U.S.-Japan Dialogue: Strengthening the Partnership on Global Health

Joint Meeting Summary Report by CSIS and JCIE

On May 3, 2017, the Center for Strategic and International Studies (CSIS) and the Japan Center for International Exchange (JCIE) co-hosted a half day meeting exploring how the Trump and Abe Administrations can continue and strengthen the two countries’ longstanding partnership in global health. The meeting convened more than 40 senior officials and policy experts from the U.S. and Japan and covered a range of areas for potential collaboration centered on global health security, including in the global health architecture, communicable diseases, governance of multilateral institutions, and innovation. The discussion built upon a previous meeting held in Washington, D.C. in March, co-hosted by JCIE and the United Nations Foundation, that identified several promising areas for future global health cooperation. 

The Japanese delegation included Minister for Health, Labour, and Welfare Yasuhisa Shiozaki; Upper House member Keizo Takemi; the heads of the Japan Agency for Medical Research and Development and the Pharmaceutical and Medical Devices Agency; and senior officials from the health and foreign ministries. Meanwhile, the U.S. side consisted of high-ranking officials from the White House, the Food and Drug Administration, the Department of Health and Human Services, USAID, the National Academy of Medicine, the National Institutes of Health, and the Centers for Disease Control and Prevention, as well as experts from the private sector, think tanks, and previous presidential administrations.

Key Discussion Points:
Discussion throughout the day was lively, engaged, and frank. Several points came up during the meeting that were largely agreed upon by both U.S. and Japanese participants. These included:

The Need for Sustained U.S. Leadership in Global Health
Senior members from the Japanese delegation stressed the need for sustained U.S. leadership in global health emanating from the executive branch. Participants pointed to the tremendous impact of U.S. engagement in global health over the past decade—including the successes of U.S.-led initiatives like PEPFAR and the President’s Malaria Initiative (PMI), as well as contributions to multilateral efforts such as Gavi, the Vaccine Alliance and the Global Fund—and cautioned that a retreat in American funding and political leadership would undermine many of these hard-fought gains.

Building upon the Existing U.S.-Japanese Relationship
A key point raised repeatedly throughout the day was the depth and strength of the broader U.S.-Japanese relationship at every level of engagement, from government-to-government, to agency-to-agency, down to expert-to-expert. While the recent political transition in Washington has caused some groups to re-evaluate their entire strategy for engaging with the United States, participants felt that this was not needed between the U.S. and Japan. Individuals noted the particularly warm response that Prime Minister Abe received from President Trump in early February and continued mutual statements of support by both governments. Furthermore, many key individuals and career experts in the U.S. are still in place and have longstanding relationships with their Japanese counterparts.

Better Evaluating the Impact of Global Health Investments
Sustaining support for U.S. engagement in global health will require better evaluative efforts moving forward. Noting the current political climate in Washington, participants emphasized the need for greater oversight of federal investments in global health and improved methods for measuring their intended impact. Such efforts would hopefully yield both increased accountability and efficacy of increasingly scarce tax dollars and help maintain political support for global health endeavors in a time of retrenchment and increasing budgetary pressures around the world.

Building Bilateral Cooperation on Matters of Global Health Security
An over-arching theme from the day’s discussions was the potential value of launching a U.S.-Japan cooperative initiative on global health security as a pillar of the broader bilateral relationship. This initiative would focus on building consensus and outlining concrete steps for collaborative action on issues of shared importance to both countries, including strengthening emergency response capacities, addressing emerging infectious disease threats, and combatting the spread of antimicrobial resistance.

U.S.-Japan Cooperation in Global Health Security   
A successful U.S.-Japan initiative on global health security would:
  1. Require high-level endorsement by both countries, ideally stemming directly from President Trump and Prime Minister Abe;
  2. Need to weave together a range of existing collaborations between various ministries and agencies in the U.S. and Japan, as well as incorporate a host of new collaborations, under a broader umbrella of global health security; and
  3. Need to include a forum for regular dialogue that focuses on broad objectives of the collaboration, convening representatives from across relevant ministries and agencies, civil society, the private sector, and other relevant actors to help break down operational silos and facilitate multi-sectoral cooperation.
The initiative would also require various modes of bilateral consultation and cooperation for a host of issues, including on matters of:
  1. Aligning Japanese and U.S. efforts overall on global health;
  2. Advancing needed reforms in multilateral forums and health institutions (such as the WHO);
  3. Providing joint funding and technical assistance to low-income countries as they seek to strengthen their pandemic preparedness capacities (most notably through continued support for the Global Health Security Agenda);
  4. Joint support for R&D in key areas;
  5. Expanding efforts to conduct joint U.S.-Japan health and development programs in targeted countries, especially between the Japan International Cooperation Agency (JICA) and the United States Agency for International Development (USAID); and
  6. Providing greater support for innovative public-private partnerships in global health
The initiative should include a range of collaborative efforts on global health security, including: fighting communicable diseases, strengthening emergency preparedness capacities, institutionalizing health security, and promoting R&D and innovation. The following are examples of possible collaboration:

Institutionalizing Health Security in the Global System
Strengthening global emergency response capacities to infectious disease threats could be a cornerstone area for U.S.-Japan collaboration. This could include ensuring that recent reforms to the global health architecture—such as WHO reform and operationalizing pandemic financing facilities—are properly implemented and coordinating the development, clinical testing of, and licensing for vaccines and pharmaceuticals. Additionally, joint efforts at combatting antimicrobial resistance (AMR) could be accomplished through such actions as continued support of the Coalition for Epidemic Preparedness Innovations (CEPI) or jointly launching new multilateral AMR initiatives—such as a Western Pacific consortium for policy consultations and research funding on AMR.

Preparing for Emergencies by Strengthening Health Systems in Vulnerable Countries
Ensuring full country compliance with the International Health Regulations (IHR) is vital to building effective prevent, detect, and respond capacities for infectious disease threats worldwide. To help vulnerable countries build the capabilities necessary to handle such public health emergencies, the U.S. and Japan could lead efforts to continue and expand global commitments to the Global Health Security Agenda, promote greater cooperation on infectious disease surveillance, and provide funding and technical assistance to help low-income countries bolster their laboratory systems.

Advancing Efforts to Battle Communicable Diseases
Continued international support of key multilateral health initiatives that combat the spread of communicable diseases, including Gavi, the Vaccine Alliance and the Global Fund, is an area ripe for U.S.-Japan leadership.  Joint leadership in supporting the Global Fund could include ensuring a successful replenishment cycle while it is currently undergoing a leadership transition, maintaining focus on AIDS, tuberculosis, and malaria while at the same time looking for potential opportunities to promote broader health systems strengthening down the road, and exploring ways to support countries as they transition out of Global Fund programs. 

Collaborating on R&D and Innovation
Japan and the United States could mutually benefit from expanded collaboration on basic research and development as well as broader innovation in health. This is particularly true in areas that relate to emerging infectious disease threats, projects focused on animal-to-human transmission of disease, coordination on data sharing and patient registries, and building public private partnerships that involve groups from both countries. Likewise, expanding regulatory cooperation between key U.S. and Japanese agencies in such areas as combatting counterfeit drugs, strengthening regulatory capacities in developing countries, and regulatory science could prove productive.