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Public Health Emergency Preparedness and Response in Ministry of Health,

Labour and Welfare (MHLW)

Toshiyasu Teratani, M.D., Ph.D. Office of Public Health Emergency Preparedness and Response

Ministry of Health, Labour, and Welfare (MHLW) Japan

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March 8, 2014 @Kojima Hall （Tokyo university）

My history

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1977

1998-2003

2004-2007

2008-

• Introduction

• Public health risk management and coordination – 1 : overview

– 2 : Response to natural disasters

– 3 : Response to pandemic influenza

• Next steps

• Summary

Outline

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Introduction

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What is Public Health?

• Time transition

• Micro vs. Macro

Public Health for people, for life

Health (Prevention)

Medicine (treatment)

Welfare (maintance function-

activity-participation)

• 1940s - 1950s Infectious Diseases • 1960s - 1970s Environmental Pollution • 1980s Medical Scandal

AIDS caused by transfusions of HIV-tainted blood products →1997 MHLW framework launch

• 1990s - Earthquakes Emerging/Re-Emerging Diseases Medical Malpractices Terrorism Weapons of Mass Destruction Climate Change

Transition of Health Risk Concerns in Japan

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Year Health Crisis Events Mass Gathering Events

1995 Hanshin-Awaji Earthquake →national framework launch Tokyo Subway Sarin Attack

1996 O157 Food Poisoning

1998 Arsenic-laced Curry Incident

1999 Criticality Nuclear Accident

2000 Contamination of Daily Products by S.aureus Volcanic Eruption (Miyakejima)

Kyushu-Okinawa G8 Summit

2002 SARS FIFA World Cup

2004 Niigata-Chuetsu Earthquake Acute Encephalopathy caused by Mushroom

2005 Railway Crash

2007 Niigata-Chuetsu Earthquake

2008 Imported Contaminated Dumplings Incident Tohyako G8 Summit

2009 H1N1 Pandemic Flu

2010 APEC Japan

2011 Great East Japan Earthquake, Tsunami and Fukushima Nuclear Power Plant Accident

Japan’s Experience in Public Health Crisis Management

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Public Health Risk Management and Coordination

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Health Crisis/emergency

Source: Basic Guideline for Health Risk Management in MHLW (January, 1997)

What is Health Risk Management?

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Unknown causes

Infectious diseases pharmaceutical products, food poisoning, infectious diseases, drinking water

Natural disasters

Man-made disasters

“Operations for prevention, mitigation, and medical countermeasures for threats and risks for public health caused by ● ● ● ● ● and other causes.”

Health Crisis/emergency

Today topic

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1:overview Health Crisis/Risk Management

3:pandemic 2:disaster medicine

Health Crisis Outbreak

Health Crisis Event

Rapid and Appropriate Response

Situation Under Control

Short/Mid-Long Term Measures

Feedb

ack

Early Detection

Improvement of Public Health

Cycle of Health Risk/Crisis Management

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Stabilization＋relief

Health Crisis Outbreak

Implementation

Action Decision Collect Information

Principles of Health Risk Management

1. Share the information

- Utilize the coordination mtg

2. Prepare the system - Update contact information, implementation guidelines

3. Operate the first action

Health Risk/Crisis Management

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Actio

n

Domestic and global health risk information

Public Health Centers

National Hospitals

Local Governments

National Research Institutes

Response to health crisis

MHLW relevant departments/offices

Office of Public Health Emergency

Preparedness and Response

Health Risk Management Coordination Meeting

Researchers

Information gathering and sharing

Cabinet Secretariat

and Other Ministries

Coordination

Public Health Risk Management in MHLW

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IHR

(WH

O)

Response to Natural Disasters

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Demand Resource

Imbalance

What is Disaster Situation?

