The 7th Nikkei FT Communicable Diseases Conference

Yokohama Communicable Diseases Statement 2020、

Table of Contents
0. Introduction
1. Countermeasures Against COVID-19 in Japan (Interim Report as of Nov. 2020)
1-1

Domestic Preparedness

1-2 Border Control
1-3

Surveillance and Collaboration System (Public Health Centers and Prefectures)

1-4 Purpose and Strategy for Testing
1-5

ICT and Infection Control Measures Utilizing Big Data

1-6 Treatment & Measures Against Asymptomatic Individuals(Hospitalization and Quarantine)
1-7 Vaccine Development and Distribution
1-8 Containment System (Contact Tracing and Counter-Cluster Measures in Japan)
1-9 Scientific Research Projects to Support Communicable Disease Control(Research Questions)
1-10 Individual Freedom and Public Welfare in Communicable Disease Control
1-11 Decision Making in Emergency Situations
1-12 Public Behavior Modification and Risk Communication
1-13 Further Innovation and Infrastructure Improvement
1-14 International Cooperation System
2. Progress and Future Issues of P3 Projects Launched by the Conference
2-1 Asian Clinical Trials Platform P3 Project Report
2-2 Malaria P3 Project Report
2-3 Antimicrobial Resistance (AMR) P3 Project Report
2-4 Candidates for the Next Communicable Disease P3 Project
3. Conclusion<Reference>Contents of the 7th Nikkei FT Communicable Diseases Conference
Lunch Sessions / Special Sessions / Breakout Sessions

1

0. Introduction
As globalization deepens the interconnectedness of nations, Japan engages in growinginteraction with Europe and the US but also with Asian nations in economic, social, andcultural spheres. With the relationships between African countries also actively
strengthening, the risks brought about by emerging and re-emerging communicablediseases such as Ebola virus disease, tuberculosis, malaria, and antimicrobial resistant(AMR) bacteria, are ever increasing at global level. Moreover, the COVID-19 pandemic
which began in 2020 has highly alerted the global society that the communicable diseases
threatens not only the people’s health, but also social and economic activities. Thus, it is ofextreme importance to take this as an opportunity to further discuss communicable disease
countermeasures and share the outcomes of the discussion between all the related parties
including the public citizens.
This conference was first held in 2014 as the Nikkei Asian Conference on
Communicable Diseases, bringing together the representatives of the private sector,
academia, and government officials responsible for health from both within and outside
Japan, with an objective to propose P3 (Public-Private Partnership) projects to tackle
various challenges against communicable diseases. Taking advice from participants of the
6th Nikkei Asia Africa Conference on Communicable Diseases that this conference would
contribute not only to Asian and African but also to global communicable disease control,
this year the conference title has been changed to the Nikkei FT Communicable Diseases
Conference. Even though overseas traveling was restricted due to the influence of the
COVID-19 pandemic, key figures from around the globe gathered in person and virtually in
Yokohama, Kanagawa for the 7th Nikkei FT Communicable Diseases Conference on Nov 6
and 7, 2020.
The conference started by reviewing the national and global efforts against
COVID-19, and then moved on to discussions focusing on future countermeasures.
Important topics included a rapid and pertinent first response (including border control), atransverse and accurate information gathering system, containment measures, scientificresearch projects to support communicable disease control, a system in which thegovernment can make policy decisions and act upon optimum plans proposed by experts
based on the latest scientific knowledge, a system where regional hospitals can cooperate
and provide medical care, securing a supply chain of medicine and medical supplies
required for communicable disease control, proper distribution of information (risk2communication) that will lead to public understanding and modification of behavior, theusage of ICT (Information and Communication Technology), the balance between personalprivacy and public benefit, and public participation in policy decision making during the
midst of an epidemic. As the examples of the latest developments to overcome the COVID19 pandemic, Japanese innovations in diagnostic drugs, treatment drugs, and vaccines andcutting-edge technology seeds born in and outside Japan were also introduced. It was
confirmed that the preparedness towards an unseen future pandemic is essential, under thecommon consensus that many of the issues and countermeasures being applied not only to
COVID-19 but to other emerging and re-emerging communicable diseases as well.
In order to plan and execute various P3 projects, since 2014, volunteers among
participants of the Nikkei FT Communicable Diseases Conference have been organizing the“Asia Africa Medical Innovation Consortium (AMIC)” which consists of consortiums
working in multiple themes. The newest progress status and development of such P3
initiatives was also reported at the conference. For example, AMIC’s Asian Clinical Trials
Platform consortium has been working on a P3 clinical trials platform to be installed in
Thailand and Indonesia and reported that they are successfully moving forward withsupport from the Japanese government. Through open discussions between a wide range of
personnel, the conference participants confirmed the necessity and efficacy of P3 initiatives.
Furthermore, such future actions as deregulation for emergency use of Japanesetreatment drugs overseas in case of an outbreak such as Ebola or COVID-19, Malaria P3
projects in Asia and Africa, proposals to support the development of new antimicrobial
resistance (AMR) drugs, plans to improve public health such as universal health coverage(UHC), the active use and promotion of the latest technological innovations forcommunicable disease control, proposal for new P3 initiatives such as the foundation of apandemic lab (so called “Emergency response central testing lab”) as a preparation towards
future communicable disease pandemics, were suggested.
Through an active plenary panel and diverse sessions, conference participants
unanimously adopted the Yokohama Communicable Diseases Statement 2020. The
statement will be widely addressed not only in Japan, where the achievements will bereported at related government meetings, but also widely to the global society in Asia,
Africa and around the world. Using this deeper level of international understanding as
leverage, Japan will be able to fulfill its responsibilities to make a stronger commitment tocombatting communicable diseases worldwide.

3

Please refer to the following links for the statements from the previous conferences;https://project.nikkeibp.co.jp/event/6thnac2019/statement2019_en.pdf
https://project.nikkeibp.co.jp/event/5thnac2018/statement2018_en.pdf
https://project.nikkeibp.co.jp/event/4thnac2017/okinawastatement2017_en.pdf
https://project.nikkeibp.co.jp/event/3rdnac2016/3rdnac_tokyo2016_statement_en.pdf
https://project.nikkeibp.co.jp/event/2ndnac2015e/OkinawaCommunicableDiseasesStatement2015.pdf
https://project.nikkeibp.co.jp/event/1stnac2014/OkinawaCommunicableDiseasesStatement2
014.pdf

1. Countermeasures Against COVID-19 in Japan (Interim Report as of Nov. 2020)
As of the end of October 2020, the number of people who tested positive for COVID-19 inJapan was about 100,000 and the number of deaths was 1,755 (*1). The number ofconfirmed cases per million people was 794, the number of deaths per million was 13.9, andthe observed case-fatality rate was 1.75%. (Population of Japan: about 126 million).
Looking at the figures, the numbers pale in comparison to Taiwan, which experienced
Severe Acute Respiratory Syndrome (SARS), and to South Korea which experienced Middle
East Respiratory Syndrome (MERS). However, the figures are better compared to theUnited States and European countries. Considering Japan’s high proportion of the elderly
population, COVID-19 infections and deaths have been kept low as of October 2020. Japan’s
infection control measures are internationally recognized as relatively successful.
However, we cannot say that Japan was sufficiently prepared, as the country had
never in the past confronted a critical situation due to emerging communicable diseases
such as SARS. Also, during the 2009 outbreak of the H1N1 influenza, the mortality rate inJapan remained low. Although communicable disease control began with suchdisadvantage, it is thought infection was suppressed to a certain degree due to the
combination of the following factors:(1) publicized the so-called “3C’s” slogan (Avoid Closed spaces, Crowded places,
Close-contact settings) to citizens at a relatively early stage(2) healthcare providers pushed to secure access to medical care(3) workers at public health centers and local governments made efforts to identify
and respond to clusters at an early stage4

(4) citizens had strong hygiene awareness and took action
However, we cannot deny the possibility of a “Factor X” particular to Japanese andother Asians such as cross-immunity and genetic factors. Also, the domestic epidemicstrains may possibly be less pathogenic compared to those in other countries. Thus, it isnecessary to continue looking into why Japan has been able to control the infection to acertain extent. After this year’s conference, Japan was hit by the 3rd wave of COVID-19,
thus we must introduce new countermeasures and stronger communicable disease control.
The following is a summary of Japan’s communicable disease control measures; an outline
according to theme, issues that have risen, and actions to take in order to solve the issues.
*1 https://www.mhlw.go.jp/stf/newpage_14546.html (Japanese)

1-1

Domestic Preparedness[Outline and Issues]
As mentioned above, it can be said that Japan was not sufficiently prepared. Since 2000,
the world has faced numerous crisis of new communicable diseases such as SARS in 2003,
MERS in 2012, and Ebola hemorrhagic fever in 2014. However, in Japan, very few people
were infected and the country did not experience the crisis. Moreover, during the 2009
outbreak of H1N1, Japan’s mortality rate per 100,000 population was the lowest in theworld.
Following the outbreak of the H1N1 pandemic in 2009, the Act on Special
Measures for Pandemic Influenza and New Infectious Diseases Preparedness and Response(“Tokusoho”) was enacted in April 2012 in order to strengthen measures against
communicable diseases. At the same time, preparations for highly pathogenic bird flu andpandemic influenza were being discussed in Japan. However, these discussions did notinclude other possible communicable diseases which are highly infectious but not highly
pathogenic like COVID-19.
Initially, the government dealt with COVID-19 under the Infectious Disease Law
and the Quarantine Act. However, as the infection spread, the government revised this in
March 2020 in order to be ready just in case. COVID-19 was added to the revision, giving
legal authority to prefectural governors to issue a state of emergency, and request or5instruct people to refrain from going out or going to school. However, these restrictions had
no legal force or penalties for violation as they do in Europe and in North America.
In addition, the lack of preparation became apparent in many respects in adopting
measures for communicable disease control. There was an overwhelming shortage ofmanpower in medical institutions during the acute phase at the start of the COVID-19
outbreak. Likewise, there was a lack of manpower to handle numerous tasks in publichealth centers, public health institutes, and local governments. The system was found to be
fragile. There was not adequate coordination between local governments and public healthinstitutes, and between the national government and local governments. The roles anddiscretion of the national government and local governments were not clearly defined. As
there are frequent changes in the government’s elite personnel, only a limited few had
experience in crisis management of communicable diseases. It was also revealed that theacademia system was not adequately organized to promptly carry out research that would
contribute to communicable disease control in such emergencies. The government was also
not prepared to make policy decisions based on expert evaluations or communicate them tothe public in a clarifying manner.
[Actions to Take]
We must learn from the fact that Japan was not able to utilize the knowledge gained fromthe 2009 H1N1 influenza outbreak, and prepare for various emergency scenarios.
① Establish national governance for crisis management and conduct proper risk
management.
② Simulate emergency situations, develop human resources, and identify relevant
communities and companies. For example, develop human resources and networks thatcan solve research questions contributing to communicable disease control at times ofan emergency.
③ Establish a system in the government that can act as a control tower, responding toemergencies as one team. The team would include related government ministries,
companies and academia.

