positions global health as its third key therapeutic area, along with dementia and oncology. In order to efficiently achieve social good in the form of “relieving anxiety over health” and “reducing health disparities” in the global health area, we have been working to eliminate neglected tropical diseases (NTDs) and malaria.
Global Health
Global health is about solving health issues on a global scale through interdisciplinary approaches. Infectious disease pandemics, widening health disparities due to growing economic gaps, the impact of global warming on health, declining birthrates and aging populations are examples of the complex global issues which transcend the barriers of borders, regions, and ages. Solving these issues requires solutions that involve a multidisciplinary approach such as medicine, nursing, public health, epidemiology, economics, politics, and sociology1. Global health not only has a direct effect on people's health, but also has an impact on the peace and prosperity of nations. It is considered to be one of the most important issues for the international community from the perspective of the co-existence of human society and the Earth2.
Neglected Tropical Diseases (NTDs) are global health issues. The World Health Organization (WHO) has designated 21 diseases as NTDs and the number of people requiring NTD interventions (both preventive and curative) is estimated to be 1.6 billion3. The WHO has developed the NTDs roadmap (2021-2030) with the aim of eliminating NTDs. The United Nations Sustainable Development Goals (SDGs) also includes the elimination of NTDs in its Goal 3 (Good Health and Well-Being) Target 3.3. The World Bank reports that NTDs together account for a significant and inequitably distributed global disease burden, similar in order of magnitude to those of tuberculosis or malaria at approximately 22 million disability-adjusted life-years (DALYs) in 2012. The World Bank estimates that cost-effective interventions to end NTDs are available for as little as US$3 per DALY averted4.
’s Initiatives to Eliminate Lymphatic Filariasis (LF)
has been working on the elimination of lymphatic filariasis (LF), one of the NTDs. LF is a parasitic disease transmitted to humans by mosquitoes. It is estimated that 880 million people are at risk of infection, mainly in developing countries5. In 2010, signed a joint statement with the WHO to provide the LF treatment diethylcarbamazine (DEC) for free, and started providing DEC tablets in 2013. The WHO conducts mass drug administration (MDA) campaigns in endemic countries to eliminate LF, and at the time of signing the joint statement, DEC tablets, one of the three treatments used for MDA, were in short supply worldwide posing a major obstacle to eliminating LF.
In 2012, , together with 12 major global pharmaceutical companies, the Bill & Melinda Gates Foundation, WHO, the governments of the United States and the United Kingdom, the World Bank, and governments of NTDs-endemic countries, participated in the London Declaration, an international public-private partnership to work together towards the elimination of NTDs. In 2022, stated its commitment to continuing to support the elimination of NTDs, including the free provision of DEC tablets, in order to achieve the WHO's NTDs roadmap (2021-2030) through the Kigali Declaration, the successor of the London Declaration.
Eliminating LF requires a comprehensive approach that includes not only provision of treatment, but also disease awareness, drug delivery, MDA, provision of diagnostic tools, and environmental improvements such as the extermination of mosquito larvae and the installation of drainage ditches. It is also essential to collaborate with many partners, including the WHO, governments of endemic countries, and local healthcare workers.
has assigned “DEC Managers” from the staff of its subsidiaries in eight countries which are located mainly in LF-endemic areas. DEC managers, who are responsible for establishing and implementing LF elimination activities, discuss with government officials in charge of LF and other local stakeholders about the contributions they can make from a local perspective to achieve the early elimination of LF, and work together with these stakeholders.
also endeavors to understand the importance of external stakeholders in setting materiality through dialogue with ESG investors, discussions that take place at international conferences which are hosted by the WHO and attended by government officials from endemic countries, as well as discussions at international conferences hosted by the Bill & Melinda Gates Foundation and attended by pharmaceutical companies.
Calculating the Social Impact of Efforts to Eliminate Lymphatic Filariasis (LF)
The social impact of mass drug administration toward LF elimination was calculated using the following method.
