Overview of the International Symposium of the 23rd Asia Pacific Forum, Awaji Conference Japan

The war in Ukraine, which began in February, is still continuing. However, this seemingly anachronistic war did not break out suddenly as there were many foreshadowing events. Russia experienced the collapse of the Soviet Union, the independence of Ukraine, the annexation of Crimea in 2014, and a consequent rise of nationalist ideology. On the other hand, Ukraine faced confusion over the political focus to be placed on either Europe or Russia after its independence, the acknowledgement of Russian residents, the Russian language and other identity issues, and many other problems.

These issues can be regarded as being in the field of geopolitics or even realpolitik (power politics). In the current war, Russia has imposed sanctions against Europe, especially Germany, by suspending natural gas supplies. At the same time, Russia has been subject to financial and other sanctions from countries around the world. Sanctioned countries never forget that the sanctions were imposed on them. On March 2 this year, when the UN General Assembly voted to denounce Russia, many countries in the Global South, such as in Africa, Asia and South America, as well as many large regional powers, such as China and India, abstained. On April 7, the UN General Assembly voted to suspend Russia from the UN Human Rights Council, but 59 countries, including Turkey and Mexico, abstained. Many of the abstaining countries have the experience of being subject to economic sanctions before. Of the countries around the Baltic Sea, which feel threatened the most by Russia's invasion of Ukraine, Finland and Sweden long shied away from the North Atlantic Treaty Organization (NATO) membership to maintain neutrality, but have quickly changed course to join NATO.

In 1950, shortly after the end of the Second World War, Japan was forced to make a big choice, and the country chose correctly in accepting the peace terms being offered. Had Japan chosen neutrality, it would not have survived.

I'd like to speak about geopolitics and realpolitik. For Russia, Ukraine is the most geopolitically important region. Kaliningrad (a Russian exclave) on the Baltic Sea coast is known as a port of call for the Baltic Fleet and is not accessible to Russia except through Lithuania or Poland. As well as this area, Ukraine’s Crimean Peninsula in the Black Sea is also important for Russia, making the geopolitical situation there so harsh and frustrating that it can be described as the “tyranny of geography.”

Japan and Taiwan are also under geopolitical pressure. Both Japan and Taiwan are located in the middle of China’s so-called "first island chain," extending from the Aleutian Islands to the Japanese Archipelago including Hokkaido, the Nansei Islands, Taiwan, the Philippines, Borneo, and Indonesia. For China, Japan's Yonaguni and Miyako islands and Taiwan are like obtrusive barricades, making the country feel as if it were boxed in. In the "first island chain," Japan and Taiwan bear the same geopolitical risks as Ukraine does. As both Japan and Taiwan are situated in the "first island chain," this structural background makes Taiwan’s emergency Japan’s emergency.

Both China and Russia are authoritarian states and are different from Japan and other democratic countries in terms of political system. Regardless of the differences, Japan needs to make an effort to get along with them, coexist with them, and effectively control any conflicts.

Today, China and Russia share a deep security interest. They have established, albeit not based on treaties, a firm alliance and a relationship of entente. On February 4 this year, China and Russian issued a joint statement, a very long screed running at more than 5,000 words in English. Using such phrases as “friendship between the two States has no limits” and “no ‘forbidden’ areas of cooperation,” the statement is a virtual semi-alliance declaration showing the countries’ determination. In addition, China has succeeded in a territorial negotiation with Vietnam. In the Yeltsin era, China also solved a territorial issue with Russia, leading to a more stable China-Russian relationship thereafter. Moreover, in order to address a serious energy problem, China has built a mutually complementary relationship with Russia by ensuring the establishment of the Power of Siberia-1, a natural gas pipeline from Russia. In February this year, when the joint statement of China and Russia was released, the countries concluded a contract to expand the quantity of gas supply through the Power of Siberia-2, a 2,600 km pipeline via Mongolia (a long-term contract of more than 30 years, with construction to be launched in 2024 and scheduled to be completed around 2030).

At present, while stabilizing its relationship of entente with China, Russia is distrustful of and hostile towards the U.S., fearing that the U.S. might destroy Russia's authoritarian system. The long-term relationship between China and Russia is expected to cause extremely difficult problems for democratic countries, such as Japan and the West, and neighboring countries.

Both China and Russia have nuclear weapons, and there is another nuclear power on the peninsula at the edge of Eurasia?North Korea. Japan is therefore forced to address two diplomatic challenges at the same time. Placed in a difficult position against China and Russia in various situations, Japan has no choice but to confront the fierce circumstances.

Today, the economy is used as power for geopolitical purposes. To end the ongoing war, it is necessary to conclude a cease-fire agreement at some stage and figure out an exit strategy toward establishing a peace agreement. For this process, the current economic sanctions regime is unavoidable. Unfortunately, however, it is expected that the sanctions will be quite prolonged.

Russia has been banned from importing semiconductors and many other items, and this is certainly a heavy blow to the country. Prior to the Second World War, Japan was also prohibited from importing goods, which was seen as a threat to the country’s survival. Economic sanctions on Russia are underway especially in the fields of resources and high technology. Since Russia is a permanent member of the Security Council and has veto power, the economic sanctions applied to the country are not those stipulated in Article 41 of the UN Charter. However, the UN Charter stipulates that economic sanctions are a legitimate means of maintaining international peace. The incentive for the use of economic sanctions, rather than military power, is increasing.

