TOKYO TOUTS CANDIDATE FOR WHO DG: HHS A/S AGWUNOBI

UNCLAS SECTION 01 OF 03 TOKYO 004368 SIPDIS DEPT FOR AIAG AMBASSADOR LANGE DEPT FOR G DEPT FOR OES/IHA SINGER AND FENDRICK DEPT FOR EAP/J HHS PASS TO CDC AND NIH HHS FOR A/S AGWUNOBI HHS FOR OGHA STEIGER, BHAT AND ELVANDER DEPT PASS TO AID/GH/HIDN DENNIS CARROLL SIPDIS SENSITIVE E.O. 12958: N/A TAGS: TBIO KFLU KSTH ECON PREL SOCI JA SUBJECT: TOKYO TOUTS CANDIDATE FOR WHO DG: HHS A/S AGWUNOBI MEETINGS WITH JAPAN'S MINISTRY OF HEALTH REF: 05 TOKYO 6750 TOKYO 00004368 001.2 OF 003 ¶1. (SBU) Summary. On July 24, Department of Health and Human Services (HHS) Assistant Secretary for Health John Agwunobi met with Ministry of Health, Labor and Welfare (MHLW) Minister Jiro Kawasaki and other senior officials to discuss a wide range of regional and bilateral health issues, including the selection of the World Health Organization's (WHO) next Director-General, avian influenza, polio eradication, and HHS-Japan bilateral cooperation. Japan is requesting that the United States support Dr. Shigeru Omi's candidacy for Director-General of the WHO. End summary. ¶2. (U) On July 24, Department of Health and Human Services (HHS) Assistant Secretary for Health Dr. John Agwunobi met with Ministry of Health, Labor and Welfare (MHLW) Minister Jiro Kawasaki, Assistant Minister for Technical Affairs Takeshi Toguchi, MHLW Parliamentary Secretary Hiroshi Okada and others to discuss a wide range of regional and bilateral health issues, including the selection of the World Health Organization's (WHO) next Director-General, avian and pandemic influenza planning and preparedness, polio eradication, and HHS-Japan bilateral cooperation. Throughout the meetings, A/S Agwunobi underscored the importance of the bilateral relationship in the area of public health and lauded Japan's work in the region and around the globe. HHS International Affairs Officer Erika Elvander, ESToff and EST FSN also attended the meetings. Agwunobi followed up with a meeting at the Ministry of Foreign Affairs (reported septel) and site visits to the International Medical Center of Japan (IMCJ) and the National Institute of Infectious Diseases (NIID). ¶3. (SBU) Minister Kawasaki began by welcoming Dr. Agwunobi to Japan. He highlighted the challenges posed by emerging infectious diseases and bioterrorism. Kawasaki explained that officials submitted a bill to the Diet this past spring to amend Japan's infectious diseases law to prevent bioterrorism (see reftel). The Minister hoped the Diet 
would pass the bill during its fall session. He believed that both the ruling and opposition parties have come to an agreement on the bill. The Minister also touched on avian influenza preparations and discussed the difficulties in planning because of differences in how various central governments relate to local ones around the world. He said that some local governments in Japan are behind in their preparations. To better coordinate Japan's international efforts on AI and other infectious diseases, Kawasaki noted that he plans to travel to China at the end of August and to the European Union in September. The Minister also mentioned that Australia's Health Minister visited Tokyo the previous week. ¶4. (SBU) Kawasaki then turned to the main message of the meeting -- Japan's request that the United States support Dr. Shigeru Omi's candidacy for Director-General of the WHO. The Minister explained that a cabinet decision was made to put forth Omi's name as Japan's candidate. Omi has done an excellent job as the WPRO director and has worked in the area of infectious diseases for many years. Kawasaki explained that the WHO's main challenge today is emerging infectious diseases and that Asia is ground zero for new outbreaks. He argued that Omi was most familiar with the region, and given the public health challenges the world faces in the near future, Omi would be an excellent candidate for the job. Kawasaki passed a letter addressed to HHS Secretary Leavitt explaining Tokyo's position and request for support. (Note: that same day the Embassy received a note verbale on the same topic, and Omi's candidacy was the main topic of conversation in a dinner hosted by the Ministry of Foreign Affairs.) TOKYO 00004368 002.2 OF 003 ¶5. (SBU) In response, A/S Agwunobi said that Dr. Omi is highly respected around the world and former Director- General Dr. Lee Jong-wook is greatly missed. Though the international community is still mourning the former DG's sudden death, the work of the WHO must go on. Agwunobi explained that Washington's policy is not to indicate whom the United States will support prior to the vote. There will be multiple candidates to consider. The U.S. would welcome a visit from Dr. Omi as part of this process. ¶6. (SBU) Agwunobi