Quad Cancer Moonshot Initiative: Strategic U.S.-Japan Health Security Cooperation

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This transcript is from a CSIS event hosted on October 29, 2024. Watch the full video here.

Katherine E. Bliss: In late September, leaders within the Quad – which includes Australia, India, Japan, and the United States – announced the Quad Moonshot Cancer Initiative. Now, the Quad is the informal name for the Quadrilateral Security Dialogue, which was launched nearly 20 years ago following the Indian Ocean tsunami in December of 2004. It serves as a mechanism to enable the four countries to work cooperatively in the Indo-Pacific region on such issues as disaster relief, humanitarian assistance, cybersecurity, maritime cooperation, and economic development. During the COVID-19 pandemic the Quad countries joined together to emphasize outbreak preparedness and response, including through initiatives related to ensuring access to new COVID-19 vaccines.

So, for the Quad, health cooperation is not new, but the focus on cancer and cancer elimination is. What’s behind this shift? What are the goals of this new Moonshot Initiative? And what should we expect to see over the next few years?

Joining me today to discuss the Quad Moonshot Cancer Initiative is Erin Murphy, senior fellow and deputy director of the India and Emerging Asia Economics Program at CSIS. And I’m pleased to note that Erin is the first guest on a new CSIS Global Health Studio broadcast series on Strategic U.S.-Japan Health Security Cooperation. Among longstanding U.S. allies, the exceptional strength and resilience of the U.S.-Japanese bilateral relationship and the recent expansion of security cooperation creates new opportunities for expanded U.S.-Japan health security collaborations. This studio broadcast series, Strategic U.S.-Japan Health Security Cooperation, produced by the CSIS Bipartisan Alliance for Global Health Security, really aims to highlight areas of mutual health interest between the United States and Japan, and offer future opportunities to expand the U.S.-Japan alliance and regional health security.

Now, earlier this month Erin and I joined with our CSIS colleague and director of the Global Heath Policy Center, Steve Morrison, in writing a short commentary on the Quad Moonshot Cancer Initiative, which has a specific focus on cervical cancer and which actually caught many Quad observers by surprise. So, Erin, thanks for joining me today, and let’s dive in.

I want to start with the Quad. You’ve been a Quad watcher for a long time. So can you start out by explaining, like, what the Quad is? When we think about kind of its greatest accomplishments, what should we really be thinking about? And how has health kind of fit into the mix over time?

Erin L. Murphy: Sure. And thank you for having me. I’m going to try to raise the bar extraordinarily high as your first guest, so that others can’t follow in my – in my wake. But it’s wonderful to be a part of this new initiative, this new broadcast series, so really excited to talk also about our piece.

The Quad, as you mentioned in your opening remarks, really kind of came together after the 2004 Boxing Day tsunami. And I kind of liken it to “Avengers, assemble.” This was a way to bring four countries with differing capacities in humanitarian and disaster relief – whether it was financial assistance, utilizing the agencies and departments that they had, and also using their private sector – to go and solve these issues.

So it really started off as a way to address a(n) incredibly serious issue. And of course, the 2004 Boxing Day tsunami affected multiple continents – multiple countries. So for these four partners to come together, it was certainly a great thing and really, you know, helped a lot of hearts and minds and building that sort of community in these countries.

It was kind of ad hoc after that, but it was really Japan that took a lot of leadership in terms of elevating it to a more regular meeting, again, focusing on the informal. But in 2007 – and I have a list here because there was a lot to do – (laughs) – in the Quad – but you know, in the first couple years, really until 2020, it was kind of ad hoc. And in 2007, it was the first meeting on the sidelines of the ASEAN Regional Forum. Still technically informal, but you had meetings at the seniormost levels, Vice President Cheney meeting with then-Australian Prime Minister Howard and with the Indian foreign minister, Mukherjee. And that’s really where these discussions started talking about where can the Quad go.