At the same time, many countries have abstained from voting on the UN resolution denouncing Russia. For the UN resolution denouncing Russia, adopted on March 2, 32 of the 35 countries that abstained from the vote were those receiving strategic infrastructure investment or loans from China or those located along China’s Belt and Road Initiative (BRI). For the UN resolution suspending Russia from the UN Human Rights Council, adopted on April 7, 47 of the 59 countries that abstained were such countries.

Of the 199 countries in the world, only 37 democratic countries, including Japan, are committed to the regime of economic sanctions against Russia; many other countries have either abstained or opposed the sanctions. According to a survey by the International Monetary Fund (IMF), 53 of the abstaining countries are in a debt crisis or on the verge of a debt crisis, suggesting that countries in the Global South, including those in Southeast Asia, will continue to refuse to vote for or against the regime. What is required is a new form of diplomacy in which a vision for stabilizing the international order is shared with such countries and what can be done is considered together.

Over the past 70 years after the Second World War, a free, open, and rule-based liberal international order (LIO) has been established mainly under the lead of the U.S., but this framework is now being greatly shaken. In bringing benefits to many countries, such as Japan, South Korea, China, and India, the LIO has contributed to building a long and miraculous post-war peace. Disruption of the LIO unavoidably leads to geopolitical realpolitik. The international order today is like a transaction conducted under a floating exchange rate system rather than a fixed exchange rate system. This is a very serious matter for Japan. When the international order was stable, Japan formed the Anglo-Japanese Alliance in 1902. Later in the century, Japan also became an ally of the U.S., with whom it had once been at war. Japan enjoys its present prosperity against the background of the stability of the international order. If the order is disturbed, however, Japan is very fragile.

In 1968, Japan surpassed West Germany to become the second largest economy in the world. In 1972, Zbigniew Brzezinski, an American international political scientist who later became President Carter’s National Security Advisor, stated in his book The Fragile Blossom that Japanese economic growth was certainly marvelous, transforming the country into an economic powerhouse quickly. However, he also indicated that Japan in the post-Nixon Shock environment showed that the country was very vulnerable to changes in the external order and that not many other countries would be as susceptible in the aftermath of things they cannot control. I feel that this perspective has been forgotten.

In the Showa era, everyone in Japan worked very hard, and the recovery from the war made Japan an economic powerhouse. However, this prosperity owed a lot to the international environment and international order that granted an opportunity to Japan. China and South Korea prospered as well, but now the situation has changed drastically.

The country with the largest “surplus” in terms of security is the U.S., which borders only Canada and Mexico in the north and south and is sandwiched between the Atlantic Ocean and the Pacific Ocean in the east and west. Today, the U.S. invests its national strength and military power heavily in the global arena, and this is largely thanks to its security “surplus” structure. Germany and Poland, on the other hand, border eight countries, while Russia and China each border 14 countries. Eurasian countries whose borders are shared with many other countries geopolitically have a security “deficit.”

Japan has a far greater advantage over the Korean Peninsula, as the East China Sea offers considerable protection against China's influence. Serving as a physical barrier, the sea allows Japan to buy some time. After the Second World War, Japan remained a security “surplus” country thanks to the international order backed by the Bretton Woods system, the UN framework, and above all, the Japan-U.S. alliance. Today, however, the “surplus” is getting smaller and smaller. To what extent can the U.S., the key player, establish and maintain its commitment to international deterrence? Some say that the withdrawal of the U.S. from the Trans-Pacific Partnership Agreement (TPP) was forced by Trump, but the Biden administration has followed the same path, clearly stating that the U.S. will not return to the TPP. The U.S. cannot provide market access, and this has produced a vacuum in the market.

Under the Abe administration, Japan demonstrated leadership in negotiating the Comprehensive and Progressive Agreement on Trans-Pacific Partnership (CPTPP), which came into force in place of the TPP. Moreover, the QUAD (a strategic dialogue between Japan, the U.S., Australia, and India), whose leaders’ meeting was held, is expected to develop into a major long-term framework. For the concept of the Free and Open Indo-Pacific (FOIP), which seems to include the QUAD, Japan thinks that although it competes against China, it will cooperate on the Belt and Road Initiative depending on the issue, as long as the same principles are shared. The launch of the very unusual Trump administration in the U.S. led the country to withdraw from the TPP, producing a vacuum. The U.S. allowed Japan to fill out the vacuum, or at least took the stance of letting Japan do so to some extent. At the same time, China tried to improve its relationship with Japan to some extent as insurance against Trump. By taking advantage of these circumstances, Japan was able to fill the vacuum.

The international order was collapsing, but nothing new was generated, and China was, rather, trying to present an alternative. Amidst this situation, the Abe administration regarded itself as a key player under the banner of “proactive contribution to peace,” and actively joined efforts to establish a free and open international order. Although Japan was not such a great power as to serve as a rule-maker, it promoted diplomacy as a rule-shaper for setting a rule-making environment. This diplomatic approach was very significant when the international order was breaking down and the security “surplus” was shrinking.

If the problems revealed through the war in Ukraine are applied to Japan, the first thing to consider is that economic sanctions are truly frightening. Before the start of the Second World War, Japan was subject to oil sanctions by the U.S. Although the sanctions did not trigger the war between Japan and the U.S., they disrupted the progress of diplomatic negotiations between the countries.

