 Good morning, good evening, good afternoon to you, wherever you are in the world. My name is Ali Velshi and welcome to this conversation, which is part of the launch of the Davos-Alzheimer's Collaborative. For those of you who are not familiar with this, there are a few instances in which the World Economic Forum comes together to gather the best, the brightest in the world to solve problems that are just done, they're solved better collaboratively and with a lot of integration. We've seen this with Gavi, the vaccine initiative. We've seen it with Cepi, which has played a role in the creation of vaccines for the Coronavirus. Now we are launching this initiative to combat the effects of Alzheimer's, to recognize all of the effects, to standardize testing around the world for Alzheimer's, and to collaborate really with each other on how best to solve this issue. We have a panel of remarkable experts to try and put this all in context for you. Many of you joining us right now might have some personal or familial experience with Alzheimer's. Recording in progress. Many of you may not, but you probably understand the imperative here. It is different from a lot of the other things that we suffer from in society. Let me give you a few statistics about this. Of the top 10 causes of death in the world, Alzheimer's is currently the only one that cannot be prevented, cured, or slowed down currently. By 2050, it is estimated that one in six people in the world will be over the age of 65, and dementia, all forms of dementia, are projected to triple to 152 million families by 2050. The annual current cost of dementia is more than a trillion dollars. Of course, for those who have experienced this in their family, they know that the costs are very high and often the cost of care is not something that's covered by government. Today in the United States, there are more than 15 million people who are providing care to people with dementia and Alzheimer's, and that totals 18 billion unpaid hours of care. Nearly 60 percent of all people with dementia live in low- and middle-income countries, in many cases with lower levels of care than are seen in the developed world, with health systems that are the least prepared to respond. We don't have widespread screening and care practices around the world. There's a scope of this problem, which a lot of people associate with aging, and we will tell you that it's not always aging. In fact, in some cases, Alzheimer's and dementia sets in the 40s and 50s, we don't know entirely why and how yet, but we do know that it is earlier onset than a lot of people think. But as we deal with all those other co-morbidities and all those other things that cause us to die earlier, and as our life expectancy increases in OECD countries, it's around the age of 79, this becomes more prevalent. As we solve other things in science, the imperative to solve Alzheimer's and dementia becomes more serious. What we are launching today with the Davos Alzheimer's Collaborative is a focus on three areas that are not met, the challenges that are not met, that are essential to speeding up progress toward the discovery, toward testing, toward the delivery of Alzheimer's prevention and treatment. The three issues that we're thinking about, and we'll talk about this with the panel, one is diversity. And that's why we want a global cohort to be part of this, to drive scientific discovery by increasing the types of people who we study. Collaborative is going to focus on building cohorts and collecting measurements that are relevant to Alzheimer's, not just in wealthy countries, but in low and middle income countries as well. We're going to try and figure out speed and best practices for clinical trials by reducing the cost and time to bring treatments to market, both nationally, in everybody's countries and globally. And we are going to focus on patient access to facilitate the implementation of global commitments to provide access to future innovations in treatment, in diagnosis, and care. So with that, I want to introduce our esteemed panel to you. We have Michelle Bonacos, who is the Chief Executive Officer at Biogen. And Biogen is sort of a leading company in therapeutics, figuring out therapeutics for Alzheimer's. But Michelle really here represents the remarkable progress that has been made in treating, or at least determining, how we can treat Alzheimer's. Jeff Huber is the Chief Executive Officer of Home Instead. Jeff's company deals with care in the home for people with various illnesses. And he's developed some specialty on how we think of Alzheimer's, Alzheimer's care, the cost of it, and how you deal with it in the home. And Amy Goldman is the CEO and chair of the GHR Foundation, which has been involved in funding the ways in which we are going to solve this problem. And she can speak to why a collaborative effort like the one being launched today by the World Economic Forum is so important. Now, it's important to understand that a lot of groundwork for what you are going to hear about today has been laid in the last year. So nobody involved in this is brand new to it, but it is brand new to the world. And I want to start, Michelle, with you, and thank you for being with us, telling us where we are in the world of scientific discovery, research, trials, therapeutics around Alzheimer's. Thank you very much, Ali. And as you so clearly described, the epidemiology is not going away. Very unfortunately, we have more than 15 million demented patients all around the world, adding million every year. And when you describe one in five or six above the age of 65, it's soon to be prevalent in some major geographies, doubling of the epidemiology approximately every 20 years. So the issue is still here. And we cannot prevent today Alzheimer's disease, but we could diagnose earlier. And this is not the case today, and I'll come back to that. I would like to say that nowadays, this epidemiology is facing some headwinds based on COVID. The patients, the caregivers are more isolated. And in addition to COVID, there is unfortunately more and more literature that demonstrates that there is a link between the climate change