Eisai Co., Ltd. (4523) Earnings Call Transcript & Summary

It is now time. We would like to begin information meeting by Eisai Co., Ltd. for fiscal 2020. This information meeting is distributed live or over telephone line. Those of you who are participating from the telephone line are kindly asked to download the slide from our website. Those of you who are watching the live stream, please continue to watch the screen. Now I would like to introduce the presenter today, President and CEO, Mr. Haruo Naito. Mr. Naito, please begin the presentation.

This is Naito speaking. This year as well, we are holding this information meeting in a remote online manner. I am not able to see your faces in person. It is quite regrettable for me, but I hope that this meeting will be helpful for you. Please give me the first slide. At our company, as you see in this slide, we are currently running business under the medium-term management plan called Plan EWAY. Plan EWAY was started in fiscal year 2016, and current fiscal year 2020 is marking the fifth year of the medium-term plan. The past 5 years, it's now named as EWAY CURRENT in this presentation. Starting from next fiscal year up until fiscal year 2025, for these 5 years, we would call it EWAY FUTURE. And after that, until fiscal year 2035, the period shall be called EWAY BEYOND in today's presentation. First, let me discuss EWAY CURRENT. For fiscal year 2020, there were financial targets set, JPY 102 billion or more in operating profit and JPY 74 billion or more for profit for the year. For ROE, we set 15% as the target for fiscal year 2025. For these targets, during fiscal year 2019, for all profit lines, we have been able to achieve these targets for ROE as well. In fiscal year 2019, we reached 18.6% of ROE, therefore, exceeding the target for 2025. The EWAY CURRENT 5-year average ROE was 10.1%, maintaining double-digit number. Please look at the bullet description. During the meantime, we increased the dividend per share by JPY 10 to JPY 160 per share. At the bottom, you can see some qualitative outcomes. Firstly, anticancer agent, LENVIMA, through our strategic alliance with Merck, which we have implemented so far, this has been a quite significant leverage for LENVIMA, which we believe have become one of leading blockbuster agents originated in this country. Currently, studies called LEAP studies based upon combination therapy of LENVIMA and KEYTRUDA for various types of cancer. And now it is establishing a position as a backbone therapy. In neurology area, for aducanumab and lecanemab, these are the 2 antibody medicines, are going to be the Alzheimer's disease-modifying therapy for the first time in the world towards such success. We are currently in the final stages towards that target. On the other hand, base inhibitor, elenbecestat, based on the recommendation of the Data Safety Monitoring Board, to our regret, we had to discontinue the development of this drug. Given the current environmental changes, such as pandemic with COVID-19, we believe that the tremendous changes are being made. So we will initiate new medium-term plan EWAY FUTURE and BEYOND at this time of various changes. Having said that, what we have accumulated and experienced in the past have to be revisited again in order to identify what will remain unchanged towards the future. I think it is very significant to recognize that. We wrote in the headline Last Year and This Year, Pierced Across by a Rod. This is a haiku poem written by Kyoshi Takahama. Pierced across by a rod, what is it? Please look at the first bullet. First of all, we are running our business, managing the business based on philosophy. In 1980s, towards the end of 1980s, since then, we have been touting this hhc philosophy. That means that we are thinking first about the benefits to patients, and we have to understand their emotions and to make contribution to the benefits to them. That has been positioned as Eisai's philosophy. For this philosophy, which is also included in our articles of incorporation of the company, in order to understand patients' emotions, we have to spend time with them. This is something we call socializing with patients. We are valuing this process a lot to understand the anxieties of patients, and we are trying to remove them through our day-to-day operation of our business. That has been our purpose of our business. We are going to keep this philosophy-based management securely without any change. The second bullet. This is about Alzheimer's disease. In the last -- second half of 1990s, in the U.S. and Japan, we launched Aricept. Since then, Eisai has been leading the world in terms of the pharmacologic treatment for patients with Alzheimer's disease, and we are determined to continue to play such role. At the same time, we are not manufacturing or offering medicines, but rather, together with people in Alzheimer's disease-related community, as I said earlier, we are going to continue to -- we have also continued to socialize with those people related to the AD community. Since the launch of Aricept over the past 25 years or so, through socialization with patients, as many as 1,600 programs have been implemented all over the world in order to relate with people with Alzheimer's disease as well as their families, through which we believe we have been able to establish relationship of trust. Fourth bullet point, Eisai has grown by creating in-house products, global products: Aricept, Pariet, HALAVEN, Fycompa, LENVIMA and DAYVIGO. Successively, we have produced these products. These have been all small molecule drugs. From now on, lecanemab or tau antibodies -- antibody medicines or other various modalities will be in our pipeline based upon our in-house developed technologies in order to further grow. The fifth point, Eisai has been growing through partnership model on a global market. In each area, we have been working with leading global players on an equal basis to grow together through partnership with them: Aricept with Pfizer; for Pariet and/or AcipHex with Johnson & Johnson; and right now, for aducanumab and lecanemab with Biogen; for LENVIMA with Merck. So we have been working together with them in order to make contribution to patients all over the world. We have continued to grow through this partnership model. Next bullet. This is to improvement. This is to improve the drug access. Medicines have to be taken by people who need such medicines. Only after that, medicines can carry values. At Eisai, how can we deliver medicines to those patients who need our medicines? We have been putting focus on this drug access or access to drugs over many years for HALAVEN and LENVIMA and Fycompa. We have implemented patient assistance program mainly in Asian countries. In particular, for HALAVEN, for India, we have offered a tiered pricing policy, multi-tiered pricing strategy since launching of this drug. For many breast cancer patients in India, we have expanded access to medicine. Since March 1 this year, in China, on NRDL, National Reimbursement Drug List, LENVIMA and Fycompa have been adopted and listed on this -- put on this list in China. Through this, we believe that access to medicine in China is accessed -- expected to grow dramatically, utilizing various schemes. We are continuing to contribute to the improvement of access to medicines. The last bullet on this page is to describe our measures, activities related to control neglected tropical diseases. SDGs are talked about a lot, but the top priority SDG measures is to correct the gap or disparity in medical care. Our work related to NTD, for us at Eisai, it is the top priority issue for us, with among various measures under SDGs. As a treatment for lymphatic filariasis diethylcarbamazine, DH -- D-E-C, DEC. 2 billion tablets have been provided free of charge to people in endemic countries all over the world. And going forward, in order to put NTDs under control, we would like to further strengthen our efforts in this area. Now EWAY FUTURE and BEYOND. FUTURE and BEYOND, there are several important changes that are expected to take place. First, market and industry structure change. This is 3-dimensional representation. Please first refer to the y axis. In the past, in industrialized countries, societies are aging, and it is understood as a serious problem. However, going forward, in the next 10 years to 20 years, the world, the entire world is going to become a super-aging society. That is a major paradigm shift that is about to occur. On the horizontal axis, in the past, medicines were delivered to patients, and that was the mission of our industry. However, going forward, people, the healthy people -- including healthy people, to the people, solutions will be delivered. Medicines are part of the solutions. We will be evolving -- our thinking will be evolving in this way. And in z axis, from vertical consolidation to horizontal division of labor, in the past, we were covering from the upstream of value chain from the discovery. And we're thinking about how to strengthen the value chain. But when we look at the current industrial structure, what is happening is as follows. If we cut value chain, for example, in discovery area of research and development, when we look at the cross-section, there are pharmaceutical industry players, and there are also various start-ups, and there are many people who have different technologies. And they coexist in R&D discovery stage, utilizing strength, working together in synchronized fashion to promote discovery. That is the world that we are going to see. In commercial stage, when we look at the cross-section of commercial stage, in commercial area, those people who are active in this stage are not limited to pharmaceutical industry players. There are various specialists related to digital technologies. There are various start-up companies, and each, with their strengths, are participating in the commercial area. We have entered into such an age of horizontal division of labor. And the same picture is seen in the manufacturing stage. Going forward, it will be very important to be fully aware of this horizontal division of labor. On the right side, competitiveness picture is shown. Traditionally, pharmaceutical industry competitiveness came from drug discovery capabilities and sales and marketing capabilities. However, now competitiveness of industry and corporations are more multidimensional. And most