If there is economic mutual dependence, those concerned will try to maintain peace, and this makes the relationship stable. However, asymmetric dependence is likely to result in weaponization of the mutual dependence. The radical impact of economic sanctions unavoidably drives the relevant country to shift its focus to a “homeland first” philosophy, and the entire world moves toward a more local and regional framework. The result is the emergence of the risk that universal principles and rules will be violated more casually. It is feared that some countries may choose to steal resources as a preemptive attack to protect themselves from economic sanctions, and such a scramble for resources would destroy the international order.

Japan needs to consider the terror of economic sanctions. Japan is not strong enough to impose economic sanctions on other countries. Japan’s energy self-sufficiency rate is only 11%, by far the lowest among the G7 countries. Although the U.S., Canada, and other countries whose self-sufficiency rate is over 100% are exceptional, even Italy, the lowest country after Japan, has a rate of 26%, with Germany at 45%. Japan is very fragile even in the field of energy as well.

In prewar Japan the military failed to protect private sea lanes and, rather tragically, resorted to confiscating private vessels. It is necessary to be alert to the possibility that malicious bugs might be embedded in network systems and to work on economic resilience together with the U.S. Before doing so, however, Japan has many things to do in terms of economic security in energy and resources, including protection of sea lanes.

After signing the San Francisco Treaty, the American politician John Foster Dulles said that the U.S. had liberated the world from the yoke of geopolitics. Certainly, the post-war international order, established mainly under the lead of the U.S., has suppressed geopolitical conflicts similar to those in the pre-war era to a considerable extent. Still, it is necessary to confront the fact seriously that Japan can no longer ensure its security and economic security only by relying on the U.S. The role to be played by Japan is becoming increasingly important in maintaining the world’s power balance and actively building an international order. Japan should therefore carry out its security policies even more thoroughly. Japan should shape itself into a national security state, equipped with security against risks with greater impact, such as climate change, pandemics, and natural disasters.

The National Institute of Infectious Diseases (hereinafter referred to as “NIID”), headed by Director-General Takaji Wakita, has a number of research departments and centers, most of which conduct basic research on pathogens, etc. However, the following three centers have different characteristics from other departments and centers: the Center for Surveillance, Immunization, and Epidemiologic Research, the Center for Emergency Preparedness and Response, and the Center for Field Epidemic Intelligence, Research and Professional Development of which I myself serve as Director. This implies that the outbreak of the novel coronavirus infectious disease (COVID-19) has influenced the present organizational configuration of the NIID.

In September 1999, the Field Epidemiology Training Program (FETP) was established within the Center for Field Epidemic Intelligence. In 1996, there was an outbreak of mass food poisoning caused by enterohemorrhagic Escherichia coli O157, mainly at primary schools in Sakai City, Osaka Prefecture, with approximately 8,000 persons infected. At that time in Japan, the national government had no systems or authority to support the responsible local government in controlling such a large-scale infection outbreak, which became a matter of public concern. In response, the Infectious Disease Law came into effect in 1999, and the FETP was launched to provide trainees with two-year on-the-job training. In the event of an epidemic outbreak, field epidemiology is the practice of undertaking an investigation without a clear hypothesis, grasping the overall picture, then analyzing and hypothesizing what is happening in the field. Those who pursue this academic discipline are called “field epidemiologists.”

The FETP is modeled on the Epidemic Intelligence Service (EIS) program of the Centers for Disease Control and Prevention (CDC) in the United States. The FETP aims to nurture “disease detectives,” as implied by the logo of EIS, which features the print of a shoe with a hole in the sole, worn through by persistent field investigations. Currently, the FETP in Japan has about 20 trainees, around 80% of whom are dispatched from local governments. I was in the first batch of FETP graduates.

Experts in field epidemiology (hereinafter referred to as “experts”) work to promptly detect cases in need of infection crisis management and respond to issues in the field. If an outbreak has actually occurred, they analyze the situation based on various information and findings, and generate a hypothesis about what will happen if certain measures are taken or not taken, in light of the present state. These experts conduct core activities to support local government staff in responding to the infection until the situation improves. It has been recognized that these experts play an important role in taking countermeasures against the COVID-19 pandemic. These experts attach importance to their firsthand knowledge obtained from the field. They provide information they have gained through field investigations to local government leaders and concerned personnel in the national government, and communicate with the general public to share the information.

At present, 75 programs are implemented around the world, producing 20,000 experts who are engaged in public health policymaking in their respective countries. On the other hand, in Japan, we have had fewer than 100 FETP graduates in the last 22 years. According to an estimate by the World Health Organization (WHO), Japan needs 600 experts, judging from the population of the country. However, given the fact that our FETP has produced fewer than 100 experts in the past two decades, it will take around 100 years to foster 600 experts. The Japanese government has directed us to make efforts to cultivate around 155 experts, assuming that one expert each is assigned to prefectures, cities with a public health center, and special districts, namely, 155 local governments in total.

Let me look back on the early state of the novel coronavirus (COVID-19) pandemic in Japan. In February 2020, the first expert panel meeting was held. The expert panel then announced that it had advised the Japanese government to make it its basic policy to maximize the effects of infection control measures, while minimizing their social and economic impact. Accordingly, from the beginning, Japan expressed that its policy was not aimed at zero-COVID cases, but for “living with COVID” so as to promote anti-infection measures while keeping the country’s social and economic functions going. The expert panel suggested the following three basic strategies to combat COVID-19 to be taken during the initial epidemic phase in Japan: (1) early detection and early response to clusters of cases, (2) the establishment of a system for appropriate medical care, and (3) changing people’s behavior.