But it was really Prime Minister Shinzo Abe in 2013 that really launched the Quad into a more – still informal formal group, but pushing on cooperation in maritime security issues. This was really in response to increased Chinese aggression in the South China Sea, also its engagement in Southeast Asia and the Pacific, and trying to make that more of a collaborated and coordinated partnership. In 2016, he came up with this idea, the Free and Open Indo-Pacific, of which many countries have taken his lead, and that includes the United States as well. And then, in 2017, Japan proposed having sideline meetings at the East Asia Summit in Manila.

And then after that is really where kind of the Quad took off. During the Trump administration, it was elevated to regular foreign minister meetings. And in the Biden administration, continuing on what the Trump administration had done, elevating it to senior level – so presidents, prime ministers – and making sure that there was, you know, different ways that they can engage.

When the Biden administration took over efforts on the Quad, COVID-19 had sort of presented itself as sort of the tsunami of its day. This was something that was affecting the entire globe. And these Quad partners were in a great position to work together and use their collaborative resources to focus on health.

So the first major thing that the Quad did in this new iteration of itself was addressing COVID-19 vaccine production. They finally made breakthroughs in terms of creating a vaccine, but how were they going to manufacture enough to get to low- and lower-middle-income countries in Asia, particularly Southeast Asia, and the Pacific Islands? And really, this was kind of where you know, the foundation of the Quad working in health care came to be.

Ms. Bliss: So if I understand what you’re saying, I mean, in part after 2004, at least for a period of time, the Quad was, as an informal alliance, kind of meeting on the sides or the margins of other meetings.

Ms. Murphy: Yeah.

Ms. Bliss: Like, if you have ASEAN, APEC, or some of these other initiatives. But it was really the pandemic in 2020 that kind of brought them together on some of the – you know, the outbreak response.

Let me ask you, I mean, 2020-2021, I mean, that was the period – it was, obviously, a very – (laughs) – unusual period that we all – that we all experienced. I mean, the production of vaccines was new. China, at the same time, was undertaking its own vaccine diplomacy. How significant a factor do you think kind of the role of China in the region and the role of China in particular with the vaccine diplomacy was in kind of spurring that particular engagement that year?

Ms. Murphy: I think it had a pretty big impact. And certainly, what China does – and that includes maritime security, on economic coercion and competition – certainly informs what the Quad does, but it doesn’t inform everything that the Quad does.

The Quad saw an opportunity on both sides: One, to address vaccine diplomacy and competition there; and, two, to address a very real crisis that was going on in the world. So, you know, I think that there was an effort to come up with a vaccine that would have, you know, a proven track record. I think there was questions on the efficacy of vaccines. But not just on producing the vaccines itself, but to do kind of the infrastructure around it, which included last-mile delivery and more rural and hard-to-get areas, but also to address vaccine hesitancy that might be present in these countries. So it was really kind of bringing all the pieces of that together – the manufacturing, making sure that there were countries that had companies that could scale the manufacturing of this, having the rules and the regulations to be able to export this to other countries, and then having the ability to be able to deliver and to make sure that people felt that it was safe to use.

Ms. Bliss: OK. So really looking at the whole health system –

Ms. Murphy: Correct.

Ms. Bliss: – the training, the supply chain logistics, and then the acceptance of new product themselves.

Ms. Murphy: Right. Right.

Ms. Bliss: So the new Moonshot Cancer Initiative has a very strong focus on cervical cancer elimination, and of course, HPV vaccines are an important element of that. You know, human papillomavirus is strongly linked with cervical cancer. But the initiative is not just about vaccines. There is – in the material that’s been shared about it, I mean, there’s a very strong emphasis on improving diagnostic capabilities; access to some of the new HPV, you know, tests that are, you know, much more effective in providing information; and also treatments. So let me ask you if you can say a bit about, how did the Quad come to take this on? I mean, this seems a little bit far afield from pandemic preparedness and response. So how do you – how do you see that it really came to kind of embrace this set of topics?

Ms. Murphy: It was kind of a coalescing of certain things. You know, I think COVID was also a coalescing of things. It was you had four partners that had the right tools – whether it was economic, technical, scale – to bring together to address that kind of issue. And I think we have it here as well, building on the foundation of the Quad partnership.

Following the vaccine initiative the Quad created the Health Security Partnership, and this was really meant to do more on the pandemic and the epidemic issues – data, surveillance, making sure that we get ahead of the next pandemic. But what the Quad also, I think, takes advantage of is seeing the work that’s already out there and seeing how they can build onto it. And of course, I turn to you in terms of discussing where other agencies like Gavi fit into this.

But for them, it – for this, it was kind of a multitude of things. One, it was, you know, Biden, of course, has his cancer moonshot. This is something very near and dear to him, something that he really wants to make progress on, not just in the United States but globally. Of course, the moonshot also hearkens back to John F. Kennedy and his moonshot initiative of trying to get us to the Moon. So, basically, you know, it’s kind of a catchall phrase for things that seem impossible but that can be done. And sometimes it has to be done in partnerships. Sometimes it’s a whole-of-government approach.

I think what also helped here is that you have Ambassador Caroline Kennedy, who’s out in Australia – of course, one of the Quad partnerships – and has had experience in all of this. You know, her father was the one that created the moonshot. Certainly, cancer is near and dear to her heart as well. And being, you know, a confidant of Biden, this was one way of trying to elevate it. And for her, seeing what Australia was already doing on HPV, particularly in the region and in its own country as well, this was a great opportunity to elevate it into the Quad senior level to discuss how can we go after this treatable, preventable disease that is killing women and infecting millions globally every year. So there was a real opportunity in that you had this cancer moonshot that was already out there; you had Australia already proving leadership in its own country and in the region on the HPV; you had Caroline Kennedy, who was in a Quad country, working for another Quad country, and trying to work on this.

But when you also looked at what the Quad could bring to an initiative like this, you also had Japan proving a lot – leadership here, especially when it came to medical infrastructure and technology. The Japan International Cooperation Agency has been doing quite a lot of work on this area, especially when it comes to cancer diagnostics and monitoring. India already has a proven, effective vaccine for HPV. And so, you know, this is another area where you could tap their ability to produce and scale to really get out there and do this.

Plus, I think this complements other efforts that were underway in terms of HPV. APEC – the Asia-Pacific Economic Cooperation Forum, which is another formal informal agency – has been doing a lot of work on HPV as well, especially as – you know, and the numbers are astounding that, you know, APEC accounts for some of the most infections of HPV a year; up to 35 percent, I think it is. All these facts and figures are in our paper, which I highly recommend to everyone.

Ms. Bliss: (Laughs.)

Ms. Murphy: Read and memorize.

But it really kind of coalesced and came together that you had these efforts already underway, you had kind of this engagement. It really just takes a few at the leadership level to connect the dots, and bring it into an organization or a grouping that has shown an effective track record on dealing with big issues.

Ms. Bliss: So it sounds like, you know, certainly there was the personal element of Ambassador Kennedy and just, you know, the experience that she brought to her engagement with the government of Australia. But really, also, you know, it seems like this is new, but there’s a long history of bilateral engagement on many of these issues, of innovation in the different countries, and certainly their own bilateral engagement within the Indo-Pacific region.

You mentioned Gavi, which of course is the Global Vaccine Alliance launched, I guess, before 2004, back in the year 2000, but really focusing on bringing these newer vaccines to people living in lower- and middle-income countries. And after the pandemic or in the course of the pandemic, really saw that uptake of the HPV vaccine had leveled off, and so had kind of relaunched that initiative in 2022, I guess, 2023, to really, you know, refocus global attention. And of course, as Gavi went through its last replenishment process, I guess in 2021, Japan hosted that – or that – the launch of that conference. So, really, there’s been a lot of diplomatic support for these vaccine initiatives as well.

On the – on the question of how the – how the Quad will work in the region, I mean, you mentioned the significant burden of HPV-related cancers and mortality in the region. How do you see – is there a sense yet of how they will – how each of the countries will kind of – are they dividing up their labor? Are they putting together a work plan? I mean, how are the efforts around diagnostics, vaccines, and treatment coming together?

Ms. Murphy: So I think what the Quad has done well – and you know, maybe it’s been trial and error, but I think what they do is they look at a project, at an initiative, and are really focused on where their particular strengths lie. It’s not everyone jumping for credit to do this or everyone going to the shiny object. And I think that is so crucial for any sort of initiative, any sort of project, whether it’s an infrastructure project or something like the cancer moonshot. You really have to kind of find your lane, and make sure that it complements, and that you have good coordination mechanisms.