concluded by asking for Japan's continued close cooperation on polio eradication. He stressed that Japan's continued leadership was critical to stamping out the disease. In response to a question from the Minister, Agwunobi briefly discussed the status of AI vaccine development in the United States, highlighting some of the challenges posed by having to choose which strains should be produced. Minister Kawasaki asked for the continued sharing of information between the U.S. and Japan, and mentioned that Japan could learn much from the U.S. in the area of fighting cancer. He also asked about the relationship between the government and pharmaceutical companies in the United States. A/S Agwunobi noted the recent awarding of more than USD one billion to five pharmaceutical vaccine development companies that would both expand domestic production capacity, develop cell based flu vaccine technology, and expand manufacturing capacity in general for flu vaccines. A/S Agwunobi also noted Secretary Leavitt's potential travel to Japan in December to attend a Global Health Security Initiative meeting. ¶7. (SBU) Immediately following the meeting with Minister Kawasaki, A/S Agwunobi met with MHLW Assistant Minister for Technical Affairs Takeshi Toguchi. Agwunobi began his remarks by stressing the importance of partnerships when facing a potential avian influenza pandemic and asked about Japan's proposed use of Tamiflu in its own preparedness plans. ¶8. (SBU) Toguchi welcomed close information sharing and said the AI threat is recognized around the world due to the efforts of President Bush and HHS Secretary Leavitt to raise awareness. The key to fighting AI will be to develop public health systems in developing countries to better deal with the disease. Japan's vaccine production continues to be egg-based, with work progressing on strain one vaccines. Toguchi explained that to date, there have been no problems with the safety of the prototype vaccine. Japan is not yet working on a strain two vaccine. Preliminary data shows that the vaccine for strain one will not work for strain two viruses. He said that obtaining a vaccine that would work on all strains would be optimal, but if that was not possible, it was important to continue work on all strains. In addition to close information sharing, Toguchi said that it was critical to obtain the cooperation of developing countries in order to obtain viral samples. The Assistant Minister explained that consensus was reached at the World Health Assembly on this issue, but that it remained to be seen whether developing countries would provide the strains to Japan and the United States quickly enough. More work is needed in this area. ¶9. (SBU) Japan's current AI vaccine prototype requires one dose in the range of 15-30 micrograms. MHLW has been working with the U.S. FDA on Tamiflu safety issues. Agwunobi said it was important to manage the potential side effects of public health interventions. The two officials then turned to a discussion on antiviral prioritization. Tamiflu usage in Japan will differ according to the pandemic stage, with prophylactic use in earlier ones. TOKYO 00004368 003.2 OF 003 Once phase four is reached in Japan, health authorities will no longer prescribe Tamiflu for seasonal flu. Japan's prioritization is to medicate first responders and critical safety officials first. Agwunobi and Toguchi also discussed the use of modeling to see how a pandemic could potentially spread. Toguchi commented that given that there are many changes still taking place in the virus, experts in Japan have not conducted any modeling studies. He did agree that modeling was a useful tool. The Assistant Minister noted that because conditions will continue to change, close cooperation would be necessary between the two countries. Agwunobi closed by calling Japan one of the United States' most important partners in the area of global health and asked for further close communication and collaboration. ¶10. (U) The same day, A/S Agwunobi met with MHLW Parliamentary Secretary Hiroshi Okada. Okada said that he would travel to Washington in August, which Agwunobi welcomed. Okada served several terms as mayor of Mito City where he dealt with public health emergency preparedness on the local level. Okada noted that Tokyo provided Yen 7.7 billion (approximately USD 68 million) for avian influenza preparedness in January as part of a supplemental budget. Japan currently has 400,000 chicks for egg based vaccine development. A/S Agwunobi expressed his appreciation for Japan's leadership in ASEAN, on polio eradication and the Global Fund, and finally with health efforts in Afghanistan and Iraq. ¶11. (U) HHS's Office of Global Health Affairs cleared this cable. SCHIEFFER