global health – UAB Institute for Human Rights Blog

Japan’s Public Health Diplomacy: A Pillar for Advancing Global Human Rights

When thinking about Japan, remembrance of its rich history and culture may come to mind. However, unknown to most is Japan’s role on the global stage for public health diplomacy. Ranging from international development to research investments, Japan has contributed to the expansion of health as a fundamental right, as stated by Article 25 of the Universal Declaration of Human Rights. Japan’s commitment to human rights is prominent through expanding global health equity, prioritizing universal access, improving technological innovation, and assisting with disaster relief.

Background of Japan’s Public Health Diplomacy

Public health diplomacy is the use of diplomatic channels and strategies to help address global health challenges. This ranges from the development of multilateral partnerships, domestic offices, funding opportunities, and more; with the main focus on addressing health issues, any avenue can be explored to address the nuances. The cultural foundation of Japan emphasizes its role as an international power; Japan’s ethos of wa, meaning harmony, and omotenashi, meaning hospitality, has further accelerated its role in space.

Japan’s emergence as a global health power began after World War II when it was developing its own healthcare infrastructure. In 1922, the Health Insurance Act was developed; this was in parallel to the German social insurance model that was managed jointly between employers and employees. In 1961, under this act, Japan finally achieved a universal healthcare system. This was done by developing the same fee schedules for all plans and requiring providers to maintain equity through contained costs. To further support underrepresented communities, subsidies were available for elderly people and children.

The strong domestic foundation developed by Japan opened up an opportunity for it to serve as a global leader as well. Since joining the WHO (World Health Organization) in 1956, it has contributed millions of dollars, giving over US$ 218 million in the 2020-2021 year to the WHO and US$ 50 million to the Contingency Fund for Emergencies; it has mobilized a lot of financial support, which has then supported humanitarian crisis in countries across the world.

Photo 1: Photo of Japan Medical Assistance Team jacket.Source: Flickr — Photo 1: Photo of Japan Medical Assistance Team jacket.
Source: Flickr

Japan’s Current Initiatives

With the successful implementation of universal health coverage, Japan has been a leader in mobilizing it in other countries. One way it has done so was through the 2017 UHC (Universal Healthcare) Forum in Tokyo. This forum, organized in collaboration with JICA (Japanese International Cooperation Agency), UNICEF (United Nations Children’s Fund), and the World Bank Group, discussed the urgency of making progress towards universal health coverage by engaging over 40 countries to motivate action towards equity for all communities. Beyond that of programmatic support, the World Bank-Japan Joint UHC Initiative has developed the analytics needed to contribute to the progress towards international UHC. This support has also been tried through bilateral collaborations; for example, Myanmar received around US$ 19 million in universal health coverage support from Japan, helping build its international health portfolio. With universal health coverage, health equities can be reduced across the globe.

Beyond that of universal health coverage, Japan has contributed to the development of valuable maternal and child health initiatives across the globe. Through programs and partnerships with entities like JICA, people can receive the training they need to support women and children who are systematically vulnerable communities. An example of their specific support is noted in Cambodia; by providing financial support and programmatic avenues, maternal mortality rates decreased significantly from the increased training for midwives and the improved clinics.

Even beyond that of the Asian continent, Japan has worked to develop programs in Africa to improve maternal health outcomes. An example of this is the Safe Motherhood program in Kenya. The program, developed in 1987, helped reduce maternal mortality by 50% in the country. Analyzing maternal and child healthcare is foundational to achieving gender equality and prioritizing sustainable development.

Japan is also strong in mobilizing support for disease relief and recovery assistance. The Japan Disaster Medical Assistance Teams have been trained to address domestic and international issues; rooted in Japan’s own history in disaster relief, their role on the global stage is prominent. For example, after the 2010 earthquake in Haiti, Japan provided over US$ 320 million in support that was mobilized as emergency assistance after the earthquake or in development assistance; this ranged from providing emergency relief goods, like jerry cans, to assisting with rehabilitating the water supply system. Another example is the US$ 500 million pledge to assist with the 2004 Indian Ocean tsunami; the multilateral support to all impacted countries was integral to their redevelopment and solidified Japan’s role as a key actor in global health diplomacy, helping restore health services to ensure affected populations are able to come back to their normal health levels.

Japan’s Model for Success

Japan is a leader in global health diplomacy and can share many insights with other nations and entities to improve their presence on the global stage as well. Despite domestic challenges of aging populations and criticisms for low refugee intake, their holistic approach is a strong suit. By combining technological innovations, hospitality, and multilateralism, they have been able to provide culturally sensitive care to countries around the world. As they contribute to work in health diplomacy, it is valuable to underline all efforts with the continued advocacy for health as a fundamental human right, addressing challenges that might exist proactively. By working to play their role, Japan has improved not only the health but the lives of millions of people across the world.

