The Global Health Innovative Technology Fund (GHIT Fund) is a global public-private partnership fund based in Japan that promotes the development of less marketable therapeutics, vaccines, and diagnostics for infectious diseases such as malaria, tuberculosis, and neglected tropical diseases (NTDs). Daiichi Sankyo has been one of the funders of the GHIT Fund since its foundation in 2013 and also a beneficiary of the investments the fund has made in research and development activities. In this interview, we ask Dr. Osamu Kunii, CEO of the GHIT Fund, who has been at the forefront of the fight against infectious diseases throughout his long career at international organizations, what the current situation is with the world facing more and more infectious diseases, and what role can we and the Japanese pharmaceutical industry play in the effort to eradicate them.
Dr. Tohru Takahashi,
Global Head, Research Platform and Strategy, Daiichi Sankyo
Pandemic preparedness: strategy, tactics, and actions
Following the COVID-19 pandemic, Daiichi Sankyo set up a cross-departmental taskforce for the research and development of vaccines and therapeutics, which led to the establishment of the Emerging and Re-emerging Infectious Diseases Research Special Team (EReDS) in April 2021 to boost the company's research and development in therapeutics for infectious diseases.
Takahashi: We have a long history of developing therapeutics for infectious diseases, such as antibacterial agents and anti-influenza medications. However, the profit margins of these products are very slim, and with the decline in the number of outbreaks of infectious diseases in developed countries thanks to improved sanitation, we had downsized this segment over the last ten or so years. As a result, we were insufficiently prepared when the COVID-19 pandemic hit and were unable to take action in the early stage. Learning from this painful lesson, we have established the EReDS. The team has already started exchanging information and opinions with GHIT Fund.
Kunii: Without new tools such as vaccines and therapeutics, it will be difficult to meet the United Nation's Sustainable Development Goals target of ending communicable diseases by 2030. To me, the motivation to join the GHIT Fund came from my desire to contribute to the global fight against COVID-19 and future pandemics as well as the existing threats of infectious diseases that blight communities around the world. Japanese pharmaceutical companies are well equipped with advanced technologies, so I have high hopes for their drug discovery work, including vaccine development.
Takahashi: The COVID-19 pandemic put the social responsibility of pharmaceutical companies into sharp focus. I feel strongly that we, the Japanese pharmaceutical industry, must organize a framework for dealing with emergency situations.
Kunii: You are absolutely right—and building such an organizational framework is something that must be done before an emergency strikes. It is important that the strategy for tackling such a situation is considered as part of regular business. However, strategies are nothing if there are no tactics and actions to implement them. What's needed is a vision to achieve a goal, forming the basis on which to build preparedness, which consists of 10% appropriate strategy and 90% devising tactics and taking actions.
Looking back and thinking about how COVID-19 vaccines were developed and made available so quickly, it is clear that the scale of efforts needed was beyond the capacity of a single company or country. The success came as a result of the global-scale efforts of international organizations, multiple national and regional governments, and many pharmaceutical companies. This is why I would like Japanese companies to be much more proactive in linking up and working with companies abroad and potentially use the GHIT Fund to do so. World leaders have agreed on an ambitious goal of developing vaccines and other tools within 100 days of a future pandemic identified*, an all-Japan team on its own would not be enough to achieve this target. We need to start working now to build a structure that is ready to move into action immediately when the next pandemic strikes.
Planetary health: a holistic look at the global environment and human health
We tend to focus on the yet ongoing COVID-19 pandemic and the threat of the next pandemic to come. However, global warming and other crises mean that existing infectious diseases and NTDs may also prove to have a grave impact on the fate of humanity.
Takahashi: It is said that dengue fever may arrive in Japan soon due to the effect of global warming. What will happen with infectious diseases and NTDs in the future?
Kunii: Since 1970, the world has seen a new infectious disease emerging almost every year. How does this happen? Around 70% begin with a spillover into humans from nature, many through animals. Another major factor is population increase, which leads to urbanization and overcrowding and makes infectious diseases easier to spread. Mosquito-borne diseases are on the increase, and they can spread from city to city, region to region, and even across international borders to cause global pandemics.
In addition to these factors, we are also facing what is known as the Great Acceleration (a rapid increase in human activities and their impact on the environment), which is also accelerating the spread of infectious diseases. There is a concept called One Health, an approach that sees the health of humans, animals, and ecosystems as one, but I think we need to start thinking in terms of Planetary Health from now on, seeing human health holistically as something closely connected with the health and sustainability of the planet.
In some parts of the world, such as in African countries, more people are actually dying of AIDS and tuberculosis than COVID-19, but this fact is still hardly known in the rest of the world. If we look at Japan, mosquitoes that can spread the West Nile virus and malaria have already reached Hokkaido and the Tohoku area. Global warming cannot be seen as a problem of far-away places.
Saving neglected people with Japanese technology
What do we need to do to fight the infectious diseases and NTDs spreading around the world? Dr. Kunii stresses the need for a partnership-based business model as well as a partnership approach to drug discovery and development.
