Japan's Contribution To Global Tuberculosis Control Dr. Nobukatsu Ishikawa Director, Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association (JATA)
1. Successful TB Control and UHC in Japan 1000 (Per 100,000) 100 10 TB Mortality in Japan World War I/ influenza Textile industry World War II Heavy industry TB Prevention Law 1951 10% Reduction 1 1900 1950 2000 Government Commitment by TB Prevention Law and Nationwide Movement: National and local governments responsibilities regulated, Health screening by X-ray, BCG vaccination, TB services totally integrated into health system with private sector fully involved (PPM) Supported by Social Welfare Services UHC has been promoted by/with TB control activities
2.Inflow of foreign born labor force will be a major portion of TB cases in Japan Labor migration Trend in Foreign workers inflow 10.4 million new TB cases globally 580,000 MDR-TB 60% from Asian countries(2015) Industrial Investment Foreign born TB cases have been and will be over 1000+. 50 % of current TB cases among all cases of 20 yrs old are foreigners (2015)
3. MDR-TB is higher among Foreign born Cases (Fukujuji Hospital, NCGM Hospital) Trend of MDR-TB Cases Proportion among all TB Cases at Fukujuji Hospital, 2008-2014 Drug resistant TB Proportion by drugs at NCGM Hospital 2010-2013 60 40 20 0 33.3 Foreign born Japanese 56.3 32 35.7 3.6 12.5 3.5 1.7 3.5 2.9 27.3 30.8 3.1 3.9 8% 6% 4% 2% 0% 4.5% Fireign born(n=66) Japanese(N=674) 9.0% 3.7% 4.0% 0.7% 4.5% 1.9% 3.0% 4.5% 0.3% 2008 2009 2010 2011 2012 2013 2014 (Yoshiyama T : Data from Fukujuji Hospital) (Takasaki,J et al: Data from NCGM Hospital)
4. Global Contribution to reduce TB will result in elimination of TB in Japan Estimated TB incidence rates, 2012 1Technical assistance based on Japan Experience Estimated new TB cases (all forms) per 100 000 population per year 0 9.9 10 19 20 49 50 124 125 299 300 499 500 No data Not applicable 2MDR Research Center and Global Collaboration new TB cases: 18,000+, Incidence rate 14.4/100,000(2015) Urban, Elderly, Foreigners if current situation continues Japan can eliminate TB only after 100+ years 3Research in LTBI Mechanism 10.4 million new cases 1.4 million death (2015) MDR-TB 580,000 (2015) LTBI 2-3 billion (1/4 of Global Pop.)
5. International Collaboration for TB by Japan (since1962: with JICA and other agencies) 1 JICA technical assistance projects Quality practices through a model area approach with human development Provision of technical tools Ghana United Arab Republic Tanzania Kenya Yemen Ethiopia Pakistan Afganistan Bangladesh Myanmar Mongolia Nepal Thailand Cambodia China Philippines 2 JICA international training courses at RIT: Practical hand in hand training (esp.in Lab) Operational research and follow-up Cultural challenge in scientific and committed way of working Indonesia Zambia 3Conduct OR/Prevalence surveys In projects Solomon Islands 4 Nationwide/global Expansion with GF (eg. community DOTS in Myanmar, prevalence surveys)
6. Over 2000 Professionals trained at RIT/JATA since1963 (2325 professional from 97 countries; 366 from 46 countries since 2006) AFR 29 Countries No. of alumni: 293 Algeria 1 Benin 2 Botswana 5 Cameroon 2 Congo 6 Eritrea 3 Ethiopia 26 Gambia 1 Ghana 12 Guinea 1 Ivory Coast 4 Kenya 34 Lesotho 5 Liberia 8 Madagascar 1 Malawi 20 Mauritania 1 Mozambique 9 Namibia 1 Nigeria 6 Senegal 4 Sierra Leone 1 South Africa 9 Swaziland 9 Tanzania 44 Togo 4 Uganda 11 Zambia 47 Zimbabwe 16 EUR 8 Countries No. of alumni: 34 Azerbaijan 1 Germany 1 Kazakhstan 1 Netherlands 1 Turkey 26 Ukraine 1 UK 2 Uzbekistan 1 EMR 13 Countries No. of alumni: 350 Afganistan 86 Djibouti 2 Egypt 59 Iran 20 Iraq 19 Kuwait 1 Pakistan 58 Palestina 1 Saudi Arabia 2 Somalia 9 Sudan 17 Syria 1 Yemen 75 International Training courses on TB Control and TB Laboratory SEAR 9 Countries No. of alumni: 656 Bangladesh 76 Bhutan 2 India 65 Indonesia 144 Maldives 1 Myanmar 91 Nepal 99 Sri Lanka 30 Thailand 148 WPR (Western Pacific Region / WHO) 22 Countries No. of alumni: 812 Cambodia 90 China 123 Fiji 3 Hong Kong 2 Japan 113 Kiribati 1 Korea 53 Laos 25 Macao 4 Malaysia 44 Marshall Islands 2 Micronesia 2 Mongolia 30 Palau 1 Papua New Guinea 34 Philippines 191 Singapore 12 Solomon Islands 9 Taiwan 10 Vanuatu 2 Viet Nam 57 The Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association (1963 2016) AMR (Region of the Americas / WHO) 16 Countries No. of alumni: 180 Argentina 2 Bolivia 26 Brazil 38 Chili 5 Colombia 8 Cuba 2 El Salvador 6 Haiti 6 Honduras 6 Jamaica 1 Mexico 12 Nicaragua 6 Paraguay 18
7. What can be done with/after Global Fund 1. Provision of Technical Assistance based on TB Control Experiences in Japan: - Mass TB screening through mobile service van with chest X ray - Involving Private Practitioners into TB control Public-Private Mix - Sharing TB in UHC achievements Japan s National Health Insurance System 2. Harmonization with JATA/RIT Training and Linkage with Alumni of over 2,000 TB Professionals worldwide: Japan will foster experts and policy professionals that will combat infectious diseases, for a total of 20 thousand people over 3 years: (by Prime Minister Abe, TICAD VI) Training courses in Japan and training on site will be coordinated and harmonized with the End TB strategy and GFATM 3. Dissemination of New Technologies in diagnostics (incl. medical devices), vaccines, drugs and ICT: