Carving a Path for High-Quality, Affordable Healthcare

Background and Evolution

I went into the semiconductor industry wanting to work on the toughest problems. My PhD thesis became my first startup 25 years ago, and the technology we built became the industry standard, being used by every advanced semiconductor chip maker today.

Later I developed Vuclip, the Netflix of emerging markets, and was on that journey for almost 13 years. It grew from nothing to becoming what more than 66 million users in many emerging markets use today. But as I was working on that, both of my parents were diagnosed with cancer.

For years I went back and forth between the US and India every two weeks, to be with my mother as she was receiving chemotherapy. As a result, I saw clearly the poor healthcare she received. Her cancer didn’t get better and progressed from second, to third, to fourth stage.

Breast cancer has a 90% survival rate in the US and 70% in India. The 20% of women who could have survived, instead die of breast cancer, mainly due to low awareness of advanced techniques among doctors, and low affordability and access to advanced diagnostics. Everything is built for the US market where insurance typically pays, while in developing countries, people pay out of pocket. My mom passed away from breast cancer, and I felt helpless because I could do nothing about it.

How did that experience shape the next chapter of your work?

I felt pretty miserable, and it hit me that the things I’d been working on weren’t really changing the world. I got involved with a childhood friend running a diagnostics company—which could have helped my mom survive the battle had I been able to get them involved earlier. Even though I had no background in healthcare, I was very motivated to prevent what happened to my mom from happening to others.

I came up with a simple rallying cry: we need diagnostic tests for cancers, infectious diseases, and genetic disorders that are attractive both to US labs that want the highest quality, and Indian and African labs that want the lowest price. If you could build one test for both markets, it could truly change the world, because it would create high quality and affordable healthcare—not one or the other.

The Covid pandemic let us test our hypothesis. We became one of the only companies able to sell identical test kits to labs in the US, India, and other parts of the world. We have had eight million people around the world tested with our test kits but, in order to truly make a difference, we need to get to 1000X these numbers. And we need to do this for more diseases—for cancers, genetic disorders and other infectious diseases. We are now well on our way to achieving that, with our first Respiratory Panel, Spinal Muscular Atrophy (SMA) test, Blood Cancer Panel and Urinary Tract Infection (UTI) panel being used in different markets.

What were some of the challenges?

When we started, attracting talent was tough because we couldn’t pay market rates and were asking for long-term commitment. But I spoke openly about my journey and it was humbling to see how many amazing and highly qualified people had experiences similar to mine, and therefore the mission resonated with them. After my mom passed, my dad was also diagnosed with cancer, and the doctors gave him one month to live. We hypothesized that the cancer wasn’t the root cause, but rather it was side effects from medications he was taking. So, using advanced diagnostics, we changed his medications and over three and a half years later, he is still alive and doing quite well. We realized it is important to advocate for your loved ones because technology alone isn’t enough to improve the quality of healthcare; relationships and advocacy matter.

Getting investors was also hard. We didn’t want to create a nonprofit because it would mean constantly putting ourselves at the mercy of donors whose mission may or may not align on an ongoing basis with ours. In my view, philanthropy should not exist unless done well—the power dynamics and inequity around it are too problematic. I know this because I happen to be on the other side of the table more often, sharing that side of the table with various partner NGOs.

What was your experience with TPW?

Through TPW, I met like-minded individuals—people who accepted that “we don’t understand everything to the level of detail that the ones in the weeds do, but we don’t need to.” It’s about betting on the team and their vision. And they were very willing to help without any drama. One member, Elliott Donnelley, has been an amazing source of support—not just as an investor, but in terms of opening up his network, too. And that is magical to me. That kind of action is what really allows us to accelerate our progress toward our vision. Elliott is a shining example of what TPW has brought me, a philanthropist who funds high impact, long-term projects.

Where have you seen philanthropy effect tangible change?