and eventually the etiology or the development of dementia all around the world because of the polluted environment and the emissions. So this is where we come. We can imagine the world not too far from now, where eventually the medical practice will be able to diagnose earlier. And this requires a lot of shift, I don't know, about you, but when I do my medical checkup every year, I'm not asked about cognition. I don't perform a test even if I perform all the others for the heart, et cetera. So I think that there is a need to better educate and shift medical practice so that we can eventually detect the risks much earlier. And we know that future disease-modifying therapies will be much more effective and cost-effective if treatment happens earlier. We are engaging with Apple on the potential fighting of digital biomarkers that may help this detection. And I think technology will help a lot. So there is hope. There is light at the end of the tunnel. While we speak, there are more than 100 studies in the clinic for potential products in Alzheimer's disease. Diagnostics are progressing extremely well, but we have also some challenges as discussed with climate, with COVID, and with this mounting epidemiology. So we have a world that needs to be engaged and collaborate if we want to influence these dramatic trends. Michel, thank you for that. You know, for those of us who are not scientists or medical people, we think about disease and cure. We have obviously, through our experiences with heart disease and cancer and things like that, thought about survival rates, long-term survival rates, which then lead to better cures. How should we be thinking about Alzheimer's? Because when you look at it in a binary fashion, it looks hopeless. It looks like more people are getting it and we don't have a cure. What is the long-term trajectory? Is there a point at which if we all collaborate properly and develop something, we might get too cure or are we looking at extending people's lives or are we looking at, as you said, treatment before the onset of dementia, if you can establish whether someone is headed in that direction? I'm sure that Jeff would be able to say much more and Amy, but nowadays in the US, to give an example, there are more than 100,000 patients moving from losing independence and moving from home to institutions. It might well be that with a disease-modifying therapy and other interventions, we'll be able to improve on the activity of daily living of those patients and for those patients to remain independent much longer. I think this is tremendous, this is tremendous for the society, for the patients, for the caregivers. This is one marker, one example. And the earlier we will be able to move towards the left, which is earlier identification with the right diagnosis but affordable for everyone will be eventually able to document better effectiveness. We are just at the beginning, but that tremendous opportunity, as long as we continue to study those products for real life evidence on how much the benefit could be for the patients and the society. Cure is still a long stretch, but obviously the entire your industry is working on that. Thank you, Michelle. Jeff, Michelle set you up there. You have said that until there's a cure, there is care. For those people in our audience who have not experienced somebody with Alzheimer's in their family, it's not comparable to caring for a relative with other illnesses. The way in which it manifests and the type of care recovered is unique. Yeah, absolutely. And this is something that we see every day at some scale. So at home instead, we provide relationship based care to older adults in their home, wherever they call home. And this year we'll provide about 100 million hours of care. Today we'll be in 100,000 homes in 15 countries around the world and about two thirds of our clients have Alzheimer's or some other form of dementia. So we see the very real effects not only on the person living with Alzheimer's disease but on their entire circle of loved ones, their sons, their daughters, their spouses, everyone around them. So I think it's good to talk about the trajectory but let's talk about like the very real lived reality of a family caregiver because for those people that is their entire world. So imagine, Ali, just the sadness of a diagnosis of something that is unstoppable, incurable, no way to really modify the trajectory upon diagnosis. But that sadness never really goes away because a piece of you is constantly grieving because this loss comes to the family in steady increments like for the first time, your father who was a brilliant surgeon can't follow simple directions or your mother who raised you doesn't recognize your face or the first time they don't say, I love you back or the time that they cannot keep up in a conversation or even remember your name. Imagine being in a constant state of worry, never getting a moment's rest and being a constant nervous wreck because your loved one might wander away. You can't sleep, you can't leave the house, you can't even go into the grocery store and leave your loved one in the car because they might wander away. Imagine your mother who was the most gentle, dignified person that you've ever known becoming outright combative or swearing uncontrollably or undressing at a wedding reception or the extreme frustration of a loving spouse because the husband is constantly following her around, she has no life of her own and she has to spoon feed her husband in the seething resentment because these are the years that we're supposed to be enjoying our grandchildren together or the overwhelming guilt because you don't wanna be around your father or your wife and you feel guilty because you hope that end comes much quicker or the guilt because when the end does come, you feel relief, not sadness. And if you're lucky enough to have help, children or siblings or can afford to pay for help, then that's your reality. And if you don't, then add to all of this the incredibly painful economic decision of whether I need to go to work or stay at home. And if you work because you must, then you're constantly worried because