Global Health Vision of
Ministry of Health, Labour and Welfare ofJapan

August 26, 2024
Ministry of Health, Labour and Welfare of Japan1

Table of Contents
1 Purpose and Objectives of the "Global Health Vision" ................................... 3(1) Realization of the mission of the MHLW ................................................ 3(2) Contributing Japan’s Insights to the International Community ............................ 4
2 Current Status and Issues ............................................................. 5
3 Policy Goals and Basic Policies ....................................................... 10(1) Policy Goals ........................................................................ 10(2) Basic Policy ........................................................................ 10
4 Specific Initiatives ................................................................... 11(1) Establishment of the "UHC Knowledge Hub” .......................................... 11(2) International Strategy for Strengthening Drug Discovery Infrastructure .................. 12(3) Strengthen collaboration between the Japan Institute for Health Security (JIHS) and theASEAN Centre for Public Health Emergencies and Emerging Diseases (ACPHEED) ... 14(4) Building an Indo-Pacific Health Strategy .............................................. 15(4-1) Development of "Ecosystem for Development of Pharmaceuticals and Medical Devices” 15(4-2) Circular Elderly Health Strategy: Foreign Care Worker Policy and Support for International
Expansion of Care Providers .................................................... 17(4-3) International development of medical care including training of foreign medical personnel
and medical inbound ........................................................... 21(5) Strategies to ensure a stable supply of pharmaceuticals as economic security ........... 23(6) Appropriate contributions to international organizations and Global Health Initiatives (GHIs)............................................................................... 24(7) Promotion of international policy dialogue ............................................ 24(8) Strengthening the governance of the Ministry’s international department and the international
health human resource strategy ................................................. 25

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1 Purpose and Objectives of the "Global Health Vision"(1) Realization of the mission of the MHLW
Promoting global health efforts will not only benefit the international community
but also help resolve domestic issues and lead to promoting health and well-being inJapan.
The concept of global health has become firmly established as it is recognized thata wide range of stakeholders, including national governments, internationalorganizations, private sectors including businesses, academic institutions, NGOs andcivil society groups, need to work together across borders in a multilayered manner toaddress factors that affect health and well-being domestically and globally.
Global health is one of the most important issues for the international community,
not only because it is directly related to health and well-being, but also because it
affects the peace and prosperity of nations and, moreover, from the perspective of
coexistence of human society and the Earth. The promotion of global health is not
only of public health significance, but also of great importance from the perspective of
diplomacy, economy, and security, as well as stability of the international community,
protecting the people and contributing to health and well-being in Japan.
In the 21st century, international collaboration has become indispensable in a wide
range of global health issues, including response to infectious diseases such as
pandemics and drug resistance (Antimicrobial Resistance: AMR), pharmaceuticaldevelopment, training and securing health workforce, and addressing the impact ofclimate change on health. Furthermore, with the rapid increase in the importance ofdigitization and data science in the health, medical, and long-term care fields,international collaboration is becoming increasingly important in promoting various
reforms in the health, medical, and long-term care sectors.
The mission of the Ministry of Health, Labour and Welfare (MHLW) is "to improveand promote social welfare, social security, and public health, to improve working
conditions and other working environments for workers, and to secure jobs, in orderto guarantee and improve the lives of the people and contribute to economic
development" (Act for Establishment of the MHLW). In order to fulfill this mission, the
MHLW needs to address global health while moving beyond its traditional inwardlooking perspective.
In this century, global and domestic health issues, including COVID-19 and AMR,

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have become closely linked to each other. The MHLW's active involvement and efforts
in global health will contribute to "guaranteeing and improving the lives of the people"
and "improving and promoting social welfare, social security, and public health", andwill help protect the people.
(2) Contributing Japan’s Insights to the International Community
The MHLW has extensive knowledge and trial-and-error experiences inachieving one of the highest levels of health and longevity in the world, while ensuring
equity and maintaining relatively low costs. For example, the MHLW has introduced
the national health insurance system in 1961, and this can be considered "Japan’s
version of universal health coverage (UHC)." Moreover, the Ministry has also worked
on ensuring access to health care, tackling infectious diseases such as tuberculosis,
promoting health through "Health Japan 21," addressing elderly care through longterm care insurance and dementia measures, and integrating health care and welfare
services through “Community-Based Integrated Care System.”
Furthermore, Japan's experience in ongoing maintenance and management of
one of the highest health standards in the world has contributed significantly to thecountry's economic development. As the super-aged society, it is vital that health,
medical, and long-term care policies will be addressed as part of economic andindustrial policies in cooperation with relevant ministries and agencies.
Leveraging these knowledge and experiences in health systems and healthfinancing can benefit the international community, and it will also contribute to solving
future challenges within our own country.
The Government of Japan released " Global Health Strategy of Japan "(approved by the Headquarters for Healthcare Policy of Japan on May 24, 2022) tooutline its direction for contributing to the international community. Nonetheless, sincethen, new conflicts, disasters, and extreme weather events have occurred, and there
have been geopolitical changes due to the increasing presence of emerging anddeveloping countries in the Global South.
This vision, while aligning with the "Global Health Strategy of Japan," aims toclarify the role of MHLW within the overall government strategy, taking into accountthe changes mentioned above.

