Global Health in Japan

Japan’s Global Health Legacy

Official Development Assistance (ODA)
Japan officially began to engage in global development assistance in 1954 upon joining the Colombo Plan. In the years that followed, Japan initiated economic cooperation activities with countries in Asia in the form of reparations and yen loans in order to build amiable relationships with its neighbors.1

By the end of the 1960s, Japan had developed into a leading player in the foreign aid sphere alongside domestic economic growth. After the concept of Official Development Assistance (ODA) was officially introduced by the OECD in 1969, Japan began to disperse ODA2 and has come be recognized as a major donor country that integrates its unique development history into its development approaches, which often includes investment and trade activities.3

Over the years, Japan’s ODA and foreign policy has continuously emphasized the concept of “human security,” which was spearheaded by JICA’s former President Sadako Ogata and former Foreign Minister Keizo Obuchi at the turn of the 21st century.4 Human security continues to be a concept upon which Japan builds its international cooperation policies and guidelines.5 Global health has been identified as a critical component to securing human security, specifically through health systems strengthening, universal health coverage, and global health security. Despite this thematic focus, much of Japan’s ODA continues to focus on infrastructure and construction projects.6

In 1992, an ODA Charter was drafted to guide ODA priorities and development work administered using ODA. This charter was revised in 2003 and “human security” was included as a key tool of policy.7 On February 10, 2015, a new development charter was drafted and approved by the Abe Administration.8 The new charter, now called the Development Cooperation Charter, builds upon the past ODA Charter but integrates four additional principles: cooperation for peace (nonmilitary restriction), promotion of inter-sectoral partnership, support for recipient countries’ capacity for development, and gender equality and women’s empowerment.9 The Development Cooperation Charter became a source of debate because it includes a provision that allows ODA to be used to assist armed services of other countries in non-military situations. Some have argued that this provision creates a channel through which Japan can indirectly support defense activities, while others, including the government, assure the public that this provision is strictly limited to peaceful operations.10

Recently, there have been calls to streamline Japan’s global health strategy by increasing coordination between the government ministries that oversee development policy and action, including the Ministry of Foreign Affairs (MOFA), the Ministry of Health, Labour and Welfare (MHLW), and the Japan International Cooperation Agency (JICA).11 It is thought that through increased inter-agency cooperation and further development of inter-sectoral partnerships (between government, NGOs, the private sector and civil society) that development work can be carried out more efficiently and effectively.

G7 Summits
Since 1996, global health has been explicitly discussed at every G7 Summit. The increasing diversity of global health stakeholders, the introduction of public-private partnerships, and the decreasing dominance of the World Health Organization have contributed to catalyzing the importance of G7 engagement and subsequent contributions.12

Japan, as a G7 member, has put a timely and critical global health issue onto the agenda at each summit it has hosted leading to subsequent and significant action.13 In fact, the first mention of a health-related issue in a G7 official summary statement appeared after the 1979 Tokyo G7 Summit. This statement identifies the need to support developing countries to address malnutrition and hunger.14 The official summary statement after the 1986 Tokyo G8 Summit exclusively mentions “a safer and healthier…world” and “the fight against…disease.” This was only the seventh time a direct reference to health was mentioned in an official summit statement since the G7 began meeting in 1975.

At the 2000 Kyushu-Okinawa G8 Summit hosted by Japan, G8 history as well as global health history was made when then Japanese Prime Minister Yoshiro Mori invited heads of state from Africa to be included in the meeting for the first time. It was also the first time that action on infectious diseases was propelled onto the G8 agenda.15 These actions transformed into a call to action to world leaders and resulted in the creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria in 2002.16

When Japan hosted the 2008 G8 Summit in Hokkaido Toyako, the focus was turned to global health, but not without significant political investment prior to the meeting. For nearly one year prior to the summit, former Prime Ministers Mori and Koizumi appealed to the Japanese public. At the same time, Prime Minister Fukuda and Foreign Minister Koumura pressed to have global health on the G8 agenda. This activity was complemented by a Global Health Summit held by HGPI and the World Bank with cooperation from the Bill and Melinda Gates Foundation, bringing together stakeholders from various sectors to catalyze action at the upcoming summit. Internationally, the Science Council of Japan facilitated the first G8+5 statement on global health, which was distributed to all G8 leadership.17 As a result of the efforts of both the government and non-government sector, global health became a major issue on the agenda at the 2008 G8 Summit leading to a strong commitment from G8 heads of state to take further action on health systems strengthening in emerging countries.18

As Japan prepares to host the G7 Summit in Ise-Shima in 2016, there is a host of activity taking place to ensure that global health has a prime position on the meeting’s agenda.

On December 16, 2015, the Japan Center for International Exchange (JCIE), MOFA, Ministry of Finance (MOF), MHLW, and JICA organized the International Conference on Universal Health Coverage in the New Development Era, one of the first international conferences on global health since the adoption of the Post-2015 Sustainable Development Goals. At this meeting, held in Tokyo, global health leaders gathered to discuss emergency preparedness, global governance, and the 2016 G7 Summit’s role in global health. The following day, prominent global health experts participated in a round-table discussion on the proposals Japan has crafted for the 2016 G7 Summit. Using the input received, members of the global health working groups who wrote the proposals were able to make revisions in order to strengthen Japan’s message at the upcoming summit.