The Eradication of Malaria in Egypt: A Triumph for Public Health and Human Rights

When thinking about malaria, we tend to forget its impact across the world. Especially living in the global north, my experience with malaria has been restricted to my coursework; however, the reality of the disease is that it exists and poses a prominent issue in many countries across the world. The illness, spread by a mosquito vector, had over 247 million cases in 2021; this spanned across many regions worldwide, primarily impacting Africa.

In recent years, the WHO (World Health Organization) has worked in many different countries to eradicate malaria and has successfully done so with their WHO Guidelines for Malaria. An example of these guidelines being successful is Algeria, which reported its last case in 2013. However, a recent accomplishment in the world of malaria has been noted, which is the eradication of the disease in Egypt. For decades, Egypt had struggled with the disease and the associated outcomes.

Image 1: Receipt of malaria-free certification in WHO Eastern Mediterranean Region.Source: WHO — Image 1: Receipt of malaria-free certification in WHO Eastern Mediterranean Region. Source: WHO

Malaria’s History in Egypt

The nature of Egypt had made it susceptible to the fruition of the illness. Historically, the disease was tested around the Nile Delta and Upper Egypt, tracing back to 4000 B.C.E. As most of the population was concentrated in these areas, it led to the development of disease impacting millions of individuals. In recent history, the illness has contributed to the fragility of the country, ranging from increased economic losses, inflated healthcare costs, and decreased labor productivity.

The first ever effort to control malaria can be dated to 1950, with the introduction of dichloro-diphenyl-trichloroethane (DDT). This initial intervention was an insecticide that was used to help not only reduce the mosquito population but also address the development of typhus and other insect-borne diseases. However, this intervention resulted in some resistance amongst the community and additional environmental concerns; as of 2001, the intervention was observed as a possible human carcinogen and has since been banned in Egyptian agriculture.

In 1969, the creation of the Aswan Dam posed a new risk for the development of disease, all of which resulted in the need for new interventions. With additional adjustments to the approach against malaria, in the 1980s, the WHO helped push towards the eradication of malaria in Egypt with their eradication program. This program included regions like Africa, the Americas, Asia-Pacific, and the Middle East and Eurasia. This resulted in outcomes such as reducing the number of cases by 300,000 between 1980 and 2010. Though these outcomes are significant, those with limited access to healthcare were still disadvantaged in the global conversation.

Image 2: Doctors in Egypt are conducting malaria tests on elderly patients in rural Egypt.Source: WHO — Image 2: Doctors in Egypt are conducting malaria tests on elderly patients in rural Egypt. Source: WHO

The New Approach to Malaria

Building upon previous interventions, additional interventions have been explored in the past few decades; these have contributed meaningfully to the eradication of malaria in the country. Before mobilizing interventions, it is important to educate communities about what malaria is and develop trust in proposed interventions. The Egyptian government, in collaboration with different NGOs (Non-Governmental Organizations), launched different campaigns that reached communities all across the country; these talked about prevention, symptoms, and where people can find diagnostic centers. These were taught in schools, local community centers, and other locations to ensure that populations were able to access the information needed to become a part of the solution. This resulted in an 80% increase in malaria case reporting in disproportionately impacted areas by 2020.

These education opportunities are coupled with healthcare access and monitoring. By improving the healthcare infrastructure, treatment facilities were able to strengthen their interventions for those impacted by malaria. However, with recent inflation and economic instability in the country, with the support of international supporters, these interventions became even more accessible by being low-cost or even free. With the additional investment into data collection and monitoring systems, the Egyptian Ministry of Health was able to monitor trends in malaria incidence and collaborate with healthcare providers to mobilize and target interventions for those who need them most. With the compounded efforts of treating and monitoring malaria, strides were made to help understand the spread of malaria in the country.

Beyond education and monitoring, it is valuable to identify interventions that would be accessible to the population. These interventions must be easily understood to ensure they are efficacious. Vector control is noted to be central to Egypt’s strategy. Leveraging the use of insecticide-treated bed nets was the most prominent intervention; by 2019, 3 million of these nets had been distributed to reduce the incidence of malaria, especially in high-risk areas. This, coupled with indoor spraying, helped reduce malaria cases by 90% in over 2 decades.