6

1-2

Border Control[Outline and Issues]
Japan dealt with border control in the early stages of the spread in response to the clusteron the British-registered cruise ship Diamond Princess. The cruise embarked on January
20 from Yokohama Port, making stops in Okinawa and Hong Kong. Infected people were
found on board the ship which returned to Yokohama on February 3. A total of roughly
3,700 passengers and crew members were forced to wait on board. When they finallydisembarked on March 1, 706 people had been infected and 4 had lost their lives. At thattime, Japan had set up a control tower function in the prime minister’s office making it
possible for cross-ministerial cooperation among the Ministry of Health, Labour andWelfare, the Ministry of Land, Infrastructure, Transport and Tourism, the Ministry ofForeign Affairs and the Ministry of Defense. This led to the success of suppressing newly
infected cases after the start of quarantine on board. However, there was a delay in
informing the public about the specific measures being taken on board and what the results
were. For this reason, it led to misunderstandings inside and outside of Japan.
It was a complicated situation in which the ship was registered in the UK,
operated by the US and docked in Japan. Nevertheless, from a humanitarian perspective,
Japan took steps to cover all necessary costs. However, it was pointed out that if thesituation involved the interests of multiple countries and presumed difficult for one country
to make decisions, it would have been possible to promptly inquire the WHO or the United
Nations for international consultation and coordination. If the measures taken by theJapanese government become the accepted rule if in the future, it raises concerns because
countries may refuse to let ships dock when there is an outbreak on board. We must
simulate such situations and discuss border control issues as a broader international
matter.
As measures for border control, the Japanese government has taken steps since
January to prevent COVID-19 from entering the country and to stop the spread of thevirus. They include measures such as immigration restrictions, travel advisories, testing ofreturnees, and stepping up quarantine. On January 30, the WHO declared that theoutbreak constitutes a Public Health Emergency of International Concern (PHEIC) and the
US issued a “Do not travel” advisory and an evacuation advisory. On February 2, persons
with a recent travel history to China were banned from entering Japan and on March 5,
landing restrictions were put in place for flights coming in from China and Korea.

7

Judging from the genome sequence analysis of viruses collected from across Japan,
it is thought that the transmission of the virus that stemmed from Wuhan, China and cameinto Japan up until the end of January has been completely contained. However, regarding
entry from Europe, where infection had been surging since March 2020, the Japanese
government did not put landing restrictions in place despite the government expert panel’surgent request to take action. Border closure was delayed and denial of landing from
European countries was not put into place until April 3. Behind the delay in responding toEurope, discussions were being held to examine the consistency of domestic and regional
infection control and border control. In addition, information from related ministries andagencies were being collected. Making decisions based on such information took time, andas a result, the delay allowed the EU virus strain to make its way into Japan and spread.
Furthermore, the system used by local medical institutions and public health centers tosystematically collect data on infection was inadequate. As the government could not
immediately grasp the country’s infection status, critical information was not reflected inpolicy decisions.

[Actions to Take]① When taking measures to both activate the flow of people and goods (the economy) andto suppress the influx of communicable diseases, the timing of execution should bedetermined with sound judgement. The judgement should be based on analyzing theinformation collected comprehensively and routinely from relevant ministries andagencies.
② It is necessary to build a system to accurately and quickly grasp the domestic influx ofcommunicable diseases. This is not limited to the issue of quarantine. Rather, a system
which systematically aggregates and analyzes the information accumulated indomestic medical institutions and public health centers is crucial.
③ For cases such as outbreaks on cruise ships, it is necessary to have international andtransparent discussions that include organizations such as the WHO, and swiftly
develop a structured set of rules on how to share the responsibility for cases involving
multiple countries; ship registration, operation, and port of call.
④ As closing and reopening of borders have a significant impact on the lives of citizens
and on economic activities, it is necessary to carefully explain and gain understanding
from the people through thoughtful risk communication.

8

1-3

Surveillance and Collaboration System (Public Health Centers and Prefectures)[Outline and Issues]
The goal of COVID-19 surveillance is to accurately understand the spread of the infection
and to enable public health authorities to effectively manage COVID-19 risks. In theinterim guidance on surveillance released on May 10, the WHO stated that the objectives of
COVID-19 surveillance include:•

enable rapid detection, isolation, testing, and management of suspected cases•

identify and follow up contacts•

guide the implementation of control measures•detect and contain outbreaks among vulnerable populations•

evaluate the impact of the pandemic on health-care systems and society•

monitor longer term epidemiologic trends and evolution of the COVID-19 virus•

understand the co-circulation of the COVID-19 virus, influenza and other respiratory
virusesSurveillance in Japan has been conducted using a system where information frompublic health centers is collected by the Local Infectious Disease Surveillance Center ineach prefecture. This information is gathered by the Infectious Disease Surveillance Centerat the National Institute of Infectious Diseases and reported to the Ministry of Health,Labour and Welfare. The public health centers standing at the forefront of COVID-19
surveillance has stretched beyond its capacity in providing consultation services. Citizens
complained about their phone calls not getting through.
Data gathering on the outbreak of COVID-19 took place as follows: If an individual
is confirmed positive, the doctor fills out a COVID-19 form by hand. It is faxed to the publichealth center where a staff enters the information into the National Epidemiological
Surveillance of Infectious Diseases (NESID) system. Abiding by this conventional procedure
made it difficult to collect information with speed and accuracy.
As a result, the Health Center Real-time information-sharing System (HER-SYS)
was created separately from the conventional surveillance framework. Currently, 99% of
local governments can aggregate information of infected cases by typing into this system.
However, many medical institutions are not entering data into HER-SYS. Doctors are still
sending the information by fax, and the staff at public health centers must type them into
the system. This is time-consuming and there is a time lag in the calculation of data. HER-

9SYS is designed to collect prognostic information such as hospitalization, discharge anddeath, but lacks the ability to systematically process the information.
The source of information on the number of infected cases viewed daily by the
public is the press release sent out to the media by local governments nationwide. These
are the numbers that the public tend to believe and rely on. COVID-19 clusters are
occurring all over the country and detailed information is accumulated in local medical
institutions and public health centers. However, there is no system to systematicallyaggregate that information.
Public health surveillance requires much effort by medical institutions and publichealth centers, but currently, the burden exceeds their capacity and HER-SYS is not being
fully utilized. As a result, various countries are voicing complaints that Japan, which drew
worldwide attention for the success of keeping the number of infected cases and deaths
under control, is not providing enough information. In order to realize effective publichealth surveillance, it is a top priority to reduce the burden by allocating more humanresources and increasing the budget.
[Actions to Take]① Promptly build a system that can quickly share COVID-19 status information between
local governments and the central government.
② Provide human and financial support to local medical institutions and public healthcenters that are critical for surveillance.
③ Introduce bold innovations such as apps in order to carry out surveillance effectively.

1-4

Purpose and Strategy for Testing[Outline and Issues]
There are 3 types of diagnostic tests for the novel coronavirus. The PCR test, antigen test,
and antibody test. In order to utilize these modules aiming to prevent the spread of
infection and severe illness in patients, we need to understand the efficacy, limitations, andpurpose of each test.
The PCR test, which detects the genomic sequence of the virus, was the only
diagnostic test available in Japan at the start of the pandemic and therefore attracted
much attention. It was publicized that the number of tests being conducted in Japan wasvery low, leading to public anxiety and the low number of COVID-19 tests became a social
issue.

10

After studying the correlation between the number of tests per population andnumber of positive cases in various countries, it was confirmed that countries with highpositive cases were doing more testing. It was also apparent that an increase in the numberof testing does not necessarily lead to better control of the spread of infection. Yet, testing is
an important tool in communicable disease control, and it was agreed that Japan should
increase testing capacity and strategically utilize diagnostic tests along with othermeasures.
There are 3 purposes for conducting a PCR test.
1. To gather information of COVID cases and quarantine patients in hospitals in order toprevent the spread. (Administrative testing)
2. To provide appropriate medical care and prevent hospital acquired infections. (Medical
testing)
3. To clear individuals for social and economic activities. (Private testing)After COVID-19 was designated as an infectious disease, the Ministry of Health,Labour and Welfare established a standard for conducting PCR tests. Cases with “a fever
higher than 37.5 ℃ or respiratory symptoms” were tested. By limiting the conditions to
conduct tests, the number of positive cases was controlled, which is one aspect of why
Japan was able to avoid a collapse in the medical system.
On July 16, the Novel Coronavirus Infectious Disease Control Subcommittee put
together the “basic rules and strategies for testing”. It classified testing subjects into thefollowing 3 categories and stated the basic approach for testing.
(1) Symptomatic: Must secure immediate testing to these clinically suspicious
patients(2a) Asymptomatic with high risk of infection/high pre-test probability: Should test
close contacts and groups which could form a cluster(2b) Asymptomatic with low risk of infection/low pre-test probability: Need to
discuss whether testing will contribute to stopping the spreading of infection
There is no doubt that testing is an essential tool to control the spread of infection,
but we must not overestimate its capacity and carry on with a clear purpose and reason andconduct tests in a structured system.

