment that resulted from her work with the Rockefeller-funded initiative called 100 Resilient Cities. But November was a lifetime ago, and since January, she’s been the chief of staff at the foundation and helping to spearhead a project to significantly improve the country’s coronavirus testing from 1 million to potentially 30 million tests per week, a necessity to safely move forward in the midst of a global pandemic.
Elizabeth Yee: My name is Liz Yee, and I’m Punahou class of 1994, and I’m the chief of staff at The Rockefeller Foundation.
AM: Liz, you sent me a note mid-February, and you’re like, “Let’s grab dinner.” And I was like, “Yeah, that sounds great. But Liz, I’m flying out for a wedding to Hawaii in early March. Let’s get together when I get back.” And in between those conversations, the world has blown up. I have been in Hawai‘i now for two months. I mean, what the heck happened here?
EY: I know. Next time, have lunch with me and don’t go to that wedding. Maybe, things will stay the same.
AM: Tell me, you were previously heading up The Rockefeller Foundation’s Climate and Resilience initiative, and now, you’re the Chief of Staff to the Foundation president.
EY: Yeah. I mean, all of this was a highly unexpected change from seeing you to not being able to have dinner with you and now being the chief of staff at the foundation. It’s all very new. And I was just very honored to be asked by Raj [Shah, Foundation President] and Steve [VanRoekel, COO] to serve in this role. And I’m just trying to ramp up into it and, if you will, balance in the stilettos that my predecessor left me. So, this is all new, and we still very much have a strong climate and resilience initiative focused on building resilience across the globe and in particular in cities.
AM: The Rockefeller Foundation has come out very vocally and proposed a national COVID-19 testing action plan to get the nation up and running. And I read through the Executive Summary, and one of the things that it says is the notion that “saving lives or saving the economy is a false choice.” Can you explain this sort of perceived dichotomy and why it’s wrong?
EY: Yeah, I mean, I guess from my perspective, Allen, this just isn’t a choice, right? You can’t decouple the two because pandemics sicken and kill people and economies at the same time. And we’re seeing this unfold right before our eyes. To me, this disease, this crisis, has really shone a spotlight on the inequality of the global economy. And we’re seeing for the first time since 1998, global poverty increasing. And I’ve heard statistics that say half a billion people could slip into poverty by the end of the year. And we’re seeing massive unemployment claims. I think we’re at 30 million people. We’ve got one in seven families having problems paying for their utility bills.
And I’m in Connecticut now, but I’m watching here in Connecticut, the line for food banks being incredibly long and food donations actually going down with kids going hungry. So, we’re already seeing this locally. And I heard… Actually, I was talking to Josh Stanbro, the chief resilience officer in Honolulu, and he was saying that unemployment locally is already at 37%. So economically, we’re seeing this happen and the effects of it already.
And then, you’ve got these demographic factors where it’s killing African-Americans at twice the rate of Caucasian Americans. And the native populations in particular, like for example in Hawai‘i, you have the Native Hawaiian population. The American Indians and the Alaska Natives, they’re particularly susceptible to this disease. And we’re working with two communities, the White Apache nation and the Navajo nation where we’re seeing devastating effects of COVID because of preexisting chronic illnesses or lower incomes and just lack of access to healthcare. So, it’s having a disproportionate impact on communities that are already being affected before COVID even existed. And so, I don’t think you can decouple the two. We’ve got to solve the two together.
AM: Can you summarize the goals of the foundation’s COVID plan and articulate the proposed timeline and cost?
EY: Sure. I’ll do my best. So, we have really three pillars of what we are trying to achieve, and it all stems from trying to scale testing capacity to a place where we feel like the economy can be safely reopened. So, the first pillar is around ramping testing capacity. And so ramping testing, so we’re at three million tests a week within the next eight weeks and with the goal of scaling to 30 million tests in the next six months. And that means we have to coordinate a very fragmented market of suppliers, buyers, laboratories, because the financial incentive for them to scale is really not there. And governments are having a challenge to front all of the costs to buy these tests. So, that I’d say is in the order of like 10 billion a month.
