At this HGPI Seminar, Health and Global Policy Institute (HGPI) Chairman Dr. Kiyoshi Kurokawa  gave his annual New Year’s presentation. This year’s presentation was entitled “New Vision for 2021” and the first time for the presentation to be given online. The event was held in a one-on-one interview format and also feature HGPI Board Member and CEO Mr. Ryoji Noritake.

We looked back on 2020, explored how the world will change in 2021, examined what position we should take in the future, and discussed the role that HGPI should play as a think tank and how we should contribute to society as the global situation continues to change. We developed the conversation on these topics through the interview with Dr. Kurokawa and through questions from the audience.

■Speaker
Dr. Kiyoshi Kurokawa (Chairman, Health and Global Policy Institute)

Listener
Mr. Ryoji Noritake (CEO and Board Member, Health and Global Policy Institute)

■Date & Time
Wednesday, January 20, 2021, 12:00-13:30

■Venue
Zoom Webinar

 

■Event Report

Noritake: At this Seminar, HGPI Chairman Kiyoshi Kurokawa and I would like to take a look back on 2020 and discuss prospects for 2021. HGPI engaged in efforts for several issues in 2020, including innovation and sustainability in the healthcare system, antimicrobial resistance (AMR), mental health, vaccines, and women’s health. In each project, we have brought together multi-stakeholders from industry, government, academia, and civil society to deepen discussions, build consensus, and present policy recommendations. In 2021, we would like to present an even broader range of policy proposals. Up until now, we have visited Diet members and related parties at each Ministry and have held non-partisan Diet member study sessions. Moving forward, instead of ending our efforts with the presentation of a policy proposal, we will take action to see our recommendations implemented.

Make the decision-making process for COVID-19 measures clear
Noritake: Looking back on 2020, it was truly a year of major, once-in-a-century changes.

Kurokawa: Everything comes back to Coronavirus Disease 2019 (COVID-19), doesn’t it? At first, I thought that the response to the COVID-19 outbreak in Wuhan was surprisingly speedy, and expected the next positive case to be someone who entered the Korean Peninsula or Japan by plane. At the time, however, a cruise ship called the Diamond Princess was in port. I see that as the beginning of the unexpected.

Noritake: At the time, it was unfortunate that some people had a field day criticizing the measures being taken. I felt that the situation also showed that healthcare professionals need to improve their communication skills, including when talking to the mass media.

Kurokawa: To get a sense of how people felt about it, I think it is important to look at how information is conveyed in Japan’s mass media, like newspapers and television, as well as how the Government communicates, such as in notices the Prime Minister’s Office. In my opinion, right now in Japan, the parties people in positions of power listen to and the processes by which they make decisions are extremely vague. During the COVID-19 pandemic, as well, I feel that the processes by which the people who generated recommendations held discussions and presented their proposals to decision-makers were lacking. Many people probably felt like something was missing.

Noritake: Many study groups and expert committees were established by the Government to control the spread of COVID-19 after the Diamond Princess response. Dr. Kurokawa, you also joined those efforts, serving as the chair of the AI Advisory Board established by the Cabinet Office. What are your thoughts on Japan’s COVID-19 measures?

Kurokawa: First, I think it was a good decision to promptly appoint a new Minister to be in charge of the Government’s COVID-19 response. Communication from then-Prime Minister Shinzo Abe was good, but the decision-making process was unclear. However, Japan’s COVID-19 control measures maintained a low mortality rate and have gained a certain amount of recognition from abroad.
COVID-19 spread around the world in the blink of an eye, but in the modern era, anyone can access information on how each country is responding using the Internet. That is why I think that the Government should actively adopt and test best practices from abroad when such practices are identified. Each decision should be made after gathering sufficient information. While every country’s abilities are being tested, the fact that everyone can share information makes the situation completely different from pandemics in the past.

Noritake: Yes, the major difference from the Spanish flu 100 years ago is the amount of information and connectivity. I think there are many things Japan can learn from COVID-19 measures taken by countries like Taiwan.

