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A Brief Report of International Symposium

"Global Partnership in the Fight Against Infectious Diseases"

November 2, 2001, Ministry of Foreign Affairs, Tokyo

On October 2, the Ministry of Foreign Affairs, together with the Ministry of Health, Labor, and Welfare and with the support of the Japan Times Ltd., held an international symposium
"Global Partnership in the Fight Against Infectious Diseases," at the Mita campus of Keio University in Tokyo. This symposium included public discussions on such matters as ways of strengthening the future global approach to dealing with infectious diseases, such as AIDS, and focused on efforts to combat AIDS, particularly the Global HIV/AIDS and Health Fund, based on the experiences of Africa and Asia. The keynote speaker was former Prime Minister Yoshiro Mori, and a number of renowned experts active in the field of infectious diseases, both in Japan and overseas, made presentations. A panel discussion was held featuring members of the media, representatives of nongovernmental organizations, and other knowledgeable people from various fields in Japan. The event was attended by an audience of approximately 240 people that included researchers and others affiliated with universities, people involved with development assistance and health organizations, representatives of NGOs, members of the media, pharmaceutical manufacturers' organizations, diplomatic corps, and international organizations. A summary of the lively discussion is presented below.

I. Keynote Speech: "Japan's International Cooperation in the Fight Against Infectious Disease"

In his keynote speech, former Prime Minister Mori spoke of Japan's experience in dealing with such infectious diseases as tuberculosis during the nation's recovery in the early postwar period. Former Prime Minister Mori also noted the role played by Japan in the eradication of polio in the western Pacific region and emphasized the initiative taken by Japan in strengthening global cooperation toward combating the three major infectious diseases (AIDS, tuberculosis, and malaria) since the G8 Summit in Okinawa last year. In a new move to strengthen cooperation on a worldwide scale, the creation of a Global Fund for AIDS and Health was announced at the G8 Summit this year in Genoa, Italy. The time is soon approaching when discussions will begin in earnest in Brussels regarding the establishment of the fund within the year. Based on the experiences of Japan, former Prime Minister Mori expressed five principles concerning the establishment of the fund: (1) Attention should be focused not only on medical treatment and caring for those stricken with illness but also on preventative measures; (2) Measures to combat AIDS should focus on Asia as well as Africa; (3) The fund should be a public-private partnership, including financial support from the private sector; (4) Countries in need should have ownership of the fund; (5) Regarding control and management of the fund, it is important to devise a framework in which full use is made of the experiences and resources of existing international organizations in order to maximize the fund's efficacy.