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2 Current Status and Issues
Previous Japan’s perspective
Japan has promoted global health based on the concept of human security, inwhich each individual pursues the right to dignity and survival. On this basis, it isinternationally recognized that the achievement of UHC has been positioned at thecenter of Japan's health diplomacy. Especially in recent years, Japan has been callingthe world’s attention to the importance of finance and health coordination instrengthening national health systems to achieve UHC, as well as the need to design
a sustainable health financing system. For example, Japan hosted the G20 Joint
Finance and Health Ministers’ Meeting for the first time at G20 Osaka Summit in 2019,
and this practice has been followed in subsequent G20 summits.
Challenges in light of the COVID-19
The COVID-19 pandemic revealed the vulnerabilities of the current global healthgovernance and financing, with the World Health Organization (WHO) at its center. As
a lesson learned from this pandemic, lively discussions are now underway amonginternational community on the need to build a Global Health Architecture (GHA)
aimed at strengthening Prevention, Preparedness, and Response (PPR) for future
pandemics.
At the same time, the experience of COVID-19 has the necessity of building aresilient health system, as advocated globally, from the viewpoint of effective responseto health crises. To strengthen responses to future pandemics, it is crucial to enhance
health systems based on the concept of human security, particularly by improving
health financing. Achieving UHC globally is fundamental to protecting people's health.
With declaration of a state of Emergency in response to COVID-19 lifted andlessons of the pandemic gradually fading, the momentum for strengthening PPR
through the establishment of a GHA and for achieving UHC is waning. The world has
repeatedly experienced “panic and neglect” with each successive pandemic. To avoid
repeating the same mistake after the COVID-19, Japan has been determined to keep
contributing to the achievement of UHC.
Complex global challenges confronting humanity
The world continues to face ongoing infectious disease, such as HIV/AIDs,
tuberculosis, and malaria, as well as longstanding issues like vaccination and5maternal and child health. In addition to these issues, over the past decade, new anddiverse challenges have emerged simultaneously. For example, there are emerging
and re-emerging infectious diseases such as COVID-19, the direct and indirect healthimpacts of climate change, AMR, the rising burden of non-communicable diseases(NCDs) and mental health conditions globally, and the various challenges associatedwith an aging population, including dementia. There are also frequent conflicts anddisasters to be addressed.
Above all, the health impacts of climate change extend beyond direct factors suchas heatstroke and floods. It also alters the distribution of infectious diseases likemalaria, affects food security though its impact on agriculture and livestock, causes
rural depopulation and urban slum growth due to large-scale population movements,
and increases the risk of zoonotic disease outbreaks due to wildfire migration. The
effects on global health, including Japan, are extensive.
Furthermore, one of the significant issues related to new global complex
challenges is the aging population, which is highly relevant to Japan. Currently, Japan
has an aging rate, the proportion of the population aged 65 and over, of around 30
percent, making it the most aged country in the world. Aging is expected to continue
to progress, with the aging rate projected to reach nearly 40 percent by the middle ofthis century. The responses required include not only maintaining social security
systems such as health insurance, long-term care insurance, and pension systems
but also addressing health issues that couple with aging population, such as, but notlimited to, dementia and mobility impairments. These responses extend beyond thehealth sector to include maintaining overall societal vitality. As global aging progresses,
the world is paying close attention to Japan’s approach to addressing this issue.
To date, various funding mechanisms have been established to address specifichealth challenges, such as The Global Fund to Fight Aids, Tuberculosis and Malaria,
Gavi, the Vaccine Alliance and CEPI (for vaccines), Global Financing Facility (formaternal and child health), and the Pandemic Fund (for health crises). However,addressing new and diverse health challenges through such individual mechanisms
alone can lead to overlap, fragmentation, and sustainability issues. To respond todiversification of global health challenges, efforts should be accelerated to strengthen
health systems with a common approach aimed at achieving resilient and sustainable
UHC.
Moreover, since the “Global Health Strategy” was released in 2022, geopolitical6

risks have increased, including Russia’s aggression against Ukraine as well as thesituation surrounding Israel and Palestine worsening since terror attacks on Israel byHamas and others in 2023. On the first day of this year 2024, the Noto Peninsula
earthquake occurred in Japan, resulting in the loss of lives and significant damage. In
the affected areas, the spread of infectious diseases, including COVID-19, influenza,
and norovirus infections, further complicated the situation, making it crucial to ensure
medical care systems, stable supply of pharmaceuticals, infection control, and support
for the health of the elderly. Furthermore, large-scale movements of refugees due toclimate change are anticipated in the future, increasing the need for humanitarianassistance, including health care needs.
Japan is one of the countries with the most extensive knowledge in the field ofDisaster Risk Management (DRM) because of its numerous domestic experienceswith disasters, and there is a significant potential for contributing to global efforts.
Various global health challenges threatening people’s lives and health are not limited
to developing counties; their impacts also affect Japan directly and indirectly. As Japan
continues to contribute in areas where it has deep expertise, such as promoting UHC,
DRM, and aging issues, the MHLW will keep to contribute to the international
community.
The United Nations’ Special Report on Human Security
Since 2002, Japan has advocated for human security by combining humanempowerment and human protection, using a community-based approach to address
individual security from a micro perspective. Over the past two decades, while
technological advancements supporting human security have accelerated, risks suchas climate change and pandemics have also become more severe.
Consequently, there has been a recognition of the need to consider humansecurity from a macro perspective in addition to this micro approach. In 2022, theUnited Nations Development Program (UNDP) released the "Special Report on
Human Security.” This report emphasizes the importance of addressing humansecurity and health challenges by analyzing the causal relationship between globalchanges and health risks, implementing measures, and conducting risk management
to achieve “coexistence between humanity and the planet.” It also underscores thenecessity for cross-border "solidarity."

