The Impact of COVID-19 Outbreak on Health Emergency and Disaster in Japan

Abstract

The coronavirus disease 2019 (COVID-19) pandemic highlighted the importance of health emergency and disaster risk management (EDRM) to reduce the risks and impacts of infectious disease outbreaks. We investigated Japan’s response to the COVID-19 pandemic, focusing on changes made to the current health EDRM. Findings from document analysis and semi-structured interviews with six experts were integrated to provide insights into Japan’s health EDRM to improve outcomes in future health emergencies. Relevant information was extracted from COVID-19 policy documents published by the Japanese government, and the interviews validated and expanded on the data already collected. Challenges faced in the country’s response to COVID-19 and the changes made to the health EDRM framework are summarised. Findings were grouped into human resource topics (including essential health EDRM positions and safety of personnel), health service delivery topics (including public health and hospital primary care services), and logistical topics (including vaccination, personal protective equipment, patient transport, and telecommunications). These responses to the pandemic could serve as an example of good practice for other countries developing strategies for future health emergencies and disasters.

1. Introduction

In emergency and disaster situations such as the coronavirus disease 2019 (COVID-19) pandemic, health care systems must maintain their usual services and cope with new situations and risks. The ability of a health care system to resist, absorb, adapt, and recover from threats in a timely and efficient manner is known as resilience [1]. However, each country has specific characteristics regarding risks and hazards because of geographical, socioeconomic, and political factors. Consequently, emergency and disaster risk management varies with each country. Some countries have coped better than others during the COVID-19 pandemic, raising questions about which factors are associated with effective coping [2]. Good practices integrated with the peacetime health care system are needed to effectively develop, support, and disseminate frameworks for emergency and disaster risk management in different countries and under different scenarios [3].

The Health Emergency and Disaster Risk Management Framework (Health EDRM Framework) was formulated by the World Health Organization (WHO) in 2019 [4]. This framework guides countries and partners in developing capacities to reduce the risks and impacts of emergencies and disasters, including epidemics and pandemics. The health EDRM framework comprises a set of functions and components drawn from multisectoral emergency and disaster management; capacities for implementing international health regulations; health system building blocks; and good practices from regions, countries, and communities. Health EDRM primarily focuses on the health sector, noting the need for collaboration with other sectors that substantially contribute to reducing health risks and consequences. Health EDRM functions consist of 10 components: (i) policy, strategy, and legislation; (ii) planning and coordination; (iii) human resources; (iv) financial resources; (v) information and knowledge management; (vi) risk communications; (vii) health infrastructure and logistics; (viii) health and related services; (ix) community capacities for health EDRM; and (x) monitoring and evaluation. The recent COVID-19 pandemic has highlighted the importance of health EDRM in many countries.

In Japan, national efforts have been made to address the COVID-19 pandemic with various stakeholders, including politicians, administrators, health care professionals, and industry. Despite having a super-aged society and a large urban population, Japan had one of the lowest rates of excess deaths caused by COVID-19 [5]. While the global COVID-19 pandemic has not yet ended, reflecting on health EDRM in Japan and identifying challenges may lead to a better response to future global infectious disease outbreaks. Therefore, we aimed to investigate Japan’s response to the COVID-19 pandemic, focusing on changes in the existing health EDRM system, and the impact of these changes for future health emergencies and disasters.

2. Materials and Methods

2.1. Study Design

The study employed a qualitative research design, combined with policy document analysis and semi-structured interviews with experts. Responses to COVID-19 were analysed from the perspective of human resources, health service delivery, and logistics.

2.2. Study Setting

The study was undertaken during the entire period of the COVID-19 pandemic in Japan. Policy documents regarding COVID-19 published by the Japanese administration between December 2019 and June 2022 were analysed. Semi-structured interviews with six experts were conducted between June and August 2022.

