(2) Global partnership and community-based action
Issues of infectious and parasitic diseases are to be viewed as a global issue requiring approaches based on global partnership. Concurrently, effective measures tackling these diseases require actions on a community level, based on the concept of primary health care (*4) (PHC). As such, it is important to incorporate measures against infectious and parasitic diseases in comprehensive programs for community development.

(3) Japan's experiences in public health activities and its role
Japan's active contribution to international efforts in the fight against these diseases can not only help protect the health of the people in developing world, but will also have an impact on the health of the Japanese people. In the postwar period, Japan developed a Public Health Center system, trained public health workers, promoted measures for maternal and child health care, and enhanced health care services in schools. These steps significantly contributed to rapidly reducing infant mortality rates. Japan also mounted major initiatives for the eradication of infectious and parasitic diseases. For instance, by linking public health activities with measures for eradicating tuberculosis, Japan succeeded in sharply reducing the number of tuberculosis related deaths in the postwar years. Okinawa itself has a history of successfully eradicating malaria, filaria and other diseases. (*5) Drawing upon these experiences of its own, Japan will provide assistance to developing countries by way of the application and modification of its own achievements. In view of the rapid progress in information technologies (IT) in recent years, Japan will promote the utilization of telemedicine.

2. Principles on Measures against Infectious and Parasitic Diseases

In view of the basic philosophy noted above, Japan will extend its cooperation with a focus on the following points.
Strengthening institution of health sector in developing countries
- Policy dialogue and advisory support for policy formulation, development of health systems, etc.
- Sustainable health and medical sector reform with a view to ensuring cost recovery.

Human resources development
- Training of experts for infectious and parasitic diseases and public health in developing countries.
- Through interaction with Japanese experts.

Partnership with civil society, donor countries and international organizations
- Further collaboration with Japanese, local and international NGOs, etc.
- Strengthening of partnership relations with donor countries, WHO, UNAIDS and other international organizations.

South-South cooperation
- Support for the exchanges of knowledge and experiences among developing countries.
- Sharing of success cases and lessons learned in developed countries, including Japan, and developing countries.

Promotion of research activities
- Support for the development of global network of research institutions on infectious and parasitic diseases.
- Promotion of research on infectious and parasitic diseases in impoverished countries with a focus on benefiting the poor.
- Promotion of international cooperation in vaccine research and development.

Promotion of public health on the community level
- Support through heath services in schools in basic education.
- Ensuring of the safe water supplies.
- Strengthening of the function of community health services.

3. Japan's Major Efforts for Tackling Infectious and Parasitic Diseases

HIV/AIDS
- Sharing of knowledge among developing countries: South-South cooperation (applying the social vaccine approach (*6) (Thailand, etc.) to other countries).
- Support for preventive measures, including the distribution of contraceptives, safe syringes, and assistance related to the delivery of drugs.
- Information, education and communication programs for young people linked with reproductive health. (*7)
- Care and counseling for AIDS orphans.
- Prevention of mother to child transmission and measures for high-risk groups (commercial sex workers, truck drivers, etc.).
- Supply of safe blood.
- Cooperation with international efforts for vaccine development.
- Measures for HIV/AIDS-TB co-infection.

Tuberculosis
- Expansion and effective implementation of DOTS (Directly Observed Treatment, Short Course) (*8) strategies.
Promotion of the WHO anti-tuberculosis program in the Western Pacific region.
- Development of DOTS-plus program (research, resistance testing, surveillance) for multi-resistant tuberculosis. (*9)
- Practical research for improved access to and effectiveness of DOTS based on PHC.

Malaria and parasitic diseases
- Promotion of the "Hashimoto Initiative" (*11) for Global parasitic disease control in collaboration with WHO's Roll Back Malaria Initiative (*10) .
- South-South cooperation: (Example: Mekong Project (*12))
- Sentinel epidemiological surveillance of malaria.
- Operational research & evaluation on measures for controlling malaria.
- Ensuring of the safe water supplies.

Polio
- Confirmation of the eradication of wild polio virus in the Western Pacific region.
- Increased support for polio eradication in South Asian and African regions.

4. Reinforced Efforts in Combatting Infectious and Parasitic Diseases through ODA

To enhance cooperation, with 2. and 3. above in mind, and in view of the Global Issues Initiative on Population and AIDS (GII) (*13), Japan will strengthen its support through various aid schemes for combatting infectious and parasitic diseases and for promoting social development relating to them. While grant aid and technical cooperation will be at the center of these efforts, the use of ODA loans will be considered when necessary based on the needs of recipient countries and noting the role that can be played by ODA loans. Thus Japan will utilize general grant aid (including grant aid for child welfare), grant assistance for grassroots projects, JICA Community Empowerment Program, JICA Partnership Programs, technical cooperation, development studies, and contributions to international organizations and other ODA schemes to enhance its assistance for measures against individual infectious and parasitic diseases, improvement of public health, development of research networks, primary and secondary education and access to safe water with the target of allocating a total of $3 billion over the next 5 years.

In addition, in view of the fact that NGOs in developing countries have a vital role to play in ensuring that assistance for infectious and parasitic diseases control reaches the community level, Japan will provide funding through the United Nations to support NGOs.

