This commentary aims to reflect on the clinical implications of past pandemics and discuss Japan’s preparedness for future pandemics, with a specific focus on enhancing national countermeasures through clinical, infrastructural, and systemic reforms. By analyzing pandemics including the Spanish flu (1918), Asian flu (1957), Hong Kong flu (1968), H1N1 influenza (2009), and COVID-19 (2019- ), the article discusses their clinical features, societal impacts, and the factors that drive the spread of infectious diseases. With Japan’s clinical context as a case study, this commentary emphasizes the importance of enhancing healthcare systems to accommodate sudden surges in cases, with a focus on expanding infrastructure and ensuring rapid access to diagnostics, treatments, and vaccines. The commentary also advocates for improved early detection systems, effective global sharing of information, and the training of healthcare professionals to respond to emerging threats. This article argue that pandemic preparedness should go beyond lessons from COVID-19, promoting a comprehensive and flexible approach that can be adapted to a range of potential future scenarios. Such measures will help ensure that healthcare systems remain resilient and capable of mitigating the impact of future pandemics.

The Japan Institute for Health Security (JIHS) will be established in April 2025 by merging the National Institute of Infectious Diseases (NIID) and the National Center for Global Health and Medicine (NCGM). JIHS aims to enhance health security against infectious disease crises by integrating NIID's surveillance, epidemiologic investigation, and research expertise with NCGM's clinical care and research capabilities. An effective response to an infectious disease crisis depends on robust intelligence, systematic data analysis, and surge capacity – the ability to rapidly scale responses through mobilization of resources and an established infrastructure. An Emergency Operations Center (EOC), which centralizes emergency response coordination, is critical to harmonizing these diverse capabilities, enabling technical experts to focus effectively on specialized tasks. NIID has contributed to disease prevention through surveillance, laboratory reference services, and devising medical countermeasures. The establishment of NIID's Center for Emergency Preparedness and Response (CEPR) in 2020 and the EOC in 2021 markedly improved crisis management in the NIID, as demonstrated during events like Tokyo 2020 and the SARS-CoV-2 Omicron variant outbreak. These experiences highlight the importance of centralized coordination, which is being incorporated in the operational framework of the newly established JIHS. This article reviews NIID EOC's evolution and its crucial role in enhancing Japan's health security by consolidating lessons learned from recent public health crises.

In 2023, the Japan Institute for Health Security (JIHS) and the Universidad Nacional de Colombia (UNAL) conducted a successful clinical trial of the LC16m8 mpox vaccine in Colombia. The joint Japan-Colombia research team categorized the trial's challenges and success factors into several key operational aspects for analysis. Key success factors were an established database of Colombian human immunodeficiency virus (HIV) patient and pre-exposure prophylaxis (PrEP) population registries, and strong experience with large-scale clinical trials of HIV and COVID-19. In addition, a strong network of infectious disease specialists in Colombia enabled close communication between the study site directors and the research team. This allowed for rapid staffing and training, which was consistent with the study schedule. The outcome of this research identifies key success factors for the immediate implementation of large-scale clinical trials and will contribute to preparedness for future pandemics.

The establishment of the Center for Field Epidemic Intelligence, Research, and Professional Development (CFEIR) within the National Institute of Infectious Diseases (NIID) in 2021 marked a significant advancement in the country's epidemiological training capacity. Japan's Field Epidemiology Training Program (FETP), launched in 1999, has since trained 128 epidemiologists as of 2025, strengthening outbreak response efforts nationwide. The COVID-19 pandemic highlighted the acute shortage of field epidemiologists, emphasizing the need for FETP expansion and regional training initiatives. The introduction of the 1+1 training model and establishment of regional training spots in Osaka and Okinawa have diversified the participant base, increasing local outbreak response capacity. Since 1999, FETP trainees have been deployed to 419 outbreak investigations, including COVID-19, measles, food poisoning, and emerging infectious diseases. With the upcoming launch of the Japan Institute for Health Security (JIHS) in April 2025, efforts will focus on strengthening human resource development using field epidemiology and integrating applied epidemiology approaches such as One Health, disaster epidemiology, and risk communication. Strengthening international collaboration, particularly in the Western Pacific and Southeast Asia, remains a key priority. This paper underscores the evolving role of field epidemiology in Japan and the necessity of sustained investments in epidemiological training, digital tools, and global health partnerships to ensure preparedness for future pandemics.

