Exclusive Interview

Leaders in Japan
Leader of Japan’s pandemic countermeasures & former chairmanof the Subcommittee on Novel Coronavirus Disease Control

No.4

Shigeru Omi

The Pandemic & Japan
By Kazumasa Oguro
When the novel coronavirus spread globally in the spring of 2020, there were serious discussions about
how to effectively control it. Now that the pandemic has calmed down to some extent today, we face theneed to review how nations confronted this challenge to be well prepared for the next one.
As of the summer of 2024, the 11th wave of coronaviruses is still ongoing in Japan, although the impact
on the lives of citizens is easing, as the proportion of fatal or seriously ill cases among those infected has
decreased significantly from the initial level. However, the number of persons per medical institution
infected with the coronavirus reported by selected medical institutions nationwide during one week, which
is currently the only indicator of the number of infected persons released by the Japanese Ministry of
Health, Labour and Welfare, has declined since May 2023 when novel coronaviruses were considered thesame as influenza. The end of the pandemic seems to be in sight.
How did the leaders of Japan’s medical experts confront this unprecedented virus in the history of
mankind? How did the low mortality rate from this virus in Japan come about? Prof. Kazumasa Oguro of
Hosei University, a member of the Japan SPOTLIGHT editorial board, interviewed Dr. Shigeru Omi, a leaderof Japan’s pandemic countermeasures and former chairman of the Subcommittee on Novel Coronavirus
Disease Control, who in September 2023 published a book titled “1,100 Days of Conflicts: Records ofExperts on the Novel Coronavirus Pandemic” (Nikkei BP) as an important lesson in preparing for future
pandemics.
(Interviewed on Aug. 6, 2024)

Overall Assessment of Pandemic
Countermeasures

as a result. Looking back, how do you evaluate thispoint? I would like to hear your thoughts on it.

Oguro: At the beginning of the novel coronavirus
pandemic, there was a high degree of uncertainty,
and the inadequacy of Japan’s PCR system, forexample, was sometimes criticized by the foreign
media. In light of this situation, Japanese experts
were collecting and analyzing epidemiologicalinformation to detect and respond to those clusters
at an early stage. Citizens were being educated to
avoid certain environments and behaviors that areprone to clusters. After that, you and others said you
would do your best to reduce the fatality rate, and I
see that an extremely low fatality rate was achieved

Omi: It is true that our PCR-testing capacity was low and Japan was
unprepared for such a pandemic. Compared to other Asian countries
and areas such as Taiwan, Singapore, and South Korea that wererelatively well prepared for a pandemic, Japan was clearly
underprepared. The reason for the preparedness of those countries
was that South Korea and Singapore had various infectious disease
outbreaks in the past, such as SARS, MERS, and the H1N1 influenza
pandemic in 2009. By fully utilizing the lessons learned, they havebeen working quite seriously to strengthen their testing capacity, as
you mentioned, or to digitize the most important medical andepidemiological information (Photos). Though Japan had the same
experience with a new strain of influenza H1N1, and also SARS, with

2 Japan SPOTLIGHT • September / October 2024

https://www.jef.or.jp/journal/

Photo: infectious disease specialist

Photo: Prof. Hiroshi Nishiura of Kyoto University

Emergency Operations Center in Japan (left) and in South Korea (right)

relatively little damage, we learned much less from those diseases
than these other nations. This might be why Japan was less preparedthan other nations.
In 2009, when a new strain of influenza (H1N1) of pig origin brokeout in Mexico, Japan was severely affected as well and a meeting washeld to reflect on the situation. Dr. Ichiro Kanazawa, then president of
the Science Council of Japan, chaired the meeting, and we examined
the situation over a fairly long period of time. Government officials,
medical personnel, and the mass media were also involved, andvarious recommendations were made to the government, in particular
the Ministry of Health, Labour and Welfare.
These included the need to increase the capacity of PCRs, the needto digitize medical information, the need to clarify roles andresponsibilities between the government and experts, and the need to
discuss the appropriate risk communication. All of these themes were
included in the recommendations at that time. However, unlike South
Korea and Singapore, Japan hardly implemented thoserecommendations. Despite insufficient levels of preparation, the death
rate was relatively low. I believe there were three major factors that
accounted for low mortality.
One is the behavior of citizens. In the case of Japan, unlike inEurope and the United States, the government policy of urging
citizens to control their behavior to mitigate infections was on arequest basis, and there were no fines or other penalties for failure tocomply. Nevertheless, with the high level of health literacy among
Japanese people and peer pressure from their surroundings, they
voluntarily cooperated with these unenforceable requests from thenational and local governments.
The first declaration of a state of emergency was issued on April 7,
2020, but even before the declaration people, especially the elderly,
had already been proactively changing their behavior taking accountof information provided by the mass media.
And then, the state of emergency added to this behavioral change.
Not only the elderly but also young people cooperated considerablywith the requests for behavior change issued by the government. Thiswas definitely one of the main reasons why there were fewer deaths.
Second, and this was the same in other countries, the medical
personnel did their best under high stress, wearing protective

