Speech at the UK-Japan 21st Century Group
39th Annual Conference Programme, Session 2“Global Health – Lessons Learned from the Pandemic”
Yasuhisa Shiozaki
January 13th, 2023, Norwich, UK

Thank you for your kind introduction.
It is my great honour to have this opportunity to share with you our lessons learned
from the COVID-19 pandemic in Japan.
Professor Dame Sally Davies kicked off this important session with her excellent
reflections on the UK’s responses. I recall the time when I was Minister of Health,and Sally and I worked together to revamp the global health architecture andhighlight AMR at the G7 Ise-Shima Sumit in 2016.
Japan will host the G7 Hiroshima Summit this May and I do hope that the lessons weshare today will contribute to the concrete actions to be discussed at the Summit.
(Slide 1)
Japan’s overall performance in terms of the reported number of cases and deaths
from COVID-19 looks somewhat better than other high-income countries.
I strongly believe that this is primarily driven by non-pharmaceutical interventions by
the general public, including mask-wearing, and vaccines. On this, I would like topraise our people.
On the other hand, we observe a large number of people who did not have access totesting and necessary care on time. Hundreds of patients died at home without any
care. In my opinion, this is a national tragedy in a country where universal healthcoverage is the core of our health system.
Seemingly good performance requires proper scientific, economic, and political
scrutiny to draw key lessons, as we now need to prepare for future pandemics.
(Four major governance challenges)
Here, I would like to focus on the fundamental governance challenges, which limited
the Japan’s policy responses during the pandemic.
The first challenge is the governance structure of our public health system itself.
This structure is defined by the Infectious Disease Law, and has remained basicallyunchanged for the past 125 years since the Meiji era.
At the time of disease outbreaks, the prefectural governors, not the centralgovernment, should be primarily responsible for containing transmission.
This decentralized system has worked well in times of stability, but obviously it1

proved to be ineffective during national emergencies and disasters, notably duringthe COVID-19 pandemic.
The lack of a centralized chain-of-command resulted in divergent and inadequate
responses, without centralized data collection, analysis and sharing.
(Slide 2)
The second governance challenge is that this Law also restricts service provision,
including testing and hospital beds.
Some people may wonder why Japan, a country with a very large number of hospitalbeds per population, is facing a collapse of its health systems.
The major reasons for this also stem from the health service provision defined by theInfectious Disease Law.
As opposed to the situation in the UK, the majority of hospital beds is privately
owned and used for chronic care of the elderly.
But more fundamentally, as indicated in the first governance challenge, there is nocontrol tower with the legal authority to oblige hospitals, including university
hospitals, to accept COVID-19 patients, to establish temporary medical facilities, andto coordinate patients’ transfer across prefectures.
Essentially the Law creates a disruption between Japanese public health and clinicalmedical services, which is quite different from the UK system.
(Slide 3)
The third major governance challenge is the lack of appropriate use of scientificevidence.
Examples include the restricted use of PCR testing and delayed roll-out of COVID-19vaccination; Japan implemented vaccination approximately 5 months after the UK
had started mass vaccination in December 2020.
In addition, Japan has not yet been able to develop its own COVID-19 vaccine so far.
The Japanese vaccine industry has long been heavily subsidized and seriously
uncompetitive. When I was Health Minister, I tried to revamp vaccine R&D capacityand modernize the industry in Japan, as vaccination is not only a public health, but anational security matter.
Investing strategically and effectively in vaccine R&D capacity, globally through CEPIand domestically through Japan’s newly created SCARDA, continues to be criticallyessential.
(Slide 4)
The final governance challenge is about data governance. The COVID-19 pandemic
highlights the relevance of digital transformation in public health, basic sciences,clinical medicine and even social and political sciences. “The RECOVERY trials” inthe UK clearly show the power of digitalized systems.

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(Slide 5)
The major factor which, I think, limits the use of scientific evidence is the lack ofappropriate data sharing and transparency. This may be reflected by a shockingly
small number of publications in peer-reviewed journals from Japan.
(Slide 4) <Repeat>
I have been facilitating the efforts on digital health in Japan, but I realize that digitaltransformation is not just about the technology, but also about people and our
mindset of sticking to the status quo.
One of the important steps to fix these governance failures is the major revision ofthe Infectious Disease Law.
Last month, our Japanese National Diet (Parliament) finally did revise the Law; but I
regret that it did not tackle the fundamental issues, which I addressed just now, andlacks the sense of urgency and effectiveness for future pandemics.
(Global Challenges and Opportunities)
Japan will host the G7 Hiroshima Summit this May and we are working to develop
concrete actionable items in collaboration with the global health community.
The UK and Japan have been working together on many global health agenda items,including UHC, AMR, R&D investment, and WHO reform, which definitely continue tobe strengthened.
But given the recent Ukraine crisis, North Korean aggression, and the US-China
confrontation, some people may think that we may need to go back to focus more on
national and territorial security rather than health and human security.
Is it too naïve to argue that health and human security are still big priorities? In myopinion, it is indeed a big awakening that there are limitations to what the UN could
do and what simple diplomacy could do.
Why didn’t the usual coordination mechanism alone solve the problem? Why didn’t
the COVAX and ACT-Accelerator work well as expected this time?
I believe that there are three important elements that are missing: trust, incentives,and new actors. (New actors include, for example, private sector, civil society, andthe media). The COVID-19 pandemic clearly shows this.
Along this line, I would like to conclude my talk with a few proposals.
First, in parallel with national security policies, the UK and Japan should consider a
new mechanism for health and human security, on the basis of trust and incentives
in collaboration with new actors.
We may call it a “strategic collective security system” in collaboration with likeminded countries, agencies, and institutions, which would include regions likeTaiwan.
(Slide 6)3Second, we must succeed in the “100 Days Mission” initiated by the UK government.
In order to do so, we must harness a new global ecosystem, led mainly by theprivate sector with effective support from international organizations andgovernments. The new ecosystem can not only develop new vaccines in 100 days
but deliver them to those who are in need in the least developed regions.
When I was Health Minister in 2016, I decided to invest in CEPI. I believe that this is
one of the best mechanisms to support the vaccine R&D globally.
And as a Global Goodwill Ambassador for CEPI, I will continue to support Japan’s
investment in vaccine R&D both domestically and globally.
Third, we need to enhance the digital transformation in global health. This requires
appropriate data governance and sharing.
(Slide 7)
Fourth, we need to pave the way for comprehensive and effective policy measuresagainst AMR through the “One Health” approach.
They should include, for instance, pull incentives for novel antimicrobials in the G7agenda. As Sally clearly warned in her 2013 book, with no doubt, AMR, the “slowpandemic” continues and will continue unless we act now.
Finally, all of them require new sources of funding, but not just traditional ODA
funding, but from venture capital, private sector, and civil society organizations.
I believe that the UK and Japan are in a really good position to work together topromote an open, transparent, and trust-based network of new ecosystems for R&D,
digital technologies, and financing.
I will continue to make every effort to support the global health agenda in tacklingchallenges that transcend national interests. I am confident that, together, we canmake a difference in overcoming these challenges.
Thank you.

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