Health Care Sector Update and Outlook

TRANSCRIPT

Health Care Sector Update and Outlook

Teresa McRoberts and C.J. Sylvester recently provided valuable insights into innovation in Covid-19 therapies and immunization, and they discussed the impact the upcoming U.S. presidential election may have on the health care industry. The call was hosted by Dennis Hearns, a senior vice president and divisional manager in our distribution organization.

TERESA MCROBERTS Senior Vice President Senior Analyst Portfolio Manager

Please note, this transcript is from a call on June 24, 2020 and it has been edited for clarity and brevity.

Dennis Hearns: Welcome to our call. My name is Dennis Hearns and I'll be your host this morning. I'm joined today by Teresa McRoberts, who is a 35-year veteran of health care investing. She's a senior vice president, senior analyst, portfolio manager of the Alger Health Sciences strategy and head of the firm's health care sector team. We are also joined by CJ Sylvester, who is vice president and analyst covering biotech and pharmaceuticals. In other words, he covers those companies making drugs and vaccines. He has over 23 years of investment experience in the health care sector. For those of you keeping score at home, it's been just over 15 weeks since we started to shelter from home and it's been just over 10 weeks since we heard from Teresa last. And so while 10 weeks is not really a reasonable investment time horizon, it seems like a lifetime from a work from home standpoint, with regular news flashes about the virus and the level and direction of infection and the potential remedies and cures. So, Teresa, can you tell us about what the health care industry has learned about the virus over these past 10 weeks? Teresa McRoberts: Well, I can't tell you everything because that would be a multi-hour call, but I think we've learned a lot of things. One of the things we've learned is a lot of the initial assumptions people made— this is a virus; we've seen other viruses like this; we know how to deal with it; we know what to do when people appear in a hospital with certain symptoms—were not always true and not necessarily the right thing to do. I think that there's been a lot of learning, unbelievably rapid learning in the health care system. If you look at the very unfortunate death rates in the New York Metro area, how high they were, other cities may see a fraction of that because they benefited from a lot of the learnings from what doctors learned in the New York area about how to treat patients, what regimens of drugs, and we have had the initial authorization for remdesivir that's been widely used. But I think people have learned an immense amount.

CJ SYLVESTER Vice President Analyst

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Teresa McRoberts (continued): There is a lot to learn still. We've also made tremendous progress on vaccines and therapies and I'll let CJ talk about that. And I think we've learned a lot about who's at risk. I know right now there is a concern about a second wave. I think there's a lot of speculation that for political reasons, there may be a vaccine approved before the election. And you certainly hear Dr. Fauci say things like by the end of the year, there will be no vaccine. So we've made a lot of progress. I'm not sure that they're going to be ready for prime time by then, but I think everybody's really, really trying, and then I’ll let CJ talk for a few minutes about vaccines and therapeutics. CJ Sylvester: I think to Teresa's point it's been rapid progress and although we still don't know a lot about the COVID virus and how to deal with it, the knowledge base of how to generate vaccines or prophylactic antibodies has progressed pretty rapidly. We are on a world record pace for developing probably three or four different vaccines against COVID. I know the timelines these companies have put out is for this summer or in the early fall. That's possible that we'll have data on initial efficacy of these vaccines, but it will take multi thousand patient studies to understand how safe these drugs are, or these vaccines are, and also to understand in an ongoing pandemic how effective they are. protracted than what a lot of the political authorities would like. I do think we may have initial data in the fall. But in terms of supplying billions of doses of a safe vaccine, I think we're probably at least a year away from that. And so I think that kind of frames the way we view the world from an investment standpoint. In the near term, I do think that there are what are called prophylactic antibodies that are being developed by a handful of companies. Those could be administered to frontline health care workers, people that are at high risk of being exposed to COVID. remains to be seen. But again, those prophylactic antibodies are something that you have to get every month. It's not like a vaccine where you could be protected for a year or two years. These prophylactic antibodies would be injections that you'd have to get every single month. And so the capacity there is nowhere near where it would need to be to get us back I think that there will definitely be vaccines. I'm confident that the timeline is probably something a little bit more Those should help keep people from getting severe disease, whether or not they help people recover faster,

to some sort of normalcy in the normal economy.

