Table of Contents
Summary
Economic inactivity in Britain is at its highest level since records began, driven by an increase in long-term sickness. This constrains economic growth, with an estimated annual cost to the economy of £43 billion.
Many individuals with long-term sickness have multiple health conditions, referred to as ‘multimorbidity’, which is primarily driven by ageing. As Britain's population ages further, our multimorbidity problem will worsen.
Ageing biology research could complement public health measures aiming to delay multimorbidity and extend “healthspan” (the time people spend living in good health), reducing economic inactivity and long-term healthcare costs. Benefits would be largest in the most deprived areas, where healthspan is lowest.
Ageing research has only recently become established as a mainstream scientific field, but is held back by weak consensus on theoretical issues. This limits investment from established pharmaceutical firms and leaves consumers vulnerable to misleading advertising.
Building on Cambridge’s unique strengths in ageing research, the government should support the development of new ageing research labs as part of a Public Sector Research Institute at Babraham Research Campus. This will promote collaboration, coordination and consensus building, strengthen theoretical foundations and crowd-in additional private sector R&D investment.
In the long term, this will support the development of interventions which reduce multimorbidity and long-term sickness, boosting economic activity and growth, with the greatest benefits felt in the most deprived areas of the country.
The Challenge
Economic inactivity in Britain is at its highest level since 2012, with 2.8 million people in the working age population inactive due to long-term sickness. This presents a significant constraint on economic growth, with an estimated annual cost to Britain of £43 billion — roughly 25% of the entire NHS’s annual budget.
Many individuals with long-term sickness suffer from multiple health conditions, a phenomenon known as ‘multimorbidity’. Amongst those aged 50-64 with long term sickness, a majority report three or more separate health conditions. As Britain’s population continues to age, multimorbidity will become even more common – the Health Foundation estimates that due to ageing, the number of adults with “major illness” (an umbrella term which includes both multimorbidity and severe individual illnesses) will rise from 6.6 million in 2019 to 9.3 million in 2040.
Multimorbidity makes treatment for each condition more difficult and expensive, and leads to more frequent hospital admissions. Britain’s Chief Medical Officer, Professor Chris Whitty, has suggested "cluster medicine" as a solution. In cluster medicine, an underlying risk factor associated with a ‘cluster’ of diseases is addressed to delay or prevent the onset of those diseases. Ageing is a key risk factor driving multimorbidity, increasing the risk of diseases including musculoskeletal conditions, depression, cancer, heart disease and Alzheimer's.
Despite the government identifying "addressing the underlying biology of ageing" as one of its missions in its 2021 Life Sciences Vision, progress in the academic field of ageing research has been poor. The theoretical foundations of the field remain weak, with widespread disagreement over which theories offer the best explanation for the causes of ageing.
The best approach to tackling biological ageing is also uncertain. While some researchers focus on preventing ageing-induced damage in the first place, others focus on repairing the damage after it occurs (also known as rejuvenation). A lack of clarity on the best biomarkers to compare different approaches makes it harder to identify the most promising solutions.
Weak theoretical foundations leave the field particularly prone to hype and exaggeration. Concerns have been raised about rigour and transparency in ageing research, alongside concerns that “immortality merchants” are misleading consumers and exploiting vulnerable individuals. For example, in 2016, a terminally ill 14-year-old girl paid £37,000 to be cryogenically frozen. This proved controversial, since cryogenics is a speculative approach to life extension with disputed plausibility.
While start-ups working on ageing have drawn investment from venture capitalists, established pharmaceutical firms with experience in taking drugs from the lab to the clinic are yet to significantly invest in the area. Stronger foundations for the field could help crowd-in additional investment from these firms, whilst helping venture capitalists to make better-informed investment decisions.
As an emerging field, ageing research offers few opportunities for junior researchers, with a limited number of research groups in Britain focussed on this area. The sparse distribution of these labs and the lack of a “national ageing institute” with a coordinating function hinders collaboration and consensus-building, contributing to weak theoretical foundations. This type of fundamental, consensus-building research is a public good which private firms will underprovide, so government intervention is needed.