Transition of the Infection Situation and Response in Japan

Because information regarding the transition of the infection situation and response in Japan is limited, relevant information is described below. When the first case of COVID-19 was identified in Wuhan (China) in December 2019, Japan protected Japanese citizens in Wuhan as a border measure [6]. After the first infection in Japan was confirmed on 24 January 2020, the Japanese government focused on measures to prevent small clusters of patients from triggering subsequent outbreaks [7]. However, as the number of infected cases increased, the government faced challenges, such as a shortage of personal protective equipment (PPE), limited testing capacity, and a strained health system. A state of emergency was first declared in some areas of Japan on 7 April 2020. This declaration was later extended to the entire country until 25 May 2020 (Figure 1).

During this time, the government closed schools and other institutions temporarily, reduced the opening hours of restaurants and bars, closed large commercial facilities, cancelled or postponed events, and urged the public not to go out unnecessarily (First wave) [8]. In January 2021, the government declared a second state of emergency after the outbreak spread again in some prefectures (Third wave) [9]. In April 2021, the third state of emergency was declared because of an increase in the number of new cases and an increase in the severity of cases in some prefectures, resulting in pressure on the health care system (Fourth wave). In February 2021, a messenger ribonucleic acid (mRNA) vaccination produced by Pfizer was launched. The administration of two doses of the vaccine was largely achieved among older people seeking the vaccine by the end of July 2021. The pandemic situation then improved rapidly in September 2021 because of increased vaccination uptake among adolescents and young people through the implementation of vaccination programmes in workplaces, mainly using the mRNA vaccine manufactured by Moderna. However, the pandemic worsened further in November 2021, with the confirmation of the Omicron variant in the country (Sixth wave). Between January and March 2022, the government carried out semi-emergency coronavirus measures as a preliminary step in declaring a state of emergency [10]. Strict measures were implemented to prevent infection and ensure testing in elderly care facilities, taking into account the characteristics of the Omicron variant.

2.3. Data Collection and Analysis

2.3.1. Document Reviews

Policy documents on COVID-19 published by the Japanese administration were collected, and information relevant to this study was extracted. The search language was limited to Japanese. A data collection protocol was developed in collaboration with members of the research team. This protocol covered the three functional components of human resources, health services, and logistics listed in the WHO publication on the health EDRM framework [4]. The information obtained was categorised into three functions: human resources, health services, and logistics. Four categories were further identified for each of these functions: (1) difficulties and challenges experienced; (2) Japan’s response to difficulties and challenges; (3) lessons learnt from the COVID-19 pandemic in preparation for future responses; and (4) the impact on the current health systems and COVID-19 health crisis management.

2.3.2. Semi-Structured Interviews

In addition to the document review, semi-structured interviews were conducted to validate and expand the data collected. The research team developed detailed protocols for semi-structured interviews, and the developed questionnaire was iteratively refined through team review and discussion. The semi-structured interview protocols included the categories used in the document analysis: (1) difficulties and challenges experienced; (2) Japan’s response to difficulties and challenges; (3) lessons learnt from the COVID-19 pandemic in preparation for future responses; and (4) the impact on the current health systems and COVID-19 health crisis management.

We selected representatives of the health EDRM and infection control practices for COVID-19 in Japan for our interviews to validate and expand the data collected by the document reviews. The interviewees were recruited through the personal networks of the research team, with six experts eventually participating. These experts included two public health administrators at prefectural and municipal public health centres, two public health professors, one manager of an infection control team at a university hospital, and one secretariat official from the Disaster Medical Assistance Team (DMAT). The interviews were conducted face to face for 60 to 90 min in the Japanese language and were audio-recorded. Data were analysed by one researcher (T.I.). Interview scripts were coded, similar groups were categorised, and the content associated with each category was listed according to (1)–(4) above. The analysis results were presented to the interviewees to elucidate their views regarding the validity of the categorisation and interpretation. Results were summarised in tables for each area including human resources, health service delivery, and logistics.

2.4. Ethical Approval

In this study, publicly available health policy documents were analysed. Therefore, ethical approval from the Institutional Review Board was not required for the document review. However, interview data were treated confidentially, and the participants’ consent was obtained.

