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Need for thorough compliance with International Health Regulations (IHR)


Need for thorough compliance with International Health Regulations (IHR)

Lessons learned from COVID-19 and Japan’s role to promote international



Hon. Keizo Takemi

Member of the House of Councillors

『International Development Journal』2020 June edition

Japan has been advocating global health initiatives through G7 Summits and other international conferences. IDJ interviewed a member of Japan’s House of Councillors, Keizo Takemi, a noted figure in the global health community and regarded as a “political catalyst” in the field of healthcare, to elicit his opinion on global health, including measures against infectious diseases and future challenges for Japan.


Inadequate domestic measures being the biggest blind spot

The “G7 Ise-Shima Vision for International Health” announced at the 2016 G7 Ise-Shima Summit presented four agendas that promote global health initiatives. Among the four, one was on strengthening the global health framework for public health emergencies, and another on strengthening health systems to achieve Universal Health Coverage (UHC).

As practical measures, the former called for the establishment of a new collaborative scheme between the World Health Organization (WHO) and the United Nations Office for Coordination of Humanitarian Affairs (OCHA) in the event of an infectious disease outbreak, and the strengthening of the core capacity of the International Health Regulations (IHR) established under the WHO Charter. Core capacity refers to the minimum ability required for hygiene management during normal times and emergency management upon outbreaks of epidemics.

In response to this, it became “common sense” in the field of global health to establish a public health crisis management system. This and the achievement of UHC are considered two sides of the same coin. The presence of Japan, who led these movements, also increased.

However, the current spread of COVID-19 has highlighted challenges in the existing global health system. One is that countries are not all adhering to the IHR. For example, the IHR imposes countries to notify WHO in the event of a potential public health crisis. However, since there are no penalties or specific measures for violation, some countries prefer not to notify WHO if they find it disadvantageous to their interest. This is not limited to China.

In Japan as well, the current pandemic revealed insufficiency in domestic core capacity. For example, Japan does not have a specific policy for dealing with epidemics of small and medium-sized infections. I have been advocating for more concrete measures for some time, but nothing has materialized as of yet. Moreover, there are no specialists of infectious diseases in the Cabinet Secretariat. We should have a permanent crisis management supervisor and a team of specialists in charge of infectious diseases; and they should take the lead in information gathering and analysis at home and abroad, as well as oversee domestic measures.

Japan suffered only a small number of domestic cases of Severe Acute Respiratory Syndrome (SARS) in 2003, and even during the outbreak of the Novel Influenza in 2009, the mortality rate per 100,000 population was 0.16 in Japan while the rate scored 1.32 in Canada and 0.53 in South Korea.

These past experiences and boasting high quality community healthcare, there seemed to have been a false sense of security and overestimation in Japan that “we can readily deal with infectious diseases.” We failed to notice any deficiency in the domestic system. This was our biggest blind spot.

On the other hand, South Korea and Taiwan succeeded in controlling COVID-19 early on and were able to avoid overwhelming their medical system. Learning from their past experiences, including SARS, they had built systems for testing, contact-tracing of infected people using digital technology, and accommodating infected patients in hospitals, already implemented in ordinary times. In the event of an emergency, the rules were already in place to quickly shift the system of health care services to accommodate the outbreak.


Promoting the Asia Human Well-Being Initiative

A future challenge in global health will be to ensure that each country adheres to the IHR. Furthermore, it is necessary to reform WHO. One is to strengthen the capacity of the WHO country offices. Since many people at WHO want to work at the headquarters, where great welfare benefits are provided, excellent human resources tend to gather at the headquarters with only rare transfers. Creating a personnel system that promotes balanced placement of excellent human resources is indispensable.

Japan should continue to demonstrate leadership in the field of global health. Among the developed countries, the US position in infectious disease control is weakening, and Japan’s role is becoming ever more important. The Government of Japan decided to contribute 10.6 billion yen to the “Coalition for Epidemic Preparedness Innovations (CEPI)” (Headquarters: Norway), through its 2020 supplementary budget. CEPI is an international public-private partnership launched in 2017 to promote vaccine development. In addition, the Government of Japan also decided to contribute 11 billion yen to Gavi (Global Alliance for Vaccines and Immunization), the Vaccine Alliance to support its various activities, including the transportation of vaccines.

It is also important to promote the “Asia Human Well-Being Initiative” that I advocated and launched in 2016 with a global health perspective. Under this initiative, in order to address the issues of aging in Asia, we are promoting knowledge-sharing through the export of Japanese nursing care models and development of nursing care personnel in the region. These efforts are also contributing to the improvement of the quality of medical services, which is one of the challenges for achieving UHC.

For example, the initiative is supporting the strengthening of the international division of the Pharmaceuticals and Medical Devices Agency (PMDA). PMDA, which oversees approval of pharmaceuticals and medical devices, established an Asia Training Center for Pharmaceuticals and Medical Devices Regulatory Affairs (PMDA-ATC) in Japan to offer training to personnel working in drug and medical device regulatory authorities in Asian countries. In the future, we plan to expand the capacity of the center and dispatch PMDA staff to Asian countries. It also seeks to convene meetings of regulators in Asian countries to encourage regional coordination in drug regulation.

In addition, the initiative aims to build a network of infectious and non-infectious diseases by developing human resources and providing equipment for clinical trials in Asian countries. These efforts can serve as a basis for joint development of medication and vaccines for COVID-19, and can also nurture common awareness and cooperation in global health among Asian countries. If Japan is to take leadership in global health, it is important to work with developing countries, even at the expense of intellectual property rights. It is not right to pursue hegemony. In that sense, while giving due respect to the role of China, we hope to deepen cooperation through the Asia Human Well-Being Initiative.


Making the Japanese “CDC” the cornerstone of crisis management

In Japan, it is essential to reexamine the domestic crisis management system. As part of that, why not set up an organization like the Centers for Disease Control and Prevention (CDC) in the US to carry out front-line epidemiological investigations and to accumulate technological capabilities to prevent the spread of infection? Let’s create a Japanese CDC as the cornerstone of a new crisis management system by combining the infectious disease control function of the National Center for Global Health and Medicine (NCGM) and the National Institute of Infectious Diseases (NIID) under the Ministry of Health, Labour and Welfare.

In doing so, it is necessary to consider the issues currently confronted by NIID, such as securing sufficient budget and strengthening authority in epidemiological surveys. The current budget of the NIID is about one-third less than what it was 10 years ago. As a result, it has not been able to train field epidemiology specialists who can serve as experts in epidemiological research. As for epidemiologic investigations, the NIID has limited research authority. For example, when an infectious disease is reported, health center staff are allowed on-site entry while NIID researchers cannot carry out a survey unless accompanied by a health center personnel. In creating a Japanese version of the CDC, it is necessary to ensure that investigators are given the same authority as health center staff.

In addition, Japan needs to have clear rules for policy decisions in emergencies such as COVID-19. In the event of an emergency, the legislative body is required to practice a well-balanced, democratic, decision-making process while ensuring a certain amount of check function. The Japanese government is now taking on this big challenge.

COVID-19 is more than an infectious disease; it is also a political and socioeconomic issue. We must analyze the situation from a multiple range of political, economic, and social aspects, and think about how to protect the future of democracy, the economy, and people’s livelihood. We must deal with it from a comprehensive perspective, including that of global health.





武見 敬三 参議院議員

























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