you're always distracted, you might lose your job, much less concentrated on advancing your career. And so then you come to the incredibly painful decision of having to put your loved one into a home and in today's world, that means that you might not ever see them again face to face. This disease, Allie, is constant. It's overwhelming. It is physically, emotionally, psychologically consuming and completely life-altering. And imagine that going on for five years, 10 years, 13 years. All too many of our audience have experienced this firsthand. And if you're lucky enough that you have it, there's a really, really good chance that you will in the future. And it doesn't matter what your economic status is, rich, poor, blue-collar, white-collar, educated or not, Alzheimer's is the great equalizer. And this is the reality today for 50 million families. And the cost, as you alluded to, is staggering. Family caregivers provide about 80 billion hours of unpaid care annually. And over the next decades, all of that's gonna triple. That's what we're up against. That's the reality today. And that's what our future will be unless we come together and I'm so grateful for the collaborative in the forum to tackle this issue. And we have to make a heroic effort now to alter that trajectory. I said at the beginning that by 2050, one in six people in the world will be over 65. We are seeing, on an annual basis, marginal increases in mortality in the age to which we live. But Amy, you have a very important point to make here and that is, it's not just an old people's disease. In fact, it strikes people, as George said earlier in this morning's earlier session, it starts just to work in the body, sometimes in the 40s and some people get it in their 50s. It's true, Ali, and that really underscores the point of why we've focused on prevention trials. So thank you, and I'm really pleased to be on here with this esteemed panel. I will say I have the personal experience that Jeff just outlined. My mother became symptomatic with Alzheimer's in her late 50s and after a long slow decline, did die of the disease. So firsthand understanding of the suffering that families go through. And it really catalyzed me to think about how we could enter in to this field and really start to focus on prevention. But it's complex science. There's large players in the field and it's difficult to navigate. So really over the past 20 years at GHR Foundation, we've been focused on prevention trials. And I will really say that I like to think of how philanthropy can enter in within three different areas of patient capital and risk capital and visionary capital. And now with the Douglas Alzheimer's Collaborative, there's an opportunity for so many more people to engage on this platform and continue to build a really strong community of those of us who have already been in the field of philanthropy and working very closely and building trust to relationships with government and with industry. So maybe Ali, if you would help, I could outline just a little bit what I mean by patient capital and risk capital and visionary capital very quickly. Patient capital is what funders have, which is to be able to be long-term and we've funded the Mayo Clinic Study and Aging, which has really helped contribute to reconceptualizing what is Alzheimer's. It used to be Alzheimer's is I can't remember things. Now we really can say it's having amyloid plaque and tangles in the brain with risk capital. This goes back a lot to the diagnostics that Michelle was talking about. We've been able to help accelerate the first test and it's a blood test to test for biomarkers for accumulation of amyloid plaque. And that can now be in clinics to reach patients. And then visionary capital is really expanding these research trials and forming public-private partnerships with philanthropy so that we can get general population studies and the first one that is going on now is the A4 trial. So it's testing all those people over age 65 and we've already discovered 30% of them have amyloid plaque buildup already in their brain. So it again underscores the points Michelle and Jeff were both making. And with A4 we're then moving on to testing therapies in a preventative way. So all of this alley is how can we prevent that tsunami coming? And it really aligns with our vision that treating Alzheimer's someday will be analogous to how we treat heart disease today. If I may, I reinforce what I think the critical I think the critical paradigm shift really to create the healthcare system instead of visiting the provider when it's almost... Michelle, I wanna ask you, when we think of public companies like yours, we imagine that you are in competition with other public companies. As you said, there are over a hundred various things in trials. What's the advantage of a collaborative to Biogen in this case? And I think George made a point earlier in his earlier session about the fact that with coronavirus we saw the benefit of public-private partnerships, collaboration in terms of speeding up a vaccine development. How does that work in your world? How does the idea of a collaborative benefit you at Biogen and benefit the end result? Certainly, but before I talk to this important question, I would like to finish what I was saying, which is basically we absolutely need a paradigm shift in the system to become a true healthcare preventative system that will allow early detection. This will be the most cost efficient use of any intervention instead of coming too late and visit the physicians and the provider when it's almost too late. So then the question is how do we achieve that? Is it by having the provider get the act together through genetic risk and family risk or having the patients, inform patients, be much more alert and having digital markers eventually to help for early detection? Coming to your question on the 100 plus trials in a very competitive environment, actually we do not compete. In this field, we are all learning from each other and the space is too large, too complex so that one company cannot make it alone. We absolutely need to collaborate also within the pharma sector. This is what