Ep06: Driving Brain Health to End Alzheimer's Globally

Episode Transcript 

[00:00:04] Dan Kendall: Welcome to the Brain Health News podcast, part of Health Unmuted. This podcast was created by Mission Based Media in association with the Davos Alzheimer's Collaborative. 

In this episode, we feature a recording of a round table discussion that was hosted by the Davos Alzheimer's Collaborative at the World Economic Forum Annual Meeting on January 16th, 2024. 

The event brought together prominent leaders in government, industry, academic and global communities to share cutting edge strategies and innovations for accelerating brain health globally. 

This episode is a little bit longer than many of the others in this series, and it is time well spent. 

It's filled with insightful conversations and groundbreaking initiatives aimed at driving down the cost of dementia care, preventing cognitive impairment through lifestyle modifications and advancing early treatment of Alzheimer's.

From revolutionary vaccine developments to cutting-edge lifestyle interventions, this episode brings you the most up-to-date information on the prevention and treatment of cognitive decline. 

So now let's join our host George Vradenburg at this round table discussion. Enjoy. 

[00:01:10] George Vradenburg: Ladies and gentlemen, my name is George Vradenburg. I'm the founding chairman of the Davos Alzheimer's Collaborative, which was born here about three years ago. 

Let me just give you a little layout of the run of the show, because this is going to probably be a half hour of overhead, where you're going to listen to some people, but then we have the rest of the time entirely devoted to conversation.

First I want to tell you, you're going to hear from

 Victor Dzau is the president of the National Academy of Medicine. 

 Victor Dzau is going to give us a few opening comments and then I'm going to give a little background and set up to the context in this. And we have Professor Miia Kivipelto here from the FINGERS Institute and, where are you, you’re just a global character,

 to talk about her work, which was really groundbreaking, and continues to be groundbreaking. And then our chief operating officer, Drew Holzapfel is going to speak about exactly what DAC does, so that you know what we do, as opposed to what we stand for, which is brain health driving prevention of Alzheimer's. 

Victor, please, some opening comments, opening thoughts about brain health and the prevention of Alzheimer's. By the way, he's on my board of directors, so he's my boss. He's my boss. 

[00:02:25] Victor Dzau: Thank you, it's a great privilege to be here and to say what a wonderful initiative this is.

I’ve actually been following this since George launched it back in 2021. In fact, it was some of the early meetings, and watch his great ambition and his vision. It's really quite, to me, rewarding and astounding to see where it is today. So I'm so glad that I'm serving on this board and of course, being able to follow the many, many things he's doing, very impressive indeed and you're going to hear some more about this.

So I'm just going to open up this meeting with just a few short remarks. First of all, of course, we’re all here for the same reason. Mental health, brain health is so important. We know that mental illness is a major disease burden globally, and in fact, the negative impact on human health and well-being is significant.

You're going to hear a lot more about this, particularly as it relates to Alzheimer's. It's a major area of unmet need. So in this context, I think achieving brain health is an imperative for health, no question about this. And also promoting brain health is being recognized as an economic imperative as well.

Health imperative, economic imperative. You're going to hear a lot of data on this certainly here in Davos about economics, and certainly the number says the OECD estimates impaired brain health costs global economy up to 8.5 trillion dollars a year. Lost productivity and so many other issues. And so the opportunity for economic growth is huge, but let's face it, I'm a health person.

The more important opportunity, of course, is a brain health where we can all thrive, live well, and particularly as you age, and even as you know, in the issue of mental health, there's really substantial impact on the adolescents and younger adults as well. I think we all believe in UHC and SDG.

Universal health coverage is one of WHO's strategic pillars and a prerequisite for achieving SDG 3, which ensures lives and promoting well-being for all ages, their target of 3.8. So integrating brain health, in my opinion, is essential in the framework integrating into UHC. And so, because this will result in healthier individuals, healthier societies, and expand potential innovation and economic growth.

So of course, as I said, the most important thing to me is to enable better lives, better well-being for all our citizens and our population. So I think there's no question why you're here today, because there's an urgent need for increasing global collaboration and strengthening global architecture to enable brain health.

And I want to congratulate George for really taking this on and particularly focus on Alzheimer's, which as you know, is a major issue, for society and for many of us. So thank you very much.

[00:05:39] George Vradenburg: Victor is a real force in global health issue, so you have to sort of wander around with him and see how many different places he is during the course of Davos. Or I was at the World Health Summit in Berlin, he was in virtually every meeting.

The World Health Summit focuses on infectious disease, and there's too little attention to the rising incidence prevalence of chronic diseases of aging and of Alzheimer's. So we're trying to set out here in Davos, to begin the conversation about the importance and centrality of the brain. Not just to suppression of disease, but also as an economic driver in this century.

So this is going to be about brain health, but also about brain disease. So you'll hear both of those, but they are, the ying and the yang, to the extent that your healthier brain and a stronger brain and a more synaptic connected brain, the more your capacity to resist disease. So these are two interrelated ideas, but they are

central to human health and to the economy. No question that we're all living longer. Fortunately, this is the good news, it's better than the alternative. And so I think this is good news for the world. It's good news because we can see how much of economic growth in the 20th century was driven, by our increasing longevity. More people working more productively, and driving economic growth, that continues.

But we do not want, the Greek myth of Teutonius, where basically he was given one question of Zeus. His one wish of Zeus was that he live forever. He forgot to ask to be healthy as long as he lived. And today we're beginning to focus on that, but rarely do you hear people talk about your brain span

equaling your health span, equaling your lifespan, because who wants to have the last 10 years of your life living in some state of dementia where all the memories of your life are gone? Prevalent disease, huge. 50 million people around the world, but this disease starts 25 years or so before you get symptoms.

So this estimate of 50 million people diagnosed around the world needs to be multiplied by a factor of eight in order to get the total number of people actually experiencing this disease in its preclinical or presymptomatic state or symptomatic state. So we're talking 400 million plus people already in the world

with this disease, and that's expected to triple by 2050. That's just an enormous number of people. So the estimate is 150 million people with diagnosed disease by 2050. That's over a billion people that will have this disease in its either pre-symptomatic form or symptomatic form by the middle of the century.

The costs to the society, to individual families, to the suffering of any of you who have experienced this in your family know that the caregiver, there's probably as much burden in terms of the disease as the person with dementia. Turns out that caregivers have worse health outcomes. Turns out that caregivers die earlier than they would absent being a caregiver.

So, caregiving, so, those numbers which I mentioned, which are already huge, have to be multiplied by another factor of two, to get the real burden of disease. Now, I am in this game because, my family has had three generations die of this disease. And so all of this is driven by the urgency that a patient feels, or an individual feels who have experienced this disease.

