A leader’s perspective on horizontal leadership, reciprocity and intersectionality in changing culture

RED LEADERSHIP PERSPECTIVES

A conversation between Ed Whiting, Director of Strategy at Wellcome and Mads Holme, Managing Partner at ReD Associates 

about

Ed Whiting became Wellcome Trust’s Director of Strategy in 2019. Since then, he has reoriented the global charitable foundation’s strategic focus around taking on the biggest health challenges facing humanity – climate and health, infectious disease, and mental health. In this interview, he speaks about the big organisational shifts required to deliver on the new strategy, how deeper, more reciprocal partnerships lead to more long-term solutions, and the importance of human understanding in both effecting change and creating equitable cultures. 

WELLCOME TRUST

London-based Wellcome Trust is the third-largest charitable foundation in the world supporting discovery research into life, health, and wellbeing. Founded in 1936, Wellcome has more than doubled in size in the last decade, and expects to spend over £16 billion in the next 10 years on research, leading policy and advocacy campaigns, and building global partnerships on the world’s biggest health challenges. Their work is funded from an investment portfolio that currently stands at £38.2billion. 

Part 1
Developing a new strategy 

ReD: Over the last year, you’ve been through a big strategy change. Why did Wellcome need a new strategy? 

Ed Whiting: When I arrived in 2016, Wellcome had just started on a journey. We had become a bigger organisation and were spending more than ever, and as an organisation of this size, realised you don’t necessarily just continue what you had been doing before. We had to think about what responsibility that brings for us in the world. How do we use our scale, independence, our science and research networks, and what should Wellcome be in the world? By 2018, we had nine priority programmes on some of these big global issues, alongside three very separate funding divisions. There was fantastic work being done, but it didn’t really add up. 

The first process was about really listening to our research partners: the people and the organisations and groups we’ve worked with, who know us, and also some who don’t know us as well. Led by Sir Jim Smith, our Director of Science, our team carried out about 150 interviews around the world. From there, we developed four distinct directions about where Wellcome could go. The first option was to focus on the next big thing. What if we focused all our scientific funding on developing new research fields – the next genomics, the next frontier of knowledge, imaging, whatever it might be? Number two was focusing exclusively on open discovery – discovery for discovery’s sake, with no direction on where it needs to go. Number three was changing the way science – research culture and research methods – is done. And the fourth was focusing on the big existential health challenges of our time. We ended up deciding on the fourth. But we also realised that if you open discovery research, you lose a big opportunity for new ideas and innovation. When you look at science research, the big, non-incremental leaps forward so often happen when you apply something developed for one condition in a completely different area of health, like with mRNA, or CRISPR. So, we chose to focus on the global challenges with an underpinning bedrock of open discovery. 

When we went around and talked to everyone, so many people agreed. One eminent researcher told us, in effect, that “I work on zebrafish. And I’m glad that you’ve funded my work on zebrafish. But if you do not address the fact that our planet is burning, and that we won’t be here in 100 years, there’s absolutely no point to what I do. You cannot be a foundation of this size in the world without addressing yourself to this existential health threat.” When we spoke to others, three challenges came up again and again: infectious disease, mental health, and climate change. We realised that if Wellcome focuses everything we do, from discovery, to commercial translation and policy and advocacy, to cultural engagement, on these three categories of health, rather than nine or twelve issues, we can help change the course of human health. 

ReD: From your time at Wellcome, what are you most proud of? 

Ed: I’m most proud of the development of Wellcome over the last six years, going through new things, trying out new things in a phase where we said, we know what we want to do in the world and we’re going to be more focused in achieving that. We’ve created something and I hope this sense of direction and engagement in the world is now fixed for the medium-term. It’s taken longer than expected, and the journey is not yet complete. The cultural and anthropological phase of teams working together is a bigger thing than I thought it would be. When teams have such different perspectives and professional backgrounds, the ‘what makes you tick’ is very different. You’re all pulling in the same direction and you all want the same thing. But the day-to-day – how you work together as teams, make decisions together, bring someone else’s insight to a particular programme – that takes time to learn, and I’ve undervalued and underestimated that. 

“The cultural and anthropological phase of teams working together is a bigger thing than I thought it would be.”

Part 2
Making partnerships more strategic 

ReD: How have you changed the organisation with the new strategy? 