Around the same time, European governments exercised their strong authority to restrict people's behavior by forcibly isolating infected persons and through other means. These countries adopted considerably strong measures to cope with the pandemic, including the development of a new legal system, changes in the application of constitutional provisions regarding emergencies, and granting special authority to entities concerned. Such strict restrictions in Europe differed greatly from those in Japan. For instance, the French government established penalty provisions for people going out without carrying a required document, as part of its efforts to contain the spread of COVID-19. In this way, the French government used the police to impose strict controls on people, unlike its Japanese counterpart, which expected people to voluntarily refrain from going out.

In Japan, the central government declared a state of emergency for prefectures when their COVID situation was assessed at so-called Stage 4, the worst of the four-tier scale on the pandemic’s severity, which required action to avoid an “explosion” of infections and prevent the health care system from being severely dysfunctional. When each prefecture reached Stage 3, which is the second worst, semi-emergency coronavirus spread prevention measures were taken. In particular, restaurants were subject to rigid control. Restaurant operators were ordered or requested to reduce service hours and suspend operations. Violators of the order or requirement were fined up to 300,000 yen. The Japanese government “requested” residents to voluntarily refrain from outings. It was made mandatory for the Cabinet to submit a report to the Diet before declaring a state of emergency or semi-emergency measures, extending the period, and changing the applicable areas. However, restrictions imposed in Japan were generally not so strict as those in other countries. Response to infection clusters is the core element of public health measures. A “cluster” was defined as “a group of five or more cases with primary exposure reported at a common event or venue where human-to-human transmission can occur.”

Public health centers nationwide have taken the lead in early detecting and promptly responding to infection clusters. As a group of experts, the NIID has supported these centers in making such response. As the initial situation of infection spread was changing greatly, anti-COVID measures focusing on cluster control lasted for long time. While these measures produced positive results, they also substantially increased the workload of health centers and people engaged in public health. It is therefore necessary to verify the effectiveness of these measures and determine the conditions for starting or ceasing the response to clusters.

The implementation guidelines for active epidemiological investigations states that “It is important to strive to stop the spread of infections by supposing the infection source, identifying close contacts, and conducting appropriate management,” as the important countermeasures against not only COVID-19 but also other infectious diseases. These measures are implemented by all public health centers across Japan. The Center for Field Epidemic Intelligence has served as the key player of the Contact Tracing Team in the Cluster Response Task Force, established by the Japanese government in February 2020. While sharing information with other universities and expert groups, the Center has supported the field activities mainly conducted by public health centers.

In the course of transmission of the novel coronavirus from one person to another, a COVID-19 cluster is formed and an infected person in a cluster can develop another cluster. If we stop the further spread of the virus by isolating infected persons, we can prevent the next large-scale transmission. In the initial phase of the pandemic, a tendency was observed; for example, if there was a cluster of ten people, nine of them did not transmit the virus to anyone but the remaining one passed the infection on to many people. This tendency stemmed from their behavior in displaying characteristics called the “three Cs” (crowded places, close contact settings, and closed spaces). For this reason, it was expected that the cluster response could be successful by taking intensive measures targeting the remaining 10% people who might act as spreaders of infection.

In addition, we have established a definition of “close contacts.” Applicable individuals are those who have lived with or had prolonged contact in closed spaces with a person with COVID-19, those who have cared for an infected person without appropriate protection against infection, and those who are likely to have directly touched contaminants, including droplets exhaled by an infected person. Close contacts may also include any others who have talked with an infected person without wearing a mask within a distance of one meter, regardless of the duration of contact. The same holds true for those who have been in close contact with an infected person for 15 minutes or more without taking sufficient infection-prevention measures, at a distance such that they could touch him/her with their hand. To identify close contacts, the NIID experts conducted surveys of people around an infected person. However, these experts found that there were many people who were actually close contacts but reluctant to state that fact, not only in Japan but also worldwide. As such, the NIID experts largely expanded the scope of investigation targets, so that all suspected close contacts were tested for COVID infection, including those who could not be determined to be close contacts only through interviews.

Recently, it has become important to early detect infections among the elderly and people with a pre-existing condition and to isolate them if they are infected with COVID-19. Those who are not sufficiently vaccinated carry a high risk of developing severe disease. We need to take action to find these cases at an early stage. As for close contacts, the present ways of identifying and caring for them are clearly less stringent than in the initial stage of the pandemic. However, it is important, as before, to control an infection cluster at the time of its occurrence in various facilities. For example, if we strengthen the infection management of a facility, we may find some cases of infection for up to 14 days after we intervened to control it with the original COVID strain. After that, however, new cases of infection are typically no longer found. After another 14 days, it is orthodox practice to declare that the infection cluster is contained. Healthcare or other facilities can effectively control infection by working together with infection management experts to respond appropriately with a future outlook.

Currently, the Omicron variants are in wide circulation. However, some papers suggest that before the prevalence of the Omicron variants, nearly half of the world’s population had already been infected with COVID-19 at least once. Since the emergence of the Omicron variants, the number of cases has increased twofold at a stroke, so a considerable part of humanity has been infected with the coronavirus. Many people around the world have acquired immunity to COVID-19 after being infected with the virus. Since Japan has many people with immunity acquired through vaccination, differences may arise in infection trends between Japan and other countries. Meanwhile, among Omicron variants, BA.5 is raging right now. In this situation, it is said that there is less need to identify close contacts and conduct contact tracing. However, please remember that Omicron is only one of the emerging COVID-19 variants. Since new mutant viruses have appeared every few months In Japan and around the world, we must continue considering how we can better prepare for the next pathogen outbreak.

