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Coronavirus highlights need for CDC in Japan

TOKYO >> 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 U.S. Centers for Disease Control and Prevention.

Prime Minister Shinzo Abe made headlines earlier this month when 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 coronavirus outbreak is the National Institute of Infectious Diseases, an entity commonly cited as Japan’s closest equivalent to the CDC. But unlike the CDC, which is granted great 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,” said an institute official. “We are not an entity independent of the health ministry.”

That arrangement came under scrutiny recently when professor Kentaro Iwata, an infection control specialist at Kobe University Hospital, posted a video to YouTube in which he identified gaps in procedure 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.

Iwata, who briefly boarded the vessel, said at a Tokyo news conference that the absence of “scientific decision-making” by an independent team of professionals 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.

Proper measures “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.

He said a center for disease control should meet these standards. He has long highlighted the need for a Japan version of the CDC.

Other countries have created their own CDCs.

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.

Japan, however, has 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, director of the Institute for Population Health at King’s College London.

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 unequipped to contain an infectious outbreak with the level of urgency and expertise of the CDC.

“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 has the ability to promptly mobilize key experts in each state during an emergency. But the NIID cedes decision-making power to the health ministry.

The institute itself is struggling as well.

The coronavirus outbreak prompted one group, the Ehime Medical Practitioners Association, to urge Abe to finance the organization more robustly. It pointed out that the NIID budget has been hit with massive cuts over the years. In fiscal 2018, its budget was 4.1 billion yen, down from 6.1 billion yen in 2009. Staff has been trimmed as well.

Meanwhile, a 2011 report revealed that despite fewer staff and a smaller budget than the CDC, the NIID was tasked with a wide range of responsibilities that in the U.S. the CDC shares with 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 … is approaching (its) limit,” it said.

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