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The new "soft governance approach" and UHC
Meanwhile, we are facing serious geopolitical conflicts, making consensusbuilding between nations increasingly difficult. In such international politicalcircumstances, the desired outcomes may not be achieved by solely relying on interstate agreements in the health sector. Instead, setting achievable goals and having
sovereign nations, international organizations, civil society, and other stakeholders,
including private sectors, collaborate towards common goals – essentially employing
a “soft governance approach” – is likely to be more effective in advancing global health.
To address global health challenges using a soft governance approach and setting
realistic goals, the primary proposal should be to aim for achieving resilient andsustainable UHC worldwide. Specifically, this involves expanding health financing inlow- and middle-income countries (LIMCs) and strengthening health systems,
including achieving sustainable health financing through stable domestic financial
resources.
As a part of this effort, Japan is currently working toward establishing a "global hub
function on UHC" with the cooperation of many countries and relevant organizations.
This hub function, which is being developed in collaboration with internationalorganization such as WHO, the World Bank is expected to truly embody the soft
governance approach in global health. Through this hub function, discussions onachieving UHC globally and strengthening efforts should be advanced.
Importance of the Indo-Pacific region
In light of the geopolitical situation surrounding our country, Japan places a strongemphasis on collaboration with Indo-Pacific countries, including those in Asia, in thehealth sector. Aging is also progressing in Asian countries, and changes in disease
structures and widening health disparities will become significant challenges. Having
a pioneered the experience of rapid population aging and low fertility, Japanpossesses a wealth of knowledge and experience in the fields of medical care, longterm care, and welfare, and can contribute in various ways, such as but not limited totransfer of clinical technologies in NCDs.
The Government of Japan has developed the “Basic Principles of the Asian Healthand Wellbeing Initiative,” (approved by the Headquarters for Healthcare PolicyofJapan on July 29, 2016) and the “Basic Principles of the Africa Health and Wellbeing
Initiative” (approved by the Headquarters for Healthcare Policy of Japan on June 20,

82019), with a focus on contributing to the achievement of UHC. Based on theprinciples, Japan has been promoting the “Asian Health and Wellbeing Initiative(AHWIN) and the Africa Health and Wellbeing Initiative (AfHWIN), with the aim ofachieving both healthy living and economic growth in aging Asia, and in Africa, whichis experiencing rapid population growth and achieving high economic growth, throughmutually beneficial cooperation as a basic approach. In addition, Japan has been
engaged in efforts to enable Asia to foster a socially and economically vibrant, healthy,
and long-lived society through various forms of support including financial
contributions to the Economic Research Institute for ASEAN and East Asia (ERIA) inthe health sector.
As emerging and developing countries, often referred to as the Global South,
increase their presence, Japan has recognized the importance of strengthening
engagement not only with the existing muti-lateral framework such as G7 and G20,
but also with other international partners. It is crucial to adopt a detailed approach that
responds to the various needs of these countries. In advancing these efforts, Japanemphasizes the importance of centering on "people" and upholding human dignity andhuman security. It remains essential to further strengthen public-private partnerships
in the field of health, medical care, and long-term care in Indo-Pacific region, including
those in Asia, and the MHLW needs to establish the organizational capacity to support
these efforts in cooperation with relevant ministries and agencies.
Utilization of innovative technologies
The field of health, medical care, and long-term care are rapidly advancing due
to digitization and data science. The utilization of such innovative technologies isenabling initiatives that can significantly contribute to achieving UHC and PPR. The
Indo-Pacific region, including the Asian countries mentioned above, is no exception.
A strong international public-private partnership in digitalization and data scienceis crucial for advancing health, medical care, and long-term care in this region,
including Japan. It is essential to consider the ongoing efforts to develop digitalizationand data science system in these fields domestically in an integrated manner. It is also
important to advance initiatives using Japan’s innovative technologies while keeping
in mind the goal of translating the outcomes of these efforts into domestic technology
development and problem-solving.

93 Policy Goals and Basic Policies(1) Policy Goals
The "Global Health Strategy of Japan" released in 2022 set to develop andpromote the following policy goals:⚫ To contribute to developing a resilient Global Health Architecture toward
international health security and strengthen prevention, preparedness andresponse (PPR) for pandemics and other public health emergencies, and;⚫ To achieve more resilient, more equitable and more sustainable universal healthcoverage (UHC) required for post-pandemic era by strengthening health systems
in each country, with a view to realizing human security.
The Strategy also presents its guiding principles as follows.
⚫ To realize adequate prevention and preparedness in peace time as well as rapid
response in emergency, strengthening international coordination and financemechanisms is essential; and⚫ In accelerating its efforts to achieve UHC, (1) health system strengthening at thecountry level, (2) resilience, (3) equity, and (4) sustainability should be taken into
consideration.
These policy goals and guiding principles will be adopted and further promoted inthis Global Health Vision of the MHLW.
(2) Basic Policy
Based on these policy goals and the current situation, the MHLW has set out thebasic policy for its global health initiatives as outlined below.
⚫ Focusing on human security and coexistence between humanity and the planet –planetary health, ensuring global safety, prosperity, and values.
⚫ Recognizing that ensuring health and safety in the international community
contributes to safeguarding life of people and enhancing social welfare, social
security and public health, which are in line with missions of the MHLW.
⚫ In particular, to strengthen GHA for health security and contribute to achieving
UHC,⚫ Sharing and utilizing extensive knowledge and experience of the MHLW on healthcare, medical care, and social welfare with other countries, contributing to10