And then in order to deliver these tests, we actually need people. So, we’re advocating as the second pillar for a community, healthcare corps. Think like the Peace Corps where we can get people back to work in a trained and skilled profession, build the public health practice out the way that we need it to be, and have them also look at doing other jobs like food delivery and helping in communities.
And then the third pillar is really around data so that we have better tracking and tracing data. And I know this is sensitive in particular in the U.S. because we’ve got strong personal privacy laws, and that’s more significant than has been in Asia and in Africa. But if we really want to fight this disease, we’ve got to figure out where the hotspots are and effectively be able to fight. That’s how they managed to address Ebola in West Africa, and that’s what they’re doing in Asia.
So, to your question about costs though, our estimate was that these closures are costing the U.S. economy about 350 to 400 billion a month. So, the cost of this with the 10 billion a month on testing, somewhere between four and 12 billion on the healthcare corps is far less than what the economic devastation is from continuing to close down the economy.
AM: I think last week, the U.S. tested approximately one million per week. You guys are coming out and saying, “Let’s get to three million in eight weeks,” which aligns with what we’re hearing from experts like Dr. Anthony Fauci, which is sort of the minimum to safely reopen. What are the main gating factors to getting to that level right now?
EY: Allen, there’s so many factors, but to be nonpolitical and to be very focused on kind of what the market failures might be, I would say the first category in my mind is around just an incredibly fragmented supply and demand market. So, you’ve got shortages of tests and reagents and PPE, things that we hear in the news. You’ve got this financing gap that I was mentioning before where you’ve got the manufacturers wanting certainty of repayment and then cities and states being budget constrained, especially because they have reduced revenue intake. And then there’s this concern emerging around technology obsolescence because we’re changing and learning so much and so fast, and it’s driving down costs. And the orders that we place now aren’t going to be filled until say, June, July. So, this fragmentation in supply and demand is something that is one key challenge.
And then, there’s kind of the overall challenge in a lack of standards. So, how do we effectively roll out a testing strategy to protect the population? And you said a million. There’s a huge gap in what I’ve heard scientists and economists say we need. So, some people say, “Oh, it’s only 750,000 a day.” And I’ve heard (economist) Paul Romer, for example, say as much as 30 million a day in the U.S. to be able to do this effectively. So, the fact that we’ve only done seven and a half million tests for this entire duration means we have a long way to go, and we have to figure out how to do it right. And we still don’t know. And that kind of goes to our third pillar of our testing strategy, and also a problem I see in the market is this real lack of data to understand who and where to test and where those hotspots are.
And then, I’d say the fourth key area is just this is all new. And we don’t know enough about this disease, and we don’t know what constitutes immunity. And we don’t know how long that’s going to last. So, it’s really hard to be able to figure out how to safely reopen without answering those core questions.
AM: Pillar one, which is testing, we’ve heard more and more about antibody testing and other types of testing that aren’t about the nasal swab. Does your first pillar include these other types of testing?
EY: Yeah, so that’s what we had kind of also included in our vision is something called a testing accelerator because we’ve had people talk to us about all these different kinds of technologies. The nasal swab requires a significant amount of PPE, and that’s obviously in shortage right now. Whereas if we can move to a saliva test or other blood tests, et cetera, that would require a far less amount of PPE and is part of this continual change and growth in how we both diagnose and then ultimately treat and test for this disease.
AM: I’m curious about the contact tracing, which I guess is sort of your third pillar. And traditional contact tracing is literally a phone bank where someone has like an Excel spreadsheet and says, “Okay, Liz, who did you meet?” And then you call those people up and said, “Who did you meet?” And now, we’re seeing alliances, for example, between Google and Apple to make available this API that allows for low energy, Bluetooth, “anonymous” contact tracing. Does The Rockefeller Foundation have a position in regards to using those two types of methodologies to contact trace?