At the initial stage of the novel coronavirus outbreak, we took countermeasures against infection clusters, including epidemiological studies, infection management, and maintaining hospital functions, in order to contain the clusters in the region and respond to clusters of cases at various facilities. With regard to infection management and maintenance of hospital functions, the local governments developed a number of schemes to strengthen the system for coordination with relevant institutions as to hospital and facility infection control, and to reinforce the system for supporting the disaster medical assistance team (DMAT). As compared with the steady advance in these activities, epidemiological studies take longer to conduct. About two thirds of infection clusters have occurred in medical institutions and facilities for the elderly. In these institutions and facilities, experts conducted epidemiological studies, provided advice on infection management, and helped maintain the hospital facility functions. However, in 2021 and onward, we saw a sharp decline in the number of requests for dispatching experts to medical institutions and elderly facilities. Soon after the advent of the Alpha variant, we took action to early detect the mutant variant by collating the genome information with epidemiological data to delay the spread of the variant as much as possible. Furthermore, since different coronavirus variants show very different epidemiological characteristics, we carried out in-depth research to discover the characteristics of the respective variants.

While continuing their activities to contain the clusters, NIID experts have encountered various cases and notified the general public of the key words and phrases for infection control. At the beginning, these were “cruise ship,” “gyms,” “day care,” “clubs with live music,” “night clubs and other entertainment venues,” “houseboats,” “hospital infections,” and “facilities for the disabled.” Later we announced “uncooperative attitudes to investigation,” “break rooms,” “insufficient standard preventive measures,” “elderly wanderers with dementia,” “male host clubs,” and “isolated island.” More recently, “U.S. military base.” It is an important role of experts to share these key words and phrases with people in Japan.

In the age of new COVID-19 variants, we have taken on a new role?to detect and prevent the spread of a variant in an early stage, so as to delay its further spread. Conventionally, every time a new variant has entered Japan, the local government concerned has tried to stop its spread by responding to each infection cluster. Among such clusters, one that could not be contained in the region led to a nationwide epidemic. As for the Alpha variant, in fact, it was initially possible to break the sequence of clusters more often than not. As it turned out afterwards, seven clusters of infection with the Beta variant triggered major epidemics, but six of them were successfully contained by the relevant local governments. In all of these successful cases, NIID members were involved in infection control in the field. All the aforementioned seven clusters were caused by variants from India and Nepal. We failed to contain the remaining one cluster, since the variant had already spread considerably when NIID experts intervened in the control activities.

With regard to the Omicron variant BA.1, several virus lineages have entered Japan. A certain lineage was subdued before causing an outbreak, since its spread was successfully stopped by public health centers in various parts of the country. On the other hand, the COVID-19 Omicron variant pandemic is thought to have something to do with U.S. military bases in Okinawa and Yamaguchi Prefectures. There was little that we could have done in a region into which a large amount of the virus had intruded from the beginning. However, it was indicated that public health centers in Japan were able to control the infection to a significant extent in cases where the virus had entered in small amounts thanks to the strict border control measures.

The NIID has yet to take sufficient measures against the Omicron BA.5 variant, since in the present situation we find it more difficult to conduct contact surveys to curb its spread, as compared with the cases of BA.1 and other preceding variants. The BA.5 variant is highly likely to have first emerged in South Africa. The currently dominant BA.5 variant and its predecessor, BA.4, are considered to be more transmissible by 10 percent or more than the initially detected variants, such as BA.1 and BA.2. It is also said that the COVID -19 vaccines may not work well against BA.5 and BA.4, since these variants reduce the neutralizing activity of antibodies from vaccinated individuals. However, receiving three or more doses of COVID vaccine will be effective against any variant.

The seventh wave of infections gradually spread from western Japan (Shimane Prefecture and the northern part of Kyushu, etc.) to eastern Japan. It was probably because BA.5, which spreads fast, replaced the prior variant more quickly in western Japan, where the prevalence of BA.2 etc. had been controlled to some extent. The number of patients infected with BA.5 has increased at an extremely rapid rate. Since so many people are becoming infected with this variant, it may cause an increase in the numbers of serious and death cases. Although it has conventionally been said that children are less vulnerable to COVID-19 infection, now there are many infected children and some of them may become seriously ill in the future. Since the percentage of vaccinated children is not so high in Japan, great care must be taken. In India, an increasing number of cases of infection with the Omicron BA2.75 variant is reported, and this alarming news has aroused fear that this situation may develop into the eighth wave of COVID-19.

In Japan, despite the many infected patients, many people think that the spread of infection has ended. However, this past year witnessed an upsurge of infections by two or three times, and every time new variants emerged, the numbers of infections and deaths increased. Another thing that is bothering me is the information that the novel coronavirus has been transmitted to wildlife as well. We are concerned about the risk of infection for people who frequently come into contact with animals and who eat animal flesh. It is important to establish a system for alerting to the possible transmission of zoonotic viruses.