representative of that in scientific evolution, genome, genetics, various human biology information is now available. Digital technology and AI and other predictive technologies and various omics technologies are also evolving day and night. And how to catch up with that scientific evolution is the key. This is not only about R&D. How to catch up with this is going to be an important element in competitiveness. Next is value chain. During the COVID pandemic, this time, what we have been mindful about the most is stable supply of our products. If we depend on one country for raw materials, in that type of logistics, there can be instability or uncertainty in the supply as we have experienced this time. International logistics and supply chain will have to be rebuilt, recombined, and multiple value chains or supply chains will have to be established to achieve stable supply in face of various different risks. This is also an important element in having competitiveness. Work style is becoming more diverse. What is the purpose of the office? That is the fundamental question that we are asking on a daily basis. For each person, in the best way, in most comfortable way, to be able to work in a very productive way, we need to prepare environment, and that will lead to reform of the work style. This is without doubt. And we have to be able to change towards that direction, and that will also be a very important part of competitiveness. Diversity. Women, minority, these diverse groups of people are essential in enhancing enterprise value. Promoting these people in positions is also very important. Corporate governance. Accountability and transparency of company have to be ensured. This is growing in importance. In terms of corporate governance, in Japanese industry, Eisai was one of the first companies to introduce the Board structure, where the majority of the Board members are outside directors and the management and the supervisory Board are clearly separated. Board members are thinking about the direction and intention of the stakeholders, and the Board members are taking actions proactively. We and the Board are working based on trust relationship, and the Board is delegating various authority to the management, and we are responding to that trust. And we are maintaining close communication with the Board. Such corporate governance will be further enhanced. SDGs. As I mentioned earlier, when I looked back, the SDGs for us is filling the gaps in health care and promoting access to drugs. And in case of Eisai, eradication of tropical disease. These are important SDGs for Eisai. This means that Eisai will have to create new network and new partnership. And we are, indeed, creating such network and partnership. And that has become a very important source of strength for our company. And lastly, philosophical management. Philosophical management questions the purpose of the business. Purpose is becoming a key word these days. The purpose of our business is to enhance benefits for patients, and this has to be achieved smoothly. Then that is indeed achieved. It should lead to the revenue and profit as a result. And that is clearly stipulated and included in articles of incorporation and shared with our shareholders. Our purpose is enhancing patient value. And when we are able to achieve this, we will be able to receive revenue. That thinking is very much in line with the importance of purpose that is much discussed today. At the very bottom of this slide, various ways are shown from AI to 6G. These are digital tools related to DX, and there is a huge significance brought about by these ways. To achieve our purpose, we will be armed with very strong weapons. With these, we will be connected to more people with speed through data. That will be possible. As shown on the left chart, the patient times medicine -- from patient times medicine to people times solution, we are changing our business model. And to achieve that change, connected with more people with speed through data, that weapon is necessary to realize this model. And therefore, revolution in these ways or means is very important. As soon as possible, we have to adopt these new ways. The essence of the piercing rod. What is at the center of this is anxiety-driven model. In case of Eisai, more than 10,000 Eisai employees globally spend 1% of their working hours, about 3 days, with patients and families of the patients. By doing so, we are able to understand the feeling of patients, especially anxieties, as if these are our own feelings and anxieties. This enables us to have empathy. This is the most important part of anxiety-driven model. Each individual employee, after understanding anxieties of the patient, will take that back to the company and will have discussion within the team to better understand what patients are anxious about. And as corporate activity, as strategy, we will develop strategy, corporate activities, remove these anxieties. And we'll implement those strategies, and we will continue with this cycle. And that is the essence of the piercing rod. This will remain constant. Now from EWAY CURRENT to EWAY FUTURE and BEYOND, there will be also a change in our perspective from the patient to the people. We will be expanding our viewpoint. That is the difference. EWAY CURRENT hhc philosophy also includes the concept of people or consumers. But so far, it has not been easy to approach the people. But with the ways, DX, with those weapons, with those new weapons, we are now able to reach many people. We are now able to approach the people. We are now able to interact with the people and communicate with the people. And the change evolution of the ways of weapons is very important. So we are now centering on the people in our perspective in our hhc philosophy, and it is now hhceco, where it is combined with ecosystem, hhc philosophy plus ecosystem. And what this concept is about is described here. We empower people to realize their fullest life. We will continue to promote creating solutions based on scientific evidence, especially in the areas of our expertise: neurology and oncology. We will improve our long-established and recognized strength, the hhc process, which is to understand and resolve customers' anxiety, to be alongside people throughout their lives. As a result, we aim to evolve into hhceco to help people realize their fullest life, from healthy time to the end. That is our philosophy during FUTURE and BEYOND. hhc philosophy plus ecosystem, or hhceco, is represented here in a high-level diagram. Please look at the subtitle. Eisai Universal Platform, EUP, I will describe this in more detail later. Centering around EUP, there are various industries and associations. In coexistence with these industries and associations, we aim to remove anxiety of people through coexistence with other industries and organizations in this ecosystem. This is a dynamic moving thing, which is breathing and palpating, and I'm very excited to think about this concept. For example, insurance industry, by tying up with EUP, may, for example, develop high-quality dementia insurance program or product. Maybe dementia insurance for people who do not have any worries about dementia or people who may be nearing the onset of dementia or early preclinical stage of dementia may be able to purchase an insurance product. Development of such insurance product may become possible by partnership between insurance industry and EUP. In the fitness industry, there are exercise programs to prevent disease. I hear that there is growing demand for such exercise programs to prevent dementia or disease. And through EUP, we should be able to satisfy such needs. In automotive industry, program to allow for safe driving by senior citizens should become the core element of connected car program. Cognitive function of drivers, how should that be assessed? I think tying up with EUP should have important significance in that respect. And how can local government help prevent shift from MCI to AD? And we should be able to help local government in that respect, with more than 160 local government we have entered into agreement regarding dementia programs. It is said that JPY 150 trillion is the asset owned by people living with dementia, and such assets may be inactive. There is a risk that these assets may remain frozen. But through tie up with EUP, it may become possible to avoid that risk. Corporate medical examination through corporate employee health data, if we are able to provide information helpful to prevent dementia, then there will be greater demand for corporate medical examination and significance of corporate medical examination will be enhanced. Through EUP, we may be able to provide a direct contribution to people to remove anxieties. But with the various different industries and organizations, we are able to work with them through EUP so that each of these industries and organizations may remove the anxieties. And in total, there will be a removal of anxiety on a very grand scale. With hhceco, we would like to realize that. Eisai Universal Platform, EUP, is shown in this high-level diagram. At the bottom is C&I, collaboration and incubation. Other companies, technologies and discoveries and inventions and our own R&D can be synchronized. And to various people, we can package solutions. And such solution packages can be delivered, that is solution delivery, to remove anxieties from people. That is the overview of EUP. Next slide, please. Now I'd like to show you details of EUP. I am sorry about this busy slide. At the bottom of this page, C&I. This means collaboration and incubation, utilizing other companies' or entities' technologies. Please remember the horizontal specialization in R&D and others. Various technologies of others can be utilized, which is becoming important. IoT tech companies and application development companies or external cohort data, those people who are organizing such external cohort data, such various technologies and our R&D, as shown by arrows, can synchronize in various ways. And our R&D, in our opinion, can be divided into 3 major portions. First one is data science. PHR, EHR, EMR, personal health record, electric health record, electric medical record, such data. Our clinical trial data of high-quality big data, these can be analyzed. By doing so, in neurology area, brain health panel, various biomarkers of polygenic information included in