The following is a conversation between Dr. Sanjeev Arora, Founder and Director of Project ECHO, and Denver Frederick,the Host of The Business of Giving.

Dr. Sanjeev Arora, Founder and Director of Project ECHO

Denver: And it’s indeed a pleasure for me to welcome to the show one of the six finalists of the MacArthur Foundation’s 100&Change competition. He is Dr. Sanjeev Arora, the Director and Founder of Project ECHO — ECHO standing for Extension for Community Health Outcomes. 

Welcome to The Business of Giving, Sanjeev, and congratulations on being named one of the superlative six! 

Dr. Sanjeev: Thank you, Denver! Thank you for the opportunity to speak to you. 

Denver: Share with listeners the mission of Project ECHO. 

Dr. Sanjeev: Our mission, Denver, is to democratize the implementation of best practices to bring better healthcare to underserved people all over the world, and we have a goal to touch the lives of one billion people by the year 2025. 

I started ECHO with the idea that we must get treatment to everyone. And that’s how the model was created — to democratize the expertise of the university and get it to the last mile of healthcare. 

Denver: Fantastic. Now, you are a hepatitis C specialist, and that is where this all began. Share with us that story that first got you started on this journey. 

Dr. Sanjeev: As you mentioned, I’m a gastroenterologist and liver disease doctor, and in 2001, I was as I am now, working at the University of New Mexico as a professor there. And I had gone into my clinic, my hepatitis C clinic, and I saw a patient there. She was a 43-year-old woman. What was different was she had two children in the room, a 9-year-old girl, and a 14-year-old boy in the room with her. And I asked her, “How can I help you?” And she said, “I have hepatitis C, and I want treatment.” “How long have you had it?” is the next question I asked her, and she said, “I’ve had it for eight years.” 

So I was concerned why she hadn’t come for treatment earlier. And she said, “I live 200 miles away from you. I’d call your clinic; there was an 8-month wait to see you. There were no specialists in rural areas, and I had a 1-year-old child at that time. I’m a single mother. There was no way I could come 12 times to see you that far, so I decided not to get treatment.” So I said, “Why did you come today?” And she said, “Now, I’m having a lot of pain in the right upper side of my abdomen.” I did an ultrasound and she had cancer of her liver, which was just a little smaller than a tennis ball. It was now too late for treatment. We gave her chemotherapy, et cetera, but she passed away six months later. 

And I asked myself, “Why did she have to die when the treatment was available, the diagnostic tests were available, all close to their home?” But she died because the right knowledge didn’t exist at the right place at the right time. There was no one there close to her home who had the expertise to treat her, and she couldn’t get to the expertise. 

And so we realized that this problem is not unique to the United States. In fact, in New Mexico where I live, at that time, 28,000 patients had been diagnosed with hepatitis C.  Less than 1,500 had been treated, and I knew thousands would die if we didn’t get treatment to everyone. So I started ECHO with the idea that we must get treatment to everyone. And that’s how the model was created — to democratize the expertise of the university and get it to the last mile of healthcare. 

Denver: And you, again, started with hepatitis C in New Mexico, but today, what are the range of offerings you provide in the health field?

Dr. Sanjeev: Over time, Denver, we realized that this problem was absolutely prevalent all over the world. Six billion people in the world didn’t have access to the right knowledge at the right place at the right time, and so they couldn’t possibly get the right care. 

It wasn’t just a money shortage problem. Everywhere, there were long waits for specialists. There were no specialists where people were living. For example, 1,100 people were dying from tuberculosis every day even though the medicines were completely free; diagnostic tests were free.  1,800 children were dying from diarrhea every single day even though oral rehydration has been shown to be effective for 50 years, and it’s inexpensive — it’s water and sugar and salt. And there’s some inexpensive antibiotics. But, unfortunately, that knowledge doesn’t exist. And so, as we were doing this for hepatitis C, we realized, yes, these rural doctors could give a chemotherapy-like regimen using the ECHO model as effectively as a university. So we said it could apply for a lot of diseases. 