The pandemic situation continues to require us to stay vigilant and prepare for the emergence of future COVID variants. We should be worried if we are unable to return to economic activities, but the current basic policy on anti-COVID measures focuses more on self-defense rather than social and economic lockdowns. The essential idea is to take action to protect yourself and the people around you. Still now, it is extremely important to receive vaccinations according to your age or any underlying condition you may have, and to adhere to usual infection control measures, such as washing your hands whenever necessary, wearing an appropriate mask, avoiding the three Cs, and keeping good ventilation. In particular, please refrain from speaking loudly when you take off your mask while eating and drinking. As for vaccination, two doses of the vaccine are not enough to offer protection in terms of the quality and quantity of immunity, but taking three doses will stabilize the antibodies in your system. If you get infected with COVID-19, you may suffer from severe aftereffects or even die. I therefore recommend that all of you, including small children to young people, should receive at least three doses?or if necessary, four doses?of the COVID-19 vaccine. To tide over the pandemic, I strongly hope that all individuals will protect themselves by taking all necessary measures against infection.

A European academic journal pointed out that various countries had difficulty changing people’s behavior even if they adopted a policy of severe punishment for violators, that initially, no country succeeded in testing large amounts of samples due to insufficient inspection capabilities, and that the surveys of contacts that Japan carried out for cluster control proved very important in the early stage of the pandemic. To conduct these surveys, public health nurses in Japan hold telephone interviews with contacts or use other means. However, most other countries in the world had no choice but to abandon the identification of close contacts and surveying their behavior, due to a remarkable increase in the number of COVID-19 patients. Furthermore, in many countries, the authorities concerned instructed these patients to isolate themselves at home while being unable to resolve various issues, including provision of food and other services for them. The governments of many countries also thought that their infection control measures were finished with the implementation of robust vaccination strategies. However, that was not the end of it, as was pointed out by the journal. Countries around the world still share the same circumstances where individual people are required to take preventive measures?specifically, washing hands, wearing an appropriate mask, avoiding the three Cs, maintaining good ventilation, and getting vaccinated.

Countermeasures against infection clusters were expected to be effective when the number of infected people increased in small increments, although these measures would not be helpful when the number had already greatly increased amid the spread of an emerging infectious disease. We anticipated that the vaccination rollout would substantially reduce the number of infected patients, and that we could diminish the spread of infection by controlling clusters when the infected number was gradually increasing. Unfortunately, however, we have seen major waves of infection persisting all the time. Countermeasures against infection clusters are effective within a limited period of time. It can be said that these measures do not work well when the infection number has increased to a large extent. However, still now household infection often constitutes more than half the cases. Contact-tracing as part of cluster control measures should be implemented only before the infection begins to spread. Even when the infection numbers increase, prevention of household infection has proved effective and we should continue to devise better prevention methods. In the future, a new virus may emerge, causing serious illness to many more people. In preparedness for the possible advent of such a virus, it is important to establish a system for switching our investigation activities On or Off.

As a measure to combat the Omicron variant, active epidemiological investigations must be carried out in individual medical institutions, elderly facilities, and the like. I recommend that the Japanese government employ a policy of switching On or Off its countermeasures against clusters (to turn On when the infection begins to spread, and turn Off while the infection is under control). When a new variant appears, the government should collect, analyze, and disseminate the genome information of its point of origin. The theoretical grounding for promoting such a policy will be provided by NIID experts.

Although people tend to think about optimistic scenarios alone, we need to think about the possibility of various virus mutations. In the process of considering this matter, it is important to discern the best measures that are convincing to people, establish a clear-cut goal, and conduct contact surveys and formulate various appropriate strategies toward achieving that goal. Experts and the general public should build a national consensus through in-depth discussions, in order to set future targets. Experts have persistently carried out various field investigations to help local governments, while walking around the problem location until the soles of their shoes are worn out. They have also held consultations to cope with each infection situation, sometimes witnessing some very sad scenes. In order to continue these activities, it is vitally necessary to obtain people’s understanding of our public health work.

This lecture covers the three phases of the world and Asian economies: their history, present, and future, more specifically, the success of the past 50 years, the impact of the current COVID-19 pandemic, and the post-COVID new normal (the establishment of new common sense) in the Asian economy, including future risks due to the war in Ukraine, and the rapidly advancing digitalization.

Over the past five decades, the share of the Asian economy in the world economy has increased considerably. The share of the 46 countries and regions defined by the Asian Development Bank (ADB) as "developing Asian economies" in the world economy increased from 4% in 1960 to 24% in 2018. When the developed economies in the Asia-Pacific region (Japan, Australia, and New Zealand) are included, the share increased from 13% in 1960 to 33% in 2018, and it is expected to increase further in the future. As a result, the poverty population percentage of developing Asian economies has fallen dramatically from around 70% in 1980 to 7% or less today.

The ADB has identified five key factors for Asia's success as follows:

①Utilization of market functions with forward-looking government support

②Sophistication of industrial structures

③Investments in productive capacity (physical capital and infrastructure) and human capital development (education, health, etc.)

④Transformation from the importers and imitators of technology from abroad to the driving force for technological innovation in the global economy

⑤Formation of effective partnerships with developed countries (including Japan) and the multilateral development banks, including the ADB and the World Bank

Government-led development policies in Asia immediately after World War II centered on industrialization policies led by governments rather than markets. Subsequently, however, governments have come to adopt market mechanisms and market-oriented reforms one after another, resulting in vigorous growth. In particular, there was a pattern in which structural changes, such as reforms, opening-up, and economic growth, took place with the occurrence of a crisis as a catalyst. Crises?the Cultural Revolution for China, the balance of payments crisis during the Gulf War for India, the Asian financial crisis for East and Southeast Asia, and World War II for Japan?spurred subsequent economic growth. Just as recovery from the Great Hanshin-Awaji Earthquake triggered the start of the Awaji Conference, crises and disasters serve as the impetus for major reforms and new movements. Therefore, the history of the past five decades suggests that the current COVID-19 pandemic and the war in Ukraine may trigger reforms.