3. Results

The document review referred to resources on the website of the Japanese Government’s Task Force on Infectious Diseases of New Coronaviruses (https://www.kantei.go.jp/jp/singi/novel_coronavirus/taisaku_honbu.html (accessed on 1 October 2022)). All participants in the interviews were engaged in community health, hospital infection control, and cluster control during the COVID-19 pandemic.

The information obtained from the document search and interviews was summarised into four human resource, two health service delivery, and five logistical topics, in line with the health EDRM framework. The four main topics that emerged from the discussion on human resources were (1) essential health EDRM positions; (2) integration of workforce development strategies with health EDRM functions and competencies; (3) licensing and accreditation of staff/volunteers; and (4) safety and security of public health personnel (

Table 1. Japan’s response to the COVID-19 * pandemic: Human resources.

(1) What Difficulties Has Your Country Experienced during COVID-19?	(2) How Did Your Country Respond to the Challenges Mentioned in (1)?	(3) What Did You Learn from the Current COVID-19 Event to Prepare for Future Responses?	(4) What Influences Have These Challenges and Responses Had on Present and Post-Coronavirus Systems?
➢ A shortage of doctors, nurses, epidemiologists, laboratory technicians, and lab doctors.	➢ Increasing the number of public health nurse positions and financial measures. ➢ Establishing a scheme for the dispatch of health care professionals between local authorities. ➢ Setting up a human resources bank to register potential public health nurses.	➢ Posts should be considered in a health emergency.	➢ Permanent staffing of health centres has been reviewed.
➢ Absence of experienced crisis management officers. ➢ Lack of skills of health centre staff engaged in infectious disease work.	➢ Building a crisis management system in cooperation with stakeholders. ➢ Using support systems via DMATs * and ministry cluster teams. ➢ Cross-training of health centre staff.	➢ There are difficulties in developing human resources for crisis management officers under job rotation. ➢ There is a lack of opportunities for experience in infectious disease work in ordinary situations.	➢ Human resources have been developed at five levels of health centre staff (from area-wide supervision to field staff) responsible for health crisis management. ➢ Non-infectious disease service personnel should also be eligible for infectious disease training.
➢ Insufficient use of external experts to provide scientific support in the health emergency.	➢ Implementing a registration management system for external experts. ➢ Increasing the number of temporary staff and outsourcing work in response to infectious disease outbreaks.	➢ External experts and temporary staff are not always immediately available.	➢ A registration management system and training implementation programme has been established for external experts. ➢ A “health and medical care delivery system assurance plan” has been formulated for each health centre, considering the structure and staffing methods used in pandemics.
➢ Safety and security of health care workers and physical and mental health problems of health workers.	➢ Reducing extra working hours because of more efficient operations. ➢ Improving working environments and rest rooms. ➢ Ensuring a health management system for occupational physicians.	➢ Supporting the safety and health of public health professionals is important.

* COVID-19: coronavirus disease 2019; DMAT: disaster medical assistance team.

). The discussion on health service delivery was categorised into two main topics: (1) public health services and (2) hospital and primary care services (

Table 2. Japan’s response to the COVID-19 * pandemic: Human services.

