“I decided that I wanted to change what I was doing because I really wanted to focus on malaria. And at that time, malaria was kind of an obsession for me because malaria is super interesting. It’s biology, but it’s also public health.”
Arnon Houri-Yafin is the founder and CEO of Zzapp Malaria, an AI-assisted mobile app that identifies malaria hotspots that can be prioritized for treatment with larvicide. But Arnon’s path there was far from direct. After studying economics at university, he briefly worked at Israel’s securities regulator, taught statistics during an MA, before leaving the MA to join a friend’s biotech startup. When that company pivoted away from malaria diagnostics, Arnon wanted to continue combatting malaria. Drawing on Israel’s own history of eliminating malaria by treating standing water bodies, he founded Zzapp to expand this approach in countries where malaria is still prevalent. Today Zzapp is partnering with ministries of health, philanthropies, the Gates Foundation and others to conduct life-saving, cost-effective, malaria operations.
In the interview we discuss how Arnon came to be interested in malaria, how his background in economics shaped his career trajectory, and how teaching others can be a great way to learn something yourself.
Your background is in economics, which might be surprising given that you ended up working in tech. How did you decide to study economics? Was there anything you found particularly interesting about it?
Yes. When I decided to learn economics, it was definitely in order to make an impact, with the idea of researching poor economies or developing economies. I think poverty was something that I was very engaged with. And also, I think the combination of quantitative and qualitative science is what I loved about economics.
How did that interest in poverty come about? Is there anything in your background that explains that?
I think like many people, I did learn about some stories about poverty in my family, but didn’t experience it directly. But I think more in terms of emotional growth, the growth of a person spiritually and emotionally is something that’s very interesting for me–and the understanding that poverty can block it. In a way, my dilemma was: would I be a teacher that interacts directly with personal growth, or would I be an economist who will help to fight poverty, which will enable personal growth?
Did you learn what you were hoping to learn with economics, and did it end up being as useful as you expected?
Definitely, yes. It’s super interesting, especially if you combine things. So I took a Philosophy, Politics, and Economics course, and I think that gave me a combination of qualitative and quantitative that I wanted. I did focus on statistics on one hand, which we will meet later in the story, and philosophy. But for someone that’s just starting, I would also recommend focusing on the history of economics. That is, I think, a very good opportunity to meet the same ideas but articulated in a very different way, especially if we speak about the more original papers of history of economics.
After your degree, you went on to work as a lecturer. Going straight from an undergraduate degree to lecturing seems unusual. Can you explain how that came about?
After university, I started to work at the Israeli Securities Agency, which is the regulator of the stock market in Israel, as a young researcher. I wasn’t good at that, and they fired me very soon. But also my intention was to start an academic career. So as part of that, I started to do an MA, and then during the MA, I also taught statistics. This is something that universities give students the opportunity to teach if they want to support their career, students that are really engaged in the research.
But more or less at that time, a friend founded a startup that tried to use machine vision to analyze blood anomalies. So I moved to that. Basically, I didn’t finish my MA, and I also after a few semesters left the teaching because I wanted to be engaged in my friend’s startup.
But if we do want to speak about teaching, I think teaching is an excellent opportunity for you to understand courses. Normally people that finish the course do not understand it, even if they got 100 in the test. But then after you teach it, you do understand it. So I really recommend, even if you don’t have the opportunity to be a lecturer, to find the opportunity to explain to others what you understand. This is the only way you personally can digest it in an effective way.
Moving to a biotech startup seems like an odd transition for someone with an economics background. Were you just interested in this specific opportunity at your friend’s startup, or did you have a pre-existing interest in biotech?
That was the reason. Because it was a friend, and because he really pushed me to do it. When he tried to convince me, he used the statement, “You want to engage with poverty, but you know that malaria is one of the primary reasons for poverty.” So he just used it as one method of convincing me, along with “It will be fun,” and other friends will be there. But yes, I would say the primary reason is because it was a friend, and the secondary reason is because it’s related to poverty. And then the last reason would be that I felt like it would teach me how to think, with the idea in my mind that after a few years, I will go back to academia and learn economics, which didn’t happen.
What was the culture and work life like in the startup?
So it was very intensive. The environment—people choose how to experience that. So for example, my boss at that time was very effective and very chill, but I experienced it as very intensive. And it doesn’t always make you more effective, but that was my experience. And it also, I would say, the experience of being few people, some of them are friends, most of them are in the same age, most of them think in a very similar way, it’s both kind of fueling, like it’s super interesting, it’s super funny, but also kind of misleading. Like you don’t get feedback from more adult people, or you don’t identify very clear mistakes that you do as a group. I think that is also something that I learned. But mostly it was a very good learning experience, being in a startup. I really recommend it.
How relevant was your background in statistics and economics for this role? Did you have to pick up many new technical skills to perform in the biotech space?
Biotech involves a lot of statistics. I did help to design clinical trials, like powering the sample size and really standard statistical things. I also led the annotation team in the startup. So we just looked at pictures and said, “This is white blood cell, this is a malaria parasite, this is a platelet,” and we’d just annotate images. And then I applied a lot of statistical thinking to that. So for example, I insisted that separate people would annotate the same patient, and then later we could compare, like what is the confusion matrix. So, I do feel that a lot of what I did was statistics. It’s also easier to speak with machine learning people if you know statistics, because you kind of understand their language.
During your time at this startup, you started Zzapp Malaria, which you now work on full-time. How did that come about?