EY: I mean, we don’t have a firm position on what good or bad looks like at this stage. I think we have a vision of what good could look like, but in terms of specific technologies, nothing that we would feel comfortable weighing in on. I think we also need some regulatory changes that would allow comfort from people that would allow tracing to happen. And we’ve seen a number of different, once again, technologies of people doing it. I think you see some really great examples actually coming out of West Africa because they just had to deal with Ebola, and the only way that they were actually able to combat that was through really significant contact tracing by tracking people’s mobile phones, figuring out where they were and who they were with, and then actually working to isolate those people so that if they were symptomatic, they were protecting themselves from infecting others in their families and friends.
AM: I think a lot of people are vaguely familiar with The Rockefeller Foundation in the same way that people are vaguely familiar with the Gates Foundation or the Wellcome Trust. Why is The Rockefeller Foundation involved with COVID-19?
EY: For us, it’s in our DNA. We were created in 1913. Our first grant actually was to the American Red Cross. In our veins, we’ve got this vision of philanthropy focused on science and innovation and really trying to support the most vulnerable communities around the globe. So just given our expertise and background and legacy in public health and this vision of where we feel like we’re falling short in terms of science and innovation and affecting vulnerable communities, it felt right that we really jump in with two feet to try to help solve this challenge. To me, I feel like COVID is the defining challenge of our time. And it’s worst because we don’t have the public health systems that we need, and we don’t have the economic equality and equity that we need and that we were already trying to fix.
So for us, Allen, you talked to me about testing. Yes, that is what we’re focused on. But we’re also very much making investments to help support people, to get food, to focus on getting the income and access to benefits, as well as this testing strategy to get people back to work because that hopefully will get us all back to a place of greater equity.
AM: I’m curious, when a foundation comes out with an action plan, what are the actual mechanics of working with federal and state and local governments to implement that plan? Do you anticipate pushback? I saw that the executive summary called for potentially invoking the DPA, the Defense Production Act. It sounds like a lot of people have got to agree for this thing to work.
EY: Yes, that’s actually right. I mean, we’ve had some conversations with federal and state governments in various capacities who are interested in our vision. We’ve spoken with Tony Fauci at the NIH, a number of senators and representatives, governors, et cetera. Mayors have reached out to us to say, “What were you thinking, and how are you envisioning that we engage in this?” I mean, I think it’s clear that the federal government has a different vision from The Rockefeller Foundation in terms of testing. But I’m pleased that we released our strategy and that there’s a lot of interest and support in it.
One of the things that we are doing in terms of implementation is we’ve created this testing solutions group. Honolulu is one of the cities in it along with about 12 other states and Native American tribes because I think for us, we feel like we need a lot of different interventions to fight this. We need policy. We need advocacy. We do need implementation so that we can both learn and see what happens and what works on the ground.
And one thing we haven’t really talked about, because I know we’ve focused this testing plan on the U.S., but is really stronger global collaboration because it’s not just the feds and the states that have to solve this alone. But we need the support of the international community institutions like the UN to come together because we’re trying to fight COVID, the disease, and then everything that’s coming along with it, the food shortages, the economic dislocation, the financial market disruption. The list goes on. And to me, if we want to win, we’ve got to get the globe to come together to fight this and get to where we want to be.
AM: If you only get buy-in from, say, 50% of the states, can the plan still work?
EY: I think so. We haven’t encountered anyone thus far who has said, “You know what? I don’t think increasing testing is a good idea.” So, I think it’s really an issue of actually getting it to happen, and that’s where we’re really trying to focus. And one of the benefits of being The Rockefeller Foundation is our convening capacity and really being a nonpartisan convener in that capacity. And so, we’re trying to bring people together. We’re also trying to support people on the ground to do the work, to help the communities that we care so much about.
AM: You, like many people around the world, are working from home, but you, unlike many people, have a very important and high power job. And also, you’re a mom. I’m wondering how that’s going for you. How are you balancing everything, and how is it to be working on a global problem when you’re working remotely?
