Global dementia legacy event: david cameron’s speech

Speech GLOBAL DEMENTIA LEGACY EVENT: DAVID CAMERON’S SPEECH The Prime Minister spoke at a summit of world health and finance leaders in London about dementia, finance and social impact

investment. This was published under the 2010 to 2015 Conservative and Liberal Democrat coalition government 6 months ago, Britain hosted the world’s first G8 dementia summit. Our message

was clear: it’s time for a global fight-back against dementia. A global effort to raise awareness and help those living with dementia to live with dignity. A global effort to delay the onset

of dementia wherever possible. But above all, a global effort to find a cure for this terrible disease. Every 4 seconds a new case of dementia is diagnosed. In the UK alone there are around

800,000 people living with dementia. Worldwide that number is 44 million – and it is set to double every 20 years. Just think of the families enduring the unspeakable pain of watching loved

ones slipping away, husbands and wives, sons and daughters finding that their loved ones no longer even recognise them. For far too long this terrible condition has been ignored,

down-played or mistaken as a natural part of the ageing process. The truth is that dementia now stands alongside cancer as one of the greatest enemies of humanity. We need to recognise this

for what it is and fight it with just the same determination and compassion that we have brought to the battle against cancer. And that’s why we are here today to continue the vital work

that was begun just before Christmas. The first thing we have to do is to help those living with dementia to live with dignity. In the UK we’re spending £50 million on transforming hospitals

and care-homes to make them more dementia friendly. So places like the Royal United Hospital in Bath now have dementia wards specifically designed to make patients feel more relaxed and at

home. We have been getting our GPs to check more closely for signs of dementia and running an awareness campaign on television because the earlier dementia is diagnosed, the easier life can

be for those living with the condition. And we’ve been working on getting the whole of our society involved in the fight-back against dementia. That means thinking about every aspect of life

– from helping people access bank accounts to using public transport. And through our campaign to find and train 1 million Dementia Friends we have helped people to understand a bit more

about what it’s like living with dementia and some of the simple things that all of us can do to help. But it’s not enough just to help people living with dementia. We have to fight to cure

it. I know some people will say that it’s not possible. That we just have to accept this is something that happens in older life. But I’m not prepared to take that defeatist attitude. Just

30 years ago, the same could have been said of cancer that there was nothing we could ever really do except make it a bit easier for people. But we’ve shown what medicine can achieve. But

now, even though we are some way from a cure, millions of people have beaten cancer because of a bold and determined global effort to invest in medical research. That’s what I want to see

now happen in dementia. Earlier today our World Dementia Envoy Dr Dennis Gillings talked about his visit to University College London where he witnessed the amazing sight of neurons from

stem cells firing in a petri dish – replicating the functioning of the brain. We don’t yet know anything like enough about how the brain becomes diseased. But already we can begin to model

how it functions. So we should just imagine what could be achieved in the coming years. But to do that we need to respond to 4 key challenges that Dennis and the World Dementia Council have

been talking about today. First, the market failure undermining dementia research and drug development. Second, the problem that even when we do develop new drugs, it still takes far too

long to get them to patients. Third, a lack of collaboration and openness with different scientists all over the world using different data and trying different approaches but frankly not

really working together enough. And fourth, there is of course the need for more investment. Let me say a word about each. First, the market failure. When only 3 out of 101 dementia drugs

developed between 1998 and 2011 have made it to market and when losses by pharmaceutical companies have reached around $50 billion, I think it’s clear that the incentives for dementia

research and drug development are not yet right. The risks are too high and the rewards are too low. And if anything, this problem is set to get more acute. Just as genomics has shown us

there are dozens of different types of breast cancer alone, so we suspect there will turn out to be many different types of dementia too. The ability to personalise therapy by developing

specific interventions based on someone’s genomic profile would be a huge step forward in the treatment of dementia and its causes. And that’s one of the reasons why I have been so

determined to invest in genomics – making Britain not just the country with the best health service in the world as the Commonwealth Fund report found yesterday but also the first country in

the world to use DNA codes in the mainstream of the National Health Service. Because when you have isolated the specific mutation that leads to a particular type of cancer or dementia, you

are left with quite a small group of patients to treat. And that makes the incentives for drug development even more critical. But of course this problem isn’t entirely new. I think we can

learn a lot from what we achieved with the drugs for so-called orphan diseases. We have these rare diseases like cystic fibrosis, Hunter’s Syndrome and Pompe’s Disease which only affect

relatively small numbers of people. For a long time no-one was prepared to invest in creating drugs to treat them because the risks were so high and the returns were so small. But in the 30

years since the Orphan Drug Act in the United States, more than 400 new orphan drugs have been approved. I think we need to look at dementia in a similar way. Here in the UK we have already

created a Patent Box – which means that if a company creates intellectual property in the UK, it will pay a corporation tax rate of just 10% on any profits generated by those patents. But I

want us to go further, including by looking at extending the length of patents so that companies which successfully invest in a new drug may have a longer period of exclusivity in reaping

the rewards for that investment. I think these new incentives will be critical in overcoming the market failure that perilously undermines research and drug development. Second, even when we

develop new drugs, it takes far too long to get them to patients. This reduces the financial benefits for those who develop the drugs. But even more critically, it means that many patients

who could be helped are denied the chance to get access to new innovative treatment. Now, of course, it’s right that any new drug should be thoroughly tested. But what we saw with HIV and

