Japan’s provision of personal protective equipment (PPE) to healthcare workers engaged in COVID-19 response as part of the “Project for the Strengthening of Health Service Delivery of Integrated Health Service Network (RISS)” currently being implemented in Honduras

Sustainable Development Goal (SDG) 3 aims to “Ensure healthy lives and promote well-being for all at all ages.” In addition, achieving “universal health coverage (UHC)” Note 51 is positioned as an important global target in order to respond to various health issues, diversified across countries and regions. On the other hand, at present, it is estimated that at least half of the world’s population has no access to basic medical care, and that approximately 5 million Note 52 children under the age of five die annually due to preventable diseases. Over 295,000 women Note 53 die during and following pregnancy and childbirth per year, primarily due to the lack of emergency obstetric care provided by obstetricians, gynecologists, and/or midwives. Moreover, COVID-19 continues to have a wide range of effects on everyone on earth. COVID-19 has not only cast an unprecedented negative impact on the entire international community, but has also exposed the vulnerabilities of the current global health architecture, including the aspects of governance and finance.

At the G7 Elmau Summit in June 2022, Prime Minister Kishida introduced Japan’s COVID-19 vaccine-related support and pointed out that this pandemic highlighted the importance of UHC. At the G20 Bali Summit in November of the same year, Prime Minister Kishida stated the need to strengthen the global health architecture and the importance of achieving more resilient, equitable, and sustainable UHC. At the same time, he expressed his intention to position global health as one of the important issues to be addressed at the G7 Hiroshima Summit under the Japanese Presidency in 2023.

● Japan’s Efforts

■ Support in Response to COVID-19

In response to COVID-19, since its outbreak, Japan has provided a total of approximately 5 billion US dollars in assistance to developing countries through bilateral channels and through international organizations. In addition, in order to underpin economic and social activities in developing countries, as well as to address their financial needs, including in the health and medical sectors, Japan has established the COVID-19 Crisis Response Emergency Support Loan and has provided loans totaling over 500 billion yen to 18 countries from July 2020 to the end of December 2022.

Japan believes it is necessary not only to overcome the current pandemic, but also to strengthen health systems to prepare for future health crises, as well as to maintain an enabling international environment for health security across broader sectors. It is under these three pillars that Japan provides assistance.

In order to contain COVID-19 worldwide, it is important to ensure equitable access to safe, effective, and quality-assured vaccines, as well as to therapeutics and diagnostics in all countries and regions. Based on this idea, Japan has provided vaccine-related assistance to various countries and regions, in line with international frameworks such as the COVAX Facility (COVID-19 Vaccine Global Access Facility). Glossary

From June 2021 to December 2022, Japan provided approximately 44 million doses of vaccines to 32 countries and regions (in 2022, approximately 4.45 million doses were provided to 2 countries as bilateral donations, and approximately 4.63 million doses to 11 countries through the COVAX Facility). In the recipient countries and regions of vaccines from Japan, the major local media widely covered Japan’s assistance on television and in newspapers, and gratitude for the vaccines was expressed on social media. As part of the “Last One Mile Support” for delivering vaccines to vaccination sites, Japan provides support for improving a cold chain Note 54 system and strengthening the vaccine administration capacity of medical personnel.

In February 2022, Prime Minister Kishida announced that the Government of Japan would support one of the constituent organizations of COVAX, the Coalition for Epidemic Preparedness Innovations (CEPI), in its vaccine development and production, through a contribution of 300 million US dollars over the next five years. In April of the same year, Prime Minister Kishida attended the Gavi COVAX Advanced Market Commitment Summit 2022 in the form of a video message. He stated that the key was to ensure equitable access to vaccines in every country and region of the world and called on the international community to demonstrate its solidarity to overcome the crisis. He also announced a further contribution of up to 500 million US dollars to COVAX, in addition to the contribution of 1 billion US dollars that had already been disbursed.

In May 2022, then State Minister for Foreign Affairs Suzuki and then State Minister of Health, Labor and Welfare Sato attended the Joint Working Session of the G7 Development and Health Ministers. At the Session, State Minister Suzuki stated that, while upholding the concept of “leaving no one’s health behind,” it is necessary to revitalize the economies and societies of developing countries and to resume cross-border travel to build back better from the COVID-19 pandemic. She then announced that Japan would provide up to 100 million US dollars in assistance to this end, primarily to the Indo-Pacific region, focusing on three pillars: national vaccination data systems in developing countries, border control management with measures against infectious diseases applied, and infectious waste disposal.