Currently, there is a member-state-led discussion in the Intergovernmental Negotiating Body of the World Health Organization (WHO) to draft and negotiate a convention, agreement, or other international instrument under the Constitution of the WHO to strengthen global pandemic prevention, preparedness, and response (WHO CA+). An access and benefit-sharing (ABS) mechanism for pathogens is likely to be a key element of this instrument, as it may provide legal certainty for rapid pathogen sharing and global access to medical countermeasures against future pandemics and in some cases public health emergencies of international concern, which are expected to be provided to countries in need. A multilateral ABS mechanism may resolve issues arising from the bilateral nature of the current ABS mechanism established under the Nagoya Protocol (which requires recipients to decipher the complex web of ABS legislation, thereby preventing rapid access to pathogens), and may also improve uneven global access to medical countermeasures during pandemics. This study analyzes the ongoing WHO discussion on ABS mechanisms while reviewing other examples of such mechanisms, including those outside the health sector. Additionally, there is a growing global interest in mapping national policies on ABS, as discussions on international policies are ongoing in multiple fora. This study furthermore introduces Japan's ABS policy, which is not widely known, and explores how the new WHO mechanism could affect Japan, namely highlighting the importance and the challenges of participating in such a system for industry and academia in the context of a developed country.

In response to the urgent need to strengthen Japan's capabilities in vaccine and pharmaceutical development for future infectious disease outbreaks, a global research "network" aimed at enhancing international collaboration was conceived. As a result, the Japanese initiative for the Global Research Network and Link on Infectious Diseases (J-GRID+), funded by the Japan Agency for Medical Research and Development (AMED), was launched in 2023. The aim of this article is to share our initiative to strengthen the global research network to prepare for infectious disease crises. Institutions participating in the J-GRID+ network have been conducting infectious disease research hubs under the previous "Japan Initiative for Global Research Network on Infectious Diseases (J-GRID project)" which supported over 20 years. The J-GRID+ was established for two key components: i) the "Overseas Research Centers Development", which strengthens research capacities in regions affected by infectious diseases through collaboration between Japanese universities and overseas research institutions, and ii) the "Operation of the J-GRID+ Network Core Center" to strengthen the monitoring of the information of signs of infectious disease outbreaks globally, to support each research center, and to strengthen communication as a global network. In April 2025, the newly established Japan Institute for Health Security (JIHS) will serve as the core center. With this outlook, J-GRID+ strives to be an enduring platform that supports global health security while respecting and strengthening international relationships.

The COVID-19 pandemic highlighted the essential role of nursing professionals in infection control and patient care across various healthcare settings in Japan. Despite their dedication, the crisis exposed significant gaps in preparedness, training, and leadership development. This paper examines the challenges nurses and public health nurses faced during the pandemic and proposes a framework for strengthening capacity development to enhance future public health emergency responses. Fundamental infection control education must be systematically incorporated into basic nursing curricula, equipping nurses with essential skills such as proper use of personal protective equipment, zoning principles, and infection prevention strategies. Simulation-based training should complement theoretical instruction to ensure practical application. Continuous professional development through structured on-the-job training is crucial, particularly for smaller hospitals and elderly care facilities where infection control expertise remains limited. Public health nurses require specialized training in epidemiological investigations and outbreak management to coordinate community health responses effectively. Leadership in clinical settings and public health must be reinforced. The Infectious Disease Health Emergency Assistance Team (IHEAT) and supervisory public health nurses played key roles in the pandemic response. Still, challenges in rapid deployment and infrastructure readiness hindered their effectiveness. Strengthening managerial education and crisis response training will be critical to improving future outcomes. Additionally, networking and knowledge-sharing systems should be expanded to enhance communication and coordination. Mental health support for nursing professionals engaged in infection control must also be prioritized. This paper advocates a comprehensive approach to nursing education, training, and leadership development to fortify Japan's healthcare system against future pandemics.

Over nearly four years (March 10, 2021–December 31, 2024), we performed a comprehensive longitudinal analysis of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants among patients in a single hospital in Tokyo, Japan. Using RT-qPCR and Sanger sequencing, complemented by whole-genome sequencing, we tested nasopharyngeal swab samples (n = 4,628) and tracked the emergence and evolution of variants of concern (VOCs). The findings demonstrate the utility of a hospital-based SARS-CoV-2 variant surveillance system for informing clinical decision-making and public health settings, including: i) serving as a reference for selecting appropriate treatments, ii) enabling early detection of VOCs, iii) contributing to the development of hospital infection control guidelines, iv) fostering cooperation with local governments, v) supporting cohort studies, and vi) identifying long-term SARS-CoV-2 infections. This work underscores the importance of real-time variant monitoring for mitigating the effects of pandemics and provides essential epidemiological and clinical data that can guide future outbreak management and policy development.

Urban centers face a complex and multifaceted array of public health threats from infectious disease outbreaks and incidents of foodborne pathogens to health crises due to disasters, posing grave risks to people's health and societal stability. As the operational backbone of emergency response systems, public health rapid response teams are mission-critical in performing disease surveillance, outbreak containment, and clinical case management across all phases of emergencies. Nevertheless, persistent structural barriers including workforce deficits and competency mismatches constrain operational effectiveness during large-scale health emergencies. To address these challenges, this study proposes a resilience-building framework for public health rapid response teams that takes into account multi-hazard scenario planning and the evolving nature of events. Key interventions including institutional capacity building, strategic foresight initiatives, cross-sector policy integration, and tiered resource allocation systems have been implemented in order to enhance the core resilience dimensions of withstanding shocks, agile adaptability, and restoration of functioning.