I focused the company on cervical cancer when I first joined, because it’s the only cancer caused by a virus–HPV, and could be potentially eliminated from the world. Yet, while countries like Australia and Denmark have almost eliminated deaths from cervical cancer, a woman in India dies from it every 7 minutes. This difference is less medical and technology-related than it is cultural. The standard approach in emerging markets is a PAP smear, but culturally, women in India are uncomfortable with strangers taking cervical swabs. Knowing how unwilling women are to go in for check-ups despite understanding the importance of doing so, what happens if we show that a vaginal swab can be just as effective? A woman could swab herself, and that completely changes the game. Of course, the test has to be more diagnostically sophisticated to deal with the lower amount of virus in a vaginal swab than a cervical swab, and that is typically expensive. But we showed it was possible and pitched it both to a local nonprofit organization in India for their last mile access to women in rural India, as well as to a Corporate Social Responsibility (CSR) fund from a corporation focused on women’s health in India. We have tested almost 15,000 women for free to-date, and for the 1,000 women that tested positive for HPV, the nonprofit organization treated them for free. This helped create massive awareness about self-sampling, leading to more women willing to get tested, and now there’s motivation to keep lowering test costs, so we can make it easier for local governments to take over the responsibility of funding this over time. These results have also spurred the rest of the philanthropic community into action, especially those who were keen to see it proven before putting in their funds.

Why has it taken so long for acceptance of both profit and purpose to take off?

Investors are critical for any company to scale. But we’re met with skepticism when we say we want to do well by doing good. They ask what that looks like, and when we say we’re dropping prices to disrupt the market, and that our margins will be very low, they are turned off. In 20 years, we’ll have built momentum and economies of scale will kick in, but that’s more than twice the life of most VC funds. They truly hope we succeed but don’t want to fund us, given these longer time horizons.

We also pitched to many philanthropists before a couple finally agreed. They all said, “Sounds interesting, show me more case studies, show me more evidence.” If that existed, we would not need you! Philanthropy shouldn’t be about playing it safe, it should be about going for the moonshots and creating a scalable template over a 5 to 10 year window so that it can eventually be replicated at scale by government bodies.

Where else have you had success with cross-sector collaboration?

We did a project in partnership with the government of Turkey to test all 1.3 million babies born annually, for Spinal Muscular Atrophy (SMA), which will affect approximately 300 of those babies, leading to death for a majority of them within a couple of years. Novartis developed a drug that costs $2.1 million per child, but it has to be administered as soon as the child is born, otherwise it isn’t effective. The government decided to pay for the treatment for children who are identified, but testing typically costs between $20 and $100 per child, or roughly $26 million to $130 million across all the babies born there annually. There was significant hesitation to do this even though they were willing to pay the approximately $500 million for treatment. Then, we demonstrated a test for SMA for only $1.49 per child, bringing the total cost down to $1.8 million to test all the babies. Our developed test has now been live in the country for over a year. If a philanthropist were willing to pay for tests like these and prove out the unit economics, it would help create a template for a government to take on, thereby having a meaningful impact on society.

How do you begin to make that case for philanthropists?

We’ve been making the case by demonstrating how many people you could impact. I know philanthropists love quantitative analysis, and governments are even more conservative with money than philanthropists. For a philanthropist, I would recommend they fund a program like this—for example, three to five years of newborn screening that generates enough data to convince the government to take over the program, because it’s de-risked entirely and shown to work. Philanthropy should take on higher risks to kickstart work that others aren’t approaching, and generate data that helps it take off and create change.

Do you feel you live your values?

I would love for my kids to say that they saw their parents’ walk match their talk, and that we did things we truly believed in. One of the most powerful lessons I learned as I grew up was that admitting “I don’t know” is a sign of strength, not weakness. I realized by watching people around me that doing that lets you truly listen. Otherwise, you take on the onus of having answers for everything.

What would you say to others trying to do good work?

Don’t be scared to make mistakes. And surround yourself with good people. I think that’s how you change the world. Whether I actually change the world or not is almost secondary. Commit fully, and enjoy the process.