(1) What Difficulties Has Your Country Experienced during COVID-19?	(2) How Did Your Country Respond to the Challenges Mentioned in (1)?	(3) What Did You Learn from the Current COVID-19 Event to Prepare for Future Responses?	(4) What Influences Have These Challenges and Responses Had on Present and Post-Coronavirus Systems?
➢ Disruptions in the provision of routine health care services.	➢ Introduction of area-wide management and information-sharing systems in the prefectures. ➢ Prioritisation of tasks and implementation of priority measures. ➢ Use of apps and other information technology. ➢ Outsourcing of administrative personnel. ➢ Alternative input by patients themselves or health care providers.	➢ It is helpful to build a system to support each health centre across the region. ➢ Improving the operational efficiency of health centres and the transfer of authority should be considered.	➢ Formulation of a government action plan that works for specific operations at the field level, such as securing hospital beds. ➢ Government financial support was ensured for the above.
➢ Shortages of medical professionals and hospital beds to respond to the rapid increase in COVID-19 medical care. ➢ Dual delivery of COVID-19 and non-COVID-19 services.	➢ Centralisation of digital management of the operational status of hospitals and the status of medical staff nationwide (G-MIS*). ➢ Improvement of the treatment of health care personnel. ➢ Dispatch of health care personnel from other regions, the Self-Defence Forces, and DMATs *. ➢ Mitigation of attendance requirements for health care personnel in close contact. ➢ Expansion of online medical services. ➢ Use of non-medical resources, including the principle of home care for people with mild symptoms.	➢ A government action plan that works for specific operations at the field level should be formulated, such as securing hospital beds. ➢ The role of each health care facility should be clarified to ensure compatibility between routine and COVID-19 care. ➢ COVID-19 treatment requires more health care personnel than the number needed in ordinary situations. ➢ Securing hospital beds and health care workers should be addressed equally.	➢ A system responsible for securing and coordinating the deployment of medical personnel was established to ensure the smooth operation of temporary medical facilities and other facilities in pandemics. ➢ Visualisation of the operational status of the health care system using G-MIS and receipt data.

* COVID-19: coronavirus disease 2019; DMAT: disaster medical assistance team; G-MIS: Gathering Medical Information System.

). After reviewing logistics, the following five main topics were identified: (1) COVID-19 vaccination; (2) personal protective equipment (PPE); (3) polymerase chain reaction (PCR) testing and specimen transport; (4) patient transport; and (5) telecommunications (

Table 3. Japan’s response to the COVID-19 * pandemic: Logistics.

(1) What Difficulties Has Your Country Experienced during COVID-19?	(2) How Did Your Country Respond to the Challenges Mentioned in (1)?	(3) What Did You Learn from the Current COVID-19 Event to Prepare for Future Responses?	(4) What Influence Have These Challenges and Responses Had on Present and Post-Coronavirus Systems?
➢ Delays in vaccine supply, inefficient distribution. ➢ Difficulties in vaccine storage (ultra-low temperatures) and transport management methods.	➢ Notification of prospective vaccine quotas. ➢ Assignment of ministers in charge and operation of liaison teams to liaise between the state and the region. ➢ Selection of wholesalers responsible for vaccine, needle, and syringe distribution by region. ➢ Vaccination authorisation by health care professionals other than physicians and nurses. ➢ Financial support for the use of the Self-Defence Forces, the establishment of large-scale vaccination centres, and the expansion of holidays and night-time working. ➢ Bulk procurement and distribution of ultra-low temperature freezers, dry ice, and cold bags for refrigerated transport.	➢ Domestic development and production of vaccines are a matter of national security. ➢ It is important to strengthen cooperation between the national government, public health centres, and stakeholders in the vaccine distribution system. ➢ There is a need to establish various vaccination regimes depending on the type of vaccine and local conditions.	➢ Support has been strengthened for the domestic development and production of vaccines.
➢ Shortage of essential materials, including PPE (face masks) and medical equipment (ethanol for hand sanitiser).	➢ Government buy-up and push distribution; emergency distribution based on application (pull distribution). ➢ Increased production, requests for entry into other industries, the release of stockpiles, priority supply, and expansion of import sales channels. ➢ Prioritisation of opportunities for use, reuse sanitisation, and substitution with similar industrial products. ➢ Use of online consultations with general patients. ➢ Restrictions on resale in the general market. ➢ Purchase and transfer by the national government of consumables for ventilators and ECMOs *.	➢ It is important to monitor the supply and demand and simulation of future pandemics.	➢ The government Action Plan defines specific items and stockpiles. ➢ Government purchases under the stockpiling operation have been implemented under the rotating stockpile system.
➢ Lack of institutions to carry out PCR*. ➢ Shortage of testing material.	➢ Review of criteria for consultation and consultation guidelines. ➢ Prioritisation of supply. ➢ Outsourcing to universities, private laboratories, and local medical associations; simplification of the establishment and registration process. ➢ Requests for increased production of testing equipment and other products. ➢ Use of simple test kits.	➢ An effective testing regime with targeted and focused inspections is needed. ➢ Cooperation should be strengthened between public health centres and relevant agencies in hospitalisation, coordination, and transfer operations. ➢ A system of temporary health facilities should be established in pandemics.	➢ The testing capacity of public laboratories has been enhanced, e.g., in regional health laboratories. ➢ Prior assurance has been given for a certain quantity of test kits in the region.
➢ Difficulties in selecting a host medical institution for patients. ➢ Shortage of patient transport personnel.	➢ Coordination of hospital admissions by the Prefectural Coordination Headquarters. ➢ Outsourcing to transfer operations. ➢ Provision of accommodation and treatment facilities for patients with mild symptoms. ➢ Temporary medical facilities to wait until admission to hospital; oxygen stations and free loans of oxygen concentrators.		➢ A “health and medical care delivery system assurance plan” was formulated for each health centre, taking into account the structure and staffing methods to be used in pandemics. ➢ Government financial support was ensured for the above.
➢ Difficulties in integrating information related to COVID-19. ➢ Administrative burden of information entry tasks.	➢ Operation of a national unified system. ➢ Improving administrative efficiency through digitisation. ➢ Increase in administrative personnel. ➢ Alternative input by patients themselves or by health care providers. ➢ Preparation of manuals for personnel.	➢ Timely improvement of the system is needed, with thorough quality control and promotion of its use. ➢ Promotion of inter-system collaboration is needed.	➢ Digitisation of health centre operations has been promoted.