You will see on your chair the Alzheimer's Bill of Rights from my friend and colleague, Jim Taylor, who heads an organization in the United States, about one year old now, which it is governed by and made up primarily of people who actually have this disease, and their caregivers. So that if you look at an organization that has the authenticity or the authority to say this is important to us, he has articulated an Alzheimer's

family's Bill of Rights. 2023 was actually a pretty good year for us. We had the first disease modifying drug, fully approved by the FDA, and covered by Medicare. We still have issues with Medicare, but at least primarily covered. Now this disease was identified in 1906,

2023 was the first time we have a disease modifying agent. It's been a while, folks. And for the patient community, this is really good news. With that said, this has a modest benefit. It reduces the rate of decline by maybe 25%, 27%. It has side effects, and it's expensive, and it's difficult to get on the drug because you have to be monitored for safety,

and, as suggested by the FDA, monitored for your genetics. So this is tough. It's now been six months since this has been approved in the United States, my guess is there are fewer than a thousand people who are actually on this drug. So this is a slow roll, guys. And it's never going to hit the rest of the world.

Too expensive, too hard to get on, too limited a benefit, and too costly for the world. So the large, huge driver of our efforts at DAC is how do we get the costs down of detecting your risk for the disease? How do you get the cost down of getting diagnosed with the disease? And how do you get the cost down of actually getting a treatment that will slow or prevent the disease?

And there are going to be drugs in the pipeline. And clearly we ought to be aiming for a vaccine, which you're going to hear about from Andrea Pfeifer today, I'll ask her a question about this. But there is in process now eight companies with vaccines at clinical development with some major investments going on, and in the same room are regulators and payers because they're saying this is our problem,

how do we approve a vaccine without you're basically having a 10 year trial to demonstrate that the vaccines are working on some people and not working in those people who don't take the vaccine. So we have regulators at the table wanting to try to solve the problem. But for them, this is a real scientific issue to demonstrate the efficacy of the vaccines and importantly for the safety.

But that's where we should be going on the therapeutic side. But even more important in terms of what we can do today, what we can actually do in the real world today at low cost, and effectively around the world is a set of developments around prevention in the sense that we can through interfering with things that we can control. Our cardiometabolic conditions, our heart, diabetes and obesity, plus lifestyle factors, we actually can prevent up to 40 percent of the cases of dementia in the future.

The person that actually demonstrated this proposition, which was not understood at all at the time, is Miia Kivipelto. Miia is the head of the FINGERS Institute and in 2015 produced a trial, which she can describe, which basically shows that lifestyle factors can in fact improve your cognition through time.

And she is now, she will describe this as well, beginning to look at a combination trial of therapeutic interventions for cardiovascular disease associated with lifestyle factors to demonstrate the additional power of putting those two things together. That can be done today around the world. With primary care physicians, with community health workers, we can do it today, folks.

Now, this is just a problem of implementation. It's non-trivial, but this is a matter of how we get countries around the world, as a national policy, to put in place treatments for cardiovascular and metabolic disease, accompanied with lifestyle factors, and then train the primary care workforce,

the health community health workers around the world. You'll hear from Drew about our work in Kenya and in the community health workers or in other countries of the world. How do you actually train up a primary care workforce to do this? This can be done today. And it's really the result of the insights and the work of Miia Kivipelto, who taught us this could be done.

So Miia, thank you for your pioneering work, your continuing work, and now our partnership with DAC. 

[00:14:15] Miia Kivipelto: Thank you so much, George. It's my great pleasure to be here and see so many of you here. I think we all share the vision that brain health and prevention should be the priority. It's our future in the aging societies, in modern societies, and there is so much we can do already today. And after listening to you, I'm convinced that with joint forces, we can do even more in the future,

really to improve and maintain brain health throughout the whole life course globally. So I'm happy to give some scientific background because I believe, and I think we all believe that what we do, our actions should be science based and science is moving on very quickly nowadays. So it's important that we try always to take the latest scientific evidence when we are moving to implementation.

So, cognitive impairment and dementia, as we heard, they are the major challenges for the brain health in the aging societies. I think we can talk about dementia epidemic. And really prevention, it is the key if we want to manage the dementia epidemic globally. And luckily it's not anymore only high age and genetics, which are the only linked factors to dementia.

And I think we still need to do quite a lot of work to educate persons that dementia is not part of normal aging, but there is so much we can do to reduce the risk. As we heard, 40 percent of all dementias are linked to modifiable lifestyle based vascular environmental risk factors,

and actually, this number may be even higher. There is now a new Lancet Commission paper coming soon. We are also working with the new risk reduction guidelines from WHO. So the risk or the prevention potential may actually be up to 50 percent. Isn't a wonderful number 50 percent of all dementias are linked to modifiable risk factors.

And there are new factors coming about hearing loss, visual loss, and other factors, air pollution. So it's not anymore only the traditional cardiovascular lifestyle factors. So the science is really moving on. It has been more difficult to translate the observational studies to successful clinical trials.

And of course, clinical trials is the highest level of evidence. And that's what we tried to do in the FINGER trial. We thought there were so many risk factors, we need to have a multi domain intervention. Targeting several risk factors and mechanisms at the same time to get an optimal preventive effect.

And that's what we did in the FINGER trial. The FINGER model has five fingers, I think it's easy to remember, and we are learning all the time more and more about these five FINGERS. Healthy balanced diet, so important for the brain health throughout the whole life course. Physical activity. I think that's one of the most powerful medicines we have for the brain health.

Everything about this happening in the body and the brain when we are physical active. And you know we are the heads down generation. You know how many hours we are sitting every day. Too many. 9 to 10 hours, even small children. So everything we can do to increase physical activity is surely important for the brain health.

The third finger, cognitive stimulation, mental activities. We have learned so much about the brain plasticity. Everything what we are doing is affecting the structure and the function of the brain and the brain plasticity is there throughout the whole life course. So I think that's very important part of the model, as well.

The fourth one, social activities. Very important for the brain health and well-being, and part of the social activity is also relaxation, stress management, and sleep, important in our societies. And we have been thinking a lot also the intergenerational aspect, having children and all the people together.

I think this is really what we talked yesterday. What I started to think very important part of this social cognitive and physical stimulation. Fifth finger. Taking care of all cardiovascular risk factors, blood pressure, cholesterol, diabetes, obesity. What is good for the heart is good for the brain. And here I would add the latest evidence is more the holistic care, hearing, vision as well.

So, there are so many things we can do there. Many of you know the FINGER results, but I just mentioned a few aspects of those. It was not only memory, but also the processing speed, executive function. It's not only preventing cognitive decline, this is maintaining, optimizing the brain health.

Functional level was better, quality of life was better. 30 percent reduced risk of stroke and quite strikingly up to 60 percent reduced risk of multi morbidity and even health economical benefits. So the same model can benefit brain health, general health, individual and societal level. And one question what they often get is, how about if I have risk genes, can I still do something with the lifestyle?

The answer is yes. We have now evidence from World-Wide FINGERS that ApoE4 carriers are getting clear benefit from this intervention. So I would say that genetics is maybe not as non-modifiable as we have been thinking. Second important question. How about if I have early Alzheimer's, can I still do something with lifestyle?

The answer is again, yes. We have been testing that and the effect of lifestyle intervention is not ending when you get the diagnosis, highlighting the need and importance of post diagnostic support as well. We have now the World-Wide FINGERS, which we launched 2017 because there was so great interest globally to test and optimize these multi domain interventions.

And I'm very happy that today we are having more than 60 countries from all continents who are part of the World-Wide FINGERS network. Many of the countries are low, middle income countries where the numbers are increasing even more rapidly. We have Africa FINGERS, we have Latin FINGERS, wonderful examples.