11

[Actions to Take]① As testing capacity increases, we must build and implement a strategy on who must be
tested and for what purpose.
② Nucleic acid amplification tests (such as PCR tests), antigen tests and antibody tests
should be utilized in accordance with their characteristics.
③ Medical institutions and private testing centers must secure quality control of theirtests.
④ The purpose of PCR tests (and other tests) needs to be explained to the public to gain
understanding.
⑤ Consider the establishment of a private testing organization (tentatively called thePandemic Lab) which will conduct general testing in normal times but can respond to
emergency situations such as a communicable disease pandemic and conduct required
testing.

1-5 ICT and Infection Control Measures Utilizing Big Data
[Outline and Issues]
How to utilize ICT and big data in measures against the novel coronavirus have attracted
attention. In addition to the aforementioned HER-SYS, Japan has taken the following
initiatives:(1) Contact-Confirming Application (COCOA)In March 2020, Singapore’s domestic distribution of a smartphone app to trace
infection routes became a hot topic and many countries followed with similar efforts. In
Japan, the government’s Anti-Covid-19 Tech Team that launched in April 2020, developed
a contact tracing app in collaboration with the Ministry of Health, Labour and Welfare.
Several private companies were developing or pursuing the idea and thegovernment was considering moving forward to ensuring compatibility between the apps.
However, on May 4, 2020 Apple and Google, developers of smartphone OS (operating
system) announced they will limit the development of apps using their technologies topublic health authorities. As a result, the Ministry of Health, Labour and Welfare decided
to collectively develop the app within the framework of HER-SYS.
COCOA uses short-range wireless communication technology (Bluetooth) on
smartphones to detect “contact” when users are within 1 meter of each other for 15 minutes

12

or more. The “contact” record is encrypted and recorded only in the user’s smartphone for
14 days. Personal information is not obtained. When a person who tested positive entersthe “processing number” issued by HER-SYS into the app, the notification server will notify
the app of the person who may have had close contact with the infected person.
The Ministry of Health, Labour and Welfare released a trial version on June 19,
2020. However, even after the one-month trial ended, developers were still busy debugging
the system. As of November 2, 2020, the app has reached approximately 19.21 million
downloads. The adoption rate in Japan is only 15.1%. One reason being that not many
people have a full understanding of COCOA. Behind this is the public’s general distrust inpolitics and the government.
Some of the world’s contact tracing apps, such as ones in China, South Korea andTaiwan, acquire location information from smartphone GPS data and capture personal
movement history. This GPS type is desirable when considering solely infection control.
However, in Japan a consensus on privacy matters could not be reached which led thegovernment to respect the Act on the Protection of Personal Information and settle with an
app that does not acquire personal information. At the conference, it was discussed that
although we should implement an app with functions to conduct public health measures,
we should always consider both public welfare and personal rights based on the Japaneseconstitution and infectious disease control law.
(2) Utilization of Mathematical Models and Big Data
As a measure against the novel coronavirus, the government adopted amathematical model of infectious diseases for the first time. In this model, the effective
reproduction number (the average number of people one person can infect if they have thevirus) goes down if measures are taken, and goes up if nothing is done.
On April 7, 2020, Japan declared a state of emergency. Prime Minister (at thetime) Shinzo Abe stated that “if we could reduce human-to-human contact by 80%, newcases will peak in 2 weeks and start to decrease after that.” The basis for this statement
was a simulation conducted by the Cluster Response Team of the Ministry of Health,Labour and Welfare. In order to evaluate the 80% reduction, they looked at the population
decline rate at points where people gather, such as major stations and downtown areas. Big
data called “human flow data” provided by cell phone companies, railway companies andsearch engine companies were used.

13

(3) Large-scale Survey by the Ministry of Health, Labour and Welfare using the LINE app
LINE signed an agreement with the Ministry of Health, Labour and Welfare andconducted the “National Survey for New Corona Countermeasures” via the LINE app 4times between late March and early May, 2020. The 5th survey was conducted in August.
Out of more than 84 million LINE users, the 2nd largest number of responses was 24.67
million (29.7% response rate). The 5th survey had the lowest number but still received 15.39
million responses (18.2% response rate). We can see the percentage of people with fever byregion as well as the preventative actions people have taken.
In the 5th survey, it became evident that those in the service industry such as foodstores and restaurants, entertainment venues, and taxi drivers found it be particularly
difficult to avoid the “3Cs”. However, even in such professions, the number of symptomaticcases were small for those who took protective measures. It can be said that infection canbe prevented even in the so-called “3Cs profession” if infection control measures are taken.
The main issues in utilizing IT for novel coronavirus countermeasures are as
follows:① Lack of end-user perspective such as the poor usability of HER-SYS② Real-time data necessary for policy decision-making cannot be collected③ Difficulty to collect big data necessary for making detailed analysis using mathematicalmodels
④ Difficulty to share and use data because data-entry forms and formats are not unified.
⑤ Too much time and effort spent by the Ministry of Health, Labour, and Welfare to build
systems such as HER-SYS, COCOA and G-MIS (Gathering Medical Information
System on COVID-19)⑥ Society’s slow adoption of infection control tools that utilize IT, such as COCOA[Actions to Take]The following actions are needed to solve the issues above:① System development with more focus on user interface (UI) and user experience (UX)
② Build a system that anonymizes individuals and allows the data to be used only forcountermeasures in the event of an emergency such as an outbreak of communicablediseases. A national consensus on the system is also needed.
③ Standardization of rules specified in the so-called “Problem Posed by 2,000 Personal
Information Protection Systems”(P2K problem) that hinder wide-range cooperation andutilization of personal information

14

④ Further promotion of open data (secondary data made available in machine-readable
format that can be accessed by anyone)⑤ Collect IT-related information and develop IT human resources in order to buildnecessary systems and develop software utilizing cloud services and open source in theevent of an emergency⑥ Promote cooperation with private companies and citizen engineers and develop a career
path that can go back and forth easily between private companies and the government
like a “revolving door”⑦ Ensure effective political leadership in emergency situations as well as public trust inpolitics and the government

1-6Treatment & Measures Against Asymptomatic Individuals(Hospitalization andQuarantine)[Outline and Issues]
In February 2020, COVID-19 became a designated infectious disease (Category Ⅱ
Infectious Disease) in Japan which requests hospitalization in a medical institution orrecuperation at home or at a lodging facility. However, during the so-called first wave in
April 2020, it took several days until the patient was admitted after first showing
symptoms since the number of PCR tests being conducted was extremely limited and thegeneral guide for medical consultation and testing was very strict. Furthermore, because
only a few medical institutions were able to admit COVID patients and because the clinicalstate of the disease had not been clear and treatment methods were not yet developed,
quite a few cases developed into a serious case.
Afterwards, asymptomatic people and those with only mild symptoms became
allowed to recuperate at home or at a lodging facility, and hospital capacity increased with
deregulation and compensation from the Ministry of Health, Labour and Welfare. This led
to an improvement in the system to hospitalize and quarantine. Testing systems also
improved, testing technology became more diversified, and treatment drugs showing someevidence were being developed.
In May 2020, the government fast-tracked the approval of the antivirus drug
Veklury (remdecivir) for severe cases, and Avigan (favipiravir) was approved for moderatecases. For both moderate and severe cases, the development of convalescent plasma therapy
and antibody drugs is also under way. As for anti-inflammatory drugs, dexamethasone has

15been approved for use. Anticoagulation therapy is also used depending on the patient’s
condition. Hence, during the second wave, the days it took until hospital admission was
shortened and the deathrate after hospitalization decreased in every age group.
Many academic and corporate institutions continue to work on the development oftreatment drugs, diagnostic technology and research of the disease. Recently, the National
Center for Global Health and Medicine (NCGM) identified five markers such as CL17 thatcan predict the onset of critical symptoms.
However, there is still a demand for a treatment drug that can deliver high efficacy
such as reducing the death rate of moderate and severe patients. It is important to continue
research and development to identify symptomatic and mild cases which have a high risk of
secondary infection or possess high probability of becoming critically ill. Implementing a
structured quarantine system to admit patients in medical institutions, lodging facilities, ortheir own homes depending on the risks is also important.
[Actions to Take]
Research and development in the following areas are required for treating patients andhandling asymptomatic cases.
① R&D for antivirus and immunomodulatory drugs that demonstrate high efficacy inmoderate and severe patients.
② Development in testing technology that can identify mild and asymptomatic patients
who may develop into a severe case. As for testing using the predictive markers identified
by NCGM, further research in a larger scale is needed to prove its efficacy. Development of
testing equipment and diagnostic drugs should also continue.
③ Current PCR tests are very sensitive and can even pick out individuals who have low
probability to cause secondary infection. There is a need to promote the development of
testing technology that can select those who are asymptomatic or only have mild symptoms
but still have a high risk of transmitting the virus.

1-7

Vaccine Development and Distribution[Outline and Issues]
Vaccine development for COVID-19 is ongoing worldwide at a faster pace than ever before.
For the ones that are ahead of the process, phase III clinical trials have begun, and someare applying for approval at the same time.

16

According to the WHO (*2), as of November 2020, 48 vaccines are in the clinical
trial phase and 164 are in the preclinical phase. As we look at the 11 which are undergoingphase III clinical trials, we see that many of them are mRNA vaccines or viral vector
vaccines which have rarely reached commercial application or have never been delivered
widely. If safety can be confirmed in the phase III clinical trials, it can be assumed thatsome of these vaccines will be commercialized in Japan as well.
As for vaccines under development in Japan, the following are leading ahead; (1)AnGes - plasmid DNA vaccine (2) KM Biologics - inactivated vaccine (3) Shionogi protein subunit vaccine (4) Daiichi-Sankyo - mRNA vaccine (5) ID pharma - nonreplicating viral vector vaccine (6) Research Institute for Microbial Diseases. Comparedto other countries, Japan has been late to begin vaccine development. Currently most havejust begun clinical trials or are in the preclinical phase. It is estimated that many willenter phase III clinical trials by 2021. Most of the vaccines being developed in Japan are
based on accumulated knowledge and experience. These will take more time untilcommercial application, but this trait may set them apart from the vaccines developed at
an early stage of the pandemic.
Never in Japan or anywhere else in the world, have so many vaccines beendeveloped and put to worldwide application in such a short period of time. What we canlearn from phase III clinical trials is limited, and therefore must bring to attention of thepossibility that some individuals may not effectively be protected by the vaccine, and that
we may see adverse reactions whether or not it is related to the administration of thevaccine.
[Actions to Take]The following actions are needed in order to push vaccine development in Japan and to
widely administrate the vaccines after they are approved.
① Set up cold chain logistics to widely transport and store the vaccines in an appropriate
condition.
② Build a structured information gathering system to swiftly collect real world data
(RWD) and respond to adverse incidents after commercial application.
③ As part of crisis and security management, provide both pull incentives and pushincentives so academia and corporations can put more effort in vaccine development at all
times.

