Japan's Official Development Assistance White Paper 2006
Main Text > Part I JAPAN'S OFFICIAL DEVELOPMENT ASSISTANCE FOR WORLD PEACE AND PROSPERITY > Chapter 2 Specific Activities of Japan's ODA > Section 5. Infectious Diseases
Section 5. Infectious Diseases
Threat of Infectious Disease and Countermeasures through ODA
Infectious diseases are a serious international problem that easily crosses national borders, threatening people's health and lives and having severe effects on society as a whole. The spread of infectious diseases can pose a threat to Japan as well. Japan therefore not only takes measures against the diseases domestically, but also actively assists developing countries that encounter difficulty in taking actions by themselves. For many developing countries with difficult living environment in terms of water, food or housing and with inadequate medical systems, infectious diseases present a major challenge that can hinder development efforts in these countries. For example, about 95% of the estimated 40 million AIDS patients in the world concentrate on developing countries. In Sub-Saharan Africa, HIV/AIDS-related deaths account for 20% of the total annual deaths. In addition, infectious diseases lead to the loss of human resources that shoulder the task of nation building and adversely impact all socioeconomic activities. Developed countries, including Japan, tend to regard the issue of infectious diseases as an issue of the past, but the risk of developed countries being affected by the spread of infectious diseases in developing countries cannot be ruled out. In view of these considerations, Japan places importance on promoting international actions against infectious diseases and actively supports developing countries' efforts in tackling this issue.
Major steps taken by Japan up to now include the launch of the Infectious Diseases Initiative (IDI) at 2000 G8 Kyushu-Okinawa Summit, chaired by Japan. Through this initiative, Japan extended a total amount of approximately US$5.8 billion over the five-year period between 2000 and 2004, which was a leap from the initially anticipated US$3 billion. Following IDI, in June 2005, Japan announced the Health and Development Initiative (HDI)22 which aims to provide comprehensive support for achieving health-related MDGs, including measures against infectious diseases. After the launch of HDI, in June 2005, the then Prime Minister Junichiro Koizumi pledged that Japan would provide support of up to US$5 billion over a five-year period through HDI. He also announced in June 2005 that Japan would contribute US$500 million in the coming years to the Global Fund to Fight AIDS, Tuberculosis and Malaria, thereby strengthening Japan's support for controlling infectious diseases.
Thanks to a variety of health-promotion measures taken in Japan after the Second World War, including improvements in nutrition, the use of maternal and child health handbooks and medical check-up for pregnant women, the use of school health care, construction of sanitation facilities, and expansion of community health care activities, maternal and child health improved markedly and several parasitic diseases were eradicated in Japan. Japan's ODA activities make use of these experiences and provide comprehensive support to developing countries for the development of health care systems, including human resource development, as well as in related areas such as education, water and sanitation, and infrastructure development.
Support for the Eradication of Polio
Measures against polio are cited as an example of how Japan's ODA achieved a local eradication of an infectious disease. After the eradication of smallpox, the eradication of polio has been an international goal. Despite the fact that the disease can be prevented through a low-cost vaccine, however, polio cases are still reported in developing countries where there is a shortage of the vaccine.
In order to eradicate polio, Japan provided assistance of more than US$280 million (the third-biggest amount among the G8 after the US and the UK) between 1993 and 2002, mainly for the provision of vaccines. Japan focused its support in East Asia and the western Pacific area including the Pacific island countries, channeling 35% of its total assistance into this area. This support has substantially contributed to achieving an eradication of polio in China, where the incidence of polio was the largest in the region. In its support for China, Japan organized National Immunization Days (NID), on which more than 80 million children around the country were vaccinated simultaneously. Because this NID program was highly effective in curbing infection, Japan later expanded NID as the principal countermeasure to countries where polio infection had been reported. As a result of these efforts, the World Health Organization (WHO) declared in October 2000 that polio had been eradicated in the western Pacific area. Even since that time, Japan has provided active support to the areas where polio has not been eradicated, which includes US$80 million over three years pledged at the 2003 G8 Evian Summit.
Impact of SARS (Severe Acute Respiratory Syndrome)
Japan's ODA in dealing with SARS, a disease which emerged principally in East Asia between 2002 and 2003, is an example of assistance taken against a new infectious disease.
SARS is a highly infectious disease with a 10% mortality rate, but its expansion can be prevented through appropriate measures. SARS first broke out in China's Guangdong Province in November 2002, and in March 2003, large-scale outbreaks occurred in Hong Kong and Viet Nam. The infection rapidly spread as people infected with the disease traveled to places such as Singapore and Toronto. Consequently, warnings against the SARS infection discouraged worldwide movement of people, exerting a widespread adverse impact on socioeconomic activity.
Chart I-13 Trends in the Number of People Entering and Leaving Japan Before and After the Outbreak of SARS
During the approximately eight month period up until WHO announced the interruption of SARS transmission in July 2003, SARS infected 8,439 people and killed 812, mainly in China. According to the Asian Development Bank, the economic impact of SARS on East Asia is estimated to have been US$18 billion, or 0.6% of the area's GDP. This case shows that even preventable infectious diseases pose the risk of spreading rapidly, thus causing enormous health damage and triggering economic repercussions.
