Japan’s Global Health Strategy: A Diplomatic Foresight on the G7 Hiroshima Summit

On May 19-21 next year, the Japanese government will host the G7 Hiroshima Summit. It is assumed that Prime Minister Kishida Fumio plans to express a strong diplomatic message for peace and nuclear disarmament by announcing a so-called “Hiroshima Action Plan” at the summit. Global issues, such as world economy, food deficiency, and the energy problem, are anticipated to be on the summit agenda. Nonetheless, special attentions may be paid to “global health” at the summit in the wake of the coronavirus pandemic. During TICAD 8 held in Tunisia on August 27-28, Kishida pledged to donate as much as $1.08 billion to the Global Fund to Fight AIDS, Tuberculosis and Malaria. How is the Kishida government planning to contribute to the enhancement of the global health system at the G7 Hiroshima Summit?

On May 24, 2022, the Kishida administration set forth its new “Global Health Strategy” as announced by the Office of Healthcare Policy of the Cabinet Secretariat. The document outline in English stresses the significance of “human security,” stating that “Health is an essential basis for development and economic policies, and is fundamental to human security, of which Japan has been a strong proponent.” The strategy has two policy goals: 1) to contribute to developing resilient “Global Health Architecture” for international health security and strengthening “prevention, preparedness, and response” (PPR) for public health crises, and 2) to accelerate the efforts to achieve more “resilient, equitable, and sustainable” Universal Health Coverage (UHC).

The strategy intends to strengthen the Global Health Architecture and to achieve UHC by following these guiding principles: 1) health systems’ strengthening at the country level, 2) resilience, 3) equity, and 4) sustainability. To attain the policy goals based on the guiding principles, a “cross-sectoral approach” is proposed with actions in the fields of education, water and sanitation, nutrition, population and development, gender equality, and the empowerment of women. Specifically, actions to be taken in the strategy include: 1) global health architecture for UHC, 2) partnership with multilateral organizations including the establishment of a WHO’s UHC Center in Japan, 3) bilateral cooperation through official development assistance (ODA), such as grant aid, loan, and technical cooperation, 4) multi-stakeholder engagement with civil society organizations (CSOs), 5) response to various challenges in global health, and 6) cross-sectoral approach.

Health and Tokyo’s Summit Diplomacy

Japan’s Global Health Strategy has profound implications for Tokyo’s summit diplomacy, through which the Japanese government has made diplomatic contributions to the development of “Global Health Architecture.” First, Japan made a diplomatic contribution by proposing an international partnership to fight AIDS, tuberculosis, and malaria at the event of the G8 Kyushu-Okinawa Summit held on July 21-23, 2000. In the Communique Okinawa 2000, G8 countries agreed on implementing an ambitious plan to address HIV/AIDS, tuberculosis, and malaria. Significantly, the establishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) was based on a proposal by former Prime Minister Mori Yoshiro at the Discussion Group on the Kyushu-Okinawa Summit held on June 5, 2000.

Second, prior to the G8 Hokkaido-Toyako Summit held on July 7-9, 2008, Prime Minister Fukuda Yasuo made these opening remarks: “From Okinawa to Toyako: Dealing with Communicable Diseases as Global Human Security Threats” on May 23, 2008. Fukuda’s speech highlights that global health issues, especially communicable diseases, should be regarded as human security threats. As one of the outcome documents of the summit, the “Toyako Framework Action for Global Health” was formulated and published by the Ministry of Foreign Affairs of Japan. The framework confirmed the necessity of a comprehensive approach toward “health-related” millennium development goals (MDGs) as well as a cross-sectoral approach against infectious diseases, such as HIV/AIDS, tuberculosis, malaria, polio, and neglected tropical diseases (NTDs). In addition, the “Report of the G8 Health Experts Group” containing policy recommendations and data on global health issues was submitted to the G8 countries in the middle of the summit.

Third, the Japanese government highlighted the importance of global health at the G7 Ise-Shima Summit held on May 26-27, 2016. Outcome documents of the summit were on quality infrastructure investment, global health, capacity building of women and girls, cybersecurity, anti-corruption, and anti-terrorism. Notably, the G7 countries announced the “G7 Ise-Shima Vision for Global Health” with concrete action plans, such as the reinforcement of the global health architecture, attainment of UHC, antimicrobial resistance (AMR), and research and development (R&D) for innovative medicine initiative. Prior to the G7 Ise-Shima Summit, an academic paper with policy proposals for the summit was submitted by the Japan Global Health Working Group, and was published by Lancet on May 21, 2016. With a view to protecting human security, the research proposed three areas of global health: 1) restructuring of the global health architecture so that it enables preparedness and responses to health emergencies, 2) development of platforms to share best practices and harness shared learning about the resilience and sustainability of health systems, and 3) strengthening of coordination and financing for research and development and system innovations for global health security.

Clearly, Japan’s previous diplomatic efforts for global health at G7/G8 summits were consistent and evolutionary even in the pre-COVID-19 period. As already mentioned at the outset, the G7 Hiroshima Summit is scheduled to be hosted by the Japanese government next year. In preparation for the summit, the Japan Center for International Exchange (JCIE) has set up the “Hiroshima G7 Global Health Task Force” under the Executive Committee on Global Health and Human Security chaired by Takemi Keizo, Member of the House of Councillors, and JCIE President Okawara Akio to make policy recommendations regarding the G7 agenda.

Human Security Agenda

Based on “human security” as Japan’s diplomatic pillar, the Kishida government is expected to make diplomatic contributions toward the G7 Hiroshima Summit in the two main agenda items: 1) promotion of nuclear nonproliferation and disarmament, and 2) global health architecture. Hiroshima is an electoral district of Prime Minister Kishida, and he is enthusiastic about making abolition of nuclear weapons a core summit agenda item, stating: “I would like to make the summit a place for the leaders to show a strong commitment from Hiroshima to never repeating the horrors of nuclear weapons and opposing military aggressions.” It is understandable for Kishida to prioritize the issue of nuclear weapons abolition in the summit, but the Japanese government would need to make global health as another pillar of the summit agenda due to the COVID-19 pandemic.

Theoretically, these two issues are core themes of the human security agenda. According to a final report by the Commission on Human Security co-chaired by Ogata Sadako and Amartya Sen, the definition of human security is “to protect the vital core of all human lives in ways that enhance human freedom and human fulfillment.” More specifically, human security is composed of three types of freedom: 1) freedom from fear, 2) freedom from want, and 3) freedom to live in dignity. Whereas abolition of nuclear weapons can be categorized as freedom from fear, enhancement of the global health system might be categorized as freedom from want, although there may be some overlapping aspects in these two categories.

Prime Minister Kishida’s Global Health Strategy is therefore consistent with Japan’s human security diplomacy through the presidency of G7/G8 summits. At the G7 Hiroshima Summit, Prime Minister Kishida might also negotiate with other G7 countries about a possibility of adopting a so-called “No First Use” of nuclear weapons as part of the Hiroshima Action Plan. The declaration of the NFU has been increasingly important after the outbreak of the Russia-Ukraine War. At the same time, the Japanese government would be able to pursue an outcome document on global health, including declaration of a so-called “Pandemic Treaty” as well as attainment of UHC based on the spirit of human security.