An Action Plan for Innovation and Healthy Aging
By Michael Hodin
With the 2021 World Health Assembly now in the record books, it’s not too soon to link the Decade of Healthy Ageing with real-world demands. A good place to start, of course, is super-aging Japan, which is already navigating the dynamics that every country will face in the next few decades. This was the precise reason for the Roundtable on Health Innovation for Super-Ageing Japan, convened jointly by the Global Coalition on Aging and Japan-based Health and Global Policy Institute (HGPI).
At the event, pharma industry executives, Japanese government officials, academic experts, and OECD leaders concluded that spending on health must be seen as an investment if we are to achieve the healthy aging envisioned by the WHO/UN Decade of Healthy Ageing. As the oldest society on the planet — reaching close to 40% over-60 very shortly — Japan’s economic imperatives demand a healthier aging so that citizens can work longer and ensure fiscal sustainability. But healthier aging is itself based on biopharmaceutical innovation — a clear lesson from Covid-19 — which in today’s Japan requires different structures and incentives, including changes to the health system itself. It also requires massive shifts in how we approach a short list of health challenges that will surely explode without the innovation to treat, prevent, or, at least, manage these conditions.
That is why the FDA’s approval of aducanumab, the first drug to slow Alzheimer’s disease, is such a breakthrough in the fight against Alzheimer’s and for the WHO/UN Decade of Healthy Ageing project. Alzheimer’s is already recognized in the US, Japan, across Europe, and globally as one of the singular and darkest burdens on healthy aging. Not only is this new innovative medicine expected to delay the progression for people in the early stages of the disease, it will also have a positive impact on pharmaceutical innovation far beyond this one drug, just as was discussed at the GCOA-HGPI JapanRoundtable earlier in May.
Nor is it surprising therefore that earlier on June 7, when the FDA was making public its momentous decision about the innovation for Alzheimer’s, there was a prescient Wall Street Journal piece, “Baby Boomers’ Biggest Financial Risk: Cognitive Decline,” dramatically underscoring the relationship between the explosive health risk of Alzheimer’s and cognitive decline and financial and fiscal risks. Indeed, harking back to a 2014 survey sponsored by Merrill Lynch, a unit of Bank of America, the WSJ piece underscored what Bank of America executives already understood: fears about dementia were revealed to outweigh all other possible illnesses combined, as Surya Kolluri of Bank of America reflected in the WSJ piece.
And since 2014, the challenge has only grown worse — on the health side and its consequences for financial risk. As Dr. Rachel Doody recently wrote, “Worldwide, around 50 million people have dementia and this number is expected to triple to more than 150 million by 2050…[already] inducing fear for many people as they age, taking a huge toll on those who live with it, and overwhelming those who love and support them. It also puts communities, health and social care systems, as well as societies under pressure. These pressures will be dramatically amplified if we don’t take action now.”
Dr. Doody knows this is true globally, where for example, the certain longevity built into today’s emerging and developing economies in Latin America, Africa, and the Middle East mean that very soon there will be more dementia in those geographies than the US or Europe. Unless…
If the Decade of Healthy Ageing is to be realized, it must take lessons from Alzheimer’s and recognize there are other too-common diseases that are dismissed because, “oh well, she’s 83, and that’s what happens when we age.” The lessons from Alzheimer’s: that it is not a normal part of aging, and that it is to be understand not just in terms of health, but also the impact on economic and financial matters. These lessons lead to an appreciation for what super-aging Japan must now do to pay for innovation, as ensuring the right incentives and structures are essential steps. And isn’t this, after all, a critical lesson from Covid-19?
The innovation lessons out of Covid — vaccines, therapies, and telehealth or telemedicine is what have gotten us through the pandemic and are now getting us out of it. And we are beginning to see it applied to other diseases aligned near perfectly with “getting old.” For example, in a recent paper by Dr. Mary Bussell for the Economist Intelligence Unit, “Integrated care pathways for bone health: an overview of global policies,” she makes it very clear that osteoporosis, like Alzheimer’s, is too often accepted as a normal part of aging. But the health and economic impact of the fragility fractures consequences of osteoporosis are getting attention in super aging Japan and all other aging societies. Prevalence increases with age; and so, as we have many more of us living longer, the economic and fiscal burden explodes.
If you take one message out of the Japan roundtable where we heard from OECD, Japanese officials and academics, the Japan HGPI think tank, and our own Global Coalition on Aging cross-industry leadership, it should be this: we need an action plan to reform health and financial systems to align with and pay for the innovation that the WHO’s Healthy Ageing demands. Three cheers for the June 7 FDA decision on Biogen’s new Alzheimer’s treatment as a great start.
