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