17

④ Support companies so they can develop and distribute vaccines not only in Japan but inother countries as well.
*2 https://www.who.int/publications/m/item/draft-landscape-of-covid-19-candidate-vaccines

1-8

Containment System (Contact Tracing and Counter-Cluster Measures in Japan)[Outline and Issues]
Japan’s containment strategy was to strictly avoid the “3 Cs”, closed spaces, crowded
places, and close-contact settings.
From detailed surveying by public healthcare centers and medical institutions,from an early stage Japan was able to grasp the characteristics of how the novel
coronavirus spreads. The influenza virus is highly contagious and one patient can spreadthe disease to multiple people. On the other hand, with the novel coronavirus (SARS-CoV2), regardless of the severity of symptoms only 1 out of 5 patients spread the disease,meaning that 80% do not infect anyone else. Within that 1 in 5 (20%) who are contagious,
there can be a super spreader which leads to a cluster of patients and widespread of
infection. This means that this communicable disease spreads by forming clusters, leading
to the strategy of preventing the spread by controlling the clusters at the early stage of an
outbreak.
In many other countries, prospective contact tracing was adopted to identify
everyone who had close contact with the patient and monitor them for symptoms. In
addition to that, Japan implemented retrospective tracing taking into account the novel
coronavirus’ characteristic mode of transmission and investigated the patient’s past
activities to identify a common place of infection to comprehensively search close contact
individuals.
Japan’s counter-cluster measures;(1) Find a common source/place of infection, conduct retrospective tracing to those who
were present, hospitalize or quarantine individuals who were found to be positive.
(2) Warn the public at an early stage about the 3 Cs and the characteristics of what cancause a cluster of infections.

18Another point to take note is that there can be a diverse type of clusters. In theearly stages of the outbreak, travelers who had been overseas were the main catalyst of acluster, but as the pandemic developed over time, 5 other situations where identified ashaving a high risk of infection. “Gatherings that accompany eating and drinking alcohol”,“Eating and drinking in a large group for a long period of time”, “Having conversations
without wearing a mask”, “Living together in close quarters” and “Bringing the guard downwhen location changes”. A cluster may occur in various types of situations.
The level and method of containment should be reviewed according to the increaseor decrease in the number of COVID cases. Thorough and careful risk communication to the
public is also important since Japanese law does not allow compulsory measures and relies
on each citizen to make responsible decisions.
[Actions to Take]① Counter-cluster measures are the basis for containment since the virus has acharacteristic to spread via clusters.
② Diverse counter-cluster measures to meet various situations are required as the numberof cases increase.
③ Government must present scientific evidence and place an effort on risk communication
to the public to encourage citizens to change their behavior voluntarily.

1-9

Scientific Research Projects to Support Communicable Disease Control (Research
Questions)[Outline and Issues]
At the beginning of an outbreak, knowledge and data regarding communicable disease
control is very limited. In order to administrate communicable disease control during an
ongoing pandemic, various research questions must be answered before implementation.
In the case of COVID-19, research questions popped up one after another. Whatkind of people are likely to cause secondary infection? What kind of people are probable todevelop into severe cases? Are there any indications of infection before the onset ofsymptoms? Of course, large scale clinical trials were called for to confirm the safety andefficacy of treatment drugs and vaccines.

19However, as the virus began to spread rapidly doctors were swamped with daily
medical practices and it became difficult to work on research plans or clinical trials. No one
had the time to design a proper research project and conduct widescale research on anational level. Large scale clinical trials were conducted in Europe, USA, and Brazil where
the pandemic hit hard, but in Japan clinical trials and research were only conducted in asmall scale.
Ideally, there should be researchers who specialize in communicable disease
epidemiology and statistics, those who can work in coordination with clinical doctors todesign clinical trials and research projects to answer research questions. However, there
are very few experts in the field of communicable disease epidemiology and statistics who
can design such research projects.
[Actions to Take]
There is a need to work on the following during normal times in order to be able to swiftly
design a research project at the time of an outbreak to find answers to research questions
needed for communicable disease control.
① Develop human resources in the much needed field of communicable diseases andstatistics. (especially in Japan)② Identify experts in communicable disease epidemiology and statistics in order to make itpossible to coordinate a research project in times of emergency. The answers to researchquestions will serve as a base for communicable disease control.

1-10

Individual Freedom and Public Welfare in Communicable Disease Control[Outline and Issues]With the declaration of a state of emergency, there was a restraint on “individual freedom”
such as the freedom to travel and convene as desired. These are rights protected by theConstitution of Japan. Under the novel coronavirus special measures law, the request is
voluntary and does not impose any penalties. The contact tracing app is sensitive topersonal information, therefore does not acquire any data on personal travel records orphone numbers. Communicable disease control must analyze the information of infectedindividuals and those who are possibly infected. It is important to find a balance between
achieving the “public benefit” of communicable disease control and protecting “personal
freedom and rights”. Currently, there is a lot of talk to revise the novel coronavirus special
measures law, but there has been no fundamental or essential discussion regarding it. It is20

important to discuss these issues on a P4 platform (Public Private People Partnership) andachieve a national consensus.
Furthermore, in order to prevent the spread of communicable diseases, it also
necessary to discuss the responsibility of each citizen on a P4 platform (Public Private
People Partnership). According to the basic principles of the infectious diseases control
law(Article 2), “measures to be taken by the national government and local public entities
for the purpose of preventing the outbreak and spread of infections is [omit] to fullyrecognize the circumstances surrounding the patients of infections so as to be able to deal
with new and other infections promptly and appropriately, and the comprehensive andsystematic adoption of these measures while respecting the rights of the patients.” At thetime of enactment in 1998, it was stated as “considering the rights of patients” but wasrevised in 2007 to “respecting the rights of the patients” in response to human right issues
that occurred in past cases of communicable disease control. （*3）Keeping in mind thiskind of history regarding communicable disease control, when discussing the
responsibilities of the general public, attention is needed so that it does not go against thebasic principles of human rights.
*3

https://www.niid.go.jp/niid/ja/law.html?start=6 (Japanese)
Discrimination has been one of the issues during this novel coronavirus pandemic.

There have been many cases where the media reported information that revealed theidentity of the patient which then led to online slandering and discrimination on social
media. Particularly, the fact that there was so much online discrimination towards medical
and healthcare workers who were at the frontline fighting against COVID could have led toa collapse in the medical system. In September 2020, a working group focusing on
prejudice, discrimination and privacy was set up by the Novel Coronavirus Infectious
Disease Control Subcommittee. They plan to release an interim report in November.
Another issue has been the burden on women. With schools closed and telework
being expanded, it was mostly the women who were forced to take on more housework andchildrearing. Domestic violence in a stay-at-home environment has also been pointed out as
an issue.
Women are also having more difficulty in securing jobs. According to a report by
the research group studying the influence of COVID on women within the Japanese21

Cabinet Office, there was a huge decrease in employment in April 2020. Specifically, a
370,000 decrease in men and a 700,000 decrease in women which shows a large difference.
Looking at the number of suicides, 651 women took their own lives during July and Augustof 2020 which marks the highest in the past five years. If you compare the numbers of eachmonth, female suicides began to increase in June and reached the highest of 187 deaths in
August. The number of male suicides in the same month was 64. This phenomenon of more
female suicides than males is unprecedented.
[Actions to Take]① Discuss the fundamental and essential issue of how to balance “individual freedom” and“public benefit” in times of crisis without trivializing the issue to the appropriateness of thenovel coronavirus special measures law. Discussions should take place to achieve a national
consensus.
② Put together a preparation group to consider the launch of a volunteer group fromparticipants of the Nikkei FT Communicable Diseases Conference to further discuss this
topic on a deeper level among various members.

1-11

Decision Making in Emergency Situations[Outline and Issues]
When a large-scale cluster developed on the cruise ship Diamond Princess in February
2020, the Novel Coronavirus Response Headquarters of the Ministry of Health, Labour andWelfare gathered medical experts from across the country to form a COVID-19
communicable disease control advisory board. Later on February 14th, the advisory board
held the Novel Coronavirus Expert Meeting to offer advice from a medical standpoint.
Ideally, the government should make policy decisions after experts assess the risks
of proposals suggested by an advisory board. However, since the government was too
occupied responding to the Diamond Princess cluster situation, it failed to explain theperspective of COVID-19 to the public. As COVID cases gradually increased in Japan,
experts plunged forward taking part in communicable disease control which was beyond
their official duties.
The Novel Coronavirus Expert Meeting was not formed under any specific law andtherefore its placement and authority was never clarified. This subsequently led to an
impression that the experts in the meeting were in-charge of all the decision making. Some22

of the experts who participated in the meeting commented “We discussed issues day andnight to the best of our abilities, but I’m afraid we may have seemed like a solitary andunstable organization to the public”.
Later on July 6th, the Advisory Council on Countermeasures against Novel
Influenza and Other Diseases set up an all Japanese Novel Coronavirus Infectious Disease
Control Subcommittee which included economic experts as well. This is the course of events
which led to the call for a structured decision-making policy.
[Actions to Take]① Government should make policy decisions, and politicians should be prepared to explain
the content and reason to the public in a comprehensive manner. We must identify experts
in academia and private sectors to form a community so that government can summon an
all-Japanese team for communicable disease control in a state of emergency.
③ After the acute stage of a pandemic, move on to P4 (Private Public People Partnership)
initiatives. For example, invite experts on risk communication or include a citizens’ point ofview into policy making on communicable disease control.

