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2018/04/25 【最新の政策提言】

イギリス・ケント州リーズ城で開催された「薬剤耐性(AMR)問題グローバル・ガバナンス会合」にてスピーチを行いました。(英語)

Speech by Yasuhisa Shiozaki
Member, House of Representatives, Japan
At the Dinner Reception for IACG:
Future Global Governance for Health
April 25, 2018
Leeds Castle, United Kingdom


Thank you very much Permanent Secretary of Department of International Development Matthew Rycroft for hosting this dinner and kind introduction.

I assume all of you here are familiar with this small book, "The Drugs Don't Work" written by Sally Davies, the Chief Medical Officer of UK. I wanted this book to be widely read in Japan as well, then my former staffs at the Health Ministry published the Japanese translated version this month. By reading it, Japanese will have a full understanding of why Sally has been so committed on AMR. We need urgent action to prevent us from returning to "pre-antibiotic era". Thank you again Sally for leading this critical agenda.

As a former Health Minister of Japan until last summer, I have been a part of the politicization process of AMR in the past three years. I attended Berlin G7 Health Ministers Meeting in 2015, which renewed my recognition on AMR. It was an occasion to find out that Japan was the only country left among G7 countries that did not have its own national action plan on AMR yet. It was also a good opportunity to confirm that the AMR issue is nothing but a security issue, not only national and global but it is a human security issue. And I also confirmed that since AMR includes so many conflicts of interests, the political leadership is indispensable. In Berlin, Secretary Hunt of UK and Minister Grohe of Germany strongly advised us to take up AMR issue on the agenda of Ise-Shima Summit to be held the next year under the presidency of Japan.

Then, we did not just decide to include AMR as one of the agenda of Ise-Shima Summit in May 2016 and of G7 Kobe Health Ministers Meeting in September 2016, but also to convene Tokyo Meeting of Health Ministers on AMR in Asia in April of 2016. Thus, together with the outcome from series of discussions on AMR, we had UNGA High Level Meeting on AMR in 2016. These unprecedented level of commitment in political community transformed AMR from a topic within science community to a global agenda.

Now, we have stronger political backup, with Global Action Plan that guides us what actions to take; such as, raising awareness, conducting surveillance, preventing infections, appropriate use while ensuring access, and R&D.

Then, what do we need next for effective implementation of the agreed plan? This is why we gather here.

For effective implementation of each objective defined by the Global Action Plan, we do need to set a target to achieve, we do need a concrete surveillance mechanism, we do need to have a robust scientific evidence, we do need sustainable financing stream and we do need to have a platform that enables all stakeholders to work in a collaborative manner. We do need to have a mechanism that would continuously encourage the new innovation for new antimicrobials. We know "Delamanid" of Otsuka Pharmaceutical is a product from the belief of one of the founders of Otsuka Family to devote themselves to the healthier living without tubercurosis of Asian people, reflecting the hardship Asian people suffered during the war time. It is obvious that we cannot rely on a simple good will of entrepreneurs in a fight against infectious disease. All these needs boils down to one discussion: what should be the optimal governance mechanism on AMR?

Today, the discussion I listened and participated reminds me of all the difficulties I experienced as a health minister to tackle on AMR. I asked my staff: how many people die of AMR every year in Japan? Is there a way to monitor prescribing practice of each doctor and hospital to identify over-prescription? Some countries restrict antimicrobial use to food-animals for growth promotion purpose. Shall we do so as well? If not, why? I could not get clear answer to these questions, at least in a satisfactory manner from our staff in the Ministry of Health.

I learned today that there could be several different options regarding the modality of the governance mechanism. Some are loose but easy to set up, others are strict while difficult to agree on and maintain. With the current limitation of scientific evidence to accurately predict the future consequence of inaction, this discussion is not easy. At least, we should learn from our experience of transition we made under the UN Framework Convention on Climate Change from Kyoto Protocol that was "top-down", "strict regulatory structure" and "limited membership" to Paris Agreement that is "bottom-up", "self-regulation by each country plus peer pressure" and "full membership".

For the successful governance over AMR issue globally, I believe the role of political leadership is the key. There are three points to be made.

Firstly, we have to maintain the current political commitment. As we have been observing in the past three to four years, political commitment played a pivotal role in transforming the agenda. I had a privilege of being a part of this transition. In the coming process of establishing a new governance mechanism on AMR, I am sure the political leadership has a vital role.

Secondly, we have to settle down conflicts and confrontations ingrained in AMR in its pursuit of One Health. For example, human health versus productivity in animal husbandry, need for new antibiotics versus return on investment for R&D, prudent use versus access to medicine: to settle these discords, we need political solutions. And the key to success is enough scientific ground and evidence to convince all the players concerned and the general public.

Thirdly, we must keep connecting global discussion with domestic solution. More simply put, we should "think globally and act locally". We do need a global governance mechanism, but to make a difference, the ultimate goal should be a change in our behavior at local level; at hospitals, at livestock farms, at fish farms and at households. A global issue always ends up as domestic and local issues. Thus, political leadership has a role to bridge between global and domestic matters. Our recent experience with TPP is a good case in this respect. For example, in my case in Ehime Prefecture, the leading tangerine country, we were to convince our tangerine farmers to accept future abolition of tariffs on oranges by introducing effective counter measures to make our tangerine agriculture more competitive.

Addressing on AMR is our responsibility for the global community and future generation. I am pleased to keep on working closely with you in this endeavor.

Thank you very much.