Global Health Needs U.S.-Japan Partnership

James Gannon is the executive director of the Japan Center for International Exchange (JCIE/USA).

For decades, the United States and Japan have touted their bilateral partnership on global health as a means to help the world’s poor and vulnerable. Inexplicably, though, almost all meaningful U.S.-Japan cooperation has vanished during the greatest global health threat of the century—the COVID-19 pandemic. Our dual transitions—both to the Biden administration and to a new phase of the pandemic with the rollout of effective vaccines—provide a golden opportunity to build back this partnership.

Japan and the United States have incentives to beat back the virus around the world. Shutting down borders may help in the short run, but no victory is sustainable if reservoirs of infection are left to fester elsewhere. Strategically, meanwhile, competitors like China and Russia have realized that the way in which we approach the next phase of the pandemic will have profound implications for international relations. If the United States and Japan are perceived as only caring about their own citizens, disregarding those suffering in poorer countries, the resentment will rightfully linger for decades.

A revival of the U.S.-Japan partnership should build on existing foundations at the bilateral level. It is rarely discussed, but there is a vibrant constellation of fellowships, exchanges, and collaborative research programs connecting Japanese and American medical researchers and health specialists. In the past year, for example, the US National Institutes of Health has supported 487 projects with Japanese institutions and hosted 134 Japanese fellows. Some of these collaborations have been harnessed for COVID-19, but still there are many areas that are ripe for a modest investment—research funding and high-level encouragement. For instance, Americans can learn from Japan’s use of artificial intelligence in COVID-19 research, while Japanese doctors can learn about treatment methods from Americans who have extensive firsthand experience with sick patients.

People-to-people exchange is central to these bilateral collaborations, but it has dwindled during the pandemic. When the pandemic wanes and things settle into a “new normal,” we should not default to a lower level of exchange. Rather, 2020 should emphasize the importance of not just reinstating previous programs, but also investing in expanding people-to-people exchanges on medicine and healthcare.

Beyond the bilateral, there is much more that Japan and the United States should do to coordinate on their global approaches. Arguably the most meaningful global initiative to combat the pandemic, the Access to COVID Tools (ACT) Accelerator has largely been driven by the European Union, with the World Health Organization (WHO) leading. The ACT-Accelerator relies on a core group of global health organizations, which have recalibrated their operations to provide COVID-19 aid to low- and middle-income countries. Japan has provided some funding for the ACT-Accelerator, but it has yet to fully commit itself. The United States has been AWOL.

The dual transitions give the United States and Japan an opportunity to “reset.” They should take on a larger role with the ACT-Accelerator, shifting it from a largely Europe-led venture toward better reflecting the G7 leadership. This would involve coordinated American and Japanese support for its mission, a major infusion of cash, and work to advance WHO governance reform—a shared concern for both countries—paired with a recommitment to the WHO and its mission.

The WHO estimates that the international health organizations central to the ACT-Accelerator’s operations need $38 billion to develop and deliver COVID-19 tests, treatments, and vaccines equitably around the world. However, only $5 billion has materialized so far, primarily from Europe. Japan has committed $228 million to Gavi and the Coalition for Epidemic Preparedness Innovations (CEPI) for the COVAX effort to provide vaccines for low-income countries, plus another $1 million for Unitaid to distribute therapeutics. It has not yet come up with any new money for the diagnostics initiative led by the Global Fund to Fight AIDS, Tuberculosis and Malaria and FIND. The United States, meanwhile, has failed to provide a single penny; its funding for the global response is hostage to Congressional negotiations on a broader COVID-19 stimulus package.

Japanese policymakers typically look to the United States when considering how much to pledge for international initiatives; the failure of the United States to step up on COVAX this summer played a role in Japan’s decision-making process. Meanwhile, US appropriators feel more comfortable when other leading countries put up funding as well, lending a self-reinforcing dynamic to American and Japanese support for international efforts. Loosely coordinated American and Japanese pledges to the initiatives outlined above could capitalize on this dynamic and demonstrate U.S.-Japan solidarity with the rest of the world.

U.S.-Japan leadership would also make a difference at the regional level in Asia. Many Asian countries have been remarkably successful at limiting the spread of the disease. But as the focus shifts to widespread vaccination, the United States and Japan must be more engaged in supporting the region, especially while China targets ASEAN with its vaccine diplomacy. Even the COVAX Advanced Market Commitment, which guarantees poor countries access to vaccines, can only provide enough doses to cover 20 percent of participating countries’ populations. Joint U.S.-Japan financial and technical support for a regional facility that supplements efforts to provide testing, treatment, and vaccinations in Asia’s poorer countries would advance Japan’s aims and help the United States make good on the rhetoric of its “Rebalance to Asia” and the “Free and Open Indo-Pacific.” Ideally, this would be done under the banner of the East Asia Summit in a way that welcomes support from other regional powers. This will work best if paired with U.S.-Japan leadership on medical supply chain efforts and expanded investments to strengthen regional surveillance systems to better spot emerging diseases.

Concerted joint efforts on these three levels—bilateral, global, and regional—would be an important first step in reviving the US-Japan partnership on global health. The incoming Biden administration has been echoing the catchphrase of former Prime Minister Shinzo Abe as it declares “the United States is back.” Working in partnership with Japan to reassert international leadership against COVID-19 provides a golden opportunity to make this a reality.