Indonesia is a large country with the largest population (240 million people: 4th in the world) and land area in ASEAN. However, the number of specialists in rheumatology is extremely small at 70, and they are unevenly distributed around the capital Jakarta. Many patients with rheumatic disease cannot receive standard treatment as in Japan today. In addition, infectious diseases such as tuberculosis are endemic in the country, requiring a high degree of safety management for biological products, which are immunosuppressive therapies.

Therefore, with the full cooperation of the Indonesian Rheumatoid Association (IRA), the project called "The Medical Program for International Promotion of Japan’s Healthcare Technologies and Services for Rheumatic Disease" was conceived by the Department of Internal Medicine of Keio University Hospital’s Division of Rheumatology, and adopted by the Ministry of Health, Labor and Welfare.* This project aims to improve the standard of rheumatic disease medical care by passing the skills and experience from Japanese doctors to local specialists.

Chugai was consulted by Keio University from the conception stage of the project, and after repeated discussions with academia and industry about the possibility of contributing to medical care in developing countries and the barriers to implementation, we provided the following support.

1．Pamphlets, self-injection starter kits, practice equipment, etc.
We provided pamphlets and practice equipment regarding treatment with biological products. These explain how Japanese doctors actually give guidance and instructions to patients and advice on points to be careful of when using biologics.

2．Symposium in Indonesia (Roche)
With the cooperation of Roche Indonesia, we supported symposiums in both Japan and Indonesia on the theme of rheumatic disease and treating connective tissue diseases. There was a lively exchange of information as the two countries' systems for testing and approval of therapeutic agents for definitive diagnosis, evaluation of drug efficacy at the time of therapeutic intervention, and knowledge of and responses to side effects were discussed. A Japanese doctor commented, "I was reminded that there is a gap between the two countries and the medical care system is not fully expanded."

3．Factory tour of biological products in Japan
In 2018, we conducted a factory tour of the Utsunomiya Factory so that Indonesian doctors could actually see the process of manufacturing biologics, which have become the mainstream in many disease areas. The doctors who participated were interested in the process of culturing and purification, including the huge tank, and were able to experience Japanese manufacturing technology.

In 2019 we also held a tour of the Ukima Factory with a lecture on the latest antibody technology and an active exchange of opinions. In addition, when explaining the manufacturing process and strict control system at the factory, an Indonesian doctor said, "In Indonesia, there are patients who have vague anxiety about biological products. By actually experiencing, I can confidently explain to patients how those are manufactured."

This project has been adopted in 2020 as well. By playing a role in industry-government-academia collaboration, we aim to contribute to the realization and quality improvement of sustainable rheumatic disease medical care in Indonesia.

Comment by Dr. Katsuya Suzuki (the Division of Rheumatology Department of Internal Medicine, Keio University)
"The reason why I started the project was that I learned about the situation of rheumatic disease medical treatment in Indonesia, where treatment which is regarded as standard care in Japan is not performed. We have continued it in response to the strong enthusiasm and needs of the local people. In industry collaboration, unexpectedly many people agreed with the project. Given the different rules and various restrictions between the two countries, Chugai in particular provided devices and the factory tour. I am grateful for the opportunity to actually experience Japanese treatment and technology. In 2020, we will support the creation of an Indonesian language textbook on rheumatoid arthritis, a pocket book for general physicians as well as the creation of the first local guidelines on SpA (Spondyloarthritis) and the expansion of clinical examinations. "

* This is a project in which the Ministry of Health, Labor and Welfare supports the international expansion of medical institutions and companies with the aim of "international contribution in the medical field" through the National Center for Global Health and Medicine. Keio University applied for the first time in 2018 and the project was adopted as the "The Medical Program for International Promotion of Japan’s Healthcare Technologies and Services for Rheumatic Disease".