Abstract
Public Health Centers of Japan, of which there are 468 across the country as of April 2022, are at the core of health crisis management, responding to natural disasters and infectious diseases according to the Community Health Act (1994). Under the Infectious Diseases Control Law, these centers have made repeated efforts to respond to COVID-19 from the first to the seventh waves, while epidemic dynamics changed, variants emerged, and pathogenicity fluctuated. All centers essentially play a common role in infectious disease control (answering questions and consultations, testing, registering cases, coordinating healthcare, transporting confirmed patients, following up with patients and close contacts, carrying out epidemiological investigations, issuing notifications for recommendations on hospital stays and work restrictions, etc.). However, due to the varying number of cases and healthcare resources depending on the region, the actual work was not identical, and local governments, which operate the centers, took different approaches.
Looking back on the epidemic, the first, second, and third waves saw travel restrictions implemented across the country, and were characterized by a demand for testing that exceeded capacity. At that time, COVID-19 was a threat to the respiratory system, no effective treatment or vaccination was available, and the number of healthcare institutions diagnosing and treating cases was inadequate. The fourth wave saw the Alpha variant ripping through nursing homes, putting a significant burden on healthcare, while the fifth wave saw the Delta variant spreading mainly from Tokyo after the Olympics. The sixth and seventh waves came with the highly-contagious Omicron variant, leading to skyrocketing patient numbers and the public health capacity quickly being overwhelmed. Local governments considered ways to reduce the burden on Public Health Centers, including outsourcing. Over this 2.5 year period, numerous advisories were issued by the Ministry of Health, Labor, and Welfare (MHLW), and the Japanese Association of Public Health Center Directors has advocated actively on behalf of the centers.
Given that Japan is a disaster-prone country, Public Health Centers in Japan are expected to play a pivotal role in crisis preparedness, responses to, and recovery from natural disasters and infectious diseases. As a coordination hub to protect lives and maintain health, here we strongly suggest that public health centers implement the lessons learned from COVID-19 to collaborate with healthcare institutions and long-term care facilities, and evolve into a sustainable social framework to advance pandemic preparedness in their respective communities.