The Opportunity
Cambridge has unique strengths in ageing research and is home to more ageing research startups than any other British city, including:
Shift Bioscience and clock.bio based at Cambridge Biomedical Campus, the largest medical research centre in Europe.
SENISCA, Five Alarm Bio and LinkGevity based at Babraham Research Campus, five miles south of Cambridge.
Babraham Research Campus is also home to the Babraham Institute, a “Public Sector Research Establishment” (PSRE) primarily funded by the Biotechnology and Biological Sciences Research Council (BBSRC) under UK Research and Innovation. The Babraham Institute has over time shifted its focus towards ageing, but its research program is narrow and restricted to three areas within the field: epigenetics, immunology and signalling.
The House of Lords Science and Technology Committee’s report on ageing recommended that public research funders give greater priority to ageing research, and their enquiry highlighted the need for a national institute to better coordinate ageing research in Britain. The Nurse Review of the innovation landscape in 2023 recommended greater clarity on the focus areas and functions of existing PSREs, alongside the creation of new PSREs where appropriate, and the new government has committed to planning reform to build new lab spaces. These commitments should be leveraged towards building on or nearby the Babraham Research Campus, with new lab spaces dedicated to public-funded ageing research.
Research at these new labs should complement the Babraham Institute’s existing focus areas, extending across disciplines including genomics, neurodegeneration and epidemiology. Consultation with the Babraham Institute should explore whether these lab spaces should become part of the existing institute, or form a new sister PSRE with an explicit ageing focus.
While attracting more researchers into the field, the physical proximity of a large number of ageing researchers would encourage collaboration and consensus-building, strengthening the theoretical foundations of ageing research. This would also enable Britain to finally establish a “national ageing institute” able to rival the Buck Institute for Research on Ageing in the USA, while playing a vital “coordinating” function for ageing research in Britain. This could build on the Babraham Institute’s existing work in coordinating proteostasis research.
Strengthening the foundations of the ageing field in this way would:
Help scientists understand the causes of ageing to inform research into interventions.
Clarify the validity of more speculative approaches to ageing research, such as “Strategies to Engineer Negligible Senescence” (SENS) and cryogenics.
Crowd-in additional private R&D investment from established pharmaceutical firms by reducing technical risk for the development of ageing therapeutics.
Support scientists, consumers and investors in scrutinising claims by “immortality merchants”.
As with most public health interventions, the benefits from advances in ageing research will be felt most strongly in deprived areas, where baseline healthspan tends to be lower.
Plan of Action
In preparation for the passing of the proposed Planning and Infrastructure Bill, the Minister of State for Science, Research and Innovation should begin discussions with the BBSRC, the Babraham Institute and the Babraham Research Campus regarding the development of new lab spaces earmarked for academic groups conducting publicly funded ageing research.
Together, these stakeholders should make decisions on:
Whether new labs can be built on the Babraham Research Campus, or would need to be built elsewhere in Cambridge.
Whether these new labs should be part of the Babraham Institute or become a new sister PSRE.
Budget
If a new sister PSRE is formed, consultation between DSIT, the BBSRC and the Medical Research Council should be used to determine which body provides these labs with core funding. The budget required would depend on the size of the new PSRE, but as an example, the Babraham Institute currently receives its core funding from the BBSRC, with £48 million of investment spread over 2024-28. A similar amount spread over 4 year cycles (£12 million per year) may be appropriate for ongoing funding for a new PSRE. One-off construction costs would be close to £50 million. Any further income can be generated by winning research funding grants from the public and philanthropic sectors.
Table 1: Estimated budget for the first four years of operation, excluding further income from grants and philanthropic contributions
By strengthening collaboration and consensus building within the field, while also playing a “coordinating” function for ageing research nationally, a dedicated ageing institute will ensure that Britain drives progress to deliver ageing therapeutics. These therapeutics will complement traditional public health interventions and extend healthspan across the country, tackling economic inactivity due to long-term sickness and boosting economic growth. The boost to growth will likely be greatest in the most deprived areas, where healthspan is lowest.
FAQ
What is the current state of the theoretical foundations of ageing research?
