Due to the 99.6% failure rate of new Alzheimer’s drugs, scepticism is the default attitude in the media coverage of everything around the increasingly occurring disease. To tackle the inevitable reputation hurdles, communication professionals should take advantage from the fact that voices of authority within the pharma industry have regained credibility – the percentage of consumers who trust experts and academics has risen. In addition, expert commentary makes stories diffuse farther and deeper on social media. This means that a well-designed influencer campaign involving key opinion leaders would go a long way. Using our Influencer Network Analysis (INA) methodology, we found which experts and academics drive the Alzheimer’s discussion. We also used network maps to illustrate how the most central commentators and the most prominent organisations interconnect in the coverage.

The global Alzheimer’s drugs market was valued at around $3.64 billion last year and is expected to generate revenues of $5.66 billion by the end of 2024, with a compound annual growth rate of around 8% between 2018 and 2024. This is the conclusion of Zion Market Research’s latest report on the evolving financial nature of the fight against the leading cause of dementia.

The market is expanding proportionally to the increasing number of people over the age of 60 – it is estimated that they will be more than 2 billion by 2050, as life expectancy is predicted to exceed 80 years in most countries thanks to the advancements in healthcare. And while there has been some progress with age-related health problems such as heart diseases, Alzheimer’s is one of the areas where there is a pressing need of speedy developments.

In the US alone, someone is diagnosed with Alzheimer’s every 66 seconds, and this is expected to happen every 33 seconds by the middle of this century, according to the Alzheimer’s Association. The total cost of Alzheimer’s care in the country is projected to reach $1 trillion, while the disease remains the only one among the top 10 causes of death in the US that has no effective treatment available.

The increasing frequency of occurrence is the key driving factor behind the development of the global Alzheimer’s drug market, alongside strong encouragement by governments in the developed countries. But despite the favourable market conditions, just five drugs have been approved by the US Food and Drug Administration (FDA): four cholinesterase inhibitors and one N-methyl-d-aspartate (NMDA) receptor antagonist, called memantine. They all have supportive or palliative functions and are not actual cures or disease-modifying therapies, and don’t affect the aftermath of the disease.

Memantine was the last drug to enter the market 15 years ago. Since then, the news has been dominated by failed clinical trials – companies such as Merck, Biogen, Axovant and Prana Biotech have all announced defeats in the last three years. This year, Eli Lilly reported a phase III failure, and Pfizer stopped researching after trial troubles.

The search for new Alzheimer’s drugs is extremely strenuous due to the fact that Alzheimer’s is an asymptomatic condition in its early phase. Scientists are able to detect neurological symptoms when the illness has already inflicted irreparable damage to the brain. There are no reliable diagnoses of the early stages, which in turn results in a shortage of candidates for productive clinical trials. Alzheimer’s patients can’t be studied for a sufficient period of time for scientists to properly test new kinds of drugs.

The quest for a better way of detecting the first signs of Alzheimer’s is now a fierce competition. The rate at which people are diagnosed with Alzheimer’s is luring more and more pharma and biotech firms, although the high failure rate and the high costs of drug development often dash the hopes of investors.

Trust issues

In an environment where scepticism is the default attitude, introducing a new product is always a considerable challenge. Pharma as a whole has an ongoing trust problem – for instance, just 38% of Americans report that they trust pharma companies, down 13% from 2017, according to Edelman’s 2018 Trust Barometer. In the case of Alzheimer’s, the long-term lack of progress puts even more hurdles on the rocky road to consumer confidence.

In the search for solutions, we should turn to another finding of Edelman’s Trust Barometer: that every healthcare company must “activate the chorus” to tell its story because the voices of authority within the industry have regained credibility. The percentage of consumers who trust spokespeople has risen: the most credible voices of authority are technical experts (trusted by 63% of consumers) and academic experts (trusted by 61%). On the other end of the spectrum, the least credible sources are journalists, and government officials and regulators.

This means that a well-designed influencer campaign involving technical and academic experts would go a long way. Using our Influencer Network Analysis (INA) methodology, we analysed the most recent Alzheimer’s coverage to determine whose voices are the loudest. In this way, we managed to find out who are the key opinion leaders driving the discussion:

Lynn Kramer’s company Eisai, together with Biogen, developed a new drug treating mild Alzheimer’s dementia by targeting amyloid, a protein accumulating in the brain and forming plaques that can affect nerve cells. The 18-month clinical trials gave statistically significant results on key efficacy indicators. The reports about this success had a notably positive sentiment, with headlines such as “Experimental Alzheimer’s drug raises hope”, “Hopes for a drug to slow Alzheimer’s disease are rising again” and “Hope grows with new drug to combat Alzheimer’s disease”.