And as part of this network, we are upgrading FINGER to FINGER 2.0, where we aim to have more individualized, more tailored interventions and combining with medications when needed so that the right persons get the right treatment at the right time. New technology, I believe, will be important here to make the intervention even more scalable and even more effective.

And finally, implementation. That's something we want to support. You know, it takes normally 15 to 20 years to implement the research findings. I think it's too long time. We can't simply wait what it comes to lifestyle interventions. So as an example, we support brain health clinics. Our memory clinics are not so prepared to give feedback about lifestyle.

So that concept I would really like to see more. Primary care, as you mentioned, George, is a wonderful place where we should support the implementation, and then the wider community as well. And finally, two concepts here I want to leave with you. One is, why not to go even earlier? I normally say it's never too early to start to prevent dementia.

It's never too late either. So we want to go to schools. And here the concept High Five for Life is something we want to support. And the second one is Fingers for Women. Because we know that women have a higher risk and there are differences in the risk profile. So World-Wide FINGERS with the diversity and the possibility for data sharing, I think is a wonderful place to study this further.

So George, I'm so grateful for our partnership and I really hope and believe that with joint forces we can do much more. We need to be ambitious about prevention and we need to move from observation to action. Thank you so much. 

[00:22:53] George Vradenburg: I am reminded by your comments that we can never start too early. The whole notion of a life course since the most correlative feature other than aging to all dementia is education levels. And so figuring out how best to go all the way back into entire life course and begin to get metrics that really track

the impact of a variety of conditions on brain health. Turns out that violence in the home is a stressor that has a long term effect. It turns out that the early youth mental illness has a predictive effect with dementia. So the ambition here is long, deep, and as you say, transformative, we can do this together.

The other reminder was a comment, as I remember, it was John F. Kennedy, who said, the time to fix the roof is when the sun is shining, right? So, we don't wait until it rains to fix the roof. Drew Holzapfel, our chief operating officer and my partner in this effort for, since the beginning,

is going to give us a few notes about what DAC is actually doing in this respect. 

[00:23:56] Drew Holzapfel: Thank you very much. And I was so glad that George, my boss, could hear that rest and relaxation is central to brain health. And I also want to thank Dr. Victor Dzau for serving on our board and appreciate your leadership.

We're at the World Economic Forum Annual Meeting, so I'd be remiss if I also didn't thank Olivier Schwab, who's also on our board. And then also, we have two senior members from our team, Susan and Peter are here from DAC. We also have two of our funders here, Eli Lilly and Roche. And they were in on this like almost from day one.

So without your support, we couldn't be up here, sharing with you what we're doing. What I'm going to do is talk through, the three areas that we're focused on, and what I want to do is give you a couple examples of what we're doing. So this is by no means exhaustive. And after this, we'll turn it over to a free-ranging discussion that George will run,

so we can go into the details of this or talk about other things. One of the first areas of focus for the Davos Alzheimer's Collaborative is equipping healthcare systems in the front line of care to improve access to treatments. In 2024, what we're really focused on is what we call 8 flagship sites in 5 different countries, and we're working with those health care systems, to improve the way we diagnose the disease.

So we're trying to speed up the time from detection to diagnosis so that we can get care to the people who need it as fast as possible. We've heard that time is brain essentially in some of these earlier remarks. So that's a really important piece. And so what we build on as we build out this program this year is a foundation where we funded 19 programs in 12 countries in 2023,

where we've developed some insights on how you can speed up essentially this diagnostic funnel. So that's going to be an important program, it's going to be about 12 million dollars that we put through, eight different sites. So the second thing that we're focused on is creating a collaboration to scale Alzheimer's and brain health longitudinal and clinical trial research. Just want to give you a few examples of how we're thinking about this. We're initiating in India, a group that is a high volume eye clinics. We think the eye can be the window to the brain. And so what we're going to do is work with those ophthalmologists to help detect cognitive impairment and get them into the healthcare system.

And so we're going to give that try in India. We've also partner with in Canada last year to start to see if this works. And so what we want to do is create that connectivity, almost like a no wrong door type of situation to the healthcare system where we're looking out for your brain and your brain health.

We are starting to look at how brain health and climate change are interconnected. Important partner in that effort is going to be IHME. And we're going to look in Kenya, we're going to look in Columbia and also in Chile. What we're going to do is we're going to take IHME satellite data.

We're going to put wearables on people who are in longitudinal cohorts. We're going to start to take bio samples, and we're going to do other measures. They're relevant to seeing the impact of brain health. And so I think it's important, one, because we should know that information, but two, I think it gives us a way to work in other areas to increase the importance of brain health.

Another thing that we're going to do that has been alluded to, and it started in Kenya with Dr. Zul Merali, who's here, who leads the Brain and Mind Institute. But what we've done in Kenya is we've taken some of the tools for measuring cognition that haven't been validated in that population that we're validating those tools in that population.

Once they're validated, what we're going to do is start to build out people that we understand with their cognition, and we're going to put them almost in this clinical trial ready cohort. And so that group of people then can go into pharmacological or non-pharmacological trials. This is where Miia's partnership is so important.

So working with FINGERS, so that's both lifestyle and pharmacological. We're going to start with metformin, but we see this as an opportunity to start to address some of the risk factors that you face at midlife. So really addressing cardiovascular disease, metabolic disease, obesity, and finding ways to get those interventions Into populations around the globe. And then the 3rd thing that we're doing is, this is important piece,

finding a way to engage governments. There have been a lot of governments and international organizations that have made commitments to Alzheimer's. And so we're committed to working with these governments to make sure that we bring those commitments forward as a way to drive forward universal health coverage.

One of the things that we've started and we'll continue to focus on in the United States is we think that the United States should be a big global funder of this public health initiative. So we've started working on the Senate, across Congress to see if we can get legislation that would empower USAID to really come into this in a big, big way.

So we'll continue to do that. For a long time George and I've been working with the G7 and so we're going to continue that focus. Last year there was some movement forward under the leadership of the Japanese government where they reinforced the commitment to Alzheimer's disease. So we'll continue to work through the G7,

we think that's an important channel. We'll look for partnerships within the G7 governments. But our board has encouraged us starting last year to really focus also on the G20, so that becomes a central part of our focus as well. So that's just a little bit of an example of what we're doing. Since our inception, we've been able to generate about 60 million dollars that we've been pouring into this effort.

We think we have about 135 programs going on. And so we think we're just getting going too. I appreciate everybody who came and appreciate everybody's support, and I'll turn it back to you, George.

[00:29:36] George Vradenburg: Just a little sampler. Next is my great pleasure and honor to introduce ambassador Luis Gallegos. The former minister of Foreign Affairs of Ecuador and the chairman of UNITAR, which he will explain about what's so exciting about the potential work that he is doing now and that we are going to potentially do together is this notion of how to go earlier and earlier and think about how to develop brain early in life and then in midlife with training. Dr. Gallegos.  

[00:30:07] Luis Gallegos: Doctor in law. Thank you very much, thank you, George, thank you for this marvelous invitation. Silvia Neira and I are from the Global Initiative on Aging. I am the president of the board of UNITAR. UNITAR is the United Nations agency for research and training.