improving the health and well-being, and safety of people worldwide.
⚫ Establishing a positive cycle in better health and well-being that links Japan andinternational community, and utilizing the insights and knowledge gained frominternational cooperation and exchange to international community.
To advance our response in accordance with the above basic policy, the MHLW
will implement the following measures.
⚫ The MHLW will develop fundamental policies for each issue and target set atinternational conferences, and coordinate with relevant domestic and internationalorganizations. This includes rule-making and international standardization, aiming
to contribute to the global health⚫ In addition, the MHLW will regularly work on maintaining and expanding
international networks, gathering information, and building a foundation for
coordination. It will also strategically utilize, develop, protect, and support global
health professionals.
⚫ For the time being, key focus areas will include UHC, international drug
development, the Indo-Pacific Health Strategy, and responses to healthemergencies such as infectious diseases.
4 Specific Initiatives(1) Establishment of the "UHC Knowledge Hub”
① Purpose
Based on the idea of human security, there is a need to strengthen national healthsystems to achieve more resilient, equitable, and sustainable UHC worldwide. Since
Japan has been actively promoting UHC globally for many years, Japan, together with
the World Bank and WHO, will establish a "UHC Knowledge Hub" in Japan in 2025.
The Hub will support knowledge sharing on UHC as well as capacity building for
finance and health authorities. It will leverage the expertise of the World Bank andWHO, while drawing on Japan's experience, such as our efforts to maintain quality
UHC amid an aging and declining population. Ultimately, serving as the Hub will aim
to be a driving force for UHC in collaboration with various international organizations
and stakeholders.
② Contents

11WHO and the World Bank will jointly offer support for capacity building with
policymakers and practitioners in health and finance ministries in LIMCs by providing
training and expert consultation on health financing. In addition, while utilizing existing
global information and analysis on UHC, the Hub will advise on policy options related
to UHC and generate new data and evidence necessary to address the financing gap.
To promote UHC and to strengthen health system resilience, it will focus on basic
health finance as well as financing other emerging and critical health issues.
The Government of Japan will support the activities of WHO and the World Bankby providing necessary human resources and financial contributions, while offering
insights based on Japan's experience with UHC-related areas, such as health careand long-term care systems. WHO and the World Bank will collaborate by leveraging
their respective strengths in data, information, and capacity building, and will further
develop training programs and curricula.
In addition, the Government of Japan, in collaboration with WHO and the World
Bank, will involve multiple stakeholders, including other international financial
institutions, international health-related organizations, bilateral aid agencies, theprivate sector, and relevant regional offices and organizations - such as WHO regional
offices - to promote broad engagement, dialogue, and capacity building on UHC.
③ Timeline
The UHC Knowledge Hub, staffed by experts from WHO and World Bank, will beestablished in Tokyo area. In preparation for the establishment of the WHO Office in
FY2026, a preparatory organization will be set up in FY2025. The Hub will consist ofa "WHO Office in Tokyo Area (tentative name),” “WB Tokyo UHC Team (tentativename)," and a coordinating body that will manage its operations.
(2) International Strategy for Strengthening Drug Discovery Infrastructure① Purpose
As new modalities such as next-generation biopharmaceuticals become
mainstream of drug discovery, the need to collaborate with global public-private
partnerships, rather than domestic ones, is increasing for the "ecosystem" involved in
drug discovery. Japan has pioneering research in academia, including universities,
startup companies, advanced medical institutions capable of conducting clinical trials,
and pharmaceutical manufacturers with a large pool of human resources and capital.

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Japan has the potential to create the groundbreaking new drugs if it can strengthen
its research and development capabilities for drug discovery seeds from a global
ecosystem perspective and become a cornerstone of global drug discovery. This
would require building effective relationships of cooperation and coordination among
these stakeholders.
To strengthen drug discovery capabilities, it is important to build an ecosystem that
supports the establishment and growth of startup companies through mutual
cooperation among entrepreneurs, academia, government, and investors.
From this perspective, by attracting human resources and funding to Japan throughinternational collaboration, we aim to revitalize the drug discovery ecosystem byfacilitating the transition from research to development and reconstruct the foundationof drug discovery in Japan.
② Contents
The MHLW will take the lead in introducing a new industrial policy to strengthen the
drug discovery infrastructure through public-private collaboration. The policy aims toparticipate in the international drug discovery ecosystem and leverage human andcapital resources in Japan and abroad. The four main points are as follows.
i. With the aim of becoming a part of the international drug discovery ecosystem, we
will take a global approach and collaborate with top-notch human resources,
facilities, and companies across the world.
ii. To enhance Japan’s attractiveness as a base, we will establish a center equippedwith laboratory and hospital functions, where specialists can interact.
iii. To bridge the gap between basic research and clinical trials, we will secure humanresources and equipment to support the initial drug discovery process, train
biotechnicians, and develop facilities for GMP1 manufacturing.
iv. We will provide grants for basic research and development closely linked to drug
discovery from the outset, while collaborating with both the public and private
sectors.
③ Timeline
We will implement various measures based on the "Strategic Goal and Action Planfor Improving Drug Discovery Capabilities to Support Early Availability of Innovative1

Abbreviation for Good Manufacturing Practice13

Drug -Toward Implementation of the Interim Report-."(3) Strengthen collaboration between the Japan Institute for Health Security (JIHS)
and the ASEAN Centre for Public Health Emergencies and Emerging Diseases(ACPHEED)① Purpose
Regional collaboration is essential for the prevention, preparedness, andresponse to health crises, and the ASEAN Centre for Public Health Emergencies andEmerging Diseases (ACPHEED) is expected to play an important role as a center for
health crisis response within ASEAN.
As part of efforts to fully prepare for the next infectious disease crisis, the Japan
Institute for Health Security (JIHS), to be established through the merger of the
National Institute of Infectious Diseases and the National Center for Global Health andMedicine, will serve as a key expert organization. It will provide high-quality scientificknowledge to the Cabinet Agency for Infectious Disease Crisis Management and the
MHLW. The JIHS is expected to enhance the system for centralized collection,
management, and evaluation of necessary information from international and foreign
public health organizations and act as a hub for networking with these organizations.
② Contents
We will continue to cooperate with relevant organizations for the smooth operationof the ACPHEED. By promoting the dispatch of experts from Japan, we aim toenhance the exchange of specialized personnel between the two organizations andstrengthen the collaboration between the JIHS and ACPHEED during ordinary times.
In the report of the "Toward the Establishment of the Japan Institute for Health
Security: For the realization of a society free from concern of infectious diseases"(Approved by the Preparatory Committee of the Japan Institute for Health Security,
April 9, 2024; hereinafter referred to as the "2024 Report"), a blueprint for the JIHS
with strengthened governance was developed and preparations are steadily
underway for the establishment of the JIHS in April 2025.
Based on the 2024 Report and other relevant documents, we will accelerate thereview and development of organizational regulations, including employment rules
and salary regulations that consider international exchange. We will advance efforts
to make the JIHS a hub for both domestic and international networks. In addition, the14