Kurokawa: I agree. National leaders also made noteworthy efforts to disseminate information. One of the most highly recognized was German Chancellor Angela Merkel. The fact that her speeches were immediately translated from German into English and three other languages and publicized was strategically excellent. In an emergency like a pandemic, it is that important for leaders to receive science-based advice and show responsibility by communicating their opinions.
Japan has been criticized for conducting few PCR tests, but the number of tests conducted was limited because of the decision to manage PCR testing at public health centers instead of hospitals and clinics. However, that does not mean that we should try to force leaders to take responsibility. Instead, it is important we learn from the decisions made in each situation. It is important to hold more open discussions and make sure to always present multiple options in a clear manner before top officials such as Ministers make decisions, and to have a process to adapt those decisions to each situation as necessary. I believe the reason why society grew dissatisfied with Japan’s COVID-19 response and that there was so much criticism was because the discussion process was difficult to see.

The unique “vertical society” in Japan and digital transformation
Noritake: What division of roles should there be between science and politics?

Kurokawa: Politicians are the ones responsible for making decisions. However, recommendations based on scientific data are not a binary choice between zero and one. They are a matter of probability. We must remember that they may be wrong. Therefore, instead of being afraid of mistakes, it is important to correct them immediately. It is only when we correct our mistakes that we gain wisdom. I think that in the past, the Japanese way of doing things has lacked this kind of culture.

Noritake: Another issue is growing workloads and busier schedules for people in the central Government. HGPI would like to make a proposal or implement a project for work style reform in Kasumigaseki in the future.
Looking at countries where measures to control COVID-19 have been effective, like Taiwan and Singapore, we see that they have well-developed data health platforms. Japan, on the other hand, is lagging behind in the field of digital health, as we saw during the COVID-19 pandemic.

Kurokawa: Of course, digitalization is necessary, but even systems like the My Number system are still not easy for the general public to use. I question if there are any serious plans for digitalization across all Ministries and agencies. Rather than having one Ministry be responsible for digitalization, the Government should take the lead and promote digitalization as a national initiative while referring to examples from other countries that have already done so.

Noritake: One major challenge facing digital health in Japan is the lack of individualized healthcare records. Currently, there is no central management of vaccination data, for example.

Kurokawa: Major advances have been made in digital technology over the past 30 years. People are now able to connect online, broadcast their opinions to the world, and demonstrate their abilities in a manner that transcends national borders. Rules and policies must be premised on these facts. The digital transformation has been underway since the 1990s and the vertical structuring of society has already ended on a global scale. It would be a shame if Japan’s unique vertical society and culture of assumption (in which people guess or assume what others are saying when communicating on the individual level) acted to prevent cross-ministry discussions and responses.

Japan’s vaccine policy and the ideal structure of the healthcare system
Noritake: Japan is also behind in vaccine development, including for COVID-19. HGPI is also working on proposals for vaccine policy, so I hope everyone will keep an eye out for them.

Kurokawa: Unlike other industries, the pharmaceutical industry requires vast sums of money for development, such as for clinical trials on research subjects, and the industry is being consolidated into a few global mega-companies through continuous mergers and acquisitions. There is no need for Japanese pharmaceutical companies to limit themselves to the domestic market. To compete, they must make proactive steps to grow into global companies. In addition to that, we need policies to boost the things that are truly needed.

Noritake: The growing number of people with COVID-19 has created a tight situation regarding the number of hospital care beds, including those in private hospitals. I think we should’ve been working on restructuring the healthcare system before the pandemic. Please share your opinion on future issues that must be addressed for this topic.

Kurokawa: While Japan has more hospitals per capita than any other developed country, the number of physicians per hospital is very low. We have to recognize that university hospitals providing advanced medical care play different roles from local clinics and rethink how the hospital system should be in Japan. It is important that we take the COVID-19 pandemic as an opportunity to consider the issue in terms of a larger framework.

Noritake: It may be important to discuss revising the Infectious Diseases Control Act, but I think we require a grand vision of how to redesign the healthcare provision system. In this era of population aging and chronic diseases, how must we transform the healthcare provision system moving forward?

Kurokawa: Tracing the roots of Japan’s medical system, it is said that Japan modeled its healthcare system on the one used in the U.K. when Japan opened up at the beginning of the Meiji Era. After World War II, the system was remodeled after the U.S. system, which I feel created some discrepancies in the system overall. Furthermore, Japan’s unique situation surrounding “free access” has become a major issue that must be addressed. This situation reaffirms my belief that we should use COVID-19 as a starting point to think about how hospitals should be.

Noritake: In the future, HGPI would also like to generate recommendations on issues related to the healthcare provision system. The COVID-19 pandemic has revealed areas for improvement in Japan, and I feel we are reaching a major turning point where we can turn danger into opportunity.

