Building an Innovation Community: Why Kristina Malzbender of Gates Ventures Joined StartUp Health’s Alzheimer’s Moonshot Impact Board
Kristina Malzbender, the Associate Director of Health and Life Sciences at Gates Ventures, joined StartUp Health’s Alzheimer's Moonshot Impact Board in 2024. We caught up with her to get her take on the state of innovation in brain health and to understand the kinds of collaborations she’ll be working to foster during her time on the Impact Board.
StartUp Health: Let’s start with getting to know you and the work you’ve been doing at Gates Ventures.
Kristina Malzbender: At Gates Ventures my focus areas are primarily around Alzheimer's disease biomarkers and diagnostics as well as clinical trials. A big chunk of my work has been working on the Diagnostic Accelerator (DxA) which is a fund that we established in partnership with the Alzheimer's Drug Discovery Foundation (ADDF). The DxA was set up in 2018 with the goal of funding companies and academic researchers developing novel biomarkers and diagnostics that are low cost and scalable. We’ve funded a lot of really amazing science and technologies but we've recognized a need for more support for these founders. That’s what led us to this partnership with StartUp Health.
StartUp Health: What was the genesis of your interest in Alzheimer’s disease?
Malzbender: Back in my consulting days I did a couple of projects looking at some of the big pipeline Alzheimer's drugs. Around the same time my grandfather was diagnosed with Alzheimer's disease and I watched my family become caregivers and navigate the healthcare system. This experience inspired me to focus my career on Alzheimer’s and neurodegeneration and I've since then doubled down and focused on this space. It's been so rewarding and I've learned a ton.
StartUp Health: Are there specific ways that your personal experience with your grandfather shaped your work today?
Malzbender: Absolutely. We always hear about how difficult it is for someone to get a diagnosis. Patients like my grandfather often end up going to their doctor and going through all of these cognitive tests and still end up with opaque diagnoses of cognitive impairment but no understanding of what's causing it or what can be done. This just reinforces the need for better biomarkers and better diagnostics.
StartUp Health: With your work at Gates Ventures and through the DxA you're getting this ecosystem view of what's coming next. What is getting you the most excited?
Malzbender: We’re at such a tipping point for the field as a whole, where we suddenly have a couple of drugs approved or are close to being approved. We have blood tests ready to hit prime time and more coming down the pipeline. We have a lot of really good digital cognitive assessments that are able to reduce the burden on providers and make the process of assessing cognition much smoother. Now we’re faced with the challenge of how do we actually get all of those advances into clinical care and implement them and get them reimbursed.
StartUp Health: Talk to us a bit more about those challenges and what you see as the unlock for taking this innovation from the lab to the market?
Malzbender: With some innovations, like blood tests, we’re waiting on FDA approval and broad accessibility. Some tests are available but not scalable enough. In terms of the digital cognitive assessments, one challenge has just been the lack of consensus about the tools, which each have different advantages. From a therapeutics standpoint, there are issues around accessibility and knowing which patients will be the best candidates for the new drugs.
StartUp Health: It wasn’t that long ago that early detection wasn’t seen as that helpful because we didn’t have much to offer in the way of treatment. Now we’re seeing advancements on both fronts. How do you see those two streams of innovation coming together?
Malzbender: I’m optimistic that we will see a flywheel effect because as we get more patients using these early detection tools because there are drugs available to treat them, there’s also going to be an off ramp for more of those patients to enter clinical trials. Right now clinical trial recruitment is really challenging. Approximately 99% of the people who could be eligible for an Alzheimer's clinical trial never get to take part in one. So there’s a big opportunity to accelerate R&D by more easily identifying the right patients for clinical trials.
StartUp Health: Your focus is more on diagnostics and biomarkers, but obviously you also have a heart, as we do, for the caregiver side of this equation. Your family has been there and experienced the challenges. Are you seeing any innovations on the caregiver side of the care continuum?
Malzbender: It's not straightforward and it is an under-addressed aspect of the field. We're making so many advances in terms of patient care but in some ways the caregivers have been left behind a little bit. For instance, many clinical trials require a care partner to participate in the trial, so the demands on the caregiver and on the family are really high. We need to think beyond the individual patient and look at the whole support ecosystem. On the positive side, there are a lot of organizations doing great work in that area, like Hilarity for Charity for example. They have some incredible respite and support programs and grants specifically for caregivers of individuals with Alzheimer's disease and dementia.
StartUp Health: Let's talk about the Alzheimer's Moonshot Impact Board. As you know, StartUp Health is about radical collaboration, and our cross-disciplinary impact board is part of that ethos. Where do you see opportunities for collaboration within Alzheimer's innovation?
