America has an Alzheimer’s problem, devastating families and driving soaring healthcare costs.
More than 7 million people over 65 years old live with Alzheimer’s dementia today, a number predicted to double by 2050. Costs are staggering, by some estimates over $1 trillion per year, which may climb to $3 trillion by 2050, or 10% of our current GDP.
We poured $250 billion of taxpayer money into Alzheimer’s and related dementia in 2025, nearly all of it through Medicare and Medicaid for health and long-term care payments. Over $4 billion went to scientific research, mostly through the National Institutes of Health.
For years, Alzheimer’s drug development was described as the quintessential graveyard of death, where promising early treatments failed in late-stage trials. This changed in 2021 when the first disease-modifying treatment, aducanumab, was approved by the Food and Drug Administration, followed by lecanemab in 2023 and donanemab in 2024.
These monoclonal antibody drugs target amyloid plaques, long considered the main target for drug development. Yet they are far from magic bullets: The latter two drugs slowed disease progression by 27% and 35%, respectively, in clinical trials, and are expensive, require regular IV, and can cause brain swelling side effects.
As with early HIV or cancer therapies, these imperfect new drugs do represent a turning point in Alzheimer’s drug development. They confirmed, for the first time, that amyloid clearance was associated with clinical benefit and validated the role of amyloid in disease progression. This paved the way for new blood-based biomarker tests that were approved by the FDA late last year.
The field has been evolving over time, and a more nuanced picture about Alzheimer’s has emerged in which plaques are the result of amyloid and tau dysregulation, vascular injury, inflammation, and metabolic dysfunction.
Alzheimer’s starts decades before symptoms begin, and Phase 3 trials are dominated by anti-amyloid monoclonal antibody treatments, many of which are focused on prevention or slowing decline. New drug classes target a wider variety of regulators of the amyloid and tau proteinopathies, or protein misfolding, reflected in the diversity of 138 novel agents in the pipeline. This includes, for example, promising new therapies, such as UB-311/AXX-AD, a synthetic peptide-based active immunotherapy that has already completed a successful Phase 2 trial.
Yet the federal government’s approach to the drug pipeline has not evolved. The field is still slow, fragmented, and risk-averse, with large gaps between academic discovery and useful therapies.
The Trump administration has a unique chance to harness these advances. In recent years, several Alzheimer’s groups and researchers have advocated the use of an Operation Warp Speed-like model to address these problems. With $18 billion in funding, OWS delivered over 1 billion doses of different COVID-19 vaccines, monoclonal antibodies, and convalescent plasma in about one year, compared to the typical decade, or more, of drug development.
An Alzheimer’s acceleration fund focused on catalysing new preventive therapies would represent an unprecedented new model for mission-oriented science. With about a $5 billion-$10 billion budget, the federal government could invest the equivalent of about 4% of our annual spending on Alzheimer’s into a portfolio of low-risk, high-reward investments that could save trillions by 2050.
There are many ways such a fund could be designed, and many details that would need to be carefully thought out, including transparency and accountability mechanisms. One option would be to design a two-tier system convened by the Department of Health and Human Services to differentiate between mature prevention candidates ready for Phase 3 trials and aimed at a validated target, which could quickly come to market pending successful results, and early candidates still in the first two phases, where investments could bear fruit down the road.
The fund could also address other persistent problems stymying the Alzheimer’s field, including the coordination of trial infrastructure to improve recruitment and trial comparability, real-world data systems, adaptive designs, and combination approaches — for example, combining amyloid clearance with tau or synaptic targets, augmented by AI structural designs. The current focus on reproducibility and open data by the NIH would help advance public trust in results. Furthermore, the placebo arms could, with some consideration, be pooled into the largest natural history cohort, providing vital insights into risk factors, biomarkers, and disease progression.
The OWS model also provides a solution to the high price of Alzheimer’s drugs now and into the future: advance purchasing agreements and milestone-based payments. Both de-risk biotech investments by guaranteeing demand, which helps innovators enter the market and achieve scale and lower costs. A fund open to U.S. companies committed to domestic manufacturing and most-favored-nation prices would ensure affordable pricing and strengthen advanced AI-robotics manufacturing.
Alzheimer’s rising health and social costs cannot be wished away, and the search for a cure should be viewed more deliberately as a national priority. Recent advances have set the stage for future progress. But creating safer, more effective, and useful drugs will not necessarily happen, or be sluggish, if we continue with the status quo. An Alzheimer’s acceleration fund could fix this.
Kevin Bardosh is a senior fellow at the Foundation for American Innovation in Washington who recently served as a senior science strategist in the Office of the Director, National Institutes of Health.