Okinawa ID (Infectious diseases) Initiative
Footnotes

*1. Major infectious and parasitic diseases
HIV/AIDS
According to the Joint United Nations Programme on HIV/AIDS (UNAIDS) Report, the number of people living with HIV/AIDS worldwide is estimated at 34.3 million as of 1999. (An estimated 18.8 million people have died of AIDS.) In 1999 alone, 5.4 million people were infected by the HIV, and another 2.8 million died of AIDS, the largest number ever. The majority were people of the developing countries with the Sub-Saharan Africa being the most seriously affected. (A total of 24.5 million infected. For instance, 35.8% of the adult population of Botswana is infected.) This pandemic has not only resulted in a sharp drop in average life expectancies (the United Nations Development Programme (UNDP) Report estimates that average life expectancies have been shortened by 17 years in African countries with HIV infection rates exceeding 10%), but has also reduced the number of the working population of these nations and led to the stagnation of social and economic development.

Tuberculosis
Tuberculosis is the world's most common re-emerging infectious disease. An estimated 1.8 billion people are infected with the tuberculosis bacillus, mostly in Asia and other developing countries. According to WHO, 8 million people develop active tuberculosis every year. Tuberculosis is taking the lives of more than 2 million people a year. Improper treatment has led to the proliferation of multi-drug resistant tuberculosis, while tuberculosis is spreading among HIV infested populations.

Malaria
According to WHO, almost 300 million clinical cases of malaria occur worldwide each year and over 1 million people die. Most of these deaths concentrate in Africa. The African Summit on Malaria held in Nigeria in April 2000 emphasized that malaria has constituted a barrier to development and poverty alleviation in Africa.

Polio
In the second half of the 1980s, the number of polio patients worldwide exceeded 30,000. But this figure steadily declined throughout the 1990s. According to WHO, 6,659 cases were reported in 1999 (mostly in Africa and South Asia). Japan has designated the East Asian and Western Pacific region countries as priority regions for polio eradication and has actively supported anti-polio programs in these regions. Accordingly, wild polio-free status in the Western Pacific region is to be announced at an international conference scheduled to be held in Kyoto in October 2000.

Parasitic Diseases
Developing country populations suffer under high rates of infection of parasitic diseases including filaria, schistosomiasis and Dracunculus medinensis (guinea worm), as well as parasites of the alimentary canal, such as ascariasis, hook worms and whip worms.

*2. Impact of infectious and parasitic diseases on development
In the case of HIV/AIDS, deaths in the working population cause various hardships while high medical costs affect household income on a personal levels. On a national level, this human loss leads to a reduction in average life expectancies, results in large orphan populations, causes changes in social structure, and has a serious impact on macroeconomic and fiscal conditions. For instance, the impact of HIV/AIDS on the emerging middle class in the Sub-Saharan Africa has become a serious impediment to nation-building itself.

*3. Gender
Gender refers to the sexual disparities existing in the social and cultural context, which are determined by socially shared values or individual way of thinking.

*4. PHC
Initially advocated by WHO and UNICEF at the International Conference on PHC (Alma Ata Conference) held in 1978. PHC is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of development in the spirit of self-reliance and self-determination.

*5. Measures for eradicating malaria and filaria in Okinawa
As a result of the public health approach, Okinawa became malaria-free in 1962 while the eradication of filaria was completed in 1978.

*6. Social vaccine
Social vaccine refers to an comprehensive package of preventive education, promotion of contraceptive use and edification of communities. This approach was used successfully by Thailand to suppress HIV infection rates in the 1990s.

*7. Reproductive health
Sexual and reproductive health. A comprehensive concept that emphasize the linkage between the issues of population and family planning, and primary health care, AIDS control measures, primary education, and women's rights.

*8. DOTS
Directly Observed Treatment, Short Course (DOTS).

*9. Multi-resistant tuberculosis
Drug resistant tuberculin strains which have emerged as a result of improper use of anti-tuberculin drugs.

*10. Roll Back Malaria
An anti-malaria initiative promoted by WHO and aimed to develop comprehensive health care systems, halve the world's malaria burden by 2010, and conduct measures for multiple drug resistant strains.

*11. Global parasitic diseases control (Hashimoto Initiative)
At the 1998 Birmingham Summit, then-Prime Minister Hashimoto proposed several steps to improve the effectiveness of international cooperation against parasitic diseases. In the proposal, he suggested the establishment of centers for human resources development and research in Asia and Africa and the formation of center-led international networking through collaboration with WHO and the G8 countries in the fight against parasitic diseases. On the occasion of TICAD II held in October 1998, it was announced that these centers (Thailand, Kenya and Ghana) would be focal points for promoting South-South cooperation in the field of human resources development. Preparation are now being made for the functioning of these centers.

*12. Mekong Project
Anti-malaria program in the six countries of the Mekong River basin (Yunnan Province of China, Myanmar, Lao PDR, Thailand, Cambodia and Vietnam). As part of WHO's Roll Back Malaria initiative (see footnote 10), such international organizations as WHO, UNICEF, UNDP and ADB, and major donor countries, including Japan, are cooperating in implementing malaria control.

*13. Global Issues Initiative on Population and AIDS (GII)
Announced in February 1994 as a programme of Japan designed to furnish a total of $3 billion over the seven-year period of FY1994 to FY2000 in support of projects in the fields of population and AIDS. In light of the concept of reproductive health, GII is being implemented with a comprehensive approach combining direct assistance to activities in family planning with a variety of indirect assistance to help curb population growth, including basic health care, primary education, and steps for the empowerment of women. As part of the Japan-US Common Agenda for Cooperation in Global Perspective framework, special importance is being placed on Japan-U.S. partnership and collaboration with NGOs in the implementation of GII.