1-12

Public Behavior Modification and Risk Communication[Outline and Issues]
In March 2020, Japan’s Act on Special Measures for Pandemic Influenza and New
Infectious Diseases Preparedness and Response was revised to include COVID-19. Hence it
became legal to issue a state of emergency and allow prefectural governors to request
citizens to stay home and schools to close. However, these requests cannot be enforced, andnon-compliance carries no penalties as in Europe and the United States. Thus, in order tosuppress the spread of COVID-19 infections, it has become important for citizens tovoluntarily change their behaviors and refrain from going out, on top of wearing masks,
washing their hands, gargling and sanitizing their hands.
Experts in Japan investigated what impacted the citizens to comply with stay-athome requests up until June 2020(*4). The investigation revealed that school closures, thedeclaration of a state of emergency, and governor requests to refrain from going out had acertain impact on the people’s behavior. What had an even greater impact was theinformation on the number of infected people updated daily by the government andprefectures. It was clear that a major factor that contained the infection was the citizens’

23

own thoughts to immediately refrain from going out. Moreover, the Cluster Response Teamof the Ministry of Health, Labour and Welfare and their expert panel identified situations
that have a high risk of clusters to occur. Citizens were told to avoid the “3Cs” (Closed
spaces, Crowded places, Close-contact settings). These actions coupled with the citizens’
high level of hygiene awareness led to voluntary decisions not to go out.
On the other hand, there were some cases where the citizens went too far. Whensome information released by the local government had contained personal informationthat could identify the individuals who were infected, those people became a target ofslander and defamation. There was discrimination and bashing against people in the“Nightlife districts” (Establishments providing food and drinks with entertainment)
identified as high-risk areas for clusters and even against healthcare workers. With limitedscientific knowledge, people were exposed to a flood of information through media reports
and social media that were rapidly spreading not only accurate information, but also fakenews, misinformation, hoaxes, and rumors. It was an “infodemic”. In addition to theimportance of mass media reporting and delivering accurate information based on thelatest scientific knowledge, we reaffirmed the significance to enlighten the public thatscientific knowledge is subject to constant change with scientific progress.
Including a “fun” element is also important in communicable disease control.
Taiwan confronted the coronavirus panic and conspiracy theories based on the idea of“humor over rumor.” Expert staff of the government used hashtags in social media andeven posted pictures of a dog, adding humor to scientific facts.
Risk communication should not be based only from a management perspective.
Perspectives of the actual parties involved must be included. Risk communication without
the perspective of the actual parties will only promote risks. Now that we are past the acutephase of the pandemic, risk communication regarding COVID-19 should be conducted
through a Public-Private-People Partnership (P4). We must listen to the voices of citizens
including minority parties. In order to make communicable disease control a natural andintegral part of our lives, it is important to involve society as a whole.
[Actions to Take]
One of the major factors that affected the infection status in Japan was that citizens
decided to modify their behaviors, such as voluntarily staying at home. Even though thewhole world is still anxious about how this pandemic will unfold, in order to effectively

24

practice communicable disease control it is necessary to have the citizens understand thecurrent infection status and various countermeasures.
① Deepen risk communication including a citizens’ perspective in order to promote
behavioral changes.
② After the acute phase of the pandemic, we must create a system to reflect the ideas of
citizens, including minorities, for policy decisions.
③ Mass media must report and deliver accurate information based on the latest scientificknowledge.
④ Come up with a way of communication including a fun element that will allow the
public to engage in scientifically-backed measures.
*4

1-13

https://www.carf.e.u-tokyo.ac.jp/research/5602/

Further Innovation and Infrastructure Improvement[Outline and Issues]
The COVID-19 pandemic has brought attention to the structural vulnerabilities ofJapanese society. Information gathering of infected individuals was not fast enough, andthe use of ICT tools in communicable disease control was insufficient. Crowded trains are
the norm since many citizens work in the city. In order to solve these issues, we must
utilize ICT, promote digital transformation (DX) and various other innovations to realize ade-centralized networking society instead of a centralized one.
Other than promoting DX in government administration and using ICT incommunicable disease control, it is also important to shift to contactless ways, such asincorporating more robotics, unmanned distribution, and developing cashless technology.
With more companies and individuals shifting to remote work, the average working style
has changed. People now have more freedom and flexibility to balance work and theirprivate lives. We can also expect the development of new services to support and improve
this new lifestyle.
The shortage of masks and medical equipment revealed the issues in the supply
chain of medical supplies and the medical device industry. With the global spread of
infection, many countries are taking a shift towards protective trade. Japan had promoted
international division of labour for medical ingredients calling for reciprocal developmentwith Asian countries continuing economic growth. This leads to concerns if a pandemic

25

reoccurs. Japan must prepare for a crisis in the international supply chain of medical
ingredients, respirators, masks, etc. Upon the outbreak of COVID-19, Japan was able toadminister the antivirus drug Avigan (Favipiravir) and swiftly conduct observational
studies. This drug had been stored as a treatment drug for novel influenza. However, thecountry still relies most of the manufacturing of pharmaceutical ingredients andintermediates to other countries, and therefore it is important to create a system to precurethese within Japan in case of a crisis.
One thing to be noted is the flexible management of Japan’s Pharmaceutical andMedical Devices Act. On April 3, the Pharmaceutical Evaluation Division and the Medical
Device Evaluation Division of the Pharmaceutical Safety and Environmental HealthBureau under the Ministry of Health, Labour and Welfare released a policy stating that“pharmaceutical regulations will be clarified in order to secure and manufacture respiratorsand other supplies for novel coronavirus disease control”. This means a speedier approvaland screening process for medical drugs, devices, in vitro diagnostics (IVDs) andregenerative medical products.
Innovations and improvement in infrastructure adapting to the new normal isnecessary. In order to progress smoothly, we can predict that reevaluation of various
regulations will be unavoidable.
However, it became evident that fear of every move being monitored by thegovernment was hindering the contact-confirming app from becoming widespread. It isnecessary to have a wide discussion and reach a consensus on how much restriction on
personal rights should be allowed to achieve public benefit. In order for continuous
innovation, a structural platform for P4 (Public Private People Partnership) communication
should also be considered.
[List of Innovations introduced at the Conference]•

Public-private coordinated PCR testing system in Kobe city (Sysmex)•

Real time PCR test with faster results (KYORIN Pharmaceutical Co., Ltd.)•

Nucleic acid amplification test by LAMP method with higher amplification efficiency
and shorter diagnostic time (EIKEN CHEMICAL Co., Ltd.)•

Antigen and antibody test kit that one can take at home while communicating withmedical institutions via phone or email (LOKI CONSULTING)

26

•

App providing one stop service of information sharing between parents and schools forthe child’s body temperature and physical condition, including medical interviews via
chatbot and medical counseling by doctors (LEBER)•

App to share COVID-19 case data between various medical institutions, a system tomonitor condition of COVID-19 patients, and an app that links together physicalcondition data and PCR test results for individuals participating in events (Allm Inc.)•

Unique system using blockchain technology for personal medical information, and an
information managing and sharing service linking data on daily social economic
activities (DataGateway)•

Innovation in Africa such as online medical advice service before testing or diagnosis,
and a database showing real time information of available ICU beds and inventory ofmasks etc. (AAIC)•

AI diagnostic support service for chest x-rays and CT scans (Delft Imaging Systems)•

Sustainable tuberculosis treatment service during the novel coronavirus pandemic
such as AI diagnostic support service for chest x-rays and CT scans (Stop TB
Partnership)•

System using AI technology with shorter time required for searching candidate
compounds etc. (Dassault Systems)•

System to quickly acquire antibodies from human peripheral blood in case ofcommunicable disease pandemic (EVEC, Inc.)•

A closed testing device that can conduct sampling and measuring of specimens andeven diagnosis (NIPRO)

Etc.

[Actions to Take]① Swiftly assess innovations ongoing in private corporations, and utilize them in a systemfor communicable disease control.
② Be prepared at all times so that influence on the supply chain is minimal during apandemic.
③ Develop new business models such as P3 to facilitate and accelerate innovation.
④ Discuss the launch of a P4 (Public Private People Partnership) platform to realize
sustainable innovation.

27

1-14

International Cooperation System[Outline and Issues]
The pandemic has shown that communicable diseases in the age of globalization cause
suffering not only to the country of origin. It has proven to be a major disaster that directly
leads to a global threat in a very short period. This is also clear from the fact that bordercontrol measures cannot be established by one country alone. Multilateral cooperation thattranscends domestic interests is essential to confront global communicable diseases.
It is difficult for one country alone to develop therapeutic drugs and vaccines
necessary for countermeasures in a short period of time, hence it is essential to cooperatewith multiple countries. In April, the Japanese government announced its policy tointernationally expand clinical research on Fujifilm Toyama Chemical’s anti-flu drug,
Avigan (Favipiravir) regarded as a promising therapeutic drug, providing emergency grandaid of $1 million.
Regarding vaccine development capabilities, the Japanese government is actively
partnering with pharmaceutical companies such as Pfizer in the US and AstraZeneca in the
UK. International cooperation is also important in terms of securing medical equipment.
Many countries are moving to restrict exports of medical supplies, revealing a global supply
chain crisis for medical supplies such as ventilators and masks. On April 15, the Japanese
government requested an increase in the production of medical equipment and devices suchas ventilators and masks and also consulted with ASEAN member states to call for theprovision of these medical supplies to Japan.
It goes without saying that Public-Private Partnership (P3) will be critical inpromoting and accelerating innovation originating in Japan for future emerging and reemerging communicable diseases that of course include COVID-19.
Many P3 efforts are already underway in the research and development oftherapeutic drugs, vaccines and diagnostic technologies. ICT and big data owned by privatecompanies were used for contact tracing apps and for analyzing contact frequency. In the
future, P3 will become even more important. Not only academia experts but also experts
from private companies need to be involved in the government communicable disease
control measures. P3 will also be crucial in order to further promote international
cooperation in sharing Japanese knowledge on communicable disease control measures aswell as treatment and diagnostic technologies to developing countries.