So I think the Quad already has that in place from the vaccine partnership to deal with COVID, but then also the expanse of what the Quad does. I mean, they’re not just doing health care. This, I think, has been the most visible thing that they’ve done, but their efforts on cybersecurity, maritime security, education, information and communications technology, and even space. So, you know, we might see some Quadmonots in space; who knows?

Ms. Bliss: (Laughs.)

Ms. Murphy: But for here, I think one –

Ms. Bliss: (Clears throat.) Excuse me.

Ms. Murphy: – one of the big questions is around financing because, of course, you have to be able to finance this. And so this is a good example of private – public-private partnership. You’re seeing Australian companies step up and provide financing for this. You’re also seeing major organizations, as well, step up and address this, whether it’s putting in money in terms of the vaccine manufacturing or being able to do the last-mile delivery. But it’s to also help build the infrastructure that would take it there. I think similar to the COVID-19 initiative you had India already as a place that can manufacture vaccines and scale well. And then we have development agencies that are used to working together – the U.S. and Japan, the U.S. and Australia. And then, trilaterally, they’ve worked on several types of initiatives for years. And you know, this is just – I think there’s a very comfortable partnership there. And you definitely have leaders in the region, as well, that know the right people to go to, the right governments to talk with, and especially when it comes to Japan and of course Australia and the Pacific Islands.

So there is, you know, probably working groups, high-level meetings, very similar to the COVID-19 vaccine initiative where there was a vaccine senior-level meeting where we were meeting every few weeks or every week, depending, and seeing where everybody was in the process: Where’s the financing from the U.S. International Development Finance Corporation going? Has it been disbursed yet? And in fact, we have a lot of U.S. agencies also involved in this. The DFC, the U.S., International Development Finance Corporation – my alma mater, I guess you could say, and I worked there during the COVID-19 issue, which is why I try to speak so, you know, poetically about it – has a Health and Prosperity Initiative. And they see this as one of their main pillars in terms of investing. So you’re seeing a lot of financing coming from them as well. They have MOUs with Japan and Australia. So that cooperation has been ongoing and will continue through this moonshot initiative.

Ms. Bliss: But if I understand correctly, some of the initiatives that the U.S. is supporting in the region are – also come through domestic funding channels. Is that right? I mean, some of the work in the Pacific Islands, not just the ones that are territories of the U.S., but also some of the further ones where I think domestic resources are also supporting health systems and that kind of thing. But this, in addition to some of the – and maybe that’s Health and Human Services funding – but there’s also – I think DOD is playing a pretty significant role in the U.S. commitments here.

Ms. Murphy: Correct. And, you know, they have a strong foothold on the ground and are, you know, pretty good at disaster and humanitarian relief – not that this is a disaster quite yet, but in terms of delivery logistics. And they have floating healthcare ships. There’s a lot that they can do. And their partnerships with these – I mean, those are two treaty allies that we’re talking about, in terms of Japan and Australia, and the ongoing cooperation that’s been there especially when it comes to deploying and implementing these types of projects.

Ms. Bliss: So I want to come back to the COVID-19 collaboration, because while there were a lot of commitments made, in the end a lot of those vaccines were either not delivered or were delivered through bilateral channels, as opposed to through the Quad. And so, you know, as we were thinking – as the information was coming in and as we were thinking about this piece, I mean, one of the things that kind of kept sticking in my mind is, you know, how are they – not only, like, how are they actually going to collaborate, is it going to be kind of adjacent or alongside, as opposed to kind of pooling resources?

And it sounds like there are so many different arrangements already in place that there are many different mechanisms to do that. But, you know, how are they really going to measure their impact in the long term? And you know, certainly in global health, you know, you see, you know, oh, we need to get to this number of infections averted, or this number of, you know, deaths averted over a time. Do you – is that something the Quad does in its different kinds of initiatives? Or do you see things evolving in that direction?