“Building back better” from COVID-19 was one of the main themes at TICAD 8 Note 55 held in August as well. The “Tunis Declaration,” which was adopted as its outcome document, confirms the commitment to uphold the concept of human security, the need to build a resilient and sustainable society to achieve the SDGs, and the importance of intensifying efforts in the health sector to achieve UHC. Japan supports the implementation of a comprehensive COVID-19 response in Africa. Japan’s support includes the contribution of up to 1.5 billion US dollars in vaccine support via the COVAX Facility, the development of cold chains to safely deliver vaccines to various vaccination sites in each country, the efforts to improve aversive feelings toward vaccination, and assistance for the production, supply, and procurement of vaccines within the region.

Furthermore, Japan responds to the acute phase of COVID-19 through financial contributions to the World Health Organization (WHO) for its Health Emergencies Programme, Glossary the Contingency Fund for Emergencies (CFE), Glossary and other relevant programs.

Japan has supported building health and medical systems in developing countries for many years from various perspectives such as supporting the capacity building of healthcare workers, networking regional hospitals, and strengthening regional health systems. During the recent COVID-19 crisis, the medical facilities that Japan has supported evidently play central roles for infection control measures.

■ Formulation of Japan’s Global Health Strategy

Global health is an important issue for the international community, as it not only directly affects people’s health, but also encompasses major economic, social, and security risks. In light of various changes in the world situation, such as the spread of COVID-19, the Government of Japan formulated the “Global Health Strategy” in May 2022. The goal of the Strategy is to contribute to developing global health architecture for international health security and strengthening Prevention, Preparedness, and Response (PPR) for public health emergencies including pandemics, and to achieve more resilient, equitable, and sustainable UHC required for the post-COVID-19 era in order to embody human security. Under this Strategy, Japan promotes efforts to strengthen PPR and achieve UHC through consolidating collaboration with various stakeholders, including international organizations, public-private partnership funds, and private companies.

■ Building a Global Health Architecture that Contributes to Health Security

Based on the experience and lessons learned from the response to COVID-19, the international community takes a growing interest in strengthening PPR for future public health crises. In 2022, Japan announced a contribution of 50 million US dollars to a new fund (the Pandemic Fund) hosted by the World Bank. Furthermore, Japan provides assistance for strengthening capacities in preparedness and responses against infectious diseases in developing countries, through an additional contribution to the Health Emergency Preparedness and Response Multi-Donor Trust Fund (HEPRTF), which Japan launched in cooperation with the World Bank Group.

In addition to developing financial mechanisms, Japan actively contributes to rulemaking in the international arena. In February 2022, under WHO, the first meeting of the Intergovernmental Negotiation Body (INB) on a WHO convention, agreement or other international instrument on pandemic PPR (WHO CA+) (so-called “Pandemic Treaty”) was held, followed by three more INB meetings until the end of 2022. Japan contributes to the meetings as a member state and a Japanese delegate serves as one of the vice-chairs of INB. Japan also actively leads the discussions on the amendments to International Health Regulations (IHR), which are taking place concurrently.

■ Promotion of UHC

A woman in Nepal, who received training through Japanese assistance, sharing information on maternal and child health and nutritional improvement as a community health volunteer (Photo: WFP/ Srawan Shrestha)

Japan promotes international cooperation based on the recognition that it is necessary not only to address existing health issues that suffered a setback during the spread of COVID-19 but also to achieve more resilient, equitable, and sustainable UHC.

Japan has heretofore provided support for the health and medical care systems in countries in Southeast Asia and Africa based on the view that building a sustainable and resilient health system is crucial to controlling infectious diseases. In addition, based on various lessons learned from global pandemics such as COVID-19, Japan works to strengthen health systems including the development and networking of core medical facilities and support for human resources development in the medical field. These efforts contribute to the promotion of UHC, as well as to the PPR for public health emergencies. Japan also provides assistance in a wider range of areas to create a more resilient environment against infectious diseases, including the development of water and sanitation infrastructure such as water supply and sewage systems, and the improvement of food security. 

Japan contributes to the prevention of infectious diseases in over 15 countries by providing water purification chemicals, fuel for water trucks, personal protective equipment (PPE) for water utility personnel, and plumbing materials, as well as encouraging handwashing and conducting awareness-raising activities. JICA takes the lead in providing support for environmental improvements through supplying safe and secure water, handwashing facilities, and soaps, and also in implementing initiatives such as the “Handwashing for Health and Life Campaign” to promote proper handwashing in developing countries. 

