The rapid spread of COVID-19 throughout Japan together with what some see as government mishandling of quarantine measures on the virus-hit Diamond Princess cruise ship are reigniting calls for Japan to establish an independent decision-making body similar to the Centers for Disease Control and Prevention (CDC) in the United States.
Prime Minister Shinzo Abe made headlines earlier this month when, in response to a ruling party lawmaker’s question, he told a Diet committee that he would “think about” creating such an organization.
On the front lines of the nation’s ongoing battle against the COVID-19 outbreak is the National Institute of Infectious Diseases (NIID), an entity commonly cited as Japan’s closest equivalent to the CDC.
But unlike the CDC, which experts say is granted greater autonomy despite being placed under the jurisdiction of the U.S. Department of Health and Human Services, the NIID lacks independence from Japan’s health ministry.
“We are the ministry’s outpost agency that takes action based on its instruction and guidance,” an NIID official said. “We are not an entity independent of the health ministry.”
That arrangement came under scrutiny last week when professor Kentaro Iwata, an infection control specialist at Kobe University Hospital, posted a video to YouTube in which he identified gaps in measures on the Diamond Princess. In the video, which went viral, he slammed what he described as a lack of a scientific principle in how quarantine had been implemented aboard the cruise ship.
Iwata, who briefly entered the vessel to inspect the situation within, told an all-English news conference in Tokyo last week that the absence of “scientific decision-making” by an independent team of professionals had led to “inadequate” infection prevention measures on the ship, including a failure to clearly distinguish between the virus-free “green” and potentially contaminated “red” zones.
Such principles “will never be given by bureaucrats because they never had an infection prevention training, they don’t have experience and they don’t have a system,” Iwata said.
A “CDC should have all of these things,” said the professor, who has long highlighted the need for a Japan version of the CDC.
Worldwide, there are already organizations that describe themselves as counterparts to the CDC. For example, the 2003 outbreak of severe acute respiratory syndrome (SARS) prompted the launch of the European Center for Disease Prevention and Control. China and South Korea also have their own versions — the Chinese Center for Disease Control and Prevention and the Korea Centers for Disease Control and Prevention.
Japan, however, has so far stopped short of establishing such a body. Anti-infection policies, including vaccination and quarantine, are so strictly controlled by the health ministry that the government has seen “little incentive to create a group of professionals outside of that framework,” according to Kenji Shibuya, a former University of Tokyo professor who now serves as director of the Institute for Population Health at King’s College London.
Moreover, he added, “There has always been an argument that ‘we already have the NIID.'”
But the NIID doesn’t even come close to fulfilling the role of the CDC, the professor said. Because its personnel are focused primarily on “basic research” into infections, they are therefore fundamentally unequipped to contain any infectious outbreak with the level of urgency and expertise of which the CDC is capable, Shibuya explained.
“Responding to a public health crisis requires the kind of intelligence and logistics abilities that you would need to deal with natural disasters or conflicts,” said Shibuya, adding that basic research of infections is “a realm completely different from actual control of infection outbreaks.”
The professor noted that the CDC, headquartered in Atlanta, has the ability to promptly mobilize key professionals in each state in the event of an emergency. But, Shibuya said, the NIID lacks such authority — ceding decision-making power to bureaucrats within the health ministry.
The NIID itself is struggling, too.
The outbreak of COVID-19 has prompted Ehime Medical Practitioners Association to issue a statement urging Abe to finance the organization more robustly.
In it, the group pointed out that the amount of budget set aside for the NIID had undergone massive cuts over the years to stand at ¥4.1 billion in fiscal 2018, down from the ¥6.1 billion in 2009.
The organization’s financial straits were perhaps flagged most urgently in a report compiled in 2011 by a group of experts assessing its situation.
The report said that despite being having fewer staff and a smaller budget than the CDC, the NIID was tasked with a wide range of responsibilities that even the CDC shared with entities such as the National Institutes of Health and the Food and Drug Administration.
“Despite the dwindling manpower and budgets, the scope of tasks and studies expected of the institute has continued to grow, leading to the point where its current operation relying on individual efforts by staff is approaching the limit,” it said.
With concerns over the lack of funding resurfacing in recent years, it seems the report’s warnings fell on deaf ears.
The issue was taken up at a Diet committee meeting in April last year by Japanese Communist Party lawmaker Tomoko Tamura, who sounded alarm about what she described as continued curtailment of manpower and budgets in the NIID. In responding to her questions, health ministry official Yasuyuki Sahara explained that the number of personnel at the institute had been trimmed in accordance with a state-led campaign to streamline the workload of civil servants.
But at the same time, he said, the ministry was keenly aware of the importance of the NIID and that for the current fiscal year, which ends on March 31, the ministry had increased the number of NIID researchers to 307 — up one person from the previous year.
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