Another source of Asian economic growth is the successful transition of the industrial structure from an agriculture-based industry to manufacturing, and then to a service industry. It is true that developed countries have also undergone similar structural changes. What was specific to Asia was as follows: the extremely rapid speed of the transition and continuous increases in the productivity of a country as a whole due to continuous productivity growth in each of the agricultural, manufacturing, and service industries.

The first thing Asia did was to import and imitate technology from developed countries. While encouraging studying abroad, dispatching engineers overseas, importing technology licenses, in which Japan was also actively involved, and promoting reverse engineering, Asia took positive action in trade and capital investment. Subsequent to this, Asia headed toward making technological innovations on its own. With regard to the number of patents approved in the United States, from 1965 to 1969, the top five countries were Germany, the United Kingdom, France, Japan, and Canada. At that time, Japan was the only Asian country ranked in the top five. In 2015, however, four Asian countries ranked in the top five: Japan ranked first, followed by South Korea, Germany, Taiwan, and China. With India ranked in the top 10, Asia is truly the driving force behind global innovation.

Until recently, economic development has progressed through inter-industry trade in line with the flying geese paradigm: with Japan as the top runner in the production of high-tech products and goods, followed by South Korea, Taiwan, Hong Kong, and Singapore, and then by Southeast and South Asian countries. Recently, however, supply chain networks and global value chains (GVCs) are increasing; Asian countries produce goods, whose technical standards are not much different, and these goods are brought together and assembled, for example, into iPhones in China. As a result, the export ratio of intermediate goods in Asia is increasing year by year, and the focus is shifting to GVCs and intra-industry trade.

In the early stages of Asia’s development, what mainly helped Asia develop on an international scale was development assistance funds from foreign countries. In various fields, the Asian region has accepted bilateral and multilateral economic, development and financial cooperation.　

The sharp increase in COVID-19 cases worldwide shows that the highly contagious Omicron variant has greatly accelerated the pandemic since early 2022. As is the case with Japan, the pandemic in Asia is still in the process of being settled. With regard to vaccination in developing Asian economies, in comparison with the United States, the second-dose coverage is higher and the third-dose coverage is lower. The COVID-19 pandemic is not merely a health and public sanitation crisis. It has also caused enormous economic damage, drastically reducing both domestic and tourism demand.

To deal with such economic damage, governments around the world came up with large-scale monetary and fiscal policies. The scale of monetary and fiscal policies in developing Asian economies as a whole is equivalent to 17% of gross domestic product (GDP). The spending was used to maintain socioeconomic activities, including medical care, life support, and business support.

Although China continues to restrict movement, including the announcement of another lockdown in Shanghai, other countries are gradually easing restrictions on socioeconomic activities, despite the spread of the Omicron variant. Consequently, in early 2022, the Asian economy started picking up and is still humming. The travel ban on international visitors, which had been imposed almost on a full scale since the World Health Organization (WHO) declared a pandemic in March 2020, has been gradually raised. International tourist arrivals in Maldives, in particular, have been back to pre-pandemic levels.

While Asian economies are recovering from the COVID-19 pandemic, Russia's invasion of Ukraine has become a new risk factor, pushing up energy and agricultural prices worldwide. The inflation rate is particularly high in Central Asia, which is close to Ukraine and Russia, but it is expected that the rate will rise also in Asia as a whole.

With regard to financial movement, in November 2021, the U.S. Federal Reserve Board (FRB) embarked on raising policy interest rates. This made the dollar stronger, resulting in the depreciation of Asian exchange rates against the U.S. dollar. Every FRB policy announcement and every Russian invasion of Ukraine leads to a fall in stock prices. Risk premiums have sharply risen in Sri Lanka, which is facing an economic crisis, and Pakistan, which is suffering from debt problems. In addition, the Ukraine crisis has brought about a surge in risk premiums also in Central Asia. Meanwhile, in response to the FRB's move to raise policy interest rates, external portfolio funds (short-term private funds) are flowing out from Asian countries other than China. To respond to this trend of weakening financial conditions, countries, such as Sri Lanka, Pakistan, and South Korea, have raised their policy interest rates and are moving toward monetary tightening.

Developing Asian economies as a whole are forecast to grow 4.6% in 2022 and 5.2% in 2023: in particular, 3.8% and 4.5% in East Asia, 6.5% and 7.1% in South Asia (excluding Sri Lanka), and 5% and 5.2% in Southeast Asia, respectively, showing a steady upturn and returning to pre-COVID-19 conditions.

Here are five issues that Asia will face and needs to resolve in the post-COVID-19 era.

①To overcome two crises: the pandemic and the Ukraine crisis. Also, to build a resilient social economy against crises and disasters that may occur in the future.

②To maintain the trend of digitalization, which has been accelerated by the COVID-19 pandemic, and use it as leverage to promote growth through technological innovation.

③To reduce disparities brought about by digitalization (digital divide) and promote sustainable reconstruction and restoration through sound build-better measures, such as climate change adoption.

④To respond to rapid demographic change, including declining birthrate and aging population.

⑤To provide resources (funds) to solve various problems.

There are three possible scenarios for the war in Ukraine:

(1) Crude oil prices continue to rise, but the socioeconomic impact is not so great.

(2) Global inflation accelerates as oil prices rise.

(3) Rapid inflation leads to economic deterioration and stagnation, causing a global financial crisis similar to the bankruptcy of Lehman Brothers in 2008.