JIHS will work closely with the MHLW, Pharmaceuticals and Medical Devices Agency(PMDA), ACPHEED, and other relevant organizations to strengthen the informationcollection and analysis system for infectious diseases, develop and secure humanresources for responding to infectious disease crises, and establish a comprehensive
research and development infrastructure from basic research to clinical trials. We willcontinue to explore specific measures to enhance all functions required of JIHS.
(4) Building an Indo-Pacific Health Strategy
In order to further strengthen cooperation in the field of health, medical care andlong-term care with Asian and Indo-Pacific countries, Japan should take the lead indeveloping an Indo-Pacific health strategy based on cooperation in the Indo-Pacific,
including Asia.
Specifically, the "Ecosystem for the Development of Pharmaceuticals and Medical
Devices" with Asian countries and Indo-Pacific countries, the Cyclical Elderly HealthStrategy, which involves the utilization of foreign human resources in the long-termcare and other fields and support for the international expansion of long-term careproviders, as well as the international expansion of medical care will be promoted.
(4-1) Development of "Ecosystem for Development of Pharmaceuticals and Medical
Devices”① Purpose
Access to essential medicines and medical devices is an important element of
UHC in the context of the SDGs. Japan needs to contribute to improving health inother countries, including Asian countries, through enhancing access to medicinesand medical devices in these regions. Under various government initiatives2, efforts
have been made to improve patient’s accessibility to medicines and medical devices
in Asian countries with UHC in mind by harmonizing pharmaceutical regulations anddeveloping clinical development systems.
Regarding the harmonization of pharmaceutical regulations, the Asia Training
Center for Pharmaceuticals and Medical Devices Regulatory Affairs (PMDA-ATC) was

2

Under the "Basic Policy Toward the Asian Health Initiative," the "Asian Grand Design for Regulatory
Harmonization of Pharmaceuticals and Medical Devices" (decided by the Headquarters for Health and Medical
Care Strategy Promotion on June 20, 2019) and the "Implementation Strategy for the Asian Grand Design forRegulatory Harmonization of Pharmaceuticals and Medical Devices" (decided by the Headquarters for Healthand Medical Care Strategy Promotion on July 14, 2020) have been formulated.

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established in 2016, This center has conducted capacity-building activities toward
regulatory harmonization with regulatory authorities especially from Asian countries.
Through bilateral meetings and symposiums with Asian countries under thegovernment initiatives, Japan has gained trust in its pharmaceutical regulatory system.
As a result, Japan has become as a reference country for the abridged regulatory
pathways3 in various countries, including those in Asia.
For the promotion of clinical development system, since 2020, in order to facilitate
Japan-led international joint clinical trials and accelerate the development and supplyof drugs, the National Cancer Center (NCC) and the National Center for Global Healthand Medicine (NCGM) have established a clinical research and clinical trials
base/network(“ATLAS” for non-infectious diseases and “ARISE” for infectious

diseases) through local education/training and improving facilities as the “Project for
Establishment of Network of Clinical Research and Clinical Trials in Asia” of the Japan
Agency for Medical Research and Development (AMED). 4 Through strengthening
collaboration between the PMDA Asia Office and the NCC Asian Partnerships Officein Bangkok, Japan will establish a parallel and cyclical support system, the so-called
drug and medical device development ecosystem, in order to improve the clinicaldevelopment environment and to strengthen regulatory capacity, starting withThailand.
Through these activities and monitoring regulatory and market trends in othercountries, Japan aims to gradually expand the ecosystem to other Asian and IndoPacific countries.
② Contents
The PMDA will continue to contribute to the capacity building of regulatory
authorities in Asian countries through the PMDA-ATC. Collaborating with the NCC and
NCGM, the PMDA will provide support to regulatory authorities, primarily in Thailand,through the PMDA Asia Office established in Bangkok in order to strengthen regulatory
capacity based on the needs of stakeholders in the country, including regulatory
authorities, industry, and academia.
The NCC and NCGM will cooperate with the PMDA to support the rapid3

A regulatory procedure wherein a market authorization decision for a drug is based on the approval
granted by another regulatory authority.

4

The various projects listed as NCGM initiatives in the text will continue to be implemented in the JIHS
after April 1, 2025.