Malzbender: Looking at the diagnostics and biomarker space there's really a huge opportunity to be unlocked by directly making the link between those two sides of the ecosystem. It will be really beneficial for both types of companies. The biomarker folks can benefit from getting involved in clinical trials for drugs and gathering more data and vice versa. For the companies developing drugs, if they have better biomarkers it is going to help them better identify the right patients for their trials and to assess earlier on whether these pipeline drugs are effective.
StartUp Health: If you could wave a magic wand and get two or three businesses around a table together to workshop a solution, who might you want to bring together?
Malzbender: I think if we can combine the efforts that are being made by these companies developing blood tests with companies developing digital cognitive assessments and companies developing novel therapeutics and get them together to think about some of these implementation challenges, that would be hugely impactful. All of these companies are trying to tackle how to get their own solution to market. We need to redefine the whole patient care workflow, so a lot can be done by having all of those folks work together towards implementation and access.
StartUp Health: What are you most excited about accomplishing through StartUp Health’s Alzheimer’s Moonshot Impact Board?
Malzbender: I want to help support these founders and the companies that are trying to tackle Alzheimer’s. I’ve seen just how challenging it is for them to fundraise and find product-market fit and identify their target customers and establish a go-to-market plan. I think building this community through the Alzheimer's Moonshot will help them round out how they actually bring those scientific advances out of the lab and then into the marketplace.
StartUp Health: When you’re assessing companies for the DxA, what are some of the intangibles that you look for in a founder that lets you know that this group has what it takes?
Malzbender: Two big things. One is focus on mission – they’ve got to be super clear on what they want to accomplish and how that fits into the patient journey. Two, they need to be adaptable and resilient. We need to know that when they face a challenge they're going to find a way around it or over it. This is an incredibly difficult field. Having that resilience and focus on mission will help companies be successful.
StartUp Health: Notably, you didn’t say they needed to have the smartest team or the most money. Can you speak more to that priority on mission and mindset?
Malzbender: If you can really clearly articulate your mission and you have that focus, you're going to be more successful fundraising and hiring the right team. I think other things will fall into place if you have that really clearly articulated mission and you keep a laser focus. Where we’ve seen some folks run into trouble is if they deviate from that mission or they pivot too much or too quickly and lose sight of where they originally started and where they’re headed.
StartUp Health: Is there anything you’d like readers to know about the health and life sciences group at Gates Ventures and the bigger picture of the work you do there?
Malzbender: As the private office of Bill Gates one thing we try to do is identify what are areas that are not necessarily being addressed effectively by other sectors of the funder community or of the research field generally. Where's the field being left behind and what are the gaps? That's part of the reason why diagnostics and biomarkers have been a focus for us, and has been the motivation for some work we’ve supported to enable things like data sharing and biosample discovery, for example.
StartUp Health: To close on a personal note, how do you want the world to be different five years from now for folks like your grandfather because of the work you’ve done at Gates Ventures and on this Moonshot?
Malzbender: The way I envision the patient journey in five years is that maybe someone initially notices that they have some cognitive issues or they're noticing memory decline. They can go to their doctor or even on their own, through their phone, get a digital cognitive assessment and in five minutes get a quick read on if there's any issues or not. They can bring that information to their primary care doctor and talk about their health holistically and then they can get an Alzheimer’s disease blood test ordered and reimbursed by their health insurance. Within a few days, that'll come back and give them a sense of whether or not their symptoms might be related to Alzheimer's disease. And if they are, they can get a prescription for a drug (that’s paid for by insurance) that will improve and extend the quality of their life, or the opportunity to participate in a clinical trial to help other patients in the future.
StartUp Health: Here’s to bringing that vision to reality. Thanks for your time, and your work on the Alzheimer’s Moonshot Impact Board.
Malzbender: Thank you!
Listen to the interview on StartUp Health NOW
Call for Alzheimer’s Innovation
With support from the Alzheimer’s Drug Discovery Foundation (ADDF) and Gates Ventures, we’ve launched a new global initiative created to develop a collaborative innovation community alongside leading companies, research teams, and stakeholders with a mission to accelerate progress in prevention, diagnosis, and management of Alzheimer’s disease and related dementias. Learn more and apply for an Alzheimer’s Moonshot Fellowship.
Become a Health Moonshot Champion
Health moonshots are fueled by passionate families, foundations, and industry organizations committed to achieving health moonshots. Learn how you can join other champions of the T1D Moonshot or one of our other global health moonshots.
Follow us on social media for daily updates on Health Transformers: Twitter, LinkedIn, Facebook, and Instagram.