we have done with the knowledge that we gained from all the success or failures and the knowledge that all those gain from our successes or failures. It's a big collaboration also on the scientific side. Thank you for that, Michelle. Amy, I wanna ask you about that too. You mentioned patients. There's also an issue about access. We've definitely watched this during coronavirus, right? We've talked for 10 months about how, wow, we hope that people get access to testing didn't happen as effectively as we would have liked, particularly those who don't have normal access to good healthcare. Then we're seeing it happen with vaccines. We've got an infrastructural problem in the United States, in Europe, all around the world with getting healthcare, basic healthcare to people who need it, who often can't afford it. How do we make sure that we don't get this wrong with Alzheimer's? Allie, it's something we think about a lot. And again, I think the role of philanthropy is to help assist both industry and government to ensure that there's equitable access. And then that comes across the whole spectrum. So equitable access in screening now that we're continuing to fund and support these rapid innovations in biomarkers and in testing that you can go to your doctor's office and get screened for Alzheimer's and make it much less expensive. Also in the therapies that are being tested now in research trials and like we've seen with the COVID vaccine that there is, that there can be many, many therapies that come on the market. We're still early days, but there's promise in a lot of these general population prevention trials that are being put together. So really it's on screening, it's on therapy and I think really and supporting longer-term longitudinal research, it's also naming and seeing these inequities that are out there. Diverse populations have different rates of developing Alzheimer's disease. Lower and middle income countries are now seeing increasing rates. So it's in guaranteeing access to all of that. And I would again, applaud the Davos Alzheimer's collaborative on setting up a pre-competitive or an uncompetitive model and I agree with Michelle, it's not competition, the problem is too big and the science too complex. Also I would challenge the Davos Alzheimer's collaborative to really think about putting in global equity protocols at the beginning. And I believe there's already a start on that and then to have each of us in whatever capacity we're playing in adopt these protocols and follow them and really push for equitable access at the beginning. I think writ large having a focus on prevention of Alzheimer's, having an understanding of who's getting Alzheimer's and having therapies to prevent it is an equity issue. It decreases the cost. Again, I go back to the analogy of maybe someday we'll have a vision where treating Alzheimer's is like heart disease, where you can go have your blood pressure taken or your cholesterol screen and then you can take a drug to lower your cholesterol or work on your blood pressure. We can get to that. That also increases then access for care and prevention across the world. And Jeff, equity issue is fairly serious. You mentioned in earlier conversation we had that women and minorities are disproportionately affected by Alzheimer's. Tell me why. I think, well, mathematically they are, but I think one of the real risks we face is that so many of the gains that women have made in the workplace over the last 40 years are at risk for being undone, simply because now they're having to make really hard decisions about whether they're gonna, and the burden falls on women primarily to be the family caregiver, whether they're going to care for their loved one or attend to their career. So people have to pass up promotions, have to reduce hours, have to take early leaves of absence, early retirement. So that's just one disparate impact that happens. But I think Michelle used a good term earlier in terms of paradigm shift. I think in terms of access, I think one of the key things we need to be thinking about is the home. If COVID has taught us anything, it's that the home is a scalable safe place to care for people. And right now the default setting is institution when we think about Alzheimer's and other forms of the dimension where we know that home can be a safe place where there's higher quality of life, better outcomes, lower costs, and where people want to be in a familiar setting. So that is one paradigm shift. And as I serve on the future of health, as healthcare is thinking about its transformation, I think we have to think about the home as being the center of care. It is the only scale we'll place, especially given the magnitude of what we're talking about. Michelle, Amy made the point that there are big companies, big names involved in this. You are one of the biggest, it's not the biggest. For people who are watching this right now, what can they do? What's the call to action? How do people who are motivated for your updates and Amy's information and Jeff's experiences, how do they do something about this? I think what I would recommend is basically while it was stigmatized as being a lethal disease for which there is no hope, I think hope exists. So I would certainly encourage the patient the caregivers, the family and the community to remain absolutely informed on the latest, being on the scientific side in terms of products to be approved potentially or being on the technology with all the improvements coming together at the service of the patients who can be at home longer enjoying his family, his grandkids being able to do his banking, taking care of himself or herself, getting dressed, cooking, doing all the activity of daily living, for that there is hope. And this is where the society has to continue to improve and to be mobilized. Half an hour conversation sounds like a lot, but in fact, I think we could have gone on for six or seven hours to talk about this. This is new to some people and it is very close and not new at all to other people. So I wanna thank the three of you as representatives of the World Economic Forum and Davos Alzheimer's Collaborative.