We train around half a million people a year and we have 30 offices around the world. My interest and my passion is aging, first of all, because I am aging. We began this road map of aging because of the pandemic. We looked into the effects of discrimination on persons who are aging. At the time I was ambassador in New York and in a good day, a thousand people would die, most of them from the aging population. But we saw an enormous discrimination in the treatment of aging.

The issue of giving the respirator to the younger person. We saw the extraordinary incapacity of the health systems to deal with the problem of aging. And we still think that as we analyze what happened in the pandemic, we are still in the phase of understanding what happened to the world.

The major crisis of the world of 193 countries that met with a pandemic that they didn't understand and that we have not gotten over. But one of the things that is a particularity of that crisis was that it affected all of us individually. We know people who have died, we had contagion, we were at risk of dying ourselves.

We created the foundation to promote not only training from youth to aging, but to look into the cracks of the system and the gaps of the system. And we are now fostering the negotiation of a UN convention for persons who are aging. Let me tell you my personal experience, because I had the honor and the pleasure of being the president of the working group that developed 

the CRPD, the Convention for Persons with Disabilities. in the year 2000, disability was not on the international agenda. It came in after the convention was signed in 2006, and now it's one of the most successful UN conventions on human rights. It covers 1.3 billion people who are disabled.

Normally, we calculate two persons for every individual who has a disability. The direct impact of family, community, healthcare and so on. We use the same metrics for aging. We're one billion people who are aging at the moment. We're more aging people than children being born. There is a demographic shift in the societies of the world.

That demographic shift is that we will be, maybe I won't be here and others won't be with here, there will be 2 billion people in the world by the year 2050, which is 26 years from now, and that means that the impact group and the people who are aging will be 6 billion people. It is a very daunting example of what administrations and governments have to deal with.

And to some of my reflections and personal reflection is that governments really are scared of dealing with the problem. So they kick the can down the road because this will affect their pension systems. Europe has a marvelous structure of a network, the United States does not. And 80 percent of aging live in the global south, which does not have networks to support.

So we are in front of a change in the dynamics of the world that will make it complex to deal with health. Although the WHO has a program of healthy aging, the decade of healthy aging, ILO has a program for active aging. Because as we progress, we are living longer, working more, more capable of working.

But a person who is born today will probably reach a 100 if he has the adequate lifestyle he requires, and maybe more. My participation here is to say that it is extremely important that we teach the world in this very intense learning curve that brain health is fundamental for the people who are aging.

We must have a joint capacity of being able to lobby not only governments, medical institutions, academia, and others, to understand the complexity of the phenomenon of this change in society we're living now, and we'll be living in the near future. For our sons and daughters, for our grandchildren, if they are lucky, they will age.

And we have to teach them since they're young, that they have to have the capacity of dealing with this phenomenon of aging. Where did we get the 65 years of age? There's a theory that we got it from Bismarck when he established the social security system in Germany in the 1800s. The world has changed.

I'll leave you with the last thought. You need, at the present moment, at least for the first 30 years of your life, to study, obtain your master's degree, or your doctoral degree, to be able to compete in the world. You work probably for another 30 to 35 years until you're 65, not really more, and you live another 30.

The system wasn't built for that. The system can't maintain the appropriation because it was based on solidarity and substitution. You need children. You need new workers. Some countries will solve the problem by migration. Others cannot because of their culture. So it's very apt that we are in Davos talking about this because this has a parameter of rights,

it has a parameter of economics, but it has a profound change in societies. I hope that what I've said today will make you and remind you that aging is one of the principal factors in the agenda of the future, and that you and all will be motivated to age and I hope you have the luck of aging.

Thank you very much.

[00:36:30] George Vradenburg: Allow me to throw out some questions to a couple of people, but I’m going to start raising hands in a few minutes, but I want to talk to an expert in Alzheimer's. Dr. Doraiswamy, Murali Doraiswamy, to talk about what we have learned, about the plasticity of the brain, the capacity of the brain to continue to build a capacity to both resist disease, but also to work productively in society.

And what have we learned? Dr. Doraiswamy, for those who don't know, is from Duke. Stand up, I’ll give you a mic, but as you were standing up, and as I give you a mic, Dr. Doraiswamy is from Duke and one of the most prominent KOL researchers in the Alzheimer's field in the world. 

[00:37:11] Murali Doraiswamy: Thank you for inviting me to speak in front of this distinguished panel.

When we were all training, we learned a saying from neuroscience which says neurons that fire together, wire together. The important thing is the brain is plastic throughout our lifetime. So neuroplasticity is crucial for how babies learn,

because they use multiple senses. You bite on things, you feel it, you smell it, you throw it, see how it bounces. Engaging that kind of multisensory ability is what forms your brain's networks, and those networks are what are crucial for forming memories and experiences. Even late in adult life, neuroplasticity persists,

you just have to stick with it for between 8 to 12 weeks. If you just try for a very short amount of time, then the neuroplasticity is lost. We've also learned of a number of electrical and chemical triggers that can enhance neuroplasticity in various, rodent models. Those have not yet been applied to humans, but it's possible.

So by extension, there is a concept called cognitive reserve. Cognitive reserve can simply be thought of as how much excess networks have you built up in your brain over a lifetime of experience, education, your occupation, your social networks, etc., and that reserve capacity is what protects you from decline if you suffer from a neurodegenerative disease.

So think of it as having excess cellphone towers, and the more cellphone towers you have, a couple get knocked out, you still have good signal. So it's very crucial for us to learn how to develop and monitor cognitive reserve and through a combination of digital tools sensors we now have the ability with our smartphone to just assess each person's brain reserve and cognitive reserve.

So that's going to also become very important. And by extension, I think, in addition to all of the pharmacotherapies that pioneers are developing, we need to also develop ways that are non-pharmacological, likewise mentioned, not just from the FINGER trial, one of the interventions that was used was cognitive remediation and cognitive training.

Now, with digital tools, such as smartphone app, it's possible to create a closed loop system where you could do cognitive self testing at home in the comfort and convenience of your home. You can also send those reports to your doctor and it can also decide to train what parts of your cognitive abilities were below normal.

And so that closed loop system has not been fully developed, there's a number of trials underway that suggests that cognitive remediation does help, it can improve memory. The question is, can cognitive remediation combined with pharmacotherapy prove a much more beneficial than cognitive therapy alone or pharmacotherapy alone.

So that's the kind of combination treatments we need to work with. So I'm just going to stop here, so I think it's important for us to focus just beyond pharmacotherapy and look at other kinds of non-pharmacological interventions. 

[00:39:56] George Vradenburg: Thank you.

So I will now ask Andrea Pfeifer. Andrea Pfeifer is the CEO of a very prominent, one of the world's finest biotech firms. She's headquartered in Switzerland. And I'm gonna ask her whether it's really true that we might be able to get an Alzheimer's vaccine.

[00:40:17] Andrea Pfeifer: So, also, non-prepared question and answer for that matter. Let me maybe just go back one step. Since years, I actually believed and worked on the fact that the earlier we treat, the less impact it has on the brain health and the earlier we treat, the more we preserve patient's life and obviously the benefit of having a healthy aging.

