During a four-day visit to Washington DC, JCIE’s 27th delegation of Diet members to the United States met with nearly 50 government officials, Congressional leaders, think tank experts, and Japan specialists to discuss the state of US-Japan relations. This program had one unique aspect: in addition to featuring general discussions on bilateral issues, it focused on ways of forging deeper cooperation on global health.
A few days after President Obama’s visit to Asia brought renewed scrutiny of the “US pivot to Asia,” four of the delegation members began the program by speaking at the Tadashi Yamamoto Memorial Seminar, a half-day conference co-sponsored by JCIE and the Council on Foreign Relations. The discussions focused on how the United States, Japan, and other countries can work together more effectively to realize their vision of a stable and prosperous East Asia. Once the conference closed, the delegation plunged into a series of meetings with their Congressional counterparts, international leaders such as World Bank President Jim Kim, and officials from the US State Department, USAID, and the Department of Health and Human Services. The delegation’s visit closed with a Capitol Hill reception co-sponsored by JCIE that convened nearly 180 key figures in US-Japan relations, including more than 20 visiting Diet members and almost a dozen Congressional members.
MOTOHISA FURUKAWA, Member, House of Representatives; former Minister for National Policy; former Minister of State for Economic and Fiscal Policy; former Deputy Chief Cabinet Secretary; Co-chair, Friends of the Global Fund Japan Diet Task Force—Democratic Party of Japan (DPJ)
NAOMI KAZAMA, Member, House of Councillors—DPJ
KENJI KOSAKA, Member, House of Councillors; Chairman, Commission on the Constitution; former Minister of Education, Culture, Sports, Science and Technology; Acting Chair, Diet Task Force on Global Polio Eradication—Liberal Democratic Party (LDP)
YASUHISA SHIOZAKI, Member, House of Representatives; former Chief Cabinet Secretary of Japan—LDP
KEIZO TAKEMI, Member, House of Councillors; Chairman, Committee on Governing Structures; former Senior Vice Minister of Health, Labour and Welfare; Chair, Executive Committee on Global Health and Human Security—LDP
MAYUKO TOYOTA, Member, House of Representatives—LDP
Strengthening the US-Japan Alliance
Many of the program discussions dealt with the overall bilateral relationship in the context of a changing East Asia. On the first day, one of the participants noted that the troubles that erupted in US-Japan relations five years ago in the early days of the Hatoyama Government have led to a sea change in Japanese thinking about bilateral relations, making Japanese leaders realize that the US-Japan alliance is not a given, but rather something that both sides need to work diligently to maintain. With this in mind, delegation members offered praise for President Obama’s recent trip to Japan as an important step to shore up bilateral relations for the long term, despite the shortsighted media criticism it has elicited in the United States. They were also optimistic that recent political developments have made the likelihood of reaching a resolution to the dispute over the relocation of the Futenma Marine Air Base in Okinawa greater than it has been in a long time.
However, domestic politics remained an area of concern for both sides. Political analysts such as Thomas Mann of the Brookings Institution spoke with the delegation about how the American legislative process has reached historic levels of dysfunction, which has affected the US ability to project leadership overseas. These concerns resonated with the delegates, given that the Japanese side has also struggled to ensure strong and stable domestic political leadership over the past two decades.
The way in which domestic politics in Japan have fueled disputes with neighboring countries over unresolved history issues was also raised in discussions with Congressional members and other US leaders. The Japanese side surprised their US counterparts by revealing that, contrary to media reports, nationalistic sentiments over relations with China and Korea have little to no impact on the voting behavior of their constituents, who are concerned primarily with the economy and the social safety net. However, the Diet members were worried by the efforts of Korean-American and Chinese-American groups to highlight the plight of so-called “comfort women,” asking why these groups hold such ardent anti-Japanese sentiments. In response, Congressional members insisted that most Asian-American groups active on this issue are not actually anti-Japanese; instead, the real picture is much more complicated. In either case, they explained, the topic of “comfort women” is seen less as a history issue in the United States and more as a straightforward matter of women’s rights.
Prospects for a TPP Deal
In a roundtable with Congressional members, one Diet participant asked, “What does the US Congress think of first when it thinks of Japan?” The immediate response was “Trade.” During their discussions, the Diet participants made it clear that Japanese leaders are also placing similar weight on trade, viewing the US ability to advance the multilateral Trans-Pacific Partnership (TPP) trade deal as a litmus test of the credibility of the United States and its commitment to the bilateral relationship.
Despite some disappointment that a bilateral deal on the conditions for TPP could not be announced during the Obama visit, the Japanese delegates felt that the two countries have reached agreement on 85 to 90 percent of the issues needed to complete the negotiations. However, ruling and opposition party members alike felt that Prime Minister Abe can no longer make any serious concessions until after the US Congress votes to grant trade promotion authority (TPA) to President Obama, allowing an up-or-down vote on the full deal. This presents a chicken-and-egg dilemma for negotiators, since the US strategy seems to be to get Japanese concessions in advance on a few key areas in order to convince Congressional members of the merits of awarding TPA to the president. While both the Diet members and their American counterparts felt there are still ways for both sides to move forward, there was a general sense that no action on TPA can be taken before the November US midterm elections, and this means that there will be little movement on the Japanese side as well.