* COVID-19: coronavirus disease 2019; ECMO: extracorporeal membrane oxygenation; PCR: polymerase chain reaction.

).

4. Discussion

4.1. Human Resources

The COVID-19 pandemic revealed a shortage of professional staff in charge of health crisis management in public health centres (Table 1). Organisations responsible for infectious disease crisis management at a community level, such as health centres, had 852 sites in 1992, staffed by 35,000 officers [11]. From 1994, frequently used health and welfare services were consolidated with the aim of transferring them to the municipalities [12]. Consequently, by 2019, the number of sites had reduced to 469, with only 28,000 officers [11]. This background may account for the overall shortage of professional staff to deal with the COVID-19 pandemic. Therefore, the Japanese government expanded the number of public health nurses engaged in infectious disease response work by 1.5 times and established a scheme to dispatch public health nurses and other support personnel between local governments. A personnel resource bank was established to register potential public health nurses and other personnel on a prefecture-by-prefecture basis. These increases in public health staff were also implemented in other countries, such as Australia [13]. Meanwhile, it should be noted that education for local staff is also an important factor for emergency preparedness [14]. Participants reported an absence of experienced crisis management officers and a lack of skills among health centre staff engaged in infectious disease work. Community health in Japan was found to operate with a field-based system in which staff are called in from the relevant departments depending on the emergency. Routine staffing differs from staffing for crisis management response—typically, only a few personnel are assigned with job rotation after 2–3 years. During the COVID-19 pandemic, public health centres in Japan established a crisis management system in cooperation with the relevant authorities, including the prefectures [15]. In difficult response situations, DMAT and cluster teams were requested by public health centres to provide support [15]. On the basis of this experience, Japan’s infectious disease crisis management system is being reviewed. Human resource development is planned in five areas: supervisors (approximately 90), administrative support leaders (approximately 800), practical personnel (approximately 2000), a human resource bank (approximately 1200), and cluster teams.