Ms. Murphy: I would say, hope I that it evolves in that direction. You know, some of the announcements that the Quad has made over the last couple of years – you know, if you cull through press releases as often as I do, which I’m sure is zero times, audience, and that’s fine – you know, there has been a lot of announcements. There’s a lot of ambition. And I think, you know, there is this deliverable machine that is present in a lot of countries, especially ours, to show that we are doing something, that we’re committed to the region. But it’s difficult to monitor whether or not this is being implemented. And things happen to kind of undermine the ability to fully implement it. It’s great to be ambitious. But then there’s sort of an expectation about these things coming through.

And for something that is more measurable, that you could have – you can apply actual metrics to health care for – in terms of maritime security, it’s, you know, how do we – how many cyber security threats did we – did we put off? Like, how many fishing vessels did we save? You know, how – there are different ways to kind of project what success looks like. And I think when you do have these initiatives and these announcements, you do have to have an end goal in mind. For COVID-19, it was 1 billion vaccines. Did not hit that number. It was about 800 million. As you said, some of it was from bilateral engagement.

And, you know, I think that that shows some of the issues that come up when this happens. When the COVID-19 vaccine partnership was announced, and India was really the prime vector for this, that they were the ones that were going to manufacture, and the Indian government was going to push forward the approval to make sure that, you know, went as smoothly as possible, and then could export. Well at the time that we were getting to that point, of course, it got hit by the Delta wave, which was deadly and wide ranging. So how can you tell the folks that are getting sick and dying in your country, well, we’re going to send all these vaccines that could potentially save your life elsewhere. And so even though they were manufacturing other vaccines, it was just a very difficult thing to sell. And, you know, I think we run into that. Not that India was the main problem here, but, you know, that’s just an example of what happens.

But in terms of measuring what success here is, you know, I think this is something that the Quad partners are going to have to consider, and that’s going to be working with the partners on the ground as well, as to measure how many vaccines are being distributed. You know, you already see the trend lines. APEC did a wonderful report kind of mapping out what the infection rates and the mortality rates were in the region. The Quad should do the same in terms of where they’re distributing this because I think, you know, this is one of those long-term goals, but you have to kind of show the numbers to show that this has – this has been effective. We know that the HPV vaccine is effective. This should be a relatively easy thing to monitor, but for these types of big initiatives the monitoring of them ends up being more of a secondary thought than to, like, the announcement of itself. So I do hope that the Quad considers doing – you know, that’s as impactful as the announcement of itself, but in terms of monitoring what the impact is.

Ms. Bliss: Well, and is your sense – maybe it comes through some of the APEC work, which, you know, I think maybe in November we’ll hear more about, you know, where some of that – some of that work on cervical cancer in the region is headed. But, you know, is your sense that there has also been an assessment about what the countries in the region that really have that high burden are – what they’re looking for from external partners?

I mean, I know last year – or earlier this year, in March there was a Forum on Cervical Cancer Elimination that brought countries around the world, you know, together to Cartagena to really kind of map out strategies for really increasing access to the vaccine, but also the diagnostics and treatment to really kind of complete that circle of prevention, and then early diagnosis and treatment. I think Indonesia has announced a huge nationwide program around scaling up HPV vaccination. But, you know, is there a sense that other countries in the region are also really prioritizing this in a way that is going to, you know, kind of align with the Quad initiatives?

Ms. Murphy: I think so. You know, Australia has been doing a lot of work in the Pacific Islands. And I think there’s a recognition of how prevalent this is. India certainly recognized how prevalent this is in their own country. And so they stand to benefit just as much as the regions where they’re sending these vaccines to. But, you know, this is an opportunity. Sometimes, especially in talking about cervical cancer, there can be some hesitancy around it. It’s not just the vaccine hesitancy, which we’ve seen quite a bit after COVID.

And then there’s that public health education campaign that needs to be put out there, whether it’s safe, if it’s effective. Japan has gone through this as well. When you know the initial deployment of its HPV vaccines, there were a lot of questions about what the side effects were. You know, women and girls were suffering from a range of symptoms. And so it kind of put the HPV vaccine deployment on hold for a bit. So, you know, these are the types of things that, you know, we’re going to have to work through in terms of educating both the government, you know, and any of the partners that are working. And that includes, you know, the NGOs, civil society, and public health infrastructure on the ground, and getting that out there.