The Global Health Innovative Technology (GHIT) Fund

In April 2013, the Japanese government took a bold step forward in the field of global health by creating a public-private partnership (PPP) called the Global Health Innovative Technology (GHIT) Fund to fund research and development (R&D) for neglected tropical diseases (NTDs), diseases are not addressed by typicalmarket mechanisms leaving nearly half of the world’s population with or at risk of a life-impacting health condition. The GHIT Fund’s current focus areas include malaria, TB, Chagas disease, and visceral leishmaniasis.

The GHIT Fund receives public sector support from MOFA, MHLW, and the United Nations Development Programme. Civil sector support is provided by the Bill & Melinda Gates Foundation and the Wellcome Trust. The GHIT Fund receives sponsorship from a variety of private firms representing various sectors, including IT and airlines.

Using this platform, the GHIT Fund brings together six Japanese pharmaceutical firms and one diagnostic company. Companies are then partnered with product development partnerships (PDPs), including the Medicines for Malaria Venture (MMV), the Drugs for Neglected Diseases initiative (DNDi), and the TB Alliance, which bring extensive knowledge and resources in the field of NTDs. It is hoped that these partnerships will bring forth the potential that exists within Japan’s diverse chemical libraries and rich compound assets to contribute to reducing the burden of NTDs.1

Because Japan is the second leading country in terms of the provision of chemical entities, it is believed that Japan can contribute to reducing the burden of NTDs across the world by uniting the wealth of Japanese innovation with global health needs.

As of November 2015, the GHIT Fund has provided over $50 million in investments for over 40 new products. There are currently six clinical trials underway in Burkina Faso, Bolivia, Ivory Coast, Peru, Tanzania, and Uganda with two additional clinical trials scheduled to begin in 2016. It is projected that efforts made possible by the GHIT Fund will result in its first completed product by 2018.2


Recent Focus on Global Health at the National Level

Global health has long been integrated into various Japanese policies, including policies that affect trade, finance, health, and education. A recent independent panel appointed by the Minister of Health, Labour and Welfare, Yasuhisa Shiozaki, identified key focus points for Japan’s health care system as it prepares for the next 20 years. One of the three main recommendations made was in the area of global health leadership. The panel, known as the Health Care 2035 Advisory Panel, suggested that Japan build a world-class system for global health security, become a more prominent leader in the field of global health, and support the health and security of those around the world. Concrete actions and policy proposals related to these recommendations are currently being considered by a newly established Global Health Panel within the MHLW. Currently, the Global Health Panel is taking the necessary steps and engaging in the required discussions to make the global health vision outlined within Health Care 2035 a reality.

References

1 “50 Years of Japan’s ODA,” Ministry of Foreign Affairs. Accessed March 15, 2016. http://www.mofa.go.jp/policy/oda/cooperation/anniv50/pamphlet/progress1.html

2 http://www.mofa.go.jp/policy/oda/summary/1994/1.html

http://www.odi.org/sites/odi.org.uk/files/odi-assets/publications-opinion-files/7619.pdf

4 http://www.jcie.org/researchpdfs/globalhealth/final_paper.pdf

http://www.odi.org/sites/odi.org.uk/files/odi-assets/publications-opinion-files/7619.pdf

6 Sugiyama, H., et. al., “Japan’s Global Health Policy.” Rowman & Littlefield Publishers, Inc. Lanham: 2013.

7 http://www.jcie.org/researchpdfs/globalhealth/final_paper.pdf

8 Asahi Shimbun. “EDITORIAL: ‘Development cooperation charter’ could transform Japan’s foreign policy.” The Asahi Shimbun. February 11, 2015.

9 Okaniwa, K., “Changes to ODA Charter reflect new realities.” The Japan Times. May 29, 2015.

10 Okaniwa, K., “Rebuttal statement against the editorial of Japan Times ‘Aid that could foment conflict’ (February 20, 2015).” Ministry of Foreign Affairs. March 9, 2015. http://www.mofa.go.jp/mofaj/ic/ap_m/page3_001121.html Accessed January 13, 2016.

11 Sugiyama, H., et. al., “Japan’s Global Health Policy.” Rowman & Littlefield Publishers, Inc. Lanham: 2013.

12 Global Action for Health Systems Strengthening

13 Japan Center for International Exchange. “Global Action for Health System Strengthening: Policy Recommendations to the G8.” 2009. p 9-15.

14 G8 Conclusions on Health, 1975–2015 John Kirton, Zaria Shaw, Julia Kulik and Fern Ramoutar and Maria Marchyshyn

15 The Global Fund. “Japan and the Global Fund.” The Global Fund. http://www.theglobalfund.org/documents/replenishment/2015/Replenishment_2015JapanDonorSheet_Report_en/ Accessed January 13, 2016.

16 Sugiyama, H., et. al., “Japan’s Global Health Policy.” Rowman & Littlefield Publishers, Inc. Lanham: 2013.

17 Kurokawa, K., et. al., “Italian G8 Summit: a critical juncture for global health.” The Lancet: Vol 373, February 14, 2009. P 526-527.

18 Reich, M. and Takemi, K. “G8 and strengthening of health systems: follow-up to the Toyako summit.” The Lancet: Vol 373, February 9, 2009. P 508-515.

19 Katsuno, K., et. al., “Hit and lead criteria in drug discovery for infectious diseases of the developing world.” Nature Reviews. Vol. 14. November 2015. p 751-758.

20 Slingsby, B.T. “How innovative financing and partnerships are transforming the infectious disease product pipeline.” Devex. November 5 2015. Accessed on January 7 2016 at https://www.devex.com/news/how-innovative-financing-and-partnerships-are-transforming-the-infectious-disease-product-pipeline-87246