April 15, 2024
6 min read
The Path Bill Gates Sees to Overcoming Alzheimer’s Biggest Remaining Challenges
Gates talks about his own experience as a caregiver and all he is doing to fight this disease
This article was produced in partnership with the Davos Alzheimer’s Collaborative by Scientific American Custom Media, a division separate from the magazine’s board of editors.
It would be hard to imagine any one person who’s had more of an impact on public health than Bill Gates. Much of the wealth he amassed as founder of Microsoft has gone to charity—according to Fortune, he is one of only five billionaires to have given away more than 20 percent of his wealth. In 2023, the Bill and Melinda Gates Foundation, which he started with his former wife, Melinda Gates, spent more than $8 billion of its more than $70-billion endowment.
Gates has focused his philanthropy largely on some of the most intractable health problems, such as malaria, HIV/AIDS and childhood vaccination. In recent years, he has turned to Alzheimer’s disease, starting with diagnostics and more recently expanding to proteomics and healthcare programs related to the disease. Scientific American Custom Media asked him about Alzheimer’s:
SCIENTIFIC AMERICAN CUSTOM MEDIA:
What sparked your interest in Alzheimer’s? How has your personal experience with the disease contributed to your decision to get involved?
Gates: Like many people, I have a personal connection to Alzheimer’s. My dad died from Alzheimer’s, so I understand first-hand what a cruel disease it is, and how difficult it can be to watch a loved one suffer with it. We were fortunate to have the resources to provide my dad with excellent care, and our family is grateful for the wonderful caregivers who helped him in the 13 years he lived with the disease. But for the majority of families battling Alzheimer’s, this is not an option. Caregiving most often falls to a spouse or a child, which can be overwhelming.
The financial burden of the disease is easier to quantify than the emotional cost. The lifetime cost of care for Alzheimer’s and other dementias is rapidly increasing in the U.S., Japan, Europe, and other countries. According to the Institute for Health Metrics and Evaluation, the global cost will exceed $1.6 trillion by 2050 and represent nearly one-third of all healthcare spending. Unlike those with many chronic diseases, people with Alzheimer’s incur long-term care costs as well as direct medical expenses. If you get the disease in your 60s or 70s, you might require expensive care for decades.
As I spent time learning about Alzheimer’s and the research into it, I came to understand the challenges. The brain can’t be sampled easily or often, for example, and the blood-brain barrier is a double-edged sword—it both protects the brain and makes it harder for treatments to get in.
Even so, as I learned about all the innovation in this field, I grew optimistic about the ability to make progress toward treatment and eventually a cure. This is a frontier where we can dramatically improve human life. It’s a miracle that people are living so much longer today, but longer life expectancies alone are not enough. People should be able to enjoy their later years—and we need a breakthrough in Alzheimer’s to fulfill that.
As someone who takes a bird’s- eye view of major health issues, how would you describe the current outlook for Alzheimer’s research and clinical practice?
After decades of negative clinical trials and dozens of failed therapies, researchers are making progress on both diagnostics and therapeutics.
Blood-based diagnostics are advancing rapidly—the first blood test for Alzheimer’s, PrecivityAD, was launched in late 2020. A few others have followed since, but we are looking forward to the first FDA-cleared blood tests on the horizon. Once this becomes a reality, the next hurdle will be ensuring these tests are used properly, accessible and available to the patients that need them, and that we understand how these tests work in different patient populations.
Read More from This Report
The New Age of Alzheimer’s
The therapeutic pipeline is diverse and robust—at the beginning of 2023, there were 187 trials assessing 141 different therapeutics. The anti-amyloid agent lecanemab has been approved for use in patients, and donanemab is expected to follow soon. Other therapeutics in the pipeline include disease-modifying therapies and cover a wide range of approaches, including amyloid and tau but also newer mechanisms such as neuroinflammation, synaptic plasticity/neuroprotection, metabolism and oxidative stress (see J. Cummings et al., Alzheimers Dement (N Y), Apr-Jun 2023, Vol. 9: e12385).
With these and other breakthroughs that are coming, it’s fair to say we’re at a tipping point on Alzheimer’s.
In recent years you’ve directed funding to accelerate development of diagnostic technologies for Alzheimer’s. Why did you pick that particular area to start?