this brain health panel, which can be established in case of oncology, CTD and a circulating tumor DNA, it is so-called liquid biopsy, and DNA condition or mutations can be understood to create genome panel. In pharmaceutical R&D activities based upon human biology, we believe that this will form a very important start, very important base, data science laboratory kind of a model. And going to the middle EGAIL/Digital. EGAIL, sorry, this is our internal jargon -- Eisai Genomic AI Laboratory is what this EGAIL means. For example, in Boston, G2D2 or H3B in Boston. EGAIL, or genomic AI-based research, have become -- has become a mainstream R&D activities there. What are they doing based on data science, brain health panel and ctDNA information are utilized, adding a mix analysis or genetic analysis or imaging analysis are conducted to create hypothesis as a target for drug creation. Genetic genome-related activities and based on the molecular strategy and hypothesize the structure or relationship and various AI algorithms are utilized for setting up such hypothesis. That is about what EGAIL or digital R&D activities mean and targets which are suggested by these and hypothesis for each target. Now real drug discovery or creation begins. Medicinal chemistry is not only wet manual work. Such days are over already. Most part, drug design is conducted based on AI and modalities are not only based on small molecule, but also middle-sized molecule and antibody. And if all target-related engagement can be conducted in most efficient and productive way and to explore such most suitable molecules, various modalities are advancing day by day. Protein degrader, for example, that is one example of that. So including such new modalities, drug discovery activities are being rolled out in modern R&D. And C&I and R&D are synchronized, and then we come to this green portion, solution package preparation. So what does it mean? At the top of green portion, healthy condition, maintenance and support package. Based on the disease awareness and prevention, test, hospital search and accurate diagnose package and package to confirm the efficacy of treatment. And the right-hand side is the care package. For each, at the very top, there is people in medicine area, the HCP, or health care professionals, in medical domain, such specialists as well. Whatever needed a solution package is for each groups of people. For example, for supporting the maintenance of a healthy condition, in this kind of package, simple biomarker or blood test. From blood test, various biomarkers are selected from blood samples. And then the prediction of disease is already becoming available in real world. Such blood test, we are collaborating with those providers of blood tests, utilizing our algorithms so that simple blood testing for providing biomarker service as a part of a package solution, this can be possible. And at pharmacist or convenience stores, drug stores, there are various consumer health care products being sold. Wearables, actually, I'm wearing a similar type of a ring or wrist -- there are various IoT devices that you can wear to your day-to-day daily activities like sleep and exercise and diet information on your daily life can be accumulated. Very important to support maintenance of a healthy condition, constituting a very important part of solution package. And it will be possible for us to offer such package and consultation site or health care portal site, which is important. For those people who are living in healthy condition, such solution package can be offered through virtual. I believe that the virtual offering will become the mainstream. Through virtual ways, we are going to be connected with large number of people. Disease awareness or prevention and test area, there is a site for consultation or with the local governments and the insurance companies, financial institution, there is information provision site. And for self-check of the cognitive functions, a simple test can be done through your smartphones or tablet called NOUKNOW. This can be offered as well. The information about disease prediction or disease-specific applications currently related to sleep, Parkinson's disease. Currently, these applications are being offered. These can be packaged together for diseases -- awareness about disease can be increased. For those people who have started to see symptoms or presymptomatic stage, we are able to provide such solution package. An accurate, in medical domain, how accurate diagnosis can be done. What kind of diagnosis can be available with blood, imaging diagnostics, blood biomarkers and what kind of online treatment can be provided. That information can be provided to the people. And when it comes to treatment, AD DMT, which will become available in the future, what kind of treatment and what efficacy can be expected, what will be the potential side effects and what about the nondrug therapies and what about the exercise therapies. Such information can be delivered to the people. On the other hand, for those health care professionals, visualizing the efficacy of the treatment or assisting the imaging diagnosis or MRI will be used for imaging. Such solution package will be offered. In terms of care for elderly people facilities, in such local communities, this kind of service is available at where -- and this is the network of clinics and hospitals in your community. Such information will be delivered to the people. Sometimes such information can be provided in virtual way or through mixture of real and virtual for HCP or MR or MSL, nowadays, digital tools are utilized in many cases to deliver information. So in the mixture of real and virtual way, solution package will be delivered. From C&I through solution delivery, the entire picture is covered by this Eisai Universal Platform, EUP. EUP is intended to remove anxieties of the people and HCPs. This is what it is expected to play a role in. And through connection with EUP, various information or service and goods or pharmaceuticals can be utilized. So this is the overall picture of what is Eisai Universal Platform is. Now turning to specific anxieties which can be removed. In dementia, this is the summary of what we believe the anxieties of people in dementia. For people in healthy state, as you see at the top in pink color, they would like to understand own health condition precisely and take disease-preventive actions. Therefore, simple blood-based biomarkers to provide a prediction of the onset of disease or disease prediction. By providing such information through EUP and blood biomarker, providers or handlers, through such collaboration, it will be possible and various wearable health care applications or IoT can be introduced to them or offered to them. So this is the kind of a package we can think of. And next, for people who are a little bit worried about their health and risk of dementia, for those people, both through online and off-line activities, we can provide the right information or let them notice the progress of disease as early as possible so that they can have an access to various medical institutions. Such solutions will be provided in package. In disease awareness area, already, we have sodan or consultation e-65.net. This is the consultation website for disease. Together, right knowledge about disease or at call centers, people can have a direct consultation. On the right-hand side, this is about cognitive function check. Of course, NOUKNOW, we would like to have people proactively utilize NOUKNOW and Easiit. If you utilize you Easiit, various personal health record can be centrally managed. And NOUKNOW is also linked with this. Therefore, regarding brain performance, over time, you can visualize your brain performance to confirm. As you can see at the bottom, we are aiming to build a society where people can visualize their own health condition and take preventive actions at an early stage. We believe this can be possible. In medical domain, first, accurate diagnosis must be made for people. The timing, well, early diagnosis at the onset of MCI or early AD, not missing that timing. They would like to get correct diagnosis and treatment. So simple and precise cognitive function checks called Cognigram. We have already adopted this service under contract. And we would like to continue to develop this cognitive -- Cognigram securely and base upon the vast amount of global data to provide accurate dementia check function. In blood biomarker, this is rapidly becoming a very important diagnostic tool. That is to say, very large burden or invasive burden is not necessary for conducting such test because we are not -- we are able to capture a lot of data without invasiveness. We can give information to people that they can feel assured and safe when getting the test. And from the local clinics to nearby clinics or family doctors to specialist doctors or hospitals, and then we can provide such information on the medical network in the community where the people live. We can provide such packaged information. Now going to medical treatment phase. The people would like to select the treatment they wish to receive among various options in a secure manner. Regarding such needs, of course, the current cutting-edge treatment for Alzheimer's disease is going to be AD DMT. If candidate drugs are approved in the neurodegenerative-related areas, these are expected to have efficacy to remove the cause or etiology, therefore, so that people will be able to have hope in treating their disease. And what people are concerned about is side effects and efficacy of the treatment they receive. For this, through Easiit, we are considering to respond to such worry. And the first stage is Easiit Pro, Easiit for health care professionals, health care information or drug information will be provided. Other than that, in dementia area, various excess therapy or DTx, digital therapeutics, are being developed, not only drug therapies. For such therapies, we believe we would be able to include them into solution package. Now turning to care. They would like to find a desirable environment when considering care or nursing care. I believe many people have that feeling. So through e-65.net site, regarding the networking collaboration between the nursing care facilities and medical facilities in the region they live in, and we can provide such solution package. At the bottom, solving