In March this year, I visited Japan for the first time since the COVID-19 pandemic. Although I have been to the country several times before, every time I walk Tokyo’s vibrant streets I am still struck by the sheer volume of people who live, work and play in the megalopolis. The greater Tokyo area is home to more than 37 million people. It seems extraordinary that a country with such urban density and the oldest population in the world has a COVID-19 mortality rate significantly lower than other comparable countries.
As of June 2023, Japan’s number of COVID-19 deaths per capita was 602 per million people. This is about half that of Canada, the G7 country with the second-lowest number of deaths per million people. And it is many multiples less than the United States, the United Kingdom and Italy, who all suffered around 3,300 deaths per million people. What did Japan have that prevented a tragic loss of life on the same scale as the rest of other OECD countries?
Part of the answer lies in Japan’s fight against TB and its achievement of universal health coverage (UHC) after World War II. In the early 1950s, Japan launched a massive nationwide effort to combat TB – at that time by far the biggest cause of death in the country – that combined the latest scientific tools, community mobilization, private sector engagement and determined efforts to reach the most marginalized communities. Many of the approaches that are deemed innovative in health systems today, such as grassroots experience informing high-level policy, local groups leading case-finding, and compulsory workplace testing, were pioneered in Japan decades ago.
Not only did Japan achieve dramatic reductions in TB infections and deaths, but it used this effort as the platform on which to create universal health coverage – a comprehensive health system available to all, with a strong public health component. Japan’s health system intervenes early, monitors patients thoroughly and, critically, aims to leave no one behind. Although no system is perfect, the country’s success against COVID-19 demonstrated the strength of this approach.
Japan has proven that focusing intensely on fighting an infectious disease delivers much more than the benefit of halting that particular threat. It also creates resilient health systems that are truly universal, reaching people who are living in poverty stigmatized, vulnerable or geographically isolated and who are often disproportionately affected by illness and disease.
We should learn from Japan and seize this double opportunity in the global fight to end TB and other infectious diseases such as HIV and malaria. In many countries across the world, the best way to achieve UHC is by finishing the unfinished fights against these three preventable, treatable diseases. Turbocharging the fight against HIV, TB and malaria will unlock the dual benefits of saving millions more lives while simultaneously building more resilient, equitable and sustainable health systems that can make the world battle-ready for future health threats.
2023 has the potential to be a landmark year in our journey toward more countries achieving UHC and strengthening global pandemic preparedness. Hundreds of international leaders will gather in New York for the United Nations General Assembly this September, where three UN high-level meetings on TB, UHC and pandemic preparedness will put global health at the heart of the deliberations of this global gathering. These historic meetings can serve as the pivot point in accelerating progress to end TB and other infectious diseases, while building a formidable health infrastructure that can deliver UHC and build stronger defenses against future health threats.
Together, we can harness the momentum and enthusiasm galvanized by these meetings to accelerate the equitable deployment of the most effective disease-specific tools and interventions for existing diseases, such as TB. At the same time, we will be building more resilient, sustainable and inclusive health and community systems to prevent and detect infectious disease threats and respond effectively whenever and wherever they occur.
We have a great opportunity to put the “U” into “UHC,” by ensuring everyone, especially the most vulnerable, has access to health care. In crafting the strategy to help us achieve that goal, we can be inspired by Japan’s example of turbocharging the fight against TB as a path to delivering UHC and strengthening pandemic preparedness.
This op-ed was first published in Forbes.