And to get to a billion people, we decided we would train every other university, every other non-government organization in the world who wanted to do ECHO. We will train them and give them a technology platform. So now, we have ECHO for more than 70 disease areas in the world. Diseases like HIV, TB in Africa; or in the United States, chronic pain, opioid addiction, mental health disorders; and in India for cancer and all the others. We currently have ECHO operating out of 41 countries, with learners in 158 countries for more than 70 disease areas. 

Denver: That is a part of your spokes-and-hub model, correct? 

Dr. Sanjeev: Yes. 

Denver: Have you gotten into any other disciplines, be it non-health? 

Dr. Sanjeev: Yes. We have started ECHO projects in the field of education because, Denver, what we realized was certainly, a patient was not getting good treatment because there was no doctor in their community that had the best knowledge. But the bigger problem was there were hundreds of millions of students all over the world, living in small towns and villages, where the teacher didn’t have access to the best practice knowledge in how to train, how to teach because knowledge has been exploding at an exponential pace. For example, medical knowledge has been doubling every three-and-a-half years since 2010. This is a huge problem. 

Similarly, in education, new technologies are coming. So we started ECHO for education and now mentor school teachers sometimes in social and emotional learning, sometimes on how to do, hold a virtual classroom. We also mentor school principals on school leadership, teachers for how to manage children with disabilities, and so on and so forth.

Denver: Sanjeev, ever since the lockdown, where so many people have started to work remotely, we’ve become more accustomed to webinars and other learning sessions via the internet and Zoom. So what makes Project ECHO so distinctive and so different that really sets it apart from anything else? 

Dr. Sanjeev: So ECHO is an all-teach-all-learn model. So going back to that story of the hepatitis C patient that I had, and when we set up the first network, that might be helpful. So we needed a psychiatrist, a liver specialist, a gastroenterologist like me, and a pharmacist. We needed all three to be opining on a patient. They don’t exist in a rural area, and there were no specialists in a rural area. So we went around and set up 21 new centers of excellence for treating hepatitis C everywhere in New Mexico — five were in the prison system, 16 in rural clinics, and each was run by a primary care clinician. So that was the first principle: to use technology to leverage expertise.

But the second key principle was sharing best practices. So to all 21 sites, we gave them a protocol and we said, “This is the way to treat hepatitis C,” and not a single one of them was willing to treat. They said, “Look, this is chemotherapy. This is too risky. We are not trained as fellows. We can’t do this. This is dangerous.” 

So I asked myself, “How did you become an expert in treating hepatitis C?” What happened was that when I did my fellowship in Boston, Massachusetts, I would see a patient present to my professor, and I would see a patient present to my professor  And I did this again and again for two years; after which, they started calling me a gastroenterologist. I said, “Aha! I’m going to use this model to create new hepatitis C specialists in New Mexico.” We call this model Iterative Guided Practice in which all teach, all learn.

And the fourth principle is to track outcomes. So the hardest ECHO is a TeleECHO clinic where all 21 join together, and one by one present patients in a de-identified way to each other and to us at the university. What we found is, in a two-hour session, we would co-manage about eight patients, and then we would give them a 15-minute lecture. And to our surprise, in about one year, they became Google experts. 

The reason they became an expert was an idea called a learning loop. They were learning from our expertise. They were learning from each other because they brought one patient to the network, but they were learning on eight a week, 300 in a year. But mostly, they were learning by doing. And the idea being whenever you’re solving a very dynamically complex problem like treating hepatitis C or TB or HIV, you need guided practice; just learning or listening to lectures is not enough.

And so that’s where…what happened is the wait in my clinic started falling, and in 18 months had fallen from eight months to two weeks. Tens of thousands of patients got treatment. And then we did research to show that these rural doctors and prison doctors could give the same level of care, which was as safe and as effective as university specialists, and we published this in the New England Journal of Medicine in 2011. 

Denver: Fantastic.

Dr. Sanjeev: So, this is much more of a model of collaboration than just a Zoom interaction. 

Denver: Sanjeev, why do you believe so many subject experts have become a part of the Project ECHO movement? Because people can be quite protective of their knowledge, but these experts seem willing, in fact, pretty eager to share this expertise with others. Why is that the case? 

Dr. Sanjeev: Denver, you’re absolutely right. Knowledge in the current economies of the world is money, it’s power, it’s fame, and it’s many good things. But an equal number of people work for other missions, too. 