Kurokawa: I agree. I think it will be important to make a gradual transition while charting a course and keeping the ideal structure of healthcare in mind.

Global trends in 2021 and the role of HGPI
Noritake: Here is a question on prospects for 2021 from a member of the audience. A new Prime Minister has been appointed in Japan, President Biden has been inaugurated in the U.S., and Chancellor Merkel of Germany has announced her retirement. With this shuffle in national leaders, 2021 is likely to become a key year for geopolitics. Dr. Kurokawa, what global trends do you foresee for 2021?

Kurokawa: As we can see from China’s successful COVID-19 response in Wuhan led by President Xi Jinping, and from China’s growing economy, China is one of the most important countries for Japan. We should avoid confrontations that will worsen relations between China and Japan in the future. I would like it if we took a broader perspective to work towards a sustainable, healthy society for all. However, national frameworks will inevitably become a hurdle.
In that regard, HGPI is an independent think tank and has the ability to communicate. We have been ranked among The Global Go-To Think Tanks by the University of Pennsylvania for eleven consecutive years. In 2019, we were ranked 2nd in Domestic Health Policy and 3rd in Global Health Policy.
(The “2020 Global Go To Think Tank Index Report” was presented on January 28, 2021, after this seminar. HGPI was included for the 12th consecutive year and was once again ranked 2nd in Domestic Health Policy and 3rd in Global Health Policy. For more information, please click here.)
For example, people age 65 and over currently make up more than 28% of Japan’s total population. In our long-lived society, dementia is attracting a great deal of attention as a policy issue, so I think we must continue to address dementia as part of our 2021 agenda. Japan will have the important role of demonstrating to the world how an aging society should be.
I was appointed a member of the World Dementia Council (WDC), which was established following the G8 Dementia Summit in December 2013, and HGPI has been able to participate in highly significant activities such as joint research, opinion exchanges, and collaboration. Japan should also actively engage in global movements like this one.

Noritake: HGPI has published various proposals on the situation surrounding population aging in society, including on dementia. The concepts of “dementia-friendly” and “age-friendly” are spreading globally. Rather than limiting discussions to policies for helping elderly people confined to hospitals and long-term care facilities, I think it will be important to deepen multi-sectoral discussions on creating a society of healthy aging as a whole. I also have high expectations for industries outside of healthcare.

Kurokawa: “Dementiehuis” (Dementia House) in the Netherlands is one example of a highly innovative initiative. I think overseas examples like that can be good references.

Noritake: It is important we create a society in which people with dementia can lead normal lives, a concept called the “normalization of diseases.” HGPI is also working to develop policy proposals under that concept together with people living with non-communicable diseases (NCDs).

Systems of governance needed by universities and organizations in Japan
Noritake: We have also received a question on the importance of medical education. Right now, out of compliance with COVID-19 countermeasures, practical training within medical education cannot be conducted. Including that, what kind of medical education will be necessary in the future?

Kurokawa: First of all, Japanese universities usually elect deans by taking a vote of professors and other faculty members. This is an unusual practice that is unique to Japan. Thinking of one of the presidents I admire most, former president of Yale University Richard C. Levin, and comparing universities in Japan to those in the U.S., I am left with the impression that governance at Japanese universities is not as effective. One problem with Japanese organizations as well as universities is that there is little mentality toward dismissing those in top positions. When it is determined that a top administrator is not fulfilling their responsibilities, failing to dismiss them will ruin the organization itself.

Noritake: Speaking of developing leadership, Japan has been criticized for not producing many global leaders. Opportunities for leadership education are insufficient in Japanese companies. Looking at global companies, we see they have young leaders who have been blessed with a wealth of experience. They are being appointed regional managers of countries by their late 30s and are placed in charge of diverse teams. Some people are concerned that if this trend continues, Japanese companies will not be able to attract young talent from overseas.

Kurokawa: While leaders must be responsible for their organizations, organizations must ensure their leaders are fulfilling their responsibilities. I also think that leaders need to have the experience of taking responsibility for making various decisions from a young age. For the past three decades, Japan’s GDP has not grown in real terms. As the national debt continues to grow, what can we leave behind for the next generation? This is a crucial theme. I would like for HGPI to help Japan contribute by analyzing the situation in Japan and overseas and sharing what we find with the world.

