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. We had to vote twice to reach a majority this time, so when I didn't get it in the first round, I froze (laughs). About a week after winning, it gradually started to sink in: "Wow, this is a post with very heavy responsibilities." Of course, I thought I understood that intellectually beforehand.

After all, a single vote entrusted with everyone's thoughts is 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 Pacific 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.

Nineteen billion people live in this 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 renovate 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 go to Washington often.

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 big 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, while diseases like tuberculosis or malaria are heading toward eradication, lifestyle-related diseases such as hypertension and diabetes are emerging. The state where both of these intersect is called transition.

The 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 2014–15 Ebola outbreak 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 aging populations. 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 fastest and running at the forefront. For example, in Africa, diseases like malaria and meningitis are still very common.

I think it's fair to say that the Western Pacific is a very high-risk region, both as an epicenter for infectious diseases and as a place that catches sparks from 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 trust is maintained, but infectious diseases are still an important issue for Japan.

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 learned a painful lesson from SARS and now has 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 in developed countries, we cannot let our guard down at all. 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 created a manual. And first of all, that manual was not understood.

Furthermore, it is necessary not only to understand it but also to conduct regular drills, which was not 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 not actually necessary 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, but you have to properly perform risk assessment on the information that comes up and make decisions 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 is 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 is 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 is necessary to be mentally prepared for that. Also, I think it is 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 tough one (laughs). Like many of my seniors, I did nothing but 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 following this path was the IMA (International Medical Association) at the Keio School of Medicine.

Actually, I wanted to be a transplant surgeon, but when I went to Brazil for a month in my sixth year, 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 wide world, I should go outside immediately rather than joining a Keio department. When I consulted a senior at the Ministry of Health and Welfare, I was told, "That's good. You should broaden your horizons," and I applied to the Ministry.

His influence was very large. I also wanted to do clinical work properly, so when I consulted him, he said, "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 I was lucky to join the Ministry of Health and Welfare at the start of my career. The 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 the Japanese 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 for Director of the Division of Health Security at the WHO became vacant, I took the exam and passed the selection. Since then, I have 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 constantly incorporating new knowledge and gaining experience, so 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 think 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 uneasy 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—exactly what we work on—is the most important core part that can stop that inward direction or, in some cases, turn it back.

Global health is basically something that cannot be achieved unless everyone in the world cooperates. Health is a very important value in any country, so by connecting that well, I hope we can stop the inward trend and create a world in a different form.

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