So, for example, I had a different kind of problem. I had done well financially. My wife is a physician. I’m a physician, and I was economically well off, but I had a different problem. And that was, I was a major expert, an international expert in treating hepatitis C, and yet the only people I could help were the people who could see me myself, people who could come to see me. I was essentially limited, enslaved by my calendar. I was running out of time to help people, and I wanted to help a hundred times more people. 

Then I realized that the only way I could do that is if I could make people as good as me in treating hepatitis C, and then I would do what we now call “force multiplication.” I would exponentially improve my capacity to help people in the world. And so, I did it for a very selfish reason. I wanted to have more impact on the world. And what I found, Denver, is the world is full of people who want to have much greater impact than they’re currently having, and ECHO is a model for them to fulfill their life’s dreams and ambitions.

Denver: And, of course, the little additional nudge you had is that your two daughters went off to college. 

Dr. Sanjeev: Exactly. What happened was that I spent a lot of my younger years bringing them up and really completely mesmerized with this whole phenomenon of bringing them up and making them pass through school.

And we started ECHO a few months after my younger daughter left for college, and I was asking myself this question — What is it? What’s the next goal of your life now that you’ve achieved this one?  That you brought up your daughters, and that’s how I was called upon.

no matter what you do in your life, the only way to be happy is to find a way to serve others.

Denver:  I think that answered the other question, too. It’s a bit of a stage of life thing, isn’t it, for a lot of people? That they get to that point where they want to do more, they want to be more purpose-driven than just the business.

Dr. Sanjeev: I think, Denver, that’s really well said because for the first many years of my life, I was very, very focused on the idea of developing myself professionally, for economic stability, for a good education for my children, and really just spending time with them to make sure they become good citizens. And that was a huge responsibility. It took a lot of time.

But after they left, there was a void, and I had to ask this question: What is the purpose? And that’s when this idea came, which essentially says that no matter what you do in your life, the only way to be happy is to find a way to serve others.

And so, when I started doing that, I found that it was so true that serving others was an enormously fulfilling activity, and spending one’s life in service was a wonderful way to not only serve other people but also set an example for the children that you have spent so many years with.

Denver: Yes. I think that’s an old Albert Schweitzer quote, if I’m correct.

Dr. Sanjeev: Exactly. He was a Nobel prize winner, worked in Africa all his life, and he gave this key insight. And what was really interesting about this quote was, he said, “The only ones amongst you who will be very happy are the ones who have found how to serve.”

Denver: It’s not a route, it’s the route. No question about it. You’re able to do all of this free for those who are engaged with you. So share with us your business model and your supporters and your sources of revenue. 

Dr. Sanjeev: We gave it very careful thought as to whether we would charge people to give them ECHO. But, Denver, we realized one thing very early on that the people we want to serve had no money. Some of them were making less than a dollar a day. So business models in healthcare don’t work at less than a dollar a day. Healthcare is hard. Knowledge is expensive. 

And so, the people who serve these underserved people often don’t have a lot of money either. They’re often non-government organizations, they’re government entities serving the poor. In most parts of the world, we find that the major provider of healthcare for poor people — and we currently have learners in 158 countries…in most of them, for poor people, it’s the government that provides care. Even in the United States, the most developed nation in the world, it’s Medicaid, and poor people get care through the government.

So we decided that “Look, we wanted specialists to democratize their knowledge. Why should we as ECHO make a business model to sustain ourselves? Why should we not democratize our expertise and our technology platform?” 

So we went to Zoom, and we have got their worldwide license. They’ve been very generous to give us an unlimited license for the world, which we can then extend to our partners. We developed another technology platform called iECHO. We developed an in-cloud solution for the repository of knowledge for all our partners. So we told all our partners:  We will give you ECHO for free. We’ll give you a technology platform. We’ll train you. But in exchange, when you create intellectual property on ECHO, will you share it with everyone else? 

So now we have a thousand networks operating out of 41 countries, out of 401 hubs, and they put their intellectual property back. So it’s a pay-it-forward model, which we then share on with anyone else who wants to do ECHO. 