clothing and the very air-tight N95 mask every day while they
themselves were also at risk of infection. Staff of public health centers
also worked hard until they were exhausted. Japan’s cluster-based
approach is characterized by contact-tracing to find out where thesource of infection is. This is not done by clinicians, but by staff ofpublic health centers. The cluster-based approach worked very well,when the number of infected patients is small, but as the number
increases, their workload becomes extremely heavy, making it
impossible to rely only on the cluster approach to control infection.
Given this, to control infection such measures as issuing a state of
emergency came into the picture.
Because the pandemic lasted so long, I think there was prejudice
and discrimination not only against the infected people but also
against the medical personnel, who were initially the target ofgratitude and praise. Because the pandemic was prolonged, there wasa medical crunch, so we issued a number of key precautionary
measures to control people’s behavior. As a result, the anxiety of the
public evident in the early stage of the pandemic was gradually turned
into dissatisfaction and frustration, which was directed at medical
personnel. People were saying, “The reason why medical crunches
occur so frequently and behavior restrictions are repeatedly imposedis because the medical personnel are not doing their best.”Third was the repeated policy of “hammer and dance”. Many
countries, such as China, the United Kingdom, and New Zealand,
implemented strong behavior restriction measures, such as
lockdowns, in the early stages of the pandemic and continued themfor a long time and all of sudden, all the strict restrictions were liftedto bring socio-economic activities to normal. In Japan, we modified
the level of restrictions tailored to the level of strains upon medical
institutions. When medical institutions were at impeding risk ofcollapse, we issued a state of emergency and the level of strains wereeased and these restrictions were lifted. This is called “hammer anddance”, which is one of the characteristics of Japan’s response.
The number of deaths in the first wave was negligibly small
compared to the eighth wave. The number of deaths had beensteadily rising toward the eighth wave. Even though the fatality rate
was decreasing, the number of deaths increased dramatically in thesixth, seventh, and eighth waves. As stated, the reason for issuing
Japan SPOTLIGHT • September / October 20243

these strong measures was not necessarily due to the increased
number of deaths, but rather to avoid a medical crunch. That is whyin the early days including the first wave, when a very small numberof medical institutions were involved in accepting infected persons,issuing a state of emergency was indispensable. In contrast, during
the sixth, seventh and eighth waves when the number of deaths
increased, no statement of emergency was issued because greaternumbers of institutions were able to respond to the spreading
infection and mortality without the need to issue a state of
emergency.
As infectious disease specialists, we also thought that there should
be a balance between infection control and socio-economic activities.
However, if the healthcare system becomes tight and collapses, wecannot talk about balance.
It is my impression that for the three reasons I just mentioned,
there were fewer deaths, and at the same time the three-year-average
decline of GDP of Japan was almost at the same level with that of theWest.

Coordination of Opinions Between Medical
Experts & Economic Experts
Oguro: I believe there was quite a split in the debate
between so-called economic experts and publichealth or medical experts regarding the policy
response to the coronaviruses. From the standpointof the economic experts, there was an argument that
restoring the economy would be as important asavoiding a medical crunch and I think this led to thecoordination of different views. As a result, thefatality rate was kept low and the economy was able
to recover to a certain extent, but I believe there were
things that went well and things that did not go wellin the process of coordinating the opinions of publichealth or medical experts and economic experts.
What do you think were the factors that contributed
to the successful outcome, including lessons for the
future?
Omi: Initially, the experts were only from the medical community, but
in consideration of the socioeconomic impact it was discussed
whether it would be better to include economic experts as well.
Therefore, in July 2020, a subcommittee was formed that included
people from the economy, society, the media, and local government.
In September 2021, the subcommittee began discussing whether it
was time to consider the impact of the economic downturn as well as
the infection on people’s lives, and how to balance the two. Such
opinions came from economic experts in particular. The
subcommittee as a whole began discussions in the latter half of 2021
on the importance of not only controlling infections, but also how to
restore the economy and society to normalcy.
From the very beginning of the pandemic, the goal of ourcountermeasures was set to minimize the level of infections as muchas possible while minimizing the impact on society and the economy.
Therefore, we were discussing how to achieve the balance. Some of
4 Japan SPOTLIGHT • September / October 2024