Negative impacts on GDP growth rates increase in the order of scenario (1), (2), and (3). In scenario (3), in particular, there could be a major economic slowdown next year. In all scenarios, inflation is expected to accelerate from 2022. The ramifications of the war in Ukraine will be felt throughout the economy.

Looking at the history of disasters, from 1960 to the present, developing Asian economies as a whole have seen an increase in natural disasters and technological hazards (including nuclear power plant accidents), with frequent floods and typhoons. Furthermore, Asian victims of and deaths from natural disasters make up 85% and 65%, respectively, of the total. It is deemed that rapid population growth and urbanization have increased disaster risk.

Despite the increase in the amount of damage caused by natural disasters, the insurance coverage rate in the market against disaster damage is very low, more specifically, 10% or less, in developing Asian economies. Therefore, it is important to have public pre- and post-disaster frameworks. For disasters, frameworks centered on the UN World Conference on Disaster Risk Reduction have evolved globally. Japan, as a disaster-prone country, is actively involved in the creation of such frameworks. Currently, disaster prevention and mitigation are being enhanced with consideration also given to climate change risks. The Sustainable Development Goals (SDGs) have been agreed to and the Paris Agreement has been adopted. It is vital to protect people's lives through these actions.

Just before the pandemic, Asia had commanded about half of the global digital market. Under these circumstances, with the rapid acceleration of digitalization worldwide to overcome the constraints imposed by the economic blockade due to the pandemic, the digitalization rate of B2C (business-to-consumer) business has risen sharply in Asia. One example is Indonesia, where the platform economy has grown rapidly. The annual benefits gained from digitization by Asia as a whole are estimated to be about 1.7 trillion dollars, boosting the annual GDP growth rate by approximately 6%. Digitalization is expected to add more or less 65 million jobs annually and also stimulate trade. Digitalization has great potential to support reconstruction and restoration.

Nevertheless, the digital divide has widened across the entire economy, such as inequality among small and medium-sized enterprises in Asia. The tendency toward wider economic disparities, including the digital divide, had already taken place over the span of about 20 years before the COVID-19 pandemic. In addition to domestic disparities, disparities among countries are serious issues: with or without advanced infrastructure, and with or without advanced digital platforms and network support. Meanwhile, the rate of greenhouse gas (GHG) emissions in Asia is increasing at the fastest speed in the world, and Asia is responsible for half of the global GHG emissions. Therefore, the transition to clean energy and the wide-scale achievement of sustainability are also immense challenges for Asia as a whole.

In Asia, the proportion of the population aged 65 and over is increasing at a faster rate than that in the developed countries in the past. Asia is aging at the fastest rate in the world. In Japan, the ratio of the population aged 65 and over was reversed with that aged under 15 in 1997. Asia as a whole will reach the turning point in 2051. Under circumstances where the working-age population is relatively declining, it will be important for Asia as a whole to support the “silver bonus” system, which encourages elderly people to work energetically and contribute to the economy.

In Japan, the lives of the elderly are supported by their personal savings and public systems. Those in their 60s tend to support other family members rather than being supported by their family members, which is very distinctive. In this way, Japanese elderly people can maintain a sustainable lifestyle. On the other hand, in South Korea and other Asian countries, personal savings and public funds are quite insufficient. Accordingly, elderly people have no choice but to depend on their family for financial support. Supporting the lives of all people in an aging society in a sustainable manner will be a serious challenge in the future. Japan's aging experience can teach a lesson to other Asian countries.

Considering reconstruction and recovery from the COVID-19 pandemic, build-better measures, and the achievement of the SDGs, a considerable amount of funds will be required. Pre-COVID estimates showed that the Asia-Pacific region as a whole would need 1.5 trillion dollars annually to achieve clean energy transition, fight poverty, invest in education and health, develop infrastructure, including ICT and technical support, and maintain biodiversity. In addition to the above, funds to help recover from the pandemic will also be required. However, having already provided huge financial support, every country is thought to have a ceiling for public funds. Therefore, it is necessary to introduce private funds, including green bonds and social bonds. Although the social and green capital markets of ASEAN+3 (consisting of the ASEAN Member States, Japan, China, and South Korea) are expanding, the countries playing a central role are Japan, China and South Korea.

First of all, each national government needs to set internationally accepted investment standards for green finance and social finance and to build an integrated system that takes into consideration ordinary economic crises and sustainability risks. In addition to improving the market environment for further investment as a whole, governments themselves need to expand their fiscal space by strengthening taxation and international tax cooperation and to make necessary investments.

Basically, for five decades of Asian economic development, governments have utilized and supported market activities . Through, for example, proactive reforms, technology has also achieved a transition from imitation to innovation.

Although the ongoing COVID-19 pandemic has caused significant economic damage, there are steady signs of recovery. Nonetheless, with the emergence of a new risk, namely, the war in Ukraine, and its negative impact on financial markets, Japanese and other Asian governments are required to take appropriate measures to maintain robust economic growth and restore the economy.

Toward the future, we need a sustainable post-COVID new normal. Responses to the following issues are essential: resilience to disasters, the promotion of digitalization, social inclusion, the minimization of the digital divide, climate change adoption and environmental measures, and the aging population.

In the final analysis, not only governments but also the private sector is expected to make necessary investments in infrastructure and the like to fill the gap in the required investment amount. Also, it is desirable that the private sector, governments, and civil society work together to build back better and achieve the SDGs.