problems in the medical field, from diagnosis to treatment and care, centered on precision brain health products, and we will support people to live lives to the fullest under any condition. Now here is one example of creating solution by EUP. Solution package, as you see on the right-hand side, advice to change their daily behaviors, practice to the people and for HCP, AD continuum path curve. These are the solution packages. And first, data. Data science, data science division will gather various data, starting from data gathered from Easiit or data held only by Eisai high-quality clinical study data or Aricept data as well in a clinical setting. The cohort data in Japan is key cohort, which is well-known cohort. And data can be captured from this or data from J-ADNI and from overseas dementia cohort data anonymized. And the data after anonymization are stored in Eisai's data lake. And EGAIL or digital division, MCI risk prediction model or dementia onset prediction algorithm or amyloid beta positive or negative prediction model or AD natural cause model, AD associated genetic polymorphism algorithm, these are to be utilized to suggest people would need to make such behavioral change. Such recommendation is issued, and then you can expect the -- you have to be prepared for the increased risk of onset of dementia. And by visualizing the current status, and then they can tell where the treatment will be positioned. Please look at the bullet at the bottom. It will promote actions, which should -- the people will be encouraged to take behavioral activities by simulating future condition if behavioral change were implemented based on MCI risk prediction and dementia onset prediction algorithm. And the bottom, understand individualized natural course and the treatment effect by visually suggesting prevention and prediction of a complex AD disease progression through AD continuum curve, which shows transition curve of cognitive function. HCP people can know this. As you can see, in red at the bottom, we will be able to provide solutions, which only Eisai can pursue based on evidence. This is such an example. Now changing the topic. How much costs are incurred in Japan for Alzheimer's disease? Looking at social burden of this disease in the statistics, this is the data for 2018. But please understand that this is the latest data. Medical costs was JPY 1.073 trillion and public care cost was JPY 4.8 trillion. On the left-hand side, invisible costs, invisible informal care cost, it is enormous. That is called C1, cost of informal care by family. This is the care provided by family members. So suppose that people other than professional carers, other than family members, provided such care. And then the monetary value of such service is calculated at JPY 6.8 trillion. And C2, because of the family care being provided, therefore, those family members are not able to work anymore or they have to shorten the working hours. Such loss of productivity amounts to about JPY 1.5 trillion. Anyway, the cost borne by family members are huge. Adding C1, the total is JPY 12.6 trillion, enormous amount. For C2 as well, the total amounts to over JPY 7 trillion. And on the right-hand side, the national medical care cost was, at that time, JPY 43 trillion. Care cost was a little over JPY 10 trillion. For your information, national defense-related expense was JPY 5 trillion. Compared to these numbers, you can tell how huge costs are incurred for dementia. I think you can understand this. As I mentioned earlier, dementia will become a serious disease even in developing countries and middle-income countries. Eisai single-handedly will not be able to fight against this. There should be public-private initiative. Public-private initiative is indispensable. That is why this slide was prepared. World Economic Forum, WEF or Davos conference took initiative to launch various mechanisms to fill the health care-related gap; Gavi, the Vaccine Alliance; CEPI, Coalition for Epidemic Preparedness Innovations. So this is a coalition for epidemic preparedness innovation to fight against infectious diseases. All of these were launched as major consortium between public and private sector at the annual meeting of World Economic Forum. And in providing COVID vaccine, Gavi is playing a major role now. In 2021, WEF launched DAC, Davos Alzheimer's Collaborative. There are going to be 3 activities. First is to establish an enlarged cohort. Second is developing environment to conduct clinical trials. And the third is health care system preparedness. In low- and middle-income countries, health care infrastructure is underdeveloped. And how can Alzheimer's disease be treated? That serious challenge will be addressed through this initiative under WEF. That initiative was recently launched, and Eisai plans to take active part in this. Now I would like to now turn to the topic of neglected tropical diseases. I've mentioned lymphatic filariasis, or LF, earlier. It began in 2010. Dr. Margaret Chan was the Secretary General of WHO at the time. Lymphatic filariasis was a difficult disease, and we were asked to cooperate. And we entered into a partnership with WHO. As shown on the right side, at our India factory, one of the treatment for LF DEC tablets will be produced to be provided to WHO at zero price. DEC tablets and ivermectin, the people are very [ material these days ], are indispensable treatment against lymphatic filariasis. In 2012, London Declaration was issued. WHO, World Bank, major governments, Bill & Melinda Gates Foundation and 13 pharmaceutical companies entered into public-private partnership to eliminate 10 NTDs. I also took part in this declaration. Only Eisai was Japanese pharmaceutical company that was part of this. And this is the biggest PPP in health care sector. And since then, similar mechanism was activated to fight against COVID. And 10 NTDs, unfortunately, was not eradicated by 2020. So this is extended to 2030. WHO road map 2030 was approved. January 30 was World NTD Day. Landmarks were illuminated in many countries, including in Japan, where Tokyo Tower was illuminated. On the right-hand side, DEC tablet picture is shown. Quality is very high, and it received prequalification from WHO. And this is characterized as price zero business by Eisai. The characteristic of NTD is such that it does not end when drugs are delivered. Patients have to take the drugs. And therefore, mass drug administration in the community is indispensable. Our employees are also actively taking part in the mass drug administration and are accumulating experience.Two billion tablets of DEC drug have been provided to 28 countries, a very large number of tablets. And out of 72 countries at risk of LF, in 17 countries, the disease was eliminated. Towards eradication by 2030, we will continue to provide DEC tablets. We are fully committed to doing so. Regarding our efforts to control NTD. There is a salient characteristic regarding our efforts at Eisai. We have a wide-ranging portfolio, and this portfolio is supported by GHIT Fund for NTDs. This is a fund that was established in Japan to support the effort. And GHIT Fund is covering all of these development themes in our portfolio. Major development was made in Japan, thanks to this GHIT Fund. This portfolio covers Chagas disease, leishmaniasis, lymphatic filariasis and mycetoma. Mycetoma is the most neglected of tropical disease. The source of infection is still unknown, but clinical trial on mycetoma is underway in Sudan. Malaria and TB are also included in the portfolio. As shown on right, DNDi, Drugs for Neglected Diseases Initiative, is another area. This is an NGO headquartered in Geneve (sic) [ Geneva ], Switzerland. But in -- on the ground in the field, activities are carried out. And [indiscernible] Frontier is also participating in DNDi since Chagas disease treatment development in 2009. In almost all of these development themes, we are collaborating with DNDi. Without GHIT and DNDi, it would not be possible for us to develop treatment for NTDs. The Gates Foundation or WHO are also members of these efforts and these global partners, and we would not have had any contact if not for these global partnerships. And this is also a strong motivating factor for employees. I would like to end by delivering this message. What do you think this photograph is? This is a photograph of Yakushima cedars on Yakushima island. We would like to become yakusugi, Yakushima cedar. What type of tree is it? Yakusugi trees are about 2,000 years old with about 50 meters in girth. It is huge. But the annual growth ring width is only about 1 millimeter. In mainland, cedars have more than 1 centimeter width of growth ring and grow narrower, straighter. I think yakusugi, Yakushima cedar, represents long-terminism -- long-termism in the nature. It towers above the sea of forest and receives plenty of Sunshine. And there are many other plants that co-exist with this tree. And this attracts various insects and small animals to create a large symbiotic community. At the root of Yakushima cedar, there is rich moss. And growth of moss is a symbol of long-term prosperity. At the tree top and at the root, Yakushima cedar creates ecosystem that enables long-term survival and prosperity. So yakusugi, in a way, is a platformer. Eisai would also like to be able to serve as a platformer that is sustainable, that is sustained over many years. And that is one of our hope in EWAY Future & Beyond. EWAY Future & Beyond Aspiration, this is the last slide. I would like to read out what is written on this slide. Eisai will build Eisai hhc ecosystem, hhceco, to support people's fullest life during the period of EWAY Future & Beyond. Eisai Universal Platform, EUP, will be the core. C&I, which is expected to induce synergy between in-house R&D capability and outside technology, creating various solutions to each individual by integrating in-house technologies and those of partners. The core will become solution package and solution delivery to provide by combined solution, which covers daily living domain and medical domain to match individual various needs. Eisai will coexist with various industries through hhceco. Aim is to realize cross-industrial hhc ecosystem as yakusugi forms symbiotic group to nurture various lives. As a result, pursuing to support people's fullest life possible by removing anxieties. Thank you very much for your kind attention.