The palpable optimism in the reports, conveyed by the repeated use of the word “hope”, was intensified by Kramer, who was quoted in almost every article for saying: “This is the first late-stage, anti-amyloid antibody study to successfully achieve statistically significant results at 18 months, further validating the amyloid hypothesis.” The conjecture that the neurodegeneration in Alzheimer’s may be due to the deposition of amyloid was first proposed more than 25 years ago. Kramer’s emphasis on the validation of that hypothesis resonated in the media because of the implications for future research directions.

Speaking on behalf of Biogen, Sandrock said: “The prospect of being able to offer meaningful disease-modifying therapies to individuals suffering from this terrible disease is both exciting and humbling.” His quotes were also popular for their suggestions about potential new paths – he highlighted that “neurodegenerative diseases may not be as intractable as they once seemed”.

Fargo secured his presence in the coverage by commenting on the same topic. As a senior figure at the Alzheimer’s Association, his opinion on the new study was quoted quite often: “This was only a phase two trial, and it’s not going to be approved by the Food and Drug Administration until results from the next larger trial are in. Accelerated approval just means you go to the front instead of the back of the line.” The comments, slightly distant from Kramer’s and Sandrock’s optimism, were brought in for a sense of balance in the reportages. This was also achieved by adding Carrillo’s opinion – she said that she is “cautiously optimistic”.

With the new drug by Eisai and Biogen being one of the top trending stories in the Alzheimer’s debate, it’s worth noting how journalists try to include commentary not only by researchers but also by representatives of industry associations. As we can deduce from the numbers, the third-party commentators from professional alliances have a similar degree of media presence as the scientists behind the stories.

An active conversation

Dudley’s prominence in the coverage was also due to a scientific advancement: the suggestion that the herpes virus affects the behaviour of genes involved in Alzheimer’s. As a co-author of the study, which was often called “landmark”, Dudley said that he usually presents his findings under the title ‘I Went Looking for Drug Targets, and All I found Were These Lousy Viruses’. In addition, he shared his beliefs that the surprising findings could assist scientists in identifying virus biomarkers, which could eventually help diagnose the disease and assess a person’s risk.

Co-author and Alzheimer’s disease specialist Sam Gandy was more reserved: “While these findings do potentially open the door for new treatment options to explore in a disease where we’ve had hundreds of failed trials, they don’t change anything that we know about the risk and susceptibility of Alzheimer’s disease or our ability to treat it today.”

Speaking on behalf of the Alzheimer’s Association, Fargo said that more research will need to be done to prove that there is a connection between herpes viruses and Alzheimer’s, and added some positive thoughts: “However, if viruses or other infections are confirmed to have roles in Alzheimer’s, it may enable researchers to find new antiviral or immune therapies to treat or prevent the disease.”

The study was funded by the National Institute on Aging, whose director Richard J. Hodes commented: “This research reinforces the complexity of Alzheimer’s disease, creates opportunities to explore Alzheimer’s more thoroughly, and highlights the importance of sharing data freely and widely with the research community.”

Other reports dominating the coverage were about researchers at the Cleveland Clinic Lerner Research Institute being able to reverse signs of Alzheimer’s disease in mice by reducing the build-up of amyloid. This is how Riqiang Yan, the author of the study, got earned his media share. “To our knowledge, this is the first observation of such a dramatic reversal of amyloid deposition in any study of Alzheimer’s disease mouse models,” he said.

Another significant development was the proposition of a new framework for diagnosing Alzheimer’s via biological clues, rather than symptoms of memory loss. “By shifting the discussion to neuropathologic changes detected in biomarkers to define Alzheimer’s, as we look at symptoms and the range of influences on development of Alzheimer’s, I think we have a better shot at finding therapies, and sooner,” said Eliezer Masliah on behalf of the National Institute on Aging.

Meanwhile, Bill Gates has established himself as an influential figure outside the world of technology by announcing a $30 million investment into developing an Alzheimer’s disease diagnostic test. “Imagine a world where diagnosing Alzheimer’s disease is as simple as getting your blood tested during your annual physical,” he wrote in his popular blog, Gates Notes, and explained his investment rationale in a video:

This level of engagement by Microsoft’s founder increases the Alzheimer’s awareness among the public and other investors alike. This is welcomed at a time when many scientists complain that the research lags behind funding.