But I think that there is an openness to this. I mean, if Indonesia is on board they’re the fourth-largest population in the world. And so, you know, just targeting that. And, of course, India, that’s recognizing that this is a huge issue. So you have 1.5 billion people already that you’re targeting, and what an impact that could have. But there will be a lot of lessons learned. This will not be perfect. You have to have the entire infrastructure there, which includes both the safe deployment of the vaccines but also the diagnostics. And the treatment should, you know, people didn’t get there in time for the vaccine and are infected.

Ms. Bliss: Well, and some of that is the most difficult. I know there’s an element within the commitments from the leaders’ meeting, you know, prioritizing access to the radioactive materials that are used for radiation. But then, particularly when you’re talking about, you know, a place like Indonesia that has very small islands and really – you know, places that just have dispersed health centers, it can be a challenge to really ensure access to some of those processes.

So it’s the end of October here. Everywhere. (Laughs.) Not just here in Washington, but it’s the end of October.

Ms. Murphy: Time has no meeting anymore. It just flies by.

Ms. Bliss: Right? We have an election next week.

Ms. Murphy: Indeed. I’ve heard about that.

Ms. Bliss: Many other elections on the horizon. How do you see – and have been recently as well. How do you – how do you see things shaping up for the Quad in 2025? What’s next?

Ms. Murphy: I think there’s always a fear with these initiatives and these groupings that they’re not political proof. That they do change in shape and size and scope with any new administration, any country that comes through. We’ve seen that with a G-7. We’ve seen that with the G-20. And I think that there are also questions and concerns about the Quad as well. Yes, it turns out we have an election next week. I’m sure very few people have heard of it. You know, there were recent leadership changes in Australia. Japan even more recently. And Ishiba has just called a snap election, which doesn’t look like it went super well for him. So, you know, kind of questions around that as well. And then there’s always a question about India’s commitment.

But I think that there are strong indications that at least the Quad itself will continue to go forward. And why do I think that? It’s because, you know, this initiative was elevated to the foreign ministry level during the Trump administration. I see no reason why that wouldn’t continue. Even at the leadership level, Trump has had pretty decent relationships with the Japanese and with the Indians. Even though he hung up on the Australian prime minister in the first call they eventually, you know, made amends and it worked out. But I think they also – his administration would see the value of the Quad partnership, particularly around the geoeconomic competition with China.

You know, in terms of health care, if this is going forward, I mean, it was under the Trump administration that the vaccine initiatives really went forward. I forget what the term was, like light speed, force action –

Ms. Bliss: Operation Warp Speed.

Ms. Murphy: There we go.

Ms. Bliss: That was the initiative.

Ms. Murphy: I was, like, it’s something that’s Star Trek-y, and I can’t think of it. (Laughter.) And I think that there is a value add, the Australians and the Japanese as well. Again, Japan has shown consistent leadership through many prime ministers on this. So I don’t suspect or expect that to change, whether it’s Ishiba or another leader in Japan. But I expect this to be a continued priority for them.

For India, they were supposed to host the senior-level meeting this fall, and then it was held in Delaware. And part of that was for logistics reasons. It wasn’t because India couldn’t host. But everyone was coming here for UNGA, do we all want to go back and do this, that, and the other thing? So there was an agreement that it just makes sense to do it here. And plus, you know, it would be Biden’s last time to host. So, you know, I think that there was a bit of that as well. But India has already committed to hosting meetings for next year. So that shows that that commitment is going to continue through 2025.

So it’s not political proof, but I think you know, for at least the near future we’re going to see the Quad move forward. And I think you’re going to see a building on where the successes have been, especially if you’re starting to see data and tangible metrics coming out of the impact that you have. Because what better PR? What better way to counter competition in the region than showing the sort of impact that you’re having?