Primary healthcare services under UHC include all services ranging from nutritional improvement, vaccination, maternal and child health, sexual and reproductive health, infectious disease control, noncommunicable disease (NCD) control, and comprehensive community care and long-term care for older persons (see “Food Security and Nutrition” regarding nutritional improvement).

Especially with regard to maternal and child health in developing countries, there are major issues still unsolved. In response to this situation, in 2022 Japan provided support in many countries including Cambodia, Laos, Bangladesh, Pakistan, Angola, Burundi, Côte d’Ivoire, Ghana, Mozambique, and Senegal to improve maternal and child health.

Furthermore, Japan carries out activities utilizing the Maternal and Child Health (MCH) Handbook as a means of improving maternal and child health, drawing on its experience and expertise. The MCH Handbook can contribute to the Continuum of Care (CoC) from pregnancy, childbirth, the post-partum period, Note 56 the neonatal period, infancy, to early childhood. It also enables mothers to acquire knowledge about health, helping them raise awareness and modify behavior. As a concrete example of this assistance, in Indonesia the MCH Handbook is widely used throughout the country as a result of Japan’s cooperation. Moreover, among the countries promoting the use of the MCH Handbook, including Cambodia, Indonesia, Laos, Timor-Leste, Papua New Guinea, Tajikistan, Kenya, and Madagascar, there are sessions organized to share their experiences and learn from each other.

Japanese NGOs also work in the area of health and medical care using the Grant Assistance for Japanese NGO Projects scheme. For example, in 2022, the NPO Rocinantes introduced compact ultrasound diagnostic equipment, helped improve water and electricity supplies for mother’s shelters, Note 57 and provided training for medical workers and community volunteers in order to improve maternal and child healthcare in Chisamba District, Zambia (see “Project Introduction Column” regarding efforts of a Japanese NGO in Honduras).

Japan works in cooperation with international organizations, such as the United Nations Population Fund (UNFPA), the International Planned Parenthood Federation (IPPF), and the World Bank, to promote maternal and child health that includes sexual and reproductive health services, aiming to thereby improve the health of a greater number of women and children. Japan also contributes to raising vaccination rates in developing countries through Gavi, the Vaccine Alliance, Glossary and bilateral cooperation (see also “Stories from the Field 7” for the active role played by Japanese UNFPA personnel).

The Asian Development Bank (ADB) positions health as one of the key priority sectors in its “Strategy 2030” and sets the following three pillars to achieve UHC in the Asia-Pacific region in cooperation with Japan: (i) building institutional framework, (ii) accelerating human resources development, and (iii) investing in infrastructures. In April 2021, Japan began contributing to the ADB’s Japan Trust Fund for the purpose of providing technical assistance and small grants to accelerate supports based on these three pillars.

In May 2022, Prime Minister Kishida held a telephone talk with WHO Director-General Tedros. They concurred on setting up a task force to materialize the establishment of a WHO UHC center in Japan. In September of the same year, Prime Minister Kishida delivered his statement at the General Debate of the 77th session of the UN General Assembly, stating that Japan would continue to take a leading role in strengthening the global health architecture and achieving UHC in the post-COVID-19 era, toward the G7 Summit under the Japanese Presidency in 2023. In the same month, Foreign Minister Hayashi co-hosted the Ministerial Meeting of the Group of Friends of UHC in New York. At the meeting, he stated that through the COVID-19 crisis, the world realized the importance of investing in health systems to enhance the foundations of resilient economies and societies. Foreign Minister Hayashi also pointed out the need to maintain and strengthen efforts to achieve UHC by making use of this momentum.

■ The Three Major Infectious Diseases (HIV/AIDS, Tuberculosis, and Malaria)

A JICA expert instructing influenza and Hand-Foot-Mouth disease (HFMD) testing techniques at the Bac Giang Centers for Disease Control in Viet Nam (Photo: JICA)

A JOCV working as a pharmacist at a private hospital in a rural area of Malawi to inspect prescriptions and manage drug inventories and orders with colleagues

SDG target 3.3 sets out to end epidemics of the three major infectious diseases by 2030. Japan makes strong efforts to support measures against them and strengthen health systems through the “Global Fund.” Note 58 From its establishment to 2022, Japan has contributed approximately 4.3 billion US dollars to the Global Fund. Furthermore, at TICAD 8 held in August 2022 and the Global Fund’s Seventh Replenishment Conference in the following month, Prime Minister Kishida announced that Japan would additionally contribute up to 1.08 billion US dollars over the next three years. In order to ensure that measures against the three major infectious diseases are carried out more effectively, Japan also implements bilateral cooperation such as enhancing health systems, community empowerment, and improving maternal and child health as a complementary support to the efforts made through the Global Fund.

