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What drove you to make parasitology and infectious diseases your life's work?

As a graduate student, I focused purely on biochemical research. My doctorate was on a discovery related to energy metabolism using E. Coli, but I suspected that a similar mechanism would be found in higher organisms, which ultimately led me to study parasites.

After earning my doctorate, I worked as an assistant professor at The University of Tokyo School of Science. Then, beginning in 1983, I got a position at the Department of Parasitology of Juntendo University and started conducting basic research on parasites. About a year and a half later, I went to Paraguay as the team leader of a Japan International Cooperation Agency (JICA) medical cooperation project. For the next couple of years, I conducted epidemiological surveys of patients with Chagas disease and Leishmania in Paraguay.

Before I would head out to conduct a field survey, I would usually have a meeting with the Paraguayan village leader. Once one of those leaders once asked, “What do you do if the blood test result is positive?” It stumped me. Although some medications for these diseases do exist, the side effects are quite severe. It has been nearly 30 years since I was first asked that question, and unfortunately there have been very few medical advances.

Because Chagas disease and Leishmania are not immediately lethal, research is not prioritized. This is common for Neglected Tropical Diseases (NTDs), whose symptoms tend to progress gradually. However, it is comparatively much easier to get research funding for diseases such as malaria, which kills patients quickly without any intervention. Research funding is critical to promoting innovation in the form of new and improved therapeutics. Through my work in the field in Paraguay, I became hyper aware of the way all these diseases take away patients' quality of life, as well as the elements that are necessary for economic development, growth of children, and a nation's prosperity.

When I returned to Japan, I decided to dedicate myself to drug discovery for parasitic diseases through basic and applied research. Over the ten years that have since passed, the concept of global health has gradually gained more attention and traction, along with globalization, and the field of parasitology has become extremely dynamic. When I finished graduate school, I never dreamed I would be doing the work I am pursuing today. It is inspiring to see my fundamental interest leading to something that helps others.

Please expand on Japan's efforts to eradicate infectious diseases such as lymphatic filariasis over the past century.

When a person is infected, the filarial parasite's larvae, microfilaria, appear in blood at night. Therefore, people gathered in public halls at night so that their blood could be sampled. After effective treatment was discovered in 1947, infected patients were immediately treated with Diethylcarbamazine. In Okinawa, it has always been common to collect rain water, which can lead to the proliferation of mosquito larvae and create hotbeds for mosquito breeding. Since mosquitos spread filariasis, measures were necessary to prevent mosquito breeding and bites.

Experts at the East Asia Research Institute of Endemics (which I mentioned earlier), regional public health centers, public health institutes, and medical residents all worked together to steadily and thoroughly eradicate infectious diseases from these regions. Not only the efforts in these areas, but also nation-wide efforts conducted throughout Japan to eradicate parasitic diseases. This is an example of the Japanese public health system and basic and clinical research on parasites successfully working together. Thanks to such collaboration, parasitic diseases such as malaria, schistosomiasis, and lymphatic filariasis have been eradicated in Japan.

Furthermore, with the efforts put forth by the country's public, private, and academic sectors, Japan's experiences and know-how were shared around the world and adapted for developing country contexts. To continue the important work of eradicating parasitic diseases and infectious diseases from the world, research and development and public health measures are all essential.

How does GHIT's proposal evaluation process work?

GHIT's domestic and international external reviewers anonymously evaluate proposals before the Selection Committee makes their own evaluation. I realize that this is a lot of work for external reviewers, but their close read and detailed comments on proposals are critical. While the Selection Committee members also objectively evaluate proposals, it is extremely helpful to be able to take into account and understand diverse and expert opinions of external reviewers as a reference.

Such an evaluation system is also used by Kaken, which houses a set of scientific research grants from Japan's Ministry of Education, Culture, Sports, Science and Technology and the Japan Society for the Promotion of Science. Nevertheless, there is sometimes a large gap between the first and second stages of evaluation. When the expertise of the reviewers is not consistent with the proposal, evaluation and selection may not be accurate or appropriate. In the present GHIT evaluation system, there are three external reviewers per proposal, the quality of evaluation and diversity of perspectives is guaranteed. In that sense, I believe that this system is very effective.

Development partnerships with proposals that are evaluated highly by external reviewers and Selection Committee members are invited to send a representative to be interviewed by the Selection Committee in person. I believe that this is a fair system that selects good proposals.

How do interviews with the Selection Committee work?

In the case of being interviewed by the Selection Committee, I think that Japanese principle investigators who have research experience in the West can communicate effectively about their science and plan for the product development. However, it is not so easy for those who are not fluent in English to pitch their ideas to and answer questions from the Selection Committee. Japanese researchers have grappled with the language barrier in the past. However, since English is the accepted global language for science, Japanese researchers must adapt.

For example, at an academic conference, you present your own research results and engage in discussion with other experts. At GHIT, however, we focus on product development for drugs, vaccines and diagnostics. You must not only explain all scientific components of the research in detail to non-experts, but you must also clearly delineate the pathway from research to productization. Honestly, I think that this is challenging for Japanese academia. In that sense, having Japanese and international research groups form a partnership to write the proposal for product development is important for the globalization of Japanese academia.

From a basic research perspective, what should GHIT strive for in its second five-year phase?

I believe that in GHIT's first years we have seen good proposals. There were some cases in which a discontinued foreign development project has restarted by joining with a Japanese company. Some of these do very well. Initially, there were more proposals that were in relatively late-stage. I believe we should support those good late-stage projects moving forward.

As GHIT's research platforms proliferated, attention was also given to exploratory research, along with basic research. Thinking far into the future, without something paving the way, when late-stage clinical trials fail, the entire body of research is considered lost. In that sense, I have been happy to see the number of proposals for early-stage research increasing.

Where does your passion for parasitology and basic research come from?

I have had many opportunities to travel around the world, and I feel that it is quite unfair that the fate of children is determined by the country in which they are born. I wondered what I could do, especially in the field of infectious diseases, to help children to grow up healthily, become productive members of the world, and fulfill their dreams.

Although it is rare for patients to suffer from parasitic diseases in Japan, a large number of people are suffering from such diseases globally. Among infectious diseases, many researchers are working on viruses and bacteria, but not as many on parasites. Since parasites are eukaryotes, antibiotics and vaccines are ineffective. Thus, I find them to be the most challenging pathogens. They are worthy opponents, worthy of research.

Furthermore, parasites are similar to cancer, and drugs developed for parasites can sometimes stop the growth of some cancerous cells. In other words, parasitology research can be applied to other fields of research.

All in all, I study parasitology because it is a challenging field and it can help transform global health. This is my motivation.

The affiliations and positions listed in this interview are at the time of publication of the interview in 2017.