Japan is a global leader when it comes to affordable health care — providing access to advanced medical care at a lower cost compared with most developed countries.
Yet with a declining and aging population, the country has been dealing with a train wreck in slow motion — a problem it has grappled with for decades, but has yet to come up with a viable solution for. It is a problem that many other Asian nations could face in the near future.
Compounding Japan’s problems in its health care system is a hidebound bureaucracy that was criticized during the pandemic for its inward-looking, analog ways — issues that health minister Keizo Takemi is quick to point out. In a recent interview, Takemi sat down with The Japan Times to talk about his vision of digitalizing Japan’s health care system, as well as sharing the country’s medical know-how with other Asian nations.
The following is an excerpt, which has been edited for clarity:
You have been promoting the Asia Health and Wellbeing Initiative to export the Japanese health care system to the region. What is the aim of this initiative?
At the core of this initiative is a global perspective. Japan has been the world's most advanced aging society, but now aging is accelerating worldwide. The situation is particularly dire in Asia.
In 2050, nearly 70% of all people age 65 or older will live in the Indo-Pacific region. With that, common diseases in those countries will change, with non-communicable diseases including cancer, heart attacks, strokes and respiratory diseases posing a more serious threat rather than infectious diseases. In several countries in Asia, the elderly population will increase before their societies become wealthy enough for universal health coverage to be achieved and the medical care delivery system like that of developed countries is properly established.
This increase in the elderly population is expected to create a widening health disparity in Asia. Japan, as a mature nation that is one of the most advanced aging societies in the world and a major industrialized country with universal health care and nursing care, should take a leading role in curbing the health disparities in the Indo-Pacific.
What are the immediate challenges for Japan’s health care in the post-pandemic world?
Japan’s health and labor authorities have focused mainly on domestic health care policies. However, it’s clear that international strategies and domestic health care system reform are inextricably linked.
For example, during the COVID-19 pandemic, the digitalization of our country's health care delivery system was very slow, and we did not have an electronic system that allowed us to grasp the number of patients testing positive for the coronavirus on a real-time basis. Also, the medical information system for each medical institution was tailor-made by their vendor, and there was no system, or a nationwide platform, to link the data held by medical institutions.
The public became well aware that the lack of such a system would be a major obstacle during crisis management of infectious diseases, such as pandemics. This created momentum for promoting digitalization. Medical DX (digital transformation) came to be recognized as the first item on the health care reform agenda in the post-COVID era.
But when there’s a pandemic it is not enough to have a system that just shares information domestically. A monitoring system for infectious diseases can only be established with the constant monitoring of overseas trends. It is essential to incorporate international perspectives in the digitalization of our medical care system.
Secondly, unfortunately, Japan was not able to produce a vaccine against the coronavirus (during the pandemic). Although Daiichi-Sankyo finally produced an mRNA-type vaccine and obtained regulatory approval, it was very late in the game. Japan needs to strengthen its drug discovery infrastructure, not only for vaccines but also for oral medication. The ecosystem includes everything from basic research and the creation of startups to clinical trials to mass production — and all the way through the regulatory approval and delivery of the drug to people who need it.
The U.S. is the only country in the world that can complete all of this within the country.
Why has Japan’s pharmaceutical industry fallen behind?
Until around 2000, Japan produced about 8% to 9% of the world's new drugs and made good medicines using small molecule compounds. But since the beginning of the 21st century, the mainstream for drug development has shifted from such small molecule compounds to drugs using biotechnology. Japan has not been successful in shifting the drug development infrastructure, which requires significant investment.
That is the reason why Japan fell behind others in the development of mRNA vaccines. Moreover, major drugmaker Takeda moved its major research base to Boston, gathering talent from the world over to strengthen the capacity of its laboratory. Drugmakers are trying to survive as individual companies by participating in the U.S. ecosystem. I hear Astellas is also expanding into California.
If major Japanese drugmakers continue to be integrated into the U.S. ecosystem, the domestic infrastructure for drug discovery could be reduced to a skeleton. On the other hand, the research and development capabilities of Japanese academia have great potential in terms of coming up with the seeds of drug discovery. (Immunology) researchers such as Dr. Shuzo Kishimoto of Osaka University have made great contributions to drug discovery in the world, and many people around them can conduct important research and development in the future.