Now, last year and this year, I was really impressed by the data which came out on two of first therapies, which we are expecting to have one approved and we have one hopefully very soon, which clearly showed the earlier you go and really early means very early, the more impact you have on people's health,

and even the reported health benefit can be doubled if you go earlier. So we have now very solid data and I'm super happy and I congratulate some of the people here like Eli Lilly and so on, showing that this is true, what actually I believe since quite some years. Now, having said this, we are working since many years on a vaccine for Alzheimer's.

We improved the technology for a long time, which finally allows us to have a very good response, identical to the antibodies, but what is very important, it's safe. So we have not seen any side effects. And what is even more important is that it produces antibodies against the pathological forms which lead to the disease.

So these things we have worked out. So now what are we missing? We are missing that we have a population where we can test these vaccines. And by the way, we have three vaccines in development. And for that, we need the collaboration with the governments, so to have access to the registries, clinical registries, we need private public partnerships.

That's why I'm so active with George and supporting him so well. And I think we need also like a funding agency, if I may say so, for rich countries and not so rich countries, because I think our work is really linked to providing a vaccine, a preventive vaccine for the world. And really, I would be so happy if there would be a vaccine out to prevent Alzheimer's in the world.

And that's what we are working on. Now to give you an update, we just have started the first prevention trial in Alzheimer's together with our partner Johnson & Johnson. So it will be a preclinical population, and we hope to report data on that very soon. In the meantime, I just, would like to support the work which George is doing, which Drew is doing in this organization, but also I would like to give some compliments to Miia, who is a very close friend, because I think at the end of the day, we have to combine pharmacological and non-pharmacological applications. As you know, my background is very much in food. And so I'm always looking at both things. And I think it's really what we should think as an industry, how we can work together on combining these two, and I'm super happy that you will start this soon. And I do know, because we're working on this together, that there is a special requirement for women,

and together from here we are starting initiative also on what is required, what is so special about women's health? So if it's small remarks, I would like to give back to George. In other words, I want to say there's hope.

[00:44:08] George Vradenburg: So Andrea and I have informally committed to try and get an Alzheimer's vaccine on market by 2030. Maybe ambitious because the trials here are going to have to be long, they'll be complicated. They have to be large and representative around the world. So constructing the mechanism by which we can both understand the science of the vaccine, the safety of it in large populations and highly diverse populations, so that the world can trust a vaccine.

And of course, the language here is going to be important. Because, some of the sponsors of these new approaches are calling it an active immunotherapy, because of the reaction of the world to the word vaccine. There's a fair amount of resistance as we learned at the Edelman conference this morning.

The world thinks that we're trying to force things on them. There's a lot of distrust in the world, if you say here is the solution, take it. As if they weren't involved, and they're not there, and they don't trust anyone that comes with them and says that. So the word vaccine implied, has a lot of promises in it, as opposed to something that's a little more obscure, like active immunotherapies, but the same result there.

And so part of what we're doing is communications. Understanding what is causing this distrust and thinking through the nomenclature we use. We've got some time here to say the least, but in fact, that is one of the challenges here, is to how it is that we can get the world to trust a vaccine if it hasn't been tested in their country,

and in fact, as the government is saying, here it is, trust us, it's going to work. One more speaker and then I open up to questions and we'll come back to some my picked speakers. Zul, you didn’t know you’re going to speak either?

Zul is the founder of the Brain and Mind Institute in Kenya at the Aga Khan Hospital there and the Aga Khan University. And so, we're working there as is Miia, together on active work in Kenya on how to introduce and wide scale in primary care or sort of the community health worker context, and interventions that will actually improve brain health and suppress brain disease. Zul.

[00:46:27] Zul Merali: Thank you, George. I didn't know you were going to ask me 

to speak, but here it goes. First of all, I wanted to thank Davos for really helping us embed our feats firmly onto this issue of healthy aging, dementia and Alzheimer's disease. So we're really, really very grateful for that. What I would like to say is that COVID has taught us one lesson, and that is, you can develop a solution that's localized, but if you don't globalize it, it'll come back to bite you.

So whatever we develop in terms of solutions, they need to be applicable globally. I think we've learned that from COVID. And in Kenya, there are regions that are pretty poor, they are not easily accessible, and we are trying to change the model of care working right from the community outwards.

The interventions that we're developing, their infrastructure that we're developing is right at the doorstep of the communities. We don't want to wait for them to come to the clinics when things get bad. This is, again, towards prevention, promotion, early detection, early intervention. I think those are the key things that we need to work about.

In Kenya, the median age is around 20, 21. That means half the population is below that age. But we have learned today that really, if you want to do interventions, you need to start early, you don't wait till things get bad, so, and we want to work across the lifespan. So we want to have interventions that are specific for different ages across Kenya.

So with that, I think I won't say more, but really, we're very excited because it's a message of hope. I think that we've heard a lot of doom and gloom. But really, I think we're learning very quickly that things can be prevented, things can be detected, things can be treated. And like, if you need to have a very robust tests and interventions very early on, and that will really help us solve the problems on the long term.

So, with that, I'll say thank you and also wanted to recognize Miia's work. So we're also working in partnership with prevention promotion with FINGERS. And so we're trying everything we can in Africa. We have a nice solid cohort of about 100,000 that is going to be clinical trial ready. Thank you.

[00:48:50] George Vradenburg: So before I get my next victim, there's a lot of discussion already and you've been talked at. So I would love to have people who might put up their hand and say, what about this, or I disagree with that or whatever the reaction is. So I invite you, you sir. 

[00:49:06] Joshua Haynes: Thank you for the lovely discussion.

My name is Joshua Haynes, American from Axent, I live in Berlin, Germany, where I run a mental health and brain health investment impact fund. So, we're looking at investing in early stage companies, non-pharmacological, to really how do we catalyze mental illness, not only focused on illness, but flourishing and the social determinants of mental health. We are seeing incredible innovations where, those who have been successful in academia or the private sector have been startup founders successful before coming together because of their own lived experience or their families lived experience to creating solutions.

Dementia. Looking at Alzheimer's, of course, ADHD, a lot of neurodiversity. My question is, how can a community like this help to also foster that innovation that we need? We know the time to market on many of these trials, the vaccines take eons. And we don't have that time, and there are a number of other options using technology or not.

And so how do we come together and look at, again, fostering this innovation ecosystem? 

Thank you. 

[00:50:05] George Vradenburg: Well, what we're finding is the importance of a large array of early detection techniques, and understanding how best to move rapidly towards either a brain health intervention, a la Miia Kivipelto, or a therapeutic intervention.

So I think what you're doing is incredibly important. Figuring out how to take what you're doing and investing in and then causing it to scale. To try it in a place, to test it out, but to validate it in a way that's extensible and broadly applicable across Germany or across much broader geographic areas, I think is critical. 

[00:50:44] Silvia Neira: Hi, my name is Silvia Neira, I'm from the Global Initiative on Aging, the vice chair with the wonderful leader Ambassador Gallegos, which is also the chairman of UNITAR. And first of all, thank you because this conversation is amazing, it is so inspiring to see all these topics in the same table, by civil society, public sector and private sector, very much needed.