Ed: Firstly, we have changed the structures. We defined the strategy and that required quite a big, organisational restructure to deliver. We’ve moved from having, in effect, nine separate priority teams, three funding divisions, and all the separate teams to having three programmes with directors running each of those programmes who have decision-making authority. Their teams are built in a matrix fashion. Those directors are running teams made up of lots of different people, but they don’t directly manage all those people. They are more flexible, which has been a big change for us and Wellcome. I think it mirrors how leadership and organisations are changing. Organisations are becoming more horizontally integrated, rather than vertically governed where you have a greater degree of control. It’s more around setting a deep context for those teams and allowing these matrix capabilities to work together. That’s been a big change. There have been other changes including putting a greater emphasis on partnerships. We’ve built a new team to do that, really sharpening what we’re doing on ethics, and also on some of that translation and portfolio management. 

ReD: You’ve always been partnering. So what’s changed, and why? 

Ed: When we were doing the strategy work, we realised that one of Wellcome’s differentiating features was a greater capability for reciprocity. In the way that we fund – partly because we don’t have a living donor – we have this independence; we can give the organisations we fund more space. We can listen to them better, understand their perspective and needs better. We do this in science funding, where we give the principal investigators a lot of space to develop and run their projects. We knew that when Wellcome works well, increasingly now in this world where we’re more engaged, we can set up partnerships. We can be a problem-solving organisation, sometimes behind the scenes, and set up these big funding partnerships to solve these challenges together, like we did with the Norwegian government, the World Economic Forum or CEPI, or the US government, and now the German and British governments around anti-microbial resistance. What we hadn’t done, was structure ourselves so that we could have proper strategic conversations with our counterparts in many of those places. So we’ve created a team that is equipped to do that now. We hope to build very deep partnerships with about 10 or 20 organisations and really understand how we put stuff together that is greater than just a single funding relationship or initiative. 

ReD: When you look around, a lot of organisations are talking about partnerships. But you’ve taken a really interesting step in making it concrete, by building a strategic partnership team. 

Ed: Yes, that was a deliberate decision. The team is part of our wider government relations and strategic partnerships team. They’re basically Wellcome’s diplomats who are out in the world representing everything Wellcome does, and making contacts and networks and relationships. Their side of the organisation is deliberately very cross-cutting and not aligned exclusively to any one of our health challenges. Their mandate is attached to the senior dialogues that we have with partner organisations. They help bring together – in a single place, which is a massive deal for Wellcome – everything we’re doing with the WHO, the state of our relationship with the Gates Foundation, and how we create new partnerships in advocacy that we’ve never done before, for example with an organisation like Amref Health Africa. The value of the team over time will be in what we create together with those partners that we couldn’t otherwise. We’re already seeing it in practice. Right now, at COP 27, we’re running a joint pavilion with the World Health Organisation at a scale that we haven’t done before with art and cultural engagement at its heart. We are bringing in what we hope is a broader and more inclusive set of speakers and conversations. 

ReD: In the areas of mental health, infectious disease, and climate, there’s a lot of discussion around intersectionality. How are you solving for that? 

Ed: There are very rich relationships between the three. The most obvious for me has been infection and climate change. We know that climate change is changing the public health systems of today and tomorrow, and in many parts of the world, will introduce or magnify risks from infectious disease dramatically in the coming decades. The future of public health is going to be determined by climate change, and so, public health will change. That is equally true for mental health and climate, and mental health and infection, particularly when you look at specific contexts, for example mental health issues arising from populations displaced by conflict or extreme weather – there are huge challenges there. 

Part 3 
Integrating DEI perspectives

ReD: Is there a particular focus or ambition in terms of who you want to help or serve, or the science you want to invest in? There’s a link here to representation and DEI conversations. 

