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Since Edward Jenner first discovered a way to prevent smallpox in 1796, vaccines have played a key role in public health. The World Health Organization estimates that vaccines currently save 2.5 million lives each year. Despite this success, even more lives could be saved if greater value were placed on them when funding health policy.

On May 10 at Tokyo American Club, the American Chamber of Commerce in Japan Healthcare Committee and Medical Devices and Diagnostics Sub­committee hosted an event in collaboration with the European Business Council in Japan. Two speakers—David E. Bloom, professor of economics and demography in the Department of Global Health and Population at Harvard T.H. Chan School of Public Health, and Manabu Akazawa, professor of public health and epidemiology at Meiji Pharmaceutical University—shared insight into the societal impact of vaccines and their importance for disease prevention policy in Japan.

REAL IMPACT
Bloom addressed the benefits of vaccination head-on. “Some­times, in economics and social science, we identify interesting theoretical ideas that don’t really amount to much in the real world. I want you to see that this is not the case when it comes to vaccinations.”

He explained that many economic studies indicate that the estimated return on investment (ROI) for education averages about 10 percent, and argued that vaccines could have even greater ROI. As a result of this high rate of return, investments in education have an exalted place as an instrument of economic growth and development. However, many studies of the social return on investment in vaccination reveal substantially higher rates of return. “The simple fact is that healthier popu­la­tions perform better economically than their less healthy counterparts, so, by promoting health, vaccination confers substantial economic benefits on society,” Bloom added.

However, Bloom acknowledged that vaccines have tended to be undervalued by economists and policymakers world­wide, leading to underinvestment in vaccination programs and in the development of new vaccines.

One danger of this is the development of disease strains with antimicrobial resistance (AMR), which some pundits have identified as an existential threat to humanity, alongside climate change and nuclear proliferation. When vaccines are underutilized, preventable illnesses that are treated with anti­biotics and other antimicrobials spread and can develop AMR.

“I know that this is a major concern here in Japan. Pneu­monia, for example, is the third leading cause of death and … [a] staggeringly high rate of almost 50 percent of Streptococcus pneumoniae is penicillin resistant at this point.”

SETTING PRIORITIES
Akazawa talked about the financial costs of elderly patients who suffer from pneumonia. “We estimate the cost of pneumonia for outpatient episodes at about $346 and inpatient at about $4,800.”

The problem, Akazawa said, is that vaccines—particularly for the elderly—are simply not seen as a priority. “Of course the public benefit is huge, and the children’s vaccination rate is very high in Japan, but the vaccination rate for the elderly is very low because individual people do not think that it is really important.”

Akazawa has been studying a program put into place by the Japanese government that provides flu vaccine subsidies for those aged 65 and older. The program began in 2014 and will run for five years. It has yet to be decided whether the program will continue beyond 2019.

He believes that information-gathering regimes similar to those of the US Centers for Disease Control and Prevention can help the government make such decisions.

THE FUTURE
One law that could impact the situation went into effect in May. The Jisedai Iryo-kiban Ho—which can be trans­lated as the “The Next-Generation Medical Infrastructure Law”—will allow anonymized Big Data from medical sources to be consolidated and utilized to study diseases and to develop new drugs. Akazawa sees the data that will become available as a result of this law as crucial to bolstering vaccination programs, saying, “The Japanese government needs to have more infor­mation to review the processes and also the benefits of the different kinds of programs.”

Bloom thinks all eyes will be on Japan, because the country is at the forefront of a demographic change that is affecting many nations: an aging population. Decisions about vaccines for the elderly will play an important role. “Japan has great potential in exercising leadership in this arena through its decision-making processes, the decisions it makes, and the ensuing results in terms of population health and economic well-being.”

Alec Jordan is a staff writer at Custom Media for The ACCJ Journal.
Japan has great potential in exercising leadership in this arena