There’s more to a long life than simply a long lifespan. The number of years we spend in good health, or healthspan, is key. With biotech spurring promising medical innovations, we look at how it can fit into investment portfolios.
August 27, 2025
Frédérique Carrier Managing Director, Head of Investment StrategyRBC Europe Limited
The quest for better health and enhanced quality of life has brought biotechnology to the forefront of health care as it drives innovative medical solutions. Our June 2024 article Longevity: Cracking the aging code noted that while we are optimistic about the development of cutting-edge methods to combat the effects of aging, one way to improve healthspans, or the number of healthy years before the end of life, is to tackle the diseases of old age.
As we continue to examine this theme, we survey the growing number of medical innovations that could revolutionize the battle against two major age-related challenges—cancer and Alzheimer’s—and explore how drugs designed for obesity may end up treating a much wider range of health issues, some of which become more prevalent with age. We also look at ways to position portfolios for the aging theme through biotech investments and beyond.
Cancer is the second-leading cause of death among the elderly. Recent scientific advancements have accelerated the development of cancer vaccines, which could make them an increasingly viable approach in cancer treatment.
The pie chart shows the leading causes of death for Canadians aged 85 and older in 2023. Diseases of the heart were the leading cause of death, accounting for 21.5% of total deaths, followed by cancer (15.5%), respiratory diseases (6.2%), strokes and aneurysms (5.4%), accidents (5.1%), COVID-19 (3.6%), and Alzheimer’s disease (2.9%).
Note: Leading causes of death among the elderly population are similar in most developed countries.
Source – RBC Wealth Management, Statistics Canada
Most traditional antiviral vaccines work by introducing small, specific components of an infectious organism—referred to as antigens—into the immune system. The aim is to induce an immune response and establish a “memory” so that future contact with a real pathogen is quickly addressed as the body easily recognizes an infectious agent as being foreign.
Cancer, however, represents a unique challenge, as it originates from a body’s own cells, making it difficult for the immune system to recognize the cancer as foreign. The realization some 20 years ago that many cancer cells are covered with unique antigens, known as “neoantigens,” was a breakthrough. Neoantigens are not typically found in the human body and usually arise through genetic mutations within cancer cells. Neoantigens hold promise for cancer therapy as they can be targeted by the immune system.
Cancer vaccines introduce neoantigens directly into the body, training the immune system to recognize them as foreign and target any cancer cells that carry them. In 2024, The Lancet, a medical journal, reported that a human trial had shown promising potential by using an mRNA, or messenger RNA, molecule to trigger the production of neoantigens that marked melanoma skin cancer for the immune system to attack. Three years after treatment in the trial, the risk of cancer recurrence or death fell by close to half, a promising result.
mRNA vaccines are best known as the technology used to change the course of the COVID-19 pandemic. Though it seemed to have appeared at that time out of nowhere, the technology has been researched for more than 40 years. The mRNA molecule carries genetic material including instructions for producing proteins in cells. These proteins can help train the immune system to recognize a virus as an invader, enabling the body to identify and attack it in the future.
Advances in mRNA technology have spearheaded the idea of personalized cancer vaccines tailored to a patient’s specific mutations. After a biopsy, the tumour is profiled, and mutations likely to generate proteins that can be recognized by the immune system are identified. An mRNA vaccine can then be developed that targets the neoantigens produced by these mutations.
Using artificial intelligence, which can predict the molecular markers most likely to stimulate the immune system into action, it’s been demonstrated that a vaccine can be produced in less than two months. In the KEYNOTE-942 trial, Moderna’s personalized mRNA vaccine was developed in just six weeks from biopsy to patient administration.
But if the process is quick, it is also very expensive, costing up to several hundred thousand dollars. Scientists are looking to develop off-the-shelf vaccines that can work in large populations by targeting common tumours. They are also exploring the potential use of cancer vaccines as an adjuvant—or booster—in combination with other immunotherapies.
Cancer vaccines are different from traditional vaccines as they aim to cure, rather than prevent, a disease. There are more than 600 ongoing clinical trials for cancer vaccines, according to ClinicalTrials.gov, a registry managed by the U.S. National Library of Medicine that tracks clinical trials conducted in more than 200 countries. These trials are targeting a wide range of cancers, including those found in the skin, ovaries, brain, and lungs.
Though much work remains to be done, cancer vaccines may well one day have progressed enough that they can lessen the reliance on more invasive treatments like chemotherapy and surgery for large numbers of patients.
By the age of 85, the probability of a person developing this devastating disease is currently one in three, according to the U.S. National Institute on Aging. A remorselessly neurodegenerative condition, Alzheimer’s leads to a gradual loss of memory and thinking skills. According to a study in The Lancet, the number of people with dementia, of which Alzheimer’s is the leading cause, is projected to rise from 57 million in 2019 to 153 million in 2050.