The company decided to move to more standard applications of blood analysis. So not malaria, but mostly complete blood count, which is the most common blood test in the developed world, in terms of market, more focused on the US than Nigeria or India. At that phase, I decided that I wanted to change what I was doing because I really wanted to focus on malaria. And at that time, malaria was kind of an obsession for me because malaria is super interesting. It’s biology, but it’s also public health–which is a very different thing, and it is behaviorally driven. Like, do you go out in the evening when mosquitoes are active or not? So I really love the multiple angles of that problem and decided that I want to be in malaria.
I then did a lot of analytical work on what I wanted to do in malaria. And then I decided that prevention is the most important thing. In Israel, we have a story of malaria elimination. It’s kind of the origin story of the state of Israel, actually eliminating malaria. It’s something that 20 years ago every child in the school would learn about. And the way they did it is mostly by treating the standing water bodies.
So I started to learn why they stopped this method in Africa; why do they focus mostly on bed nets? One answer is that bed nets are just great. But the second answer is that operationally, larvicidal techniques are very difficult. My thinking was that using technology, we can make it easier if we integrate mobile apps, or if we integrate drone or satellite imagery analysis.
One idea, which every malaria scientist would agree with, is that if you want to eliminate malaria, you need to attack it from multiple angles. It must be holistic. And our idea was that first, the water body is an important angle–and second, that mapping of the water bodies is also a cornerstone of applying more holistic methods–because if you understand where the water bodies are, you understand where the hotspots are.
It’s very clear how to eliminate malaria by brute force, if you spray all of the houses, if you give all of the people bed nets, if you treat all of the water bodies, if you give all of the people drugs, if you build more clinics, et cetera. But that would cost much more than any African country can afford. If you want to integrate different malaria methods, you must operate not with brute force, but with optimization. Based on the characteristics of a specific village or a specific catchment, you can choose what intervention to take. Our thinking was that the primary driver of saying “this malaria area is of class A or class B” is based on the types of water bodies and the abundance of the water bodies. I would also highlight that the cost-effectiveness of water body treatment, compared to bed nets, is mostly related to population density. Because the cost of bed nets is per capita, and the cost of locating and treating water bodies is per square km, in some areas you may be 2 times or even more cost-effective with larviciding compared to bed nets.
Was your intention always to start an organization, or would you have been happy to join something pre-existing?
I don’t think so. Looking forward, I don’t think I would prefer starting an organization again. First, it’s difficult. And second, I think at least in the past, I was too introverted for that. I’m not an introverted person–my friends would not tell you Arnon is an introvert. But in order to start an organization in which the funding depends mostly on your ability to convince people–that’s difficult. It’s not a bad thing, but sometimes it’s better to use something that is already out there.
I also have special privilege because I received a lot of support from the diagnostics company – Sight Diagnostics, and also from Ari Eicher who ideated the strategy of how to build a malaria elimination focused company. Getting such a partnership at an early stage is crucial.
How did you navigate finding funding, given that this doesn’t come entirely naturally to you?
Early in the process, we decided that this would be a for-profit company. Now, eventually, all of the money that we received was NGO-like money. We received money from the Gates Foundation, and we got the XPRIZE Artificial Intelligence for Good, for $3 million. But I spent a lot of time really trying to build the optimal PowerPoint presentation for private investors, and speaking to investors, and it just never worked. The reason for that was that it’s very tough to sell someone that you’re a malaria-only company. Our thinking was that people would invest because of the impact. But then you just confuse people. Because people think, “okay, if it’s for impact, why aren’t you an NGO”?
So that was a bad experience. And vice versa, I really learned to like the process of getting philanthropic money. It’s more similar to the money that professors in the university get. You just explain cost-effectiveness reasoning, a thesis, risks to the project, and then a smart institution like the Gates Foundation might like it. This is something that I actually find I enjoy, and it worked for me. But also, I think that it actually improves what you do similar to how teaching is good for understanding. In the same way, writing a grant, when you believe that the person that reads the grant is a professional, makes you think more proficiently.
Your role seems to involve travel to where Zzapp operates. How much travel do you do, and how have you found that?
So first, I love it. I really like the experience. I don’t travel most of the time when I’m abroad. I’m not interested in seeing a new river, just seeing the land as it is, speaking with people. I really love it. I find it really enriching for myself. And it is in my comfort zone. So I think the difference between an initiative like bed nets and an initiative like larviciding, spraying of water bodies, is that what we are trying to build is not a commodity. It’s not something that would be produced in a factory in the Netherlands and will be shipped to Africa, but something that happens on the ground. There is no sense in building it if you are not very familiar with how a Ministry of Health in Africa works, what challenges people on the ground have, and what water bodies in Africa look like. It’s a lot of learning by doing stuff. You need to train them on your own app to see what is trivial for them, what is difficult for them, or what is intuitive.
Is there anything advice you’d give to people exploring a similar route?
I think career-wise, one of the challenges is the slowness of this type of operation. So for example, you agree with a minister of health that you would start a project, and in your mind “starting a project” means starting it tomorrow. But in reality, it might be in 2 years from now. And it’s first emotionally very difficult, and second, it’s also financially very difficult. For example, do I need to hire an Operations Manager for Country X? Because I don’t know if I’ll need one tomorrow or 2 years from now.
And I think that people that do want to do similar activities in the developing world, similar initiatives, whether it’s NGOs or startups, should have patience. They should somehow find money with patience. So investors or donors should also understand that things may take time. And this patience is something that I believe people can develop in themselves.
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