EY: Well, the good news is, Allen, I came from 100 Resilient Cities where we were working with a 100 cities in 48 countries. So, most of our work was remote, and that’s not difficult. And I’m grateful that we have strong enough Wi-Fi and technology, at least today, to have this conversation with you and others. But it’s been harder. Honestly, there is a huge technology divide and gap, and so for some of our grantees, actually even in the U.S. and overseas, it’s been harder to connect with them. And those are the communities that we usually work with more in-person. So, I miss the watercooler conversations and the people stopping by my office. But really, it’s not that hard to do my job remotely. The real challenge has been trying to successfully educate my two children, which is far harder than any job that I could do because I know everyone that we’re working with is so, so committed to trying to end this and get us back to whatever new normal awaits us after all of this.
AM: I’ve had the opportunity to talk to a lot of epidemiologists and doctors, and I’ve kind of posed this question to them, how do you think this ends?
EY: I think it’s going to go on for a while. I feel like it would be good, Allen, if you wanted to take an over and under bet. I think it’s going to take until we get a vaccine and then a bit beyond that because we’re still learning so much about this. And I think it’s going to be a while, and what our normal looks like on the other side is probably going to be pretty different than what we remembered from what I keep calling for my kids, BC, before COVID. So, I said to my daughter, I don’t think she understood what I was saying. She’s seven, but I said, “I think you guys are going to be Generation C, Generation COVID.” Because I do feel like this is going to be an indelible experience on their childhood that may change their decision making and the way they approach things going forward. And I just want for them to have the success and fulfillment and happiness that we have all had and building a more equitable world in the process.
AM: You’ve had what I would consider to be a pretty unconventional series of jobs. You went to U Penn as an undergrad. You went over to the finance sector and worked in wealth management, then went into public finance, then into climate. And now, your current position is the chief of staff to The Rockefeller Foundation. How much of this was planned? What did you want to be when you graduated from Punahou?
EY: Oh, my poor Asian parents. I know I can say that to you, Allen. I think I was supposed to be a doctor or a lawyer, and I’ve done none of those things well at all. And none of my career was planned, which I think was much to the chagrin of my parents. And I’m an only child. So, if my parents are listening, they’re going to be horrified. But for me, I think at Punahou, I always loved learning and working with different people and experiencing new cultures. My mom has a travel bug that is an insatiable travel bug. And so, I’ve always loved history and had a really strong interest in global affairs and politics but no real clear vision as to what I wanted to do. I took three different languages. I took Latin, German, and Spanish. And I thought about joining the Foreign Service in college.
But I went to Penn, and if you can leave Penn unscathed without being interested in the financial markets, that’s great. But I couldn’t help myself. So, that was how I ended up in finance and really looking to try to find a role that would enable me to intersect with government and delivering impact on the ground, which I felt was really important from my Punahou and Penn experience. So, that’s why I spent so much time in banking before I made the transition to come over to the nonprofit world. And I think that’s really served me well to have a background in something, in a specific skillset that I can fall back on. For me, I think life is all about these opportunities, and you have to take them when they’re handed to you or grab them when you see them. And so, that’s kind of how I’ve always approached my career, is really finding these incredible opportunities to try to make a difference.
AM: I’ve had a lot of conversations with Punahou seniors and some college seniors who have given up the last few months because of COVID and are missing on so many of the traditions that we associate with these times in life. I wonder if you can impart some words of wisdom to these kids about how life will proceed and what they should look forward to.
EY: I have been thinking very much about this time, especially for all of the people, students in particular, who are making critical transitions, whether it be from like fourth to fifth grade or from high school to college because I can’t imagine what it must be like to kind of end a huge experience like Punahou in this time. The thing that I feel like is really neat about the Punahou experience is that, Allen, we’re still in touch and that so many of my friends are still close together that we still get together in New York, that we still have this incredible shared experience that we’ve lived through the years at Punahou. And so, I know it’s not ending the way that we all expected in Blaisdell Center with the leis and the songs and the speeches written by our classmates. But this shared experience is one that I think will go on and something to cherish and hold on to.
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