And so how do we get supported through philanthropy?  We found, fortunately, some very generous philanthropists who have taken the time to understand the model. Sometimes, it’s very hard to get it unless one spends a fair amount of time studying it. But once they understand it, they realize the leverage and the force multiplication that occurs that is there is truly an exponential impact when you take a super specialist of one kind and multiply his impact 10 times, 100 hundred times.  First hundreds of thousands and then millions of patients benefit. 

Denver: In a force multiplication, your organization has been beyond busy since the outbreak of COVID-19. Give us an idea, Sanjeev, of all that you’ve been doing.

Dr. Sanjeev: So what happened was in February — and we had, of course, lots of hubs all over the world, lots of foreign organization partners; every leading university in the United States was already doing ECHO, and then COVID-19 came along. And we found, “Wow. This was an amazing problem because no doctor, no nurse, no community health worker in the community knew anything about it, and the knowledge was constantly changing.” 

So our partner in Vietnam, Vietnam Children’s Hospital first launched ECHO for COVID-19 and rapidly trained 12,000 health care professionals. And we said, “Wow. This was very impressive, what they did.” And we then started asking the question: In what domains are training required? 

We realized there was training required in two separate domains. One is amplifying the public health response. And that had to do with PPE. How to use it? How to reuse it? There was a shortage. How to prevent COVID from spreading? What communication systems should be built? How should you do testing? What kind of testing machines should you buy? How do you contact trace? How do you quarantine patients? How do you isolate them? So that was the one whole area. 

But then there was this other problem, patients with symptoms were arriving at doctors’ doors who didn’t know what to do. So how do we treat them? Who should be treated at home? Who should be treated in the office? Who should be hospitalized? On the floor or in the ICU? What should the ventilator setting be? Should they be on their stomach or on their back? Now, we know that on their stomach, they do better. Now then later on, dexamethasone comes along, remdesevir comes along. 

So a continuously changing field in which doctors have no way, so more than a hundred of our hubs launched COVID-19 projects. We launched projects in partnership with the World Health Organization in the African region, partnered with the USCDC. We partnered with the federal government Assistant Secretary for emergency preparedness. And we have now trained more than 600,000 healthcare professionals all over the world in the COVID-19 response. And it’s been very gratifying to see the rapid uptake of ECHO, that we can help a little bit in these absolutely difficult situations for the whole world. 

Denver: Congratulations on stepping up and meeting that moment. And I guess the next moment is going to be readying — I don’t know — a multimillion-person vaccine workforce in the next six months to a year? Are you thinking about that? 

Dr. Sanjeev: Yes. In fact, I recently gave an interview to Forbes about that. And the challenge we are going to meet, Denver, is that 7 billion people will need to be vaccinated, and the world has never done that in a short period of time. In fact, in most countries in the world, the poor countries in which I have a major interest, especially in Africa and countries like India or other regions of the world, adult vaccination is not a really big thing at all. Most adults don’t get vaccinated. Like we get an annual flu vaccine; in most countries, they don’t. Vaccination is mostly a children’s and mother’s problem. They get vaccinated. Children get vaccinated. So they don’t have a workforce which is large enough to train. 

But the other issue is that a recent survey was done in the United States, and a third of the US citizens said that even when a vaccine would be available, they wouldn’t take it. There’s tremendous vaccine hesitancy in the world. There’s no trust in the system that it’s safe. 

And so, first of all, we have to train a very large community health workforce to overcome vaccine hesitancy so that somebody whom they trust, in a culturally appropriate way, in their own language explains to them: What is the benefit to them? What is the risk to them? What are the potential side effects? Then we have to train vaccinators on how to vaccinate, how to store this vaccine… because some vaccines will require cold storage; some will not. Some actually require minus 20 to minus 70. Then there’s this issue of managing side effects, training the workforce because let’s say 1% of the people have side effects…

Denver: A lot of people still.

Dr. Sanjeev: That’s still 70 million people. And then a smaller number, let’s say 0.1% or less have very serious side effects, they may get admitted to a hospital. It’s still an effective vaccine, but those people need to be treated. 

So there is tremendous work to be done to rapidly scale up the vaccine workforce in the world, and we want to use our global network. We have the railway tracks already set up, but we have to drive the vaccine trains on these tracks now. 

