Perspectives

Mark Ivory

Time for the promised Moonshot to get off the launchpad  

By Mark Ivory, Editor of the Journal of Dementia Care 

Two contrasting medicinal tales can be told about 2021, one of success and one of failure.  Covid-19 vaccines have been a great success by any yardstick, but the story of the search for a dementia treatment has been less happy as the latest twist in the “aducanumab” saga has shown.  It is unfair to call this Alzheimer’s treatment a “failure” all told because the drug marketed in the US as Aduhelm has been licensed there for people in the early stages of the condition. But if its manufacturer Biogen was hoping for a Christmas present from the European Medicines Agency (EMA), the agency’s decision in December to refuse a licence for aducanumab in the EU must have come as a severe blow.  It is not even clear whether Biogen will apply for a UK licence. 

 

Alzheimer’s Research UK’s chief executive Hilary Evans called the EMA’s decision “bitterly disappointing news for people with Alzheimer’s disease.”  Perhaps we should look for part of the reason to international research priorities.  It is here that the tale of two treatments mentioned earlier seems highly relevant: global public spending on coronavirus research hit £3.75 billion in 2020 and National Audit Office figures suggest that the UK government contributed £600 million to the search for a vaccine.  Yet the government’s “Dementia Moonshot” pledge of a mere £160 million a year for dementia research, made in its 2019 manifesto, remains unfulfilled.   

Dementia remains low on the priority list for too many governments internationally.  As Paola Barbarino points out in this issue of JDC, it is unlikely that public health targets in the World Health Organisation’s Global Action Plan on dementia will be met.  Around the world, to take one example, 75% of the 55 million people living with dementia are undiagnosed.  Time is running out for governments to prepare their health systems for the impending “tsunami of demand,” Barbarino says.   

Dementia is the UK’s leading cause of death and and an adequate response to this sobering fact is every bit as necessary as it was for coronavirus.  An important way to give dementia the attention it deserves is for the government to meet its spending commitments on research.  So far it has put together a funding package for research on neurodegenerative diseases worth £75 million a year, but it is unclear how much of this is new money and how much is for dementia as such.  What is clear is that it is less than half the amount promised in the Dementia Moonshot pledge.   

Honouring this promise would strengthen the “centres of excellence” led by the UK Dementia Research Institute and open the way to more ground-breaking investigations of the causes of dementia that are a pre-requisite of successful treatments.  This will need to run alongside investment in care and technological innovation to enable people with dementia to lead more independent, fulfilling lives.  

Coronavirus has been worth every penny of public expenditure on medical research.  So is dementia.  Time for the Moonshot to get off the launchpad.