Takeshi Kasai: Appointed as WHO Regional Director for the Western Pacific

I believe my election was entirely due to everyone's support, and I am deeply grateful. During the campaign, I felt a great sense of responsibility, carrying the hopes of those who supported me on my shoulders.

In that sense, when I won, I felt relieved that I could finally give a proper report to everyone. This time, we had two rounds of voting before reaching a majority, and when I didn't get it in the first round, I froze (laughs). About a week after winning, it gradually sank in that this is a post with very heavy responsibilities. Of course, I thought I understood that intellectually, but...

A single vote entrusted with everyone's hopes is truly a heavy thing.

Exactly. I think that is a very good way to put it.

There were four, including myself. Two women who had previously worked for the WHO, and a man with dual citizenship from New Zealand and the small island nation of Niue.

Of the 37 countries and areas, 30 have voting rights, and 14 of those are island nations. If they had united and gained one or two more votes, I would have lost.

I am the third. The first was Dr. Hiroshi Nakajima, who later became the Director-General of the WHO. The second was Dr. Shigeru Omi. He also studied at Keio's Faculty of Law and is a Special Keio University alumni. The term is five years, with a maximum of two terms.

There are 1.9 billion people living in the Western Pacific region. The work of the Regional Director is very broad. For example, in my specialty of infectious diseases, if a new strain of influenza were to occur, I would have to lead the command for cross-border measures. So, first, there is work related to health crisis management.

Furthermore, as Asian countries are currently undergoing rapid economic development, they have reached a point where they must modernize their healthcare systems. Providing advice for that is also an important role.

We have WHO country representatives in each nation, and through those offices, we provide direct advice on each country's healthcare system.

My predecessor was on business trips for about 200 days a year. There are 37 countries and areas, plus the headquarters in Geneva, and I also expect to visit Washington frequently.

I'd have to ask them to be sure (laughs). I really put them through a lot during the six-month election period. I only returned home for two days. They seemed to think that something major was happening, though they weren't quite sure what.

Because society is developing so rapidly in this region, we must implement proactive policies.

In the field of healthcare, there is a concept called "health transition." As society develops, diseases like tuberculosis or malaria are being eradicated, while lifestyle-related diseases such as hypertension and diabetes are increasing. The state where both are intersecting is called transition.

WHO has the experience and knowledge to achieve great results regarding diseases that can be eradicated in the future. For example, in maternal and child health, maternal mortality has dropped by 63% over the past 10 years, tuberculosis mortality by 30%, and malaria by about 90%.

On the other hand, we have not yet identified proper measures for diseases that are expected to increase. Therefore, I want to implement proactive healthcare policies for these "future problems."

What are these "future problems"? One is infectious disease crisis management. Ironically, while our response capabilities have improved, the movement of people and goods between countries has also increased rapidly, so a disease from a remote area in Africa can enter Japan within 48 hours.

The Ebola outbreak in 2014–15 is a typical example. When we ran simulations during the 2003 SARS (Severe Acute Respiratory Syndrome) outbreak, infections from Asian airports reached only a very limited number of airports outside the region. However, during Ebola, seven Asian airports were flagged as "high risk." Air traffic has tripled in the past 15 years, and the risk of infectious diseases in this region is also increasing.

The second problem is the clear increase in lifestyle-related diseases and the issue of an aging population. While it took over 100 years for the proportion of the elderly population to double in Europe, it took 24 years in Japan and 17 years in Vietnam. China is also facing aging at a similar pace.

In China, the number of people aged 60 and over is already twice the total population of Japan.

Thirdly, we must also take measures against health damage associated with climate change and environmental destruction as a future problem.

These three issues are undoubtedly concerns for all regions, but the Western Pacific is positioned as the region that is developing the fastest and is at the forefront. For example, in Africa, diseases like malaria and meningitis are still very common.

The Western Pacific region can be described as a very high-risk area, both as an epicenter for infectious diseases and as a place that receives the spread of diseases originating outside the region. Therefore, we must prepare for the future.

To issue a slight warning to Japan, for example, one of the seven operations we are running this week concerns the rubella outbreak in Japan. The Japanese government recently announced very solid measures, so I believe their reliability is guaranteed, but infectious diseases remain an important issue for Japan as well.

I felt this particularly when MERS (Middle East Respiratory Syndrome) broke out in South Korea in 2015. Despite South Korea's very high medical standards, 186 patients were reported. Having capacity and being prepared are two different things.