Next, we would like the floor -- we would like to open the floor for Q&A session. [Operator Instructions] I, as an emcee, am going to designate the person who is asked to raise questions. So now we are receiving questions from the audience. We received the first person from Citigroup Securities, Mr. Yamaguchi from Citigroup Securities.

Can you hear me?

Yes, we can.

My name is Yamaguchi. I'm from Citi. I have several questions. First, based on the history of your company, you have emphasized on the partnership. I believe that it is true that you have successfully grew through partnership model. Briefly, please answer my question. Through the experience of your partnership, what has been the key in your experience to make such partnership or alliance successful? What was the key?

Mr. Yamaguchi, thank you very much for your question. Well, roughly speaking, this may have been the CEO to CEO communication. To be aligned in values, if we can be successful in that, I believe that the alliance can be successful as well overcoming various challenges. That is derived from the understanding between CEOs. That's what I think.

Regarding ecosystem, I think that was one of your main themes of your presentation today, setting aside oncology, but particularly in dementia, through ecosystem, I understand that your business can be potentially grown. But on the other hand, in terms of people, you're talking about very wide-ranging people and partner businesses may spread all over across the industries. Then I believe that the brand of Eisai is based on your pharmaceutical business. I know that your brand is very well known in this industry. But for general public and consumers or industries across the board, I don't think that your brand recognition is very high or strong. And there are many pushy kind of information spreading in the world. So in order to have an access to the people, you mentioned that you are going to have a partnership with various companies. So this is -- is this what you are going to do going forward in order to have access to various people? Or do you already have access through such a partnership? So are you going to expand the existing partnership? Or do you have such a business model? And are there any potential new alliances going forward?

Well, thank you very much for your question. I would like to give you a conceptual explanation, and I would like to call upon the person in charge as a director. First, I think everything starts from data. Therefore, how much data of high quality can be utilized? And I think that is the key to win. In that sense, as a player in pharmaceutical industry, we have cutting-edge or latest information from clinical trials, which cannot be held by anybody else. And this is the asset of the highest quality. So we can start deploying such data for business opportunities. As has been pointed out, in that sense, we have not obtained the solution delivery partners in a complete meaning, but corporate venture capitals or small-sized start-ups with whom we can have a relationship, through which, for example, telemedicine or various IoT device providers, such specific partnership is being established now. Well, anyhow, regarding the details, I'd like to ask the director in charge to respond to your question. The person in charge of ecosystem is Mr. Keisuke Naito, who is an executive officer.

Thank you for your question. Chief Digital Officer of the company, Keisuke Naito speaking. Regarding your question. For consumers, how are we going to deploy platformer? How are we going to be connected with consumers? I think that was your question. One thing is we have a consumer health division. So we have anti-aging brand that has been established in that division. I think this is going to be one of the key channels to be connected with them. And from that, how are we going to connect such efforts to HCPs? And then in the medical side, we have site, medical.jp, for health care professionals. And through this information meeting, CEO mentioned, Easiit. DNA company, we have created the application. So combining these in digital way, we will be able to connect with people at large. And furthermore, we have a pharmaceutical and consumer health care teams working in the business field. Therefore, we can have the mixture of virtual ways and real ways or physical ways in order to be connected with the general public or consumers. That's all I have.

Next from Sophia University, journalism department, Shimoyama-san.

Can you hear me?

Yes, we can hear you.

Mr. Naito, it's been a while since we last met. I'm Shimoyama from Sophia University. Fighting Alzheimer's disease, I have 3 questions. First, aducanumab and lecanemab, BAN2401. Let's say that aducanumab is approved and -- so if BAN2401 is approved, what will be the distinctive roles to be played by each of the drugs? How will they be differentiated? Pharmacologically, I believe the actions are similar. How would you differentiate these 2 products?

