Japan’s Response to Ebola Outbreak in West Africa A case of strengthening national implementation & lessons for cooperation and assistance Tomoya Saito, MD, MPH, PhD Chief Senior Researcher Department of Health Crisis Management NATIONAL INSTITUTE OF PUBLIC HEATLH, MHLW Visiting Associate Professor Graduate School of Science and Technology TOKYO INSTITUTE OF TECHNOLOGY BWC Expert Meeting 2015
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Japan’s Response to Ebola Outbreak in West AfricaA case of strengthening national implementation& lessons for cooperation and assistance
Tomoya Saito, MD, MPH, PhDChief Senior Researcher
Department of Health Crisis Management NATIONAL INSTITUTE OF PUBLIC HEATLH, MHLW
Visiting Associate ProfessorGraduate School of Science and Technology
n Ebola Virus Disease (EVD) outbreak in West Africa started in 2014 was the largest outbreak in history.q “Public Health Emergency of International Concern”q “constitutes a threat to international peace and security”
UN Security Council Resolution 2177 (2014)
n Although travelling between Japan and West Africa is very limited, Government of Japan reinforced the response capacity, taking a whole-‐of-‐government approach.
n Reinforcement of domestic capacity and international cooperation for EVD were reviewed to derive lessons for BWC context.
n Legal Preparednessq Act on Infectious Disease Control
n Category 1 Infectious Diseases1)
q Hospitalization in Specified or Class 1 Infectious Disease Hospitals2)
q Restriction of activities, etc.
q Quarantine Actn Quarantine Diseases
q Isolation, Quarantine, etc.
n Medical Preparednessq 453) Infectious Disease hospitals for treatment2)
q Dx capacity at BSL-‐3 Laboratory in National Institute of Infectious Diseases
Preparedness for Viral Hemorrhagic Feversin Japan
1) Others include Smallpox and Plague2) With a negative pressured private ward with toilet and shower, dedicated ventilation and drainage, etc.3) 3 Specified* (designated by GOJ) and 44 Class 1* (designated by local gov.) as of Aug. 2014. * 2 are designated for both.
n Trainings in Infection Control (PPE, etc.)n 2 newly designated Class 1 Infectious Disease Hospital
q Convergence of limited expertisen Expert Committee for Therapeutics of Category 1 diseases at MHLW
q Operation of BSL4 Lab in NIIDn MoH reached an agreement with a local municipality in operating a BSL4 facility in NIIDn MoH designated NIID as a possessor of VHF pathogens on August 7, 2015.
n Interdepartmental collaborationq Whole-‐of-‐government responseq Collaboration of public health institute with Police/Fire Defense
n Documented protocol for transporting patients/lab samples
q Exercises in all 141 municipalities that owns public health centers
Public health legacies in Japanafter EVD outbreak in West Africa
n Development of anti-‐virals for EVDq Provided for an emergency use
in developed countries and a clinical trial (JIKI study) in Guinea by Toyama Chemical (in-‐kind)
q Pre-‐clinical studiesn Pharmacokinetics*n Safety studies in juvenile monkeys*n Challenge studies in animal model
q Development of intravenous injection form*
Development and in-‐kind contribution of medical countermeasures (2)
Favipiravir(Toyama Chemicals)
Licensed in Japan fornovel/re-‐emerging influenzaEfficacy for EVD in Mouse
*Project for Research and Development of Therapeutics and Diagnostics for EVD controlPI: Professor Tsutomu Takeuchi, St. Luke’s International University/funded by AMED
n Challenges in cooperation and assistanceq Personnel contribution was limited to 〜20 expertsn Lack of human resourcesn No deployable national team for an outbreak assistance n Safety and security
q Medvac capacity
Japan’s response to the Ebola outbreak in West Africa
Human resource development for global infectious disease control in Japann Development Program for Experts of Infectious Disease Crisis Management by MHLWq 2 year program
n OJT as a medical officer in MHLW, a trainee in FETP in NIID and an infectious disease physician in a hospital
n OJT in international agencies, etc.
q 5 MDs/yearq Registered as “Infectious Disease
Crisis Management Experts”to be dispatched in global emergency
Summary (1)A case of strengthening national implementationn EVD outbreak from 2014 provided a crucial opportunity to reveal challenges and to improve preparedness in Japan for rare but high impact emerging diseases that are prone to be neglected. q Progress in interdepartmental collaboration was
remarkable through whole-‐of-‐government approach.q Efforts to sustain “legacies” may help contain future
emerging diseases including acts of bioterrorism and pandemic influenza.
n Continuous international support is required for developing IHR core capacity.
n Cooperation and assistance for surrounding non-‐endemic countries should not be neglected.
n Safety and security for dispatching experts to affected countries is a challenge even in a natural outbreak.q More efforts on capacity development concerning safety
and security of personnel is required for the assistance under Article VII.
n National Institute of Infectious Diseasesq Drs. Saijo, Shimojima, Fukushi (Dept. of Virology I)
n St.Lukes International Universityq Prof. Takeuchi, Ms. Maehira
n Nagasaki Universityq Prof. Yasuda
n National Institute for Defense Studiesq Dr. Tanaka
n Japan International Cooperation Agency (JICA)n Ministry of Foreign Affairs, Japann Research Fund from Japan Agency for Medical Research and Development
(15fk0108012h0201,15fk0108039h0002)and JSPS KAKENHI Grant Number 15KT0054