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commercialization of pharmaceuticals and other products by consulting, coordinating,and conducting international joint clinical trials and clinical research, initially focusing
primarily on Thailand.
With future expansion of the ecosystem in mind, we will move forward withaccepting the entire application dossier in English for the market approval of ethicaldrugs in Japan and, in parallel, conduct research on regulations, market needs, andother relevant factors in other Asian countries.
③ Timeline
The PMDA will promote research activities and coordination response tounderstand the needs of Asian countries through the PMDA Asia Office established in
Bangkok in July 2024. The NCC will maintain the structure of two full-time Japanese
staff in the Thai office of ATLAS. The NCGM will also expand the cooperative office atSiriraj Hospital in Thailand in 2024.
(4-2) Circular Elderly Health Strategy: Foreign Care Worker Policy and Support forInternational Expansion of Care Providers① Purpose
Aging is a global challenge, and particularly for Asian countries that will facesignificant aging issues in the coming years, it is crucial to establish and strengthen
sustainable health care systems for the elderly. Japan has been a pioneer inestablishing a system for providing high-quality long-term care services under its longterm care insurance system and has created career paths for long-term care workers,
including certified care workers. Under the current circumstances, a key issue is tosecure a sufficient workforce to ensure that necessary long-term care services can bereliably provide in the future.
In order to strengthen cooperation with Asian countries and to address thesechallenges, Japan will take the opportunity of the ongoing discussions on theInternational Organization for Standardization (ISO) on international standards forlong-term care. Japan aims to share its extensive knowledge on high-quality long-termcare services and human resource development by actively contributing to various
international discussions in the field of elderly health care. By enhancing international
credibility in the area of long-term care through these efforts, Japan will increase thenumber of foreign caregivers interested in learning about Japan’s long-term care,17which, in turn, will help to secure domestic care service workers. Additionally, foreign
caregivers who have learned about Japan’s long-term care will introduce thesepractices in their home countries, thereby creating a virtuous cycle in the elderly healthcare. In this context, efforts to secure foreign caregivers will be strengthened fromboth quality and quantity perspectives, including strategic efforts to recruit theoverseas foreign caregivers and support them for settling in Japan.
② Contents
Sharing of knowledge on long-term care services
Currently, the ISO is investigating the formulation of international standards forlong-term care, and discussions are also taking place in Japan in private committeescomposed of academics, related organizations, and others. By actively contributing tothese discussions and other international discussions in various frameworks in thefield of health care for the elderly, our country aims to share knowledge on Japan's
high-quality long-term care services and to contribute to international understandingof Japan's high-quality long-term care services, including dementia care.
In addition, given the recent downward trend in the rate of Certification of
Needed Long-Term Care by age group in Japan amidst the aging population, ourcountry will collect and organize further evidence on how this trend relates to Japan’s
health promotion and care prevention efforts through community support programs.
We also examine the relationship between the extension of healthy life expectancy
and the cost of long-term care and share the knowledge with other countries. This willcontribute to the realization of vibrant, healthy societies with longevity in each country.
Through these efforts, we aim to increase Japan's international credibility in thefield of long-term care, and to attract foreign long-term care workers interested inJapan’s long-term care, as well as to encourage the international expansion ofdomestic long-term care providers.
Strengthening of outreach to overseas local communities
The direction of a comprehensive and strategic response to strengthen the ability
to attract foreign caregivers will be discussed with the participation of government
agencies, local governments, academics, care providers, and other experts. In thisprocess, we will establish the sending-out routes to Japan according to thecircumstances of each country. In particular, for countries like India, where18establishing such routes is particularly urgent, we will develop the recruitment
approaches in accordance with their economic development, regions, target groups,
and other factors, by addressing key issues and fostering networking among relevant
stakeholders.
*For example, a creative approach is needed in Vietnam and the Philippines such as recruiting in rural
areas, while recruitment in Myanmar is on the rise due to its Japan-friendly environment. Nepal and Sri
Lanka are expected to have people who will be accepted as students aiming to become caregivers andas specified skilled workers, while more and more people from Indonesia and India are expected to be
accepted due to the size of their populations.

In addition, with the needs of Asian countries in mind, we have been gradually
expanding Tests related to specified skilled workers. We will continue to consider theaccessibility of test sites and test venues and strengthen information dissemination byholding local information sessions to raise awareness of employment opportunities in
the long-term care field in Japan and to enhance understanding of the Japan’s
approach to long-term care.
In order to secure foreign long-term care personnel in Japan, MHLW will support
long-term care providers who are actively expanding overseas by building
relationships and strengthening cooperation with overseas local educational
institutions, and by conducting recruitment and publicity activities through local job fair.
In addition, with regard to JICA's project to strengthen the long-term care humanresources capacity in Indonesia, the MHLW will dispatch experts to support thedevelopment of educational programs and materials for long-term care workers at
public training schools and the training of teachers in this field, with a view to also
contributing to increasing the number of caregivers working in Japan.
We will promote networking among foreign long-term care workers who haveworked in Japan and returned to their home countries, and visualize how theirexperience in Japan can benefit their careers in their home countries, such as working
in the local long-term care industry, to demonstrate incentives to working in Japan. In
addition, we will consider supporting efforts to standardize and disseminate Japanese
long-term care techniques in Asian countries, and organize related issues, including
mutual recognition of long-term care qualifications, so that there will be opportunities
for returnees to work after their return and for Japanese employees to be dispatchedto overseas long-term care facilities.

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Promotion of support for settlement in JapanTo ensure that foreign caregivers can work comfortably in Japan, we will support
host organizations in improving working and living conditions. We will enhance theattractiveness of long-term employment in Japan by enabling them to experience
diverse tasks and advance their careers. For example, we will require hostorganizations to create career development plans for those engaged in home-visit
services and improve access to initial training and practical training programs. By
providing clear career pathways in the long-term care filed and facilitating careeradvancement, we aim to make long-term employment in Japan more appealing. In
addition, in order for foreign nationals who come to Japan under Technical Intern
Training Program and other programs to be able to enjoy the benefits of the use of thegovernment-issued ID card, “My Number Card,” as a health insurance card, such as
better medical care, as soon as possible, the relevant organizations, including
supervisory bodies, will provide thorough support for obtaining the My Number Card
promptly after their arrival in Japan.
Moreover, we will provide learning support for the acquisition of the national
qualification of care worker, such as holding test preparation courses throughout
Japan. In addition, as part of efforts to create an environment conducive to taking thenational examination, we will consider introducing a part-passing system for thenational care worker examination so that everyone can balance work and study andaim for career advancement.
Furthermore, we will provide information to domestic long-term care providers on
how they can actively expand internationally to acquire human resources and accept
foreign long-term care workers from emerging countries.
③ Timeline
We have already participated as an observer in a domestic committee of experts
on international standards for long-term care, and will continue to engagein
discussions in cooperation with related organizations.
Regarding the outcomes of the Preventive Service to Long-Term Care efforts, wewill continue our research in FY2024.
Regarding the enhancement of the ability to attract foreign caregivers, the directionof action will be discussed by experts in FY2024.
The committee of experts is currently working on the introduction of a partial pass20

