Conversations with the Director: Public Health in Japan

May 13, 2014

Public Health in Japan

CDC Director Tom Frieden, MD, MPH, has been active regarding our agency’s commitment to global health security. Turns out, CDC EIS Fellow Hajime Kamiya, MD, MPH, shares in this commitment to the international community, and is especially interested in how he can assist his native Japan with their public health efforts. Kamiya, from the Division of Bacterial Diseases, Meningitis and Vaccine Preventable Diseases Branch, was grateful for the opportunity to speak with Frieden and started with a personal anecdote about his father’s background in the field of medicine. “My father was a pediatrician and was involved in immunization, this is one of the reasons for my interest in the field of public health,” said Kamiya.

“I think we have a dual purpose for this meeting. I want to learn about your work, and I want you to teach me about Japan,” said Frieden. “And your English is perfect. How do you come to speak it so well?” Kamiya stated that when he was 8 years old, his family lived in Philadelphia for a year while his father was a guest researcher. In addition, once he returned to his hometown of Tsu, Japan (about three hours from Tokyo by train), his parents asked a missionary in a local church to continue teaching him the English language.

Kamiya then went on to share how he came to work at CDC, explaining that he worked at the Japanese National Institute of Infectious Disease in the Field Epidemiology Training Program (FETP) before coming to CDC (FETP officers are patterned on our EIS officers). He added, “In Japan, public health is not considered a priority the way clinical practice is. I was very lucky to have the opportunity to work in the San Diego County Immunization Branch to explore local public health activities and attend Emory’s MPH program. That’s how I got the opportunity to work here at CDC. Because of my wonderful public health experiences in the United States, I want people in Japan to see what’s going on here. I think that would help Japanese people understand epidemiologists and their role in decision making. I was also fortunate to have the opportunity to be involved in the recent Princeton outbreak of meningococcal meningitis. I helped in the mass vaccination clinic. I admired the way that people at CDC worked so hard to convince others that controlling the outbreak was important. That was helpful for me to see. I want people in Japan to understand the virtue of working in public health.”

Frieden listened intently and appreciated hearing about Kamiya’s childhood and academic and professional background. He then inquired, “So, we have a number of challenges in the United States with regard to public health. Tell me about Japan.”

“Japan has a few issues of concern to me,” Kamiya stated. “For instance, there is an issue related to the HPV vaccine. There are approximately 10,000 new cases of cervical cancer per year, resulting in about 3,000 deaths. HPV vaccine has been included in the national immunization program since 2010, but it has been suspended. This suspension is based on five cases of ‘complex regional pain syndrome,’ which was self-reported as an adverse event after administration of the HPV vaccine, and is characterized by pain in multiple areas of the body. While the committee experts showed evidence that indicate no relationship between HPV vaccine and this adverse event, emotional media coverage and the decisions of a few leaders have led the government to cease administration of the vaccine. Expert opinion is valued more than evidence. If you have an expert who is popular, they may have influence over the public.”

Kamiya went on to say that “In Japan, changes come from Congress, and they are very difficult to make. They don’t always vote in favor of public health. Also, staff at the Ministry of Health rotate about every two years and that makes it difficult to have continuous discussions with leadership.”

Frieden then grinned and asked, “Now, tell me why the Japanese live so long.” After the two shared a laugh, he continued, “Seriously, you have one of the longest life expectancies in the world.” Kamiya attempted to explain. “I believe it’s because there is such a good national insurance system there. Going to the doctor is such an easy process. We don’t have assigned family doctors; we just go to any doctor who is available. Within 30 minutes, you can get any basic test. Additionally, the tests are all covered by insurance and the patient is only responsible for 20 to 30 percent of the cost. The good side is that you have great access to care; the negative side is that people there don’t think about prevention. And that is another problem that Japanese public health officers face.”

Frieden commented, “Well, Japan and the United States are strong partners. One key issue with regard to public health institutions is credibility. According to the polls, CDC is consistently one of the most, or the most, trusted government institutions in the United States. I believe this is because we’re honest—even when the message is unpleasant.”

Kamiya paused to consider and followed with, “I would like Japan to become as developed in public health as it is economically.” He then pointed out, “Because it’s difficult to increase public health budgets or the number of workers in Japan, my goal is to improve the quality of the public health staff. It’s worthwhile, and necessary, for Japanese staff to be here routinely. Coming to CDC will give public health officers technical training and experience, which will foster pride and confidence. Great work is being done, but it isn’t recognized. With support from CDC, I would like to do all I can to achieve this goal.”

Sensing the sincerity and altruism in what he had just heard, Frieden took a deep breath and replied, “If you make your best effort, you’ll never have regrets. I think it’s admirable that you would try.”

This Inside Story by William Jones

CDC Connects Story Manager: Kathy Chastney