Progress in finding treatments has been slow, partly because the root cause of the disease has been difficult to identify.
Many scientists believe that Alzheimer’s is most likely caused by an abnormal buildup of beta-amyloid proteins in the brain, forming plaques that trigger the formation of tangled clumps of another protein, tau. What initiates this process remains unclear, but researchers believe these developments lead to neuron dysfunction and eventual death.
The graph depicts the numbers of individuals with Alzheimer’s worldwide, both males and females, from 1990 to 2019 and the projected numbers to 2050. The base-case scenario is shown accompanied by an optimistic and a pessimistic scenario. In 1990, there were some 14 million females with Alzheimer’s. The number increased to 33 million in 2019 and is expected to reach 98 million in 2050. In the optimistic scenario, only 78 million females would contract the disease in 2050, while in the pessimistic scenario as many as 121 million could be afflicted. As for the male population, in 1990, there were some 8 million with Alzheimer’s. The number swelled to 19 million in 2019 and is expected to reach 53 million in 2050. In the optimistic scenario, only 44 million males would contract the disease worldwide in 2050, though in the pessimistic scenario as many as 62 million could be afflicted.
Notes: Estimated trends in global all-age number of cases, with 95% uncertainty intervals, 2019–2050; the solid line is the predicted change in the number of cases over time, based on statistical modeling. The shaded areas around the solid line represent the 95% uncertainty interval, meaning there is a 95% probability that the true estimate of the trend in all-age number of cases lies in the shaded areas.
Study by the Global Burden of Disease (GBD) 2019 Dementia Forecasting Collaborators. GBD is a globally recognized research initiative led by the Institute for Health Metrics and Evaluation at the University of Washington. This study was funded by the Bill & Melinda Gates Foundation and Gates Ventures. It was corroborated by a July 2025 study in BMC Medicine, “Trend analysis and future predictions of global burden of Alzheimer’s disease and other dementias: a study based on the global burden of disease database from 1990 to 2021” (Hao & Chen).
Source – The Lancet, Public Health 2022
Scientists thus focused on targeting amyloid proteins and developed lecanemab and donanemab, two drugs approved by the U.S. Food and Drug Administration in 2023 for patients with mild cognitive impairment. These treatments are designed to artificially produce antibodies, or specialized blood proteins, to counter beta-amyloid proteins. The drugs work by flooding the bloodstream with antibodies that bind to the beta-amyloid plaques, prompting immune cells to clear them away. According to The Pharmaceutical Journal, the drugs have been shown to slow the progress of cognitive decline by up to 35 percent.
However, the therapies are not without limitations, and there are ongoing concerns regarding their effectiveness, practicality, and safety. Though they may slow the progression of Alzheimer’s, these drugs do not halt or reverse it, and they must be administered biweekly via intravenous infusion as they break down quickly in the body. The regimen also requires frequent MRI scans to monitor for serious side effects—such as brain swelling and bleeding. These drawbacks, as well as the high overall treatment cost, limit the accessibility of these drugs for widespread use.
Today, a growing number in the scientific community are contending that plaques and tangles are not the cause of Alzheimer’s but rather the body’s response to an underlying viral infection. This theory builds on the discovery that viruses can trigger neurological diseases, much like how the SARS‑CoV‑2 virus (the cause of COVID‑19) is linked to neurological symptoms and complications, or how the Epstein-Barr virus is linked to multiple sclerosis. If such a link can be established with certainty, then eliminating a virus through vaccination or antiviral drugs could offer a path to disease prevention or treatment. Clinical trials are ongoing to test the efficacy of antiviral drugs.
Scientists are also exploring a blood test designed to recognize traces of abnormal tangles of tau proteins up to two decades before Alzheimer’s symptoms appear. Poor diagnosis is currently a challenge, with less than five percent of patients in the UK receiving an accurate Alzheimer’s diagnosis through PET scans or lumbar punctures, according to Alzheimer’s Research UK. Early diagnosis is crucial for accessing appropriate care and enabling the use of current and future treatments.
While current treatments for Alzheimer’s may offer limited comfort to those already afflicted with the disease, they are an important step forward. Like many first-generation therapies, they lay the foundation for future innovations, raising hope that, in time, the burden of the disease may be eased for the next generation.
Originally developed for type 2 diabetes, glucagon-like peptide 1, or GLP‑1, drugs gained widespread recognition in 2021 for their effectiveness in treating obesity. Obesity remains a major public health challenge in most of the Western world. In the U.S., over 39 percent of adults are considered obese and suffer from various related conditions including heart disease, diabetes, and certain cancers, per data from the Centers for Disease Control and Prevention.
GLP‑1 drugs are synthetic versions of a natural gut hormone that helps control the levels of sugar in the blood by triggering insulin release and slowing digestion. They are receptor agonist medications, meaning they trigger a physiological response when they bind to a receptor.