28

The WHO is accelerating efforts to strengthen 4 areas: diagnosis, treatment,
vaccines, and health systems. In April 2020, the “ACT Accelerator” (Access to COVID-19
Tools Accelerator) was established as a framework for international collaboration to fairly
distribute the results of the WHO efforts to each country. As powerful nations compete toprocure vaccines, GAVI (the Vaccine Alliance), CEPI (Coalition for Epidemic Preparedness
Innovations) and the WHO co-launched “COVAX Facility”, a P3 initiative to jointly
purchase and distribute vaccines to people all over the world. The Japanese government
was quick to announce its participation and leadership among developed countries. Now,
over 180 countries and regions have joined to unite against “vaccine nationalism”. Whenthe vaccines currently in development are approved for practical use, they are expected tobe supplied in accordance with international cooperation. P3 initiatives involving numerous
countries and companies have never been carried out on such a large scale. It can be said
that P3 itself has shown new possibilities through COVID-19.
On the other hand, Japan’s ability to spread information across the world is weak,
missing the opportunity to make valuable international contributions. For example, Japan
has been recognized to have one of the highest levels of COVID-19 treatment in the world.
Japan possesses various medical information accumulated through trial and error which isuseful for healthcare professionals around the world struggling to treat patients. Even
though this useful information is an opportunity to make an international contribution,
Japan lacks the effort to compile the information, translate it into English and spread it
across the globe. Consequently, the information is not shared with healthcare providers
worldwide.
Another example is the nucleic acid amplification test using the LAMP method inwhich Japan was the first in the world to put to practical use. Although it is an excellent
platform in terms of precision and cost, it is not well known because of the lack of Japan’sability to spread information globally. Japan already has outstanding experience andtechnology. It can be said that actively sharing such information with the world is an
important part of international cooperation that Japan should focus on.
[Actions to Take]① Japan needs to make a strong commitment to various initiatives around the world suchas the ACT Accelerator.
② Japan needs to actively spread the country’s innovations to the world.

29

2. Progress and Future Issues of P3 Projects Launched by the Conference
Through open discussions among a wide range of participants and P3 (Public Private
Partnership) collaboration, the Nikkei FT Communicable Diseases Conference has
propelled various efforts against communicable diseases. Aiming to plan and implement P3
projects throughout the year, volunteers from the Nikkei FT Communicable Diseases
Conference organize the “Asia Africa Medical Innovation Consortium (AMIC)”. During thispast year, AMIC’s Asian Clinical Trials Platform consortium and Malaria consortium haveshown progress. A new AMR consortium has also kicked off and is currently working tocreate a concrete proposal to the government.
Although it can be assumed that government, private corporations and academia
resources will continue to be occupied to deal with COVID-19, it was stressed in theconference that each AMIC consortium needs to continue their activities to solve theproblems they each face. We are considering the formation of new consortiums like Dengue
Fever where Japanese P3 could contribute. Furthermore, conference members confirmed
the need to further develop P3 projects and discuss what kind of platform could create astructure for rapid response in times of an unknown communicable disease pandemic in the
future.

2-1

Asian Clinical Trials Platform P3 Project Report

Clinical trials for diseases uncommon in Japan cannot be conducted in Japan. In order forJapan to develop new drugs and diagnostic drugs for these diseases, it is necessary to setup
clinical trials abroad where the patients exist. There is a need for a network for
epidemiological studies on communicable diseases, a network of medical facilities, humanresource development, and strong relationships between local authorities and thegovernment. The Asian Clinical Trials Platform P3 project was launched at the 2017
Communicable Disease Conference, and an official proposal was submitted to thegovernment in 2019.
In July 2020, it was officially adopted by AMED (the Japan Agency for Medical
Research and Development) as a subsidized project “Pilot project and clinical research/trial
platform which will promote international research collaboration between Japan and Asian
countries in the field of communicable diseases” under the “Research project in clinicalresearch/trials and building a clinical research/trial network in Asia”. It is a JPY3 billion

30

public project with various sub-projects underway related to the novel coronavirus,
tuberculosis (Indonesia) and malaria (Thailand).
P3 projects are already producing results. The 5-aminolevulinic acid (ALA)
supplement by Neopharma Japan which was initially made to prevent the reinfection ofmalaria after elimination of the parasite and drug treatment has shown research resultsthat it could be effective against the novel coronavirus.

2-2Malaria P3 Project Report

200 million people were reported to be infected with malaria in 2016. Since its launch in2016, the malaria consortium has been organizing P3 projects in Asian and African regionsin the 3 fields of testing & diagnosis, drug development and vector control for prevention. A
government proposal was submitted in 2018 and deep discussions have continued, but after
the outbreak of the novel coronavirus actions against malaria have dwindled globally andthe death toll is estimated to rise. It was once again confirmed that it is important toreinforce and continue our efforts.
Since last year’s conference in September, measures against asymptomatic malaria
was again a focal issue in Asia, and projects continued under the Asian Clinical Trials
platform with NCGM taking the lead. Among the high-sensitivity tests in development(EIKEN CHEMICAL: An ultra-high sensitivity testing method using LAMP technology for
Malaria gene detection, SYSMEX CORPORATION: the XN-31 automated hematology
analyzer utilizes the principle of fluorescence flow cytometry to rapidly detect parasites),
the automated hematology analyzer was approved in June 2020 in Japan and is underevaluation at Mahidol University. Mahidol University and NCGM also agreed to launch a
co-project to evaluate the performance of the malaria LAMP method in epidemic areas inThailand. They aim to create a surveillance system for early detection of an outbreak thatcan supplement current testing methods. As for new treatment methods (Neopharma
Japan: 5-ALA supplement to prevent reinfection after elimination of parasite and drug
treatment), evaluation of efficacy is ongoing with the Laos Pasteur Institute as part of aninternational collaboration for structured clinical research and clinical trials.
In Africa, research led by Osaka City University’s SATREPS project is looking into
the possibility of eradication of Malaria in tropical Africa mainly with diagnosis andtreatment in severe cases of pediatric malaria (XN-31 and 5-ALA supplement mentioned

31

above) and vector control (Sumitomo Chemical: Olyset Plus which is a long lasting
insecticidal bed net that can give protection from insecticide resistant mosquitos, andSumiShield, which is an indoor residual spray). In coordination with JBCA (the Japan
Business Council for Africa) which was launched by the government after TICAD 7, inJanuary 2020 we accompanied the Cabinet Secretariat’s observation trip to Ghana and spokewith members of the local Ministry of Health. This marked the beginning of a public-private
coordinated effort towards communication with local governments and health ministries.
From now on we will work to harmonize regulations towards implementing new technology
and products in each country, support the government in meeting WHO Prequalification (PQ),
and accelerate our activities, mainly the development of new diagnostic and treatment
technology in coordination with the Asian Clinical Trials Platform initiative.

2-3

Antimicrobial Resistance (AMR) P3 Project Report

If no measures were taken against AMR, it is estimated that the annual number of deaths
will rise to approximately 10 million in 2050. In Japan, deaths related to two types of
antimicrobial resistant bacteria are estimated to be 8,000 per year. As the novel
coronavirus pandemic is drawing global attention, AMR can be called a “silent pandemic”.
However, research and development for treating AMR is drastically decreasing due to its
difficulty, high costs and low profit. Even if commercialized, the use of antimicrobial drugs
is usually held back in order to prevent the emergence of drug-resistant strains, andtherefore it is difficult to secure retail and expect enough profit that matches investment.
This is making large pharmaceutical companies to withdraw from the antimicrobial drug
market or sell out its enterprise. Some members at the conference expressed concerns not
only about AMR related deaths but also about necessary surgeries not taking place fromfear of surgical infections.
Many countries are adopting “push incentives” which support the funding ofresearch and development, however, except for a few experimental cases, there are no fully
established “pull incentives” that offer support after drug approval. Aiming to secure profit
after approval and to build a pull incentive system to sustainably support R&D of AMR
drugs, AMIC decided to launch an “AMR consortium” at the 6th Nikkei Asia Africa
Conference on Communicable Diseases.
The AMR consortium has since been discussing a feasible system in Japan,
preparing a proposal to the government by defining and classifying antimicrobial resistant32

bacteria and pull incentives, figuring out the budget scale and funding schemes, andplanning on how to alert the public about AMR and prompt a better understanding.
Namely, “MER (Market Entry Reward)” which ensures a predictable return on investment
on top of the sales income based on the amount used, “SM (Subscription Model)” where afixed price is paid periodically no matter how much is used, and a “profit guarantee system”
which ensures the same annual profit as other drugs for antimicrobials. The total budget
for this is estimated to be around 20 to 80 billion JPY per item. (2 to 8 billion JPY annually
if compensation period is 10 years)
Moving forward, it will be necessary to alert the public and deepen anunderstanding towards the risk of AMR and proper use of antimicrobials, strengtheninternational cooperation, and accelerate discussions on funding and pharmaceutical prices.
It will also be important to include a wide range of stakeholders in the discussions for a“One Health” approach. As for ways to approach the public, we must utilize new types ofcommunication tools to achieve effective risk communication. Industry, academia,
government and private sectors will continue to work together towards the realization of apull incentive system.

2-4

Candidates for the Next Communicable Diseases P3 ProjectP3 projects led by AMIC consortiums have produced some results, showing that Japanesetechnology seeds can contribute to global communicable disease control. The conference also
discussed about the seeds of future P3 projects.
Dengue fever is a communicable disease transmitted by mosquitos. Over 4 billion
people in 128 countries are at risk of infection, and there has been a case in Tokyo in 2014.
With global warming on the rise, it could become a more familiar disease in Japan. The live
attenuated dengue vaccine being developed by KM Biologics (Kumamoto city) shows an
immune response to all types of the dengue virus which lasts for five years in clinical trials
conducted with monkeys. Since there were no serious adverse events in the phase 1 clinical
trials, it will move on to phase 2 aiming to confirm safety on adults in an endemic region.
The Global Health Innovative Technology Fund (GHIT Fund) pointed out that the wholeworld is focusing on the novel coronavirus, but there is still a need to heighten awareness of
NTDs (Neglected Tropical Diseases). On the brighter side, the novel coronavirus pandemic
has led to innovations in R&D, access and delivery.