Connecting the dots

In order to illustrate how different influencers are interconnected in the coverage, we drew a cluster map with the help of our Influencer Network Analysis (INA) methodology, which employs natural language processing, entity extraction, free-text data mining and dynamic network mapping technology:

Alzheimer organisations

The size of each spokesperson’s circle denotes the prominence of their presence in the coverage, and the strength of their connections to others visualises the degree of association between different opinion leaders. For instance, the strong links between Dudley, Fargo and Gandy mean that they have often featured together in the same articles – take as an example this CNN report on the role of the Herpes virus in Alzheimer’s. Bill Gates’ strongest connection is with Leonard Lauder because they both invested in developing the Alzheimer’s disease diagnostic test.

As it can be seen on the map, the most vocal commentators were experts and academics, and they have strong connections to each other as they are mentioned in research reports together. They usually have links to corporate representatives when commenting on some findings – for instance, neurologist Stephen Salloway of Brown University gave his opinion on the Eisai/Biogen drug, and this constituted his relation to Kramer.

This chart outlines the roles of the most vocal opinion leaders:

The dominance of experts and academics is due to the fact that most articles are about scientific advancements, drug trials and new research programmes. The academics are also active as third-party commentators on new developments in the market. Meanwhile, market analysts rarely get quoted, because not many Alzheimer’s stories focus on the financial aspects of the disease – while mentioning costs and funding, the focal point of most articles is scientific progress, not prices of stocks. By getting so much media attention, academics and experts have positioned themselves as the primary power of influence in the Alzheimer’s debate.

On the other hand, companies are more prominent than universities and research centres – while academics are the winners among influencers, they don’t preside over a great deal of coverage about the work of individual corporates. The reports about the activities of specific firms are more than the articles taking a deeper dive into an issue by including expert commentary.

This could be noticed in our second cluster map, where the presence of firms is much more palpable:

We can see the prominence of Eisai and Biogen and the strong link between them, which is due to a large number of reports about their common success with the new drug. The presence of Pfizer, Eli Lilly, AstraZeneca and Merck is due to the many reports about them abandoning Alzheimer’s studies. In the meantime, AbbVie is on the map because of the announcements of its collaboration with Voyager aimed at developing new Alzheimer’s treatments. As we can notice, its presence is still not as strong, while Voyager is not yet on the map at all, but this is much likely to change when their collaboration starts to yield results.

Capitalising on influence

However, the articles without expert commentary are only quantitatively more. Deep diving into the coverage, we found out that the articles featuring influencers’ opinions are the ones top trending on social media. For instance, the Eisai/Biogen report which got the highest number of Facebook engagements (1.3K) and Twitter shares (233) was this piece on Forbes, which included comments by Gandy and by Lon Schneider, a doctor and Alzheimer’s researcher at the University of Southern California. The second most popular article on the same subject was on CNBC and featured the opinion of Carrillo, while the third was on Vox and was enriched with comments by Fargo and Ronald Petersen, director of the Mayo Clinic Alzheimer’s Disease Research Center.

The fact that such stories became top trending aligns with Edelman’s finding that the voices of authority within pharma has regained credibility: people are more likely to share what they find credible, so it’s no surprise that expert commentary makes stories diffuse farther and deeper. Leveraging social media in such a manner is incumbent on pharma companies – for more on that topic, take a look at our Social Media in Pharma blog post.

The inevitable conclusion from our case study is that if pharma players want to dip their toes into challenging markets like Alzheimer’s, they would need to draft an effective influencer-based marketing campaign.

When companies such and AbbVie and Voyager enter the field, they would have to consider the general cynicism engendered by the high failure rate. The public has already fallen into the habit of taking the news about new projects with a pinch of salt. Such levels of scepticism have to be overcome with a marketing strategy bolstering the confidence of consumers and enhancing the corporate image of firms.

Since commentary by experts and academics are what lends credibility to brands and ensures the deep diffusion of messages, an influencer-based PR strategy involving the most trusted commentators would secure a powerful media presence. And keeping an eagle eye on the opinion-makers and trend-setters via sophisticated analytics tools is a productive modus operandi when designing such campaigns.