The programmed end to Japan’s coronavirus ‘Mizaru’ policy

Back to Tokyo from a short trip to Nikko, Tochigi Prefecture, where I could see the celebrated “Three monkeys” at the Toshogu Shrine, I cannot refrain from drawing the analogy with the COVID-19 crisis, feeling that Japan has been so far, like the “Mizaru,” avoiding seeing this evil (it should stay on foreign ships), or testing for it (less than 50,000 tests done, despite a daily capacity of 6,000 to 8,000) and preparing to fight it (is there a Plan B, and what is Plan A?).

Recent data show that the virus that has spread around the world is now severely affecting Japan as well, albeit in lesser but rapidly growing proportion.

While Japan was one of the first countries exposed to the new coronavirus, it did not use this “time advantage” to prepare actively for containment measures. The questionable handling of the Diamond Princess quarantine was widely and globally exposed, and the few measures taken were controversial and not well explained at best (the closure of schools nationwide, for example).

This lack of public understanding of government decisions may result from the absence of a reliable and authoritative medical spokesperson, although Japan has a chief medical and global health officer, who would have qualified for this communication role. The lack of transparency of the decision process is also a consequence of the political agenda influence on the public health measures needed: this included protecting the 2020 Tokyo Olympics as well as the frail economic situation of Japan.

The lack of data on the pandemics progression (as a consequence of anecdotal testing so far), on the health system preparedness and on a plan and timelines to fight the virus are preparing the country for difficult times. A delayed implementation of a confinement plan means both that more people could be infected and potentially die, and that Japan will recover later than other countries, which will have an additional impact on its industry’s competitiveness.

Talking about industry, let me focus on the biopharmaceutical industry, in which I spent the last 35 years, of which 20 in Japan. The race for treatment and prevention solutions against COVID-19 is well underway. More than 100 clinical trials are underway, including a large multi-country trial (“Solidarity”) launched by the World Health Organization.

Some of the drugs investigated, most or all being repurposed existing products, originate from Japan. They offer the best chances for a treatment to be found soon, although some of the drugs discussed these days, including one from Japan, present significant side effects profiles limiting their potential usage.

Prototype vaccines are also developed for prevention, but a few years will be needed for routine vaccination against this virus (as a reference, a first vaccine was approved against Ebola end of last year, about five years after the start of Ebola crisis). The immediate contribution of the industry relates to diagnostic tests, which are progressively made available around the world after a rapid development, some of them allowing results to be read after 15 minutes.

What else could this industry do for Japan? It is time to express solidarity and this could be done beyond measures already taken by companies (reduction of commercial activities, telework, event cancellations, etc.).

Idea No. 1: Pool together the progressively idle medical representatives (MRs) operating in pharmaceutical companies in Japan — who number up to 60,000 — and train them quickly to support medical facilities having to face the disease (this could be based on a volunteer system). There is a shortage of co-medical workers and this will become acute at pandemic stage as seen in Italy or other countries. MRs are usually well trained in medical matters and spend their time in health care facilities, where they are known from the medical staff.

Idea No 2: Provide manufacturing capacity from qualified industry sites in Japan to produce disinfectant products (surface and hand disinfectants). This may concern also the cosmetic industry, which is used to handle alcohol-based products. Big volumes are needed with a priority to the health facilities/providers, but also to the public.

Beyond the life sciences industry, other relevant industries should have already been tasked to produce respirators, ventilators and other needed equipment that are already scarcely available in the world. If some of these measures are already implemented, the public should be informed to feel protected at a time when basic goods have been missing in Tokyo for more than a month already.

These proactive approaches should be complemented by government-sponsored programs in order to encourage solidarity in research and development around COVID-19 (and its mutations as well as other future coronavirus risks):

Idea No 3: Allocate larger funds to the Agency for Medical Research and Development (AMED), for research programs related to COVID-19 treatment/prevention research (currently AMED displays on its website only one diagnosis program, one therapeutics program and two vaccines programs).

Additional projects or funds could be contributed by the Global Health Innovative Technology (GHIT) Fund, a Japanese public-private fund. Company contributions (financial and projects) should be integrated too and incentivized. This could be done in collaboration with global initiatives such as the ones of the Coalition for Epidemic Preparedness Innovations(CEPI) foundation, largely funded by Japan, and should focus on the virus strains and its mutations, to prepare for future pandemics.

Idea No. 4: Provide tax incentives, including deferred or/and limited price revisions to biopharmaceutical companies actively contributing to the above activities and to COVID-19 research.

Japan’s attractiveness to the global pharmaceutical industry has been decreasing due to multiple measures taken to limit the health care budget expansion, making it more unpredictable and less investment-friendly. Current unfortunate circumstances offer a possibility to build new frameworks and alliances to change these perceptions and trends. It will become acutely relevant at the time of recovery, when resources will be mobilized in a different world order.

Having had ample time to observe the lessons from other affected countries, it is now time for Japan to face this COVID-19 evil bravely and proactively: “ non progredi est regredi (To not go forward is to go backward).”

Philippe Fauchet is a former general manager of major global pharmaceutical companies in Japan, a director on the board of Japanese biotech companies, a healthcare industry consultant and an adjunct professor at the University of Tokyo.