the discussions were quite heated because of the different views,
which I thought was healthy. The medical community expressed theirviews. The people in the economy voiced their opinions too. My role
was basically to bring both sides together and reach a consensus.
Oguro: In discussing with the economic experts, I know

there was some reconciliation of different opinions,but in hindsight was there anything that went
particularly well among these two types of experts?

Omi: As I mentioned a while ago in September 2021, a person fromthe economy side expressed the opinion that since the lives lost to
infectious diseases and the lives lost to unemployment were thesame, we should consider both, not just one or the other, and thiswas very persuasive. I believe this created momentum to accelerate
the discussion on the economy. Furthermore, in November 2021,
with the vaccine now available, discussions on how to restore social
life to normal accelerated considerably. Then in March 2022,
economic experts showed the impact of strong restriction measureson the economy in terms of the unemployment rate, in numericalterms. This led to the need for more discussion on this point. In thatsense, I think it was good that we included economic experts.
However, comparing the number of deaths between the first andeighth waves, the fatality rate decreased but the actual number ofdeaths increased toward the eighth wave. Although the fatality rate
has decreased, the number of infected people has become very large,
especially with the Omicron strain, so the absolute number of deaths
was still increasing. Even if the fatality rate is reduced by a factor of
10, the number of deaths will increase by a factor of 10 if the infection
rate increases by a factor of 100.
We in the medical profession agree with the urgent need forrestoring socio-economic activities. No one disagrees with this.
However, medical experts had to make it clear why the number ofdeaths is increasing despite the fact that the fatality rate is decreasing.
But inevitably, economic experts will say that because the fatality rate
is low, economic activity should be restored. We medical
professionals understand the economists’ point of view. However, as
medical professionals, our view was that we must consider threefactors: lethality, infectivity, and impact on medicine and society. At
that time, we in the medical profession argued that although thecoronavirus was becoming a common disease, partly in terms of thecase-fatality rate, it had not yet become one completely. That is why
we said that the transition of coronaviruses to Category 5 infectious
diseases, the same category as for influenza, should be done with a
stepwise approach and caution. There was quite a heated debate overthese different positions.
The virus can escape the immune system, and as is still the casetoday, and there are problems with the sequelae of the disease named
long Covid. So the medical experts argued that although it is indeed
gradually becoming a normal disease, it would be giving the public
the wrong impression that this disease has become completely
ordinary. Despite the different positions of medical and economic
experts, in August 2022 medical experts and economic experts
cooperated together and called for the need to gradually change theresponse tailored to the characteristics of the Omicron strain, in orderto return the social economy to normalcy.

