On April 21, 2022, Peter Sands, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM or the Global Fund) paid a courtesy visit to Japanese Foreign Minister Hayashi Yoshimasa. Hayashi praised the role of the Global Fund for combatting the three major infectious diseases in the middle of the coronavirus pandemic. Director Sands appreciated Japan’s continuous contributions to the Global Fund and reported the status quo of the infectious diseases in Ukraine after the outbreak of the Russia-Ukraine conflict. Both Hayashi and Sands agreed to continue further cooperation for achieving universal health coverage (UHC) and improving the global health system to prevent and prepare for future pandemics.
Japan’s Summit Diplomacy to Establish and Facilitate the Global Fund
The Global Fund was established in January 2002 based on a statement by Japanese Prime Minister Mori Yoshiro who mentioned the importance of establishing “new partnerships” and international cooperation to fight against infectious diseases at the Kyushu-Okinawa G8 Summit in 2000. Notably, it was announced in the G8 Communique Okinawa 2000 that the Group of Eight (G8) would strengthen its partnership with other governments and the World Health Organization (WHO) to reduce the number of HIV/AIDS-infected young people by 25 percent, deaths by tuberculosis and prevalence of the disease by 50 percent, and the burden of disease associated with malaria by 50 percent, by 2010.
In June 2005, Prime Minister Koizumi Junichiro pledged US$500 million to the Global Fund and reiterated US$5 billion pledge over five years as Japan’s official development assistance (ODA) for health and development. Koizumi said that these decisions had been made based on “human security” as one of core pillars of Japanese diplomacy. In a symposium, “From Okinawa to Toyako: Dealing with Communicable Diseases as Global Human Security Threats” held on May 23, 2008, Prime Minister Fukuda Yasuo recalled the role of the Kyushu-Okinawa Summit during which the establishment of the Global Fund was proposed, and stated that Japan as a “peace fostering nation” should make contributions to international health cooperation for combating the three major infectious diseases. As a result of the Hokkaido-Toyako G8 Summit held in July 2008, the Task Force on Global Action for Health System Strengthening submitted a report as policy recommendations to the G8. The task force was composed of global health policy experts, including Takemi Keizo as a Diet member of the Upper House, former Tokai University Professor, and a research fellow at Harvard School of Public Health.
Multi-partisan Support for Japan’s Financial Contributions to the Global Fund
During the administration by the Democratic Party of Japan (DPJ), the Japanese government continued its contribution to the Global Fund. State Secretary for Foreign Affairs Banno Yutaka of the Kan Naoto administration pledged US$800 million at the Third Voluntary Replenishment Conference of the Global Fund held on October 5, 2010 in New York. On June 3, 2011, Banno stated that although Japan had suffered from the Great East Japan Earthquake, its policy on international cooperation including contribution to the Global Fund would not be changed. Banno’s remarks indicate that Japan’s policy on the Global Fund had been consistent during the DPJ administration, even after the nationwide disasters in 2011.
After the Liberal Democratic Party (LDP) and Komeito came back to power in 2012, the LDP-Komeito coalition government resumed the contributions to the Global Fund. On March 12, 2013, Vice-Foreign Minister Matsuyama Masaji met Mark Dybul, Executive Director of the Global Fund, and encouraged him to participate in the Fifth Tokyo International Conference on African Development (TICAD 5). In response, Executive Director Dybul stated that he would attend the conference and cooperate with Japan in the field of global health. On December 3, 2013, Parliamentary Vice-Minister for Foreign Affairs Kihara Seiji as a special envoy of Prime Minister Abe Shinzo delivered a speech at the Fourth Voluntary Replenishment Conference of the Global Fund. Kihara stressed the importance of human security and the realization of UHC, and pledged US$800 million in the coming years.
On December 17, 2015, Foreign Minister Kishida Fumio made a speech at the Fifth Replenishment Preparatory Meeting of the Global Fund, and expressed Japan’s further support for the Global Fund based on human security concept, while referring to the significance of the 2000 Kyushu-Okinawa G8 Summit and Japan’s G7 presidency in 2016. During the Sixth Voluntary Replenishment Conference held in October 9-10, 2016, State Minister for Foreign Affairs Suzuki Keisuke mentioned that Japan would host the G20 Osaka Summit and TICAD 7 in 2016, and pledged US$840 million to the Global Fund, a 5 percent increase compared to the amount pledged in the previous replenishment conference. Thus, it can be observed that Kishida as foreign minister was active in facilitating Japan’s global health diplomacy for the Global Fund in the Abe administration.