In addition, insufficient use of external experts to provide scientific support during the pandemic was identified. The government founded the Infectious disease Health Emergency Assistance Team (IHEAT) in August 2020 [16] to address the inability of the normal public health centre personnel structure to respond in the early stages of the COVID-19 pandemic. IHEAT is a human resource bank made up of external professionals (approximately 3500 public health nurses, physicians, and registered nurses) recruited through relevant academic societies and organisations to support work centred on an active epidemiological investigation at public health centres [16]. Alternatively, in developing countries where health care workers are limited, local residents were utilised as volunteers for epidemiological surveys [17]. However, these external expert volunteers were not necessarily familiar with the type of work required, and therefore, there were regional differences in the utilisation of IHEAT. There is an urgent need to clarify the position of IHEAT in existing plans and to strengthen training for IHEAT registrants.

Public health centre staff experienced overwork during the COVID-19 pandemic. Burnout, insomnia, and stress were reported, often linked to unreasonable demands and complaints from the public and relevant authorities [18]. Some public health centres have taken steps to use existing resources, such as reducing extra working hours by streamlining administration, improving the environment, including work and rest areas, and implementing health management schemes, including interviews with occupational physicians. Meanwhile, interviewees expressed concern that occupational health and safety services are insufficient for staff in many health centres. Occupational health and safety for staff is associated with their willingness to respond to the COVID-19 pandemic [19].

4.2. Health Service Delivery

The COVID-19 pandemic led to significant operational delays and a lack of response because of the strain on health services (Table 2). For instance, difficulties occurred in securing inpatient beds for infected people. Consequently, each prefecture with multiple public health centres under its jurisdiction set up an area-wide coordination headquarters to enable the management of hospital admissions by coordinators, such as physicians with experience in disaster response [10]. Public health centres prioritised their work or reduced or postponed routine work during periods of infection spread, increased the number of temporary administrative personnel, and requested support from departments in charge of non-infectious diseases [20]. Furthermore, outsourcing opened up the work of health centres to universities and private companies to reduce workload by requesting cooperation from medical institutions, business establishments, and other relevant organisations. Information technology (IT) was used, where possible, to carry out procedures for individuals [10]. These findings suggest that it is important to establish a system to support public health centres across the wider region. Currently, each region incorporates these measures in the health care delivery system assurance plan, depending on the pandemic situation. Regions also experienced shortages of medical personnel and specialised beds to handle the rapidly increasing burden of COVID-19 treatment, delays in consultations or scheduled surgeries, and hospital admissions in non-COVID-19 care [21]. Interviewees reported that early government action plans did not work for specific operations at the field level, e.g., for securing hospital beds. In March 2020, the government introduced the Medical Institution Information Support System (G-MIS) to all medical institutions (approximately 38,000) in Japan [11]. This enabled centralised monitoring and support of the operational status of hospitals, available beds and medical staff, the number of patients and tests, and the availability of medical equipment (e.g., ventilators) and medical materials (e.g., face masks and protective clothing). Such promotion of public–private partnerships has the potential to improve the health care system in both emergency and non-emergency situations [22].

Information from G-MIS and requests from the community resulted in Self-Defence Force (SDF) nurses and nurses from other prefectures being dispatched to support medical care [11]. The government expanded online medical care and home nursing, established guidelines for the home rest and recuperation of people with minor symptoms, and used non-medical resources [10]. As health care resources are limited, medical facilities must share roles in the community according to their functions, such as priority medical facilities and partner organisations for receiving patients with suspected infection. In addition, as COVID-19 treatment requires more medical personnel than regular treatment, policies to secure hospital beds and medical personnel need to be implemented in an integrated way.

4.3. Logistics

There were several challenges in facilitating vaccination that spanned multiple ministries and agencies. These included establishing vaccination systems in local government and storing and transporting vaccines at ultra-low temperatures (Table 3). In January 2021, a new minister in charge of vaccination promotion was assigned to coordinate vaccine administration and information dissemination. The government started dispatching liaisons to inform local authorities about the prospects of vaccine allocation to facilitate practical vaccination plans and coordinate liaison between the government and local authorities [23]. Different vaccines require different methods of administration and transport. Thus, vaccination locations were categorised as medical centres, large vaccination sites, and workplaces, and single vaccines were supplied to them. As a result, two-dose vaccination among older people was largely achieved by July 2021. Progress was also made in vaccinating adolescents and young people through the implementation of vaccination at workplaces [24]. The Japanese population traditionally has strong vaccine hesitancy, partly caused by the dependence on imports of COVID-19 vaccine [25]. Therefore, the development of domestically produced vaccines was encouraged.