33

As for countermeasures against COVID-19 in Japan, we must expedite theconstruction of a specific action plan on how to be prepared for the next pandemic, and how
to solve the issues we are currently facing. There has been no fundamental discussion in
Japan on how to balance the right to personal freedom and communicable disease control
which is for the public benefit. P3 projects launched by this conference could be a good place
to start the discussion. Since testing capacity has been an issue with the novel coronavirus,
there was talk about establishing an emergency response central testing lab (tentatively
called the Pandemic Lab). There was also a suggestion to launch a new working group to
discuss the functions of a control tower organization “Community Against Pandemic(tentative name)” where industry, government, academia and the public would work
together to make strategical decisions based on information gathering, data science, andreal-world data.

3. Conclusion
Japan was able to suppress the 2009 H1N1 influenza pandemic but could not prevent the
COVID-19 pandemic. Although Japan’s case fatality rate is lower than other parts of theworld, as of yet no country has obtained effective measures to stop the COVID-19 pandemic.
Despite being in the midst of the pandemic, the conference was held to reflect on such
experience. We thoroughly inspected the country’s response to the COVID-19 pandemic
up until mid-November 2020, extracted problems, discussed the solutions and made some
proposals and agreements. It is our hope that the fruits of this conference will contribute tosuppress the second wave of the novel coronavirus pandemic as well as other emerging andre-emerging communicable diseases.
The Asian Clinical Trials Platform initiative, which was agreed at our 6th
conference, has begun to steadily move forward toward building bases in Thailand andIndonesia with the support of the Japanese government. The AMR consortium, establishedafter the 6th conference, is finalizing detailed proposals for P3 initiatives. The endeavors totackle communicable diseases (tuberculosis, malaria, Ebola, etc.) through P3 projects
launched by the conference have already produced some good results, confirming that P3
initiatives are effective for communicable disease measures. P3 proposals for dengue fever
were also made during this conference. Additionally, a P3 project to launch a “Pandemic
Lab (tentative name for an emergency response central testing lab)” was also discussed in
preparation for the next pandemic.

34

However, there are still challenges for P3 to overcome in communicable disease
control. It is imperative to raise political attention to communicable diseases in response to
the growing public interest in the novel coronavirus pandemic. Furthermore, efforts arenecessary to maintain continued public awareness of communicable diseases after COVID19 is contained. By further strengthening cooperation among stakeholders in Japan andother countries, it is our hope to see concrete progress being made at the 8th conference
regarding the “Actions To Take” proposed in this statement. The contents discussed in theconference breakout sessions are included at the end of this statement for reference.

[7th NIKKEI FT Communicable Diseases Conference]・Organizer: Nikkei Inc.
・Co-organizer: The Financial Times Ltd.
・Supporters: CABINET OFFICE, Office of Hideyo Noguchi Africa Prize,
Ministry of Economy, Trade and Industry, Ministry of Health, Labour and Welfare,
Ministry of Education, Culture, Sports, Science and Technology
・In Association with: Mitsubishi UFJ Research and Consulting Co., Ltd.,
Japan International Cooperation Agency(JICA), Bill & Melinda Gates Foundation,
Nikkei Business Publications, Inc.
・Special Sponsors: The Japan Pharmaceutical Manufacturers Association (JPMA),
BD Japan, Alfresa Corporation, H.U. Group Holdings, Inc., KM Biologics, Saraya Co., Ltd.,SHIONOGI, SYSMEX CORPORATION, DAIICHI SANKYO CO., LTD., Nippon Trading EST.,The Research Foundation for Microbial Diseases of Osaka University,
FUJIFILM Toyama Chemical Co., Ltd., FUMAKILLA LIMITED・Sponsors: Asia Africa Investment & Consulting, Eiken chemical Co., Ltd., Eclair Co.,Ltd.,MSD K.K., MTG Co., Ltd. Okura. Co., Ltd. KYORIN Pharmaceutical Co.,Ltd.,
Global Health Innovative Technology Fund(GHIT Fund), Sumitomo Chemical Co., Ltd.,
Takeda Pharmaceutical Company Limited, Sumitomo Dainippon Pharma Co., Ltd.,
Dassault Systèmes K.K. NIPRO CORPORATION, Japan Antibiotics Research Association,
Precision System Science Co., Ltd. LOKI CONSULTING Co.,Ltd.

35

<Reference>thContents of the 7 Nikkei FT Communicable Diseases Conference
Lunch Sessions / Special Sessions / Breakout Sessions

Lunch Session 1 (BD Japan)“The role of testing in communicable diseases -Learning from COVID-19”
In the early stages of the novel coronavirus outbreak, tests and diagnosis for the clusterthat broke out on the cruise ship “Diamond Princess” were conducted in collaboration withToho University using Becton Dickenson Japan PCR testing devices. During April and May
when public health centers were conducting the tests, it took several days for the results tocome out. This resulted in the high consumption of personal protective equipment such asmasks in medical institutions such as the Toyonaka Municipal Hospital. The situation
improved after it became possible to carry out rapid testing at the hospital. Issues in thetesting system became apparent in this pandemic, and industry, government and academia
need to work together to build a system for crisis management. It is also important tomeasure cost effectiveness from the perspective of medical economics and consider how to
cut down the use and preserve the limited medical resources, including human resources.
Revising the testing system should lead to conserving medical resources.
Rapid testing is also important in communicable diseases caused by antimicrobial
resistance (AMR), a problem that is becoming more serious in Japan. Rapid testing willallow proper and targeted use of antimicrobials and lead to suppressing the occurrence
AMR. Toyonaka Municipal Hospital has adopted a device to check for methicillin-resistant
Staphylococcus aureus (MRSA) infection. Conducting this test in advance has helped
prevent infection, but such method has not expanded nationwide. It was pointed out frommultiple stakeholders including doctors working at the forefront that we should establish asystem for communicable disease testing that offers medical fee reimbursement andinsurance coverage for equipment use.

Lunch Session 2 (The Japan Pharmaceutical Manufacturers Association)“Strengthening Future Measures against Communicable Diseases through PPP-Towards Prompt Supply of Essential Therapeutic Drugs and Vaccines”
In Japan, in order to shorten the development period of therapeutic drugs for COVID-19,
progress is being made on drug repositioning, which is an approach to utilize alreadyapproved compounds. For vaccine development, industry and academia are working

36together to focus on new methods such as messenger RNA. The country is moving forward
by improving the production system and securing vaccines from overseas manufacturers.
Japan was one of the first countries to commit to “COVAX,” a framework in which eachcountry jointly invests and purchases vaccines for the novel coronavirus, and currently,
more than 180 countries are participating.
On the other hand, the AMR Action Plan compiled in 2016 has not shown muchprogress. Promoting AMR research and development was one of the pillars indicated in theplan, since antimicrobial resistance (AMR) has continued to become more serious in Japan.
In July, more than 20 pharmaceutical companies around the world, including 5 from Japan,
pledged about US$1 billion and provided funding to venture companies that develop
antimicrobial drugs. The “AMR Action Fund” was also established with the goal oflaunching 2 to 4 items in the next 10 years. It is also necessary to have pull incentives toprepare the market environment after launching and allow companies to continue
development.
Even after the complete suppression of the novel coronavirus, other communicablediseases and threats such as AMR will occur. In order to effectively promote measures
including research and development against communicable diseases, it was suggested weshould have a “control tower” that can draw up national strategy plans. Communicabledisease control is a part of national security in the US. As activities by private companies
decline when it comes to communicable diseases, it is important to establish a system toensure researchers stay in academia.

Special Session (Bill & Melinda Gates Foundation)“Embodiment of “Sanpo-yoshi”- Global Health and the Japanese Private Sector”
The Japanese government has contributed US$130 million to the “Gavi Vaccine Alliance,”
an international organization that promotes access to vaccines for developing countries. In
order to promote R&D and production of the novel coronavirus (COVID-19) vaccine, they
have also contributed US$98 million to the Coalition for Epidemic Preparedness
Innovations (CEPI), an international public-private partnership. In addition, Japan was thefirst developed country to pledge funding to ACT Accelerator, a countermeasure framework
for COVID-19 supported by Gavi.
These frameworks such as Gavi and CEPI have been supported by the Bill andMelinda Gates Foundation. According to a research method commissioned by the Gates
Foundation, if the first 2 billion doses of vaccine concentrate in the wealthy countries, theglobal death toll could be double that of a fair worldwide distribution.

37

Shionogi & Co., Ltd. reported that there could be more than 10 million AMR
related deaths by 2050, exceeding the number of deaths from cancer. The company
identifies communicable diseases as the most important treatment field.
However, there are 2 issues. One is that only 0.4% of researchers in Japan
specialize in communicable diseases. Also, unlike the field of cancer and rare diseaseresearch where profit can be generated, the issue is how to continue the business ofcommunicable diseases which is likely to fall into the red. It is necessary for public andprivate sectors to create a system to support companies with pull incentives. Furthermore,in order to continue innovative R&D, it is essential to further refine efforts such as
developing patent-based businesses in advanced countries while giving up patent incomesin emerging countries.
Takeda Pharmaceutical Company announced that it has established a joint systemwith other pharmaceutical companies to develop Takeda’s fractionated plasma products
and hyperimmune globulin medicine for treating patients at risk of severe COVID-19.
Clinical trials have already begun and they plan to make treatment available as a nonprofit drug in 2021. The company is also conducting Phase 3 clinical trials for a dengue
vaccine which they expect to apply for regulatory approval in early 2021.
Since June 2019, NEC has been working together with the Gavi Vaccine Allianceand Simprints, a British scanner technology startup. They aim to make vaccine accessible
by developing fingerprint authentication for infants. With the support of the Gates
Foundation, a demonstration experiment began in Tanzania in August 2020 and in
Bangladesh in November.
Japanese companies have inherited the “Sanpo-yoshi” management philosophy of
the Omi merchants in the Edo period, in which there is a 3-way benefit for sellers, buyers
and the community. In order to realize Sanpo-yoshi, a medium to long-term strategy that
includes financing and human resource development is indispensable. Strategic
partnerships between different sectors are also important for expanding andcommercializing sustainable models in developing countries.
In order to support the efforts of Japanese companies on global health, The Gates
Foundation funded Mitsubishi UFJ Research & Consulting which established “WELCO
Lab” in October 2020. 13 companies are currently taking part in this new businessinitiative.