Division of Roles Between Experts &Government
Oguro: I believe that discussion of thesecountermeasures against the pandemic has posed anumber of issues, including how to ensure that thescientific knowledge of experts is properly
understood by the public, including politicians, thedivision of roles between politics and experts, andthe ideal risk communication.
Omi: It is extremely important to talk about the division of roles andresponsibilities between experts and the government. During thisCovid-19 pandemic, we experts had to come to the front in many
ways, including risk communications. There were reasons for this,and I will explain them in detail, because I believe it is important for
future pandemics.
When the outbreak began, in January and February 2020, we
experts knew three things.
First, for this infectious disease there are many asymptomatic
people who can infect others, meaning that the virus is very difficult
to deal with, more specifically to bring down to zero. We can’t test all
asymptomatic people every day. Second, in January and February of
2020, our judgment was that the disease was not only spreading on
cruise ships where infections started in Japan, but that it was alreadyslowly spreading in the community. Third, it was our judgment that
this would not be contained quickly, and that it would be a long-term
battle.
We experts wanted the government to communicate those three
things to the public as soon as possible. Therefore, we submitted
recommendations to the government in writing at the expert meetingon Feb. 24, 2020 to ask it to communicate the three things to the
public. By the way, NHK learned of the fact that experts submitted
recommendations, and thought that the public should be informed, so
NHK, through the Ministry of Health, Labour and Welfare, asked me
to appear on the 7:00 p.m. news to explain about ourrecommendations. In NHK’s view, the public naturally had the right toknow, and the ministry did not object, so I explained it live on air.
Then at the request of other newspapers, television and other media
outlets, a press conference was held at the ministry at 9:00 p.m. thatsame day. I explained the summary of the recommendations in frontof many media outlets.
This set a precedent, and thereafter it became customary for us
experts to hold a press conference each time we issued arecommendation. In fact, we have issued more than 100
recommendations in three and a half years. The pattern of holding apress conference each time a recommendation was made has
become an established practice.
In addition, at the request of the Prime Minister’s Office, I, on
behalf of experts, attended the prime minister’s press conference.
Since we are members of the Japanese government’s Covid-19
advisory panel, there was no choice but to accept the request. My role
was to provide support to the prime minister when technicalquestions were asked by the media. Furthermore, I was called to theDiet every day for a while. These are the reasons why we experts
became so visible.
Now when it comes to the relationship between the government
and experts, there is essentially an ideal form of relationship between
the two.
It so happened that what researchers studying optimal divisionwere thinking and what we experts were thinking were exactly thesame. Namely, experts would analyze the situation, and based onthat, would make recommendations as to what measures should betaken. The government’s role would then be to make the politicaldecisions on whether to adopt the recommendations or not. Now
incidentally, the government has adopted many of the more than 100
recommendations we have made.
Naturally the government’s viewpoints are sometimes different
from the viewpoints of experts, so the government does not have to
adopt all of the recommendations by the experts. However, if they do
not adopt them, it is very important for political leaders to clearly
explain why they do not adopt, what they will do instead, and so on.
Unfortunately, however, at that time there was no clear explanationfrom the government. This may have obscured the decision-making
process and created the impression that the government and theexperts were at odds with each other and sometimes gave theimpression that it is the experts who made final decisions. This was
one lesson learned.

Importance of Communicating Scientific
Findings to the Public
Oguro: The government is now emphasizing objective
policy formation based on data, including EBPM. Do
you think the pandemic experience encouraged the
spread of data-based policy formation? Also, I thinkthat communication with the public about specialized
scientific knowledge will become increasingly
important in the future. What do you think about this?
Omi: We felt great frustration about the lack of digitalized
epidemiological information. Epidemiology is the study of analyzing
how and why virus transmission is occurring based on information
about the number of patients, gender differences, regional
differences, and date of onset of disease for an entire region, etc. In
Japan, there are several world-renowned experts in epidemiology.
However, the data itself for analysis is inadequate, both in terms oftiming and quality. In South Korea and Taiwan, data on the spot arequickly collected through IT, but Japan lacked such a system.
In each infected spot, public health nurses interviewed infectedpatients in order to obtain data for analysis, so it means that somedata, although it may not be complete, does exist at the community
level. But in Japan, such data was not shared with other regions or
the central government, because different local governments havedifficult legal provisions pertaining to protection of private
information. Some experts had to call responsible persons in each
community to get information on the phone or ask them to send it to
us by fax. We wanted to make rational policy proposals based on theJapan SPOTLIGHT • September / October 2024