And actually, I wanted to mention two things. One is to bring a little bit of a reality of the change of narrative that we live in right now to follow up from Ambassador Gallegos, because he leads to this conversation. Because the world wasn't thought to live beyond 65 years old, and now we're a 100.

What are we going to do about it? We have a society that we have not thought structurally in a healthcare, social, economical aspect, how to be implemented, how to survive economically and in a positive way. So brain health is number one, because when you tackle brain health, it means that positive outlook in life, which brings inclusivity into society.

Then you bring in labor inclusion, physical wellness, you bring in social integration, etc., etc. So as a community, as an institution and government body, it should be the number one thing that we should all be looking about. So it's actually very positive. We need to change the narrative about what it means to have a disease. A disease is what it is, but we have ways to prevent.

So concentrating our efforts on that should be one of the key factors to ensure that we live with a positive, profitable, outlook in life. So we are, graceful and happy to age. So following your point, which I didn’t get your name, Joshua, actually I was thinking about that before you, it's like you read my mind.

Education on the things that we already know. There's a lot of data, there's a lot of research. Clinical trials that have proved the lifestyle, nutrition, simple methodologies that we know that works to use that plasticity that, I didn’t get your name either professor, but you mentioned the neuroplasticity, I’m so sorry, that works, that we can prevent, but we have not been taught in a school in education, we have not been taught at an early age that we have those skills, we are capable of taking charge of our brain and our health. We have a lot more to do and empowerment to do within our health that we've been told.

We thought initially when the genetic research worldwide came out in the world, we thought that we were all a product of our genes. And we have realized that we have as many genes as a butterfly, which is ironic. So what it means is that we are product of our epigenetics. And what that means is our product of our lifestyle, of our environment, how we understand our interpretation of what happens to us activates or doesn't activate what we are more prone or not to be,

so we can be in power. Again, brain health. How do we do that? We educate from the beginning. Now that we have this amazing group of individuals here, let's come up with a solution on how we support this DAC initiative to an extra layer of education to start now, not wait for the trials.

Implement now with education, with the things that we already know. Implement with the education to make sure that we're reinforcing the seniors, we're reinforcing the whole population. Bring awareness campaigns, educate. The people doesn't know, people doesn't know that we have a way of empowering your brain and that will have a direct impact on who you are as an individual for the longevity of your life.

So let's do something about it. You have the funds, we have the knowledge, let's get something going. 

[00:54:34] George Vradenburg: Somebody I admired greatly once said the GDP measures financial performance, measures economic performance, but it measures nothing that really matters in life. Love, purpose, connection to God and the like. So, it is so right that we ought to be thinking those are products of the mind, the brain.

I think Antonella was next. Founder of the Women's Brain Project and a great champions for women's health. 

[00:54:59] Antonella Santuccione Chadha: Actually, I wanted to respond to Joshua. What do we need to bring innovation to patients? And this goes with a story. I belong to the team of scientists who have developed aducanumab, the first disease modifying treatment that was approved in the United States.

This molecule has been developed in Switzerland, not far away from where we are having this wonderful lunch. But nevertheless, European patients and Swiss patients can't access this drug. Now we can debate whether the drug works, doesn't work, can work better. We should start maybe earlier with the treatment.

This is to real world evidences and medicine to determine. But the real fact is that we invest in Europe, our private money as citizen contributing to taxation, but also the one of, you know, investors and public funds into great research that get benefited elsewhere. So as a European, this is a topic that it's very dear to me.

I worked as a regulator as well, and it was a painful exercise to see that brilliant science that getting supported by, as I said, European funding, it's not serving the patients in Europe. And it's about years of delay. And now we know that time is brain. So for me to have a dear one that maybe has an early diagnosis of Alzheimer's and aducanumab was approved already two years and a half ago, to a point where I could do something, but I can't access the drug because it's not available in my territory,

and by the way, my scientists have developed it, that's the paradox of things. So we have to act on our mindset as European to be more prone to risks. We have to talk about pricing of drugs, because of course, for drug developers, there is a true benefit to bring a drug into the United States, because pricing, it is more rewarding.

 It is much higher price, which there is a direct interest to bring a drug first in that market than elsewhere. And finally, it's the mindset, as I said, the ability to be able to take a risk of having a drug that maybe it is not wonderfully characterized yet, but still might have a huge impact on our well being lifelong and

 I think that European have a lot to do and regulation should be slightly lifted. And I think we're getting worse and worse, GDPR is going to mess it up. So think about it and let's do something about it. And about the Women's Brain Project, I want to conclude just saying one word.

You have to allow me that, George. It is my third child. I have two kids, that's my third one. The Women's Brain Project started in 2017. We were the first organization worldwide to say Alzheimer's is female. Roger Nitsch, my mentor, the one who developed aducanumab, he said, Antonella, what are you doing? I mean, is it really true? I said George, that’s what data says. George, sorry, Roger, this is what data says. And at the end, when I met Roger just last year in a congress, he said, Antonella, you were right. It's not only about the number, the prevalence, but it is about the trajectory of the disease.

How fast women declined with Alzheimer's compared to men. It is how the women respond to the treatment and that's a very delicate topic that we do not like to really debate, especially it's a difficult one, but what we know from aducanumab, lecanemab and gantenerumab is that there is a trend that shows that women do not respond to treatment.

Now this is a huge elephant in the room, it's a Pandora box. We need to understand nevertheless, the reason why we need to generate the science that explain us why it's this the case and why women maybe need to be considered much more in clinical development and diagnostic. Not to talk about the misdiagnosis of women across the board because of brain health

it is really female. It's about Alzheimer's, depression, anxiety, migraine, multiple sclerosis, you name it, you have it. So, longevity as well, women live longer, and I conclude quoting data from the OECD. The just informed us that those countries who provided data to the OECD have the tendency to have, of course, the confirmation as we know that more women have Alzheimer's, but sadly, we know that more women are institutionalized as compared to men. Meaning living in an elderly home or in a nursery home and surprise, surprise, which for me, as a psychiatrist, it's a shame. Women receive a higher prescription of antipsychotic, and antipsychotic,

this is worldwide, all the OECD data provided. And antipsychotic are proxy indicator of poor standard of care. With this, I leave you. 

[00:59:42] George Vradenburg: Thank you.

Any question or comment over here?

[00:59:45] Noemie Le Pertel: Hi, I'm Dr. Noemie Le Pertel, and I started my career in research for apoptosis in neural cells for cancer at Columbia, and now I run the Institute for Global Flourishing. So what I found after working in pediatric oncology and these other divisions in neurology is that a lot of the problems that we see originate in the workplace.

And so it's both an area of challenge, we spend most of our working lives there and also an area of opportunity. So my research is on workforce flourishing and the different levers for brain health and sustainability from a workforce perspective and longevity. And at the Harvard Human Flourishing Program, we have a big study, it's the Global Flourishing Study.

And it aims to be the largest study on the world's flourishing. Looking at mental health, physical health, and the number of different proxies from childhood predictors all the way across the lifespan. And so that's underway with Gallup and Baylor University in Harvard, and the call to action that I wanted to put forward was really for leaders in the room who are working in organizations.