However, until now, a mechanism in Japan to provide funding for such basic research tied to the discovery of specific drugs has been lacking. Also, venture capital related to drug discovery has not been developed on a large scale in Japan. Japan has no mechanism to connect startups to the market.
The Cabinet Secretariat has established the Office of Healthcare Policy, which is now planning a public-private conference to establish a mechanism to strengthen the foundation for drug discovery. The Health, Labor and Welfare Ministry is also cooperating.
How do you assess the state of the current health care system in Japan?
Of all the new drugs around the world, which include medication for rare diseases, I think about 60% of them have not seen an application filed for drug approval in Japan. If this situation continues, medical advances will be out of reach in the country. This means the quality of medical care provided in Japan will gradually decline compared to that of the most advanced countries.
Drugmakers that had supported the medical advances in Japan are now less capable of developing new drugs than in the past, and they are taking their main research institutes elsewhere to revive their business. So, if Japan is to survive as a country that manufactures the world's most advanced pharmaceuticals, it must strengthen its domestic infrastructure once again, and establish a system that allows domestic pharmaceutical companies to collaborate not only with domestic firms but also with global players, so that the Japanese people will be able to access the fruits of their efforts.
In order to establish such a system, the government must of course raise a considerable amount of funds, but it is also necessary to raise funds from the private sector and to ensure that money is channeled into areas that, from the conventional perspective of drug discovery, would be called "risk money.”
Prime Minister Fumio Kishida has announced the establishment of a public-private liaison council to discuss how to create such a system. It is clear from these examples that international strategies and domestic policies are inextricably linked. Therefore, I recently established the International Strategy Headquarters in the health ministry under my leadership, and I gave a big order to establish a system within the ministry to draw up domestic policies and international strategies in an inextricably linked manner.
The other important thing is controlling cutting-edge technology in Japan for crisis management. Japan has not been able to do this.
However, to prepare for future pandemics, it is necessary to establish a top commander position in charge of infectious disease management. The Cabinet Secretariat has created the Cabinet Agency for Infectious Disease Crisis Management Management Agency, which is responsible for making the highest-level political decisions. The administrative side of it will be handled by a new entity called the Japan Institute for Health Security. We call it JIHS. It will be created through the merger of the National Institute of Infectious Diseases and the National Center for Global Health and Medicine. The person to lead the new institute will be decided this fall, followed by other personnel decisions, and it will be inaugurated on April 1 next year.
As I mentioned earlier, a disease monitoring system cannot function without overseas cooperation, so the core language will be English as well as Japanese. For example, in Japan, the language used for local medical care is Japanese, so information must be collected in that language, but unless that language is translated into English and information is shared with foreign countries, it will not be possible to collaborate with overseas agencies. Furthermore, Japan has to play a (leadership) role in (discussions on) international health regulations, so this new organization will play that role.
Let’s ask about your role in all of this. The name "Takemi" carries a special meaning in the Japanese medical community because of your father Taro Takemi, who was an outspoken president of the Japan Medical Association for 25 years. Yet, you are not a medical doctor yourself.
I am a scholar of international politics.
At the same time, you have long been involved in the area of global health. Do you think your unique career has helped you form policy as a health minister and a member of the government?
It has helped tremendously. My father was surprisingly loving toward his children. In 1970, when I was in high school or college, my father led a massive strike, where tens of thousands of doctors in private practice refused to provide insured health care (to protest the government’s health care reform). I had many opportunities to hear from him about the background behind such actions and about health care policy in general. At the same time, just before he died, my father donated to Harvard University and created the Takemi Program in International Health. Because he died just after the program was established, I was tasked with the actual follow-up work of the program over 40 years. It held international seminars, where extremely talented researchers from all over the world gathered for a year and published their research results. I was always in and out of such places, sometimes working with the researchers on various projects, so this helped me to deepen my understanding of global health issues.
