Learning from COVID-19
But there are lessons to be learned from the COVID-19 pandemic, which has demonstrated the need for greater planning to escape the woefully suboptimal cycles of neglect and panic: neglecting health challenges until they are upon us, and then panicking to belatedly address them.
Unlike COVID-19-type pandemics, which are characterized as low-probability and high-visibility, the gathering storm of dementia is high-probability and low-visibility. COVID-19 showed that the global community is able to tackle the most complex research challenges rapidly and effectively when the economic peril of inaction is obvious and we invest sufficient resources.
Health care systems worldwide need to begin reconsidering their approach to delivering care to people with dementia. Support for interdisciplinary team-based care for patients and families living with dementia should be a priority, especially in high- and middle-income countries. Disease management programs, which implement standardized approaches to delivering and coordinating care for people with particular chronic diseases, and innovative financing mechanisms (for example, value-based or outcomes-based contracting) are examples of how such care can be scaled up in many settings.
With respect to the development of novel therapies, governments of advanced economies must lead an effort to ramp up spending on dementia. These countries currently bear most of the economic and societal costs of dementia because of their populations’ age structure and thus have the most to gain in the short term. Increased investment would also bolster their economies, offering additional financial benefits.
Advanced economies should invest in three areas to boost dementia R&D: direct funding (especially basic research); stronger incentives for private investment in R&D; and support for patient access to the fruits of R&D, including the absorption of patient costs—particularly in low- and middle-income countries. This support may extend to development of the health care infrastructure. As part of any such initiative, governments of advanced economies should build a global R&D ecosystem that can develop necessary clinical trial infrastructure and repositories of biological samples (biobanks). These governments should encourage investment in many simultaneous drug development projects, which, by diversifying across projects, would mitigate the extreme risk of a lone development project. The necessary capital could be raised through the establishment of a megafund with a government guarantee on the principal investments. Investments in the mega-fund could work like bond financing: investors get their original investment back plus interest from the proceeds of successful drug developments (Fagnan and others 2013).
Such investments are critical to improve global economic equity. Informal caretaking is a large part of the reality of living with dementia, particularly as the disease progresses. Family members often perform that role, and it is intense, difficult, and often heartbreaking work. Women typically bear a disproportionate burden of caregiving in many countries, halting their progress toward equity in the labor force. Equity is particularly relevant in low- and middle-income countries, as many of the risk factors for dementia are associated with systemic disadvantages (including air pollution and lack of access to education or nutritious foods). The economic burden is thus concentrated among those already in the most challenging financial situations, feeding the cycle of poverty. Rich-country efforts to link, scale, and invest from richer countries can help the poorer ones realize their full productive capacity in the coming years.