5

data, but the information we needed was inadequate and accessing it
was time-consuming.
Even with these limitations and constraints, epidemiologists had tosubmit their view to the government based on information gatheredby fax or phone. Working too hard under such frustrations, someexperts were hospitalized. Now, the Digital Agency and others are
doing a lot of work on digitalization, but I think the speed of progress
is too slow. Political leadership is needed to prompt it.
The next topic, risk communication, was also difficult. For example,
the issue of PCR testing. Some people have said that experts may bedeliberately suppressing PCR testing. It is true that at the expert
meeting on Feb. 16, 2020, the government proposed that people
should visit hospitals for PCR testing, if their temperature is 37.5
degrees Celsius or higher for four days or longer, and we agreed atthat point because the testing capacity was extremely limited at thatearly stage of pandemic. At the same time, however, werecommended strengthening inspection capacity 15 times between
February 2020 and August 2021.
But then around August of 2020, it was as if the national opinion
was divided over testing. There was a time when people were arguing
every day, with one side saying that everyone, including
asymptomatic people, should be tested, and the other side saying thatit should be done strategically.
I thought that it is not good to let the division continue. Therefore,
experts, both medical and economic, spent a lot of time and energy todeveloped a PCR testing-related strategy that we had someconfidence in. It is natural to test people who are symptomatic. But
what to do with asymptomatic people was the crux of the issue at thetime. So we divided the asymptomatic population conceptually into
two groups.
One was the group that would have a high probability of testing
positive if tested. People who have been in close contact with theinfected belong to this group. And also people in the hospitality
industry, as well as in the food and beverage industry belong to thisgroup. These people should be intensively tested even if they are
asymptomatic. We know theoretically and empirically that testing thisgroup of people will lower the effective reproduction number (thenumber of people spreading the infection per infected person).
Because of its effectiveness in fighting infection, we decided that its
cost should be covered by the public and taxpayers, not by ourselves.
On the other hand, when, for example, a journalist or businessman
wants to go abroad for interviews or business, testing such a personwith a relatively low prior probability of infection will not necessarily
lead to a reduction in the effective number of reproductions. We
understand that there is a need to test these people for their own
peace of mind, so in that case we decided to do so at the expense of
the individual, not the taxpayer.
What I remember well about this testing strategy is that when weheld a press conference to explain in detail about this strategy, media
hardly reported this. The reason why they didn’t cover it was thatmost of the media attention was focused on the government’s “GoTo”
campaign in support of tourism and our disagreement over the
campaign with the government. This is the difficulty of risk
communication, what we really wanted to convey as a key message tothe public was not really conveyed in fact.
6 Japan SPOTLIGHT • September / October 2024

Another difficulty in risk-communication is that we made more than
100 recommendations, and of course we cannot make them based on
our own arbitrary feelings and thoughts. If our recommendations are
adopted by the government, they will be implemented, and this will
directly or indirectly affect people’s lives, work, and education. This
was the case, for example, when we proposed that the 2021 Tokyo
Olympics be held without spectators. Naturally, in our proposal, we
included as much data, rationale, and thinking as possible, as well as
our common sense as infectious disease specialists. We felt
developing recommendations based upon data and rationale was ourprimary task. However, the basis for our recommendations was rarely
discussed or reported. Only our conclusions, or more specifically,
only part of our conclusions, were conveyed to the public, so that the
public was not informed on the rationale behind therecommendations or the context in which the recommendations weredeveloped.
One of the reasons I published 1,100 Days of Conflict, a record of
our fight against the pandemic, is that I thought it would be necessary
for us to explain how we think, and on what basis we maderecommendations so that our recommendations can be put to the testof history later. But until now, there has been little or no discussion of
the rationale behind the recommendations.
Finally, I would like to share one more specific example of the
difficulty of risk communication. Initially, around March 2020, there
was concern that the infection might have spread from snow festivalsin Hokkaido. But we were unaware of it, because young, infected
persons develop no or only mild symptoms. However, the young
people who were infected traveled to the remote Hokkaido area forwork and other reasons, and had opportunities to meet with relatively
elderly people. Since the elderly are more likely to present apparent
symptoms, it was there and then that the infection situation appearedon our “radar”.
But I was fully aware that if I did not say enough, and carefully, I
would be interpreted as only blaming the young people, and so I
explained politely and carefully that this is not the fault of the young
people at all, but is a characteristic of the virus. And because young
people move a lot, and although it is not their fault, it is true that theelderly are infected through their movements as a result. However, I
was still told by young people that I was bullying youth on behalf of
medical experts. This was the difficulty of risk communication.

Lessons Learned to Prepare for the Next
Pandemic
Oguro: In the case of earthquakes, since they occur atshorter intervals than pandemics, knowledge can bepassed on through the response of earthquake
specialists and related ministries and agencies to the
Noto and Great East Japan Earthquakes. On theother hand, the last time a pandemic occurred was
100 years ago or so. What are the essential lessons
that should be passed on to the future? What kind ofthings should be properly considered by experts andthose in government?

developing countries.
Japan is now producing various diagnostic reagents and diagnostic
kits for AMR and other diseases. I believe the public, private sector,
and academia should strengthen collaboration in this area, andexpand the network all over the world. Young Japanese people today
are unfortunately rather inward looking and I think they should begiven incentives to pay more attention to the world outside Japan anduse their energy for global challenges. In particular, in areas likehealth care, risk management or countermeasures for pandemics,
international collaboration will be key in the future and thus building
up international human networks is extremely important.
In addition, I think the Japanese government’s budget and othercommitments to vaccines have been low. Vaccines are important, but
unless the government invests, and drives the development ofvaccines, there will be no incentive for companies to develop them toprevent pandemics.