38

Special Session I (Research Foundation for Microbial Diseases of Osaka University BIKEN Foundation)“Challenges in Preventing and Controlling Emerging Infectious Diseases- A look at BIKEN's Vaccine Development Platform”
The Research Foundation for Microbial Diseases of Osaka University (BIKEN Foundation)
which started in 1934 is an institution where industry, government and academia areworking together to develop a vaccine against the novel coronavirus (COVID-19).
The foundation is currently conducting research on various types of vaccines suchas inactivated vaccines, live-attenuated vaccines, protein-based vaccines (including VLP
vaccines), and recombinant vaccines (including viral vector vaccines). Utilizing its long
history of experiences in R&D and manufacturing, the foundation plans to select an optimalcandidate for development and aim for practical application.

Special Session II (KM Biologics)“Expectations for development of COVID-19 vaccines in Japan:
Development of an inactivated vaccine by KM Biologics”
KM Biologics succeeded the main businesses of Kaketsuken and joined the Meiji Group in
2018. The company develops and provides a wide range of biopharmaceuticals including
human vaccines, animal vaccines, plasma derivatives and neonatal screening. With regards
to the novel coronavirus (COVID-19) the company is working on the following:(1) Creation and development of an inactivated vaccine(2) Creation and development of a live attenuated vaccine(3) Formulation of AstraZeneca’s viral vector vaccine(4) Manufacturing and supplying adjuvant for GlaxoSmithKline
For the manufacturing of COVID-19 vaccines, the company will utilize the novel
influenza vaccine manufacturing facility built under a government project.

Breakout Sessions A-1 & A-2 (SHIONOGI／ DAIICHI SANKYO CO., LTD.)“Challenges and Efforts to Address the Threat of Infectious Diseases- Learning from the Cases of AMR and COVID-19”
The global outbreak of the emerging communicable disease COVID-19 has strongly
reminded us of the threat of communicable diseases. Many of the arising issues such as
AMR are common with other emerging and re-emerging communicable diseases.

39

From the standpoint of national crisis management, preparation is paramount. We
must continuously work on a system that will wisely utilize clinical data into R&D, develop
human resources and expand a scientific foundation regarding communicable disease
control. In order to create a market environment where corporations can secure business
continuity, there was talk about the need for new systems such as push and pull incentives
that can secure sustainability not just for the development but also for manufacturing anddistribution of vaccines and treatment drugs. Participation in global scale frameworks was
also encouraged.
In order to realize these activities, stronger coordination between industry,
government and academia will be key. Foundation of an organization that can serve as acontrol tower for tackling various issues is called for. We must also make sure that thesystem incorporates the voices of the public.

Breakout Session A-3 (SYSMEX CORPORATION)“Be confident fighting malaria -Innovative diagnostics towards achieving SDGs”
Malaria is one of the three main communicable diseases in the world. Early diagnosis andefficient testing are key to providing proper treatment. The automated hematology analyzer
utilizing fluorescence flow cytometry can not only rapidly detect malarial parasites, but it ishighly sensitive and does not require expertise compared to traditional testing devices
which use antigen and antibody response.
The issues regarding malaria-countermeasures are different in each region. In
Asia, AMR and the occurrence of new types of malaria along with medication adherence are
the main issues. In Africa, there is also a serious social issue of malaria-related anaemia
leading to poor labor productivity. Innovations in malaria testing could help to resolve suchsocial issues. As the novel coronavirus (COVID-19) pandemic is calling for solutions which
can adapt to our society, corporate innovations can not only contribute to communicabledisease control but also to the achievement of SDG goals.

Breakout Session B-1 (H.U. Group Holdings, Inc.)“Optimal COVID-19 test selection based on characteristic of testing method”
When testing for the novel coronavirus (COVID-19), a PCR test and antigen test detects thecurrent state of infection, while an antibody test detects if one was infected in the past. The
Japan Medical Association task force submitted a progress report in May which outlined
three issues on why PCR tests were not being conducted enough.

40

1. The issue of human resources, equipment and testing facilities
2. A supply side issue of corporations
3. Issues in the administration system of testing facilities
Furthermore, a US report has shown that the sensitivity of PCR tests varies bymore than 7000 depending on the reagent, which tells us there are still issues instandardization and accuracy control. On the other hand, a test with high sensitivity has ademerit of possibly detecting fragments of the virus from patients who are not contagious.
According to data released by the Ministry of Health, Labour and Welfare, it’s been taking
about 5 days from the onset of symptoms until a patient is diagnosed with COVID-19. If
patients are contagious for 7 to 10 days after the onset of symptoms, this period must be
shortened in order to suppress the spread of infection. Rapid antigen tests and highsensitive antigen tests that match PCR tests are available now, and we must utilize themas needed. Nasopharyngeal swabs have the risk of causing coughs or sneezes, but nasal
swabs and testing with saliva is also available now. This could be a positive for hospitals
and clinics now that we are entering flu season as well. Organizing a structure forstandardization and accuracy control is also essential. The development of Japanese drugs
is also crucial to secure a stable supply within the country.

Breakout Session B-2 (Saraya Co., Ltd.)“Infection prevention and control in the era with COVID-19: New Normal of healthcareassociated infections and public health”
A “zero tolerance” stance in healthcare-associated infection is necessary for IPC (infection
prevention and control) of COVID-19. On the other hand, it is difficult to cease social andeconomic activities outside the hospital, so we must find a balance between
countermeasures against this public health crisis and take actions in two stages.
On the Diamond Princess cruise ship, those who tested positive and those who
were suspected to be infected were quarantined in their rooms, but asymptomatic
individuals were sharing facilities with other passengers. The surrounding environment of
COVID-19 patients is highly contaminated with SARS-CoV-2, and contact through various
environmental surfaces is thought to be one of the causes of the spread of infection. It has
been reported that SARS-CoV-2 retains infectivity on environmental surfaces for about 3days, which means hand hygiene and sanitizing the whole area where a patient has been isespecially important.
Our society still lacks effective vaccines and medical drugs, hence NPI (nonpharmaceutical interventions) is necessary. We must take measures from a public hygiene

41standpoint such as the use of ABHR (alcohol-based hand rubs). Experts in this field should
cooperate to advertise measures based on scientific evidence and explain the usage ofhygiene products in detail to build trust with the public users.
Saraya has been working with the Osaka Research Institute for Microbial Diseases(Masato Igawa Laboratory) since May 2020, conducting efficacy evaluation tests using the
new coronavirus pathogen (SARS-CoV-2) in their products and sterilized components.
The development of new drugs and vaccines during this state of emergency is also
imperative. We must establish “adaptive design clinical trials” which allows modifications
to the trial and/or statistical procedures in treatment groups predicted to show higher
efficacy.

Breakout Session C-1 (FUMAKILLA LIMITED)“Inactivation of novel corona virus by low-alcohol products- Possibility of contributing to countermeasures in daily life
In order to prevent the spread of COVID-19, it is important to prevent contact infection as
well as droplet infection. Since February 2020, not only facemasks but antiseptic supplies
including quasi-pharmaceutical products and everyday commodities were sold out in many
stores. However, scientific verification of the efficacy of these goods to eliminate the novel
coronavirus (SARS-CoV-2) was not conducted.
FUMAKILLA has been selling low alcohol antiseptic wipes since 1986 and theirwide variety includes kitchen wipes, garment wipes, hand wipes and so on. By combining
fermentation alcohol, grapefruit seed extract which has a natural antibacterial
characteristic and pH adjusters, their products are said to eliminate bacteria and viruses
quickly. A virus inactivation test conducted at Hiroshima University showed that these
antibacterial components had an effect to inactivate the novel coronavirus.
Enveloped viruses such as the influenza and coronavirus are packaged in a lipid
membrane which dissolves with alcohol. This is why alcohol antiseptics are generally
effective. Furthermore, since grapefruit seed extract is slower to evaporate and remains on
the surface, it can be said that the effect to eliminate and destroy the virus is sustained
longer.
Kitasato University conducted a virus inactivation experiment in test tubes withvarious products on the market containing ethanol and surfactants that may have adisinfection effect on the novel coronavirus. The results showed that ethanol with a densityof over 50% can disinfect a solution containing 30,000 novel coronaviruses in one minute ofcontact time.

42

These commodities and quasi-pharmaceutical products with viral inactivation
properties can be utilized to clean not only solid surfaces such as hands and fingers but also
clothes and other daily items made with fabric. Such information and products should bemade known globally.

Breakout Session C-2 (FUJIFILM Toyama Chemical Co., Ltd.)“Treatment Drug for COVID-19 – Effectiveness and Validation”
COVID-19 has become a global pandemic. Beginning treatment at an early stage of
exposure to SARS-CoV-2 or at a pre-symptomatic stage, is said to reduce the number ofsevere cases and deaths.
An animal model (hamsters) with COVID-19 pneumonia has shown thatadministration of Avigan (favipiravir) has an antiviral effect. Administering the drug postexposure at a pre-symptomatic stage results in higher efficacy. At the Diamond Princess
cruise ship, Avigan was administered to asymptomatic individuals and mild case patients,
and results showed it has an effect to break the fever earlier. There were no severe cases ordeaths in the cruise ship case.
Clinical trials on non-severe pneumonia patients has shown efficacy to reduce theperiod of disease, and Avigan is currently waiting for approval. We must enhance contact
tracing, consider randomized controlled trials on the efficacy of post exposure prophylaxis(PEP), begin PEP or drug treatment in case of outbreaks in long-term care facilities andnursing homes to contain the infection, and gather high quality data within Asia utilizing
the Asian Clinical Trials Platform.

43