The Infectious Diseases and Humanitarian Crisis in War-torn Ukraine
During the Kishida administration, the Japanese government has continued to make diplomatic efforts for the Global Fund. On February 24, 2022, Kunii Osamu as a Management Executive Committee member of the Global Fund paid a courtesy visit to Vice-Foreign Minister Suzuki Takako. Both Suzuki and Kunii agreed that it is important to foster experts and activists who can contribute to the field of global health. Furthermore, Akahori Takeshi, Ambassador, Director-General for Global Issues of the Foreign Ministry, visited Geneva and had talks with Executive Director Peter Sands on April 8, 2022. Both Sands and Akahori agreed that Japan and the Global Fund would continue further cooperation for the realization of UHC and the strengthening of health systems to prepare for future pandemic.
In recent years, the total number of those who have suffered from AIDS (acquired immunodeficiency syndrome) caused by HIV (human immunodeficiency virus) infection in Japan has been on the increase since the 1980s, and amounted to 32,480 by the end of 2020, but early detection enables HIV/AIDS patients to be treated by medication. On the other hand, some 260,000 people in Ukraine are suffering from HIV/AIDS, and medical service in the country has been disrupted due to Russia’s invasion since February 24, 2022. The Global Fund has been working together with the WHO and the United Nations Children’s Fund (UNICEF) to address this issue in the war-affected country.
Nowadays, people in Japan tend to consider that tuberculosis is a disease of the past, but the number of those who are infected by tuberculosis has increased in Japan. In 2017, the Japanese government alerted that as many as 18,000 people were infected by tuberculosis every year in Japan, and some 1,900 of them passed away owing to the disease each year. According to the Ministry of Health, Labour and Welfare (MHLW), 12,739 people in Japan were registered as patients of tuberculosis in 2020. In Ukraine, approximately 30,000 people are infected by tuberculosis annually, and Anthony Fauci as Director of the National Institute of Allergy and Infectious Diseases in the United States warned that the Russian invasion of Ukraine would cause a serious tuberculosis problem as well as a “terrible public health tragedy.” Likewise, medical experts around the world have been concerned about “public health catastrophe” especially treatment for HIV/AIDS and tuberculosis in Ukraine.
According to the Cabinet Office, malaria has been eradicated in Japan, and the final case of malaria infection was reported in Shiga Prefecture in 1959. But, of late, Japanese people are being infected by the disease outside of the country. For Japanese people, malaria is still a travel-related infectious disease, but lethal nature of the disease cannot be underestimated. It was reported that 61 people in Japan were diagnosed with malaria in 2017, and 2 of them died. In 2019, 57 people in Japan were infected by malaria. According to the US Centers for Disease Control and Prevention (CDC) moreover, some neighboring countries, such as China and South Korea, are categorized as malaria-endemic countries. In this sense, the spread of malaria into Japan should not be overlooked in the progress of global warming as well as the globalization of tropical diseases. According to World Malaria Report 2021 publish by the WHO, 14 million more malaria cases and 47,000 more deaths in 2020 in comparison with 2019 were reported, indicating the negative impact of the coronavirus.
Significance of the G7 Summit to Strengthen Global Health System
Thus, the rise in cases of the three major infectious diseases are all influenced by the COVID-19 pandemic, and HIV/AIDS and tuberculosis patients in Ukraine need continuous medical treatment in the middle of the Russia-Ukraine War that has disrupted ordinary medical services in the country. Hence, the international community, especially the Group of Seven (G7) member-states, is expected to take more proactive measures against the spread of the three major infectious diseases. On May 8, 2022, G7 leaders’ online conference was held alongside Ukraine. In the “G7 Leaders Statement,” it was confirmed that Russia’s “illegal military aggression against Ukraine” has resulted in “terrible humanitarian catastrophe.”
This month, from June 26 to 28, 2022, the G7 Summit will take place at Schloss Elmau in the Bavarian Alps in Germany, and Japan is expected to make further diplomatic and financial contributions to the enhancement of global health system severely influenced by the COVID-19 pandemic and disrupted by the Russia-Ukraine War.