China had a painful experience with SARS and now has quite high-level infectious disease control measures. South Korea also amended its laws after the MERS outbreak. Japan is steadily improving its capabilities, but it is the only one among Japan, China, and South Korea that has not had a painful experience.

Exactly. Even developed countries cannot afford to be complacent. In particular, the MERS outbreak in South Korea occurred within a major hospital that was considered very solid. Even if they were having discussions, there were aspects where it didn't lead to actual action.

The biggest factor was that they thought they were prepared once they had created a manual. And first of all, that manual was not understood.

Furthermore, it's not enough to just understand it; you need to conduct regular drills, but that wasn't being done. Also, there was a lack of information sharing between departments.

This was lacking within hospitals, between hospitals, between hospitals and healthcare departments, and between the Ministry of Health and other crisis management departments. As a result, school closures that were actually unnecessary were carried out nationwide, incurring a large economic cost.

Infectious disease control is basically about creating a system to find them early. And—this is the difficult part—making a proper risk assessment judgment based on the information that comes up, and then making a decision based on that.

A system where someone ultimately makes a decision must be created in advance. And since the final decision involves choosing "let's go with this" from among many options, I think it's very important to finalize communication regarding that act within the organization beforehand.

During SARS, we issued travel advisories. Whether to enforce them is up to each country, but in practice, when the WHO issues a travel advisory, most countries follow it.

On the other hand, if domestic measures pose a danger to neighboring countries or the world as a whole, there is an international treaty called the "International Health Regulations," and the WHO may intervene and issue direct recommendations.

The decision-making process I witnessed during SARS also took time. It's something that affects the entire world.

Within the WHO organization, that decision is made through consultation between me, as the Regional Director, and the Director-General at headquarters, so it's necessary to be mentally prepared for that. Also, I think it's important to share with the health ministers of each country in advance that "when such a situation occurs, we will make this kind of decision."

That's a bit embarrassing (laughs). Like many of my seniors, I was just doing sports. I was in the tennis club and remember winning the first division of the Eastern Japan Medical Students' General Athletic Meet.

And the catalyst for me taking this path was the IMA (International Medical Association) at Keio School of Medicine.

Actually, I wanted to be a transplant surgeon, but when I was a sixth-year student, I went to Brazil and spent a month there. I realized there was a world I had never imagined, and I wanted to work in an international setting.

After graduation, I thought that if I wanted to see the wider world, I should go outside immediately rather than joining a department at Keio. When I consulted a senior at the Ministry of Health and Welfare, he said, "That's good. You should broaden your horizons," so I applied to the Ministry.

His influence was very large. I also wanted to do clinical work properly, so when I consulted him, he told me, "You can do clinical training in a concentrated form," and I ended up going from the Ministry of Health and Welfare to the Emergency and Trauma Center at Iwate Medical University. However, as an emergency doctor, far from being concentrated, I didn't even have time to eat (laughs). But it was very enjoyable.

I think it was lucky for me to join the Ministry of Health and Welfare at the start of my career. WHO basically works by interacting with national governments to change their systems and thereby contribute to people's health. The experience and skills I gained in Japan's health administration organization have been very useful. Without this professional experience, I don't think I would have reached this position at the WHO.

Initially, I went back and forth between the Ministry of Health and Welfare and the WHO, but when the post of Director of the Division of Health Security at the WHO became vacant, I took the exam and passed the selection. Since then, I've spent a total of 18 years at the WHO.

There are three things. One is an organization that keeps growing. Since we are a specialized agency, we are always incorporating new knowledge and gaining experience. I want us to grow by including knowledge of the "how" part, not just the "what" as we have done until now.

Second, we must produce results. Just accumulating knowledge won't lead to results, so I want to work with national governments to bring about change.

Third, since we are a UN agency, I want to consider diversity. I aim for an organization where men, women, and people of various nationalities respect different cultures and customs, and create something new from those differences.

This third one is very difficult, but I believe it's something that can only be done because we are a UN agency.

That is a very important point, and everyone within the WHO feels very anxious about the world turning inward. I feel a sense of responsibility toward that movement. By responsibility, I don't mean for it happening, but because I believe that global health—which is exactly what we work on—is the most important core part that can stop that inward direction, or in some cases, reverse it.

Global health basically cannot exist unless everyone in the world cooperates. Since health is a very important value in every country, I hope that by connecting it well, we can stop the inward trend and create a world in a different form.

I wonder if we can move forward using frameworks like the "SDGs (Sustainable Development Goals)" or Universal Health Coverage, which Japan is promoting, as common values.