#moonshot is a handy way to convey a seeming impossible challenge that requires disruptive, innovative thinking and the right mix of resources, talent and effort. The Biden Cancer Moonshot, a national effort to end cancer as we know it,readily comes to mind. Its goals are to prevent more than 4 million cancer deaths by 2047 and to improve the experience of people who are touched by cancer.
Cure asked four healthcare thought leaders recently about their moonshots and what drives them to pursue these goals. This conversation has been edited for length and clarity.
Laurie Glimcher, MD, President and CEO of Dana-Farber Cancer Institute:
"Preventive cancer vaccines. One of our faculty members has a therapeutic cancer vaccine for metastatic melanoma. It was designed for eight people who were at death's door. They hadn't responded to chemotherapy and were no longer responding to immunotherapy. She made an individualized vaccine from the tumor of each patient. Several years later, six of those eight patients are alive with very little melanoma. She has now made personalized vaccines for renal cancer, glioblastoma, ovarian cancer and pancreatic cancer. They are given in combination with immunotherapy and chemotherapy.
"But when I look at my small grandchildren, I think, 'Wouldn't it be fantastic if one day they could go to the pediatrician and get a vaccine that will prevent cancer?' I think it's doable. If it can be done for viruses, it can be done for cancer."
Gregory Petsko, DPhil, Professor of Neurology, Ann Romney Center for Neurologic Diseases, Brigham & Women's Hospital:
"Prevention of neurodegenerative diseases. When I was born, there were about 1.2 million people in the United States over the age of 80. There are now 15 million people over 80, and within the next 30 years, that number will grow to 35 million. About 40 percent of those will develop dementia. And the cost is astronomical. We spend about $200 billion right now on care for Alzheimer's patients. By the time we get to the middle of this century, about 15 to 20 million people will have dementia and the cost will be a trillion dollars. It's a tidal wave of astronomical proportions. And it's not just going to hit the United States — it's going to hit most of the world.
"Did you know that if you have Alzheimer's disease, your risk for nearly every cancer goes down significantly? The reverse is also true. That means there is something in one that is somehow preventive for the other. If we could develop a program to jointly look at the connection between those two diseases, we might find a preventive strategy."
Eric Fischer, PhD, cancer biologist, Dana-Farber Cancer Institute:
"We should eliminate the term 'undruggable.' We should not be thinking about something that we can't do. We need to have an atomic molecular understanding of biology. The composition of a cell is a very specific mix of proteins that changes all the time because proteins get damaged and newly made over the cycle of the day. Our body has this intrinsic ability to destroy every protein. If they get damaged, it destroys them. If you apply this ability to a therapeutic agent, we could virtually erase the term undruggable because you could help the body go after every protein. We could redirect the intrinsic system that the body already has to eradicate disease by targeting disease-causing proteins.
"We have tools at our disposal that we didn't have 10, 15, 20 years ago. We have small molecules, antibodies and gene therapies, and we're starting to understand how to use these different parts together."
Rick Bright, PhD, former Director of Biomedical Advanced R&D Authority (BARDA) and former CEO of the Rockefeller Foundation Pandemic Preparedness Institute:
"Better access to new treatments. People may be dying in a hospital or at home while a cure is sitting on a shelf, already approved. There's a huge gap between having a treatment and getting it to people. My moonshot would be a systemic way of breaking down old barriers to make sure that when we have a new technology developed and approved by the FDA, it is accessible and used on a hospital formulary immediately. Our systems are archaic and need to change, because patients are dying while they wait for an approved drug to get to them.
"I also think we need to keep the floodgates of innovation open. During the COVID pandemic, it was impressive to see collaboration among companies that were former competitors. Instead of taking 10 or 15 or 20 years to develop a vaccine, it took 10 months. But now we are regressing. I think if a pandemic were to hit us in the next year to five years, we would be worse off than we were going into the 2019 COVID pandemic because of exhaustion in our healthcare workforce and the mentality that we need to close the doors and shift our attention elsewhere. But we can reverse that so we are better prepared for the next pandemic."