As for bilateral cooperation in HIV/AIDS countermeasures, Japan provides assistance to raise awareness for preventing new infections as well as to promote testing and counseling. Primarily in Africa, in 2022, Japan Overseas Cooperation Volunteers (JOCVs) continued to engage vigorously in deepening people’s knowledge and understanding of HIV/AIDS prevention and providing care and support to people living with HIV/AIDS.

With regard to tuberculosis, Japan engages in reducing the annual number of deaths from tuberculosis in developing countries, particularly in Asia and Africa, in accordance with the “Stop TB Japan Action Plan,” revised in 2021. As an interim goal by 2025, Japan aims to achieve a 75% reduction in deaths from tuberculosis (compared to 2015) and a 50% reduction in tuberculosis incidence (compared to 2015; less than 55 cases per 100,000 people) through a public-private partnership, drawing on Japan’s own experience and technology cultivated through its struggle against tuberculosis.

In respect of malaria, one of the major causes of infant mortality, Japan supports the effort to strengthen local communities in Myanmar and Solomon Islands as anti-malaria countermeasures. Through contributions to the Global Fund, Japan also takes measures against malaria on a worldwide level.

Six African Countries Note 1 and Four Asian Countries Note 2Public nomination

Infectious Disease Control Measures through Partnership between an International Organization and Japanese Companies
Sustainable Technology Promotion Platform (STePP) Demonstration Project to Transfer Japanese Technologies and Products to Developing Countries to Limit the Impact of COVID-19 Note 3
Contributions and Subscriptions to International Organizations (Supplementary Budget) (November 2020 – December 2022)

In 2020, with the widespread threat of COVID-19, secondary infections spread at medical care institutions in developing countries in Africa and Asia because of outdated healthcare and medical technologies as well as insufficient hygiene awareness.

The United Nations Industrial Development Organization Investment and Technology Promotion Office in Tokyo (UNIDO ITPO Tokyo), with the financial contribution of the Ministry of Foreign Affairs of Japan, launched a project to transfer Japanese technologies that would contribute to infectious disease mitigation in developing countries. 12 Japanese companies were selected for the project from among those registered with the Sustainable Technology Promotion Platform (STePP) operated by UNIDO ITPO Tokyo.Note 4

The project was implemented in 10 countries in Africa and Asia, and the selected companies transferred their technologies for the needs of each country such as disinfectant fabrication, antibacterial coating, and medical testing equipment. Initially, the companies planned to send Japanese engineers to the countries, but the spread of COVID-19 infections in each country made travel difficult. Therefore, the Japanese companies sought alternative ways to carry out their efforts by sending the relevant equipment to the cooperation sites and providing technical training online.

In Kenya, medical waste had become a source of infection as it was not properly handled and disposed of. In response to this situation, technical assistance guided the installation and trial operation of a medical waste incinerator at a medical facility via online technical training and workshops. As a result, it became possible to properly incinerate all of the medical waste generated at the medical facility, which is around one ton every week. In Viet Nam, a total of eight sets of water-purifying equipment were installed at a medical facility and a food-processing factory that had hygiene management problems. Technical guidance was provided remotely concerning the maintenance, management, and operation of the equipment. It led to the improvement of hygiene conditions for 220,000 employees and hospital patients, and 100,000 consumers.

This project led to the new discovery that Japanese technologies could contribute to mitigating the impact of infectious diseases in developing countries and that they could be transferred remotely. Based on this experience, UNIDO promotes its partnership with Japanese companies and supports their overseas expansion.

The hospital in Nairobi, Kenya that introduced a medical waste incinerator from KINSEI SANGYO CO., Ltd., of Japan. The incinerator made it possible to dispose of all the medical waste generated at the facility. (Photo: UNIDO ITPO Tokyo)

Members of AGC Inc. holding an online meeting with staff members of a medical facility in Viet Nam for the installation of water-purifying equipment (Photo: UNIDO ITPO Tokyo)

Note 1: Kenya, Madagascar, Morocco, Nigeria, Senegal, and Uganda

Note 2: India, Indonesia, Mongolia, and Viet Nam

Note 3: See below for the details of this project.
http://www.unido.or.jp/en/activities/technology_transfer/stepp-demo-results/

Note 4: A platform designed to introduce excellent Japanese technologies to developing and emerging countries. The platform broadly showcases Japanese technologies and knowhow that contribute to inclusive and sustainable industrial development through its website, exhibitions, and programs for inviting officials from developing countries who specialize in investment promotion. As of December 2022, 135 technologies from 117 companies are registered on the platform.