1) Output | 2) Outcome | 3) Impact |
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The number of people who have benefited from DEC administration | ① The number of people who were able to avoid LF infection, ② the number of people with existing subclinical disease who were able to avoid progression to clinical disease, and ③ the number of people who showed improvement in acute attack frequency or chronic symptoms | (the number of work days recovered per year) x (the minimum wage)+healthcare cost reduction)) x life expectancy |
1) Output
The output is the number of people whose risk of LF infection was reduced by administering therapeutic drugs including ’s DEC tablets. Aiming to eliminate LF, the WHO conducts mass drug administration (MDA) to residents in endemic areas once a year. The WHO collects data such as the number of people living in each area and the number of people who have received drugs, and publishes it annually as country-specific data6. According to the WHO guidelines for LF treatment, efficacy can be expected with five annual MDAs when DEC tablets and GSK's albendazole are administered, whereas efficacy can be expected with two annual MDAs when these two drugs are combined with MSD's ivermectin7. The number of people who benefited from receiving DEC tablets was calculated based on the number of people who received drugs and the number of MDA.
2) Outcome
According to a published article which highlights the efficacy of MDA for LF, it is reported that 10% of the at-risk population avoid LF infection, 50% of people with existing subclinical disease avoid progression to clinical disease, and even those who are already showing symptoms experience improvements in acute attack frequency and chronic symptoms8.
Based on the article, we calculated the number of people who benefited from the administration of DEC tablets: 1) the number of people who benefit from DEC administration, 2) the number of people who were able to slow the disease progression from asymptomatic to symptomatic stage, and 3) the number of people who showed improvements in acute attack frequency or chronic symptoms.
3) Impact
The lifetime impact for people in categories ①-③ was calculated as below:
Lifetime social impact = (“number of work days recovered per year due to avoided infection, and improvement in seizure frequency and symptoms” x “minimum wage in each country” + healthcare cost reduction) x life expectancy9.
’s Initiatives for Mycetoma
Mycetoma is a disease transmitted through the skin, which can cause swelling masses in the limbs and other parts of the body if left untreated. It is said to be one of the most neglected tropical diseases as treatment methods are limited and there is a lack of basic information, including its transmission pathway and incidence.
Aiming to develop the world’s first treatment for mycetoma through clinical trials for mycetoma patients, we are working with the Mycetoma Research Centre, Drugs for Neglected Diseases initiative (DNDi), and the Global Health Innovative Technology Fund (GHIT Fund) to conduct the clinical study for E1224, ’s in-house developed anti-fungal drug fosravuconazole, and engaging in discussions with Sudanese regulatory authorities about the process for future regulatory submissions. At the same time, we are holding dialogues with stakeholders both within and outside Sudan aiming to establish an access plan for the effective delivery of the new treatment to as many patients as possible.
New Drug Development
We are working to create new drugs for NTDs such as mycetoma and Chagas disease, as well as malaria and tuberculosis which are included in the three major infectious diseases.
We are conducting drug development projects by gathering great ideas, cutting edge technology, and experience and know-how in onsite clinical development by receiving both domestic and international funds aiming to eliminate tropical diseases, such as the GHIT Fund, and cooperating with top-level academia and research organizations across the globe, such as the Broad Institute, and non-profit R&D groups such as DNDi.
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1
Tomohiko Sugishita, Journal of the National Institute of Public Health (2019) Vol.68 No.5 p.372-379
(in Japanese only) -
2
Global Health Strategies, 2022, May 24, Headquarters for Healthcare Policy, Prime Minister's office of Japan
(in Japanese only) -
3
Neglected tropical diseases, World Health Organization
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4
Holmes KK, Bertozzi S, Bloom BR, et al., Major Infectious Diseases. 3rd edition (2017) Chapter 17, An Investment Case for Ending Neglected Tropical Diseases, The International Bank for Reconstruction and Development / The World Bank
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5
Lymphatic filariasis, World Health Organization
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6
PCT Databank - Lymphatic filariasis, World Health Organization
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7
Guidelines for certifying lymphatic filariasis elimination -- including discussion of critical issues and rationale, World Health Organization
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8
Turner et al., Infectious Diseases of Poverty (2016) 5:54
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9
Yanagi, Freiberg (2022) (in Japanese only)