Japan’s COVID-19 Response as Crisis Management (#2)
Continued from #1
Crisis Management System at the Prime Minister’s Office
In the face of the national crisis, COVID-19 pandemic, Prime Minister Abe’s Office took control within the government (for details, refer to Part III, Chapter 2, “Prime Minister’s Office” in “The Independent Investigation Commission on the Japanese Government’s Response to COVID-19: Report on Best Practices and Lessons Learned”).
Following the Wuhan lockdown on January 23, 2020, the prime minister’s liaison meetings were held almost daily at the Prime Minister’s Office, starting on Sunday, January 26. The agenda at the first liaison meeting was repatriating Japanese nationals stranded in Wuhan. Information from each ministry was passed on at the prime minister’s liaison meeting, which became a cross-ministerial system for sharing information.
Besides Prime Minister Abe, the conference comprised key staff at Abe’s office—Executive Secretary and Special Adviser to the Prime Minister Takaya Imai and Secretaries Hirotsugu Shinkawa and Kozo Saeki—senior officials of the Cabinet Secretariat led by Chief Cabinet Secretary Yoshihide Suga and Deputy Chief Cabinet Secretary Kazuhiro Sugita, Health, Labour and Welfare Minister Katsunobu Kato, COVID-19 Response Minister Yasutoshi Nishimura, National Security Secretariat Secretary General Shigeru Kitamura, Health Ministry’s Administrative Vice Minister Toshihiko Suzuki, Chief Medical and Global Health Officer Yasuhiro Suzuki, Vice Foreign Minister Takeo Akiba, and Vice Defense Minister Kenichi Takahashi.
Initially, Deputy Chief Cabinet Secretary for Crisis Management Yoshiki Okita presided over the conference. After the Act on Special Measures was revised in March 2020 and the Office for Novel Coronavirus Disease Control (the “Office for COVID-19 Control”) was set up at the Cabinet Secretariat, head of the office Hideki Tarumi took over. The prime minister’s liaison meetings scrutinized the information, assessed the situation, and discussed the pros and cons of response options. Based on this, the Prime Minister showed his policy and made the decision.
On February 3, 2020, the cruise ship Diamond Princess entered the Port of Yokohama. On the evening of February 4, the government was shocked when 10 out of 31 from the ship were COVID-19 positive by PCR testing. The high positive rate was the result of tests conducted mainly on those with fever and other symptoms. But considering the scale of 3,711 passengers and crew members, a considerable number of positive cases were expected at the time. Very late that night, Chief Cabinet Secretary Suga hastily summoned the Health Minister, Land, Infrastructure, Transport and Tourism Minister, Deputy Chief Cabinet Secretary for Crisis Management, and senior officials from related ministries. Since then, response measures were discussed every night at a hotel in Tokyo.
From mid-March, the Prime Minister’s Office launched a task force to fill the sectionalism gap among ministries and to generate public, private, and local government collaboration. The task force addressed issues such as securing accommodation facilities for mild cases, procuring masks and personal protective equipment (PPE), border control (especially tighter quarantine), enhanced domestic testing system, and the “future COVID-19 measures” that Prime Minister Abe presented in his resignation announcement in late August. Following instructions from Abe and Chief Cabinet Secretary Suga, the task force developed the frameworks and systems one after another by mobilizing staff from the Cabinet Secretariat and various ministries. The task force had the ministries execute the developed policies and monitored their performance. The collaboration between the MHLW and local governments had been scarce, with exchanges conducted mainly through “governance by administrative notices,” in which the MHLW issued copious one-way administrative circulars and notices to the local government’s health and medical affairs bureaus. Personnel from the Ministry of Internal Affairs and Communications (MIC) were also involved in the task force.
The policy coordination framework led by the Prime Minister’s Office, such as the prime minister’s liaison meeting and the task force, was effective to a certain extent in breaking through sectionalism and taking a whole-government approach in planning and prompt execution of measures. But launching a secretariat function for supporting this policy coordination by the Prime Minister’s Office was a series of trials and errors.
