Challenges in nuclear emergency preparedness: pharmacists’ awareness, knowledge, and willingness to participate in the emergency distribution of stable iodine in Japan

Abstract

The effective implementation of stable iodine (SI) prophylaxis is a critical component of nuclear emergency preparedness; however, the role and readiness of pharmacists, who are key providers of medication guidance, remain unclear. This nationwide survey aimed to assess pharmacists’ awareness, knowledge, and willingness to participate in the emergency distribution of stable iodine (EDSI) and to compare those outcomes in prefectures that include areas within 30 km of a nuclear power plant (Zone-included) with those in other prefectures (Zone-excluded). Among 489 pharmacists aware of SI, the Zone-included demonstrated significantly higher awareness of EDSI procedures and priority populations. However, their willingness to cooperate in EDSI was paradoxically lower than that of the Zone-excluded. Only one-third of all respondents understood priority groups for SI prophylaxis, and many expressed concerns about providing accurate medication counseling during emergencies. These findings reveal critical gaps in professional preparedness and highlight the need for targeted education, structured training in nuclear emergency medicine, and institutional frameworks that support pharmacists’ roles during nuclear incidents. Strengthening these systems is essential to ensure timely, safe, and effective public protection in future nuclear emergencies.