“Innovation is considered something important in the Japanese political arena,” explains Daisuke Imoto, business development director at the Drugs for Neglected Diseases initiative, or DNDi, Japan.
Over the past few decades, that ethos has uniquely placed Japan to be a leader in global health — a position that will take center stage at the Ninth Tokyo International Conference on African Development, or TICAD 9. Co-hosted by the government of Japan, the event will showcase co-created innovative solutions to some of the African continent's most pressing challenges and future perspectives, particularly when it comes to the elimination of neglected tropical diseases, or NTDs.
One such solution to be showcased is the new pediatric treatment for schistosomiasis — an NTD caused by parasitic worms that can lead to chronic ill health. Developed by the Pediatric Praziquantel Consortium — funded by Japan’s Global Health Innovative Technology Fund, or GHIT — and introduced through the Consortium’s ADOPT program, the achievement marks GHIT’s first supported innovation to reach people in need since its establishment in 2013.
It’s just one achievement in the country’s long history of drug discovery and innovation, which, coupled with Japan’s political leadership, continues to drive NTD elimination goals around the world through research and development, or R&D, multilateral partnerships, and drug donation programs.
“We call ourselves one of the first public-private partnerships in R&D,” explains Hayato Urabe, associate vice president of investment at GHIT.
The international fund works to pull in different sources of funding around three key disease areas — malaria, tuberculosis, and NTDs — giving grants for product development of vaccines, diagnostics, and therapeutics over different phases: discovery, preclinical and clinical, all the way to regulatory approval. In addition to the pediatric schistosomiasis treatment, the fund also has products in development for leprosy, leishmaniasis, mycetoma, and a dengue vaccine currently in clinical trials.
Then there are the partnerships spurred by the fund itself. “All the programs that we have funded have to have a Japanese entity combined with an overseas entity,” Urabe explains. To date, the fund has worked with over 60 Japanese organizations and over 120 international organizations, with pediatric praziquantel representing the first drug accompanied up to market authorization, making it into the hands of people who need it most.
In 2023, Japan was the world’s fourth-largest global health donor, and over the nine-year period before the pandemic (2010-2019), Japan contributed more than 15 billion yen ($100 million) to the global fight against NTDs — with spending concentrated in R&D.
With around half of the funding GHIT mobilizes coming from the Japanese government, it’s just one example of the country’s longstanding interest in combating infectious diseases.
Following its own successful history of eliminating or eradicating major neglected parasitic diseases such as schistosomiasis and filariasis, Japan announced the Hashimoto Initiative at the G8 Birmingham Summit in 1998. Initiated by then-Prime Minister Ryutaro Hashimoto, it proposed several steps to improve the effectiveness of international cooperation against parasitic diseases, including the establishment of centers for research in Asia and Africa and the formation of center-led international networking through collaboration with the World Health Organization and the Group of Eight countries.
In 2006, the Japanese government established the Hideyo Noguchi Africa Prize in honor of the Japanese medical scientist Dr. Hideyo Noguchi. The prize highlights fundamental medical and clinical research and celebrates the efforts of organizations and individuals tackling infectious diseases affecting primarily African communities.
This year’s recipient, DNDi, was recognized for its work in ensuring NTDs aren’t neglected in pharmaceutical research and that innovative partnerships help spur future progress on the road to elimination. One initiative to that end is DNDi’s NTD Drug Discovery Booster — a global consortium of pharmaceutical companies, including four Japanese ones, collaborating to remove early-stage commercial barriers. The initiative has accelerated the hunt for new treatment leads, aiding the design of the next generation of treatments for NTDs.
DNDi acts as a virtual, delocalized R&D company, and has worked with a number of Japanese organizations to screen a wide range of compounds against NTDs. “NTDs don’t offer commercial incentives to pharmaceutical companies,” Imoto explains. “DNDi was an attempt to provide an answer to that problem.” Besides partnering with pharmaceutical companies, DNDi links up with various groups, including academia, policymakers, and research institutes in endemic countries. Combination therapies for leishmaniasis, the development of new compounds for Chagas' disease — these all form part of DNDi’s Japanese collaborations with the ultimate goal to deliver safe, effective, affordable medicine.
Another key player advocating for NTDs is Japanese pharmaceutical company Eisai — operating on the global health landscape with a uniquely Japanese approach. “We have a corporate concept of ‘human health care,’ [which means] we focus on the social first,” says Miwa Jindo, senior director of Eisai’s strategy and global health coordination group. In 2013, Eisai agreed to produce and supply to WHO up to 2.2 billion tablets of diethylcarbamazine, a medicine used to treat lymphatic filariasis — a disease affecting 657 million people globally — free of charge.
The company views this less as a donation and more as a long-term investment. “We hope to expand future markets by contributing to the economic development in developing or emerging countries,” Jindo explains. “Since 2013, by our estimate, the tablet has reached 22 million people.” Among the 32 countries Eisai has donated to, Brazil, East Timor, Egypt, Kiribati, Laos, Maldives, Sri Lanka, and Thailand have all achieved elimination of the disease.
But drug donations are only part of the puzzle in tackling these diseases, as community awareness is equally important on the ground, Jindo notes. “Only providing the tablet is not enough to completely eliminate lymphatic filariasis. [We also engage in] mosquito control through local employment and educational programs for students or kids to raise disease awareness.”
In an age of shifting global priorities — away from international collaboration and global health financing — there is a domino effect that means not every part of the “bench-to-bedside” pipeline receives funding and is de facto competing interests.
“I would express a deep concern for the millions of patients that are currently affected by the various funding cuts,” Imoto says. “We have to carefully monitor the impact of the political changes that are happening right now.” GHIT’s Urabe refers to it as “a wake-up call” for those in global health. The overreliance on single funders is no longer feasible, and new ways of doing things will need to be found.
“Over the last 15 years, a lot of effort has been invested — money, time — to develop drugs and diagnostics for certain NTDs to overcome challenges with control and elimination,” explains Peter Steinmann, a public health specialist from the Swiss Tropical and Public Health Institute and co-lead of the Consortium’s ADOPT program. “Some of these results — for example, the pediatric praziquantel — are now becoming available and offer an opportunity to build on the successes that have been achieved. We risk losing part of the gains we have made in terms of control, and we risk not achieving certain goals that have been set towards transmission, interruption, and elimination.”
“Only one company or only one organization or only one person can’t achieve anything in global health,” adds Eisai’s Jindo. “It’s important to collaborate and work together towards the same goal.”
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