Ms. Bliss: So there are – this really came together out of some personal histories and commitments, but a long history of bilateral engagement on health research as well as health and, you know, broader economic development cooperation in the region. And it was really spurred by the experience of the pandemic, but has brought these four countries together out of both shared kind of domestic experiences with cervical cancer and, you know, really in an appreciation for the opportunities that new technology, new approaches in all three areas – prevention, diagnostics, and treatment – afford. But also, a sense that it’s important to engage in solidarity in the Indo-Pacific region.

I think, you know, potentially we can hope to see, in addition to measurable impact of this initiative, lessons for, you know, broader approaches to cancer in the region, and hopefully health security within the larger region instead. As you look ahead 10 years or so, what do you – will we still be talking about the Quad and health? Do you do see these, you know, really being kind of enduring areas of commitment over the long term?

Ms. Murphy: I do. And, you know, I think part of this comes from a personal wish that the Quad continues because I think that they are having an impact. And again, the initial, you know, Avengers assemble for the Quad in 2004 really came out of a place of we need to do something. We need to help people. And healthcare is just definitely one of those things that crops up, is an emergency, but also a place where I think that you can have a lot more efforts. We’re already seeing such incredible advances in medical technology using AI. We’re starting to see a lot of changes in cancer technology.

That’s more your space, so I’m not going to start spewing out my WebMD medical jargon and, you know, whatever I diagnosed myself with over the weekend. Which is several things, by the way, but – (laughter) – it’s a dangerous thing, that website. But where I think the Quad can be incredibly helpful is that – you know, I think what the COVID-19 pandemic showed, everyone became a supply chain expert, and that includes on the health care issue in terms of where the health care infrastructure is. It’s not just producing vaccines for COVID, but how are we going to continue to manufacture pharmaceuticals, vaccines for other issues like MMRs, childhood vaccines, the flu shot, things that are continuing to be an issue.

But also, where can we start manufacturing PPE, medical grade oxygen, just some of your basic stuff? And I think that there was an idea that we need to really diversify the supply chain on health care. And the Asia-Pacific region, or the Indo-Pacific region, is certainly one of those areas where you can do that. Where there’s, you know, beginnings of this type of technology that you can scale. And, of course, the workforce as well. ASEAN has a very young population. You see efforts on pharmaceuticals and vaccine productions in Indonesia, Malaysia, Vietnam, the Philippines, Thailand of course has a role to play here as well.

And when you think of where a lot of the pandemics and potential epidemics could come from, a lot of them start in that region, unfortunately. So this is really kind of, I think, an area to focus on. But as they’re building out this infrastructure focusing on cancer, there’s other efforts as well that they could do and think of that have a long-term impact. Like lab strengthening for, you know, agnostic – medical terms are flying out of my head – but, you know, non-disease – disease agnostic ways to monitor, you know, infections and noncommunicable diseases. How do we – how do we deal with this?

Because in some of these regions, you have issues on heart disease, kidney disease, diabetes, that, you know, the Quad is in a great place to focus on and maybe start pioneering technology, but also getting to those populations that are often forgotten or missed because the infrastructure isn’t there, the financing isn’t there, or it’s just too hard to get to them. When you think of the Indonesia archipelago, but also the Pacific Islands. So, you know, I think that in 10 years there is a great foundation that has been built here. And I think, you know, this is – they should take this as a sign that they should continue going forward with this.

Ms. Bliss: Well, and if you think about it, I mean, cervical cancer is kind of a – I won’t – perfect maybe isn’t the right word. But it’s a very suitable bridge. It’s an infectious – human papillomavirus is infectious. It’s vaccine preventable. But, you know, you’ve also got the potential with this initiative to really expand that whole infrastructure for noncommunicable diseases and really disease surveillance as well. So really leading to the – feeding back into that overarching health security Quad initiative.

Erin Murphy, senior fellow and deputy director of the CSIS India and Emerging Asia Economics Program. I have to look at that to make sure I get all the words.

Ms. Murphy: It’s a new thing. So yeah, we’re all learning our new titles here.

Ms. Bliss: But thank you very much for joining me today. And it will be very interesting to see what’s in store for the Quad and health in the months and year to come.

Ms. Murphy: Thank you so much for having me.

Ms. Bliss: Thank you.

(END.)