I also spent two years in Boston as a Takemi fellow under the program after I lost my Upper House seat in 2007. I did a comparative analysis of health care systems and acquired knowledge and analytical methods from an international perspective. In around 2007, the Japanese health care system was still largely unknown in the world, so I made a presentation on it in English at various conferences. Many people took an interest, and Richard Horton of The Lancet asked me to help him produce a special issue on Japan. Dr. Kenji Shibuya, who was then at the University of Tokyo, took the lead in this project. Such an experience proved useful when I became a member of the Upper House again and then the health minister.
My appointment as health minister was very timely, too, as the pandemic phase of COVID-19 had just come to a close. Various issues had come to light and it was time to resolve them properly. In that sense, I think I was very lucky. I would not have been able to utilize my knowledge had I become the minister in the middle of a pandemic.
Do you think your identity as an international politics scholar has also helped promote the Asia Health and Wellbeing Initiative?
Yes. Population theory has always been a fundamental part of the field of international politics, and presents a perspective through which we look at international society. It is also closely related to the structure of diseases in society. I had read many research studies in this field.
Changing the subject, according to the latest estimate, the number of people with dementia in Japan will rise to nearly 6 million by 2040. How do you think the government and the ministry should respond to this?
First of all, the immediate and pressing issue is how to establish a system that can provide stable care services necessary for people with the disease. Japan has had a nursing care insurance system since 2000, under which the burden and benefits are balanced well, and it has been able to provide the public with very unique nursing care services to date. In particular, support services to ensure the independent living of people have contributed considerably to the extension of healthy life expectancy in Japan.
The problem is that the increase in the population of elderly people is increasing the cost of insurance. Insurance premiums are steadily getting higher, and we need to rethink how we should bear the burden. I think there are several ways to deal with this situation.
First, digitalization needs to be more actively incorporated into nursing care. Wearable devices, such as smartwatches and smart rings, can measure health indicators including blood levels. As the accuracy of these indicators becomes higher, we can use the newly developed AI to notify people when abnormal values are detected, and at the same time send the information to their family doctor or hospital that has been registered in advance. This way, the patient would be able to know in real time what kind of initial measures to take when abnormal values are found, and receive diagnosis and treatment more promptly.
Now, people with dementia can also wear the wearable device. Some of them wander around at night or even during the daytime, but it will be possible to not only manage their health but also to identify their location. That way, we can provide higher-quality care services, using wearable devices, without the need for human intervention. This is something we will have to do within the next four or five years. I think the pace of progress in this field will be very fast.
Another thing is to raise the wages of those who are engaged in this kind of care work and ensure a certain level of economic security for them.
And the third is foreign workers. We need to secure high-quality labor from overseas and have them acquire qualifications at domestic nursing care schools so they can engage in nursing care services in Japan.
How many foreign care providers do you think Japan needs to accept?
This depends on the overall balance. For example, if the digitalization of nursing care progresses rapidly, the number of staff needed at nursing homes may become smaller. With our efforts to raise wages and make workplaces more attractive, we should be able to procure a certain number of nursing care workers in Japan. However, we still need to secure workers from overseas to fill the shortage, and I think it is necessary to create a strategy that effectively combines these three. This is not a domestic-only matter. A mechanism to attract high-quality labor from overseas needs to be created. Domestic policies and international strategies are closely and inseparably linked in this area as well.
Recently, functional foods have come under heavy scrutiny, with Kobayashi Pharmaceutical’s beni kōji red yeast rice supplements linked to the death of some 80 people. The Consumer Affairs Agency is primarily responsible for handling the issue, but do you think the health ministry should be more actively engaged as a ministry that safeguards people’s health?
The health ministry is dealing with this issue in the context of the Food Sanitation Act. In addition, we are cooperating with investigations to determine whether or not a causal relationship exists between the food product and a specific disease, and which ingredients are responsible for such a relationship. Research institutes affiliated with the ministry can conduct animal experiments to investigate the cause and mechanism of renal disease, for example, so we have certainly played a role in this area.
The health ministry deals with a huge variety of issues: Pandemics, beni kōji and host clubs. You recently met with representatives of groups trying to support women who have fallen prey to unscrupulous hosts.
I actually met women who were victimized by hosts and their family. I thought it was outrageous that these men make a business out of shaking people's hearts and minds like that.
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