Omi: This was a once-in-a-century crisis. Many lives were lost, theeconomy was damaged, people were divided, and young people
missed out on a period of their adolescence. On businesses, althoughsome received subsidies for cooperation, some people were seriously
hurt financially. Some of the elderly were unable to get out of thehouse, and their dementia may have progressed. There was also thecrisis of a medical crunch. We should carefully examine why thishappened - for example, why the crisis in medical care occurred,
which was the most important issue from this pandemic. Otherwise
the same thing could happen again.
Also, many people cooperated with us in controlling their behavior,
but there were actually some who did not cooperate. Do we enforce
such people with penalties? Or do we give them a financial incentive
to comply? And then there is no clear definition of the roles between
experts and politicians. But these important issues are hardly
examined and discussed.
Such a thorough retrospective evaluation is essential if we are to
take the most advantage of what we have gone through to be well
prepared for the next pandemic. Without a thorough examination ofwhat was the real cause of the healthcare crunch, we will end up withrepeating it again.

Oguro: You were director general of WHO in theWestern Pacific region, so I would like to ask if you
think Japan should take more initiative in global
healthcare cooperation, especially in Asia?

The Ideal Form of Japanese Healthcare –Cooperation with Asian Countries Key

Omi: Yes, indeed. TICAD in Africa is important, but Japan should also
show leadership in Asia. Japan’s ODA has a good reputation in Asia.

Oguro: As we all know, bacteria with antimicrobial
resistance (AMR), which reduces the effectiveness of
medication, could cause 10 million deaths per year
worldwide by 2050, more than deaths from cancer,
according to a report published in December 2014 by
the British economist Jim O’Neill. Countries aroundthe world are required to take measures to reducesuch drug-resistant bacteria. Can Japan takesufficient measures? Also, the mRNA vaccines thatwere effective in this pandemic were developed andmass-produced in Europe and the US, anddistributed to Japan, but if they were really only
produced in limited and small lots there would be apossibility they might not be distributed to Japan. So
we still have to be seriously concerned about the factthat Japanese pharmaceutical manufacturers wereunable to develop the product. What do you thinkshould be done to improve this situation?
Omi: I feel that Japan’s presence in the international community is
gradually declining. But, Japan actually has a lot of experience andknow-how to share with the international community in the field ofhealth care. Japan cannot take a leadership role in military affairs.
What I see as areas for Japan’s international contribution to further
accelerate is areas such as universal health coverage, pandemic
preparedness and tuberculosis control. Health is everyone’s concern.
I am now with the Japan Anti Tuberculosis Association. Although
the number of deaths from infectious diseases is decreasing in Japan,
tuberculosis is still the leading cause of death worldwide. TB is aconstant pandemic. This affects social and economic development inOguro: If they are Asian, the clinical trial data will besimilar.
Omi: Yes. Although China and the G7 are now in a bit of a difficult
relationship, I think that healthcare cooperation, as one of the pillarsof diplomacy with various countries, such as Indonesia and thePhilippines, should be done strategically. I think there are many
countries that, like Japan, have problems with population aging andwould like to cooperate with Japan on health care. I believe thatdeepening cooperative relationships with Asian countries, especiallythose in ASEAN, through such issues and building such alliances willlead to the enhancement of Japan’s presence not only in Asia but also
in the world.
Oguro: Thank you very much for your valuable views.
Article translated from the original Japanese by Naoyuki Haraoka.
Interviewer: Kazumasa Oguro has been a professor at the Faculty of
Economics, Hosei University, since 2015. He graduated from the Faculty of
Science of Kyoto University and received a Ph.D. in Economics at Hitotsubashi
University. He is currently also a senior visiting researcher at PRI, a consulting
fellow at the Research Institute of Economy, Trade and Industry (RIETI), andadvisor to “Japan Vision: Health Care 2035”.

Japan SPOTLIGHT • September / October 20247