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What is the history of Japan's leadership in global health policy and strategy?

Japan became involved in the field of global health in a major way through the G7 and G8 summits. Japan raised the issue of infectious diseases for the first time at the Summit held in Kyushu and Okinawa in 2000 where the government announced the Okinawa Infectious Diseases Initiative, committing three billion US dollars in funding to support the initiative. Japan's leadership on this eventually led to the establishment of The Global Fund to Fight AIDS, Tuberculosis and Malaria.

In 2008, Japan hosted the Hokkaido Toyako Summit, where the government strongly emphasized the need for health systems strengthening in the global health field. Japan played a pivotal role in making this new theme mainstream in global health. At the time, it was noted that disease-specific—or “vertical”—approaches, which focus only on infectious diseases measurements, are insufficient to solving comprehensive health and medical issues in low- and middle-income countries. In addition, there was a growing awareness of the need to strengthen health systems overall, including through capacity development of health care professionals. Given this context, Japan proposed that global health issues could be more effectively addressed by strengthening the horizontal axis of health systems, in addition to the vertical axis of disease-specific approaches using traditional infectious disease measures and vaccination. Health systems strengthening has since become the one of the most important themes in the global health arena.

At the Ise-Shima G7 Summit in 2016, Japan proposed reinforcing the global health architecture to strengthen responses to public health emergencies in peacetime at the local, national, and even global levels, based on the outbreaks of infectious diseases such as Ebola and Zika, which had recently made a serious impact on public health and the world economy. Moreover, Japan strongly appealed for a collaborative international framework to help create a more robust and sustainable health system in each country. The end goal is universal health coverage, another critical health theme that Japan has been promoting.

This is how Japan has consistently played a pioneering and leadership role in shaping global health policy and strategy. More recently, Japan has also aggressively engaged in global health R&D, helping to create new innovations by leveraging Japan's cutting-edge pharmaceutical technology and capability. The GHIT Fund has played a catalytic role in launching and accelerating these activities.

R&D has recently become another important pillar of Japan's global health policy. What is the rationale for Japanese R&D support for infectious diseases that are not prevalent domestically?

There are several reasons for this. First, even if we are talking about drugs that are predominantly needed in low- and middle-income countries, it is important to recognize that infectious diseases like Ebola can be carried to Japan. In today's global society there is a lot of mobility among people and goods; we can't afford to think of infectious diseases as occurring only on distant shores. Japan needs to be actively involved in dealing with this issue.

The second reason is that infectious diseases are have a drastic impact on the economic development of low- and middle-income countries, which in turn carries economic and geopolitical implications for Japan. For example, if a country that exports to Japan ceases to function properly or its economy stalls, Japan will be impacted both politically and in its business relations. Japan, as a developed and mature nation, has a responsibility to pro-actively address and contribute these challenges.

The third reason is that it is necessary to create an environment and opportunities that allow Japanese pharmaceutical companies to leverage their advanced technologies to make global contributions. They cannot only do business in the domestic marketplace; Japanese businesses are also expected to work globally, including in low- and middle-income countries. In doing so, I believe that Japanese companies will be able to increase their international competitiveness. In addition, Japanese pharmaceutical companies can create new business opportunities over the mid- to longer-term. Creating and delivering new drugs for diseases in low-and middle income countries will help Japan and its pharmaceutical industry secure an important position in those countries' markets as they grow and expand. My understanding is that GHIT's efforts are the first step in that direction.

How were you involved in GHIT's establishment?

When launching the GHIT Fund, Dr. Slingsby (the founding CEO of the GHIT Fund), who worked for Eisai at that time, collaborated with other Japanese pharmaceutical companies to create the basic concept for the Fund. Then they collaborated with Gates Foundation and other founding partners to establish a clear structure.

During this time, I worked with the Government of Japan to help facilitate its involvement. It was important for us to make sure GHIT had an innovation delivery support function from the outset, so that people in low- and middle-income countries could actually use our products. In other word, the goal was not simply to create innovation, but also to ensure access to and appropriate use of that innovation.

However, drug development falls under the purview of the Ministry of Health, Labour and Welfare, and jurisdiction for delivery involves the Japan International Cooperation Agency (JICA) and international organizations, so the Ministry of Foreign Affairs also needed to be involved. Accordingly, realizing GHIT's vision required both ministries to provide funds—in fact this represented the first time two ministries funded a project jointly. It was extraordinarily difficult to make both ministries fully understand the concept of the GHIT Fund and help with funding. Fortunately, we were successful. Both ministries are deeply involved in GHIT's governance. In the future, continuous effort from the Japanese government will be critical to ensuring that the GHIT Fund grows as a flagship model for international public–private partnership and innovation.

What drew you personally to the field of global health?

There were a number of coincidences that led me to work in this field. I was originally studying international political science at university. It just so happened that I became a member of the House of Councilors and began working on health and medical system reforms for Japan. Through that process, I think I naturally gained an awareness of issues with the health and medical system from an international perspective.

Further, my father, in his later years as Chairman of the Japan Medical Association, created the Takemi International Health Program at the Harvard School of Public Health, which promotes and supports Harvard-based research on international health. It financially backs researchers—both overseas and in Japan—and contributes to the creation of programs. Through these activities, he was able to support global health-related academic activities over the course of many years, and I personally had an opportunity to study global health policy there. Through these experiences, I became aware of the new field of global health, and it became tied to my activities as a politician. That led to my interest and involvement in today's global health initiatives.

I'm happy that I have been able to realize many of my goals. In the future, I would also like to focus my energies on creating platforms that make global contributions by leveraging the various insights and expertise that Japan, an advanced country with an aging population, has accumulated, in advance of populations aging throughout the rest of Asia.

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