Ed: Our ambition in each of these programmes is for global impact. This is about changing the course of human health. Many of those areas require us to think in a geographically specific way. Climate change will affect everyone in the world, but it will devastate some communities or some geographies more than others. Socially, within different countries and communities within those, certain geographies will be able to more effectively adapt than others, partially because of economic opportunity or structural issues, including racism and social determinants. These challenges do not affect everyone equally. We know that our strategies need to be sensitive and attuned to that. We’re not so hubristic that we believe, as Wellcome, that it’s right or appropriate for us to march into a place and go, we’re going to fund some research here and this will be the answer that we drop in a place. These challenges will only be solved through long-term partnership and engagement, and genuine partnership sometimes means getting totally out of the way. We are developing and supporting the growth of longer-term capacity in different places. We’ve done it for a long time in Infectious Disease with specific research programmes in Southeast Asia and in Sub- Saharan Africa, in Malawi, Kenya, South Africa, Thailand, and Vietnam. We know that you go further with those longer-term research partnerships, so we’ll build more of those.  

“These challenges will only be solved through long-term partnership and engagement, and genuine partnership sometimes means getting totally out of the way.”

ReD: What role has diversity and equity played in Wellcome’s new strategy? How are you thinking about that in the trust going forward? 

Ed: There are a number of lenses. The starting proposition we have is that the nature of the impact of these challenges on different communities in the world is different, not equal. Therefore, we need to understand the lived experience (as opposed to traditional academic experience or expertise) of people in those geographies better. Lived experience is a big part of the mental health programme and informs our priority setting. So that firstly, the human understanding of where those challenges really land. The second part is that the research endeavour and the research culture community that we have around us is not yet optimised in terms of the leadership culture and the way research works. That’s not to say that the research programmes are badly run or that there are not fantastic leaders in research. But we know – we did this work in 2018 that we called ‘reimagine research’, where we listened to the research sector in the UK in particular – that cultural leadership is undervalued and needs to be better valued. How do we promote better leadership, better culture and practice, and improve representation of different minoritised groups in research, communities, and research? And that means both culture, but then also how these changes affect people, meaning that we will need to take a stance on equity, for example in the distribution of vaccines against Covid-19. Access to medicines is also a big part of the way that we work when we think about the development of specific projects. We often fund with specific access conditions embedded, and equitable access is at the core of how we think about research in infectious disease, for example. But we’ll also be adding to the other tools. The last lens is internal. At Wellcome, following the publication of an independent evaluation of our anti-racism work which found continuing instances of racist behaviour and outcomes, we recognised that we do not have the representation that we need or the culture or policies to create the depth of respect and support for one other that will be essential for success as an organisation. We learned that we do not have the organisation that we need to deliver this mission yet, and that becomes even more important if we are seeking to serve a broad range of communities around the world and in the UK. It becomes more and more important as you go. So it is a big cultural change. We’ve changed the makeup of the organisation, but there is much further we need to go, not least in improving representation at senior levels of Wellcome. We’re on that journey and will be held to account for our progress. A lot of the experiences we had, particularly over this summer, on the anti-racism evaluation report, were a deep reminder that if you do not understand the experiences of the people around you, you cannot build an organisation that embraces those experiences and helps to create an equitable culture. 

“When we look at the challenges, there is an increasingly deep understanding now that challenges exist in contexts. And the social sciences enable us to engage with and understand context.”

Part 4 
Applying the human and social sciences

ReD: How do you see the role of the social and human sciences, in terms of what is happening now, but also in the years ahead? Do we need to see a change of understanding, or capabilities? 

Ed: At Wellcome we’ve got to a point now where the social sciences, broadly understood, are part of this enterprise of scientific discovery in a way that sits closely alongside the biomedical sciences. In every funding round, we are funding significant projects and programmes looking at how we understand health and health in context and science in context. That is ingrained now in what Wellcome is. Similarly, when we look at the challenges, there is an increasingly deep understanding now that challenges exist in contexts. And the social sciences enable us to engage with and understand context. We’ve supported big streams of research on vaccine hesitancy and uptake, the social and cultural underpinnings of big infectious disease outbreaks, the social and ethical underpinnings and so on. I would love to see Wellcome continue to work on the social sciences, or the social science mindset alongside the biomedical mindset – they’re very complementary. 

Three recommendations for future leaders looking for growth 

1. Horizontal leadership: being able to lead across diverse parts of an organisation, where you don’t have direct control. This is also about leading with honesty and openness and having the authenticity to sometimes say, I don’t know what the answer is but we can find it together. 

2. Clarity of execution and clarity of commitment. Ask yourself: what is the structure we need? What are the pieces that we need to put together?

3. Fully imagining the vision that you wish to create and really understanding what it takes to realise that vision. That imagination and creative exercise is critical.