Temporary shortages of PPE, medicines, test kits, and laboratories to carry out Polymerase Chain Reaction (PCR) tests were also reported. The initial Government Action Plan did not specify these items or stockpiles. However, the government changed from the initial scheme, in which they requested manufacturers and wholesale distributors to distribute the products, to a system whereby medical masks were purchased and distributed in an on-demand way, in March 2020 [11]. They also asked health care providers to prioritise opportunities for using N95 and other products, to reuse them after disinfection and make use of alternative industrial products with similar specifications. In April 2020, as pull-type support, a system was put in place to identify supply shortages at medical institutions using G-MIS and to carry out emergency distribution [11]. The registration procedures and criteria for private institutions to establish PCR testing laboratories were amended. Faced with a shortage of PCR test kits, targeted PCR testing was carried out in specific regions and industries (e.g., locations with entertainment venues in urban areas of cities) [10]. In response to the shortage of PPE, each country took their own actions: adjusting prices, limiting exports, and distributing on a priority basis [26,27,28]. These experiences suggest that monitoring supply and demand, simulation-based stockpiling, and capacity building are key mechanisms.

Under the Infectious Diseases Law, public health centres should undertake the transfer of COVID-19 patients to medical facilities. However, the considerable frontline workload made this challenging to achieve. The issue of inadequate information sharing regarding available medical facilities among stakeholders was also identified [29]. Hence, a Regional Coordination Headquarters was set up, and the hospitalisation coordination tasks assigned to public health centres were centralised at the prefectural headquarters [10]. To maintain the health care delivery system, the government used private hotels and other accommodation facilities as venues for infected people with minor symptoms. In some urban areas with large numbers of infected people, oxygen stations were established to administer oxygen to those requiring hospitalisation while their transport destination was finalised. These stations were implemented temporarily during a period of difficulty in securing beds. The health care delivery system assurance plans for each region included the creation of a general coordinating body, strengthening coordination between relevant agencies, and establishing a hypothetical health facility during an outbreak.

Using faxes to count the number of infections became a burden in the field, and rapid data collection and analysis were cited as a challenge [29]. Accordingly, a Health Centre Real-time Information-sharing System (HER-SYS) for COVID-19 cases and a Vaccination Record System (VRS) were developed and introduced [30]. System modification was performed occasionally because of the lack of personnel and the complexity of the system operation [30]. Additional temporary administrative personnel and alternative input from patients and health care providers were introduced. These experiences represent a step towards promoting the digitisation of existing vaccination registers and other information management systems in public health centres.

4.4. Limitations

The current study entails several limitations. First, the literature review was not systematic, and some themes/opinions may have been overlooked. Second, as there were only six interviewees, respondents’ views may have been biased by their beliefs or particular experiences. However, the current preliminary report may contain useful information regarding the timeliness of reporting for health emergency preparedness during the COVID-19 pandemic. Finally, the literature review and interviews were not intended to delve deeply into specific details but to provide an overview of health EDRM in Japan.

5. Conclusions

The study summarised the changes made to the existing health EDRM during the health response to the COVID-19 pandemic in Japan. Although the number of public health personnel has been increased and volunteers have been utilised under the COVID-19 epidemic, their education and post-COVID-19 staffing need to be addressed. Health service delivery has become more efficient through an administrative monitoring system, which is expected to have a positive impact on health care in peacetime. The logistics of vaccine and PPE distribution and patient transport were improved by establishing a coordination platform among stakeholders and the utilisation of information technology. The analysis of Japan’s response provides examples of good practice for other countries developing strategies for future health emergencies and disasters.