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Pre-

disaster

phase

Emergency

phase

Recovery

phase

Rehabilitation/

Reconstruction phase

Inter-

disaster

phase

Impact phase

disaster preparedness

rescue emergency medicine

health management

mental health care

Public health and medicine

takes part in all phases

Necessary to keep the regular health/medical system

In a Disaster Cycle

Resilience and Surge Capacity

Resilience → Expand Surge Capacity

Huge increase in the needs of public health and medical care

Disaster Occurrence

time line

recovery phase before after

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Mid-long term Sub-acute period Acute period

Occurrence of disaster

Collect and share information

Support in securing medical care systems in facilities

Health monitoring in medical relief centers

Emergency medical care

Recovery of affected medical care facilities

Disaster Response Transition

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Hanshin-awaji 1995

500/6400

On-site Medical Facility

Disaster site

Disaster base hospital

Triage Treatment Transportation

Admission and treatment

Rescue

Affected area Non-affected area

Wide-area transportation

Provide drugs

Accept patients

Dispatch DMAT

Disaster Medical System

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Information system(EMIS)

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24 hrs 72 hrs

Traditional Medical teams

Survive rate

Basic Concept of DMAT

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EMIS(Emergency Medical Information System)

Hanamaki

Chitose

Hyakuri

Osaka: Itami

Fukuoka

5 teams

24 teams 49 teams

Dispatched by Air: DMAT 82 teams, 407 personnel

380 teams, 1800 personnel (12days) Iwate, Miyagi , Fukushima ,Ibaraki

Activities：

- Support hospitals

- Inpatients evacuation

- Regional evacuation

- Wide-area transportation

Summary of Japan DMAT Activities after the Great East Japan Earthquake and Tsunami (3.11)

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Supporting disaster-base hospitals

DMAT Activities

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Hanamaki Airport Staging Care Unit

Received 136 pts - Wide-area air

transportation: 16 pts - transported to Morioka

city: 120 pts

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In the C-1 jet plane to Haneda Airport Receive patients from coastal area

Carry in patients to the aircraft

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Fukushima Prefectural Office

DMAT Supervisors in Prefectural Government Offices

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Response to Pandemic Influenza

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En-demic

epi-demic

pan-demic

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What is Pandemic?

When a virus derived from animals such as birds with an influenza virus

enters the world of humans and acquires the ability for human to human transmission,

Since humans do not have immunity against this new type of virus,

- it would lead to a global pandemic, and

- could result in severe virulence in individuals because of the lack of immunity (resistance)

Causing major health damage (patients, severely ill patients and deaths), secondary impacts on social activities and functions, causing social stagnation and decline

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What is Pandemic Influenza?

Pandemic year Known as Virus type Number of

deaths

1918-1919 Spanish Influenza H1N1 40 million

1957-1958 Asian Influenza H2N2 ≥ 2 million

1968-1969 Hong Kong Influenza

H3N2 ≥ 1 million

Inpatients: 0.5-2 million Deaths : 0.2-0.6 million

(Reference)

The pandemic influenza control action plan estimate following the scale of the damage:

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Estimated Scales and Patient Numbers

1. To contain the range of infection as far as possible while minimizing health damage

2. Not to allow escalation into collapse of the society or economy

(According to the following policies as national crisis management)

⇒ To build a clear framework for speedy actions

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Actions not taken

Actions taken

Peak

delayed

Peak patient number reduced

Pat

ient

num

ber

Stronger care

framework Capacity for

care provision

Securing the minimum

society infrastructure

Time

Conceptual Illustration of Effects of Actions

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Next steps

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Situation awareness

37 All hazard approach

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国土強靱化計画 （Kokudokyoujinka）

= national resilience ??? = National risk assessment and management ???

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Management system × micromanagement

ICS

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Triage

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Whose is Public health

1. MHLW of Japan developed a framework for sharing information on potential health risks and crisis in 1997.（HIV incident）

2. Office of Public Health Emergency Preparedness and Response coordinates with relevant departments/offices for early alerting and response to address all-hazard health risks.

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Summary

3. It is necessary to prepare for complex incident/disaster in Japan.

– Situation awareness

– All hazard approach

– Management system（customized to fit the Japan）

4.public health for/by everyone

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Summary