Dennis Hearns: Teresa, you mentioned the second wave. Now, with most states in some sort of reopening phase, we're starting to see an uptick in infections. Are you concerned about a second wave and the potential to shut down the economy again? Teresa McRoberts: I think I, like everyone, is worried about the second wave. I do think that some of the areas where we're seeing very significant, like in Texas, they didn't really have a first wave. So for them it's kind of a first wave, but I think it's a broader question. Am I concerned about widespread spread of the virus? I am. Clearly there seems to be and it's hard to parse out how much of this came from the reopening and the sort of relief that people saw. They felt that they were allowed to go out and behave normally because I think most people want to behave one way. And at the same time, we had significant amount of protests about social injustice. One of the areas that we keep hearing where hospitals are the hardest hit is the city of Houston, also an area where George Floyd grew up, and so the protests about social injustice and racial injustice were actually very, very large in Houston. It’s a little hard to say that shutting down the economy is necessarily the right thing, unless we're going to ban all those protests, which everyone seems to decide that isn't the case. And I think in general, even in states that are hit very hard and that shut down rapidly, they don't seem to want to go back to the shutdown. They really want to slow the reopenings. Where I am in Florida, they just put in a requirement that you need masks now. I know already up in the New York area, people are now wearing masks. So, I don't think in general people think that shutting down the economy is necessarily the right thing to do, except for possibly very significant hotspots and very controlled areas. Certainly shutting down an entire state because of what's going on in one city is not necessarily the right thing to do. I think people are still trying to figure this out. As you know, we had a lot of excitement in the market; airline stocks and hotels and cruise lines all went up on hopes that we were going to get a smooth reopening and then the cases started picking up. And now the market is having jitters about the whole reopening trade again.

Conference Call 2/8

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Teresa McRoberts (continued): I do think it's something that has to be watched and we have to try to figure out how to address it. But I keep coming back to the good news of this is while infections are trending up, hospitalizations thus far are manageable. Death rates seem to be lower than they were in the New York Metro area. A good thing. If the health care system starts getting overwhelmed, that's where we run into an issue and that's one of the things that's troubling the markets today, specifically there's a lot of concern that certain geographic areas may ban elective procedures again or not let them happen. And some of these hospitals just have been open for a few weeks or a little bit over a month. So that’s an area of concern. Again, I don't know, we'll have to see if, again, the infections curtail or not. And I don't know if you have any other thoughts on that, CJ. impacted by the flu season. And we do have some early reads right now because in the southern hemisphere it's the winter, and it doesn't appear at least initially that there is a huge surge in flu illness. And so I think we'll have to keep a close eye on what's going on with the southern hemisphere. It may give us a better feel as to what could happen in the fall and winter in the United States. If flu is kind of taking a backseat to COVID for whatever reason, that could dramatically change the burden on the health care system. Teresa McRoberts: And less than half the people in the U.S. get a flu shot, even though they're widely available. They may rethink that decision not to get a flu shot. And we may see more people get a flu shot, which while not 100% effective against the flu in any year, I don't think we have an idea yet of how effective this flu vaccine is. It's certainly better than not getting one. So that may also help by keeping it down. But I think we're just going to have to watch and wait and see how maybe somebody has. New York just reopened. We'll see if in a month New York has a spike in cases; that'll tell us a lot. Dennis Hearns: Yeah. Well, early on in the pandemic, there seemed to be a real issue with the supply chain of medical supplies. Has the U.S. medical supply industry sufficiently pivoted to address the need by now, or are we still highly dependent on foreign suppliers? CJ Sylvester: I do think one of the fears that needs to be dealt with is whether or not the COVID second wave, ongoing infections, call it what you want, will be