What can we do and how can we join forces to seize the opportunity to really work on the workforce, to upskill people, to understand the role of their brain health, and how it impacts not only organization, society, the economy, but the future of our society. And so in April, I'm hosting through this working group on the economics of well-being and global flourishing at Harvard, a summit,

and I'd love to invite you to partner and invite you all, if you'd like to come and contribute your leadership, so that we can continue the conversation after Davos. So thank you and hope to meet you.

[01:01:22] George Vradenburg: We will have someone at your summit. We have a business collaboration for brain health that has a number of companies involved, including Eli Lilly, but, a number AARP and others. We'd very much like to participate. So we'll do that. 

We have a question here. 

[01:01:38] Mikele Epperly: Hi, I'm Mikele Epperly and I work at Roche in a role focused on brain health and women's health. And I wanted to build on Silvia's inspiring plea to work together and actually a number of people have reiterated this by just sharing a bit about Roche's priorities and saying that we know we can't go it alone,

we really need to partner with organizations like you are all. So if any of these things resonate with you, please reach out to me. So one of the areas that we're focused on is data generation, and this really starts from Simona's brainchild, and what are the gaps in information that we need for prioritization and funding of brain health?

I'll get back to that in a moment. The second area is awareness and education for the public, for clinicians, and frankly, in our internal organization as well. And then the third area where DAC's really taken a leadership role is health system optimization. Everything in order to optimally deliver care. That can be policy setting, clinical guideline, development, tests of medical practice change and we really need external partnerships to make those effective.

I wanted to get back really quickly to the data generation because, pulled some of the data that we've been generating in partnership with IHME and thought it would be helpful to share a statistic related to Alzheimer's considering DAC is our convener here. You may already know this, but if you look at just Switzerland over the past 20 years for disease burden of brain health disorders, Alzheimer's is ranked number two with 14 percent of the total disability adjusted life years.

But if you look at burden in a different way by direct spending, Alzheimer's jumps up to number one by far, with 38 percent of direct spending associated with Alzheimer's. And yet, if you look at a different measure, lost income, Alzheimer's drops down to rank number 13 with 2.5 percent of lost income, not surprisingly because of the age force

that Alzheimer's impacts. But I say all this because depending on your agenda, you can find any data point to make your case. I think the strength in our message is going to be us speaking with the same data, the same definitions. And I ask us all, how will we measure and quantify brain health moving forward?

[01:04:14] George Vradenburg: Ian, you're next. 

[01:04:15] Ian Hickie: Ian Hickie, I'm a psychiatrist and co-director of the Brain and Mind Center. So it's the same name at the university of Sydney. Pleasure talking to George and others yesterday. I want to talk about your concept about vaccines.

This is one we've addressed in the mental health field more generally. I've started to use the terminology of social vaccines, which include a whole range of strategies of the things that you do. So to build on the strength of vaccines, people understand vaccines prevent things. And many of us, of course, are the beneficiaries of childhood vaccines. For polio and many other diseases, which is sort of lost at the moment, but people kind of understand that. It goes to the issue of trust that you were raising, George.

I think the issue is one of choice that sits behind that and if you talk for vaccines, they include the social options, as Miia has elegantly outlined and included in that is the choice to add medical factors to that, particularly if you're genetically at risk, or socially at risk, or for some other reason, and don't have the top down kind of approach that unfortunately during the pandemic, governments would decide for you and people reacting against that.

So I think there is a narrative in a public relations issue about how to bring it together. Miia's type have worked to use the strength of the concept of vaccines, but tie it to choice on an ongoing basis. I think the second thing relates to the terminology of this brain capital. We have a forum tomorrow at the Hard Rock Hotel.

We've been talking about mental wealth. It's something you build across the whole time. It's not just the individual brains, adding up to brain capability, it's also the social cohesion, the collective to make decisions, and we were developing metrics of that. So having metrics of measuring, not just the individual capability, which I think morally actually elegantly set out, we now have the technologies for that through smartphones, through other devices to do that.

But how you add that up is an individual capability question, plus the social collective, the social actions that spring from that. And we then have organizations and governments and we wish we could persuade national health organizations, not just to talk about infectious diseases, but to talk about growing health.

And I say, we've had some success with this in Australia with the mental wealth concept where previous prime minister, conservative prime minister say, that's what we should invest in. The future of our country is not digging up and selling minerals, it's actually inside people's heads and the social behavior and in particularly developed countries, we had to get smarter about that.

So I think that was one that politicians and economists and others. Some of the problems have been in the health area, going back to pandemics made this somewhat worse, vaccines, it's all infectious diseases, and the rest is just sort of low lifestyle choices, not real. So that's where I come back to where I started.

I think actually the vaccines is a strong word, but it needs to be tied to a social concept and tied to one of choices that people can actively make and empower communities that will be available across the world in different ways. And to use that collectively, you grow the mental wealth of a country and that is the real value beyond the GDP.

[01:06:45] George Vradenburg: Good. 

[01:06:48] Tanya Woods: I thank you for the work you're all doing, it's amazing. I don't come from this space organically. I'm a lawyer and a technologist and I've been in technology for 20 some years.

I've negotiated trade agreements, written laws, trying to help governments understand what's happening in the world of tech, but I started in IP and one of the use cases I learned about first, which kept me going in this lane was breast cancer, and how one company held all the tests and all the data because of their IP.

And so I made three points just listening and I'll share a little bit of why I'm sitting here quickly, because there's others that I want to hear from selfishly. An Alzheimer's data bank would be a brilliant contribution for this collaborative. And I'm asking you to think about it because I've been sitting in and I've worked on AI solutions for a long time and AI is fed by data and it is only good if good data goes in, and proper data goes in and transparent provenance led data goes in. And people are developing health solutions and many mental health solutions based on really crappy data. So I really encourage this group of thinkers, you're the leaders in the world, to contribute to one central space of your excellence, of what you know to be true, and put it in a place because then the world's innovators can actually take it and go faster, they can innovate way faster.

So that's my first contribution. My second contribution is what I've spent 13 years testing. It was this idea of what could we do in our world as it's interrupted by technology chronically and designed to interrupt us, to bring us back together. Because when I started looking at my family, we've gone through Alzheimer's, many generations of it, I thought, okay, it got worse when people were alone.

That was my observation. The more alone, the worse it got. The more traumatic response came, the more people didn't know how to react to it, it lacked empathy in treatment and so on, it's not a nice thing to watch. But when you look at stuff about blue zones, I don't know if some of you've studied the blue zones.

Okay, community, it's kind of a trend, right? Inclusion and what brings people together is really simple. It's kindness. It's doing things in the community together. And so I started an innovative experiment, we'll call it that, 13 years ago called Kind Village. And it was actually an economic modeling based off Michael Porter, Mark Kramer's shared value model.

And I thought, what could we do to get businesses not giving cash, they give cash, yes, we want that, we like cash, but getting everybody in their company out in the community, thinking about in kind philanthropy, because it is a bottom line calculable metric and it's in law. And how could we get everybody feeling valuable to their contribution that they're making personally in a corporate environment,

and how could we just exponentially test this out? And we tested it out on hunger. We tested it on poverty and we're now testing it out, which is my third point, in Ukraine in high conflict, acute stress zones. And so we're partnered with a hospital in Ukraine who is built by Ukrainian, his resilience is outstanding and really something to see.