II. Session One: "National Responses to the epidemics:Lessons to be learned from Africa and Asian experiences"

  1. Crispus Kiyonga, Uganda's former Minister of Health, made a presentation based on Africa's experience in which he made the following points: (1) A fundamental part of combating AIDS is overcoming the stigma attached to those infected by improving education about public health and using the media to provide information; (2) In a country such as Uganda, which has an annual per-capita GDP of only about $400, anti-AIDS drugs are unlikely to spread even if the price falls from $2,000 per person annually to $1,000, and care support is difficult to provide due to the extremely frail health-care system; (3) It can be thought that the rapid increase in the use of condoms is one important reason behind the decrease in the number of people infected with the AIDS virus; (4) While joint research is taking place among universities in Uganda and foreign countries concerning the development of new tools to prevent the AIDS virus from being passed from mother to child, it is also important for this kind of developmental research to be conducted in developing countries.
  2. From Asia, Dr.Suwit Wibulpolprasert, Deputy Permanent Secretary of Thailand's Ministry of Public Health reported on the success of Thailand's campaign for 100% condom use by sex workers. Because of the high number of sexual contacts between sex workers and their clients, they are at risk of spreading the disease. The plan, aimed at underlining the importance of condom use among all sex workers, was put into effect with political leadership. As a result, there has been a substantial drop in the number of infected persons. The details of this plan were explained in an easy-to-understand and inspiring manner by Deputy Permanent Secretary Suwit. The presentation emphasized the importance of not being satisfied with the success to date but continuing to move forward in promoting the expansion of condoms use, a kind of "social vaccine," as a measure to prevent AIDS. He also expressed his concern on the importance of starting prevention program for youth.
    Next, Yoshifumi Takeda, former Director General of the National Institute of Infectious Diseases, reported on the results of Japan's international cooperation in supporting the fight against infectious disease in developing countries in Asia and elsewhere in the world. Former Director General Takeda stated that it is important for Japan not just to make financial contributions but to undertake cooperation based on the nation's experience and specialized knowledge in the fields of health and medicine.
  3. Subsequently, Hatsuhisa Takashima, Director of the United Nations Information Center in Tokyo, led the panel in a discussion. Professor Masayoshi Tarui of Keio University commented that while a "social vaccine" is important as a preventative measure, the development of a real vaccine is imperative as well, and this is a task that requires government support. Fumihiko Yoshida, editorial writer at the Asahi news paper, added that political leadership and a society that supports it are necessary, and that a commitment at a political level is needed in order to continue to keep the media focused on the issue. Kiyomichi Fujisaki, Managing Director of the Japan International Cooperation Agency's Medical Cooperation Department, stressed the importance of inclusive countermeasures that correspond to different levels of society and noted that Japan is continuing to actively make human contributions in the medical field under the Okinawa Initiative.