Teresa McRoberts: We are still highly dependent on foreign suppliers. It's going to be a long time before there can be, if ever, a total U.S. solution. One of the reasons we're dependent on foreign suppliers is those products are made much more cheaply outside the U.S. I'll also say that most of the personal protective equipment, et cetera, medical grade stuff always has a higher standard in terms of manufacturing and something that–a mask for somebody who works at a construction site, even though it is a mask, it's not medical grade and that extra medical grade quality costs more. So that's part of the reason we are dependent upon outside suppliers. With the bills in Congress to try to bring all this stuff back, that's not an easy thing to do. So yes, we still need the foreign suppliers and I think it would be some years before we could supply all our needs, especially if they're as expensive as they were in the first wave in the New York City area where people use multiple masks and gowns and needed them in a day. Dennis Hearns: On our last call, you talked quite a bit about innovation within the health care sector being a major theme. Two questions come to mind. First, is innovation outside of the coronavirus suffering as a result of the race to a vaccine? And second, have companies in general increased their R&D spending or cut it in some fashion? reallocated resources. They have pushed some other things aside. It's not like you had a bunch of bench scientists sitting around twiddling their thumbs. You obviously had to pull them off of something else to ask, to have them work on Coronavirus. Most people have been very happy to do this. It's a very sort of personal thing for a lot of people. So yeah, there's definitely been shifting. Presumably they, those people were reallocated to something that was deemed to be less important. And the other thing on the regulatory side, certainly the FDA has also shifted their resources. They've put out a huge amount of emergency use authorizations, all of which required their time and attention to get these products approved within days. Teresa McRoberts: So for people who have expertise or want to try to help with the Coronavirus and their expertise allows them to be helpful, there's just

Conference Call 3/8

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Teresa McRoberts (continued): The FDA has also reallocated resources, shifted people off of certain things, but the FDA has also tried to make sure that lifesaving therapies for cancer, gene therapies and other things have continued to be approved. And in fact, they have continued to improve things in general on time that were most of the way through the approval process. So that's a positive. Certainly companies' budgets were set, for this year, were set at some point right last year or even in the fall of last year. So they haven’t really cut their budgets, but they might not use them. In some cases, if somebody is working on something that’s thought to be deemed a central product, they haven't been allowed on their labs to work on things. Still they're receiving their paycheck though, so it's hard to say. People are not saying I'm going to stop doing R&D, but clearly, they haven't even been just logistically allowed in some cases. Also one of the things that happened during the Clinton health care reform era, which was a while ago, companies did cut R&D budgets because they were afraid they couldn't launch their products with the freedom as they wished to. And they paid the price for that a decade later. And they all learned their lesson that when you cut early stage R&D, you pay for it later, and it can be very painful. So I don't see companies using this as a reason to cut R&D, but I was just surprised that sometimes they actually can't physically do the R&D until their facilities are open up and people are allowed back in. There's also a tremendous amount of early stage money still from the venture capital people and from investors continuing to support IPOs. So there's a lot of interest in continuing to support innovative science. Absolutely no time to slow down in that area. Dennis Hearns: Okay. So here comes the tough question. In your view, is there a specific industry or industry group within the health care sector that offers the best investment opportunity as we evolve through this period of global pandemic? Teresa McRoberts: I would say that there's not a specific industry. Health care is very stock-specific and it's partly because people are working on difficult medical issues. And so one of the things that you see if you're working on a cancer product and you have a

huge breakthrough, you and maybe a few other people are working on similar products get the benefit, but not the whole sector. So it's very idiosyncratic. And that's how I've always invested in health care; is the individual stock worth investing in? And so one of the ways that I have focused in this, is that I'm still not sure when they're going to open up, when health care is going to go back to being normal, even when R&D would go back to being normal. So I have tended to focus on areas of innovation. Some of the areas that we've talked about in the past, like diabetes, something that affects a large chunk of the population, it's still a very attractive area. Sadly diabetics are among the most at-risk patients for COVID. If anything, the virus is for those people to get themselves under control, even more importantly. I think the pandemic is going to change the way people think, something like telemedicine doing virtual health care visits. I think that is going to be a change that is going to be permanent just like we all do Zoom or Zoom-like videos now instead of physical meetings. I think that we're not going back to 100% physical meetings for a long time. I think there are things like that that are going to be a benefit. I think some areas where I still have a lot of questions about, as I said, it's when the hospitals go back to normal. And so when do what they call elective procedures, which means anything that's a scheduled procedure, when do they go back to normal? When do people go back to getting their heart operation, their cancer operations, which don't sound particularly elective, but they were considered elective. No one wants to go back to keeping people away from that kind of care for months on end. So, I'm sticking with innovation. I still think cancer, gene therapy, things that save people's lives on the therapeutic side, those names are going to get rewarded. It may take an extra three months or six months to get the product out because of a pandemic. It might take an extra year, but these are such high unmet needs. At the end of the day, if you can find something to deal with some of these very serious medical issues, even if there's a slight delay, because of COVID, it would still be a good product to have. So that's sort of where I'm focusing.

