The latest research being conducted in Japan is "preparing" drugs for the treatment of unknown infectious diseases

What kind of medical technology is needed to deal with unknown infectious diseases? Mr. Yoshiharu Matsuura, Director and Specially Appointed Professor of Osaka University's Infectious Disease Comprehensive Education Research Center, said, "Infectious disease research that has been carried out since the development of infectious diseases has been passive. We are not thinking about vaccines, but preparing therapeutics in advance, and by 2050 or so, it should be so. ”

Sooner or later, the virus infection will appear

To date, humanity has suffered in order to survive. One of them is the fight against infectious diseases.

As the oldest recorded infectious disease, traces of smallpox's characteristic incarnation have been found in the mummy of Ramses V, who ruled Egypt in the 12th century BC. Smallpox has been a recurring epidemic around the world since ancient times. During the Nara period in Japan, due to earthquakes and famines, coupled with the smallpox pandemic, in order to calm social unrest, Emperor Shomu built the Great Buddha of Todaiji Temple. In 14th-century Europe, a plague known as the Black Death killed a third of the population. In addition, malaria, cholera, tuberculosis, etc., human beings have been fighting deadly infectious diseases.

In 1796, Jenner of the United Kingdom successfully developed the first smallpox vaccine for humans, and the World Health Organization declared smallpox eradicated more than 200 years later in 1980. The antibiotic streptomycin, discovered in 1943, has played a great role in the treatment of bacterial infections, and in Japan, it is known as tuberculosis, a national disease, and streptomycin has saved many lives as a special drug. Thanks to antibiotics such as streptomycin, plague has now also become a rare infectious disease.

"Why can't Japan produce vaccines?"

"When I was a student, I heard a professor of microbiology say that infectious diseases will disappear in the 21st century, but they haven't disappeared at all. This exposes the social fragility of human resistance to infectious diseases, even with such advanced science. ”

So says Professor Yoshiharu Matsuura, director of Osaka University's Infectious Disease Comprehensive Education Research Center. Matsuura, an infectious disease expert, expressed concern that Japan is lagging far behind Europe and the United States in the development of new coronavirus vaccines.

"Japan has an unfounded confidence that 'it's a clean country with good infrastructure, so it's fine,' so infectious disease research itself is slighted, and researchers are not trained. When the pandemic (worldwide pandemic) hit, there was neither one nor money, and even if you were asked, "Why can't Japan produce vaccines and medicines?", you could only answer "no". It's not a question of what researchers are capable or incapable of. ”

The lessons of past infectious diseases have not been learned

New coronaviruses in the 21st century include SARS (SARS), which was endemic in Asia and Canada in 2003, and MERS (Middle East Respiratory Syndrome), which was prevalent in the Middle East in 2012. It is a virus that is very infectious and virulent. However, there is no need to develop preventive vaccines and therapeutics to solve the problem in advance through the classical countermeasures of isolation and quarantine.

"At that time, just produce drugs for SARS and mars. However, it was said that there was no demand even after production, so production was stopped. ”

It is true that the development of new drugs requires huge costs. For pharmaceutical companies, if they only invest and do not recycle, they will not survive. Nevertheless, the reason why European and American pharmaceutical companies were able to develop a new coronavirus vaccine in less than a year is because of the serious disaster, coupled with the accumulation of technology in developed countries for vaccines, the government has invested huge amounts of development funds.

Japan, which has almost no vaccine development record

In contrast, Japanese pharmaceutical companies have little track record of developing new vaccines. In 2010, based on the epidemic of the new influenza, a meeting of government intellectuals proposed strengthening the vaccine development and manufacturing system from the perspective of "national security."

But lagging behind in both research and development and budgets, it is a painful history that vaccines against H1N1 and MARS have been interrupted because they have not received state support.

In the past, there have been extremely rare cases of paralysis of hands and feet with live polio vaccines, and some Japanese people have delayed the development of vaccines because they are distrustful of the vaccine for fear of side effects caused by cervical cancer vaccines. However, as the vaccinated party, it is natural to consider the benefits and losses.

Vaccines such as mumps, whooping cough, influenza, etc., can be vaccinated for free in many countries, but Japan is charged, and the vaccination rate is naturally lower than that of other countries.

It is a mistake to cite these as reasons for delays in vaccine development.

There is no crisis management for infectious diseases

"Japan does not have crisis management for infectious diseases. Japan has absolutely no sense of national security. In this regard, foreign infectious disease research is actively promoted by the state. ”

In 2021, the OECD, known as the "club of developed countries", released the "Healthcare 2021 in the Chart", in which "Corporate Pharmaceutical R&D Expenditure and the Government's 2018 Medical Field Research Budget" showed that Japan's corporate pharmaceutical research expenditure was less than one-fifth of that of the United States, and the government's pharmaceutical research budget was 6% of that of the United States. Matsuura points out that this tendency is particularly pronounced in the field of infectious diseases.

Looking further at the OECD's medical data, CT, MRI (magnetic resonance imaging) and PET, two ultra-expensive diagnostic imaging devices, Japan's population is far ahead, about twice that of the second place United States.

Due to the expansion of the new coronavirus infection, there are many people who cannot be hospitalized, and even so, the number of hospital beds per population is the largest. On the other hand, the average number of doctors per population ranks sixth from the bottom among the 38 OECD member countries, and the "proportion of patients who give sufficient time during treatment" ranks lowest among OECD countries. Although expensive medical equipment and facilities are well equipped, there are not enough experts to make use of them.