The underlying mechanism by which biological ageing occurs remains unclear. Existing theories can be loosely categorised into ‘damage theories’, which argue that biological ageing is caused by the accumulation of damage over time, and 'program theories', which argue that biological ageing is programmed into our genes, but emerging evidence continues to challenge existing ideas. A famous paper discusses the “hallmarks of ageing”, but the extent to which these hallmarks cause or are caused by ageing remains unclear.
Ageing researchers lack consensus on the best approach to extending healthspan. Approaches range from preventing or delaying ageing-induced damage in the first place (geroprotection), to letting the damage happen and repairing it afterwards (rejuvenation). Comparing different approaches requires scientists to evaluate their impact on ageing, measured using biomarkers known as “biological ageing clocks”, but there is no consensus on which ageing clock is most suitable. This was highlighted as a key problem by the House of Lords Science and Technology Committee’s report on ageing. There is also no consensus on the best measure of healthspan.
Why Cambridge?
In addition to the Babraham Institute, Cambridge is home to more ageing startups than any other British city, including Altos Labs, Shift Bioscience, clock.bio, SENISCA, Five Alarm Bio and LinkGevity. The University of Cambridge and the Babraham Institute are also affiliated with the Medical Research Council’s new “Ageing Cluster”, and Cambridge is also home to Cambridge Biomedical Campus, Europe’s largest medical research centre.
While long constrained by planning laws, upcoming reforms present an opportunity to rapidly expand lab space in Cambridge and more cost-effectively cement a clear geographical home for Britain’s ageing research sector.
Why can’t we leave it to the private sector?
While multiple startups are working on ageing, the field is still in its early stages. Weak theoretical foundations mean that established pharmaceutical firms such as AstraZeneca, GlaxoSmithKline and Pfizer are yet to make significant investments in the area. As the field is still small, many scientists are now associated with private startups, which impedes collaboration.
Early-stage, field-building research is a public good. Individual firms would be unable to internalise most of the value of this type of research, so are unlikely to support it. The government is best placed to establish an ageing research cluster, support academic collaborations and strengthen the theoretical foundations of the field. This will crowd-in private sector R&D investment by reducing technical risk for pharmaceutical firms.
What are other governments doing in this area?
Motivated by the need to improve public health in Saudi Arabia, in 2021 the Saudi Arabian government launched the Hevolution Foundation, a non-profit providing funding for early-stage ageing research.
In 2022, Singapore established the Centre for Healthy Longevity as a dedicated national institute integrating pre-clinical and clinical research on ageing biology.
UK government involvement could help guide the field towards the development of scalable, affordable interventions, rather than highly expensive interventions which may not meet the National Institute for Health and Care Excellence’s willingness-to-pay threshold. These interventions could play a similar role to antihypertensives and statins, where they are widely prescribed to delay multiple diseases, and improve rather than worsen health equality.
What additional areas within ageing could these new labs focus on?
While the Babraham Institute is focused on epigenetics, immunology and signalling, many other subfields within ageing exist. In addition to these fields, the Buck Institute for Research on Ageing in the USA also focuses on ageing’s intersections with stem cell research, cellular senescence and inflammation, neurodegeneration, female reproductive longevity, bioenergetics and cancer. Ageing research groups elsewhere in Britain also focus on genomics and epidemiology. Collaboration by researchers working in close proximity across different areas could strengthen the theoretical foundations of ageing research.
Sanjush Dalmia is the Science Policy Lead at UK Day One. Previously, he was a Policy Advisor to the Shadow Minister for Science, Research and Innovation. He holds a masters degree in medical research which focused on ageing, and has interned at the Babraham Institute. He is in the process of completing his medical training, and has spent the last two years witnessing the impacts of ageing and multimorbidity on NHS wards across West Yorkshire, including on an elderly medicine ward.
Tina Woods is Founder and CEO of Collider Health and Business for Health. She is the Healthy Longevity Champion for the National Innovation Centre for Ageing, co-leading the Quantum Healthy Longevity Innovation Mission and City of Longevity programme. Tina sits on various advisory groups, including the XPRIZE Global Visioneering Brain Trust, Strategic Advisory Board for the BBSRC Bioscience for an Integrated Understanding of Health and BSI standards group for AI in health and care. She is also a trustee for the British Society for Research on Ageing.