Conference Call 4/8

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Teresa McRoberts (continued): And there's just a huge amount of innovation. If anything, people have looked at COVID and said, we need to fund all sorts of innovation, it's important that we continue to make progress. If you think about how quickly the industry as a whole has been able to find out things, the genetic sequence of the virus within weeks. The vaccine companies put vaccine products in the clinic again within weeks because of the tremendous scientific knowledge we have about how to do these things. So I think that focusing on innovation is the one way to go and we'll have to pick and choose. But really this is what we've continued to do. I haven't shifted things that are really driving now. Dennis Hearns: You mentioned a number of times when we get back to normal. The last time we spoke, you said the number one question you were hearing from the portfolio managers was when do we get back to normal? So how are you responding to that question now? And what new questions are they asking you? Teresa McRoberts: Well, they're not really asking when we're going to get back to normal. I think they've all decided that this is something very variable and people have very different views on this about exactly what means normal. I think if we did a poll, there'd be some people on this call who would be willing to go to a restaurant and some who would not, and that may be a different group of people who are getting on an airplane and a different group who would not. So it’s what is normal and what is acceptable risk, I think vary greatly by person, by age, by underlying health status and a lot of other things. And I think that the one thing we've gotten a lot of questions about when we have a vaccine, I personally think there's a lot of confusion about vaccines. And they're not a magic bullet. They're very important and they're going to be very helpful to control this, but almost no vaccines are 100% effective. And we need to remember that. We also saw clear how long before we have enough capacity for a vaccine to vaccinate everyone. As I said, the flu vaccine is widely available and yet less than half the people in the country get it. I've seen recent polls when asked, would you take a COVID vaccine if it's available, about the same number of people said they would take a COVID vaccine, only about half the people out. So that in and of itself tells you something about rather that the vaccine is not a magic bullet.

I do think there's going to be some changes that are permanent like after 9/11, the security changes at airports are permanent. I think there'll be some things that come from COVID that will last a long time, but I'm not really hearing a lot of questions about the new normal. There are very specific questions about, will this vaccine be available? I mean, I forget that there's a lot of vaccines in development. Something will be available in the next year, year and a half, whether it's going to be available in six months and then that would, that'd be pretty heroic. So that's not ruling anything out. Dennis Hearns: Okay. So let's turn to the Alger Health Sciences strategy, where you're the portfolio manager. I've noticed that your top three sector weightings are biotech, health care equipment and suppliers, and then pharma. Is your high exposure to biotech a result of the current Coronavirus environment, or is your exposure part of a longer term theme or thesis? Teresa McRoberts: It's a little bit of both. Again, I think of biotech very much on a one-off basis, I mean, I don't just buy the index. I'm looking for very specific stories, if it's huge amount of innovation going on often with a lot of very interesting stories. A couple of things about both. I think the Coronavirus has made a lot of people think, oh, there is a value to therapeutics, biotech or pharma. We also have a group that had done very little in the last few weeks; biotech has broken out of the very long-term base. If you're a technician, you can look at it and see that this group has done very little and it is currently hitting all-time highs, which is something that the market had been doing a lot of last year. But biotech was not. So I think part of it is the group has underperformed for quite a while. It's also a group that I think a lot of people haven't had exposure to, and so I think that's the other reason. It's a lot of things, but we look at biotech and we see a lot of innovation and we see investors being willing to participate in that. And so that makes us also equally interested in participating in it. But so it's just a combination of factors and sometimes the groups just are left out and then they come back to life and that's one of these groups right now.