In 2021, Osaka University opened a comprehensive infectious disease education research center in consideration of the worldwide pandemic of the new coronavirus infection and the promotion of infectious disease measures at "All Handai". The rationale for establishing the base is that "the proliferation of untold information on television and the Internet, basic research on underestimated infectious diseases, and a medical system that lacks resistance to infectious disease epidemics highlight the challenges facing Japan." ”

Fight with the idea of "one health"

An infectious disease is a disease caused by the invasion of a pathogen into the body. Although there are also diseases caused by fungi such as mold and yeast, parasites, etc., most infectious diseases are caused by bacteria and viruses. Among them, bacteria are small organisms that can only be seen with light microscopy, and as long as there are nutrients, they will divide and increase on their own. Among them are bacteria that are beneficial to our lives, such as lactic acid bacteria and nattobacteria, as well as bacteria that are often seen in food poisoning news, such as salmonella, Campylobacter, and Staphylococcus aureus. Tuberculosis is caused by tuberculosis bacteria.

Viruses are smaller than bacteria, so they must be observed using an electron microscope. And the virus cannot survive alone, but uses people or animals and plants as the host, enters living cells, that is, uses the host's system after infection, so that it replicates its own cells and increases. As a treatment, the use of antimicrobials and antibiotics against bacteria is effective. In contrast, antibiotics do not work against viruses. As a treatment for infections caused by viruses, treatments have been developed for influenza and HIV, but there are very few treatments for all viruses that cause infections.

Moreover, Tamiflu, which has high hopes as a flu treatment, can only shorten the duration of symptoms by about 20 hours. The pandemic of the new coronavirus is also a reason why we attach importance to virus countermeasures.

In this regard, Matsuura reflected on the idea of One Health. Regarding One Health, the Japan Veterinary Medical Association said, "All three are indispensable for the health of people, the health of animals, and the preservation of the environment. Based on the 'One' way of thinking, we build close partnerships and carry out activities to solve problems. Researchers have each conducted in-depth studies of several viruses limited to humans, but on the other hand, the situation of other viruses, even if the types are similar, is not clear to many people. Everyone is only doing their own profession and is in a state of exhaustion, although everyone knows that 'this will not work', but it is difficult to change. ”

Deal with this virus that has no name

Once a person is infected with the virus, as a biological response, the immune system kicks in to try to eliminate the virus. In this case, even if the type of virus is different, there will be a virus that reacts the same. The virus countermeasures proposed by Matsuura do not judge the type of virus based on its function and traits as in the past, but classify viruses according to the response pattern of the organism when the virus enters the body.

"Divide the biological response into several parts and prepare the corresponding treatment. For example, when a new epidemic disease appears, it is judged that "this is type B because there are such cells active." In this way, we will know, 'If we make this cell stronger, maybe we can get rid of it.'" ”

In the treatment that has been carried out so far, the diagnosis is carried out first, the name of the disease is determined, and then the treatment is carried out according to the guidelines established by the society and the procedures of insurance diagnosis and treatment. This is orthodox medicine in Japan. But the treatment Matsuura wants to do is the opposite. The name of the disease is uncertain and treatment is started according to the symptoms. Because, for unknown infectious diseases, there may not be a disease name at all. Even if the virus is identified from a pathological point of view, the symptoms will worsen during this period, and it may be too late. This is not the case, but the treatment and drugs corresponding to the symptoms are prepared in advance to deal with the new infection first.

Future medical treatment requires the preparation of therapeutic drugs in advance

"Making vaccines after infectious diseases emerge is the research of infectious diseases so far. Basically, the vaccine is launched later, so it will be launched later. We are not thinking about a vaccine, but about preparing a treatment in advance. For example, if there are symptoms of A, use this medicine, and if there are symptoms of B, use this medicine. In this way, as soon as an unknown infection appears, you can immediately say, 'This is effective, so let's try it first.'" Prepare in advance. I think by around 2050, that will be possible. ”

The Advanced Research and Development Strategy Center (SCARDA), a national undertaking, was established in 2022 to prepare various vaccines for pathogens that may cause influenza. In this regard, Matsuura et al. prepared the drug with the same point of view. In this way, not only infectious diseases caused by viruses, but also the possibility of responding to various diseases, if it can be achieved, will save many lives.

Learn about the virus and live "friendly"

The novel coronavirus caused a pandemic. In an era when science and technology, including medical care, were so advanced, almost no one expected that a pandemic of infectious diseases would lead to many deaths and social life would fall into great chaos. However, this has become a reality.

With the advent of the Age of Discovery, viruses that lived peacefully with wildlife were brought from the Old World to the New World, causing new infectious diseases. In modern society, large-scale human migration and densely populated urbanization, new lifestyles and various medical practices, petization of rare wild animals, and large-scale deforestation and other environmental destruction have made unknown viruses encounter humans.

One of the results of the people-centered pursuit of economic growth and new stimulus comes in the form of pandemics caused by infectious diseases. Based on the "One Health" philosophy described above, society in the future must consider not only human health, but also the natural environment including domestic animals. Animal health in a comfortable environment will also be more important than ever. Look at our bodies, there are many microorganisms in organs such as lungs and blood. Surprisingly, a person's body inhabits more than 100 trillion bacteria, molds, viruses, etc., and usually no problems occur. More precisely, for example, gut bacteria are able to digest food fiber that humans cannot digest. The formation of the placenta takes advantage of the functions of viruses that have been infected in the past. From the perspective of the virus, if the host dies due to overdoing too much, it will not be able to survive itself.

"Viruses know cells better than we do and speak the language of cells. So, don't just be afraid of the virus, it's more important to understand it. I hope we can get along. ”

Regarding the new coronavirus, Matsuura said, "It may be raging in an unfamiliar environment. "Emerging infections require appropriate prevention and treatment. At the same time, we hope to use the idea of "one health" to create an earth where living things, including viruses, can coexist.