Beyond diabetes and obesity, GLP‑1 drugs are being studied as potential treatments for an unprecedently wide range of other medical conditions that goes far beyond pharma companies’ usual search for new markets for their drugs.
In fact, in March 2024, semaglutide, a GLP‑1 drug sold as Ozempic for diabetes and Wegovy for weight loss, was approved in the U.S. for cardiovascular disease in overweight patients. How can a drug that was originally developed for diabetes help treat heart disease? Because it interacts with GLP‑1 receptors found on blood vessels and heart cells, potentially reducing the risk of strokes and heart attacks. These cardiovascular benefits seem to be independent of weight loss.
Trials are also ongoing to assess whether GLP‑1 drugs could be used to treat chronic kidney and liver disease, delay the onset of neurodegenerative diseases such as Alzheimer’s and Parkinson’s, treat substance abuse and addictions, and combat conditions characterized by inflammation such as atherosclerosis.
One reason for optimism is that GLP‑1 drugs seem to support cellular health. When cells with GLP‑1 receptors become damaged or dysfunctional, treatment with GLP‑1 drugs seems to help them recover. These drugs may thus be able to reduce inflammation throughout the body, and since inflammation is thought to be a key trigger of many diseases, the potential benefits of GLP‑1 drugs could extend beyond current uses.
Optimism needs to be tempered as challenging hurdles remain—just because a drug shows potential in treating a condition does not mean it will become an approved treatment. Moreover, it may turn out to not be as effective as existing medications on the market, or the price of the drug could limit its uptake.
GLP‑1 drugs are expensive—some have out-of-pocket costs reaching $16,000 per year in the U.S.—though prices vary internationally. Innovation could help reduce the cost of these drugs, such as developing a pill version to replace current injectables—a breakthrough that many researchers in the field think may be possible within the next two years. Additionally, patent expirations outside the West in less than a decade should encourage the production of more affordable generic versions.
Another medical innovation worth mentioning, CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats) gene editing, also appears to hold great promise. CRISPR is a tool that enables scientists to precisely edit DNA, much like cutting and pasting text in a document. It can repair faulty genes and treat diseases by making targeted changes to the genetic code. The first CRISPR gene editing treatment for sickle cell disease, a genetic disorder, was approved in the U.S. in 2023. The technology could potentially be used to develop cures for a wide range of conditions from cancer to high cholesterol. For cancer, the treatment would involve removing immune cells from a patient, editing them to enable the cells to attack the disease more powerfully, and then reintroducing them into the body.
Biotech is the obvious sector through which to invest in the theme of combatting aging. Biotech companies are often perceived by investors as the research pipeline of Big Pharma. With ample cash on their balance sheets and over $350 billion in annual pharmaceutical sales at risk over the next decade due to patent expirations, RBC Capital Markets expects pharmaceutical companies’ merger and acquisition (M&A) activity to pick up, bolstered by a more permissive Federal Trade Commission in the U.S.
The Trump administration’s unconventional choice of Robert F. Kennedy Jr. as Secretary of Health and Human Services raises some uncertainties for the biotech industry. Despite these, RBC Capital Markets analysts perceive the industry’s fundamentals, including robust pricing power, as positive. They also think commercial-stage companies that are undervalued and potential M&A targets, or those with underappreciated upside catalysts, look like the most interesting opportunities.
Medtech is another industry with a focus on developing innovative medical solutions to address age-related health issues. Innovations in patient treatments and delivery methods are being driven by increased demand from an aging population. Many growth areas remain underpenetrated with significant market share up for grabs, in RBC Capital Markets’ view. For example, innovations in robotic surgery are making treatments safer and minimally invasive, with faster patient recovery times. The market share of surgical robotics is currently low from a global perspective, but it is not inconceivable that robot-assisted surgeries will become the norm within 10 to 15 years, according to Nature Medicine.
Other industries may also experience shifts in demand as the population ages and play into the theme as well:
Insurance and wealth management companies may well find they have an attentive audience as individuals will need to consider how not to outlive their savings.
Homebuilders in various geographies may experience changing demand for residential space. Housing demand to accommodate multi-generational households may rise in some regions, while others may see growing demand for single-occupancy homes.
Select Industrials may harness their ingenuity to develop innovations designed to help the elderly. For instance, Japanese engineers have developed a floor firm enough for use by wheelchairs that also has shock-absorbing properties. As a result, the fall impact is reduced by half versus a conventional floor, according to the manufacturer. The innovative floor is currently being used in a growing number of medical institutions and nursing homes in Japan to help prevent fractures caused by falls—the leading cause of death among the elderly.
The prospects for positive healthspan outcomes appear more promising today than 20 years ago, driven by a surge in innovation from biotech and medtech companies. At the same time, industrial sectors such as homebuilders are developing solutions to make the later stages of life more comfortable and secure. We believe these sectors present compelling long-term opportunities for investors as the aged population grows.
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