The Prime Minister’s Office and the Cabinet Secretariat had assumed that the Office for Pandemic Influenza and New Infectious Diseases Preparedness and Response (the “Office for Influenza Response”) that sees over the Act on Special Measures would be the first to respond to an infectious disease crisis. But because the Cabinet Legislation Bureau decided that COVID-19 does not apply to a new infectious disease covered by the Act on Special Measures, the MHLW, instead of the Office for Influenza Response, became the responding section from the initial move. The Office for Influenza Response was not prepared nor had the capacity to respond to the national crisis of the COVID-19 pandemic in the first place. The annual drill by the Office for Influenza Response only supposed cases of extremely limited scale, and had become an entirely pro forma affair. Later, as the infection spread, the Act on Special Measures was revised on March 13, and the Office for COVID-19 Control was established with the Office for Influenza Response as the base.
Immediately after the Wuhan lockdown, the Prime Minister’s Office worked on bringing back Japanese nationals from the city. For this cross-section operation involving the Foreign Ministry, Transport Ministry, and MHLW, the “Situation Office” comprising the Assistant Chief Cabinet Secretary Office (situation response and crisis management) and staff in charge of crisis control took charge of overall coordination. Later, when the operation was complete, from around February, Deputy Chief Cabinet Secretary for Crisis Management Okita and the Situation Office went back to focusing on their original crisis response tasks. Since they can only play limited roles in infectious disease crisis management, this turned out to be a wise choice, because North Korea fired ballistic missiles four times in March. For COVID-19 response as infectious disease crisis management, Assistant Chief Cabinet Secretary (in charge of domestic affairs) Kazuyuki Furuya and Health Ministry Chief Medical and Global Health Officer Yasuhiro Suzuki took initiative. From mid-March, the Office for COVID-19 Control mainly handled the overall coordination.
The National Security Secretariat (NSS) also played a vital role in the COVID-19 response by mainly handling border control. During the operation for Japanese nationals’ evacuation, discussions on entry restrictions and legal measures for preventing infection from the Hubei Province were held in Tokyo. At a prime minister’s liaison meeting in late January, NSS Secretary General Kitamura received instructions for the NSS to consider border control measures (for details, refer to Part II, Chapter 9, “Border Control” in “The Independent Investigation Commission on the Japanese Government’s Response to COVID-19: Report on Best Practices and Lessons Learned”).
What was COVID-19, an unknown infectious disease that emerged in China? And what was going on over there? The NSS was responsible for the overall coordination for the series of administration, from collecting information, aptly analyzing intelligence, taking in the diplomatic and security situation between Japan and each country, drafting the strategy and policy of the border control measures, discussing with the Foreign Affairs, Justice, and other relevant Ministries, and promptly deciding the measures to seek judgment from Suga and Abe.
Border control involves security and mobility. It was the Economic Division (initially the Economic Division Preparatory Office), scheduled for launch on April 1, 2020, that was responsible for border control measures at the NSS. Besides overseeing economic security, the division was expected to contrive a way of building security into the legal framework.
In the early hours of January 31, the WHO declared COVID-19 a Public Health Emergency of International Concern (PHEIC). Based on Article 5, Section 1, Clause 14 of the Immigration Control Act, the Justice Ministry decided to refuse entry to Japan, foreigners who have been in the pandemic-conflicted Hubei Province within the past 14 days, or those with Chinese passports issued by the province. Initially, wariness in applying the Act was prevalent during Justice Ministry discussions. But in a crisis that required protecting the people’s lives and health, then Justice Minister Masako Mori decided to go ahead. It was an extraordinary measure to refuse, in principle, all foreigners who have stayed in a certain country and region from entering Japan, instead of a particular individual, such as a terrorist suspect. Therefore, the NSS organized the Cabinet Ministers’ Meeting on Emergencies under the National Security Council. Although the members rotated, a senior Cabinet Secretariat official said that the meeting was “a decision-making body with considerable pressure,” which became the structure to “endorse” the Justice Minister’s decision on the Immigration Control Act.
The NSS had close relations with the Foreign and Defense Ministries, and the border control measures became an opportunity for it to collaborate widely with other ministries as well. For Europe, contiguous with the Middle East, and the U.S., with Latin America on the same continent, border control is an issue that directly affects the economy and security. For Japan, an island nation, border control did not have much political priority. But now, through border control measures to protect Japan from the invisible threat of COVID-19, the Japanese government must also address “human travel” head-on as a security issue. The NSS Economic Division, which oversees economic security, took on this role. After many cross-ministry discussions, the division strengthened border control measures and formulated standards and negotiation policies on resuming international travel. One senior Cabinet Secretariat official said, “The NSS Economic Division is a newcomer, but its driving force within the government has certainly increased.”