Takahashi: It is expected that future population growth will occur mainly in sub-Saharan Africa. In order to be a fully committed participant as a pharmaceutical company in the field of infectious diseases, I believe we need to work with local communities in these areas to build our operation while supporting their self-reliance. It is our mission to deliver medicines to these regions both as our international contribution and as a viable business operation that targets the BOP** market.
Kunii: How we can empower local communities is certainly an important consideration. At the same time, we should remember that some African countries are now experiencing double-digit growth in GDP. I hope the pharmaceutical industry will treat work in these areas not merely as an international aid initiative, but as a fully-fledged business activity. I was engaged in medical support work in Africa, which made me acutely aware that you cannot do anything without access to medicines. I feel strongly that we must provide "Last One Mile Support" to ensure that medical care and medicines are delivered to those who need them most.
In Africa, there are many areas that lack hospitals, but do have pharmacies. There will always be a demand for medicines even in remote areas away from urban centers. However, in order to ensure that they are delivered to people who need them, I think it will be necessary to work with a variety of partners, including those who provide logistics. In tomorrow's market, we will need a business model where we deliver not only the education of doctors and nurses, but also make use of digital technology to provide a comprehensive set of services encompassing diagnostic imaging and the delivery of medicines using drones.
Takahashi: Africa is also an area with a very high rate of smartphone use. It already has an environment ready for the deployment of remote diagnosis, so the question is how to prescribe medicines. This may be unthinkable in Japan, but in some countries, medicines can be provided in individual packaging. The demands for such a service may be much greater than we think.
Kunii: We know from our experience in the past that, if we act first and demonstrate that we can save people in these areas, funding will follow. Having said that, I concede it is more complicated in the case of research and development, as companies cannot develop medicines that do not yield profits. The role of the GHIT Fund in my view is to link up the public and private sectors in order to generate the incentive to do just that.
Of the new chemical compounds developed from 2000 to 2011, only 1% were intended for tropical diseases. I would like to see this figure go up. There are only 20 staff members at the GHIT Fund. I tell them to think every day how they can accelerate and swiftly lift research programs to the next stages so that products can be delivered to the frontline as quickly as possible.
The GHIT Fund receives financial support from Daiichi Sankyo, but we would like to develop our partnership further, including technical aspects. How can you apply the technologies you have in the company to infectious diseases? How can compounds in your possession be identified accurately using AI and other technologies? Let's look at these questions together so that we can find out what needs to be done for successful medicine development.
Takahashi: Thank you for your encouraging words. We hope to make good use of the GHIT Fund so that we can use our technologies to make social contributions with an all-planet perspective while achieving profits and growth as a company.
EReDS Hosts Talk by Osamu Kunii, CEO of GHIT Fund
Audiences listening attentively to Dr. Kunii's talk
In July 2022, EReDS hosted a lecture by Dr. Osamu Kunii, CEO of the GHIT Fund, at the Daiichi Sankyo Shinagawa R&D Center. The event was attended by 120 people, including an online audience.
Dr. Kunii talked passionately about the importance of access to pharmaceuticals he saw through his wealth of experience in medical work in Africa, the importance of partnership between public and private sectors highlighted by the COVID-19 pandemic, and the GHIT Fund's role in the industry and its future plans.
The audience asked many questions, and among the feedback received after the talk, a participant commented, “Infectious diseases are meant to be one of our strengths; we should think about ways to contribute to the world's health by making good use of external funding and partnerships.”
Profile: Osamu Kunii
Dr. Osamu Kunii, MD, MPH, PhD, was appointed as CEO of the GHIT Fund in March 2022. He received his medical degree from Jichi Medical University, a Master of Public Health from Harvard T.H. Chan School of Public Health, and doctoral degree from the University of Tokyo.
As a student volunteer, he engaged in emergency medical relief for Somali refugees escaping the Ogaden War and co-founded the Association of Medical Doctors of Asia (AMDA), an international medical NGO. After working at Japan's National Center for Global Health and Medicine, the University of Tokyo, and the Ministry of Foreign Affairs of Japan, he was appointed Professor of Global Health at the Institute of Tropical Medicine, Nagasaki University in 2004.
In 2006, he joined UNICEF's New York Headquarters as Senior Health Strategy Advisor, and then oversaw health, nutrition, water, sanitation, and hygiene programs in Myanmar and Somalia. From February 2013, he served as a Management Executive Committee member of the Global Fund to Fight AIDS, Tuberculosis, and Malaria as Head of the Strategy, Investment, and Impact Division.
- *At the G7 Summit held in Cornwall in June 2021, leaders agreed to the 100 Days Mission to Respond to Future Pandemic Threats. The project aims to have safe and effective vaccines, therapeutics, and diagnostics available within 100 days of a pandemic threat being identified.
- **BOP stands for “base/bottom of the pyramid.” The term refers to the low-income segment of the economy with an annual income of $3,000 dollars or less on a purchasing power parity basis. It is said that the BOP segment makes up as much as 70% of the world population, mainly concentrated in developing countries.