Contribution of Japan's ODA to Tackle SARS
In the middle of March 2003, WHO issued a statement specifying the SARS-affected regions and an emergency travel advisory. To deal with the SARS infection, WHO recommended reporting suspected cases of infection and the quarantine of patients. The organization, in cooperation with the international community, also took actions such as preventing the spread of the infection in countries where outbreaks occurred, conducting monitoring and epidemiological surveys. However, it was concerned that an inadequate level of medical care and lack of equipment in the countries affected by SARS caused delay in these countermeasures.
In view of these difficulties in halting the spread of the SARS infection, Japan provided a total of ¥2 billion mainly in support for the provision of medical equipment and materials to China, Viet Nam, the Philippines, Mongolia, Thailand, Laos, Cambodia, Myanmar, and Indonesia. For China, where the infection was most widespread, Japan provided about ¥1.7 billion in support for the provision of equipment and materials to inland regions where the spread of the infection was most feared because of inadequate medical care systems. To bring the infection swiftly under control, Japan dispatched Expert Teams as the Japan Disaster Relief (JDR) Teams, first to Viet Nam and then to China.
A preventive measure against SARS infections in Viet Nam (Photo: JICA)
The Expert Team was dispatched to Viet Nam only four days after it had been reported that SARS-infected patients appeared in Viet Nam and that cases of secondary infection had occurred in hospitals. The Expert Team provided guidance and advice on preventing infection by exchanging views with medical personnel, holding seminars, and preparing manuals on countermeasures. The dispatch of the Expert Team at an early stage contributed to the effective containment of secondary infections in hospitals in Viet Nam.
In China, where the suffering was most serious, Japan's Expert Team worked during the six-day period beginning May 11—four days after the request from China—focusing on the Japan-China Friendship Hospital in Beijing, where the SARS patients were housed. This hospital was constructed in 1980 through grant aid by Japan and with subsequent provisions of equipment and materials and technical assistance by Japan, it is now one of China's leading general hospitals. Because this hospital was able to accommodate many patients with the infection, the Chinese Government designated it as a special SARS hospital after the infection broke out in Beijing. However, because the hospital was not specialized in infectious diseases, it lacked the required knowledge and experience to deal with SARS, so there was a need to take measures against hospital infections that had occurred at the initial stage of receiving patients. Japan's Expert Team informed medical personnel and the Beijing sanitation authorities of measures taken and disinfecting techniques used in Japan. It also held seminars to introduce measures taken against SARS in Viet Nam and to explain protection methods and criteria for diagnosing complete recovery. In addition, the Expert Team provided the hospital with protective clothing, respirators, and other equipment that it carried for its own use and gave demonstrations on their use. This swift provision of technical guidance and equipment enhanced the capacity of the Japan-China Friendship Hospital to deal with SARS and contributed substantially to promoting measures against SARS in Beijing.
Response from the Assisted Countries
The Vietnamese Government expressed its appreciation to Japan on various occasions, stating that Japan's assistance contributed to bring SARS swiftly under control. In June 2003, the Japanese ambassador to Viet Nam was presented with an honorary medal for this contribution. The Chinese Government also expressed its appreciation for Japan's support on many occasions, referring to it as the largest of all support China had received for coping with SARS. At the Japan-China Summit Meeting held in May 2003, President Hu Jintao expressed to the then Prime Minister Junichiro Koizumi his heartfelt appreciation for Japan's assistance on behalf of the people of China and his government. In addition, Foreign Minister Li Zhaoxing repeatedly expressed his appreciation to Japanese representatives at meetings such as Japan-China foreign ministers' meetings, mentioning that Japan's support for countering SARS was the most generous of all. Furthermore, upon the visit to China by JICA President Sadako Ogata in March 2006, Foreign Minister Li Zhaoxing highly praised Japan's support.
Avian and Human Pandemic Influenza
The world today faces a growing risk that avian and human pandemic influenza will further expand. The highly-pathogenic H5N1 avian influenza seems to carry the risk of spreading around the world, and if H5N1 mutates into a human one, it is pointed out that it could result in the death of several millions of people around the world. Although human-to-human transmission has not yet occurred, the poultry industry in many countries has suffered considerable losses and damages have been inflicted on employment and tourism.
In January 2006, Japan announced the contribution of US$155 million to fight avian and human pandemic influenza. As part of this contribution, Japan provided support for the stockpiling of effective anti-viral drugs and other necessary equipment for the containment of the pandemic (US$46.8 million to the Japan-ASEAN Integration Fund (JAIF) for the stockpiling 500,000 courses of anti-viral drugs and preventive equipment for 700,000 people). Japan also assisted in educating residents, strengthening monitoring, and in efforts for epidemic prevention through United Nations Children's Fund (UNICEF) and WHO; in activities by the World Bank and the Asian Development Bank; and in activities by the Office International des Epizooties (OIE) and FAO, to strengthen countries' veterinary administration, reporting systems, and preventive measures. Moreover, Japan co-hosted with WHO the Japan-WHO Joint Meeting, on Early Response to Potential Influenza Pandemic, in January 2006 to promote coordination of early response among countries. From the experience in dealing with SARS, countries must take swift and effective measures in a coordinated manner when fighting against newly emerging diseases. Japan intends to lead the efforts to tackle avian and human pandemic influenza in cooperation with partner countries and international organizations through international and other fora (see Part II, Chapter 2, Section 2 for details).