Shimoyama-san, it is nice to hear your voice. I read your book. And in the Alzheimer's community, you are a huge supporter. Thank you very much for acting as a huge supporter for Alzheimer's community. Aducanumab and lecanemab are to be approved. If both are approved, that's ideal, and we believe that it is going to be in the near future. Aducanumab may be the big brother, and lecanemab may be the younger brother. Regarding efficacy and safety, how that will be ultimately confirmed. So we will have to see what will be included in package insert, Shimoyama-san is well aware of. Regarding lecanemab, in preclinical stage as well, we would like to expand indication to preclinical stage. And we believe that there is -- it is possible for these 2 drugs to coexist. With Biogen -- between Biogen and Eisai, we are not persistent about who owns what. These products are children of our joint endeavor. And between CEOs, this is always confirmed. So each compound will be able to fulfill its efficacy to the fullest extent. Personally, I'm convinced that, that will be possible. I don't know if this answers your question but that is all.

The second question, control or conquering Alzheimer's -- familial Alzheimer cohort study was started, DIAN-TU, D-I-A-N-T-U, familiar Alzheimer disease is included in the book. Before the publication of the book, Dian and Eisai were not connected. But after the publication of the book on March 16, DIAN-TU, regarding the next-generation tau antibody, DIAN selected Eisai's 2814 and received a press release. I think that you may have some emotional reaction to this. DIAN inherited Alzheimer's disease patients. How have you felt about this? Could you share your thoughts on this?

Shimoyama-san, in your book, there was a statement of DIAN patient that is quoted in your book. Irrespective of my background, the patient hopes to be able to live ordinary life someday soon. That was -- that left a deep impression on me, and I'm sharing that impression with our associates in the company. And as tau antibody, as you know, MTBR tau affinity -- antibody with affinity to tau, MTBR antibody was selected. And we believe that clinical trial will begin. And regarding sporadic AD population, Phase II clinical trial will also be carried out. As for the genetic background, the background is different, but pathophysiologically, the profile of biomarkers are similar between inherited Alzheimer's and sporadic Alzheimer's, according to our scientists at DIAN-TU. We really hope that our drug will be evaluated sooner.

Now third question. You may also have some emotional reaction to this question. In my book, Conquering Alzheimer's, I wrote that, in the latter half of the 1980s, the efforts made by Eisai to control Alzheimer's was such that it started with Aricept. And after the patent cliff, after the expiry of the patent of Aricept and BAN2401 to aducanumab, I've traced the history of Alzheimer's treatment development of Eisai in my book. Since days before Mr. Naito became CEO, the history of Alzheimer's treatment development is covered in my book. And immediately after reading that, what was your impression? That is what I would like to know.

I cried.

Oh, you cried? Why did you cry?

Hachiro Sugimoto and other people who were working very hard were mentioned in your book, and my name was also mentioned in each episode. I cried. Maybe that was too emotional a reaction about [indiscernible] I think you had valued highly his talent.

And next person from JPMorgan Securities, Mr. Wakao.

Yes, this is Wakao speaking. I'm from JPMorgan Securities. Can you hear me?

Yes.

I have 2 questions. First one is for early AD. AD DMT, how pricing shall be? In 2017, at the information meeting, the value of contribution to patients will be reflected in pricing. So the high value will be provided. Regarding the DMT, you are expecting that higher pricing, that's what I thought you suggested. And today, Alzheimer's has huge social costs being considered, and then the relatively high pricing will be acceptable in the society. That's what I thought. But as has been explained earlier, access by patients, if the drug price is high and then that may hamper the access by the patients to the medicine. So for access by patients being considered. And then when it comes to the pricing of the DMT, how is your view -- what is your take on how pricing of DMT should be?

Regarding our thought on pricing. I myself think that pricing should be based on values, value-based pricing. That's what I have been saying. That values will be brought about by specific medicine, how much the value will be brought about, medical value and societal value. There are various types of values. As I said today, costs related to nursing care, by reducing significantly such care-related costs, there is such a value in modern society. How should we evaluate such values? I believe this is going to be very important discussion. For that, we needed to have a thorough discussion. And on the other hand, in each country, there is unique medical care system or drug pricing system in each country. Therefore, we have to take into account the framework of each individual system because each carries its own meaning and significance. Therefore, that factor has to be taken into account. Like in Japan, we have universal coverage system. In the U.K., NHS is offering similar services. And as you pointed out, for low- to medium-income countries, how are we going to address pricing issue there? There are various funding mechanisms which have to be tailored to the needs of such low- to medium -- middle-income countries. As we pointed out, I believe this is going to be very complicated processes or work to be done, but I also believe that we have to secure access by patients to medicines. And logics of access have to be maintained. We would like to strike a right balance considering these various factors. Thank you.

Then this is my last question and the second question. For early diagnosis, for the people, and you have introduced to us various measures. And there are some ideas which can be implemented soon. And now we are about to know the approval of aducanumab. And for those upcoming medicines, it is very important to provide such services available. And could you please provide us the specific timing -- time frame for certain services to be launched, if possible.

There are some services which are subject to regulatory approval. For such services such as PET-related people, CSF-related people or blood-related people, they are working towards getting regulatory approval. I understand that they have already started their work to prepare for that. And the drug itself -- well, approval for the drug itself will not be delayed or much later than our expectation. That's what I hope. But I believe that all the stakeholders and relevant people are making their utmost efforts to be ready. Is this all right?

Yes. Understood very well.

Next, Mr. Hashiguchi from Daiwa Securities.

This is Hashiguchi. I have 3 questions. In the beginning, you've mentioned that EWAY Future & Beyond will start as new medium-term plan. In fiscal 2016, EWAY 2025 was announced, and profit target for year 2020 was announced at the time. But this time, you have not announced profit target. What is the reason? And going forward, we will not announce profit target? Or is this only for this time that you decided not to announce profit target?

CFO, Mr. Yanagi, will respond.