Amid the COVID crisis, politicians basically respected the view of the experts in deciding the measures. The experts also provided expertise that contributed to the decision-making by the Prime Minister’s Office in assessing and managing risks.
Many members of the expert panel and the government’s subcommittee had worked on the infectious disease crisis management during the 2009 H1N1 pandemic, along with MHLW medical technical officers, and this was a big factor in enabling such collaboration between science and politics.
Of course, the cooperative relationship was not that of politicians blindly accepting expert advice. At times, there were clashes between the Prime Minister’s Office and the expert panel, and as one expert stated, “bargaining” was required on both sides. An example is the policy on reducing social contact by “at least 70 percent, preferably 80 percent,” and the argument on the criteria for lifting the state of emergency. There were often cases where the experts felt they were used by the government. Nevertheless, when making decisions, the Prime Minister’s Office listened to experts’ opinions, and the experts also actively presented wisdom with a strong sense of responsibility and ownership.
Looking back on Japan’s response to COVID-19, PM Abe said the most challenging decision was “definitely when declaring the state of emergency (in April 2020).” “If everyone wouldn’t cooperate, it would end in failure. To not let it fail, we must move in step with how they feel. That was the difficult part,” he recalled.
The experts were well aware that the state of emergency would be a blow to the economy. Chairman Omi of the government’s subcommittee had a similar experience in 2003 when he was the WPRO Regional Director in the fight against SARS. At the time, the WHO issued a global recommendation to postpone travels—travel advisory—to Hong Kong and Guangdong Province in China. It was the first case in the WHO’s history of half a century. Omi recalled the 2003 situation, saying, “I understood the economic shock would be great, but if we left it as it is, the infection could spread across the world and cause catastrophic damage.” “We just had to go to the last resort. It would sour the relations with China and hurt the economy. But if we didn’t take the infection measures, the WHO would not be able to fulfill its mission.” Faced with this dilemma, he decided to issue the travel advisory as the WPRO Regional Director.
With such vast experience as a leader of an administrative organization, Omi first narrowed down the policies to the ones the government could implement, then provided proposals. While figuring out how far he could go with politicians, at times, he made bold proposals.
Applying Lessons Learned in International Organizations
Experience is everything in crisis management. During a crisis, the expertise to continue launching optimal measures within the limited options becomes an advantage in the next crisis.
Just in the past 30 years, countries around the world have experienced diverse infection crises, including the highly pathogenic bird flu HSN1, SARS, new influenza H1N1, H7N9 bird flu, Ebola, dengue fever, MERS, Zika virus disease, and COVID-19. Yet, we must not forget that every year, over 2.5 million people die of tuberculosis, malaria, and HIV/AIDS alone. COVID-19 caused serious damage in densely populated urban areas, and infectious disease was in the spotlight in 2020. However, life in many developing countries continues to be a brush with death. In disputing states like Yemen, transporting medicines and vaccines requires negotiating with the conflicting party, with the risk of them being plundered before reaching the people. Some infections have limited epicenters, such as Southeast Asia or West Africa, and remain as epidemics.
It is the WHO that has experience with all these diverse infections.
In Japan’s response to COVID-19, the doctors who have experienced infection measures at the WHO have strived continuously. Among the government’s subcommittee members, Omi has led the battle against SARS as the WPRO Regional Director and, under his supervision, Tohoku University Professor Hitoshi Oshitani served as a regional advisor of WPRO in charge of the SARS measures special team. Kawasaki City Institute for Public Health Director Nobuhiko Okabe (Special Advisor to the Cabinet) had also been the WPRO Contagious Disease Prevention Measures Section Head during the early 1990s. And within the government, Chief Medical and Global Health Officer Yasuhiro Suzuki served as the Assistant Directors-General at the WHO Headquarters from 1998 to 2002.
Also, the network between incumbent Japanese WHO staff and the MHLW medical technical officers with experience in global health diplomacy is extremely important in practice. Japan’s administrative officials working at the MHLW and Foreign Ministry in Tokyo, the Permanent Mission of Japan to the UN in New York, and the Permanent Mission of Japan to the International Organizations in Geneva, are collaborating closely with the WHO Headquarters in Geneva and the WPRO Japanese staff in Manila to counter the COVID crisis. The UN Charter Article 100 states the staff shall not seek or receive instructions from any government in the performance of their duties, and the Permanent Mission Staff pledge they will perform duties by maintaining neutrality, independent of the positions of member states or their country of origin. Japanese staff, including those dispatched by the government, cannot work solely for the Japanese government. Yet, it is the network of acquaintances that comes in handy during a crisis. Those who have gone through a crisis well remember the connections during the devastating experience.