Denver: Looking beyond that vaccine challenge, Sanjeev, how do you believe COVID is going to change the way knowledge is shared in the future? 

Dr. Sanjeev: First of all, of course, COVID will permanently change our interactions to some extent. I still believe that as a society, personal human interaction is important. So I’m hoping that we’ll go back to our old ways—

Denver: I’m hoping, too.

Dr. Sanjeev: –a little bit after COVID-19 is over. But here’s one really major issue that is it’s coming up in our COVID-19 response in the whole world. 

One is that our healthcare systems around pandemics are arranged around country boundaries. So we have national response– US response, French response, German response. But the virus, in a pandemic like COVID-19, does not respect national boundaries. So in order to be effective, we need global response. So one thing I hope will happen is we will think of healthcare on this planet much more of a global health problem rather than a national health problem. A national health problem is hypertension, but a pandemic is a global health problem. 

The other thing I’m hoping people will realize is there is a tremendous amount of suffering that occurs in the world because of wars, famines, and terrorism… and disparities, inequities are at the root cause of a lot of societal dysfunction.

Now, of course, there are a huge number of philanthropists. They share money with these poor countries, but at the end of the day, this money is a limited resource. And when I share — if I have a hundred dollars and I give you 50, then I’m only left with 50. But when I share my knowledge with you in an ECHO-like platform, in which all teach, all learn, two things happen.  You learn from me, but I also learn from you, and we are both richer at the end. 

So the physics of knowledge is such that by sharing in a respectful, loving, empathetic, and kind way, and building communities of practice, knowledge increases. So we can all, we can create a win-win solution by sharing knowledge freely, by mentoring each other to work at the highest level of our human potential. And I’m hoping that this knowledge sharing will be the beginning of a new world, to create more peace and joy for all of us. 

What was a really big insight was the right knowledge at the right place at the right time is essential. Without that, even if you had money like we have in the United States, you cannot get the right care.

Denver: I hope you’re right. Being one of the six semifinalists in a competition to find solutions, I know there are going to be a lot of listeners out there who are going to be curious about how you approached this challenge, so I want to ask you a few things about that. 

And I know that much of the success comes from defining the problem you’re seeking to solve. Tell us how you came up with your problem statement, reframed it to see it from multiple perspectives, disaggregated it to find the critical path, and so on. Tell us how you approached that as you started Project ECHO. 

Dr. Sanjeev: I think, really, it started with the idea of service — service to others. ECHO is just a model in itself. The mission of my life is not ECHO. The mission in my life is to serve humanity. And so ECHO is a useful way to share knowledge, share expertise, but at the heart of it, as we start spreading ECHO around the world, from one disease to another, in an organic way, I got exposed to disparity, which was beyond imagination. Like I mentioned to you, 1800 children dying every day of diarrhea — that shouldn’t happen. I’m a gastroenterologist. I know that should not happen, and the families that are destroyed.

And I also realized one thing, which was very impactful, that often we don’t tackle these problems because we say it’s a lack of resources. There’s not enough money to do this. But I realized that not everything requires money. There are so many things we can do just by sharing knowledge. 

There are hundreds of diseases for which genetic medicines are available for pennies. A tablet of ciprofloxacin in Africa costs less than 2 cents, which is effective medicine for diarrhea. Anti-malarial medicines are freely available. Tuberculosis medicines are free. HIV medicines are provided free to almost all patients in Africa through the PEPFAR program. Yet people die. What was a really big insight was the right knowledge at the right place at the right time is essential. Without that, even if you had  money like we have in the United States, you cannot get the right care.

And because of this physics of knowledge and the availability of technology, if we, as experts, shifted our mindset and said, “What if I spend 10% of my time, just 10% of my time serving humanity, it would change the world. It would change the world because with my 10%, I would create 10 more Sanjeevs, and that has an exponential pay-it-forward growth paradigm associated with it because knowledge is not restricted. It doesn’t have to be carried in these large supertankers. It flows easily. And I think that’s why we’ve chosen this. And we think we can help all 6 billion people in the world by getting the right knowledge at the right place at the right time.

