Opinion Sector News — 20 March 2015

Dr Margaret Chan Director-General of the World Health Organization

Conference on Global Action against Dementia, WHO, Geneva, Switzerland 17 March 2015

Honourable ministers, ambassadors, distinguished scientists, colleagues in the UN system, representatives of civil society organizations and foundations, ladies and gentlemen, I thank the government of the United Kingdom, and particularly the Secretary of State, for taking a leadership role on dementia and for supporting us in organizing this first-ever ministerial conference. I thank OECD for their technical support. The world has plans for dealing with a nuclear accident, cleaning up chemical spills, managing natural disasters, responding to an influenza pandemic, and combatting antimicrobial resistance. But we do not have a comprehensive and affordable plan for coping with the tidal wave of dementia that is coming our way. OECD gives three succinct reasons for elevating the priority given to dementia worldwide. Dementia has a large human cost. Dementia has a large financial cost. Both of these costs are increasing. An estimated 47.5 million people are currently living with dementia. About 60% of this disease burden falls on low- and middle-income countries, which have the least capacity to cope. As population ageing continues to accelerate, the number of dementia cases is expected to nearly double every 20 years. In 2010, the worldwide cost of dementia was estimated at $607 billion per year. These costs are growing even faster than the prevalence of this disease.

Dementia 24 October ACCSAt the personal level, the costs of care are catastrophic, especially as they are often paid for out-of-pocket. Lifetime savings are lost. The wages of informal caregivers are sacrificed as meeting the needs of a person with advanced dementia is a full-time job. The costs of care go beyond financial outlays. Research shows that family members and other caregivers suffer from much higher rates of physical and mental disorders. Ladies and gentlemen, I can think of no other disease that has such a profound effect on loss of function, loss of independence, and the need for care. I can think of no other disease so deeply dreaded by anyone who wants to age gracefully and with dignity. I can think of no other disease that places such a heavy burden on families, communities, and societies. I can think of no other disease where innovation, including breakthrough discoveries to develop a cure, is so badly needed. Let me ask you. If wealthy countries are overwhelmed by the burdens and costs of dementia, what hope do low- and middle-income countries have? In terms of a cure, or even treatments that can modify the disease or slow its progression, we are nearly empty-handed. Innovations to improve care and support are equally needed. Cutting-edge technologies are being developed to help keep patients safe, signal problems, and relieve some of the burden on caregivers.

Innovations are also needed to help patients manage the routines of daily life. We need research to improve our understanding of opportunities for prevention. Many of the same risk factors for heart disease, cancer, and diabetes can increase the risk of dementia. The evidence for other causative factors is suggestive, but not yet conclusive. We need primary care providers who are trained to detect dementia early and introduce appropriate interventions. We need integrated models of care that include non-drug interventions, especially since the risk of over-medication is so great. Giving dementia higher priority also means capturing the great collective wisdom of caregivers in a more systematic way, learning from each other. Fortunately, all of these needs are now being addressed.

Friends and colleagues, We have been running behind the curve with dementia for a long time. But several recent events tell us we are catching up. In 2012, WHO and Alzheimer’s Disease International jointly issued a report that explained why dementia must be treated as a global public health priority. The report set out a range of actions to improve care and services for people with dementia and their caregivers, and for countries to develop and implement dementia plans. The G8 dementia summit, organized by the UK government in December 2013, was a watershed event. Among its many achievements, the summit set out the bold ambition of doubling funding for dementia research and identifying a cure or disease-modifying therapy by 2025. That was a courageous and critically needed ambition. After a catalogue of repeated and costly failures, pharmaceutical companies are retreating from the search for a dementia cure. Research projects are being postponed or shelved because of the technical and financial risk of failure. The dementia summit was followed by a series of legacy events that have explored ways to break through some long-standing barriers to rapid product development. How to streamline, simplify, and harmonize regulatory approval. How to get research conducted in publicly-funded institutes working in synergy with research undertaken by the pharmaceutical industry. How to jump-start innovation when market forces fail. WHO is pleased to convene this first ministerial conference to exchange views and experiences and also to translate commitment into action. Seeing the number of Member States that have responded to our call, I feel confident that no country will feel left alone in tackling dementia.

Yesterday, you heard about many promising initiatives that are acting on multiple fronts to meet the challenges of this extremely difficult, demanding, and devastating disease.Urgency inspires invention. The solutions being proposed are foresighted as well as innovative, as they can carve out ways of pushing other badly needed medical products through discovery and regulatory approval and onto the market. But with the tidal wave of new cases poised to sweep over the world, we cannot wait to take action. The job now is to weave these multiple strands of hope coming from multiple new initiatives into a comprehensive plan that can also work in low-resource settings. The plan must be backed by strong political and government commitment expressed through resources and practical policies. Coping with dementia is also a health systems and social welfare issue. Planning must likewise consider the demands placed on these services. We do not currently have the tools to stop the tidal wave. But we can cushion its impact as we continue to build a foundation for urgent action on multiple fronts. Thank you.

This transcript first appeared WHO, 17 March 2015.

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