III. Session Two: "Mobilizing Global Responses for the Fight Against Infectious Disease"

  1. Session two was chaired by Yukio Takasu(then), Director-General of the Multilateral Cooperation Department at the Ministry of Foreign Affairs, who explained international developments concerning the establishment of the Global Fund for AIDS and Health to date, including the Kyushu-Okinawa Summit and the Okinawa International Conference on Infectious Diseases in 2000; the African Summit on HIV/AIDS, Tuberculosis, and Other Related Infectious Diseases held in Abuja, Nigeria, in April 2001; the meeting in May 2001 between U.S. President George W. Bush, United Nations Secretary General Kofi Annan, and Nigerian President Olusegun Obasanjo, at which support for the establishment of the Global Fund for AIDS and Health was announced along with the U.S. contribution of $200 million; the U.N. General Assembly Special Session on HIV/AIDS held in June 2001; and the G8 Summit held in Genoa, Italy, in July 2001. A Transitional Working Group begins discussions this month in Brussels for the purpose of setting up the fund. Director General Takasu expressed his hope that Japanese involved in this area would make clear what they expect from the fund, and that their ideas would be reflected in the Transitional Working Group.
  2. Dr. Peter Piot, UNAIDS Executive Director, made the following points in his presentation: (1) Thanks to Japanese leadership, the Kyushu-Okinawa Summit was a turning point in the global fight against AIDS and other infectious diseases; 20 years after the outbreak, the seriousness of AIDS as a global problem has been recognized and people have begun advocating the importance of large-scale countermeasures. (2) While Asia's problem is not as serious as that of sub-Saharan Africa, the region already has 7 million infected people; there are very few examples of success like Thailand's campaign for 100% use of condoms by sex workers, and the situation is serious in countries like Cambodia, where AIDS is spreading quickly; and large-scale countermeasures that involve all of society are necessary. (3) While funding is important, the key to success lies in combining courageous government policies with such measures as the spread of condoms; leadership that makes countermeasures a national priority and promotes tackling the issue at the level of local communities is indispensable. (4) It is important to fight the social stigma of AIDS, to approach problems with a focus on local communities, and for those managing various support projects to coordinate their efforts. (5) Donations to the Global Fund for AIDS and Health are coming from developing nations as well, and African nations have declared that they will move to allocate 15% of their government budgets to combating AIDS; a totally new form of ownership is being born. (6) A global approach is absolutely necessary for fighting AIDS, and further funding is indispensable. (7) A gap should not develop between the hopes and the reality of the fund, whose primary role is to serve as a catalyst. (8) The principles of the new fund involve a new partnership that includes the private sector, ownership by developing countries, and efforts to point the way to the alleviation of poverty and the protection of human security; the fund should also place a heavy emphasis on cost-effectiveness, so no new administrative structures should be created; it is important to utilize the knowledge of existing international agencies. (9) The fund should support activities at the national level, and in order to produce results it is necessary to use methods that have been proven scientifically at the national and local levels. (10) It is important to give serious consideration to economies of scale in the manufacture of products like condoms; it is also necessary to strengthen capacity building. (11) The window of opportunity will not be open for long, so it is important to act soon.
  3. Dr. Arata Kochi, Director of HIV/AIDS Care and Support at the World Health Organization, reported in detail on two programs carried out by the WHO: Roll Back Malaria and Stop Tuberculosis. What was learned in particular in the implementation of the tuberculosis program is that a fixed strategy and clear target are necessary; it is important to follow different strategies and plans in different countries; and while a new partnership that involves the private sector is important, there will be some difficulties. Concerning AIDS measures, Dr. Kochi noted the following: Political leadership is important; while prevention measures are critical, care and support are necessary as well; training and capacity building are necessary; and greater funding is needed.
  4. The final presentation was made by Crispus Kiyonga, Uganda's former Minister of Health and now Chairman of the Transitional Working Group of the Global Fund for AIDS and Health. Kiyonga noted that the number of people around the world infected with HIV stands at 62 million, a crisis situation, and explained that 35% of all deaths in sub-Saharan Africa are the result of infectious diseases. Kiyonga pointed out that, due to the failure of the market, medicine has not been making its way into the hands of the poor and also stated that the health-care systems in these countries are extremely weak. He noted the necessity of measures that correspond to a country's circumstances in nations where there is political and financial instability or conflict. Kiyonga deemed partnership to be important and stressed the need for cooperation between the Northern and Southern states, even in the field of research. In addition, Kiyonga stressed the importance of finding solutions politically to such issues as intellectual property rights to medicines, the right to force manufacturers to act on their patents, and a two-tiered pricing system for drugs.
    Regarding the Global Fund for AIDS and Health, Chairman Kiyonga stated that the Transitional Working Group must agree by December on an organization of governance, including a board , a secretariat, and other administrative bodies. It must also name a trustee, decide on the standard level of assistance to be provided to countries that qualify to receive funding, and decide on application guidelines. Kiyonga deemed it important to build on existing organizations rather than constructing a new one. Kiyonga also declared that making adjustments to the programs is critical to how they are put into effect.
  5. Following the presentations, a panel discussion was held. Chizuko Ikegami, Executive Director of Place Tokyo(community-based non-governmental organization dealing with infectious diseases), noted the necessity of considering how to support foreign residents in Japan in the event that they become infected. Regarding measures to prevent infection, Ikegami stated that it is necessary to take a broad approach, responding from the perspectives of culture and consciousness and empowering women. Professor Yasuhide Nakamura of Osaka University commented on the fund, saying that the people of developing countries, who need the support the fund will provide, and the taxpayers of donor countries should be given an explanation in plain language why it is necessary. Nakamura also pointed out that, rather than seeking quick results, steady measures, such as planning carefully integration with the systems of local communities, is important. Senior Commentator Tomoko Sakota of NHK (Japan Broadcasting Corp.) declared the necessity of considering how to respond to women in developing countries, the people that have the greatest sense of crisis regarding HIV infection. Sakota also stated the necessity of considering how best to get money from the fund to NGOs that are undertaking support activities deep in local communities.

IV. Question and Answer Session with the Audience

Based on the discussions that took place in the above two sessions, panelists of the symposium and the audience engaged in a useful question and answer session.

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