We systematically looked at the barriers to R&D on Alzheimer’s disease, and we heard consistently that not having a simple, non-invasive, scalable and relatively inexpensive diagnostic (such as a blood test) was a key challenge. It’s a barrier to early diagnosis and subsequent enrollment in clinical trials—and continuing to make advances on the disease depends on getting enough people enrolled early enough in trials.
Another problem is that the commercial market for diagnostics does not stimulate investment, so potential scientific breakthroughs are not being pushed forward as rapidly as they should be. This is why I partnered with the Alzheimer’s Drug Discovery Foundation to create the Diagnostics Accelerator, which is designed to advance bold ideas for easier, more accurate and earlier diagnosis of Alzheimer’s disease.
Do you have any plans to direct funding to accelerate progress in other areas of Alzheimer’s, such as treatments, diversity in clinical trials, public-health outreach or others?
We’re focused on five areas: understanding the biology of the disease, diagnosing it, treating it, overcoming bottlenecks in clinical trials, and making it easier for researchers to share data with each other.
One of our latest investments is with the Global Neurodegeneration Proteomics Consortium, which brings together data from more than 40,000 blood samples around the world so researchers can identify biomarkers for detecting neurodegenerative diseases and identifying new mechanisms to test. We’re also partners in the Clinical Trial Recruitment Lab and the Global Alzheimer’s Platform Bio-Hermes Study, both of which are aimed at recruiting people from diverse backgrounds to join clinical trials.
We’re also partnering in the Davos Alzheimer’s Collaborative’s Healthcare System Preparedness Initiative, as well as a recently announced Innovative Health Initiative-funded program, AD-RIDDLE, all of which are efforts to ensure that breakthroughs can be deployed in healthcare systems once they’re approved for use.
You’ve written about how data sharing is vital to learning more about Alzheimer’s disease and accelerating progress. Why is that so important and how is that effort going?
Over the past few decades, drug trials and longitudinal cohort studies have generated an enormous amount of data. But right now, that information is not being shared to the fullest extent possible. Much of it remains locked away or accessible only to select groups. That’s a missed opportunity as well as a disservice to the people who agreed to join studies so they could help advance the field.
To help unlock these datasets while making sure they’re used responsibly, we worked with several partners to launch the Alzheimer’s Disease Data Initiative. Our goal is to help researchers from around the world access more information by making data and data platforms interoperable. So far, the effort has established interoperability with several data platforms, including the Dementias Platform U.K. portal, the Vivli Platform, and the Global Alzheimer’s Association Interactive Network platform (GAAIN).
More recently we’ve gotten involved in the European Platform for Neurodegenerative Diseases (EPND), which is building a platform that will help researchers make their data and biosamples shareable. Their platform will build on data and analysis tools made available by the Alzheimer’s Disease Data Initiative, including the Global Research and Imaging Platform, a nonprofit that I fund. Finally, we’ve created a two-year fellowship, named after my dad, that brings in researchers from around the world to work on data analysis and to champion the idea of interoperability.
What is the biggest obstacle to making progress on Alzheimer’s? Is there a cultural shift that needs to happen?
Although we’ve recently seen important advances in therapeutics and diagnostics, there is still a lot we don’t know about Alzheimer’s disease and the brain. Timely diagnosis is the first major shift that needs to happen—many studies have shown that Alzheimer’s disease and dementia are dramatically underdiagnosed today. If we’re able to catch the disease sooner, we’ll be able to give patients more options for treatment, social services, and participating in clinical trials and other research opportunities.
But Alzheimer’s disease is also a heterogeneous disease, and patients who have it show a wide range of pathologies in the brain and resulting symptoms. I’m hopeful that the field will be able to capitalize on recent advances in diagnosis and treatment—and also make it easier and more efficient for people to enroll in Alzheimer’s clinical trials—so we can continue to improve our understanding of subtypes of the disease and target our efforts at treatment and prevention.
Finally, there is still a lot of stigma surrounding neurodegenerative diseases. That makes it harder to discuss them openly. But I think a lot of that is driven by the fact that these diseases seem so mysterious because we haven’t had sophisticated diagnostics or treatments. I’m optimistic that as more advances happen, the stigma will fade, and open public conversations about Alzheimer’s will accelerate progress even more.
This article is part of The New Age of Alzheimer’s, a special report on the advances fueling hope for ending this devastating disease.
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