The developing countries are where the UN and other international organizations engage in activities. Conflicts, coups, riots, terrors, tsunamis, typhoons, famines, and infections—it is the job of the international organization staff to confront these crises with their expertise. They undergo devastating situations of people’s life and death. Such experience, and the network cultivated there, are used in Japan’s crisis management.
Are the Lessons Learned Put to Use?
Crises are ever changing form. Moreover, the unknown infection, COVID-19, forced Japan to “respond in a blindfold.” The parties involved in crisis management try desperately to figure out what it is. They risk their lives to confront the crisis. But the experience starts to fade the moment the crisis is over. It is forgotten even among those who were involved. Or it is replaced by a “success story.” That is why immediately after or even during a crisis, the experience needs documenting. Government officials at each administrative authority can only see the crisis from their perspective. The same crisis looks entirely different depending on where you are.
Here lies the significance of a policy review. Lessons are not given; they need to be earned. In what position were the government officials at, and why did they make the decision, within a limited time, based on the information at hand? The hearing by the Independent Investigation Commission closed on the decisions and anguish of the involved parties. The Commission summarized the best practices, issues, and lessons learned, and provided specific proposals in the report’s conclusion.
One thing we must not forget is that Japan fared well in the first half of 2020, mainly because its citizens cooperated with the request for self-restraint. That is why Japan could go through with a soft lockdown without legal power. But there are limits to crisis management relying on people’s voluntary cooperation. The report proposed amending the infectious disease crisis legal system to include penalties and compensatory measures (payment). Later, from around November, the pandemic continued to spread, and the Suga administration was compelled to declare a second state of emergency. In February 2021, the government revised the Act on Special Measures and the Infectious Diseases Control Law to make the measures more effective and to stipulate support in combination with administrative measures.
The Independent Investigation Commission report also proposed establishing a reserve system to secure an appropriate emergency response framework for the central and local governments during an infectious disease crisis. Following the “Kanagawa model” developed through the experience of the Diamond Princess incident, the government and the prefectures worked to optimize medical resources and hospital beds and streamline coordination to maintain and strengthen the system for providing healthcare. As the high chances of survival with the heart-lung machine ECMO show, superior intensive care has saved many severe patients. The government is also aware of the need for surge capacity and developed a system for securing and flexibly dispatching health nurses and nurses. However, the third wave of COVID-19 revealed the turnaround of the system for providing healthcare was insufficient. Healthcare professionals were exhausted. The financial support to prop hospital management that deteriorated with patients refraining visits and reduced surgeries was one step behind. According to the MHLW, hospital beds had been reserved for COVID patients. But in practice, there were not enough beds ready for use when considering the doctors and nurses on site.
Issues also remain in the central and local government’s chain of command. With laws for infectious disease crisis response, including the Infectious Diseases Control Law, Act on Special Measures, Quarantine Act, and Preventive Vaccination Act, the governors and local governments execute the policies in principle. That is, the central government does not have much controlling authority, and it is difficult to create a system that rapidly responds to a contingency.
Even as more people are vaccinated, the virus continues to mutate, and the crisis is likely to go on for some time. Within several years, a new pandemic by an unknown infection may occur.
The central and local governments, medical institutions, and experts must all work together to address strengthening the system for infectious disease crisis management.
This is a translation of the Japanese original published in the vol. 94 (May 2021) of the Asteion magazine.
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Yoshiyuki Sagara is a senior research fellow at the Asia Pacific Initiative (API). He earned an MA in public policy from the University of Tokyo. His careers include DeNA Co., Ltd., Agricultural and Rural Development Department of Japan International Cooperation Agency (JICA), International Organization for Migration Sudan, Policy and Mediation Division of the UN Department of Political Affairs, and Assistant Director of the Second Northeast Asia Division at the Ministry of Foreign Affairs. His areas of expertise are international conflicts, crisis management, sanctions, economic security, and health security. He is the co-author of The Independent Investigation Commission on the Japanese Government’s Response to COVID-19: Report on Best Practices and Lessons Learned (Discover 21).