BT Slingsby was 13 years old when he made a career decision: to become a medical doctor.
Slingsby, now a doctor and CEO of the Tokyo-based Global Health Innovative Technology Fund, was living in Egypt with his family at the time. One day he saw a group of men smoking water pipes and hanging around on a street. One of them had huge, swollen legs below his knees — heavy like a brick and he could barely move.
The young Slingsby became curious and walked up to the man, who was probably in his 40s, and asked him about his legs. The man told him that he contracted a disease through a mosquito bite and that while he no longer had the disease, its complications left him with those gigantic limbs.
“That really made a significant impression on me,” Slingsby, now 41, recalled recently at the GHIT Fund headquarters in the Roppongi district in Tokyo, where he led the foundation of the public-private partnership fund and currently manages its committed $345 million that invests in research and development of medicine for the developing world.
“He was originally working in construction, in manual labor, and he could no longer do his job. This meant his entire life changed because of one mosquito bite. And it’s not the fact that there was no medicine; it’s the fact that he didn’t take the right medicine at the right time.”
The man, Slingsby now knows, had contracted lymphatic filariasis, one of many tropical infectious diseases afflicting people in developing countries. The disease blocks the flow of lymph in one’s body, leading to the extreme enlargement and hardening of legs and external genitals.
Slingsby, a California native, got a master’s and doctorate in public health in Japan, went back to medical school and trained as a physician in the U.S., then returned to Japan and started working at drugmaker Eisai & Co. in 2010.
But that teenage experience was always on his mind, he says. It eventually led him — together with his mentor, Dr. Tachi Yamada, then a Takeda Pharmaceutical executive — to come up with the idea of a unique matching fund where the Japanese government’s contributions to research and development of medicine for the developing world are matched by donations from private sector entities.
The fund — one of the world’s first nonprofit, public-private partnerships aimed at developing medicine specifically for low- and middle-income countries — was launched in 2013. It had an initial commitment of $100 million over five years, involving multisector entities as its founding partners: the Foreign Ministry and the Health, Labor and Welfare Ministry; the U.N. Development Programme; Astellas Pharma Inc.; Daiichi Sankyo Co.; Eisai & Co.; Shionogi & Co.; Takeda Pharmaceutical Co.; and the Bill & Melinda Gates Foundation.
The number of partners has since grown to include 16 drugmakers and the U.K.-based Wellcome Trust.
As of Monday, the fund had invested in 68 projects, out of which 40 are still going. To maximize its cost performance, the fund evaluates all ongoing projects every six months, swiftly terminating support for poor performers.
Around 42 percent of its investments have gone to projects related to malaria, 13 percent to tuberculosis and the rest to “neglected tropical diseases,” referring to a variety of tropical infectious diseases that hit low-income populations in low-income countries the hardest.
In terms of the type of products, the fund has invested some 71 percent of its money in development of medicine for treating the diseases, 24 percent in vaccines and the rest in diagnostic drugs.
Slingsby said the fund is meant to be a “catalyst” for Japan’s pharmaceutical sector — which he stressed is a leader in drug development — to play a bigger role in solving global public health issues with their technologies and expertise. Products developed through GHIT-supported projects will be regarded as public health goods and priced on a no-gain, no-loss basis.
In the five years from 2018, the fund aims to bring two of its projects to a stage where a request for regulatory approval is filed, he said.
One of the products in the pipeline and among the closest to hitting the market is a pediatric formulation of praziquantel, a drug widely used to treat worm infections called Schistosomiasis.
According to the World Health Organization, the disease, caused by parasitic worms, affects some 240 million people worldwide. It particularly affects poor rural communities, where people are infected by coming in contact with worm-infested fresh water. The disease’s mortality rate is not high, but it can cause abdominal pain, diarrhea or bloody stool. People who have been exposed for a long time may experience liver damage, kidney failure, infertility or bladder cancer. Children are particularly vulnerable to infection, according to the WHO.
Praziquantel, which has been around for some 40 years, is safe and works well for the disease, but its bitter taste has kept many, especially young children, from taking the tablet drug, said Hiroyuki Kojima, a 44-year-old researcher at Astellas Pharma, which is part of an international, multicontinental consortium aimed at developing the pediatric formulation of praziquantel.
“Praziquantel, in its currently available form, is also big — almost the size of a ¥10 coin,” he said. “What people in Africa are doing right now when administering the drug to young children is to grind the tablets and turn them into powder, but because the drug is so bitter children often spit it out.”
That’s where Astellas comes in. The firm has a track record of formulating medicines in such a way that they are easier for patients to take, such as by using taste-masking technologies to make them palatable, and by making them soluble in the mouth, Kojima said.
With funding from the GHIT Fund and the Bill & Melinda Gates Foundation, Astellas researchers including Kojima worked together with other members of the consortium in the Netherlands, Germany, Switzerland, the U.S., Britain and Brazil, often calling late-night conferences and sometimes speaking via Portuguese interpreters, to come up with a smaller praziquantel tablet for children.
Now the product is undergoing a clinical trial in Cote d’Ivoire, and the consortium is eyeing its delivery in some African countries by 2020, Astellas officials said.
“Members of the consortium all shared a strong passion to have the drug delivered to the children in Africa,” Kojima said.
Slingsby says the GHIT Fund has given researchers a chance to do what they enjoy and feel rewarded the most — to save and improve people’s lives through their technologies — free from the pressure to make a huge profit, which is essential for commercial drug development.
“At every pharmaceutical company I’ve interacted with, the scientists and researchers in the company want to do this work,” he said.
But why should the rest of us — the public with no stake in, or direct ties with, the pharmaceutical industry or the developing world — care about global public health issues?
Slingsby said people in Japan, who have risen from its devastating defeat in World War II, should remember this nation is a leader in global health, as it has overcome widespread infectious and parasitic diseases itself. Japan has also produced a number of scientists who have led transformational drug discoveries, such as microbiologist Satoshi Omura, he said. Omura won the Nobel Prize in physiology or medicine in 2015 for his discovery of ivermectin, which is effective against parasitic diseases.
Helping people in the farthest parts of the world combat diseases will also eventually come back to help people here, he stressed.
“The dengue fever outbreak in Japan a few years ago, the SARS epidemic before that, and the more recent Ebola and Zika epidemics serve as reminders of the fact that disease knows no borders,” he said. “Protecting the world from disease is directly correlated to protecting the people of Japan from disease.”
A Matter of Health covers current research, technology and policy issues relating to health in Japan.