This commentary introduces an approach to health systems analysis and reform, presents the implications of the health systems approach for pandemic preparedness and responses, and offers potential suggestions for the Japan Institute for Health Security (JIHS) to consider adopting in its activities for pandemic policies and health systems. The paper examines actions for health system strengthening that have important implications for pandemic preparedness and responses in five areas of policy intervention (according to the book Getting Health Reform Right: A Guide to Improving Performance and Equity): i) financing, how funds are mobilized, placed in risk pools, and allocated in a health system; ii) payment, how different actors and institutions in a health system are paid; iii) organization, how a health system is organized and managed; iv) regulation, how government rules are used to change the actions of both private and public institutions; and v) persuasion, how information and targeted interventions are used to change the choices and behaviors of specific actors in a health system. The commentary also makes four tentative suggestions for JIHS: mobilize expertise in all health system areas, develop a new unit for health system analysis, establish global relevance, and merge the two organizations effectively.

The COVID-19 pandemic posed a serious challenge to national and global pandemic preparedness and response (PPR). Timely identification and development of diagnostics, therapeutics and vaccines through prompt evidence generation from clinical trials was recognized as an important health security agenda. In 2022, under the guidance of Japan Ministry of Health, Labour and Welfare (MHLW), a health policy research team was convened to analyze the COVID-19 related clinical trial ecosystem in the context of PPR in Japan and abroad with a focus on clinical trials for therapeutics. The research mainly composed of the following: a narrative review of relevant peer reviewed journals and grey literature, interview of global experts and stakeholders including those from the United States and the United Kingdom, and a culminating meeting in Japan with various stakeholders. Based on the outcomes of this research, the team makes the following three recommendations: (1) Strengthen the leadership group's role in infectious disease clinical trials, (2) Promote sustained coordination and collaboration among stakeholders, and (3) Apply innovative clinical trial designs and create an enabling research environment. Clinical trials, as a public health good, must be further integrated into healthcare. The team advocates for the implementation of these recommendations at the policy level to help improve the clinical trial ecosystem for future health emergencies in Japan.