The International Longevity Alliance (ILA) welcomes the WHO’s commitment to the concerted action on the Decade of Healthy Ageing and has taken part in the online consultations for Decade proposals which are open until 8 September 2019.

We certainly welcome the WHO’s vision of the world, where all people can live longer and healthier lives. However, the Zero draft does not sufficiently address "Strategic Objective 5: Improving measurement, monitoring and research on healthy ageing" of the WHO's Global strategy and action plan on ageing and health.

Regarding section 4.4 of the Zero draft for the Decade of Healthy Ageing from June 12, 2019 “Fostering research and innovation”, it should be significantly strengthened by the addition of biomedical and clinical research agenda items. In fact, a separate section should be developed on biomedical research and innovation on ageing.

The principal feature of ageing is the progressive increase of the risk of deterioration of health and the organism’s intrinsic capacity. Ageing is acknowledged by the WHO as a risk factor for diseases as evidenced by the the extension code XT9T “Ageing-related” into the International Classification of Diseases 11 in 2019. “Ageing-related” is defined as "caused by pathological processes which persistently lead to the loss of organism's adaptation and progress in older ages".

R&D in the areas of biological ageing and ageing-related disease is the major long-term strategy to improve health and the quality of life in older ages. Therefore, the work and cooperation in the area of biomedical and clinical research in ageing and ageing-related diseases by the WHO, the WHO parties, and non-governmental stakeholders’ should be explicitly stated as an agenda item for the Decade of Healthy Ageing. There is a consensus about the need to include R&D for healthy longevity as a part of the global WHO agenda (see, e.g. Stambler I, Jin K, Lederman S, Barzilai N, Olshansky SJ, Omokaro E, Barratt J, Anisimov VN, Rattan S, Yang S, Forster M, Byles J. Aging health and R&D for healthy longevity must be included into the WHO Work Program. Aging and Disease, 9(2), 331-333, 2018).

We propose the following changes in the Zero draft:

1. The first paragraph in the section “Longer lives” needs to include biomedical research and innovation among the reasons behind increased healthy life expectancy along with “better public health measures”.

2. The section “Longer and healthier life” should include a stronger emphasis on the extension of healthy lifespan, including by biomedical means. In particular:

2.1. The third paragraph in the section “Longer and healthier lives” needs to include biomedical research and innovation. Supportive environments come in addition, but preventive and curative biomedical solutions are of particularly great value in extending healthy lifespan.

2.2. The fourth paragraph in the section “Longer and healthier lives” needs to include biomedical research and innovation and the style of the writing should not undermine the importance of physical and mental capacity. Biomedical solutions should not be ignored, therefore an addendum to the fourth paragraph is proposed: "This ability is in part determined by the physical and mental capacity of the individual, and this can be markedly improved by biomedical developments. Functional ability can also be improved by physical and social environments. Biomedical developments should be the focus of political commitment and societal action alongside environments".

2.3. In the section “Longer and healthier lives”, particularly in the fifth paragraph, it should be stated that solutions to improve physical or mental health are preferred. This is true for both biomedical and environmental solutions and essential to favor better solutions for healthier lives.

3. Regarding Section 3.2 “Ensure person-centred integrated care for older people”, ILA proposes that quality medical care for older people should be accessible, but also oriented towards generating new medical knowledge for the benefit of older people.

4. Regarding the Section 4.4 “Fostering research and innovation”, a separate section should be developed in addition to the Section 4, “Partnering for change”. In this section, pathogenic processes of aging, biomarkers of aging, aging-ameliorating biomedical innovations, including new medicines, genetic and cell therapies should become the main focus. It is necessary to move away from disease-specific approaches while developing global long-term biomedical solutions.

5. The new section should make a strong emphasis on biomedical R&D should include the following elements:

5.1. The Decade agenda should include a stronger emphasis on improving acquisition, processing, and sharing of data about the aging population, its diseases and disabilities as well as effective evidence-based therapeutic interventions. Thus, medical record databases would ensure better properties of medical advice in terms of effective preventive measures. Ultimately, governments should support the development of AI-based medical information systems, including systems for both research literature and personal medical data analysis.

5.2. Clinical practice guidelines should be developed to prevent and treat not only aging-related diseases, but degenerative aging as a pathological process (i.e. clinical practice guidelines for systemic primary prevention of multimorbidity in middle and old ages). That would enable medical practitioners to prescribe aging-ameliorating evidence-based lifestyle interventions, supplements, medicines and other therapies, which would ultimately give universal access to these therapies.

5.3. It is essential to improve the evidence-based definitions of intrinsic capacity and functional ability to include measurable physiological, biological, and functional parameters evaluating the aging health and effectiveness of aging-ameliorating interventions.

5.4. To achieve such major advancements in healthy longevity, it is necessary to support large cohort and other studies of biomarkers of aging, which are needed to monitor and develop adequate health solutions. While there has been significant progress in this area, especially in frailty biomarkers, more effort is needed before a consensus on aging biomarkers is reached. Personalized analysis should be integrated into the biomarker systems to significantly contribute to health developments and ensure a more effective development of new therapies and other medical solutions in the near future.

6. Considering the tasks for the Member States, Secretariat (WHO and other UN system bodies), National and international partners, we propose the following:

6.1. Among the tasks for the Secretariat (WHO and other UN system bodies), the World Health Organization should form a special unit to ensure global coordination on biomedical research on aging. There should be a global project for biomedical research on aging under the aegis of the World Health Organization (perhaps, jointly by Aging and Life Course Department and Noncommunicable Disease division), much like the Human Genome Project. There should be an international working group to monitor and set global priorities for both fundamental and translational research on aging while providing governments with advice and guidance. The development of promising breakthrough therapies such as gene editing, stem cell use, senolytics or epigenetic-based therapies should be supported globally.

6.2. Considering the tasks for the Member States, national regulators should facilitate investment into aging-ameliorating therapeutical developments: i) healthcare systems should finance clinical developments and access to aging-ameliorating therapies; ii) retirement systems should consider investing their assets into such solutions; iii) care providers, people in community care, and those in retirement homes should be encouraged to become involved in clinical trials on aging-ameliorating interventions with good ethical profiles and high benefit/risk ratios.

6.3. Among the tasks for the national and international partners, we propose that the World Health Organization encourage the WHO parties to invest in biomedical research on aging in accordance with the UN Political Declaration on Noncommunicable Diseases and the UN Sustainable Development Goal 3.b. This could take the following forms:

more financial support for public investment, and financial support and tax benefits for companies developing new therapies in the areas of aging and longevity, including targeted support of aging-ameliorating clinical trials;

encouraging medical research institutions to organize and lead basic research and small and large clinical trials in the areas of aging and longevity, including therapies with high potential health benefits but expired patents;

including biomedical research on health and longevity in national research plans and programs;

not only high-income countries, but also low- and middle-income countries should be involved in multinational research projects and clinical trials to ensure genetic diversity, global R&D cost reduction, and expertise transfer.

7. Indicators of R&D in the area of healthy ageing and longevity need to be included as success measures.