And the last point I want to make, Denver, here is even when there is no money or very little money, the right knowledge tells you how to spend it and get the highest return for that investment. So all of this combined creates our vision of changing the world and changing it fast. 

The other thing that it does is when you share and mentor other people, it’s an act of caring, and it’s an act of empathy and kindness, and that sort of helps grow the most fundamental human qualities that are required for the world to be a safer, better place. 

Denver: I think you’re absolutely right about that. Somebody on the show recently said that the best chief financial officers often will be single mothers with three or four children because they can take whatever money they have and stretch it and work miracles with it. So I think sometimes having a lack of resources does make us more creative and just more industrious in terms of how we tackle things.

Dr. Sanjeev: Denver, there’s a sort of a lovely way to think about it. If you have one candle and with that candle, you go around lighting 50 other candles, it doesn’t diminish the brightness of your candle, right? And that’s how knowledge essentially operates. And it has the ability to change the world.

The other thing that it does is when you share and mentor other people, it’s an act of caring, and it’s an act of empathy and kindness, and that sort of helps grow the most fundamental human qualities that are required for the world to be a safer, better place. 

Denver: Let me ask you about money in a different way, and that’s turning our attention to the $100 million award that will be given by the MacArthur Foundation to one of the six semifinalists. How will you use that $100 million if you should be so fortunate to be declared the winner? And what will it allow you to do, Sanjeev, that you’re not doing now? 

Dr. Sanjeev: So, first of all, we have 401 hubs right now. We have learners in 158 countries, but we want to touch a billion people. We can’t do that with these few hubs. The world is just too big. So we want to increase the number of hubs in the world to a thousand. We want to tackle some of the biggest problems of humanity. So of course, the first year or two of the grant, we would like to use it for COVID-19 response in a very robust way, and you talked about one of the major uses is vaccination, but there are other uses of it, Denver. 

As you know all too well, there’s no effective treatment right now. There’s dexamethasone, there’s remdesivir, but they’re both marginally effective. Once new treatments come, we need more effective treatments. They will have to be disseminated, and people will have to be taught how to use it. So that, plus vaccination will keep us busy for some time because we think that this problem of COVID-19 is not going away in six months. It’s not going away in a year. We are with it for some time, and we need to address it. And we want to create a more humane approach to it, that we tap into this problem at a global level rather than a national level. So that’s why we have partnerships with all kinds of experts. 

More recently, we have just started a global collaborative forum where the last session we had, there was the Director-General from CDC from China. There were people from South Africa. There were people from WHO, the USCDC, et cetera, all sharing best practices with each other to help each other in this effort. So that will be the beginning part of our work, and really setting up centers all over the world for training vaccinators, training, community health workforce, partnering with governments to help them amplify their public health response. So that’s one goal. 

The second is we want to launch an ECHO ambassador program. What we mean by that is what we have found is it is very hard for people to understand quickly what ECHO is. They think, “Yes, so it’s a video conference. So what?” So because of that reason, typically, ECHO has spread by word of mouth, maybe going to explain what ECHO is, and then we offer our services.

So we want a worldwide ambassador program. So currently we work in 45 countries in Africa, but we have partners to go to different non-government organizations, ministries of health, state governments, district government, and explain ECHO, offer them our technical assistance to launch the ECHO process, launch the technology to do that.

So there are certain parts of the world where we have no geographic presence right now. Of course, we do everything remotely. We can train remotely. We have virtual training sessions. But it would be helpful for us, like in India, we have an office… to have a couple of offices in Africa. Now, there may not be buildings now in the new world, but we need presence, local people there who can speak the language, who understand the culture, who understand the barriers, and can then help the continent themselves. 

We want to partner with large — there are already our collaborative partners like the World Health Organization.  Africa Union, for example, is our partner. We are using ECHO for global health security in 40 countries in Africa, but we want to enable them to use the ECHO model to disseminate best practices across continents. And each country in Africa should have many hubs for the chronic diseases after COVID-19 such as TB, HIV, diabetes, strokes, kidney disease, et cetera.

