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It would be hard to imagine any one person who’s had more of an impact on public health than Bill Gates. Much of the wealth he amassed as founder of Microsoft has gone to charity—according to Fortune, he is one of only five billionaires to have given away more than 20 percent of his wealth. In 2023, the Bill and Melinda Gates Foundation, which he started with his former wife, Melinda Gates, spent more than $8 billion of its more than $70-billion endowment. 

Gates has focused his philanthropy largely on some of the most intractable health problems, such as malaria, HIV/AIDS, and childhood vaccination. In recent years, he has turned to Alzheimer’s disease, starting with diagnostics and more recently expanding to proteomics and healthcare programs related to the disease. Scientific American Custom Media asked him about Alzheimer’s:

SCIENTIFIC AMERICAN CUSTOM MEDIA:
What sparked your interest in Alzheimer’s? How has your personal experience with the disease contributed to your decision to get involved?

Gates: Like many people, I have a personal connection to Alzheimer’s. My dad died from Alzheimer’s, so I understand first-hand what a cruel disease it is, and how difficult it can be to watch a loved one suffer with it. We were fortunate to have the resources to provide my dad with excellent care, and our family is grateful for the wonderful caregivers who helped him in the 13 years he lived with the disease. But for the majority of families battling Alzheimer’s, this is not an option. Caregiving most often falls to a spouse or a child, which can be overwhelming.

The financial burden of the disease is easier to quantify than the emotional cost. The lifetime cost of care for Alzheimer’s and other dementias is rapidly increasing in the U.S., Japan, Europe, and other countries. According to the Institute for Health Metrics and Evaluation, the global cost will exceed $1.6 trillion by 2050 and represent nearly one-third of all healthcare spending. Unlike those with many chronic diseases, people with Alzheimer’s incur long-term care costs as well as direct medical expenses. If you get the disease in your 60s or 70s, you might require expensive care for decades. 

As I spent time learning about Alzheimer’s and the research into it, I came to understand the challenges. The brain can’t be sampled easily or often, for example, and the blood-brain barrier is a double-edged sword—it both protects the brain and makes it harder for treatments to get in.

Even so, as I learned about all the innovation in this field, I grew optimistic about the ability to make progress toward treatment and eventually a cure. This is a frontier where we can dramatically improve human life. It’s a miracle that people are living so much longer today, but longer life expectancies alone are not enough. People should be able to enjoy their later years—and we need a breakthrough in Alzheimer’s to fulfill that. 

As someone who takes a bird’s- eye view of major health issues, how would you describe the current outlook for Alzheimer’s research and clinical practice? 

After decades of negative clinical trials and dozens of failed therapies, researchers are making progress on both diagnostics and therapeutics. 

Blood-based diagnostics are advancing rapidly—the first blood test for Alzheimer’s, PrecivityAD, was launched in late 2020. A few others have followed since, but we are looking forward to the first FDA-cleared blood tests on the horizon. Once this becomes a reality, the next hurdle will be ensuring these tests are used properly, accessible, and available to the patients that need them, and that we understand how these tests work in different patient populations.

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Tony Healey

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