The Korea Centers for Disease Control and Prevention (KCDC) was established in 2004 after the SARS epidemic. As a national disease control agency, KCDC strengthened its capacities for global health security based on experiences from some important issues such as the Influenza A/H1N1 pandemic (2009), the Middle East Respiratory Syndrome outbreak in Korea (2015), the Zika epidemic (2016), and COVID-19 pandemic (2020-2024). KCDC can make or revise infectious disease prevention and control related law, and collect, manage and analyze disease data from all the local public health centers and medical institutions in Korea. Based on the indicator-based surveillance, event-based surveillance and laboratory-based surveillance, KCDC conducts risk assessment for public health threats and has full responsibility as a competing authority in responding to outbreaks on a legal basis, which is specified in the national disaster framework. All quarantine stations in airports and sea ports belong to KCDC, and individual international travel history data at point of entries are linked to the National Health Insurance Services Database and medical doctors can access the database when the symptomatic individual visits the clinics/hospitals to check his/her travel history in the affected countries. This is a backbone to identify and notify imported infectious diseases from local clinic/hospitals to KCDC. Based on risk assessment in KCDC, KCDC triggers the Emergency Operations Center to respond. This KCDC-centered public health governance with centralized, comprehensive surveillance and response is one of the model cases from the health security perspective to consider for countries that are to establish new national public health institutes in the post-COVID-19 era.

On April 1, 2025, the National Center for Global Health and Medicine (NCGM) and the National Institute of Infectious Diseases (NIID) will be merged to establish the Japan Institute for Health Security (JIHS). This merger strengthens Japan's capacity to address infectious diseases and health threats, aiming for a resilient and secure society. This paper highlights the establishment of JIHS, its alignment with government reforms, and its strategic priorities for the future. The initiative originated on October 6, 2020, when the Liberal Democratic Party's Policy Research Council proposed measures to address vulnerabilities exposed by COVID-19. In 2022, the Japanese government called for formulating a central control tower, the Cabinet Agency for Infectious Disease Crisis Management (CAICM), upgrading the divisions related to infectious diseases to the Department of Infectious Disease Prevention and Control in the Ministry of Health, Labour and Welfare (MHLW), and establishing the JIHS. JIHS will serve as a scientific advisory body during infectious disease crises, guiding the Prime Minister and the MHLW. It focuses on four key areas: i) Disease intelligence: risk assessment and data analysis; ii) Research, development, and innovation: advancing medical science; iii) Comprehensive medical services: strengthening clinical response capacity; and iv) Human resource development and international cooperation: building expertise and partnerships. Through integration, JIHS aims to improve existing systems and create synergy between basic and clinical research. As a hub for domestic and international collaboration, JIHS will consolidate critical information, catalyze innovative research, and deliver transformative solutions to address domestic and global infectious disease challenges.

The COVID-19 pandemic has highlighted the importance of pandemic prevention, preparedness, and response (PPPR) in global health. This review first examined global health governance (GHG) for PPPR, identifying its core-satellite structure. Key GHG functions include rule-setting, resource mobilization, medical countermeasures (MCMs) supply, surveillance and data/pathogen sharing with rapid response, and One Health. Major gaps exist in global collaboration, enforcement of the International Health Regulations (IHR), and the World Health Organization's (WHO) capacity. The most urgent issue is pathogen access and benefit-sharing (PABS). Second, the PPPR capacity across world regions were assessed using two public datasets: eSPAR and GHS Index. Sub-Saharan Africa requires urgent support to strengthen most PPPR aspects, while epidemiological and laboratory surveillance, infection prevention and control (IPC), and regulatory functions need improvement in low- and middle-income countries (LMICs) in various regions outside Europe. Japan, with its strong PPPR capacity, is well-positioned to assist. Lastly, the review explored the link between PPPR and health systems strengthening (HSS). PPPR must be firmly integrated into HSS to ensure resilience, equity, inclusiveness, continuity of care, and sustainability. Core health system components — service delivery, workforce, health information systems, MCMs access, and governance — along with communication and trust-building, effectively contribute to PPPR. However, pandemic exceptionalism and the over-securitization of PPPR and health security may hinder coordination. The enhanced GHG for PPPR, led by the empowered WHO, should effectively facilitate and coordinate technical assistance to LMICs to strengthen their PPPR capacities and promote PPPR-HSS integration by bringing together the often-divided health security and HSS communities.

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.