Imagine if our response to COVID-19 was to ignore vaccine development and instead focus on getting better at treating the disease. This absurd strategy is precisely how we are trying to address the epidemic of age-related chronic disease in America — and unsurprisingly, we are failing.
According to the National Council on Aging, more than two-thirds of Americans over age 65 have two or more chronic illnesses. These diseases of aging such as heart disease, cancer, dementia and diabetes are responsible for seven out of every 10 deaths in the United States, and even this figure understates their deadly nature. COVID-19 has shown us just how susceptible people with chronic illnesses are to other diseases. Factor in co-morbidities and the toll from chronic disease is even higher.
Irrationally, our nation’s response to the chronic disease crisis is to pursue better disease treatment instead of disease prevention. Seventy-five percent of all health care spending — over $2.8 trillion per year — goes toward treating chronic illnesses. An examination of novel drug approvals over the past decade suggests that research and development funding for pharmaceuticals is almost exclusively focused on therapies for disease treatment, rather than for disease prevention.
When we do include prevention, the focus is on lifestyle modifications such as better diets, more exercise and less or no consumption of alcohol and tobacco. This is important, and there is a lot we can do in and out of the health care system to encourage Americans to live healthier. But we need to be realistic about the size of the challenge posed by America’s chronic disease epidemic and our ability to achieve a population-wide shift in behavior capable of matching it. Relying on lifestyle modification alone to end this epidemic is akin to relying on masking and social distancing to end the COVID-19 pandemic. It is a piece of the puzzle but we cannot expect to address the crisis adequately without preventative therapies.
That is why we should take a lesson from COVID-19 and establish an “Operation Warp Speed” for the development of a “vaccine” against age-related chronic disease. Of course, the term “vaccine” is not technically correct, but it does accurately describe the goal: preventative therapies that significantly reduce the susceptibility of Americans to developing chronic illnesses later in life.
Where would such therapies come from? There are many promising areas.
For example, recent research has revealed an amazing connection between changes in our gut microbiome and the development of chronic diseases, especially diabetes and cancer. Scientists are seeing if treatments to maintain healthy gut bacteria as we age can keep us healthy.
Another promising area of discovery is geroscience. This exciting new field studies the changes in our cells that occur as we get older and how those changes lead to the development of many chronic diseases. The geroscience hypothesis is that we can prevent, or at least significantly delay, the onset of chronic diseases by treating the cellular aging process directly.
Geroscientists have had significant successes in the lab. Treated animals spend a much longer portion of their lives in good health, live longer, and die with fewer complications. The treatments range from small molecules that need to be taken daily to one-time gene therapies.
President Biden has stated his goal to cure cancer and Alzheimer’s disease during his term of office. He should set a more ambitious goal of “ending” these and other chronic diseases by organizing a strategy for the development of preventative therapies. Here are several places for him and Congress to start:
The first is in the appropriations process. Aging is the No. 1 risk factor for disease, but the National Institutes of Health (NIH) spends less than 1 percent of its budget studying the biology of aging. The development of preventative therapies against the diseases of aging will require a much larger pool of basic science research for the biopharmaceutical sector to draw from to identify promising targets for trials in humans. Congress should triple funding for the Division of Aging Biology at the National Institute on Aging within NIH.
The second is the creation of a dedicated pathway at the Food and Drug Administration (FDA) for preventative therapies for age-related chronic diseases. The current clinical trial regime is structured to prove efficacy in treating a disease over a relatively short amount of time. It is difficult to apply that same standard to preventative therapies for conditions that take years, even decades, to manifest. There are precedents using biomarkers and abbreviated pathways that could be applied to preventative therapies, but the instructions for FDA to create them would need to be written into law. This would be a good goal for inclusion in a 21st Century Cures 2.0 bill.
The third opportunity comes with President Biden’s call for the creation of the Advanced Research Projects Agency-Health (ARPA-H), which promises to do for health care what DARPA does for military technology. The development of preventative therapies for age-related chronic illness is exactly the sort of big project that ARPA-H should take on because the current economic incentives of our health care system are so biased toward disease treatment. ARPA-H could fill in the gaps in funding that make it difficult for potential therapies to cross the valley from basic science to the private biopharmaceutical sector.
The development of preventative therapies for age-related chronic diseases will be a significant biological challenge. It is, however, the only solution capable of meeting the scale of the chronic disease crisis in America. Focusing science and industry with a project to develop a “vaccine” against chronic disease would put us on the path to finally having the tools we need to address this crisis.
Joe DeSantis is the chief strategy officer at Gingrich 360. He writes on health care technology, biopharma, price and quality transparency, and strategies to increase human health span. Follow him on Twitter @joedesantis.