Malaria Eradication is a Victory for Human Rights

As outlined in the International Covenant on Economic, Social, and Cultural Rights, the right to health is fundamental to human existence. By working to eradicate malaria in the country, Egypt has made strides to fulfill this right for its citizens of all socioeconomic classes.

Egypt’s victory brings hope to the fight against malaria; not only can public health interventions align with human rights, but they can create a sustainable model for health equity. Many countries in the global south are in a place that Egypt was in not too long ago; as global communities begin to face the amplification of health issues, Egypt’s framework and history of eradication can be seen as a success and applied to other countries.

Now that malaria is off the docket of issues Egypt faces, it is not time to focus on addressing other inequities the country is facing. As health equity is improved in the country, issues such as mental health, maternal and child health, and non-communicable diseases can be addressed with the utmost efficiency, helping improve outcomes in the country.

Understanding Vaccine Diplomacy in the Case of COVID-19: A Global Approach to Health EquityUnderstanding Vaccine Diplomacy: A Global Approach to Health Equity

In the landscape of global health, vaccine diplomacy has emerged as a compelling strategy, melding healthcare initiatives with international relations. This approach is pivotal in the ongoing battle against infectious diseases, most recently the COVID-19 pandemic. Vaccine diplomacy involves countries utilizing their surplus vaccine supplies to forge diplomatic ties, enhance global influence, and foster goodwill. This is often done in partnership with private pharmaceutical entities and public health organizations. However, while aiming to address the urgent need for equitable vaccine access worldwide, vaccine diplomacy raises critical questions concerning human rights and health equity on a global scale.

Evolution of Vaccine Diplomacy

The vaccine diplomacy has existed long before the COVID-19 pandemic, but we noted its increased influence during this unique time. Nations like the United States, Canada, and the United Kingdom, possessing robust vaccine manufacturing capabilities, sought to leverage their surplus doses as a means of geopolitical influence. For example, the United States promised to donate over 1.1 billion vaccines by 2023. This approach gained momentum as vaccine shortages persisted across continents, exacerbating health inequities, especially among women and children, and prompting a response beyond national borders.

Photo of vaccine vile.Source: Flickr — Photo of vaccine vile. Source: Flickr

Examples of Vaccine Diplomacy

Vaccine diplomacy has manifested in diverse forms. China and Russia have actively supplied their respective COVID-19 vaccines, including Sinovac, Sinopharm, and Sputnik V, to various nations as part of aid packages or through bilateral agreements. India, known for its significant vaccine production capacity, contributed doses through the COVAX initiative and direct donations to neighboring countries and beyond. These mobilization efforts are valuable to the development and growth of vaccine diplomacy through the lens of aid. This improves the well-being of marginalized groups and pushes national interests abroad.

Photo of kids lining up to get vaccinated.Source: Flickr — Photo of kids lining up to get vaccinated. Source: Flickr

Human Rights and Vaccine Diplomacy

At its core, vaccine diplomacy intersects with human rights, particularly the right to health. Access to vaccines is considered a fundamental human right, and ensuring equitable distribution is paramount to providing equal protection against COVID-19. Yet, the disparities in vaccine access have sparked concerns about the violation of this right for marginalized and vulnerable populations globally. Several countries have taken commendable steps to uplift vaccine diplomacy and do their part to make interventions more accessible. The United States pledged substantial donations of vaccine doses through COVAX and direct allocations to nations facing acute shortages, aiming to bolster global vaccine access. Countries like Sweden and Norway have also committed funds to support COVAX’s efforts in distributing vaccines to low-income nations.

To enhance the accessibility and efficacy of vaccine diplomacy, countries must prioritize transparent vaccine-sharing mechanisms, equitable distribution plans, and fair allocation strategies. Greater collaboration among nations, regulatory transparency, and a resolute commitment to multilateralism are essential elements for ensuring broader vaccine access. This can be done through working alongside pharmaceutical companies, local organizations, and many other avenues.

How to Get Involved

Individual engagement plays a pivotal role in advancing the cause of equitable vaccine distribution. Advocating for fair vaccine distribution, supporting initiatives that promote vaccine access in underserved communities, and raising awareness about the critical importance of global health equity are impactful ways for individuals to contribute. Engaging with policymakers, supporting organizations dedicated to vaccine distribution, and staying informed about global health issues are pivotal steps toward effecting change.

Vaccine diplomacy stands at the nexus of opportunity and challenge in addressing the global vaccine disparity. While it serves as a conduit for international cooperation, its success hinges upon ensuring vaccines reach those most in need, aligning with the fundamental principles of human rights and health equity.