for the national examination for caregivers. A summary of the results is expected to becompleted by the summer of 2024.
(4-3) International development of medical care including training of foreign medical
personnel and medical inbound① Purpose
Through strategic efforts in developing foreign healthcare professionals andinternational expansion of medical care, including medical inbound, we aim toenhance healthcare standards and address health disparities in the Indo-Pacificregion, including Asian countries. This will contribute to the international communityand support the growth and further innovation of Japan’s healthcare industry.
② Contents
We will promote the development of foreign healthcare professionals to contributeto improving healthcare standards and addressing the health disparities in the IndoPacific region, including Asian countries. Specifically, we will engage in ademonstration project involving the establishment of a model5 for accepting foreign
students into Japanese medical schools, utilizing scholarships funded by contributions
to the ERIA. This project will involve approximately 20 participants.
In addition, we will promote the acceptance of foreign patients visiting Japan(inbound) and the international expansion of pharmaceuticals and medical devices(outbound). While carefully considering our regional healthcare based on our national
universal health insurance system, we will collaborate with relevant government
ministries and agencies to establish a system for accepting foreign patients based on
private medical care. Specifically, we will undertake projects to enhance theacceptance system for foreign patients at medical institutions, such as providing
medical interpreters and coordinators for foreign patients. We will also promote theinternational expansion of healthcare technologies through dispatching healthcare
professionals and accepting trainees, led by the JIHS, and conducting research
projects aimed at the practical application of medical technologies considering theneeds of developing and emerging countries. Moreover, we will support Japanesecompanies in acquiring WHO Prequalification (PQ) and the promote the international

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Also consider the specific details of the scheme, such as the university's medical school capacity andthe system for accepting international students.

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expansion of pharmaceuticals and medical devices by utilizing procurement
frameworks of international organizations. Furthermore, the objective of providing
advanced medical care to foreign visitors to Japan (medical inbound) is to address
health disparities in Asia and other regions, ensure that the benefits of innovation are
widely distributed among the public, and extend Japan's healthcare model across Asia.
This will lay the groundwork for improving and disseminating the quality of medical
devices, pharmaceuticals, and other products. In collaboration with the relevant
ministries and organizations related to medical inbound 6 , we will promote efforts
towards achieving these goals by conducting assessments and analyses of thecurrent situation and challenges, and set strategic goals to maintain and advancecutting-edge medical technologies while organizing and promoting the acceptance of
foreign patients.
③ Timeline
We will begin examining a demonstration project for establishing a model for
accepting foreign students into Japanese medical schools, utilizing scholarships
funded by contributions to ERIA from the fiscal year 2024.
Regarding the promotion of the foreign patients acceptance system at medical
institutions, we will continue implementing the project through private companies andrelevant agencies in the fiscal year 2024, with the aim of expanding it in subsequent
years.
For the international expansion of medical technologies, the project will continue inthe fiscal year 2024 through NCGM7 and private companies, with a view to expanding
to the Asian region and beyond in the following years.
The research projects on the practical application of medical technologies indeveloping and emerging countries through private companies and relevant agencies
will continue to be implemented in the fiscal year 2024, with plans for expansion insubsequent years.
The promotion of international expansion of pharmaceutical and medical device
6

The Japan Medical Education Foundation (JMIP) certifies medical institutions that provide foreigners
with safe and secure medical services in Japan, such as multilingual medical information and crosscultural/religious support, and recommends hospitals that are willing and able to receive travelers as
Japan International Hospitals (JIH). Medical Excellence Japan (MEJ), which recommends hospitals that are
willing and able to receive travelers as Japan International Hospitals (JIH).

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JIHS will be established in April 2025 through the merger of the National Institute of Infectious

Diseases and NCGM.

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industries utilizing procurement frameworks of international organizations will continue
in the fiscal year 2024 through private enterprises.
(5) Strategies to ensure a stable supply of pharmaceuticals as economic security① Purpose
In March 2019, a serious issue occurred due to prolonged supply disruption of
cephazolin, an antimicrobial drug with a high dependence on active pharmaceuticalingredients (APIs) from China. The supply issues, stemming from manufacturing
troubles in China, had a significant impact on the smooth provision of medical care in
Japan.
In light of this background, the “Act on the Promotion of Ensuring National Security
through Integrated Implementation of Economic Measures” enacted in May 2022
designates antimicrobial drugs among the 8 Stably Secured Pharmaceuticals as
specified critical products under the Act, along with efforts to promote diversificationof supply sources of APIs for other pharmaceutical products, In addition to efforts topromote diversification of supply sources of APIs for other drugs, a system to supply
products to medical facilities without interruption even when supply of APIs fromoverseas is disrupted should be established.
② Contents
Regarding antimicrobial drugs, which are specified critical products, domestically
produced APIs are expected to be more expensive than those produced overseas.
The increased cost is anticipated to reduce the profitability for manufactures. For thisreason, in the second supplementary budget for FY2022, ¥55.3 billion has been
allocated for domestication of antimicrobial APIs, covering part of the costs associatedwith constructing manufacturing facilities and other related expenses.
In addition, it is necessary to create an environment in which domesticallymanufactured APIs can be used continuously in the production of antimicrobial drugs
during normal times. We will comprehensively consider various issues, including
trends in the price differences between domestic and foreign APIs, the structure of
support measures including its operation cost, and the feasibility of support measures.
For pharmaceuticals other than specified critical products, we have been
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The Ministry of Health, Labour and Welfare (MHLW) has selected these drugs as those that are necessary
for the seamless provision of medical care to protect the lives of the people in terms of Japan's
security, and for which special consideration is required to ensure stability.

