Dr. Norio Ohmagari on Japan’s AMR crisis and global challenges

Dr. Norio Ohmagari is an infectious disease specialist and medical doctor. He serves as Director of the Department of Infectious Disease Clinical Policy at the Bureau of Health Security and Management, Specially Appointed Deputy Hospital Director and Director of the Disease Control and Prevention Center of the National Center for Global Health and Medicine in Japan where he oversees infection control, crisis management, and disaster medicine.

GARDP interviewed Dr. Ohmagari, an expert in infectious diseases, infection prevention and control, and health crisis management, about his work and the growing threat of antimicrobial resistance (AMR) globally and in Japan.

Is AMR already a problem in Japan?

Yes, AMR is already a serious problem in Japan. While it is sometimes reported that the situation is less severe than in other countries, this is not the case in reality. Currently, methicillin-resistant Staphylococcus aureus (MRSA) and drug-resistant E. coli are major concerns in Japan, and bloodstream infections caused by these bacteria are estimated to result in around 10,000 deaths annually. AMR is not a future threat—it is a growing problem within Japan’s healthcare system.

What would happen to healthcare if antibiotics stopped working?

It could have a significant impact on medical practice itself. Antibiotics are used to prevent infections during surgery, and if they no longer work, performing surgery becomes extremely difficult. In cancer treatment, antibiotics are essential to manage infections caused by weakened immunity due to chemotherapy. The same applies to advanced medical procedures such as organ transplantation. AMR is not simply a matter of infections becoming untreatable—it represents a crisis in which healthcare itself may cease to function.

Why is it difficult to develop new antibiotics?

Developing antibiotics is technically challenging and requires enormous investment. At the same time, antibiotics are neither high-priced drugs nor widely used, which limits their revenue potential. As a result, companies struggle to recover their investments, and there have even been cases where some have gone bankrupt after obtaining regulatory approval. Because of these structural challenges, relying solely on the private sector for antibiotic development has clear limitations.

How should the approach to antibiotic development be changed?

Private companies operate on the premise of securing profits, but antibiotics is a field that is difficult to sustain under market principles alone. This is why government and public-sector involvement is essential. Antibiotics are akin to a “public good” that underpins healthcare across society, and their value cannot be measured solely in terms of short-term financial returns.

In response to these challenges, efforts are underway involving a range of stakeholders—including public mechanisms and non-profit actors—to fundamentally rethink and redesign how antibiotic development and access are carried out.

Within this broader context, GARDP can be seen as one example that is already demonstrating, in practice, a new approach to antibiotic development. There are many areas where our goals and approaches align, and I believe there is strong potential for collaboration. By working together, it may be possible to establish similar mechanisms in Japan, and in doing so, transform how research and development (R&D), and access are structured—ultimately contributing to a more sustainable and resilient healthcare system. In that sense, the potential benefits for Japan could be significant. However, sustaining such systems requires strong public understanding.

Can AMR be addressed by one country alone?

No, it cannot. The spread of drug-resistant bacteria is increasing worldwide, meaning that problems abroad quickly become problems for Japan as well. International collaboration is also essential for R&D. While Japan has strong research capabilities, it may not always be possible to recruit sufficient patient numbers domestically for clinical trials. By bringing together the strengths of different countries, overall progress in R&D can be accelerated. AMR is a challenge that cannot be solved without global cooperation.

What role is Japan expected to play?

Japan has important strengths, including its universal health insurance system, a well-developed infection control infrastructure, and a stable healthcare delivery system. In addition, its R&D capabilities are highly regarded internationally. In recent years, international partners have sometimes said, “We hope Japan will not step back.” Even as global cooperation becomes less stable, Japan has maintained relatively consistent engagement in global health. There are high expectations for its continuity and reliability.

On the other hand, what challenges does Japan face?

The biggest challenge is that a sense of urgency is not yet widely shared among the public. While the risks of COVID-19 and Ebola are easily understood, awareness of the threat posed by AMR has not yet fullyspread. In the United Kingdom, public awareness campaigns and school-based education have been conducted for many years, whereas in Japan, AMR tends to be treated as an issue confined to health experts.

In addition, reflecting our own efforts, activities in R&D, infection prevention, appropriate antibiotic use, expanding access, policy, and international cooperation are not sufficiently interconnected.

Rather than working in silos, it is essential to share common goals and connect these efforts.

This, I believe, is what is most needed in Japan today.

 

Video (2:39) | What Happens If Antibiotics Stop Working? | Dr. Norio Ohmagari on AMR