The hospital is called Superhumans Center and his response to getting the government to drop a number of bombs on his house because there were missiles being launched from his backyard at Kyiv, was to build this hospital, to treat veterans immediately, to amputate them. It's called Superhumans Center for those that don't know and were engaged with it.

And now we're working on a program which involves 15 different executives, and their institutions and their experts as psychologists, psychiatrists developing, I believe it's one of the first mental health protocols that is going to be delivered in modules digitally to the hospitals in Ukraine developed with them, and then creating a coaching community, mental health coaching community, and then it will be scaled around the world.

And it's being done 95 percent within kind. So you can't call money the barrier to progress, it's not. And the will is huge and the need is huge. So if anybody wants to learn more about anything I said, I'd be happy to chat about it, but thank you very, very much for having me today, George. And for this great initiative. 

[01:10:41] George Vradenburg: Great timing. 

In a number of communities around the world.

There are grandmas benches where basically grandmothers go sit and people are invited to come and just have conversation and it proves to be at some level of psychiatric benefit, clinical benefit, a very powerful idea. So what you're doing is great. Miia and I totally agree on your notion of a common data set.

Both of us independently committed and now we're jointly committed to putting it in something called the Alzheimer's Disease Data Initiative, which basically has been done by the Gates Ventures. So that's where we're going with that idea. Jim Taylor. Jim Taylor is the chair and president of Voices of Alzheimer's.

[01:11:27] Jim Taylor: I'm the voice to the patient. My wife was diagnosed 12 years ago. Was recently institutionalized. This is the first time I've traveled without her. What's most important for me to say is thank you. For every patient, every caregiver, and all those of us who don't know that we're going to be patients or caregivers, thank you.

Because it's so important what you're doing. It's vital to us. And you don't hear it often enough. We don't take the time to thank you. But we really know that our lives and our children's lives are dependent on what you're doing. My wife is a double four, so we know that our son is highly likely to develop this disease.

He's 45. Joshua said we don't have eons. 2040 maybe, 2030 may be aggressive for a vaccine, but not in my eyes. So one of the things I look at is how do we get from the microscope to the infusion? And I'm afraid there are a couple of points that are critical that we're not looking at sufficiently. All the testing we've talked about here today

can only be used in patients when it's been validated in heterogeneous clinical trials. Less than 1 percent of people in the United States participate in clinical trials of Alzheimer's. Cancer is 6 to 8, but cancer has many, many proven solutions, alternatives. We have very few, if any. One of the things we must do if we're going to bring any of these therapeutics to market is look at increasing participation rates in clinical trials, and I hope you will help us do that because we can't just stay in our silos,

we have to look at cross-silo challenges. The other problem I'm really concerned about is now that we have therapies, it's estimated the United States that we will have soon a 3 or 4 year wait to see a neurologist or a specialist who can prescribe. So it's an oxymoron to have an early stage treatment if I can't get it for three or four years.

That's not an incentive to get diagnosed. So one of the things we must do, and that DAC is helping with, is find out how we train, how we support, and how we incent by changing our reimbursement structure, general practitioners, not just in the United States, but across the world, because you won't be able to do it in Kenya, you won't be able to do it in Europe, or in Asia, unless we train our general practitioners more in their universities,

but also now we must learn what it is we have to do to educate them. So I hope you all gain an appreciation for that concern. We all have many concerns, but it's one that, from a patient point of view, is very important to us in getting treatment. Thank you.

[01:14:24] George Vradenburg: I think I'd like to end there. I do want to hear from Lilly, just for a minute, if I could, or two minutes. Lilly is both in the cardiometabolic business in a big way. Also in Alzheimer's business, hopefully in a big way.

And you can solve this whole problem for us, Ilya. 

[01:14:45] Ilya Yuffa: I lead international for Eli Lilly and one, it's great to have so many different stakeholders here excited with energy to make a difference. And Jim, thank you for, I know you've inspired so many people at our company to, work faster. I think one of the things that maybe I would comment on is that we can't lose this time and milestone where it's taken too long to have some therapies

that will have, I think, access to many people across the globe. That's our mission. But that's not the end to this journey, and I think we need to accelerate and create the sense of urgency to utilize, from a data standpoint, if we're going to create and understand science, everything, both pharmacokinetic, but also lifestyle, we need data sets and standards, a platform, a way to share data across the globe. Where other diseases,

we have the ability to do that from a registry standpoint. I don't think we're at that point where we have the standards there. The other piece that Jim mentioned is the sense of urgency to bring ways to diagnose much faster in a simple way that's cost effective. And I think that science is moving quickly, but we need to help push that forward from a regulatory standpoint across the board because without it, there will be, from a capacity standpoint, the ability to not just from an education standpoint, but the tools necessary, it will be difficult to make a change.

And then maybe the third, which is what we all can do in different seats, different hats that we wear, is to have a collective, to have the sense of urgency for governments to act, to have funding for the ecosystem that needs to build out. Not just the treatments, but, it's not just the treatment.

It has to be the full ecosystem. And as I travel around to different markets, It's amazing to see the variability in how brain health is actually structured. And some have good centers of excellence, but they're very isolated in their capacity and some ones are very dispersed. And I think we have an opportunity here to change that and change the rhythm and the momentum of what is yet to come.

And maybe my other point, because my mission and mandate is to actually bring our innovation outside of the US, I'm committed to working with a lot of different governments to figure out in Europe, in particular on how to actually solve bringing innovation forward much faster. I think that is a critical component that Europe is struggling with,

and there are ways to solve that. So we're committed to working through that, not just for Alzheimer's, but the broader cardiometabolic that is also a key component of brain health. 

[01:17:44] George Vradenburg: Ok, I can’t say yes to Lilly and no to Roche, so Simona, last word. 

[01:17:53] Simona Skerjanec: What I wanted to comment on was to what Jim was saying.

We talked a lot about the long term things, but I think there are short term things that really matter to patients and caregivers. And one of the things that I said to you earlier, George, is that when you look at the data, economic data, and what drives the cost in the society today, is really in the developed world, including Europe,

is the cost of nursing homes. And I think maybe when you were asking where to invest, how do you create value in that space? I think that could create a lot of value for patients and families, but also for society. So let's be a little bit short term focused as well, because I think that will really matter to people that are struggling with that today.

Thank you very much.

[01:18:47] George Vradenburg: Your last comment reminded me of an apocryphal, but I think a real conversation that was had with the guy who invented the polio vaccine. So Salk was told as iron lungs and leg braces, were needed for polio victims, he was told, we need more iron lung hospitals. We need more leg brace hospitals and Salk said back, no, we need a cure.

So Andrea is going to deliver that for us. And so I want to thank you all. You've stayed around, you've been very patient, it was a great conversation, we love you all, we want you all part of the DAC team. So thank you for being 

here. 

[01:19:32] Dan Kendall: Thanks for tuning into the Brain Health News Podcast. Be sure to visit healthunmuted.com for more information about brain health. Please also visit www.davosalzheimerscollaborative.org for more information about the work they're doing to promote brain health and end Alzheimer's globally.