Noritake: HGPI is operated with support from highly-skilled young staff, and I would like to continue making HGPI an organization that is attractive to young people. Next is a personal question for Dr. Kurokawa: Why are you so energetic, Dr. Kurokawa? If you have a morning routine, please tell us what it is.

Kurokawa: Not in particular. The only thing I really pay attention to is keeping my carbohydrate intake low. Generally, I think it’s okay to have one serving per day.

We want to help the next generation find their calling.
Noritake: Dr. Kurokawa, if you have any personal themes for 2021, please share them with us.

Kurokawa: This year, I think I will be supporting more university students who have decided what they want to do with their lives, like with Mr. Kobayashi (Mr. Ryosuke Kobayashi, CEO, HLAB) when he created HLAB. It is important to nurture the next generation. When people in Japan are in their third year of university, they tend to focus only on finding a job. I want to give them earlier opportunities to find their true callings. This reinforces my belief that when people go abroad, they can start to see Japan’s weaknesses, which then helps them develop a healthy sense of patriotism and the desire to improve the country. I think it is very important to know your country well.

Noritake: I think that is also important to avoid falling into narrow-minded nationalism. The authority of the Government is being reexamined due to the effects of COVID-19 and I think it is important to break away from nationalism and adopt a global perspective. Now, we have received another question. “What books have you read recently that you recommend?”

Kurokawa: There have been several, but I can’t remember the titles off the top of my head.

Noritake: In that case, we will share those with everyone at a later date. By the way, I would like to recommend Limits to Medicine: Medical Nemesis, the Expropriation of Health by Ivan Ilyich, a medical sociologist. It is a book that points out that the medical system itself may be a source of disease. With more talk on the rise of the social distancing police due to COVID-19, I feel that is a concept we should reconsider from the perspectives of medical sociology and medical anthropology.

Kurokawa: Recently, it seems that young Japanese people tend to avoid studying abroad, but I still think it is beneficial to go abroad to develop a healthy sense of patriotism. I tell students, “You don’t necessarily have to return to Japan, because you will stay Japanese for the rest of your life.” Charles William Eliot, who served as president of Harvard University for 40 years starting in the late 1800s, said that the purpose of a university is to help students find their true callings. I agree.

Noritake: I believe one reason HGPI is evaluated so highly by the University of Pennsylvania in its ranking of global think tanks is because of its effective operations as a non-profit. We kindly request everyone’s continued support in 2021.

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■ Profile
Dr. Kiyoshi Kurokawa (Chairman, Health and Global Policy Institute)
Dr. Kiyoshi Kurokawa is a professor emeritus at the National Graduate Institute for Policy Studies (GRIPS), Member of World Dementia Council (WDC), International Scientific Advisory Committee (ISAC), and Harvard T.H. Chan School of Public Health, John B. Little (JBL) Center for Radiation Sciences. After graduating from the University of Tokyo Faculty of Medicine, he served as a professor at the School of Medicine of UCLA (1979-1984), University of Tokyo (1989-1996), the dean of Tokai University School of Medicine (1996-2002), the president of the Science Council of Japan (2003-2006), the science advisor to the Prime Minister (2006-2008), World Health Organization (WHO) commissioner (2005-2009), Chair and Representative Director of Global Health Innovative Technology (GHIT: 2013.1-2018.6) and the executive member of many other national and international professional societies. He was also the chairman of the Fukushima Nuclear Accident Independent Investigation Commission by the National Diet of Japan from December 2011 to July 2012.

Mr. Ryoji Noritake (CEO and Board Member, Health and Global Policy Institute)
Mr. Ryoji Noritake is the CEO, Board Member of Health and Global Policy Institute (HGPI), a Tokyo-based independent and non-profit health policy think tank established in 2004. He also serves as a pro-bono consultant for Project HOPE, a US-based medical humanitarian aid organization. Through HOPE and HGPI, he has led health system strengthening projects in the Asia-Pacific region and engaged in US Navy’s medical humanitarian projects. His focus is a multi-sectoral approach for health issues such as public-private partnerships and civil-military coordination. He was a member of Tokyo Metropolitan Government’s Policy Discussion Roundtable for Super Ageing Society (2018). He is a graduate of Keio University’s Faculty of Policy Management, holds a MSc in Medical Anthropology from the University of Amsterdam, the Netherlands. He is currently a Visiting Scholar at the National Graduate Institute for Policy Studies, a member of Salzburg Global Seminar’s Advisory Council and is an Advisory Board Member of Elsevier Atlas.

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