Aids in the 1980s is that when faced with a terminal condition some patients are prepared to take a chance on new treatment. Patients who don’t have the time to wait another decade for a new

proven advance are sometimes prepared to try out new drugs in the hope that they might provide benefits sooner. Let me be absolutely clear about what I am saying. We have a responsibility

to ensure that any drug is properly tested before it is made available. But there are different levels of proof of success that can be demanded while preserving quality and of course public

safety. For example, do you wait until a drug has proven that it can extend years of life even if that means holding that drug back from potential patients for years or do you take the test

results that might show it can help the brain to function with no side effects and use that as a basis to allow people to try it if they wish. These are difficult medical judgements that are

certainly not for me to make. But they are questions we should be rightly asking. The principle of allowing consenting patients earlier access to innovative new treatments – where there is

an unmet need – has surely got to be right. Right for the patient living with dementia. Right for the businesses looking to invest in bringing new drugs to market. And right above all for

our children and grandchildren who could one day be spared this terrible condition. Third, our global efforts in tackling dementia can be undermined by a lack of openness and collaboration.

Too often research is not close enough to the market – and it’s too disjointed. We’ve got different scientists all over the world, working in different laboratories, using different data and

trying different approaches. I think we need to join up the dots and create a big, bold global push to beat this. As Dennis described earlier, we could create a global digital platform.

This could join together those with dementia, their families, carers, academics, pharmaceutical companies, regulators and research funders to share knowledge and solutions in real time

throughout the world. We should look too at innovative ways to incentivise partnerships between science and business. In Quebec, for example, if a university collaborates with a company they

get a surplus in their research grant. These sorts of partnerships are vital in stimulating research that is closer to the market. Fourth and finally, we need to generate much higher levels

of investment. In Britain we will have already doubled the funding for dementia by the end of this Parliament. And I want us to double that again by 2025. But it’s not just about

governments making funding commitments. We need more innovation in finance. There are a series of questions we need to work through which will affect the kinds of fund or funds that we need

to establish. What do we need to focus on – basic science, for instance, or biopharmaceutical investment and clinical trials? What type of investors do we need to draw in and what type of

return can they expect? One possibility might be more social finance. The UK has been pioneering the growth of Social Impact Bonds. We’ve been saying to social entrepreneurs: “if you can

solve the problem, and thereby save the taxpayer money, we’ll give you money”. And then social entrepreneurs have been able to go out and raise new sources of capital. Today there are more

social impact bonds in the UK than in the rest of the world put together. So when it comes to a global problem like dementia, could we explore global social investment for dementia?

Governments around the world could commit to count properly the downstream costs of dementia and channel a percentage of that into outcome payments for successful research and development.

Or perhaps a layered fund – where donors take a first loss position to bring in new commercial investment like the principles behind the Gates Global Health Innovative Technology Fund or the

African Agricultural Capital Fund? It’s not for me to stand here today and dictate the right model. We need you - the experts here in this room - to commit today to working up these models.

And we need governments like mine to show we are prepared to look seriously at these models and take bold decisions to back them when we can. So my hope is that we can make progress on

these 4 challenges that I’ve set out. That governments around the world can work together to create new incentives to correct the market failure in research and drug development. That we can

enable earlier access to new and innovative treatments, that we can promote greater openness and collaboration between all those working in this vital battle against dementia and that we

can explore new and innovative sources of finance to increase investment. I am today writing to other G7 leaders to encourage them to work with us on this, perhaps even to bring these 4

elements together in a new global charter that can help to win the fight against dementia. Here in the UK, I am today tasking the Office for Life Sciences and the Cabinet Office to take

forward the development of each of these 4 steps. And I am delighted to say that we are making a start on these commitments straight away. Today Alzheimer’s Research UK is launching a £100

million campaign over the next 5 years beginning with a £30 million network of Discovery Institutes and a ground-breaking Global Clinical Development Fund dedicated to taking promising new

treatments into testing in people. And the UK’s Medical Research Council is today announcing the world’s biggest study into dementia, involving 2 million people. I believe these are exciting

developments. But I know we are at the beginning of one of the greatest battles in human medicine. It will take years of patient work. There will be many false dawns. And progress will at

times be all too painfully slow. But we have shown with other diseases that we can make extraordinary progress. And we will do so again. UPDATES TO THIS PAGE Published 19 June 2014