Thank you for your question. This is Yanagi, CFO, speaking. As you pointed out, when EWAY was announced initially, profit target for 2020, JPY 102 billion of operating profit and ROE 15% for 2025 were announced. At the time of the start of the EWAY 2025 in 2016, in disclosure information and in press release, clear line item target for 2025 or 2030 were not disclosed this time. The circumstances are rather complex. I would like to explain. For one thing, overall, when we look at the macro environment, environment is very complex. PL line item 5 years from now to disclose that forecast numerically, it may not be the best practice in fair disclosure in Western countries as well as in Japan. Line item target is no longer disclosed by most of the Western companies nor by Japanese companies either. And fair disclosure rule of [ DSC ] is adopted, and there are expert meetings. As a member of expert meeting, I have also provided my recommendation. P&L line item fixed numerical target for 5 years from now or 10 years from now, it's not a best practice. That is the conclusion. Rather, general direction and KPIs should be shown in every year in earnings results. We announced annual forecast. And on those occasions, performance forecast will be disclosed. And I think that is fair disclosure or best practice over medium to long term. I think the -- there is an aspect of change in best of practice. And the global standard is such that there is no longer a line item target disclosure. And for this fiscal year, there was COVID-19, and there is a greater uncertainty because of DX as well. And aducanumab and lecanemab, our major next-generation AD products, whether they are approved, whether approval is attached with conditions, those of all of the possible factors, and there will be volatilities associated with those factors. And it would be unfaithful if we disclose numerical target. As for KPIs, in integrated reports, we are making sufficient disclosure over medium to long term as a piercing rod, which is constant from this year to next year. ROE to be raised over medium to long term, that is ROE on 10-year average to be greater than 8% or a possible 10% spread. 15% ROE is always kept in mind, and we have achieved that last year. And once again, we will be considering that as a target. And ROE higher than the capital cost of more than 8% spread and a dividend of JPY 160. DOE, 7% to 8% range, JPY 160 or stable dividend, those remain unchanged. And that is supportive of financial integrity. And KPIs to reflect the financial integrity are also disclosed. Net DER is positive 0.3% to point -- to around 12.3%. And so a stable dividend and long -- medium to long-term investment can be covered by this. Rather than short-termism, long-termism is adopted and guidance over medium to long term is given. That is the stance that we are adopting. Does that mean that we will not do anything over medium to long term? At every occasion, regarding the short-term guidance, we would like to refer to the best practice in the market and look at uncertainties, volatilities and consider what is appropriate at any given time. But equity spread, net DER, DOE, these KPIs remain unchanged. And in this way, shareholder value, corporate value enhancement will be pursued over medium to long term.

Mr. Naito, CEO, will also make additional comment.

Mr. Hashiguchi, thank you very much for your question. This is Naito speaking. Mr. Yanagi, CFO, just commented, and I agree with that. Over long term, of course, there will be results from these studies for LENVIMA. And we have seen good results already from RCC, HCC, and I believe that success probability is becoming greater for other cancer types. But eventually, there will be a time when [ LE ] arrives. I did not discuss in detail today, but AD DMT included regarding neurodegenerative disease, we will have more products in the portfolio in that area. And I believe that there is a potentially robust upside or growth potential in that area. Between oncology and neurology, over longer term, we believe that long-term growth can be achieved with neurology being more dominant between the two. This is somewhat ambiguous but I wanted to supplement.

Second question, EUP will be the trunk composing hhc ecosystem to remove people's anxiety. And on Page 12 and beyond, various examples were shown regarding the profit model. It was not very clear. How do you plan to generate revenue and profit? There were specific examples given, and there may be different profit models. But in the near future, where do you hope large revenue and profit will come from? Can you give examples as to source of major revenue and profit? Or rather not directly from EUP, but are you considering EUP as a means of increasing sales of drugs? If that is the case, if you could explain in that way, please?

Chief Strategy Officer, Mr. Nagayama will respond.

Thank you for your question. This is Nagayama speaking, in charge of strategy. I would like to respond to your question. Regarding the health care and health going forward, it was discussed during the presentation. It is not necessarily the case that after the manifestation of the symptoms, people will receive diagnosis and treatment. There will be evolution away from that pattern. Even in healthy state, there will be greater interest on prevention. Based on pathophysiological definition, precision medicine will be given. I think that will be the evolution. Unlike before, based on big data, for each individual, there will be prevention and treatment options available. And in treatment, the timing of the administration of the treatment, the alternatives, nutritional options and adjustment of the treatment based on the response, from all of these, best approach will be explored. Ecosystem and digital prowess, without these, we will not be able to achieve this universally. Treatment scheme is becoming more complex. So with accurate monitoring, we will improve the effectiveness. And monitoring will allow for confirmation of the effectiveness, and then treatment can be adjusted further or early intervention may be possible and appropriate timing of intervention may be identified in case of AD. And I think that will bring about great benefit to patients. Next-generation AD DMT, aducanumab and lecanemab peak sales substantially can be pushed up through these efforts. And in solution packages, solution packages offer value for which we are able to receive consideration from the users directly. Furthermore, Eisai Universal Platform have gene, EHR, PHR and cohort study data. Various data will be included in EUP. And in dementia and in oncology area, we would like to use the data to enable prevention and more effective treatment. With various industries and businesses, combining the knowledge from EUP, working with various industries and businesses, we would like to be able to offer benefit to the people, and I think such benefit will also come from other industries. Regarding Eisai and about your question of profit to be generated by Eisai. We're using EUP from other industries. I think we can expect certain level of royalty as well. For example, existing platform model may be managed by some of the companies. And platformers receive a few percentage of fee, and I think that can be a model that we can reference.

Final question, AD DMT value-based pricing. What is the state of discussion? What is the current status of the discussion regarding pricing of AD DMT? Because of AD, various cost is incurred by the society. But looking at the cost of treatment that is reimbursed by insurance -- health insurance, this was confined in the scope of health insurance discussion. But decreasing other costs in the society may result in greater health insurance cost. How are you going to persuade the society to accept this? What is the type of discussion that you're having in this respect? And what mechanisms do you plan to introduce?

Thank you for your question. Neurology Business Group President, Ivan Cheung, will address that question. NBG President, Ivan Cheung, will respond.

This is Ivan Cheung from Neurology Business Group. Thank you very much for your question. There are multiple steps involved in this process. The first step, as you heard from CEO Naito earlier, of course, is with regard to the actual creation of the value-based pricing model of an AD DMT, considering all elements of value to the patients and to the society. That's one very important step. And in this step, we involve not only our internal experts in both Biogen and Eisai, we also have a number of distinguished experts in health economics, disciplines, well-known professors, well-known experts to work with us in developing such high-quality value-based pricing model. The next step, in addition to creating the model, of course, is to engage with different stakeholders. And there are a large group of stakeholders we have to engage, not only the government and the payers, but also patient efficacy groups and also other community leaders involved in Alzheimer's disease. So this is the second step. And third step, which you also heard from CEO Naito earlier, is to look into different creative funding mechanisms. Depending on which country, there are different insurance systems in place, whether we are talking about government-funded insurance systems or other types of private or nonprofit funding mechanisms. And there are different ways we can think about how we can support patients through different models with these different funding mechanisms. So these are the 3 major steps involved in this process. I hope I answered your question.

Next, from Mitsubishi UFJ Trust Bank, [ Shogo-san ].

Yes. My name is [ Shogo ] speaking. I'm from Mitsubishi UFJ Trust Bank. Thank you for explanation. I have 2 questions. Regarding business model of ecosystem, could you please elaborate on that? From outsider's view, this business model deepening or evolution, where should I look at in order to decide or judge whether such a model is going well or not? I understand that the data is very important. But it is going to be really the competitive edge. And then the alliance or partnership can be accelerated further. But from outsider view, I don't think that we are able to see it currently. So -- and could you please provide us a time line? And where should we put focus on when -- in order to decide whether this model is going well? The second question is about corporate governance. As Mr. Naito explained, corporate governance, the Board of Director itself has evolved with more independents and advanced governance. I have expectations to that model. And from the executive branch, corporate governance, if there are any issues currently with the corporate governance system, could you please provide that? And in the evolution of the ecosystem, and I believe the business model is going to be changed. And the attributes of the -- or skill sets of the outside independent director may change as well. Could you please make a comment on the roles to be played by such outside directors as well?

