As of end of January 2021, concerns in Japan grow over domestic production of vaccines, as Chief Cabinet Secretary Kato Katsunobu has reinforced.[1] The deaths of some elderly Pfizer vaccine recipients in Norway, as well as other news of some other allergic or immune reactions, have produced concern in the public.[2] Israel’s vaccine take-up and Prime Minister Netanyahu’s willingness to share critical inoculation data is a fascinating examination of give and take in global health.[3] But some are commenting that Israel has about the same number of deaths with a smaller population, and more seriously ill cases: essentially, its national situation is several times worse.
Currently, the major vaccine orders come from US Pfizer, US Moderna, and UK Astra Zeneca. Pfizer’s vaccine was the first to seek Japanese health ministry approval, submitting application with fast-track request in December 2020.[4] The Japanese government had negotiated a deal of 120 million doses from Pfizer at an early stage, around July 2020.[5] Pfizer and Japanese authorities have had a good relationship since AIDS treatments in the late 1980s, in a kind of three-way relationship with Burroughs Wellcome (now GSK) to manufacture enough supply of AZT, a few more details in my upcoming article ‘Pricing Retrovir’. Pfizer vaccines will be rolled out in the country in February for the elderly and front-line healthcare workers, and on in phases throughout March and April. Kono Taro was appointed the new ‘minister for vaccines’ on 19 January 2021.[6]
A few days ago, AstraZeneca signed an agreement with Hyogo-based JCR Pharma to ensure that vaccines sold to Japan will be manufactured domestically. Six companies will receive government subsidies for production infrastructure to match vaccines to the national population: AstraZeneca, Takeda Pharmaceutical, Daiichi Sankyo, Shionogi, AnGes and KM Biologics.[7]
The ‘All Osaka’ vaccine effort led by Osaka University has presumably been plugging along, so let me dive into the biomedical particulars in another post, because it has not been reported in the media as it doesn’t seem directly relevant to national public health. I am curious to see whether the Osaka vaccine is intervening fundamentally in the conversation on domestic vaccine supply.
In contrast to AIDS, therapeutics are considered secondary to vaccines (ironic!) but the fundamental research on viruses and immunology is ongoing, with some therapeutic applications. At University of Tokyo, Professor Inoue Junichi’s team has for the past year been looking for treatments and in March 2020, announced the potential effectiveness of an existing treatment, Nafamostat (ふさん).[8] Inoue commented to ANNnewsCH, ‘the fundamental scientific research on the virus itself is continuing at extraordinary speed and we are certainly learning a lot’ (my translation). His team started clinical trials in May 2020 but cases in Tokyo declined to about 2 patients/day and data could not be gathered. Conversely, now, with the rising number of seriously ill, there is not enough staff on hand to help with the research – neither too little or too many patients helps research progress.[9] Existing treatments such as Remdesivir, Avigan and Ivermectin have been considered before in various countries. With members of the Japanese public concerned about the vaccine fervour, there is some growing support for therapeutics as opposed to vaccines, especially from countries with significantly different domestic COVID situations.
Figure: Inoue’s Visualisation of Nafamostat potentially prevents entry of COVID virus into cells. Screenshot from: ANNnewsCH, 「待たれるコロナ『治療薬』 その研究“最前線”」2021年１月1日<https://youtu.be/eq8eEsdRwK8>.
This reminds me of historian of medicine Victoria Harden’s National Institutes of Health 1997 oral history interview with Dr Samuel Broder at the National Cancer Institute on how azidothymidine was synthesized through bringing together fundamental research progress on molecular immunology: the 1970s was, in the history of US medical research, the era of NIH-driven cancer research.[10] I particularly enjoyed Dr Broder’s recollections on how, in the rush to cure for HIV, there was a "lack of an appreciation, an ineradicable lack of appreciation, for the role that certain types of clinical advances play in the basic research agenda." He expands:
“There was a destructive level of skepticism at one point. Some scientists forgot that skepticism is a tool of science; it is not a replacement for science. It is a tool that allows you to analyze, to weigh and consider, not to be fooled, not to let your emotions run away with you.” (Broder 1997, Harden with Interview, p. 11)
So is it research on treatments or vaccines that progresses our fundamental understanding of new and emerging viruses and their interactions with the human body? Are fundamental understandings of the virus and its interactions with the human body (even various human bodies in different environmental circumstances) needed in order to make effective vaccines?
[1]テレ東N EW S「コロナワクチン国内位で生産へ」2021年1月28日<https://youtu.be/4NYPbznc__I>. [2] ANNnewsCH「ワクチン接種後に高齢者が相次ぎ死亡 ノルウェー」2021年１月１９日 <https://youtu.be/MDJ36VLINSk>; John Lauerman and Jason Gale, ‘What to Know about Vaccine-Linked Deaths, Allergies’, Bloomberg (18 January 2021) <https://www.bloomberg.com/news/articles/2021-01-18/what-to-know-about-vaccine-related-deaths-allergies-quicktake>. [3] Lionel Laurent, ‘Israel’s vaccine data has lessons for all’, The Japan Times (30 January 2021). <https://www.japantimes.co.jp/opinion/2021/01/30/commentary/world-commentary/israel-vaccine-lessons/>; テレ東NEWS「コロナ緊急取材！イスラエルの対策チーム代表を直撃」2021年1月31日<https://youtu.be/XLONFyRsqyE>. [4] Nippon TV News 24 Japan (Youtube), ‘Pfizer applies for coronavirus vaccine approval in Japan’, 18 December 2020. [https://youtu.be/1IgIngeYlVY]; 日本経済新聞（ユーチューブ）、「ファイザーのコロナワクチン 特徴は？日本はいつ供給？（キーワードで振り返る１週間）」13 November 2020. [https://youtu.be/npy8jyjF11I]. [5]Arai Juntaro, ‘AstraZeneca to supply Japan with 120m COVID-19 vaccine doses’, Nikkei Asia (8 August 2020). <https://asia.nikkei.com/Business/Pharmaceuticals/AstraZeneca-to-supply-Japan-with-120m-COVID-19-vaccine-doses>. [6] ANNnewCH, 「『ノーカット』河野大臣コメント コロナワクチン接種について」(25 January 2021) <https://youtu.be/-GuXN5rD1vo>. [7] Arai, ‘AstraZeneca’. [8] ANNnewsCH, 「待たれるコロナ『治療薬』 その研究“最前線”」2021年１月1日<https://youtu.be/eq8eEsdRwK8>. [9] Another clinical trial was started in a Korean university hospital in June 2020, but is not yet recruiting participants: <https://clinicaltrials.gov/ct2/show/NCT04418128>. [10]NIH Oral Histories are fascinating resources for teaching medical history; the interview with Dr Broder was conducted 2 February 1997, <https://history.nih.gov/display/history/Dr.+Samuel+Broder>.
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