And we have to strengthen our technology platform, which we call ECHO Digital, so that automatic outcome tracking can occur. And also, if there’s a doctor in rural Kenya, how does he find out about ECHO? Can he use the technology platform to learn? If there’s a rheumatologist sitting in Red Hook in Namibia who wants to use and democratize his knowledge? As in every religion in the world, there is an explicit request to share with underserved people. We call it tithing in Christianity. We call it Zakat in the Islamic world or Seva in India. Every religion has that. So people all over the world want to share. We want a technology platform that is freely available to them at no cost so that they can find their learners whom they want to mentor. Learners can find teachers so that a new economy of knowledge sharing is created in the world. 

And then, of course, we want to evaluate our project to demonstrate how effective it is. We already have 275 peer-reviewed publications showing the effectiveness of ECHO, but we need many more from the lowest income countries in the world. And some of this funding will go for that purpose also. 

Denver: You’ve touched on some of this, but let me close with this, Sanjeev. You clearly have some formidable and worthy competition in the other semifinalists. I’ve been preparing for those interviews and they, too, are doing some really amazing stuff. So what case would you make as to why Project ECHO is the one that will have the greatest impact and be of the greatest benefit to humankind?

Dr. Sanjeev: I was afraid you would ask me this question. 

Denver: It’s my Shark Tank question.

Dr. Sanjeev: First of all, I’ve looked at all the other projects, and they are doing amazing work. So I would be very happy for any one of them to be funded. 

What I can say is what we do bring to the table, I wouldn’t say it’s better than what they bring to the table.  But what I can say is that we have the potential to immediately address the COVID-19 pandemic today. We are addressing it today. We have already trained 600,000 healthcare professionals. But of course, when you get to 7 billion people, the numbers are enormous. We have to train many, many millions more.  Much work needs to be done. We want to work on the vaccine problem. 

And because ECHO sessions are typically weekly, we have the existing railway tracks along which these COVID-19 trains will flow. So what I mean by that is: I anticipate over the next two years, every couple of weeks, new insights will be coming out on COVID-19. New things about transmission. New things about treatment. New things about prevention. Are there nutritionals you could take? Are there particular health practices that we can do to protect ourselves? All of this science will be created. What I have been told is there are about 200 new publications coming out on COVID-19 every single day. How will a doctor in a rural area or a nurse or a community health worker keep up with this?

So we want to be the voice of science to take some of this knowledge to the last mile and do it quickly. And because we already have the existing platform — as I said, we have 650,000 people who’ve already been mentored who are in 158 countries — and we just have to build on it, but just using the existing network, we can do a lot of good in COVID-19.

And secondly, once these global networks and a philosophy of sharing is established, I am very optimistic that governments that have a need to serve poor people will then use this platform for strengthening their health systems in every other area. We also are rapidly seeing — even though I’m a physician, I’m not an expert in education — that experts in education are rapidly adopting the ECHO model. And we see that as a collateral benefit for which we will not be spending the MacArthur Foundation dollars if we were lucky enough to get it.  But that collateral benefit is occurring… that these large education organizations are coming to us, and we are embedding ECHO in their organizations to do good in the field of education. So I see ultimately the impact of ECHO in education will be as big as in healthcare. 

Denver: Sanjeev, tell us about your website and some of the things visitors will find there. 

Dr. Sanjeev: So I think if you head to our website as a philanthropist, you can, of course, learn about the ECHO model, what it is and where we work. If you went there as an individual who has a certain kind of expertise that you want to share with the world, and you say, “I want to spend two hours a week helping the world,” then ECHO is the model for you. You can find how to become a collaborative partner. How can you get the technology expertise? How will we train you to do ECHO and then give you the technical assistance you need. So that’s the second thing. 

If you are a doctor, a nurse, or a community health worker or a school teacher that wants to be trained on ECHO in a particular area of interest, you could go to our website and learn: What are the current ECHO programs going on? Where are they going on? How should I contact the people who are running it? Can I be their mentee? That’s another option available for you there. So there are many, many things available on our website, and I encourage you to visit it. It’s 

Denver: Well, best of luck to you and your team in the MacArthur Foundation’s 100&Change competition. It was a real pleasure to have you on the show, Sanjeev. Thanks for being here. 

Dr. Sanjeev: It was a pleasure to talk to you, too, Denver. Thank you for having me. 

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