■ Responding to Anti-Microbial Resistance (AMR)

Anti-microbial Resistance (AMR) Note 59 is a serious threat to public health, and in recent years, countermeasures against AMR have gained momentum. In order to advance measures against AMR, Japan promotes the “One Health Approach,” which aims to link, across sectors, those engaged in the field of sanitation concerning humans, animals, and the environment. Based on the agreement at the G20 Osaka Summit in 2019 on promoting the “One Health Approach,” Japan announced that it would contribute approximately 1 billion yen to the Global Antibiotic Research & Development Partnership (GARDP), which promotes research and development for new antibiotics and diagnosis development. Japan takes the lead in tackling AMR, including through participation in the Global Leaders Group on Antimicrobial Resistance. In 2022, Japan contributed approximately 200 million yen to GARDP.

■ Neglected Tropical Diseases (NTDs)

Medical workers publicizing mass drug administration to control Filariasis in East New Britain Province, Papua New Guinea (Photo: JICA)

Parasitic and bacterial infections, such as Chagas disease, Filariasis, and Schistosomiasis, are known as “neglected tropical diseases (NTDs).” More than 1 billion people worldwide are infected with NTDs, causing major socio-economic losses to developing countries. Japan contributed a total of 14.3 billion yen to the Global Health Innovative Technology (GHIT) Fund by 2022 and provided support for countermeasures against NTDs through GHIT. In addition, Japan signed “the Kigali Declaration on neglected tropical diseases (NTDs)” in June 2022, and cooperates closely with the relevant countries and international organizations on countermeasures against NTDs.

Furthermore, Japan has provided support against Lymphatic Filariasis for Pacific Island countries through technical cooperation since the 1970s. The “Project for Elimination of Lymphatic Filariasis in the Pacific Region” supports mass drug administration of anthelmintics to stop transmissions in infected areas via public-private partnership, dispatching Japanese experts to provide technical instructions, and utilizing drugs provided to WHO free of charge by the Japanese pharmaceutical company Eisai Co., Ltd. This long-term support from Japan has proved successful, with 9 of 14 Pacific Island countries (Cook Islands, Kiribati, Marshall Islands, Nauru, Niue, Palau, Solomon Islands, Tonga, and Vanuatu) having eliminated Lymphatic Filariasis. Through the dispatch of experts and other means, Japan will continue to support the elimination of Lymphatic Filariasis in Pacific Island countries.

■ Polio

Polio is on the brink of eradication. Japan, mainly in cooperation with UNICEF and Gavi, provides support toward its eradication with a focus on countries where cases of infection are still being identified (polio-endemic countries: Afghanistan and Pakistan). During 2022, in Afghanistan, Japan provided support for routine immunization activities and the procurement of vaccines necessary for polio vaccination campaigns in cooperation with UNICEF.

1. Note 51: The concept that all people have access to effective and quality-assured health services at affordable costs without financial hardship.
2. Note 52: According to the United Nations Children’s Fund (UNICEF) survey (as of 2020). The previous total was over 5.2 million children.
3. Note 53: According to the World Health Organization (WHO) survey (as of 2017). The previous total was over 303,000 women.
4. Note 54: A mechanism to deliver products to their destination while maintaining low temperatures. This allows the quality of medical goods such as vaccines to be preserved.
5. Note 55: See “ODA Topics.”
6. Note 56: The period after childbirth in which women recover to a similar condition before pregnancy, usually around one to two months after birth.
7. Note 57: A facility that accommodates expectant mothers who are about to give birth until the delivery date or time.
8. Note 58: Public-Private Partnership established in 2002, led by the discussion held at the G8 Kyushu-Okinawa Summit in 2000 when infectious diseases control was set as a major discussion topic for the first time. It contributes to efforts to achieve the SDGs by providing financial cooperation for measures against the three major infectious diseases (AIDS, tuberculosis, and malaria) and strengthening health systems in developing countries.
9. Note 59: Pathogenic microorganisms, including bacteria and viruses, gaining resistance to antimicrobials such as antibiotics and antiviral drugs, which causes the drugs to lose sufficient efficacy.

Main Text | Reference Statistics | Appendix | Stories from the Field | Master Techniques from Japan to the World | ODA Topics