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promoting stockpiling through the “Support Project for Stable Supply of
Pharmaceuticals,” which includes diversifying supply sources of APIs and securing
internal and distribution stocks. We will continue to advance these initiatives moving
forward.
③ Timeline
Regarding antimicrobial drugs, which are specified critical products, we willconsider a framework for ensuring the continuous use of domestically manufactured
APIs and strategies to secure a certain level of domestic distribution. We aim to reacha conclusion on these matters by the end of FY2024.
(6) Appropriate contributions to international organizations and Global Health
Initiatives (GHIs)
Tuberculosis (TB), malaria, Ebola, and HIV/AIDS have a major impact on society
and the economy worldwide, transcending national borders. In recent years, COVID19, AMR, neglected tropical diseases (NTDs), and other issues have significantly
increased the need for the international community to cooperate and collaborate toaddress these challenges.
Currently, the MHLW contributes to international organizations such as WHO, theJoint United Nations Programme on HIV/AIDS (UNAIDS), and the International
Agency for Research on Cancer (IARC), as well as to GHIs, including the Global
Health Innovative Technology Fund (GHIT Fund), Coalition for Innovation in Fighting
Infectious Disease Epidemics (CEPI), Global Drug Facility (GDF), Gavi, the Vaccine
Alliance, Global Antimicrobial Research and Development Partnership (GARDP),
Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund), and CARB-X(the Biopharmaceutical Accelerator against Drug Resistance). The MHLW will
promote the strengthening of these partnerships while ensuring that each organization
make the most of the contributions to deliver their performance in effective andefficient manner, performance in alignment with the MHLW’s contribution objectives.
(7) Promotion of international policy dialogue
To date, Japan has been actively engaged in the G7 Health Ministers’ Meetingand the G20 Health Ministers’ Meeting to address various global health challenges.
Recently, we have discussed building and strengthening the GHAs to respond to24health emergencies, contributing to the achievement of more resilient, equitable, andsustainable UHC through strengthening health systems, and promoting healthinnovation to address various health challenges.
Since 2003, Japan has hosted the ASEAN-Japan High-Level Meeting on Caring
Societies with the aim of strengthening cooperative relations and human resource
development in the field of social security with ASEAN countries. Additionally,“Trilateral Health Ministers’ Meeting among Japan, People’s Republic of China andthe Republic of Korea has been held annually since 2007. Furthermore, the ASEAN+3(China, Republic of Korea, and Japan) Health Ministers’ Meeting has been heldbiennially since 2004.
There is also a need to strategically increase opportunities for bilateral policy
dialogue, where such dialogues can be more effective, particularly in areas like drug
discovery-related collaboration.
(8) Strengthening the governance of the Ministry’s international department and theinternational health human resource strategy
In order for the MHLW to work strategically on global health, governance needs tobe strengthened with regard to the international department within the Ministry.
Specific measures to strengthen the organization are as follows.
⚫ The Office of Global Health Coordination, headed by the Vice-Minister for Medical
Affairs, will be established to coordinate the Ministry’s global health initiatives,
particularly in priority areas. This office will operate through the line of the ViceMinister for Medical Affairs, Senior Assistant Minister, and Deputy AssistantMinister.
⚫ The International Affairs Division of the Minister’s Secretariat will serve as thesecretariat and act as a cross-sectoral coordinating body for international projects
within the Ministry. It will work in cooperation with the International Labour Division.
In addition, deputy assistant minister-level positions in the relevant bureaus will
be concurrently assigned to the International Affairs Division to ensure that they
can promote measures in alignment with the International Affairs Division staff.
Moreover, in order for the Government of Japan to demonstrate its initiatives incollaboration with international organizations, we will provide support to increase thenumber of Japanese staff working in these organizations and ensure that their abilities

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are fully utilized. To ensure that necessary personnel are placed in the appropriate
positions, the MHLW will strategically develop, utilize, and support these humanresources. The International Affairs Division and the Human Resource Strategy
Center for Global Health of NCGM will collaboratively form the “Global Health Human
Resource Pool” and implement the following measures.
①Development of human resources for global health
The MHLW will cultivate and train human resources to be effective at the forefront
by actively appointing outstanding individuals to positions in internationalorganizations. In collaboration with the Human Resource Strategy Center for Global
Health of NCGM, the MHWL will research and develop strategies for personnel
development methods, including those in the private sector.
② Utilization of international health human resources
The MHLW will compile a list of potential personnel from within and outside the
Ministry, including those who have lived or studied abroad, and will support them tobe appointed to the position in the international organization.
③Support for Japanese staff
Form communities with Japanese staff belonging to each internationalorganization, hold exchanges or meetings at least once a year at the International
Affairs Division, and provide necessary support to the extent possible.
Furthermore, in advancing the initiatives across various field, the MHLW will also
focus on setting the international standard that help to address global healthchallenges we are facing. We will work on developing personnel capable of leadinginternational standardization and will collaborate with the private sector and otherorganizations to promote integrated efforts in international collaboration andqualification.

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