Thank you for your question. For your first question, I would like to call upon Chief Digital Officer, Keisuke Naito, to respond to your question.

Thank you for your question. My name is Keisuke Naito, Chief Digital Officer. As Mr. Yamaguchi of Citi asked question earlier, I failed to respond to that. Regarding the formation of ecosystem, as I said earlier, we have in-house infrastructure channels to be strengthened further. And we needed to have that partnership and -- which is also important. And the presentation in today's information meeting, the collaboration and incubation, C&I, shall be advanced to strengthen them. As Mr. Nakayama responded to earlier question, AD DMT, for example, in order to substantially grow sales, I think this is -- can be one of the key barometers. And when it comes to formation of ecosystem and a deeper alliance or larger efforts will be introduced one by -- one after another. So by this, I think that these will be demonstrating whether the ecosystem model is working well. Is this answering your question?

This is Naito speaking, [ Shogo-san ]. Thank you for your question. Regarding corporate governance, well, stakeholders, or most important focal point for stakeholders, where as such focal points are located, it really depends on the time point. But how should I interpret that? Or how should we understand that? Actually, that is very important. And we briefly discussed this earlier, comparing short-termism and long-termism. How can we consider the right balance between the two? And ROE level for medium term and equity spread and capital cost fluctuations, for these issues, how deeply we should understand and capture the status? And with high transparency, are we able to explain this? I think this is going to be the key. In the meantime, SDG or ESG. these aspects are now becoming very important. And on the other hand, climate change and emission of CO2 gas in pharmaceutical industry, how are we going to compete or fight those issues? Of course, we are going to present what we are going to do in these areas. I think I mentioned this earlier today. But for pharmaceutical industry, there are ESG or SDG goals or measures to be done for each company, each player. There are certain areas where we can make our contribution to the medicine gaps or disparity or the access to medicines and how secure and thorough work we have been doing in each area. Immediate financial return may not be directly derived from these efforts in some cases. But how should people evaluate those efforts or how people should support such activities, which may not directly lead to financial results. Whether or not we are able to explain in an orderly manner of all these points to [ Mr. Hyodo ], I think that is the key, and that is something I am keeping in my mind.

As a front-runner in terms of governance, I hope that you will continue to run as a front-runner going forward. Regarding ecosystem, there is another -- just one follow-up question. Mr. Yanagi has mentioned frequently in terms of the capital cost and equity spread must be positive. And in that understanding, you are deploying this business right?

Yes, of course. That is correct. That is the function, which is expect to be upside.

Yes, understood. Okay. I have expectation to how this will be playing out.

Next, Mitsui Sumitomo DS Asset Management (sic) [ Sumitomo Mitsui DS Asset Management ], [ Otomo-san ].

Can you hear me?

Yes.

I'm [ Otomo ] from Mitsui Sumitomo DS Asset Management. I have one question. This is a qualitative question asking for qualitative response. In the model to remove anxiety, what happens after removing people's anxiety with EUP? By building EUP in over a long term, you have built empathy for the patients and families, and you have built relations with HCPs and government. And I think, as a result, uniquely, Eisai is able to take certain actions so that when you completely implemented measures to remove anxieties, what will wait afterwards? Is it to eliminate all of the anxieties regarding dementia? So in a way, my question is what the ultimate mission of Eisai is regarding dementia?

This is Naito. Thank you for your question. The answer is trust. After removing anxiety, there will be trust between the people and Eisai. We will be able to build trust between the people and Eisai after removing anxiety. Thank you very much.

This will be one last question. The last question is from Mitsui Sumitomo Trust Asset Management (sic) [ Sumitomo Mitsui Trust Asset Management ], Koguchi-san.

My name is Koguchi. Can you hear me?

Yes, I can.

I may be repeating what has been already discussed. I'd like to ask you to elaborate further on ecosystem. Management philosophy, hhc, human health care and ecosystem, from this aspect, I would like to ask you a question. This grand platform, for this platform to perform well, you needed to share the interest with stakeholders. Within Eisai, it may have been challenging for you to share these values or philosophy among people inside the company. But when it comes to how to share these values or philosophy with wide-ranging stakeholders, particularly those people other than HCPs, players in other industries, when it comes to alliance with those players in other industries, it will be even more difficult. Could you please give us your impression or take on what you have experienced so far? Are there any measures that you are thinking about in order to facilitate the process?

Chief Digital Officer, Keisuke Naito, is going to respond to your question.

Thank you for your question. Partnership to form an ecosystem, the difficulties and challenges and how are we going to overcome them, I think that was your question. In pharmaceutical industry, through a partnership and collaboration and incubation, we are going to advance these. And that's what we explained in today's information meeting. And in these areas, in order to advance these efforts, we needed to have a POC. In earlier question, what impact will be brought about? That was the earlier question. But in order to have a stable business, at scale, what can be realized, that these have to be measured, and then we have to have -- conduct a scaling. This will be a key. So for these efforts, regarding the partnership, we needed to take steps one by one steadily. Have I answered your question? If you have any further or follow-up questions.

Sorry, sorry. This is Naito speaking. I think the corporate philosophy may not be necessary according to what you have just answered.

Ecosystem is supported by hhc or your corporate philosophy. Is this correct?

Naito speaking. Yes, please. If I may follow-up our comments. As you pointed out, to understand patients' anxieties itself was very challenging. We do not think that we have understood everything, all the anxieties completely. Over the past 25 years, we have been doing this. And at last, we think that we have been able to elucidate some of the anxieties. Now expanding the subjects to the people more widely, and then how are we going to do this? Are we going to share time with the patients? And then if the patients are replaced by the people, how are we going to spend time together with the people? This is what we have to keep in our mind at all times. Particularly, we are currently under pandemic situation with COVID-19, so it will be very difficult to interact with the people in person. So for example, at normal times or peace times, in our office, we can create a community space where we can host various events, and we can have a chance to interact with people, residents in the community at the Kawashima complex. We have cafe. And we can expand that as well. But under new normal state, we will be able to do this, and we'd like to. But otherwise, in remote settings, how are we going to implement them through digital manner? How are we going to do this? Then that data held by individuals will be one important clue to understand the patients. Another is imaging or video. Excellent documental films are available. Under pandemic, we have come to know this. The producers of documentary films have created excellent documental films. If the producers are excellent, and then you can be moved to see them with very deep message. Through such documentary film, we are able to understand the anxieties of the people. That's what we have already started internally. As pointed out by you, I think that is the key for us. We have philosophy and expanding the subject to the people and the philosophy can be the key for doing this. We don't have perfect answer to that now, but currently, we are making utmost efforts to -- expand efforts to various option.

Understood. So you are feeling the achievements in day-to-day operation, right?

Well, looking at the such documentary films as well as contacts through remote manner, we are sharing what we have experienced with associates and employees. And I think that the new achievements and the results are being seen now.

I hope that your trunk will become wider going forward.

Thank you very much. I'm sorry, but now we have used up our time for today. So we'd like to conclude our session. Thank you very much for taking time out of your busy schedule to participate in this event, and I hope that you will continue to support Eisai. [Statements in English on this transcript were spoken by an interpreter present on the live call.]