Shared Challenges of Foreign Assistance
In their discussions, it became clear that proponents of foreign assistance in both countries face similar domestic political challenges. Congressional members and Diet members shared their frustrations with the challenge of trying to explain to their constituents how important it is to provide assistance to developing countries, even when the economy is bad at home. They discussed how they use the rationales of meeting humanitarian needs, expanding market access, competing on the geopolitical stage, combating terrorism, and advancing human security to explain to voters why foreign assistance is so important. But both sides still worry that their constituents mistakenly feel that foreign assistance comprises a much larger portion of their national budgets than the tiny percentage it actually occupies and that it should be further reduced.
Despite these challenges, a former White House official emphasized how much priority the Obama administration has placed in internal discussions of US-Japan relations on finding ways to cooperate more closely on development issues, going beyond the more traditional bilateral focus on security and economics. This has come to fruition with the recently launched US-Japan dialogue on development, and several participants noted that they hope that issues related to health can be an important part of those discussions.
In addition, Japan’s support for the Global Fund to Fight AIDS, Tuberculosis and Malaria—it contributed US$289 million this year—was singled out for praise by several Congressional members and numerous administration officials. In response, a number of Diet members noted that Japan has placed special priority in its foreign policy on supporting global health initiatives like the Global Fund, and the fact that Japan has maintained the level of its dollar-denominated donations to these programs despite a 20 percent decline in the yen shows the depth of the national commitment. One senator added that Japan’s contribution is particularly helpful in mobilizing US funds, since the amount of US funds that can be disbursed is legally capped at one-third of total contributions from all donors worldwide.
Cooperating on Global Health
The delegation’s discussions corroborated their sense that there are numerous areas ripe for deeper cooperation on global health. A number of US leaders expressed hopes that the United States and Japan can coordinate more on their funding for multilateral health programs such as the Global Fund and the Global Alliance for Vaccines and Immunisation (GAVI), noting how the support of the United States for these can reinforce the work of Japan and vice versa. One senator emphasized the fact that the United States and Japan should jointly play a central role in emphasizing good governance and accountability in countries they support through the Global Fund and other initiatives.
The delegation members spent considerable time discussing how the United States and Japan can work together to better integrate programs that tackle specific diseases—like the Global Fund to Fight AIDS, Tuberculosis and Malaria—with approaches that aim to strengthen health systems across the board so that developing countries can better deal with a wide range of medical issues. The delegation explained that Japan remains a major contributor to the former, particularly through its support for the Global Fund, and Prime Minister Abe has also started to champion the latter by explicitly stating that promotion of universal health coverage (UHC) in developing countries is a priority for Japan. In fact, during the program, Diet members urged Americans to be more supportive of UHC, while World Bank President Jim Kim expressed his gratitude to the delegation for Japan’s leadership role in this area.
Some US government officials said they detect a growing embrace of UHC by American leaders, who have traditionally been resistant to it. But key Congressional members warned the delegation that the US public is still unlikely to support the introduction of any major new initiative to build up other countries’ health systems. Instead, they explained that, in this era of budget cutting, the real battle should be just to maintain the current level of US funding for the disease-specific approaches that are already succeeding, like the Global Fund and PEPFAR [President’s Emergency Plan for AIDS Relief].
Given the budgetary pressures both countries face, some US experts suggested that one way forward for Japan and the United States in the near future may be to further integrate efforts to strengthen health systems into current disease-specific programs. They praised the Global Fund for its success in doing this and also pointed out that already almost one-quarter of PEPFAR funding goes for work related to health system strengthening. Some Diet members also expressed their hopes that further efforts can be made to urge the private sector and new donor countries to play a greater role in health financing and to encourage developing countries to provide more of their own domestic budgets for healthcare.
Several other promising areas for US-Japan cooperation were also proposed in the discussions. In addition to closer cooperation on disease surveillance, both sides felt that Japan and the United States can play a special role in helping strengthen food and drug regulatory systems in developing countries, especially by training food and drug safety professionals. Joint studies on dementia were also raised as one area ripe for cooperation. In addition, US officials proposed more bilateral cooperation on the development of antimicrobials in the face of growing resistance to existing drugs, while the Diet members explained how Japan is playing a growing role in supporting pharmaceutical research on neglected tropical diseases through its new Global Health Innovative Technology Fund.
The discussion also touched upon the need for more regular interactions between US and Japanese institutions. For instance, USAID and JICA used to regularly exchange staff to serve as liaisons on joint global health programs, but this practice was discontinued several years ago. Meanwhile, the US Centers for Disease Control and Prevention has a regular exchange with its Chinese counterpart, but no comparable interactions with Japan. Citing these, both the delegation members and their US counterparts speculated that a greater institutionalization of US-Japan exchanges could help pave the way for deeper bilateral cooperation in a variety of fields related to global health.
The delegation program ended with a reception co-sponsored by a number of US-Japan legislative exchange organizations. The reception was opened by Heather Foley, the wife of the late House Speaker Thomas S. Foley, who spoke about how her husband was first introduced to Japan by JCIE’s US-Japan Parliamentary Exchange Program and how the regular dialogues hosted by JCIE and other organizations have played a crucial role in improving bilateral relations. These sentiments were echoed by the other speakers—Senator Mazie Hirono, Congressman Greg Walden, and LDP Secretary General Shigeru Ishiba—who called for deeper and more expansive bilateral exchange to help undergird US-Japan cooperation in a variety of areas.
The 2014 program was organized in conjunction with the Friends of the Global Fund, Japan (FGFJ) and its Diet Task Force, which is sponsored by JCIE. Diet Task Force members have also participated in visits to Myanmar and South Africa.