Conference Call 5/8

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Dennis Hearns: Early in 2019, when Elizabeth Warren was leading in the polls for the democratic nomination, the market was not kind to the health care sector. And then in early 2020 pre-COVID, president Trump was leading in the presidential polls and health care was performing quite nicely. Now the presumptive democratic candidate is Joe Biden and he has a rather sizable lead in the polls. How would a Biden presidency impact the health care sector? Teresa McRoberts: It's actually a very difficult question. Unlike a traditional election year, I mean, because of COVID, Vice President Biden has really not been out to campaign. Hasn't really been out talking much about his plan. And I will tell you that we have calls with various Washington people and no one really seems to know what Biden is likely to do. Biden has historically been a centralist and someone who liked to have more bipartisan deals as opposed to very partisan deals. He likes to work across the aisle. He does have long standing relationships with senators. He was in the Senate for a long time. And so he's tended to be a centrist. The question is given the environment right now with all the shutdowns and informants and COVID, with the concerns about social injustice as well as a democratic base that is much more liberal, does he feel pulled to the left? For as many people as I hear talk and say he will be pulled to the left, I hear an equal number of people who say he is at heart a centrist. So I guess the answer is, I don't know how he's going to act. The most important thing is whether or not the Senate flips if he becomes president. So and whether or not the Senate will flip will determine a lot about president Biden and what the policies can be. In the Senate, you do have to have 60 votes, but there's some things they can get through with simply 51 votes. And there is a half dozen seats that could flip from republican to democratic. And so I think that will determine how far left his policies go. We know that he wants to expand access. He wants to shore up the ACA. He's talked about a public option. He has been very clear that he's not interested in Medicare for all. But I feel we don't really know and maybe we'll get more on the campaign trail. Health care is always a very powerful issue for the Democrats. So what are they going to do? Go on the campaign trail, say, I’m going to lower your health care costs more than the other guy.

That's very hard to know. I wish I knew, and I guess we'll learn more during the course of the election.

Dennis Hearns: Fair enough. Operator, can we go to the audience for Q&A?

Speaker Question: In the first five minutes of the call, you mentioned that the race to bring the vaccine to market is political. And I'm just curious, it seems like the companies that are working on the vaccine are competitive companies. They're capitalists, they're looking to be the first, and certainly if I was president or you were president, you'd probably want to help the citizens, not only in the United States, but around the world. I'm just curious why you would say that was political. Thank you. Teresa McRoberts: I think the most difficult issue that it's going to require someone to sort out is how much safety data do you need for a vaccine? Historically, we have required immense amount of safety data for something that is going to be used in billions of people, 330 million people in the U.S. Some of whom are not all that healthy. That is a hurdle or hurdles in the past for the amount of data we need for vaccines is very extensive and this is going to be a decision. We are not going to have 100,000 people trials to know what is the one in 100,000 safety events that can happen. There've been several vaccines in the last, however many years, that once they got into people, they discovered these rare side effects and a rare side effect when you give it to millions of people, isn't as rare when it’s, one in 10,000, one in 100,000. So that is the question. And what is that rare side effect? So that is why this is going to be a political decision because somebody is going to have to decide what is the safety cutoff? We're going to know the efficacy, but if you want me to have 10,000 people, are we really going to know what those rare, potentially extremely serious safety events are? Or somebody's going to just say, okay, we're happy to do that. And I don't know if you want to add, CJ? CJ Sylvester: Yeah. Well, that's entirely the point. It's just a safety call. Typically it's three or four years of safety that are needed in tens of thousands of patients. And we're just not going to have that.

Conference Call 6/8

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Teresa McRoberts : I would say the other thing is, I think it's actually a good thing that we're going to have multiple vaccine choices because there may be one that has this side effect and for certain people that wouldn't be good, but a different one that doesn't have that side effect. They're not all the same. They're trying to do the same thing, but they're doing it a different way. And so I actually think multiple vaccines is good because maybe some of them are safer or less concerning for certain kinds of people. Thank you for the question. Dennis Hearns: I'm going to ask one last thing. I noticed that the Russell indices are reconstituting this Friday and that health care weights in the growth benchmarks are increasing across all the various market caps. Can you comment on that? Teresa McRoberts: The effect of the rebalancing, which happens every year at the end of June, is that we're seeing very significant increases in health care as part of the growth benchmark. I think part of that has to do with there being more interest in health care in general.

I think because of that, people may have been suddenly realized how underweight health care they're going to be if even if they're at the benchmark now, they're now going to be underweight come next Monday. And some people were underweight health care because of the election year and whatnot. And it generally is being rebalanced in the therapeutic area. That's where the bulk of it is. And in general, it's coming out of a variety of economically sensitive areas. Which again, if you think about what's been going on in the last six months, that's highly understandable. Given if those are more economically sensitive areas in the shutdown hotel, especially cars. So, we have increased some of the general trends have been increasing their health care rates because of it. Dennis Hearns: Okay, great. Thank you for that. Alright, well that concludes our call for today. Thank you, Teresa and CJ, for participating, and thank you all for listening in and your support for Alger.

Conference Call 7/8

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DISCLOSURE

The views expressed are the views of Fred Alger Management, LLC (“FAM”) and its affiliates as of June 2020. These views are subject to change at any time and may not represent the views of all portfolio management teams. These views should not be interpreted as a guarantee of the future performance of the markets, any security or any funds managed by FAM. These views are not meant to provide investment advice and should not be considered a recommendation to purchase or sell securities. This material is provided for informational purposes only and is not meant to constitute medical or healthcare advice. Please consult a doctor for medical information. Risk Disclosures : Investing in the stock market involves risks, including the potential loss of principal. Growth stocks may be more volatile than other stocks as their prices tend to be higher in relation to their companies’ earnings and may be more sensitive to market, political, and economic developments. A significant portion of assets will be invested in healthcare companies, which may be significantly affected by competition, innovation, regulation, and product obsolescence, and may be more volatile than the securities of other companies. Investing in companies of small capitalizations involve the risk that such issuers may have limited product lines or financial resources, lack management depth, or have limited liquidity. Private placements are offerings of a company’s securities not registered with the SEC and not offered to the public, for which limited information may be available. Such investments are generally considered to be illiquid. Foreign securities involve special risks including currency fluctuations, inefficient trading, political and economic instability, and increased volatility. Active trading may increase transaction costs, brokerage commissions, and taxes, which can lower the return on investment. Past performance is not indicative of future performance. Investors whose reference currency differs from that in which the underlying assets are invested may be subject to exchange rate movements that alter the value of their investments. Important Information for US Investors: This material must be accompanied by the most recent fund fact sheet(s) if used in connection with the sale of mutual fund shares. Fred Alger & Company, LLC serves as distributor of the Alger mutual funds. Important Information for UK and EU Investors: This material is directed at investment professionals and qualified investors (as defined by MiFID/FCA regulations). It is for information purposes only and has been prepared and is made available for the benefit investors. This material does not constitute an offer or solicitation to any person in any jurisdiction in which it is not authorised or permitted, or to anyone who would be an unlawful recipient, and is only intended for use by original recipients and addressees. The original recipient is solely responsible for any actions in further distributing this material and should be satisfied in doing so that there is no breach of local legislation or regulation. Certain products may be subject to restrictions with regard to certain persons or in certain countries under national regulations applicable to such persons or countries.

Alger Management, Ltd. (company house number 8634056, domiciled at 78 Brook Street, London W1K 5EF, UK) is authorised and regulated by the Financial Conduct Authority, for the distribution of regulated financial products and services. FAM and/or Weatherbie Capital, LLC, U.S. registered investment advisors, serve as sub-portfolio manager to financial products distributed by Alger Management, Ltd. Alger Group Holdings, LLC (parent company of FAM) and Fred Alger & Company, LLC are not an authorized persons for the purposes of the Financial Services and Markets Act 2000 of the United Kingdom (“FSMA”) and this material has not been approved by an authorized person for the purposes of Section 21(2)(b) of the FSMA. Important information for Investors in Israel: This material is provided in Israel only to investors of the type listed in the first schedule of the Securities Law, 1968 (the "Securities Law") and the Regulation of Investment Advice, Investment Marketing and Investment Portfolio Management Law, 1995. The Fund units will not be sold to investors who are not of the type listed in the first schedule of the Securities Law. The Russell 3000 Health Care Index is an unmanaged index that measures the performance of those companies in the Russell 3000 Index involved in the medical services or health care field. Also included are companies involved in research, development and production of pharmaceuticals and biotechnology. The Russell 3000® Index measures the performance of the 3,000 largest U.S. companies based on the total market capitalization, which represents 99% of the U.S. equity market. Russell 3000 Health Care Index performance does not reflect deductions for fees or expenses. The following positions represented the noted percentages of assets in the Alger Health Sciences strategy as of 3/31/20: Gilead Sciences Inc., 2.96%, and Zoom Video Communications Inc., 0%.

Fred Alger & Company, LLC 360 Park Avenue South, New York, NY 10010 / 800.992.3863 / www.alger.com

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Conference Call 8/8

Fred Alger & Company, LLC 360 Park Avenue South, New York, NY 10010 / www.alger.com

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